Septic Episodes Caused by Acinetobacter Baumannii, Klebsiella Pneumoniae and Pseudomonas Aeruginosa in a Tertiary Hospital in 2018-2020: Trends and Considerations

Intro: This study aimed at evaluating healthcare-related sepses caused by three multi-drug resistant Gram-negative bacteria (Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa) in a tertiary hospital in 2018-2020, particularly concerning therapy, antibiotic-resistance and outcomes, by also comparing the pre-COVID (2018-2019) and COVID (2020) periods. Method(s): An observational, retrospective-cohort analysis was based on data related to patients admitted to the "SS. Antonio e Biagio e Cesare Arrigo" Hospital in Alessandria (Italy) between 2018 and 2020, with septic episodes from bacteria of the examined species, whose antibiogram proved resistance to >= 2 antimicrobial classes indicated by the European Centre for Disease Prevention and Control. Data were retrieved from patients' medical records and the hospital's computer-based application. Statistics involved Fisher-test comparisons and cumulative incidence analyses. Finding(s): Inclusion criteria led to enrolment of 174 patients. Comparison between 2020 and 2018-2019 showed a relative increase in A. baumannii cases, at the expense of the other species (p<0.0001), and an increasing resistance trend for K. pneumoniae, with a higher proportion of cases resistant to 3-4 classes of antimicrobials (p<0.0001). Overall, most patients were treated with carbapenems (72.4%), although the COVID period saw a significant rise in the use of polymyxins, particularly colistin (62.5% vs 36%, p=0.0005). In both periods, more than half patients recovered (53-57%) and around one third died (27-34%), but with different outcomes according to the infecting bacterium, generally better for P. aeruginosa (70% recovered at 60 days) and worse for A. baumannii (55% recovered). Discussion(s): The study confirmed the importance of the burden connected to healthcare-related sepses. Moreover, since the COVID outbreak, a trend could be spotted towards higher relative incidence of complex cases, caused by antimicrobial-resistant bacteria and thus requiring second-line therapy. Conclusion(s): These findings underline the importance of appropriate antimicrobial stewardship and infection control in view of the evolving healthcare needs.Copyright © 2023

Patient Navigator Pilot to Improve Completion of FIT Testing in Primary Care

Introduction: Colorectal cancer (CRC) screening is a critical preventative service and part of routine patient care. CRC is the second leading cause of cancer death in the US, and yet a third of the eligible population does not undergo routine screening. Endoscopy centers have been stretched thin by both COVID-19 and the recent drop in screening initiation age to 45. Fecal immunochemical testing (FIT), a sensitive and specific CRC screening modality, may be used to reach and risk-stratify more patients to increase the yield for detecting advanced neoplasia and cancer, reducing pressure on colonoscopy centers. Unfortunately, FIT is often suboptimal as patients inconsistently complete and return the test for analysis. Method(s): We performed a retrospective analysis of 5211 individuals at a single internal medicine clinic who had FIT ordered as part of USPSTF recommended care from 01/2017 through 12/2021. Starting in 01/2021 we instituted a dedicated patient navigator to support patients in completing FIT. Chi-square, Fisher exact test, and Student's t-tests were performed for descriptive analyses. Multivariable logistic regression was used to compare FIT kit drop off rates pre- and post-intervention, with the model adjusted by age, gender, race, ethnicity, language, and insurance status. Analysis was performed in SAS version 9.4. (Table) Results: The post-intervention period included 1181 (22.7%) patients. The predominant reasons cited for failure to complete testing were forgot (25%), too busy (13%), and lost kit (11%). Our intervention improved drop off rates from 46.4% to 51.3% at 2 weeks (OR 1.19, 95%CI 1.01-1.41), 56.7% to 73.7% at 1 month (2.14 [1.78-2.58]), 64.7% to 89.7% at 3 months (4.73 [3.66-6.12]), and 78.9% to 98.2% at 1 year (14.39 [8.25-25.12]). Overall, our intervention improved FIT kit drop off rates by 53.4% (1.53 [1.30-1.81]). FIT was positive in 4.9% (p=0.0529). (Figure) Conclusion(s): FIT can increase CRC screening rates, particularly in resource-limited settings, and may decrease the burden on endoscopy centers nationwide by improving the efficiency of colonoscopy in the average risk screening population. The addition of a dedicated patient navigator is a simple intervention that, by providing culturally competent care and personalized attention, improves completion rates and return time, allowing FIT to be a reliable method of screening. The ability to increase screening rates and prioritize patients for diagnostic colonoscopies will ultimately lead to earlier detection and treatment of CRC.

