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1.
Pol Arch Intern Med ; 2022 Jul 04.
Article in English | MEDLINE | ID: covidwho-1924853

ABSTRACT

INTRODUCTION: The course of consecutive COVID-19 waves was influenced by medical and organizational factors. OBJECTIVES: to assess the outcomes of in-hospital COVID-19 cases within the first three waves of the pandemic. PATIENTS AND METHODS: A retrospective medical record analysis of all COVID-19 patients admitted to the University Hospital (UH) in Krakow, the reference COVID-19 hospital in Lesser Poland, between March 1' 2020 - May 31' 2021 was performed. The waves were defined as 1 - 3, respectively: March-July 2020, August 2020 - January 2021, February 2021 - May 2021. Patient's characteristics and outcomes of waves 1-3 were compared. RESULTS: Data analyses included 5191 COVID-19 patients. We defined differences in age (mean [SD] were 60.2 [17.3] years. Vs. 62.4 [16.8] years vs. 61.9 [16.1] years respectively for wave 1 vs 2 vs 3, P = 0.003); gender distribution (proportion of women: 51.4% vs. 44.2% vs. 43.6%, P = 0.003); inflammatory markers and oxygen saturation (the lowest and the highest for wave 1, respectively, P <0.001). The hospital death rate in subsequent waves was: 10.4%, 19.8%, 20.3%; P <0.001. Despite similar patients' characteristics, the length of the hospital and Intensive Care Unit stay was shorter for wave 3 compared to wave 2. The risk factors for in-hospital death were: advanced age, male sex, cardiovascular or chronic kidney disease, higher C-reactive protein level and hospitalization during the 2nd or 3rd waive. CONCLUSIONS: We identified differences in patient's clinical characteristics and outcomes between consecutive waves, which probably reflect changes in terms of COVID-19 isolation policy, hospitalization indications and treatment strategies.

2.
Diabetes ; 71, 2022.
Article in English | ProQuest Central | ID: covidwho-1923969

ABSTRACT

Introduction: Diabetes is a risk factor for severe COVID-course. In this one-center report, we assessed clinical characteristics and risk factors associated with unfavorable outcomes in diabetic patients (DP) hospitalized due to COVID-19. Methods: We retrospectively analyzed data from a cohort of patients with confirmed SARS-CoV2 infection admitted to the University Hospital in Krakow (Poland) , a regional reference center for COVID-19, between March 6th 2020 and May 15th 2021. The data was collected from electronic medical records. Results: We included 5191 patients, mean age 61.98±16.66 years, 2348 (45.2%) women, 1364 (26.3%) DP. DP were older as compared to non-diabetics (median age 70 vs. 62 years, IQR 62-77 and 47-72, p<0.001) with similar gender distribution. DP were characterized by higher mortality (26.4% vs. 15.6%, p<0.001) , longer hospital stay (median 15 vs. 13 days, IQR 10-24 and 9-20, p<0.001) , more frequent ICU admission (15.7% vs. 11%, p<0.001) and more frequent requirement for mechanical ventilation (15.5% vs. 11.3%, p<0.001) . When adjusted for sex and age, the relative risk for in-hospital death, ICU admission and mechanical ventilation was 1.32 (95%CI 1.13-1.54) , 1.4 (95%CI 1.17-1.69) and 1.3 (95%CI 1.08-1.57) , respectively. Multivariable logistic regression showed age, CRP and D-dimer level, history of heart failure, and loop diuretic use were associated with higher risk of death, whereas anticoagulation therapy, ACEI/sartan/mineralocorticoid receptor antagonist use and thiazide use were associated with lower risk. Conclusions: In this large COVID-cohort, DP constituted more than one fourth of hospitalized patients. Their risk of death was ca. 30% higher as compared to non-diabetics, as was the risk of other important clinical outcomes. We identified a number of clinical, laboratory and therapeutical variables associated with risk of hospital death in DP with COVID-19.

