Real-Time Measurement of Psychological Impact Due to E- Learning, among the Undergraduate Dental Students during Covid-19

Objectives: To assess the psychological factors in undergraduate dental students towards e-learning in clinical skills education compared to traditional teaching methods and their relationship with performance during the COVID-19 pandemic. Method(s): In this study, survey conductedamong 494undergraduate dentalstudents of all four sessions from different dental universities within the Pakistan. Total 494 undergraduate dental students responded to a 28-question online survey to identify e- learning is more convenient and practicalthan traditional learning and to measure it 5- pointLikertScaleused. To measure level of psychological impact, Hamilton Anxiety Scale used due to e-learning among undergraduate dental students. Result(s): The majority of undergraduate dental student's responded e-learning is not convenient and practical than traditional learning system. The majority of undergraduate dentalstudents reportedveryseverelevelof psychologicalimpactdueto e-learning and closing of institutions during COVID-19 pandemic. Results are statistically significant and analyzed on IBM SPSS version 23. There are 82% students responded having problem with e-learning system and among them 58 % have very severe anxiety and 24% have severe anxiety. So the results shows increased percentage of anxiety due e-learning. Conclusion(s): Dental students expressed a higher level of comfort and effective learning in a recognizable, conventional classroom circumstance. Teaching with traditional system improvesstudent'scriticalthinkingskillsandformulatesopinionsorargumentsbyengaging in live discussions. This study reveals that students face challenges in using the e-learning resources because of incompetency in the IT skills, lack of motivation and access to proper internet. The most important issue identified by this study is maintaining an effective interaction with dental students in e-learning system of teaching to fill the gap between the teacher and students. There should be further flexibility workload and learning time to students to reduce the level of anxiety among the dental students.Copyright © 2020 Ubiquity Press. All rights reserved.

Comparing patient outcomes from COVID-19 infection across three separate waves

Introduction: Since the onset of the SARS-COV2 Virus, there's been rapid developments in our understanding of the disease and its management, such as antibiotics, steroids, advanced oxygen therapy (AOT), and vaccines. We aimed to determine the impact of these treatments over three consecutive waves. Method(s): Three patient cohorts were retrospectively analysed from Russells Hall Hospital, Dudley UK;wave 1 (23/3/20-1/5/20), wave 2 (1/11/20-31/1/21) and wave 3 (1/8/21-31/8/21). Data obtained from electronic records included length of stay (LoS), mortality and treatment given. For wave 3 data on vaccination status was also obtained. A multivariable analysis was conducted where appropriate and a p-value<0.05 was considered statistically significant. Result(s): 25 patients were analysed from wave 1 and 2 each, and 61 from wave 3. Table 1 outlines the interventions used per wave. When comparing wave 1,2 and 3;the mean age was 67, 66 and 59 years, LoS was 8, 12 and 6 days and mortality rate was 42.5%, 25.8% and 13.1% respectively. In wave 3, 41% of admitted patients were vaccinated. Advanced age was associated with an increase in mortality (p=0.016) and the use of AOT was associated with longer hospital admission (p=0.004). In wave 3, the mortality amongst vaccinated patients was less than those unvaccinated (12% vs. 20%, p=0.26). Table 1 shows the interventions used in each wave. Conclusion(s): Our small study shows improvement in mortality, likely a result of increased knowledge in disease management and the use of vaccinations. Larger studies are now needed to corroborate our findings.