Vaccination in Patients with Inflammatory Rheumatic Diseases: Preliminary Results of an International, Real-World Life Panlar's Register

Objectives: To evaluate vaccination among patients with inflammatory rheumatic diseases initiating disease-modifying antirheumatic drugs (DMARD) Methods: Data from the real-world life PANLAR's register of consecutive patients diagnosed with RA, PsA, and axSpa (2010 ACR-EULAR /2006 CASPAR-2009 ASAS) from Dec 2021 to Dec 2022 were analyzed. Prevalence of recommended vaccinations were compared between different inflammatory rheumatic diseases. Categorical variables were expressed as %. Tables were analyzed with chi2 or Fisher tests, continuous variables (median, IQR)with the Kruskal-Wallis test, according with the variables type. A p value <=0.05 was considered significant. Result(s): 608 patients were included. Among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial Spondyloarthritis (axSpA) are presented in the table. RA and axSpA seemed to have lower vaccination rate of pneumococcal vaccines than PsA. (p = 0.045 for conjugate anti pneumococcal vaccine in RA vs PsA). A large percentage of the population was vaccinated against COVID-19. There was a high rate of influenza vaccination in all three diseases. Conclusion(s): In Latin America, anti-pneumococcal vaccination is low, especially in patients with RA and axSpA. For other vaccines there was an acceptable level of vaccination without differences between diseases.

First in-neonate use of non-invasive transcutaneous auricular vagus nerve stimulation: 18-month neurodevelopmental and sensory follow-up

Objective: Non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) paired with oral feeding is a novel intervention for infants with feeding delays that may improve feeding and help avoid a gastrostomy tube (Gtube). However, the long-term impact of this neurostimulation on infant's development remains unknown. We investigated the neurodevelopmental and sensory outcomes of infants who received taVNS paired with bottle feeding. Method(s): Twenty-one of 35 toddlers who participated in the open label trial of taVNS paired with one or two feeds a day for 2-3 weeks, underwent comprehensive developmental assessments at 18 months of age using Cognitive Adaptive Test, Clinical Linguistics and Auditory Milestone, and Peabody gross motor scores. Twelve of those assessed achieved full oral feeds ('responders') and 9 had G-tube placed for feeds ('non-responders'). Before COVID, 12 toddlers (5 responders, 7 non-responders) were also assessed in the home using the Bayley-III and Sensory Profile (SP-2) assessments. Area deprivation index (ADI) was used to measure resource poor environments and relate to test scores. We used Fishers exact test and Pearson correlation coefficients to compare neurodevelopmental and sensory performance in responders versus non-responders. Result(s): taVNS responders showed significantly better general sensory processing in SP-2 than did non-responders (p =0.04). There were no significant differences in Bayley-III or CAT/CLAMS/ASQ scores in areas of cognition, receptive language, fine motor, and gross motor skills in this small sample size, but are similar to published scores for preterm infants who received G-tubes. ADI was not significantly associated with neurodevelopmental scores. Conclusion(s): These results suggest that taVNS paired with feeding may have a potential long-term positive neurodevelopmental effect on sensory processing in neonates with poor feeding. The current open-label results need testing in randomized controlled trials of taVNS paired with oral feeding in developmentally delayed infants failing oral feeds. Research Category and Technology and Methods Clinical Research: 12. Vagus Nerve Stimulation (VNS) Keywords: Neurodevelopment, taVNS, feeding, developmental delaysCopyright © 2023