3.
Pol Arch Intern Med ; 2022 May 06.
Article in English | MEDLINE | ID: covidwho-1836208

ABSTRACT

INTRODUCTION: High-sensitive cardiac troponin (hs-cTnT) and N terminal pro B type natriuretic peptide (NT-proBNP) are known markers of cardiac injury. However, the role of these markers in predicting severity of coronavirus disease (COVID-19) remains to be investigated.    Objectives: To analyze an association between hs-cTnT and NT-proBNP with in-hospital mortality in COVID-19 patients, with emphasis on those with concomitant chronic heart failure (CHF). PATIENTS AND METHODS: 1,729 consecutive patients with COVID-19 were enrolled. Demographic data, laboratory parameters and clinical outcomes (discharged or death) were analyzed. ROC curves and logistic regression analyses for hs-cTnT and NT-proBNP values and the risk of death were performed. RESULTS: Hs-cTnT was determined in 1,041 patients, while NT-proBNP was assessed in 715. CHF was present in 179 cases (10.4% of the cohort). The median of hs-cTnT, NT-proBNP values and in-hospital mortality were higher in CHF patients in comparison to those without CHF. In patients without CHF, the mortality was highest in those with the 4 th quartile of hs-cTnT or NT-proBNP values. In the ROC analysis, hs-cTnT ≥ 142 ng/ml, and NT-proBNP ≥ 969 pg/ml predicted in-hospital death. In cases without CHF, each 10 ng/L increase in hs-cTnT or 100 pg/mL increase in NT-proBNP was associated with risk of death: OR 1.01 and OR 1.02 (P<0.01), respectively. CONCLUSION: Hs-cTnT or NT-proBNP predicts in-hospital mortality in COVID-19 patients. Both Hs-cTnT and NT-proBNP should be routinely measured at admission in all patients hospitalized due to COVID-19 for early detection of subjects with an increased risk of in-hospital death, even if they do not have concomitant heart failure.

4.
Folia Med Cracov ; 61(4): 5-44, 2021 12 28.
Article in English | MEDLINE | ID: covidwho-1700594

ABSTRACT

The complex course of the COVID-19 and the distant complications of the SARS-CoV-2 infection still remain an unfaded challenge for modern medicine. The care of patients with the symptomatic course of COVID-19 exceeds the competence of a single specialty, often requiring a multispecialist approach. The CRACoV-HHS (CRAcow in CoVid pandemic - Home, Hospital and Staff) project has been developed by a team of scientists and clinicians with the aim of optimizing medical care at hospital and ambulatory settings and treatment of patients with SARS-CoV-2 infection. The CRACoV project integrates 26 basic and clinical research from multiple medical disciplines, involving different populations infected with SARS-CoV-2 virus and exposed to infection. Between January 2021 and April 2022 we plan to recruit subjects among patients diagnosed and treated in the University Hospital in Cracow, the largest public hospital in Poland, i.e. 1) patients admitted to the hospital due to COVID-19 [main module: 'Hospital']; 2) patients with signs of infection who have been confirmed as having SARS-CoV-2 infection and have been referred to home isolation due to their mild course (module: 'Home isolation'); 3) patients with symptoms of infection and high exposure to SARS- CoV-2 who have a negative RT-PCR test result. In addition, survey in various professional groups of hospital employees, both medical and non-medical, and final-fifth year medical students (module: 'Staff') is planned. The project carries both scientific and practical dimension and is expected to develop a multidisciplinary model of care of COVID-19 patients as well as recommendations for the management of particular groups of patients including: asymptomatic patient or with mild symptoms of COVID-19; symptomatic patients requiring hospitalization due to more severe clinical course of disease and organ complications; patient requiring surgery; patient with diabetes; patient requiring psychological support; patient with undesirable consequences of pharmacological treatment.


Subject(s)
COVID-19 , Hospitals, Special , Humans , Pandemics , Personnel, Hospital , SARS-CoV-2
5.
Brain Sci ; 12(2)2022 Jan 30.
Article in English | MEDLINE | ID: covidwho-1667051

