ABSTRACT
Introduction: For detecting myocardial injury in severe and critical COVID-19, the electrocardiogram (ECG) is neither sensitive nor specific;but in a resource-poor environment, it remains relevant. Changes in the ECG can be a potential marker of severe and critical COVID-19 to be used for predicting not only disease severity but also the prognosis for recovery. Method(s): The admitting and interval ECGs of 1,333 COVID-19 patients were reviewed in a two-year, single-center, retrospective cohort study. Each was evaluated for 29 pre-defined ECG patterns under the categories of rhythm, rate, McGinn-White and RV overload patterns, axis and QRS abnormalities, ischemia/infarct patterns, and AV blocks before univariate and multivariate regression analyses for correlation with disease severity;need for advanced ventilatory support;and in-hospital mortality. Result(s): Of the 29 ECG patterns, 18 showed a significant association with the dependent variables on univariate analysis. Multivariate analysis revealed that atrial fibrillation, HR >100 bpm, low QRS voltage, QTc >500msec, diffuse nonspecific T-wave changes, and 'any AMI' ECG patterns correlate with disease severity;need for advanced ventilatory support and in-hospital mortality. S1Q3 and S1Q3T3 increased the odds of critical disease and need for high oxygen requirement by 2.5-3 fold. Fractionated QRS increased odds of advanced ventilatory support. Conclusion(s): The ECG can be useful for predicting the severity and outcome of more than moderate COVID-19. Their use can facilitate rapid triage, predict disease trajectory, and prompt a decision to intensify therapy early in the disease to make a positive impact on clinical outcomes.
ABSTRACT
Introduction: Convalescent plasma therapy (CPT) is a type of experimental passive immunotherapy with a sizable background in viral outbreaks. Although there has been documented favorable outcomes in using CPT in the treatment of viral illnesses, its use in COVID-19 is still experimental. Objectives: To determine if adding convalescent plasma to standard of care is associated with better clinical outcomes than giving standard of care alone to severe and critical COVID-19 patients admitted in a tertiary hospital in Cebu City. Methods: This is a retrospective cohort study conducted in a tertiary hospital in Cebu between March to September 2020. The data of a total of 22 COVID-19 patients who received convalescent plasma therapy plus standard treatment regimen based on the institution's interim guideline were identified by chart review. The demographic information, laboratory results, management and outcome data from this group were collated, matched with and compared to 43 critically ill COVID-19 patients who received COVID-19 standard treatment regimen only. Results: Both the CPT and non-CPT groups are comparable in terms of the socio-clinical variables, inflammatory marker levels, laboratory test results and therapeutic interventions. However, there is no relationship between the level of inflammatory markers and the illness day to which CPT was given. Additionally, the outcomes also differ significantly in terms of duration of admission, severity of illness, critical care support and mortalities. The control group has shorter hospital admissions, more patients with critical illness and more mortalities. The intervention arm, however, has more recoveries but longer duration of critical care. Conclusion: Convalescent Plasma Therapy added to standard treatment is not associated with improved clinical outcomes among Filipino patients with severe or life-threatening COVID-19 infection admitted in a tertiary hospital in Cebu City. © 2021, Philippine College of Physicians. All rights reserved.
ABSTRACT
Introduction: COVID 19 has become the most important public health issue today. It has the potential to significantly affect the mental health of frontline healthcare workers (HCW) putting them at a higher risk of developing psychological problems especially to those who acquired COVID19 infection. Objectives: To determine the level of depression, stress, anxiety and coping strategies among Filipino HCWs with confirmed COVID-19 infection and its association with demographic and clinical profiles. Study Design: Single center Descriptive study Materials and Methods Consisted of 114 Filipino HCW with COVID 19 infection. Data were collected utilizing the Filipino translation of DASS 21 and Filipino Coping Strategy scale. Results: There was a significant increase of HCWs with moderate depression, anxiety, and stress. A large proportion of the HCWs were also severely depressed, severely anxious and severely stress. Majority of the COVID19 positive HCWs were nurses accounting to 35%. More likely, the occupation was significantly associated with their degree of depression and stress. Hypertension associated significantly with elevated stress while having diabetes was instrumental for the depression, anxiety and stress. Moreover, appreciation was more felt at the workplace, then at home. While discrimination was prevalent in the community, workplace and social media. Religiosity ranked the most sought coping strategy. Conclusion: The study has found that a large percentage of HCWs had moderate level and a notable portion of respondents had severe to extremely severe level in each of the psychological domains in which factors such as gender, occupation, comorbidities, area of assignment and disease severity have brought significant impact. Discrimination is prevalent in the community and surprisingly in the workplace. In contrast, appreciation was felt more at home and in the workplace. Religiosity was shown to be the top coping strategy among HCWs who tested positive.