ABSTRACT
Background: Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared as a pandemic in 2019-2020. Most cases are usually self-limited;however, it may unpredictably progress to severe form with high mortality rate. Objectives: To highlight the role of measuring serum procalcitonin (PCT) and receiving early prophylactic antibiotic therapy in terms of their relation to the mortality rate in hospitalized critical COVID-19 patients. Methods: this study analyzed sixty COVID-19 critical patients admitted to Tanta University Isolation Hospital from June to November, 2020. Respiratory tract and blood samples were collected Results: Our results showed that the mean serum PCT levels were significantly higher in deceased patients (15%) than in those who could survive corona-virus infection. Patients who received early prophylactic antibiotic therapy showed significant better survival rate than those who didn't. Conclusion: This study demonstrated that measuring PCT shows statically significant results with COVID-19 patients' outcome more than other commonly used laboratory markers such as CRP. Moreover, early administration of prophylactic antibiotic therapy in COVID-19 patients, especially critical ones, is crucial even in those with negative PCT values. © 2020 The author (s). Published by Zagazig University.
ABSTRACT
Background and objectives: Malaysia first announced Movement Control Order (MCO) in March 2020 following escalation of COVID-19 outbreak and declaration of pandemic, leading to nationwide partial lockdown. Fear of virus spread and MCO directives were presumed to markedly affect trends in visits to the emergency department (ED). This study aims to observe the trend in ED utilization among hybrid hospitals in Malaysia following the MCO period. Methods: This retrospective, observational, cross-sectional study involved COVID-19 hybrid hospitals under Ministry of Health Malaysia. Hybrid hospitals are institutions that manage both confirmed and non-COVID-19 patients and were included in the study. Full COVID-19 and screening hospitals were excluded. Data were taken from January to October 2020 and compared with 2019 data of same months. Primary outcome is monthly trend of total ED utilization by adult and pediatric population, and secondary outcome observes the trend of ED attendance according to triage categories. Changes in attendance were calculated in percentage. Descriptive analysis was reported in median and interquartile range. Mann-Whitney U test was used to compare the difference between two medians in each month. Results: A total of 25 hospitals were included in the study. Total attendance to ED has dropped significantly nationwide from March 2020 onward after MCO was initiated. Reduction in total attendance between March and October 2020 ranges between 36.4% and 63.4% with significant difference compared to 2019. Higher percentage of reduction was seen in the pediatric population between 56.2% and 76.1% compared to the adult population which ranged between 32.5% and 60.9%. These differences were significant from April to October 2020 (p<0.05). Comparing the triage categories, no significant difference was seen in utilization of critical zone despite reduction in number of cases. Attendance to semi-critical zones showed significant differences in April to June 2020 with reduction of 47% (p<0.001), 33% (p=0.029), and 29.5% (p=0.021), respectively. Non-critical zone saw significant difference in its utilization from April to October 2020 compared to preceding year Conclusions: This study showed Malaysian perspective of COVID-19 effects on ED utilization during the first outbreak wave. Despite general reduction in total attendance, ED still receives substantial number of critical patients with high-acuity presentations.