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Introduction: Pulmonology residents are at the forefront of COVID-19 patient care and have had significant changes in their clinical practices during the pandemic. We aimed to evaluate the use of online education and telemedicine and regarding residents' perspectives. Method(s): An online survey link, questioning use of online education, and perceptions of changes in education, was sent to 486 pulmonology residents in Turkey via e-mail and messages. Result(s): Based on assumptions of 200 participants, with a response rate of 41%, online education was quite limited in the first wave of the pandemic (generally <10%). In the last one year of their training, nearly half of the residents stated that the online education was beneficial;while 67% thought that online lessons/meetings were less effective than face-to-face activities. Residents mostly preferred intermittent use of online education after pandemic (Table 1). Only a quarter of them had telemedicine (TM) experience;while nearly half of them thought that it had a positive effect on their clinical experience. Conclusion(s): During pandemic era, online education requirement increased in Turkey. While online-education or telemedicine cannot replace the hands-on training and clinical practice, respectively;the combination of online and onsite modules may be a viable alternative.
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OBJECTIVE: Telemedicine has been defined as a valuable tool in delivering care for COVID-19 patients. However, clinicians and policymakers should be convinced that traditional and new technological methods of clinical management may be equally effective. The purpose of this study was to generate some initial recommendations based on the clinical utility of videoconference consultation in forward triage and follow-up for COVID-19 patients. MATERIAL AND METHODS: This retrospective cross-sectional study evaluated the medical records of 100 COVID-19 patients consulted using a videoconference program (Skype), from September 1, 2020, to February 3, 2021. The data were analyzed on demographic characteristics, disease history, the need for physical examination after videoconference consultation, pre-diagnostics and diagnostics, treatment decisions, number of videoconference consultation sessions in follow-up, duration of sessions, and final outcome. RESULT(S): The male COVID-19 patients constituted 54% of the total sample. The median age was 51 (42-61) years. The median duration of the initial videoconference consultation session was 16 (12-21) minutes. Following the initial videoconference consultation session, 14 patients required follow-up with all face-to-face visits;the remaining patients were primarily followed with videoconference consultation sessions. For 25 patients, it was sufficient to provide only videoconference consultation sessions;they were not required to be in the hospital for physical examination or any subsequent investigation at all. A total of 14 patients were hospitalized. There was no statistically significant difference between the high-risk group and the other patients according to the components of the disease management process via videoconference consultation. CONCLUSION(S): Videoconference consultation enables a holistic assessment regardless of the patient's characteristics and allows for more time to be spent on each patient, particularly during the pandemic period without risk of contagion. It can be used as a forward triage and follow-up tool to identify patients in need of emergency hospitalization and continuous health care.Copyright © Author(s).
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Introduction: The pandemic has changed regular pattern of work in clinics. We aimed to evaluate the COVID-19 related workload and psychosocial burden, as well as the possible associated factors among the pulmonology residents in Turkey. Method(s): An online survey was sent to pulmonology residents through e-mails and messages. Result(s): Out of 200 participants, majority was female (67%), between 24-29 years (72%) of age, from university hospitals (59%), and under training in 1st wave of Covid-19 (69%). Most of the residents trained during 1st wave (86%) expressed their stress and anxiety levels as more than moderate and nearly 1/3 considered resigning. Most of the residents were unsatisfied with their jobs and job conditions, and feeling stressed, anxious, worried about contamination (Table 1). Stress and anxiety was associated with gender, residency level, previous experience in Covid-19 wards, stress level during 1st wave, resigning desire, workload, and insufficient knowledge (p<0.05). On the other hand;age, hospital type, living with kids, workload, tiredness, stress level, resigning desire were associated with depressive mood. Conclusion(s): Residents were mostly affected psychosocially by the Covid-19 crisis. Considering the modifiable factors, pulmonology residency programs should be aware of and closely monitor these effects.