Common mental disorders among high school students during COVID-19 pandemic with online education satisfaction level in Pakistan

Objective: The objective of the study is to determine the prevalence of common mental disorders among high school students and their online education satisfaction levels in Pakistan. Study Design: It was an observational, cross sectional study. Place and Duration of Study: The study took place among students registered across various high schools at different cities in Pakistan. The duration of the study was about six months from January 2021 to June 2021. Material and Methods: A cross sectional study was conducted across different high schools in Pakistan. For a total of 275 selected study participants, structured and validated questionnaires were used to determine the common mental disorders such as anxiety, depression, and Psychosis. Chi square was used to determine the association between the satisfaction levels of online learning with mental disorders. Results: Among students 28% and 34. 7% and 32%, suffered from severe anxiety, depression and Psychotic disorder respectively. The relationship of severe depression (r=0.7 (p=0.001)), severe anxiety (r=0.6 (p=0.036)) and severe psychotic (r=0.8 (p=0.002)) disorder had significant strong relationship with student's satisfaction with online classes. Conclusion: High levels of mental disorders among students during the pandemic and low satisfaction with online learning were common among students due to stress. It is recommended that the mental level of students should be monitored, and counseling services should be provided.

Vaccine hesitancy and distrust: concerns of healthcare workers of Pakistani origin-a survey

Background: Vaccine acceptance can play a pivotal role towards control of COVID-19. Many healthcare workers (HCWs) have articulated safety and effectiveness concerns despite being the frontline takers of vaccination. This survey was aimed to investigate the causes of COVID-19 vaccine hesitancy and distrust among HCWs of Pakistani origin. Methodology: This internet-based survey was conducted on 138 HCWs of Pakistani origin from January 2021 to April 2021. Result(s): Out of a total of 138 subjects, 137 (99.3%) HCWs responded to the survey. COVID-19 vaccinations had already been administered to 101 (74%) of the respondents. Out of 36 (26.2%) unvaccinated individuals, 19 (14%) completely declined the vaccination. The prevalence of participants who distrust vaccination effectiveness and safety was 110 (80.3%), while 94 (68.6%) believed vaccine safety was compromised due to rapid development. The prevalence of HCWs who believed long-term adverse effects and that the manufacturers falsified the data was 36 (26.3%) and 22 (16%) respectively. Conclusion(s): Our survey found that fears and concerns about the efficacy of the vaccine can impasse struggles to disease transmission and vaccine distribution. Healthcare workers in Pakistan had a higher prevalence of vaccine acceptance compared to other surveys. Copyright © 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.

Assessment of the severity of COVID-19 symptoms after vaccination among the Saudi population suffering from chronic conditions

Since the emergence of COVID-19 disease, more than 600 million people have been affected. However, the severity and the risk of mortality of the disease were shown to depend on whether the infected individual was suffering from any other comorbidities. The present study is designed to determine a group of people with comorbidities who are more susceptible to developing severe symptoms after infection with COVID-19. We also aim to compare the side effects of different COVID-19 vaccines in the Saudi population. Here we report a statistically significant difference between the chronic medical condition of the participants and their COVID-19 status (p = 0.03). We also observed a statistically significant difference between vaccine status and COVID-19 infection, as more than 70% of the participants (n=195) were unvaccinated when they tested positive for COVID-19. In our study, most of the participants (n=856, 77.5%) took the Pfizer-BioNTech vaccine, while 14.7% (n=162) and 4.5% (n=50) of the participants took Oxford-Astra Zeneca and Modema Vaccines, respectively. There were also statistically significant differences in the severity of side effects between different vaccines (p=0.001). In conclusion, severe side effects were reported after the Oxford-AstraZeneca vaccine. In addition, the side effects, including fever, tiredness, headache, nausea, chills, pain, swelling at the injection site, body pain, and muscle pains, were reported more frequently after the vaccine's first dose, and participants with either one or more comorbidities.

Impact of the COVID-19 on the Health System and Healthcare Workers: A Systematic Review

