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1.
Jac-Antimicrobial Resistance ; 4(6), 2022.
Article in English | Web of Science | ID: covidwho-2161069

ABSTRACT

Introduction The primary outcome of the study was to evaluate the effect on 30 day mortality of the combination ceftazidime/avibactam + fosfomycin in the treatment of bloodstream infections (BSIs) caused by KPC-producing Klebsiella pneumoniae (KPC-Kp). Materials and methods From October 2018 to March 2021, a retrospective, two-centre study was performed on patients with KPC-Kp BSI hospitalized at Sapienza University (Rome) and ISMETT-IRCCS (Palermo) and treated with ceftazidime/avibactam-containing regimens. A matched cohort (1:1) analysis was performed. Cases were patients receiving ceftazidime/avibactam + fosfomycin and controls were patients receiving ceftazidime/avibactam alone or in combination with in vitro non-active drugs different from fosfomycin (ceftazidime/avibactam +/- other). Patients were matched for age, Charlson comorbidity index, ward of isolation (ICU or non-ICU), source of infection and severity of BSI, expressed as INCREMENT carbapenemase-producing Enterobacteriaceae (CPE) score. Results Overall, 221 patients were included in the study. Following the 1:1 match, 122 subjects were retrieved: 61 cases (ceftazidime/avibactam + fosfomycin) and 61 controls (ceftazidime/avibactam +/- other). No difference in overall mortality emerged between cases and controls, whereas controls had more non-BSI KPC-Kp infections and a higher number of deaths attributable to secondary infections. Almost half of ceftazidime/avibactam + fosfomycin patients were prescribed fosfomycin without MIC fosfomycin availability. No difference in the outcome emerged after stratification for fosfomycin susceptibility availability and dosage. SARS-CoV-2 infection and ICS >= 8 independently predicted 30 day mortality, whereas an appropriate definitive therapy was protective. Conclusions Our data show that fosfomycin was used in the treatment of KPC-Kp BSI independently from having its susceptibility testing available. Although no difference was found in 30 day overall mortality, ceftazidime/avibactam + fosfomycin was associated with a lower rate of subsequent KPC-Kp infections and secondary infections than other ceftazidime/avibactam-based regimens.

2.
Pakistan Journal of Medical and Health Sciences ; 16(7):438-440, 2022.
Article in English | EMBASE | ID: covidwho-2067742

ABSTRACT

Introduction: Pandemics affect people in a defeatist manner and become stressful for people with relatives which need specific forms of care and attention. The study was conducted to find out if anxiety prevails among caretakers during the Covid-19 Pandemic as according to the literature review caregivers experience burden and fears related to their care-recipients and telerehabilitation. Material and Methods: The study used cross sectional survey and quantitative research.50 care-givers participated in the research where they filled online questionnaires inspired and derived from care-giver burden scale and beck anxiety inventory. Anxiety was clearly evident as most of the care-givers agreed to have feelings of nervousness 19 (38%), feeling anxious 18 (36%), feeling distressed 22 (44%), complaints about emotional burden 23 (43%) and 23 (46%) constant immersion in duties towards care-recipients. Results: SPSS tables depict the analyzed results and their interpretation. The results show 36%of the care-givers agreed that they face anxiety when a situation gets out of control, 44% were distressed about not getting enough help from healthcare team and other family and friends, 55% are apprehensive about their present condition and 46% are emotionally challenged and constantly immersed in duties owing to their family members. Conclusions: Anxiety and depression as a result of caregiving burden is common among care-givers and needs to be addressed as soon as possible. This makes it essential that health professionals pay heed and attention to develop interventions for care-givers and provide them with pertinent knowledge.

4.
Pakistan Armed Forces Medical Journal ; 72(3):1041-1044, 2022.
Article in English | Scopus | ID: covidwho-1935064

ABSTRACT

Objective: To compare the outcome in COVID 19 patients on oxygen managed with 6mg and 12 mg Dexamethasone at Pak Emirates Military Hospital Rawalpindi. Study Design: Comparative cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi Pakistan, from Aug 2020 to Aug 2021. Methodology: Patients diagnosed with COVID-19 on PCR and were oxygen-dependent but not mechanical ventilation dependent were included in the study. They were randomly divided into two groups. Group-I received 6mg Dexamethasone, while Group-II received 12 mg Dexamethasone for ten days. They were followed up for 30 days to look for the outcome (prolonged admission, high dependency unit admission, intensive care admission, death). The difference in outcome in both groups was studied using the Pearson chi-square test. Results: Out of 600 patients included in the study, 401 (66.8%) were male, while 199 (33.2%) were female. The mean age of the study participants was 47.81 ± 8.716 years. 306 (51%) were given 6mg of Dexamethasone for ten days, while 294 (49%) were given 12mg of Dexamethasone for a similar time. prolonged admission (p-value-0.178), high dependency unit admission (p-value-0.409), intensive care admission (p-value-0.176) and mortality (p-value-0.588) were not statistically significantly different in both the groups. Conclusion: All the outcome variables, including mortality and admission to the critical care unit, were not statistically significant in groups taking 6mg or 12 mg of Dexamethasone, so it could be concluded that a high dose of this medication is not superior in terms of efficacy when compared to the low dose of 6mg. © 2022, Army Medical College. All rights reserved.

