ABSTRACT
Background. New York City emerged as the Epicenter for Covid-19 due to novel Coronavirus SARS-CoV-2 soon after it was declared a Global Pandemic in early 2020 by the WHO. Covid-19 presents with a wide spectrum of illness from asymptomatic to severe respiratory failure, shock, multiorgan failure and death. Although the overall fatality rate is low, there is significant mortality among hospitalized patients. There is limited information exploring the impact of Covid-19 in community hospital settings in ethnically diverse populations. We aimed to identify risk factors for Covid-19 mortality in our institution. Methods. We conducted a retrospective cohort study of hospitalized in our institution for Covid 19 from March 1st to June 21st 2020. It comprised of 425 discharged patients and 245 expired patients. Information was extracted from our EMR which included demographics, presenting symptoms, and laboratory data. We propensity matched 245 expired patients with a concurrent cohort of discharged patients. Statistically significant covariates were applied in matching, which included age, gender, race, body mass index (BMI), diabetes mellitus, and hypertension. The admission clinical attributes and laboratory parameters and outcomes were analyzed. Results. The mean age of the matched cohort was 66.9 years. Expired patients had a higher incidence of dyspnea (P < 0.001) and headache (0.031). In addition, expired patients had elevated CRP- hs (mg/dl) ≥ 123 (< .0001), SGOT or AST (IU/L) ≥ 54 (p < 0.001), SGPT or ALT (IU/L) ≥ 41 (p < 0.001), and creatinine (mg/dl) ≥ 1.135 (0.001), lower WBC counts (k/ul) ≥ 8.42 (0.009). Furthermore, on multivariate logistic regression, dyspnea (OR = 2.56, P < 0.001), creatinine ≥ 1.135 (OR = 1.79, P = 0.007), LDH(U/L) > 465 (OR = 2.18, P = 0.001), systolic blood pressure < 90 mm Hg (OR = 4.28, p = .02), respiratory rate > 24 (OR = 2.88, p = .001), absolute lymphocyte percent (≤ 12%) (OR = 1.68, p = .001) and procalcitonin (ng/ml) ≥ 0.305 (OR = 1.71, P = .027) predicted in- hospital mortality in all matched patients. Conclusion. Our case series provides admission clinical characteristics and laboratory parameters that predict in- hospital mortality in propensity Covid 19 matched patients with a large Hispanic population. These risk factors will require further validation.
ABSTRACT
Objectives: This study assesses the impact of COVID-19 on various aspects of clinical practice including clinic and hospital practice, immunisation and newborn and emergency care services among paediatricians practising in South India. The study also describes the practice of personal protection and risk perception by the same paediatricians Method: Purposive sampling with snowball technique was used. The duration of collection of data was from August to October 2020. Quantitative survey of 176 practising paediatricians from South India was done using a validated questionnaire using Google forms which were sent via email or WhatsApp links. Qualitative data were collected by telephonic interview by the key primary researcher. After obtaining verbal consent, the telephonic conversation was recorded and data was analysed. Results: While most of the doctors kept their clinics open, with limited timings during the pandemic, 31.5% completely closed their clinics;88.8% have experienced a fall in the number of patients and 92% experienced a fall in their income. Majority made changes in their clinic practice like using hand sanitizer, minimising bystanders and use of masks and face shields in the clinic. The time spent with each patient during the pandemic was also reduced by 60%. The time spent on counselling sessions has been reduced by 64.3% of the consultants. Majority of the paediatricians continued to give immunisation but more than half of them experienced a decrease in the number of children brought for immunisation. Among the patients who visited the clinics, majority were for non-respiratory complaints. Most doctors were not involved in paid teleconsultation. Conclusions: COVID 19 has affected paediatricians at all levels. There is a major change in the clinical practice so as to reduce the risk of transmission of the virus. © 2021, Sri Lanka Journal of Child Health. All Rights Reserved.