Context: The coronavirus disease 2019 (COVID-19) pandemic has affected all sectors of life. The health system and healthcare workers also have been affected by the COVID-19 pandemic. Healthcare workers (HCWs) have faced major challenges in working in the hospi-tals due to COVID-19 pandemic. There is a need to provide evidence regarding challenges to working during the COVID-19 pandemic, specifically in developing countries.Objectives: The objective of this study was to evaluate the effect of the COVID-19 pandemic on health professionals and the health system.Methods: Ten studies conducted from January 1, 2020, to December 31, 2021were included in this review. Common search terms were impact, health, healthcare, providers, abuses, burden, and system. Different databases, such as Scopus, Web of Science, PubMed, and Google Scholar, were used. Data extraction was performed following the PRISMA recommendations.Results: The results of the systematic review showed that the hospitalization rate and numbers of out-patients have increased, lead-ing to imposing a burden on the health system and healthcare workers (HCWs). A serious type of disease may need hospitalization and ventilatory support. The quality of healthcare institutions is unique and complex. HCWs, in their routine activities, face diverse challenges. The unexpected development of the COVID-19 pandemic was a great challenge faced by the health system and health professionals.Conclusions: The pandemic has altered the healthcare system and healthcare practice with innovative workplaces and social chal-lenges confronted by the HCWs.

Effects of HVAC Settings And Windows Open Or Close On The SARS-COV-2 Virus Transmission Inside A Mass Transit System Bus

With the current outbreak of SARS-CoV-2, public transportation is a key area which must be investigated to ensure both passenger safety and efficiency of passenger transport to best serve the community and reduce environmental footprint. In this paper, the transport of the SARS-CoV-2 virus through human respiratory particles is examined using transient Computational Fluid Dynamics (CFD) simulations to determine the impacts different ventilation configurations on the probability of viral exposure. The motion of the viral particles was simulated first by solving for the flow field inside the bus using a proprietary Navier-Stokes finite-volume solver, RavenCFD by Corvid Technologies, and then using Lagrangian particle tracking (LPT) post processing techniques. The LPT methods used allowed for the injection of respiratory particles, according to distributions found in literature, which included sneezing, coughing, and speaking. To fully investigate the problem space the moving bus was modeled with the windows in various states of closure and with various HVAC configurations. In all scenarios, a volumetric Viral Mean Exposure Time (VMET), which considers the viral load calculations, was used to quantify the various exposure risk of all passengers on the bus. It was found that the most efficient ventilation system on a public transport bus was to keep the windows closed and HVAC of main cabin at maximum to minimize the viral exposure within the bus. © 2021 by ASME.

Protocolized transition from continuous infusion analgosedation in critically ill medicine patients

INTRODUCTION/HYPOTHESIS: Analgosedation is standard of care in management of patients on mechanical ventilation. Drug shortages before and during the COVID-19 pandemic presented unique challenges, particularly during surges. The purpose of this study was to evaluate the impact of a structured, daily huddle report on analgosedative medication use in mechanically ventilated MICU patients. METHODS: This retrospective, single-center analysis included 3 two-month epochs before (E1), during (E2) and after (E3) initiation of an interprofessional pre-round huddle. Two metrics presented included continuous infusion (CI) analgosedation and drug shortages in effort to identify opportunities for scheduled enteral or parenteral therapies to aid CI weaning. Adult patients admitted to the MICU and on CI analgosedation were included. The primary endpoint compared daily and cumulative scheduled parenteral, enteral, and CI analgosedation administered between epochs. Secondary endpoints included percent-time in goal RASS, Objective Pain Assessment Scale (OPAS), time without delirium, evaluation of drug costs, and effect on ICU outcomes between epochs. RESULTS: A total of 81 patients (E1: 27;E2: 23;E3: 31) were included. Mean age (E1, 65.9±15.4 vs E2, 59.7±10.3 vs E3, 56.3±12.6 years;p=0.021) and proportion COVIDpositive (E1, 0 [0%] vs E2, 6 [26.1%] vs E3, 3 [9.7%];p=0.013) were different between groups. Cumulative CI opioid requirements (E1, 719.5 (214.4-1874.5) vs E2, 641.9 (503.7-1675.9) vs E3, 430.4 (247.2-856.5) mg morphine equivalents;p=0.029) were significantly different. Time on CI fentanyl (E1, 85.9 (46.1-170.5) vs E2, 95.3 (47.2-161.7) vs E3, 41.4 (12.4-67.2) hours;p=0.003) was also decreased. Percent-time in goal OPAS, RASS, without delirium were similar between epochs. Drug cost for CI fentanyl (E1, 3842.1 [1144.9-100009.83] vs E2, 4019.7 [2607.3-8954.4] vs E3, 2208.1 [1321.7-4451.4];p=0.023) was reduced. CONCLUSIONS: This exploratory analysis of a structured approach in scheduling enteral and parenteral agents to wean off CI analgosedation during drug shortages may be effective. Time on, overall CI fentanyl requirements, and costs were significantly reduced while maintaining adequate analgesia and sedation. These results may introduce novel strategies to mitigate drug shortages while maintaining clinical outcomes.