In bed hybrid tracheostomy procedure in COVID-19 patients. Technique and results

Background: COVID-19 pandemic, results in a great number of critically ill patients requiring long-lasting periods of invasive mechanical ventilatory support;tracheostomy is considered during their hospital stay, to free patients from ventilatory support and optimize the resources, we developed a safe in bed hybrid tracheostomy procedure to avoid the operating room and minimize SARS-CoV2 transmission due to aerosols exposure. Method(s): We developed this protocol using PDCA (Plan, Do, Check, Act) in order to perform a safe in bed hybrid tracheostomy: percutaneous tracheostomy + flexible bronchoscopy. We used the Ciaglia Blue Rhino technique and flexible bronchoscopy. We analyzed: Gender, age, body mass index, intubation days, ventilatory parameters, procedure time, apnea time, oxygen saturation, complications and patient clinical evolution. Statistical evaluation: Fisher test, U Mann-Whitney, T test, logistic regression and Kaplan-Meier curves. Result(s): From march 2020 to February 2021, 292 patients underwent hybrid tracheostomy;Tracheostomy was successfully completed in all patients: 211 men (72.2%);81 women (27.8%), age 58.5 years old, intubation days before tracheostomy 23 days (19 to 28 days), 133 patients (45.5%) deaths due to COVID19 complications. Procedure time 6 to 14 minutes (mean 9 minutes), apnea time 147 to 360 seconds (mean 240 seconds), O2 saturation 66%-96% (mean 87%), PaO2/fiO2 106-194 (mean 142), SOFA 4-6 (mean 5). No complications due to the trachesotomy. Conclusion(s): In bed hybrid tracheostomy procedure implementation with the PDCA cycles is safe, with good results, zero procedure complications and a good and rapid learning curve.

Laboratory and clinical findings in hospitalized pregnant women with Covid-19 based on disease outcome during the outbreak of Delta variant in Ardabil (summer and autumn 2021).

Introduction: Due to the high risk of Covid-19 disease, especially delta variant in pregnant women, as well as the novelty of this epidemic in the world and the lack of similar studies in Iran and the region, it seems necessary to perform a study on mortality rate and laboratory and clinical findings of the disease in pregnant women. Therefore, this study was performed aimed to determine the laboratory and clinical findings in hospitalized pregnant women with Covid -19 based on disease outcome during the outbreak of Delta variant (summer and autumn 2021) in Ardabil province. Method(s): In this cross-sectional and descriptive study, all pregnant women with Covid-19 admitted to the hospitals of Ardabil province in summer and autumn 2021 at the time of delta outbreak were included. Finally, 187 infected pregnant mothers were studied. Demographic information, clinical signs and laboratory findings were studied in all mothers. Data were analyzed by SPSS (version 24) and Fisher Exact test and Pearson Correlation. P<0.05 was considered statistically significant. Result(s): Of the 187 infected pregnant women, 8 mothers died. Comorbidity was observed in 41 pregnant women. The most common clinical finding was shortness of breath (Dyspnea) and cough, and the most common laboratory finding was lymphopenia. Comparing the cured and dead mothers according to laboratory findings using Fisher's exact test showed that the difference between ALT (p <0.05), lactate dehydrogenase (p <0.001), AST (p <0.001), BS (P <0.05), creatinine (p <0.05) and total bilirubin (p<0.05) were statistically significant between the two groups. Conclusion(s): Infection to delta variant of Covid-19 disease resulted in 187 hospitalizations and 8 deaths of pregnant mothers in Ardabil province. Shortness of breath (Dyspnea) and cough were the most common clinical findings and lymphopenia was the most common laboratory finding.Copyright © 2022, Mashhad University of Medical Sciences. All rights reserved.