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Introduction: Advanced age is an important prognostic indicator for the mortality of coronavirus disease 2019, especially in patients over 65. Patients with chronic underlying conditions such as hypertension showed the worst outcomes. This study aimed to identify predictors of mortality in elderly hypertensive patients hospitalized in intensive care units. Material(s) and Method(s): Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records and compared between survivors and non-survivors. Univariate and multivariate logistic regression methods were used to explore the indicators of in-hospital mortality. Result(s): One hundred and ninety-eight patients with a median age of 75 years (65-94 years) were included in this study, of whom 95 were discharged from the intensive care units, and 103 died. Shortness of breath [hazard ratio (HR): 1.65, 95% confidence interval (CI): 1.04-2.61, p: 0.034], C-reactive protein (CRP)/albumin ratio (>51.32) (HR: 1.83, 95% CI: 1.12-2.97, p: 0.015), serum creatinine (>1.62 mg/dl) (HR: 2.04, 95% CI: 1.13-3.33, p: 0.001), aspartate transaminase (>34 u/l) (HR: 1.99, 95% CI: 1.28-3.09, p: 0.002), D-dimer (>781 ng/ml) (HR: 1.59, 95% CI: 1.04-2.43, p: 0.031), leukocyte (>12,000' 103/microl) (HR: 1.68, 95% CI: 1.09-2.59, p: 0.018) and lymphocyte count, (<=660' 103/microl) (HR: 1.76, 95% CI: 1.17-2.63, p: 0.006) were independent predictors for mortality in elderly hypertensive patients. Conclusion(s): Using these predictors with cut-off values can identify patients at risk of death and needing aggressive intervention earlier in the disease course. Copyright © 2022, Geriatrics Society. All rights reserved.
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In the COVID-19 pandemic, flexible work schedules were terminated in June 2020, normalization practices were initiated, and resignation/ retirement bans on healthcare workers were lifted. This study aims to evaluate the decisions of doctors who've resigned or retired during the COVID-19 pandemic from a sociological perspective. This qualitative research was conducted online using the semi-structured face-to-face interview technique with physician interviewees. Of the interviewees (M-age = 50.9 years), 9 had resigned and 10 had decided to retire. When coding the interview statements, the factors affecting the decision to leave employment were investigated such as organizational problems, managerial approaches, the conditions for cognizance in performing and understanding the profession, personality traits, and approaches in their immediate environment. During the pandemic, healthcare workers' acts of resigning or retiring have been explained of being infected/infecting someone else, problems in the health system, intense work conditions, and feeling burned out due to not knowing how long the process will take. In the context of the crisis as an anomie in which the individual loses faith in society and social solidarity dissolves, the main factors setting the basis for leaving work have been identified as unfair distribution of tasks, organizational disorders, ambiguity regarding the concept of responsibility due to uncertainty, collegiate behaviors that shirk duty, lack of appreciation, and personality traits. The imbalance in exchange with society has led individuals to choose to give themselves the rewards that they are unable to get from others. This research performs a kind of autopsy to understand the factors behind cases of resignation and retirement during the COVID-19 pandemic and what needs to be done to prevent this from turning into a contagion turnover.
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Objective: In this study, we aimed to investigate the effect of hypertension (HT) and antihypertensive treatment on prognosis, which is one of the cardiovascular risk factors affecting the prognosis of COVID-19. Methods: We included 117 patients diagnosed with COVID-19 by nasopharyngeal polymerase chain reaction (PCR). The patients were divided into a hypertensive group and a control group. Biochemical, complete blood count and imaging data of the patients were recorded. Mortality of patients with and without HT was evaluated. The effect of antihypertensive therapy on mortality was evaluated. Results: In thorax CT, ground glass opacity and pneumonic consolidation were found statistically significantly higher in the hypertensive group (p <0,001). Hospital stay duration (days) of the patients were significantly longer in the hypertensive group and need for intensive care unit was statistically higher in the hypertensive group (p <0,001). Mortality of hypertensive patients was higher than of those without hypertension (p <0,001). There was no statistically significant difference in mortality in antihypertensive treatment groups (p = 0,801). Conclusion: Hypertension is an important risk factor that increases mortality in COVID-19 patients. Uncontrolled hypertension was common in most patients. Inflammatory parameters are higher especially in patients with uncontrolled hypertension. Patients with uncontrolled hypertension have a higher risk of mortality. There is no data to suggesting that the use of ACEI/ARB worsens prognosis. High blood pressure on admission to the hospital is important and the patient’s current antihypertensive therapy should not be discontinued.
