Ventilator associated pneumonia surveillance in critically ill patients with COVID-19 in a tertiary care hospital

Background: Ventilator associated events (VAE) algorithm is increasingly used for the surveillance of ventilator associated problems as an alternative tool of traditional ventilator associated pneumonia (VAP) definition for surveillance. COVID-19's impact on reliability of VAE for VAP is poorly defined. Aims and objectives: To compare the performance of traditional VAP criteria with VAE criteria to detect ventilator associated problems in intensive care unit (ICU) patients with COVID-19 pneumonia. Method(s): Patients who were intubated for more than 48 hours in COVID-19 ICU were included. COVID-19 was diagnosed with polymerase chain reaction. For traditional VAP surveillance definition, CDC PNEU/VAP criteria were used. For VAE definition, CDC/NHSN VAE algorithm was used. Both VAE and PNEU/VAP surveillance were conducted manually by two investigators who were blind to each other. NHSN VAE calculator version 8.1 was used to verify VAE. Result(s): Seventy-seven patients met inclusion criteria during the 1-year study period. Mean (+/- SD) age was 68.7 (+/-13), 67.5% were male, median Charlson comorbidity index score was 4 (IQR 3). Thirty-three patients were diagnosed as PNEU/VAP. VAE were detected in fifteen patients. Eleven patients met both VAP and VAE criteria. The VAP rate was 13.55 per 1000 ventilator days, VAE rate was 6.16 per 1000 ventilator days. Conclusion(s): CDC PNEU/VAP criteria detected higher rate of ventilator associated problems when compared with VAE in patients with COVID-19.

Back to the First Days of the Pandemic: How Well Have We Done to Diagnose COVID-19 in Healthcare Workers?

Introduction: Healthcare workers (HCWs) are one of the most vulnerable groups for COVID-19. SARS-CoV-2 PCR was offered to HCWs who had symptoms compatible with COVID-19 or who had a close contact with COVID-19 patient. A rapid antibody test was used to identify the risk of exposure of the HCWs who worked at high-risk units in our hospital during the first month of the pandemic. Herein, we aimed to evaluate the usefulness of this approach. Materials and Methods: The records of the HCWs from a university hospital who were tested by SARS-CoV-2 PCR or rapid antibody test between March 12, 2020 and April 04, 2020 were reviewed retrospectively. Demographic and clinical characteristics of HCWs were extracted from the electronic database. Wards or outpatient clinics that served COVID-19 patients were defined as high-risk units. Results: A total of 599 HCWs were tested for SARS-CoV-2 by PCR and 409 by rapid antibody test. Thirty-seven (6.2%) were found to be PCR positive. Eleven (29.7%) out of 37 HCWs were asymptomatic when they were tested. There was no statistically significant relationship between PCR positivity and occupation or working unit. A positive PCR result was detected in 24 HCWs during the first admission. Eleven out of 114 HCWs who were tested by a second PCR were found to be positive and two out of 17 HCWs who were tested by a third test were reported as PCR positive. Median interval between the first and second PCR was seven days (IQR= 8.5 days) and median interval between second and third PCR test was 4.5 days for the HCWs who were reported as positive at repeated PCR tests. Rapid antibody test was positive in one HCW who did not have a history of COVID-19. Conclusion: Approximately, one third of the SARS-CoV-2 PCR positive HCWs were asymptomatic. In case of increasing incidence of COVID-19 in the community, a regular screening policy for the HCWs regardless of their occupation and contact tracing might help to have a safe environment in hospitals. Screening policy should be based on well validated tests.

Knowledge and attitudes of pharmacy students about COVID-19. (COVID-19 dedicated issue.)

The level of knowledge about COVID-19 varies among students in the field of healthcare. In this study, it was aimed to compare pharmacy students' level of knowledge about COVID-19 before and after an educational seminar. This study was conducted in the first wave of COVID-19 and just at the beginning of the pandemic. A seminar on COVID-19 and protection ways was presented by an infectious disease physician to the pharmacy students in a faculty of pharmacy from Ankara. Before and after the seminar, a questionnaire about COVID-19 consisting of 17 multiple-choice or open-ended questions was applied to the students. A total of 114 pharmacy students (46.5% female) attended the seminar and all of them participated in the study. The most common information resources in terms of COVID-19 that were used by the participants was internet (non-scientific resources) (n=90, 78.9%), classical media (TV, newspaper) (n=79, 69.3%) and social media (n=77, 67.5%). The rates of knowing that the coronavirus is a zoonotic virus (p < 0.001) and awareness of cough and dyspnea, which are symptoms of COVID-19, showed a statistically significant increase after the seminar (p=0.039 and p < 0.001, respectively). The students' knowledge of protection from the disease such as covering the nose and mouth with tissue paper, using eyeglasses, and wearing protective clothing was significantly improved after the seminar (p=0.043, p < 0.001, p < 0.004, respectively). Although the knowledge of pharmacy students about the new pandemic was not insufficient, it had also increased significantly after the seminar. It is thought that determining and improving their knowledge about the pandemic will contribute to pandemic management.

COVID-19, parvovirus and acute HIV infection in the gamut of diagnosis of fever and rash

Coronavirus disease-19 (COVID-19) patients continue to experience different symptoms each day. Many patients were seen with common symptoms such as fever, fatigue, myalgia, respiratory symptoms (e.g., dry cough, dyspnea), smell and taste disorders, gastrointestinal symptoms, and dermatological findings. Although, fever lasting <7 days has been reported in most patients, it has been seen in patients with persistent or recurrent fever patterns in the second week of illness. Although, any symptoms accompanying fever during the pandemic suggest the diagnosis of COVID-19, other etiologies should also be kept in mind. In this case report, we present two patients who were admitted with fever and rash were initially thought to have COVID-19 but were diagnosed with acute parvovirus infection and acute HIV infection finally. These cases are presented to draw attention to the importance of taking a good history and making a rational differential diagnosis.