Laboratory and clinical findings in hospitalized pregnant women with Covid-19 based on disease outcome during the outbreak of Delta variant in Ardabil (summer and autumn 2021).

Introduction: Due to the high risk of Covid-19 disease, especially delta variant in pregnant women, as well as the novelty of this epidemic in the world and the lack of similar studies in Iran and the region, it seems necessary to perform a study on mortality rate and laboratory and clinical findings of the disease in pregnant women. Therefore, this study was performed aimed to determine the laboratory and clinical findings in hospitalized pregnant women with Covid -19 based on disease outcome during the outbreak of Delta variant (summer and autumn 2021) in Ardabil province. Method(s): In this cross-sectional and descriptive study, all pregnant women with Covid-19 admitted to the hospitals of Ardabil province in summer and autumn 2021 at the time of delta outbreak were included. Finally, 187 infected pregnant mothers were studied. Demographic information, clinical signs and laboratory findings were studied in all mothers. Data were analyzed by SPSS (version 24) and Fisher Exact test and Pearson Correlation. P<0.05 was considered statistically significant. Result(s): Of the 187 infected pregnant women, 8 mothers died. Comorbidity was observed in 41 pregnant women. The most common clinical finding was shortness of breath (Dyspnea) and cough, and the most common laboratory finding was lymphopenia. Comparing the cured and dead mothers according to laboratory findings using Fisher's exact test showed that the difference between ALT (p <0.05), lactate dehydrogenase (p <0.001), AST (p <0.001), BS (P <0.05), creatinine (p <0.05) and total bilirubin (p<0.05) were statistically significant between the two groups. Conclusion(s): Infection to delta variant of Covid-19 disease resulted in 187 hospitalizations and 8 deaths of pregnant mothers in Ardabil province. Shortness of breath (Dyspnea) and cough were the most common clinical findings and lymphopenia was the most common laboratory finding.Copyright © 2022, Mashhad University of Medical Sciences. All rights reserved.

A Covid-19-vakcinákkal kapcsolatos attitűdök vizsgálata az egészségügyi dolgozók és a laikusok körében

Aim: This study aimed to assess the attitudes towards Covid-19 vaccines among health care workers and laymen and to shed light on the similarities and differences between the two groups. Methods: A self-constructed online questionnaire was administered between June and September of 2022. The sampling method was not random, but we relied on the easy to access people. Data were analysed with IBM SPSS 20.6;descriptive statistics, chi-square, Mann-Whitney probes, and Fisher exact tests were applied (p<0.05). There were 1,041 questionnaires included in the final analysis. Results: There is a vast difference based on vaccination between the two groups;77.9% of healthcare workers have 3 or more vaccines, while 45.9% of laymen have at least 3. According to health care workers vaccination is the most effective way of defence against Covid-19, although they have experienced more side effects and psychological stress due to vaccination than laymen. Laymen are less trusting they think vaccines are dangerous and have more negative effects. Health care workers get information from experts, while laymen rely on online sources and social media. The majority would accept Western vaccines. Based on the vaccine acceptance defined by the WHO both groups are more repulsive than the populations studied earlier. Conclusions: The fears and negative attitudes towards Covid-19 vaccines among laymen can be diminished only by health care workers, therefore it is of high importance that they are well informed. Célkitűzés: A kutatás célja felmérni a laikusok és egészségügyi dolgozók attitűdjét a koronavírus elleni védőoltásokkal kapcsolatban, megkeresni a két csoport közötti hasonlóságokat, különbözőségeket. Vizsgálat módszere: Az online felmérés egy saját készítésű kérdőívvel történt 2022. október–november hónapokban, nem véletlenszerű mintavételi módszerrel, egyszerűen elérhető alanyokra támaszkodó mintavételi eljárással. Az adatfeldolgozás és adatelemzés IBM SPSS 20.6 statisztikai programmal, leíró statisztikai módszerrel, valamint χ2 és Mann–Whitney-próbákkal, Fisher-féle egzakt teszttel történt (p<0,05). Összesen 1041 értékelhető válasz érkezett. Eredmények: Három vagy annál több Covid elleni oltással rendelkezik az egészségügyi szakemberek 77,9%-a, a laikusok 45,9%-a. Az egészségügyi dolgozók szerint az oltás a leghatásosabb védekezés a koronavírus ellen, azonban közülük többen tapasztaltak mellékhatásokat az oltások után, és lelkileg jobban megviselte őket az oltakozás, mint a laikusokat. A laikusok bizalmatlanok, veszélyesebbnek tartják az oltásokat és több negatív hatást tulajdonítanak neki, mint az egészségügyi dolgozók. A legtöbb egészségügyi dolgozó a szakemberektől, míg a laikusok inkább az internetes hírportálokról, közösségi médiából szerzik az információkat. Többségében a nyugati vakcinák elfogadása jellemző a válaszadók körében, azonban a WHO védőoltás elfogadására való hajlandóság stációinak vizsgálata alapján megállapítható, hogy mindkét válaszadói csoportot a szakirodalmi arányokhoz képest elutasító attitűd jellemzi a koronavírus elleni oltással kapcsolatban. Következtetések: A laikusok félelmeit, negatív attitűdjét csak a jól informált egészségügyi dolgozók tudják csökkenteni, ezért fontos az egészségügyi szakember hiteles informálása a védőoltásokról.