ABSTRACT

We aimed to search whether neurological symptoms or signs (NSS) and the MEWS (Modified Early Warning Score) score were associated with in-hospital mortality or oxygen requirement during the first 14 days of hospitalization in COVID-19 patients recruited at the University Hospital in Krakow, Poland. The detailed clinical questionnaires on twenty NSS were either filled out by patients prospectively or retrospectively assessed by neurologists based on daily medical records. NSS were considered high or low-risk if they were associated with increased or decreased mortality in the univariable analysis. This cohort study included 349 patients with COVID-19 (median age 64, interquartile range (51-77), women 54.72%). The presence of high-risk NSS (decreased level of consciousness, delirium, seizures, and symptoms of stroke or transient ischemic attack) or its combination with the absence of low-risk NSS (headache, dizziness, decreased mood, and fatigue) increased the risk of in-hospital mortality in SARS-CoV-2 infection 3.13 and 7.67-fold, respectively. The presence of low-risk NSS decreased the risk of in-hospital mortality in COVID-19 patients more than 6-fold. Death in patients with SARS-CoV-2 infection, apart from NSS, was predicted by older age, neoplasm, and higher MEWS scores on admission. High-risk NSS or their combination with the absence of low-risk NSS increased the risk of oxygen requirement during hospitalization in COVID-19 patients 4.48 and 1.86-fold, respectively. Independent predictors of oxygen therapy during hospitalization in patients with SARS-CoV-2 infection were also older age, male sex, neoplasm, and higher MEWS score on admission.

6.
Kardiol Pol ; 79(7-8): 773-780, 2021.
Article in English | MEDLINE | ID: covidwho-1399787

ABSTRACT

BACKGROUND: The coronavirus disease 19 (COVID-19) recently became one of the leading causes of death worldwide, similar to cardiovascular disease (CVD). Coexisting CVD may influence the prognosis of patients with COVID-19. AIMS: We analyzed the impact of CVD and the use of cardiovascular drugs on the in-hospital course and mortality of patients with COVID-19. METHODS: We retrospectively studied data for consecutive patients admitted to our hospital, with COVID-19 between March 6th and October 15th, 2020. RESULTS: 1729 patients (median interquartile range age 63 [50-75] years; women 48.8%) were included. Overall, in-hospital mortality was 12.9%. The most prevalent CVD was arterial hypertension (56.1%), followed by hyperlipidemia (27.4%), diabetes mellitus (DM) (25.7%), coronary artery disease (16.8%), heart failure (HF) (10.3%), atrial fibrillation (13.5%), and stroke (8%). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) were used in 25.0% of patients, ß-blockers in 40.7%, statins in 15.6%, and antiplatelet therapy in 19.9%. Age over 65 years (odds ratio [OR], 6.4; 95% CI, 4.3-9.6), male sex (OR, 1.4; 95% CI, 1.1-2.0), pre-existing DM (OR, 1.5; 95% CI, 1.1-2.1), and HF (OR, 2.3; 95% CI, 1.5-3.5) were independent predictors of in-hospital death, whereas treatment with ACEIs/ARBs (OR, 0.4; 95% CI, 0.3-0.6), ß-blockers (OR, 0.6; 95% CI, 0.4-0.9), statins (OR, 0.5; 95% CI, 0.3-0.8), or antiplatelet therapy (OR, 0.6; 95% CI: 0.4-0.9) was associated with lower risk of death. CONCLUSIONS: Among cardiovascular risk factors and diseases, HF and DM appeared to increase in-hospital COVID-19 mortality, whereas the use of cardiovascular drugs was associated with lower mortality.


Subject(s)
COVID-19 , Cardiovascular Agents , Cardiovascular Diseases , Hypertension , Aged , Angiotensin Receptor Antagonists , Angiotensin-Converting Enzyme Inhibitors , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/epidemiology , Female , Hospital Mortality , Hospitals , Humans , Male , Middle Aged , Poland/epidemiology , Registries , Retrospective Studies , SARS-CoV-2
7.
Psychiatr Pol ; 55(3): 511-523, 2021 Jun 30.
Article in English, Polish | MEDLINE | ID: covidwho-1395318

ABSTRACT

OBJECTIVES: Assessment of mental state of patients with T1DM - the level of anxiety, stress and general mental health in the stressful conditions of an epidemic. Moreover, it was checked whether the stress response to the epidemic in the T1DM group differed from that in the control group. This is the first study to address these questions in the type 1 diabetes population in Poland. METHODS: An e-mail was sent to all T1DM patients under the care of a diabetes clinic with information about the possibility of online consultation with a psychologist / psychiatrist, with a set of psychological tests attached. The study included 49 patients with T1DM who responded within the first month and agreed to participate in the study. 38 people from the control group were randomly recruited. Each person completed a set of psychological tools. RESULTS: In both groups, the level of stress was higher than typical for the general population in the situation without stressor. T1DM patients who have been ill for over 10 years more often cope with stress through a task-oriented approach. Patients who have been ill for less than 10 years use avoidance strategies. In the first phase of the epidemic,women with T1DM used avoidance strategies. Patients with diabetes and mental disorders react more anxiously and thus require special care in coping with diabetes. CONCLUSIONS: In a situation of stress such as a epidemic, patients suffering from T1DM require optimization of treatment and cooperation of specialists in the field of diabetes and psychology / psychiatry.


