ABSTRACT
Background: To date, the 2019 novel coronavirus pneumonia (COVID-19) is the greatest public medical issue in the world. World Health Organization (WHO) declared this outbreak a “public health emergency of international concern” on January 31, 2020. Therefore, it bodes well to look for a potential biomarker that could quickly and effectively distinguish serious cases early. Of the total confirmed Covid-19 patients, the severe cases often suffer from underlying diseases such as cardiovascular disease and diabetes that can accelerate the movement of 2019 novel coronavirus (SARS-CoV-2) infection. Moreover, acute respiratory distress syndrome could lead to death in some severe Covid-19 patients, and various disorders often accompany this. Biochemical findings showed representative features of acute respiratory distress syndrome and association of multiple organs. Aim: To estimate routine biochemical parameters of patients admitted to the Covid-19 ward. Method: Clinical samples from cases of Covid-19 admitted to Adesh Medical College and Hospital, Mohri, Shahbad (M), Haryana, India, during 1st, 2nd, and 3rd waves were collected and analyzed. Result: In this study, we investigated routine biochemical investigations (RBS, LFT, RFT & Serum Electrolyte) of Covid-19 patients and calculated De Ritis ratio. It was found that biochemical parameters and De Ritis ratio were worse affected than the first and second waves. Conclusion: De Ritis ratio may be a good marker for liver abnormalities and prognosis and a hospital stay of the Covid-19 patients.
ABSTRACT
Background: Policy changes such as the Advancing American Kidney Health Initiative and the impact of the COVID-19 pandemic will accelerate the trend for more home dialysis. Expanding the pool of patients eligible for HHD will require health care practitioner assisted models to be developed and deployed. We hypothesize that many barriers to delivering assisted HHD (aHHD) exist and implementation of a successful program would require meaningful input from frontline home dialysis nurses. Our primary objective of this study is to survey these key stakeholders to identify these barriers. Methods: We conducted a semi-structured focus group of leaders within our large Canadian home dialysis program to anticipate key aspects of implementing aHHD, including gauging local demand, identifying eligible patients, and recognizing essential operational components. From this, we constructed questionnaires for frontline nursing staff within HHD, peritoneal dialysis (PD) and assisted PD (aPD) programs. We performed a qualitative analysis to identify common themes and implementation barriers. Results: Twenty-six responses from three sites were received. 20/21 PD nurses reported existing aPD programs expanded the eligible pool of PD patients. 5/5 HHD nurses felt an aHHD program would keep more patients on the modality and prevent technique failure. Only 2/5 felt aHHD should be offered as a transition to HHD. While 18/21 PD nurses reported they could easily identify patients for aPD, only 2/5 HHD nurses agreed. Patients with sensory deficits, functional impairments, and limited support networks were felt to benefit most from aHHD. Lack of confidence and phobias were not agreed upon. Behavioral and safety issues, clinical instability, and inability to manage emergencies may be barriers to aHHD. Machine set-up, take-down, and establishing access were thought to be essential services. PD nurses felt clinical assessments should be routine. Few nurses felt complete assistance was necessary. Conclusions: Our findings suggest there is a strong local demand for aHHD provided there is a clear criterion for enrollment and operational plans are well established. Frontline nurses have identified several important barriers to implementation which we will acknowledge and address when deploying our assisted home program over the upcoming year.