Lesson learned from the pandemic for learning physics

Background: Valuable safeguards against fast‐spreading conjectures about learning in times of fear and uncertainty are evidence‐based approaches to the assessment of the impact of sudden and unforeseen disruptions on learning practices. The present research focused on physics learning in such times because conceptual and computational literacy in physics is critical to the development of a scientifically and technologically literate society. Objectives: The present research aimed (a) to offer an objective assessment of whether performance differences in a physics course of the general education curriculum existed between the face‐to‐face medium (familiar mode of instruction) and the online medium (unfamiliar mode of instruction) for both male and female students, and then (b) to develop a response to the evidence collected to ensure a quality education for all parties involved. The research intended to fill two critical gaps in the extant literature: mixed findings concerning students' performance in the face‐to‐face and online mediums as well as scarce coverage of specific domains of knowledge that are critical to STEM learners. Methods: Students' performance was examined as a function of the type of assessment (formative and summative), instructional mode (online and face‐to‐face), and gender. An understudied student population of STEM students of Middle Eastern descent without prior formal exposure to online instruction was targeted. Results and Conclusions: In both formative and summative assessments, male students performed better online than face‐to‐face, whereas the performance of female students was either higher online or equivalent between instructional mediums. The evidence collected suggested that consideration be given to remedies that foster academic success in the face‐to‐face instructional medium, particularly for male students. Takeaways: An evidence‐based approach to learning dismantled emotion‐driven expectations regarding the impact of the online medium on physics learning, and encouraged new perspectives about instruction. Lay Description: What is already known?: Ongoing debates on the impact of the pandemic on students' learning shape decisions regarding future reliance on the online medium for instruction. What this paper adds: The extant literature is mixed concerning performance in the face‐to‐face and online mediums, including particular domains of knowledge critical to STEM learning.This study focused on physics learning in an understudied population of STEM students who were unaccustomed to online instruction.Performance was higher online than face‐to‐face, but gender differences emerged. Implications for practice: Lessons learned focused on the flexibility of online learning and on the need to develop materials to enhance learning in males enrolled in face‐to‐face or hybrid/blended classes.

Identifying diseases associated with Post-COVID syndrome through an integrated network biology approach.