Impact of Lockdown on Air Pollutants during COVID-19 at Patna, India

Many countries shut their borders, imposed nationwide lockdown, and restricted several anthropogenic activities to arrest the spread of COVID-19. In the present study, the concentration of several air pollutants (PM10, PM2.5, NO2, NH3, SO2, CO and O3) during different phases of lockdown from monitoring stations of Patna was analyzed to assess the effect of lockdown restriction on air quality. Reduction in PM2.5, NH3, NO2, PM10 and CO concentration was observed by 59.79%, 58.2%, 49.49%, 39.57% and 24.04%, respectively during the lockdown period. National Air Quality Index (NAQI) value in the year 2020 had been observed to lower by 57.88% compared to the year 2019, during the same period. A more significant fall in the concentration of air pollutants was observed during the early phase of post-lockdown compared to the late stages of post-lockdown. The study reflects the significance of restriction on anthropogenic activities in improving air quality and provides clues for future action plans for improving air quality. © 2021. by Asian Association for Atmospheric Environment.

Isolated EBV-induced acute hepatitis in the absence of infectious mononucleosis

Introduction: Epstein-Barr virus (EBV) is a globally prevalent herpesvirus with an estimated 90-95% seropositivity rate worldwide. It is most known for causing infectious mononucleosis characterized by the classic triad of fever, pharyngitis, and lymphadenopathy. Hepatitis is a common manifestation seen in 90% of cases;however, isolated acute hepatitis in the absence of infectious mononucleosis is a rare clinical presentation. Case Description/Methods: An 18-year-old female with no medical history presented with fevers, fatigue, myalgia, and headache ongoing for one week. She had been evaluated previously with recommendations for supportive care for an unspecified viral illness. Workup at the time had been negative for urine hCG, COVID-19, heterophile antibody, Lyme disease, and bacteremia. However, symptoms worsened with the development of nausea, vomiting, and darkening of her urine. Prior to this, patient had been in her normal state of health without sick contacts, travel history, animal exposures, risky sexual practices, or substance use. Exam revealed cervical lymphadenopathy and hepatosplenomegaly. Labs showed normal leukocyte count 8.4 thou/cmm with differential significant for reactive lymphocytosis 19% and bandemia 8%. Liver function tests were abnormal with elevated total bilirubin 3.8 mg/dL, AST 366 U/L, ALT 460 U/L, ALP 562 U/L. Synthetic function was intact. Hepatic ultrasound was unrevealing. Extensive infectious workup revealed acute EBV infection with serologies showing positive VCA IgM Ab 74.3 U/mL, negative VCA IgG Ab 11.9 U/mL, negative EA Ab < 5 U/mL, negative EBNA Ab < 3 U/mL. Patient was managed supportively with improved symptoms. She was instructed to avoid physical contact sports for one month upon discharge. Discussion: Clinically significant EBV induced hepatitis is a rare entity seen in < 5% of cases. Nevertheless, it is important to consider EBV as a causative pathogen of acute hepatitis. Heterophile antibody or Monospot test is the diagnostic test of choice with a sensitivity of 85% and a specificity of 100%;however, false negatives can occur especially early in the disease course. EBV serology has an improved sensitivity of 97% with a comparable specificity of 94%. As such, follow-up serology is necessary especially if clinical suspicion is high. While no specific EBV targeted therapies exist, it is important to identify it given the potential complications, including splenic rupture, airway obstruction, malignancies, lymphoproliferative disorders, among others.

