Determinants, predictors and negative impacts of burnout among health care workers during COVID-19 pandemic.

The first defense line of the battle, healthcare workers (HCWs), faces a significant challenge in managing the current COVID-19 pandemic. An online electronic survey was sent to HCWs via email and social media networks. Socio-demographic data and work environment-related variables were assessed. Consequences of burnout (BO) were reported, e.g., elicited medical errors. Maslach burnout inventory was used to diagnose BO. Two hundred and eighty-four participants were included with a mean age of 39.83 ± 7.34 years, 70.8% worked in the COVID-19 frontline, 91.9% were followed daily updates about COVID-19, 63.7% were not satisfied with the coordination between triage and isolation, 64.4% got COVID-19 infection, 91.9% had a colleague or family member developed COVID-19 infection, and 21.5% experienced a colleague /a family member died due to COVID-19. Multivariate analysis by linear regression revealed that; working as a frontline HCW (OR 1.28, CI = 0.14-2.55) and sleep deprivation (OR 3.93, CI = 1.88-8.22) were the predictors of burnout.

Acute Kidney Injury Among COVID-19 Positive Patients is Associated With Higher Mortality: Single Center Experience

BACKGROUND AND AIMS Despite the lungs are the major targets of COVID-19, other organs such as the kidneys are also affected. Renal complications of COVID-19 are not yet well studied. We aimed to study the prevalence of acute kidney injury (AKI) among positive COVID-19 cases that were managed in the intensive care unit (ICU) in a single isolation hospital during the pandemic, and to explore its impact on patient outcome. METHOD This retrospective study included 616 patients with COVID-19 who were managed in the ICU in a single isolation hospital in Kuwait during the pandemic, from February to December 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Of the 616 patients, 40.2% developed AKI (group 1, n = 248) and were compared with the patients without AKI (group 2, n = 368). RESULTS Most of cases in the two groups were males (73% versus 70.7%), aged (60.8 ± 14 versus 51.7 ± 16 years), respectively. The two groups were comparable regarding chronic kidney disease (2% versus 0.8%) and chronic pulmonary disease. Other factors were significantly predominating among group 1 as diabetes mellitus (63.7 versus 40.5%), hypertension (74.2% versus 40.5%) and ischemic heart disease (26.2% versus 12.5%) (P < .05). Fever, cough, shortness of breath and dehydration were significantly more frequent presentations among patients of group 1, and had radiological findings that were synchronized with COVID-19 (89.5% versus 50.8%) (P < .05). Moreover, sepsis, volume depletion, shock, arrhythmias and ARDS predominated among the AKI group (P < .05). The number of cases who were managed by therapeutic anticoagulation was significantly higher in AKI patients (89.9% versus 51.9%);also, cases who received supportive vasopressors and convalescent plasma transfusion as well as steroid were significantly higher in the same group (P < .05). Other therapeutic modalities such as antivirals, tocilizumab and hydroxychloroquine were comparable in both groups. We found that acute respiratory failure requiring mechanical ventilation was significant among the AKI group (66.8% versus 29.4%), and the overall mortality rate was significantly higher in the same group (62.5% versus 32.8%). CONCLUSION The prevalence of AKI in patients with COVID-19 was 40.2%, and it was associated with poor prognosis among ICU COVID-19 positive cases.

COVID-somnia: anxiety, insomnia, and poor sleep among second-line healthcare workers during COVID-19 pandemic

Background Little information is available about the linkage between sleep affection and COVID-19. Preliminary reports and clinical observations focused on the appearance of related mental health issues, especially in healthcare workers (HCWs). Methods A cross-sectional study is conducted on the COVID-19 second-line HCWs using an English online survey prepared via Google forms. The survey focused on sociodemographic and profession-related characteristics (age, sex, smoking, history of previous sleep disorders or medications affecting sleep, comorbidities specialty, years of experience, and number of hours worked per week) and COVID-19-associated risks (being on the second line of COVID-19 management, following updates and news about COVID-19, and getting an infection with COVID-19 or having a colleague/friend who was infected with or died of COVID-19). Assessment of anxiety, insomnia, and sleep quality was done using the relevant diagnostic scales. Results This study included 162 second-line HCWs with a mean age of 34.36 ± 8.49 years. Although being in second lines, there was a high prevalence of anxiety (49.38%), insomnia (56.17%), and poor sleep quality (67.9%) during the pandemic. One condition was recently developed after the pandemic: insomnia in 6.6%, anxiety in 5.7%, and poor sleep in 16%. Two conditions were developed: insomnia and poor sleep in 21.7%, anxiety and poor sleep in 7.5%, and insomnia and anxiety in 10.4%. The three conditions were de novo experienced in 19.8%. A total of 22.4% of those who followed daily COVID-19 updates developed de novo combined anxiety, insomnia, and poor sleep. A total of 38.5% of participants that had been infected with COVID-19 developed de novo combined anxiety, insomnia, and poor sleep. A total of 50% of participants who had a colleague/friend who died with COVID-19 developed de novo combined anxiety, insomnia, and poor sleep. Conclusion Although being in second lines, there was a high prevalence of anxiety, depression, and poor sleep concerning COVID-19-related factors.

Better outcome of COVID-19 positive kidney transplant recipients during the unremitting stage with optimized anticoagulation and immunosuppression.

INTRODUCTION: COVID-19 is an ongoing pandemic with high morbidity and mortality and with a reported high risk of severe disease in kidney transplant recipients (KTR). AIM: We aimed to report the largest number of COVID-19-positive cases in KTR in a single center and to discuss their demographics, management, and evolution. METHODS: We enrolled all the two thousand KTR followed up in our center in Kuwait and collected the data of all COVID-19-positive KTR (104) from the start of the outbreak till the end of July 2020 and have reported the clinical features, management details, and both patient and graft outcomes. RESULTS: Out of the one hundred and four cases reported, most of them were males aged 49.3 ± 14.7 years. Eighty-two of them needed hospitalization, of which thirty-one were managed in the intensive care unit (ICU). Main comorbidities among these patients were hypertension in 64.4%, diabetes in 51%, and ischemic heart disease in 20.2%. Management strategies included anticoagulation in 56.7%, withdrawal of antimetabolites in 54.8%, calcineurin inhibitor (CNI) withdrawal in 33.7%, the addition of antibiotics in 57.7%, Tocilizumab in 8.7%, and antivirals in 16.3%. During a follow-up of 30 days, the reported number of acute kidney injury (AKI) was 28.7%, respiratory failure requiring oxygen therapy 46.2%, and overall mortality rate was 10.6% with hospital mortality of 13.4% including an ICU mortality rate of 35.5%. CONCLUSION: Better outcome of COVID-19-positive KTR in our cohort during this unremitting stage could be due to the younger age of patients and early optimized management of anticoagulation, modification of immunosuppression, and prompt treatment of secondary bacterial infections. Mild cases can successfully be managed at home without any change in immunosuppression.