A growing body of research shows that COVID-19 is now recognized as a multi-organ disease with a wide range of manifestations that can have long-lasting repercussions, referred to as post-COVID-19 syndrome. It is unknown why the vast majority of COVID-19 patients develop post-COVID-19 syndrome, or why patients with pre-existing disorders are more likely to experience severe COVID-19. This study used an integrated network biology approach to obtain a comprehensive understanding of the relationship between COVID-19 and other disorders. The approach involved building a PPI network with COVID-19 genes and identifying highly interconnected regions. The molecular information contained within these subnetworks, as well as the pathway annotations, were used to reveal the link between COVID-19 and other disorders. Using Fisher's exact test and disease-specific gene information, significant COVID-19-disease associations were discovered. The study discovered diseases that affect multiple organs and organ systems, thus proving the theory of multiple organ damage caused by COVID-19. Cancers, neurological disorders, hepatic diseases, cardiac disorders, pulmonary diseases, and hypertensive diseases are just a few of the conditions linked to COVID-19. Pathway enrichment analysis of shared proteins revealed the shared molecular mechanism of COVID-19 and these diseases. The findings of the study shed new light on the major COVID-19-associated disease conditions and how their molecular mechanisms interact with COVID-19. The novelty of studying disease associations in the context of COVID-19 provides new insights into the management of rapidly evolving long-COVID and post-COVID syndromes, which have significant global implications.Communicated by Ramaswamy H. Sarma.

Retrospective Analysis of C - Reactive Protein, Haematological Biomarkers and Coagulation Profile in Patients of SARS-Cov-2 in a Tertiary Care Hospital of Eastern India

Introduction: Blood tests play an important role in the early detection of disease given that they provide doctors with information about inflammatory processes. A complete blood count (CBC) is easy and inexpensive to perform. These parameters can be used alone as markers of inflammation. Their mutual ratio is also an indicator of early inflammation.4 In light of previous studies, the use of circulating biomarkers instead of inflammation and immune system has been considered a prognostic indicator for COVID-19 positive patients. Aims/ objective: To examines the role of biomarkers from peripheral blood samples in the diagnosis of hospitalized COVID-19 patients with a history of fever. Materials and Method: Haematological biomarkers and coagulation profile was compared between RT-PCR positive and negative patients. Systemic inflammatory index (SII) was calculated by multiplying thrombocyte count with neutrophil count and dividing the value by lymphocyte count. Neutrophil lymphocyte ratio (NLR) was calculated by dividing absolute neutrophil count by absolute lymphocyte count. Platelet lymphocyte ratio (PLR) was calculated by dividing absolute platelet by absolute lymphocyte count. Fisher exact test and unpaired t-test were used to compare categorical and continuous data respectively. Results: Analysis was done on 57 retrospective cases of RT-PCR positive patients and 61 RT-PCR negative patients with history of fever. COVID-19 positive patients showed leukopenia, neutropenia, thrombocytopenia, and lymphocytosis. SII and NLR decreased and PLR increased. PT and APTT were generally within normal limits in most of the patients. There was significant difference between two groups with respect to lymphocyte counts and PLR. Conclusion: The most standardized non-invasive and inexpensive tests such as CBC, coagulation and biochemical tests are available to assess disease severity for wise allocation of medical resources in developing countries such as India where resources and care are limited.

Identifying parent anxiety and family distress of critically ill children in response to changes in hospital visitation policies during the COVID-19 pandemic