Acute acalculous cholecystitis: An unusual first manifestation of COVID-19

Introduction: COVID-19 pandemic has become a major global health challenge, with more than 178 million confirmed cases and over 3.86 million deaths to date. While general and respiratory symptoms are common, it may have atypical GI involvement. We chronicle here an extremely rare case of acute acalculous cholecystitis (AAC) in a patient with COVID-19. Case Description/Methods: A previously healthy 35-year-old male presented to the emergency room with abdominal pain and non-biliary vomiting. He was nonsmoker, nonalcoholic, and drugfree. His vitals revealed: temperature 37.1°C, heart rate 82 bpm, blood pressure 114/72 mm Hg, respiratory rate 16/minute, and an oxygen saturation of 99% in room air. Physical examination revealed a positive Murphy's sign. Laboratory parameters revealed leukocytosis and high CRP level. Abdominal ultrasound showed marked gallbladder wall thickening, normal CBD, with no cholelithiasis or sludge formation. EUS also ruled out stones in the gallbladder. Therein, coronavirus rRTPCR came back positive. CT chest revealed bilateral patchy peripheral ground-glass opacities in the lungs, consistent with COVID-19. Based on these findings and exclusion of probable causes of AAC, COVID-19-related AAC was diagnosed. The patient was initiated on standard COVID-19 treatment for the mild disease and conservative treatment for AAC. His hospital course remained unremarkable, except for fever and dyspnea on day 4 of admission. He remained hemodynamically stable. On day 7 of admission, his abdominal pain, vomiting, and fever disappeared with treatment. On day 9 of admission, he was afebrile, dyspnea had resolved, and had no abdominal pain. He was then discharged home in a stable condition. He continues to do well for 2 months now. Discussion: Published medical literature is bereft of reports on the association between AAC and COVID-19. A PubMed search was conducted for all case reports of AAC amidst COVID-19 till June 2021. Search terms included ''acalculus cholecystitis'' and ''COVID-19''. The search resulted in only 4 case reports to date. This case highlights that the GI symptoms may precede the pulmonary manifestations of COVID-19. It further provides the clinical evidence behind a causal relationship between SARS-CoV-2 infection and biliary involvement. The extrapulmonary symptomology of this infection has not been extensively studied, warranting a high index of suspicion for rare manifestations like AAC. Thus, new-onset GI symptoms may indicate COVID-19, requiring prompt testing for SARSCoV- 2.

Fear and practice modifications among dentists to combat novel coronavirus disease (COVID-19) outbreak

An outbreak of novel coronavirus disease (COVID-19) in China has influenced every aspect of life. Healthcare professionals, especially dentists, are exposed to a higher risk of getting infected due to close contact with infected patients. The current study was conducted to assess anxiety and fear of getting infected among dentists while working during the current novel coronavirus diseases (COVID-19) outbreak. In addition, dentists' knowledge about various practice modifications to combat COVID-19 has been evaluated. A cross-sectional study was conducted using an online survey from 10th to 17th March 2020. The well-constructed questionnaire was designed and registered at online website (Kwiksurveys) and validated. A total of 669 participants from 30 different countries across the world responded. After scrutiny, completed questionnaires (n = 650) were included in the study. Statistical analysis was performed using SPSS version 25. Chi-Square and Spearman correlation tests were applied to control confounders and assess the relation of dentists' response with respect to gender and educational level. More than two-thirds of the general dental practitioners (78%) from 30 countries questioned were anxious and scared by the devastating effects of COVID-19. A large number of dentists (90%) were aware of recent changes in the treatment protocols. However, execution of amended treatment protocol was recorded as 61%. The majority of the dentists (76%) were working in the hospital setting out of which 74% were from private, and 20% were from government setups. Individually we received a large number of responses from Pakistan and Saudi Arabia, but collectively more than 50% of the responses were from other parts of the world. Despite having a high standard of knowledge and practice, dental practitioners around the globe are in a state of anxiety and fear while working in their respective fields due to the COVID-19 pandemic impact on humanity. A number of dental practices have either modified their services according to the recommended guidelines to emergency treatment only or closed down practices for an uncertain period.