5.
Infection ; 50(5): 1373-1382, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1920272

ABSTRACT

BACKGROUND: We evaluated clinical features and risk factors for mortality in patients with haematological malignancies and COVID-19. METHODS: Retrospective, case-control (1:3) study in hospitalized patients with COVID-19. Cases were patients with haematological malignancies and COVID-19, controls had COVID-19 without haematological malignancies. Patients were matched for sex, age and time of hospitalization. RESULTS: Overall, 66 cases and 198 controls were included in the study. Cases had higher prior corticosteroid use, infection rates, thrombocytopenia and neutropenia and more likely received corticosteroids and antibiotics than controls. Cases had higher respiratory deterioration than controls (78.7% vs 65.5%, p = 0.04). Notably, 29% of cases developed respiratory worsening > 10 days after hospital admission, compared to only 5% in controls. Intensive Care Unit admission and mortality were higher in cases than in controls (27% vs 8%, p = 0.002, and 35% vs 10%, p < 0.001). At multivariable analysis, having haematological malignancy [OR4.76, p < 0.001], chronic corticosteroid therapy [OR3.65, p = 0.004], prior infections [OR57.7, p = 0.006], thrombocytopenia [OR3.03, p < 0.001] and neutropenia [OR31.1, p = 0.001], low albumin levels [OR3.1, p = 0.001] and ≥ 10 days from hospital admission to respiratory worsening [OR3.3, p = 0.002] were independently associated with mortality. In cases, neutropenia [OR3.1, p < 0.001], prior infections [OR7.7, p < 0.001], ≥ 10 days to respiratory worsening [OR4.1, p < 0.001], multiple myeloma [OR1.5, p = 0.044], the variation of the CT lung score during hospitalization [OR2.6, p = 0.006] and active treatment [OR 4.4, p < 0.001] all were associated with a worse outcome. CONCLUSION: An underlying haematological malignancy was associated with a worse clinical outcome in COVID-19 patients. A prolonged clinical monitoring is needed, since respiratory worsening may occur later during hospitalization.


Subject(s)
COVID-19 , Hematologic Neoplasms , Neutropenia , Thrombocytopenia , Adrenal Cortex Hormones/therapeutic use , Albumins , Anti-Bacterial Agents , COVID-19/epidemiology , Case-Control Studies , Hematologic Neoplasms/complications , Humans , Neutropenia/complications , Retrospective Studies , SARS-CoV-2 , Thrombocytopenia/complications
6.
Pakistan Armed Forces Medical Journal ; 72(2):547-550, 2022.
Article in English | Scopus | ID: covidwho-1912788

ABSTRACT

Objective: To determine the efficacy of therapeutic plasma exchange in patients suffering from COVID-19 requiring admission in the critical care setting. Study Design: Comparative cross-sectional study. Setting and Duration of Study: Critical Care Unit, Pak Emirates Military Hospital Rawalpindi, from Apr 2020 to Jun 2020. Methodology: The study was carried out on 160 patients managed at the Critical Care setting of our hospital in three months. Data were extracted from the record regarding the patients who underwent therapeutic plasma exchange and others who were only given supportive management. Overall mortality, duration of hospital stay, duration of Intensive Care Unit stay and duration of oxygen supplementation was compared in both the groups. Results: A total of 160 patients met the inclusion/exclusion criteria. Of these, 100 (62.5%) underwent therapeutic plasma exchange, while 60 (37.5%) did not undergo this procedure. The mean age of participants was 62.19 ± 5.192 years. Out of 15 (15%) patients died who underwent therapeutic plasma exchange, while 51 (85%) patients died who did not undergo plasma exchange (p-value <0.001). Length of hospital and Intensive Care unit stay and duration of oxygen supplementation were significantly less among those who underwent therapeutic plasma exchange than those who did not undergo this procedure (p-value <0.05). Conclusion: Therapeutic plasma exchange emerged as an effective procedure for patients of COVID-19 requiring Critical Care admission and organ support due to complications of this infection. Overall mortality and other clinical parameters were also significantly improved among patients undergoing therapeutic plasma exchange. © 2022, Army Medical College. All rights reserved.

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