This research study describes parent anxiety and family distress among three study groups of varying restrictions in parent presence for children in the PICU during a pandemic. A retrospective study was conducted to describe differences in parent anxiety and family distress for parents of children hospitalized before and during the COVID-19 pandemic. Participants fell into three study groups based on the dates of the child's hospital stay and the level of parent and family presence or restriction they experienced. Participants were asked to complete a survey that included basic demographic information along with utilization of the GAD-7 and FDI measures. The data were assessed using descriptive statistics, Fisher's exact test, and the Kruskal-Wallis test. A total of 82 parents of children hospitalized during the specified times in the PICU participated. There was a statistically significant difference among the three cohorts in diagnoses (respiratory, cardiovascular, and medical-surgical), p ≤0.001. A larger percentage of children of the study participants were hospitalized with respiratory illnesses (62.5%) in the unrestricted study group when compared to the other study groups with higher patient acuity. There was also a statistical significance among the three study groups regarding whether the second parent was able to visit the child during the PICU admission (p = 0.007). Our study suggests that restricting parent and visitor presence does not increase parent anxiety or family distress during a child's admission to the PICU. The literature widely supports that having a critically ill child is undoubtedly stressful for parents and families, but the most significant causation for the anxiety and stress remains unknown and is likely multifactorial. Parents who experienced rigid restrictions in parent and visitor presence did not have increased anxiety. Other impactful variables such as a child's mortality risk and the uncertainty of outcome may have impacted anxiety for parents whose children were critically ill. Further research is needed to understand which stressors are most significant, during a critically ill child's hospitalization, from a parent's perspective. Limiting staff and patient exposure to persons who may have contagious illness (restricting parent and family presence) may not in itself lead to increased anxiety and distress for parents and families. This study may provide context for careful development of hospital visitation policies to ensure balance between patient and family centered care and protection from infectious disease. • A child's admission to a pediatric intensive care unit (PICU) is one of the most stressful and anxiety-provoking situations for parents. • Restricting parent presence interrupts the social and emotional relationship and offers less time for bonding.. • Coronavirus-19 (COVID-19) forced hospitals to make abrupt changes to existing visitation policies. • This research provides context for support of careful development and implementation of hospital visitation policies.

Cervical, breast, and colorectal cancer screening by COVID-19 booster and influenza vaccination status in a sample of women in Puerto Rico

Background: Recommendation by a healthcare provider is essential for women to seek preventative cancer screening. Research has shown patients are receptive to information about cancer screening given by health professionals administering influenza vaccines. Promotion of cancer screening during vaccination may be particularly important in Puerto Rico (PR), which, relative to the continental United States, has low cervical and colorectal cancer screening rates. Objective(s): This study aims to determine if receiving the influenza vaccine in the past year or ever receiving the COVID-19 booster is associated with an increased likelihood of women participating in cervical, breast, and colorectal cancer screening in the past year. Method(s): Women older than 18 are recruited weekly in different ongoing community outreach events throughout Puerto Rico as part of the Puerto Rico Community Engagement Alliance (PR-CEAL) against COVID-19 disparities. The PR-CEAL outreach team completes an online community survey as part of their field activities. Initial data was collected from February 17th 2022 through May 28th 2022, with data collection currently ongoing. Pearson chi2 test or Fisher exact test, as appropriate, was used to quantify the association between participation in cancer screening and vaccination status. Result(s): As of May 31st, 253 women with a median age of 59 had been recruited. Of these, 56.1% had received the influenza vaccine in the past year, and 52.6% had received a COVID-19 booster. Nearly 52% of women with the booster and 65% without the booster received cervical cancer screening (p-value =0.29). Women with the booster and those without the booster (75% each) received breast cancer screening (p-value = 0.99). Only 16.1% of women with the booster and 11.8% without the booster had received colorectal cancer screening (p-value = 0.99). Receipt of cancer screening according to influenza vaccine status was as follows: 59.3% vaccinated and 51.5% unvaccinated received cervical cancer screening (p-value = 0.35);31.4% vaccinated and 41.2% unvaccinated received breast cancer screening (p-value = 0.56);and 13.1% vaccinated and 9.3% unvaccinated received colorectal cancer screening (p-value = 0.46). Conclusion(s): No differences in receipt of cancer screening were found by influenza or COVID-19 booster vaccination status among adult women in Puerto Rico. Routine vaccination appointments may therefore represent a missed opportunity to promote cancer screening.