Assessment of Knowledge, Attitude, and Perception towards COVID-19 Vaccine among the General Population in the Hail Province, KSA

Aim: Coronavirus infection has caused disease at the pandemic level with several deaths worldwide and affected all aspects of human life. One way to minimize virus transmission and its effects is to perform mass vaccination within the general population so that herd immunity is developed against the SARS-CoV-2 virus. However, low health literacy and vaccine hesitancy are potential threats in achieving this. The present study is designed to measure the Knowledge, Attitude, and Perception levels towards COVID-19 and assess public perception and acceptance levels of the vaccine among the general population in the Hail province of Saudi Arabia. Methods: A bilingual, community-based questionnaire, consisting of the respondents' socio-demographic profile, COVID-19 knowledge, and attitude & perception towards COVID-19 vaccination, was circulated using different social media platforms. The collected data was analyzed using SPSS software. Results: Appropriate knowledge level was found in 74.8% of the respondents, whereas inappropriate knowledge levels were observed in females and participants with non-health-related occupations and were inversely related to willingness to the vaccine. More than 60% of the respondents had a negative attitude towards the COVID-19 vaccine, as only 51% were willing to get vaccinated. A negative attitude was significantly associated with female respondents. Conclusion: Our study reports a high knowledge level among the respondents in the Hail province. However, there is also a decreased willingness to be vaccinated, suggesting that more vaccine and health literacy seminars should be conducted to generate awareness among the general population in the Hail province, KSA.

Outcomes with COVID-19 in patients with hematopoietic stem cell transplant and cellular therapy: A systemic review and meta-analysis

Background: Coronavirus Disease 2019 (COVID19) was declared a pandemic on March 11, 2020. COVID-19 has caused over 100 million infections and over 2 million deaths globally. Patients who have received a hematogenic stem cell transplant or cellular therapy (HCT) have a high risk of mortality and morbidity with COVID-19 due to severe immune dysregulation. We conducted a systematic review and metaanalysis aimed to evaluate the outcomes of COVID-19 in HCT patients. Methods: A literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA) guidelines was performed on 3 databases (PubMed, Cochrane, and Clinical trials.gov) from the date of inception to Jan 2021. MeSH terms included 'hematological malignancies', 'hematopoietic stem cell transplantation', 'SARS-CoV-2', and 'COVID 19'. We screened 99 articles and 6 studies (4 retrospective studies, 2 prospective) were included after excluding review, duplicate, and non-relevant articles. Quality evaluation was done using the NIH quality assessment tool. The Inter-study heterogeneity among the studies was assessed using the Q statistic proposed by Cochrane and the I2 index introduced by Higgins and Thompson. Pooled analysis was done using the 'metaXL', and the random effects model was used to estimate the pooled prevalence with 95% CI. Results: Of 1619 patients in 6studies, 646 HCT patients were analyzed (Table ). The median age of patients was 63 years and 59% were males. Median days since HCT for autologous (auto) HCT and allogeneic (allo) HCT patients were 690 and 450 days respectively. The average follow-up duration after COVID-19 was 24 days. COVID-19 mortality in HCT patients was 20% (95%CI 0.17 to 0.23, I2=0). Roedl et al (n=6) reported a mortality of 83% and was excluded from the pooled analysis. The mortality rate was 19% (95% CI 0.15 to 0.24, I2=0%) in auto HCT patients and 21% (95% CI 0.17 to 0.25, I2=0%) in allo HCT patients. Conclusions: The HCT patients are at significant risk of increased mortality and morbidity due to COVID-19. There is a need to prioritize HCT patients for COVID-19 vaccination, close surveillance, and aggressive management. (Table Presented).