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Background: Hydroxychloroquine (HCQ) alone or with some antibiotic and antiviral agents is used off label in the treatment of Coronavirus Disease 2019 (COVID-19). It seems that the most important safety problem about these medications are their cardiac side effects. Although there are data on arrhythmogenic events associated with the use of HCQ alone, such as corrected QT (QTc) prolongation, Torsade de pointes (TdP) or bradycardia, there are insufficient data on its combination with moxifloxacin (MOX). Objective: The aim of our study is to analyze the effect of HCQ alone or in combination with the use of MOX on QTc interval, heart rate, and arrhythmic events in patients with a diagnosis of COVID-19. Methods: This is a single center cohort study of non-intensive care unit (ICU) patients hospitalized with clinical signs consistent with pneumonia and at least one positive COVID-19 nasopharyngeal polymerase chain reaction test result. QTc intervals and heart rates in patients whose treatment consisted of HCQ alone or its separate combination with MOX at baseline and post-treatment were calculated and compared. Results: 312 patients were included (median age of 42 [IQR: 31.25-57.75] years, 54.16% male). Patients were divided into two groups based on their in-hospital treatment strategy as follows: HCQ alone (n: 166, 53.20%) or HCQ + MOX (n: 146, 46.79%). As compared to baseline, QTc intervals were significantly increased in all patients after treatment (406.00 [388.00-422.00] ms vs 418.00 [401.00-435.00] ms, p<0.001). When the baseline QTc intervals were evaluated, there was no statistically significant difference between HCQ alone and HCQ + MOX groups (403.00 [384.50-419.00] ms vs. 409.50 [390.00-425.00] ms, p: 0.086). After treatment period, QTc intervals were significantly higher in HCQ + MOX group compared to the group in which patients only used HCQ (413.00 [398.00-430.00] ms vs. 426.50 [405.00-441.00] ms, p<0.001). We found a significant decrease in heart rate in both groups after treatment period. From 79.00 (70.00-88.00) bpm to 70.00 (63.00-79.00) bpm in HCQ alone group (p<0.001) and from 80.00 (70.00-88.00) bpm to 70.50 (63.00-78.75) bpm in HCQ + MOX group (p<0.001). On the other hand, no statistically significant difference was observed between the groups in terms of heart rates either before or after the treatment. Conclusion: In this cohort study, patients who received HCQ for the treatment of COVID-19 were at high risk of QTc prolongation, and concurrent treatment with MOX was associated with greater changes in QTc. However, none of patients experienced malignant ventricular arrhythmia or death during treatment. Clinicians should carefully weigh risks and benefits with close monitoring of QTc if considering treatment with HCQ especially concomitant use with MOX. Further prospective studies are needed to determine the exact implications of these drugs on arrhythmias in patients with COVID-19.
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Contracting COVID-19 during pregnancy is a clinical concern as knowledge of altered immunity is limited, and so cases should be considered separately in terms of diagnosis and treatment. Although there is no clear evidence that pregnancy increases the risk of COVID-19, it is thought that susceptibility to infection and the intensification of respiratory symptoms may be increased, given the physiological changes in pregnancy and increased mortality and morbidity in many viral diseases. Accordingly, the management of COVID-19 in pregnant patients and those considered among the high-risk groups represent a challenge for clinicians. Numerous studies of COVID-19 have been published to date or are ongoing, yet pregnant women are generally excluded from clinical studies. Clinical experiences and case reports occupy an important position in literature, and we present hare a case in which the diagnosis of a patient being followed by our clinic was delayed due to the absence of SARS CoV-2 in recurrent upper-respiratory-tract sampling, and whose clinical findings worsened with initial COVID-19 treatment during pregnancy. Her delivery by caesarean section (C-section) was the result of a multidisciplinary decision. We draw attention to the diagnostic process and treatment approach.