Subject(s)
Anxiety/psychology , COVID-19/psychology , Diabetes Mellitus, Type 1/psychology , Stress, Psychological/epidemiology , Stress, Psychological/psychology , Adaptation, Psychological , Adult , Anxiety/epidemiology , COVID-19/epidemiology , Case-Control Studies , Diabetes Mellitus, Type 1/epidemiology , Female , Humans , Male , Mental Health/statistics & numerical data , Middle Aged , Surveys and Questionnaires , Young Adult
8.
Diabetes ; 70, 2021.
Article in English | ProQuest Central | ID: covidwho-1362286

ABSTRACT

The COVID-19 pandemic has forced a rapid adaptation of healthcare services to secure medical care for many patients' groups. This includes women with Gestational diabetes mellitus (GDM). We evaluated the impacts of the first COVID-19 wave on parameters such as the GDM treatment, glycemic control and pregnancy outcomes. In this retrospective study from a reference diabetes centre (Krakow, Poland), we compared patient data from two different time periods: the first wave of COVID-19 pandemic (March 2020 - June 2020) and the preceding five months (October 2019 - February 2020). Data was collected from the medical records and telephone surveys. No patient was diagnosed with concomitant COVID-19. We included 155 women - Group 1 N=73 and Group 2 N= 82 from the COVID-19 pandemic period and non-COVID-19 period, respectively. During the COVID-19 pandemic, almost half of all GDM women (N1=36, 49.3%) used telemedicine as a method of contacting their diabetic specialist while this tool was not utilized in the earlier period. Moreover, these patients reported difficulties in performing blood glucose self-control more often (N1=20, 27.4% vs. N2=7, 8.5% p=0.002) and spent less time on diabetes education and training than the control group on average (N1=39, 53.4% vs. N2=9, 9.8% below 2 hours of training;p≤0.001). Glycemic control parameters were very similar and most analysed pregnancy outcomes occurred with comparable frequencies. Differences were found with respect to the incidence of prolonged labour which was more frequent in the COVID-19 period Group 1 (N1=12, 16.4% vs. N2=3, 3.7% p=0.007) whereas no episodes of pre-eclampsia were observed in this group (N1=0 vs. N2=7, 8.5% p=0.01) during this same time period. We report that the first wave of the COVID-19 pandemic did not seem to have a negative impact on glycemic control and pregnancy outcomes in GDM women, in spite of difficulties in diabetes management delivery.

10.
J Diabetes Res ; 2021: 5515902, 2021.
Article in English | MEDLINE | ID: covidwho-1301733

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has forced a rapid adaptation of healthcare services to secure care for many patient groups. This includes women with gestational diabetes mellitus (GDM). We evaluated the impacts of the first COVID-19 wave on parameters such as the GDM treatment, glycemic control, and pregnancy outcomes. METHODS: In this retrospective study from a reference diabetes center (Krakow, Poland), we compared patient data from two different time periods: the first wave of the COVID-19 pandemic (March 2020-June 2020) and the preceding five months (October 2019-February 2020). Data was collected from the medical records and telephone surveys. RESULTS: We included 155 consecutive women (group N1 = 73 and group N2 = 82 from the COVID-19 pandemic period and non-COVID-19 period, respectively). During the COVID-19 pandemic, almost half of all GDM women (N1 = 36, 49.3%) used telemedicine as a method of contacting their diabetic specialists while this tool was not utilized in the earlier period. Moreover, these patients reported difficulties in performing blood glucose self-control more often (N1 = 20, 27.4%, vs N2 = 7, 8.5%; p ≤ 0.01) and spent less time on diabetes education than the control group on average (N1 = 39, 53.4%, vs N2 = 9, 9.8% below 2 hours of training; p ≤ 0.01). Most analyzed glycemic parameters and pregnancy outcomes were similar. Differences were found with respect to the incidence of prolonged labor (N1 = 12, 16.4%, vs N2 = 3, 3.7%; p ≤ 0.01) and preeclampsia (N1 = 0 vs N2 = 7, 8.5%; p = 0.01). CONCLUSION: In this single-center observational study, the first wave of the COVID-19 pandemic did not seem to have a negative impact on pregnancy outcomes in GDM women, despite the difficulties in diabetes management delivery.