Can HbA1c levels be used as an independent marker of mortality and morbidity risk in patients with COVID-19 positive swabs?

Background: Diabetes mellitus has been considered a significant risk factor for morbidity and mortality for COVID-19.1 HbA1c levels are often used as a marker of poor glycaemic control and are one way of diagnosing pre-diabetes as well as diabetes.2,3 We tried to explore whether HbA1c levels could be an independent risk factor for mortality and morbidity in patients with positive coronavirus (SARS-COv-2) swabs. Methods: This was a retrospective multicentre study of coronavirus swab positive patients who had a recent HbA1c test. Their demographic data, medical history, COVID-19 swab and laboratory results, and final outcomes were analysed. Patients were divided into three groups;HbA1c in normal (group 1), pre-diabetic (group 2) and diabetic (group 3) ranges. Data were analysed using JASP and statistical computation using a χ2 test. Results: A total of 1,226 patients had SARS-CoV-2 RNA identification swabs between 10 February 2020 and 1 May 2020. A cohort of 120 of these patients had positive swab results and recent HbA1c results. Mortality rates for group 1 (normal HbA1c) and 3 (diabetic HbA1c) were relatively higher than group 2 (pre-diabetic HbA1c). Among group 2, female patients had greater mortality, perhaps because of fewer male patients, although overall co-morbidity was less (4/120 (3.33%) in group 2 compared with 18/120 (15%) in group 1 and 14/120 (11.66%) in group 3. Overall, 36/120 (30%) patients died and 84/120 (70%) survived. Survival curves after analysis of data showed that increasing HbA1c levels were associated with poorer outcomes across all groups. Analysis was significant with p=0.003. Conclusions: HbA1c levels in this study were an independent marker of increased risk of mortality in COVID-19 swab positive patients. The findings are statistically significant (p=0.003). Increased co-morbidities at normal HbA1c seem to have a contributing role in enhanced mortality.

Assessing national critical care capacity: A snapshot of facilities across pakistan

INTRODUCTION: As the COVID-19 pandemic threatens to strain health care systems worldwide, the presence of gaps in the global critical care capacity has become glaringly obvious, particularly in less developed countries like Pakistan. To identify existing gaps, an assessment of the critical care units across Pakistan was carried out. METHODS: A novel checklist for assessing critical care units was developed based on the Partners in Health 4S Framework. Our checklist evaluated the following key components: Space/Infrastructure, Staffing, Stuff/Equipment, and Systems/Protocols. A series of surveys was conducted using telephonic and on-site interviews at hospitals identified by the Ministry of Health in Pakistan. RESULTS: Critical care facilities at 53 hospitals were surveyed. The majority were from the public sector (62%) and located in metropolitan cities (62%). In terms of infrastructure, the majority of units were adequate, with gaps primarily being identified for negative-pressure rooms (21%), donning-doffing areas (58%) and isolation rooms (64%). In terms of staffing, the majority of hospitals had trainee doctors (94%) and nursing staff (100%) available, with gaps being identified in terms of presence of qualified intensivists (47%) and ancillary staff (ethicists - 17%, dietitians - 45%). Furthermore, an adequate nurse-to-patient ratio of 1:2 or 1:3 was only present in 53% of the hospitals. Equipment was present in the majority of facilities including ventilators (96%, n=9.7±1.1) and BIPAP machines (85%, n=4.5±0.6), with a relative lack of high-flow nasal cannulas (64%, n=3.2±0.9). More than 80% of hospitals had protocols in place for COVID-19 management and staffing, but fewer had them for patient surge (60%), clinician credentialing (58%) and risk mitigation (49%). On chi-square analysis, statistically significant differences (p<0.05) were noted between public and private sectors as well as metropolitan and rural hospitals in terms of availability of negative pressure rooms, ancillary staff like dietitians, and optimal nurse-to-patient ratio. CONCLUSIONS: The results from this study will be pivotal to guide policy makers in devising strategies for improving the quality of critical care units across Pakistan during the COVID-19 pandemic and beyond.