Subject(s)
COVID-19/epidemiology , Diabetes, Gestational/therapy , Pandemics , SARS-CoV-2 , Adult , Blood Glucose/metabolism , Diabetes, Gestational/blood , Disease Management , Female , Humans , Infant, Newborn , Male , Poland/epidemiology , Pregnancy , Pregnancy Outcome , Retrospective Studies , Telemedicine
11.
JMIR Ment Health ; 8(6): e28097, 2021 Jun 30.
Article in English | MEDLINE | ID: covidwho-1290239

ABSTRACT

BACKGROUND: The COVID-19 pandemic has challenged the worldviews of most people. Social isolation after the COVID-19 lockdown has not only led to economic difficulties but also resulted in adverse psychological reactions. As in most countries, including Poland, this situation has been very challenging for patients with type 1 diabetes mellitus (T1DM). In Poland, a crisis intervention team for patients with T1DM was established. The goal of the team was to provide psychological support for these patients, if needed, and to present information concerning how these patients may obtain medical consultations and prescriptions. OBJECTIVE: We aimed to analyze the psychological parameters and main emotional reactions of patients with T1DM during the COVID-19 lockdown. METHODS: An email with information concerning the possibility of having a web-based consultation with psychologists and psychiatrists and an attached set of psychological tests was sent to all patients with T1DM who were under the care of an outpatient diabetes clinic. The consultations were performed by licensed clinical psychologists and psychologists. This study was approved by the Bioethics Committee of the Jagiellonian University in Krakow, Poland. RESULTS: The patients who decided to use psychological support had statistically higher levels of anxiety (state P=.043; trait P=.022), stress (P=.001) than those of patients from the group who did not seek support. CONCLUSIONS: The presented intervention team may be perceived as an example of important and successful cooperation and communication between specialists of different fields of medicine (diabetology, psychiatry, and psychology) in a crisis situation.

12.
Neurol Neurochir Pol ; 55(3): 314-321, 2021.
Article in English | MEDLINE | ID: covidwho-1244327

ABSTRACT

OBJECTIVES: To evaluate the spectrum of neurological symptoms in patients with COVID-19 during the first 14 days of hospitalisation and its association with in-hospital mortality. MATERIAL AND METHODS: We included 200 patients with RT-PCR-confirmed COVID-19 admitted to University Hospital in Krakow, Poland. In 164 patients, a detailed questionnaire concerning neurological symptoms and signs was performed prospectively within 14 days of hospitalisation. In the remaining 36 patients, such questionnaires were completed retrospectively based on daily observations in the Department of Neurology. RESULTS: During hospitalisation, 169 patients (84.5%) experienced neurological symptoms; the most common were: fatigue (62.5%), decreased mood (45.5%), myalgia (43.5%), and muscle weakness (42.5%). Patients who died during hospitalisation compared to the remainder were older (79 [70.5-88.5] vs. 63.5 [51-77] years, p = 0.001), and more often had decreased level of consciousness (50.0% vs. 9.3%, p < 0.001), delirium (33.3% vs. 4.4%, p < 0.001), arterial hypotension (50.0% vs. 19.6%, p = 0.005) or stroke during (18.8% vs. 3.3%, p = 0.026) or before hospitalisation (50.0% vs. 7.1, p < 0.001), whereas those who survived more often suffered from headache (42.1% vs. 0%, p = 0.012) or decreased mood (51.7% vs. 0%, p = 0.003). CONCLUSIONS: Most hospitalised patients with COVID-19 experience neurological symptoms. Decreased level of consciousness, delirium, arterial hypotension, and stroke during or before hospitalisation increase the risk of in-hospital mortality.


Subject(s)
COVID-19 , Hospital Mortality , Humans , Poland , Retrospective Studies , SARS-CoV-2
13.
Case Rep Infect Dis ; 2021: 6627207, 2021.
Article in English | MEDLINE | ID: covidwho-1201312

ABSTRACT

We present a case of a patient with clinical symptoms of pneumonia, negative in several polymerase chain reaction COVID-19 tests from nasopharyngeal swabs but suspected in computed tomography and finally confirmed in bronchoalveolar lavage material.

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