Experience of Noninfectious Disease Doctors Redeployed to COVID-19 Duties in a Tertiary Center

Objective: The global healthcare system was severely impacted by the coronavirus disease 2019 (COVID-19). Healthcare professionals, especially doctors, faced a tremendous amount of responsibility irrespective of the specialty and levels of ex-perience. The majority of nations saw physicians from all medical specialties relocate to COVID-19 wards. Working outside of one's comfort zone would have a significant psychosocial impact, especially in a crisis like the pandemic. To describe the experience of noninfectious disease physicians redeployed to COVID-19 duties. Material(s) and Method(s): All noninfectious disease physicians who were redeployed to COVID-19 duties received a Google form with 25 questions. Using the Pearson chi-squared test and the Fisher exact test, the relationship between survey responses and working experience and department was investigated. Statistical threshold was set at p<0.05. Result(s): Out of 180 respondents, 114 completed the survey in total. Most of the participants were female (64.9%) aged between 31-40 years old (86.8%) with 64.9% having 5-10 years of working experience. During the redeployment, 57% of respondents reported experiencing psychological effects, and 73.7% felt underprepared. However, 71.1% said their assign-ment to COVID-19 wards was beneficial, and 38.4% were willing to receive redeployment. Conclusion(s): The results of the survey indicate that COVID-19 ward redeployment was successful because participants believed their participation was important and the lead team in the COVID-19 wards offered enough direction and assistance. Doctors are prepared to safely treat COVID-19 patients, thanks to the intensive crash course and their fundamental medical knowledge. Copyright © 2023 by Erciyes University Faculty of Medicine.

Çocuklarda COVID-19'un Seyri ve Aile Íçi Yayılım Ílişkisi

Objective: SARS-CoV-2 infection in children is usually mild, so the real positivity rate and the effect on children's virus spread are not excatly known. The purpose of this study is investigate the effect of children on the spread of COVID-19. Material and Methods: Children who were followed up and treated with a pre-diagnosis of COVID-19 between April and June 2020 were included in this study. The protocol for this retrospective study was approved by the Ministry of Health, Turkey, and the ethics committee of a university medical school. Data were collected retrospectively from the hospital medical system. Data analysis was done with IBM SPSS v21.0 statistical program. Categorical variables were expressed as n and %, while numerical variables were expressed as mean ± std and median (min-max). The conformity of the data to the normal distribution was analyzed with the Kolmogorov Smirnov test. Chi-square test and Fisher's exact test were used in the analysis of categorical variables. In comparisons between groups, Independent-t and Mann-Whitney U tests were used. For correlation between continuous variables, Pearson and Spearman correlation coefficients were used. p< 0.05 was accepted for statistical significance. Results: A total of 205 children were hospitalized in a three-month period with a suspected COVID-19 disease. SARS-CoV-2 RT-PCR was positive in 72.7% of the participants from 86 different families. As the number of siblings and households increased, SARS-CoV-2 RT-PCR positive cases also increased and were found to be statistically significant (p< 0.05). The presence of another SARS-CoV-2 RT-PCR confirmed case in the household under the age of 18 increases the clustering of cases within the family (p< 0.001). There was domestic contact in 74% of the participants;this rate is 91.9% for positive cases and 26.8% for probable cases, which is statistically significant (p< 0.001). WBC, neutrophil, platelet and CRP parameters of positive cases are lower than probable cases. Conclusion: COVID-19 infection in children appears to be asymptomatic or mildly symptomatic. Although the role of children in the spread of COVID-19 infection is unclear, the domestic clustering rate of COVID-19 infection is high in families with many children. Therefore, in order to reduce the spread of the disease, family clustering should be determined and quarantine measures should be taken.

A Comparative Analysis of the Blood Products used in the Emergency Room and other Clinics with the Pre-pandemic Period

Aim: In this study, we evaluated the blood transfusion statistics by determining the frequency of blood component transfusions by year and the total number of transfusions administered in emergency departments (EDs) and all inpatient clinics across Turkey, to provide a foresight of the future and to guide planning. Method(s): The study was conducted retrospectively, covering the period between January 1, 2016, and January 1, 2022. The numerical data of the blood transfusions applied in the 2nd and 3rd level public hospitals in Turkey were collected as the number of units, and the data were used by obtaining the necessary permissions from the Ministry of Health. The most frequently used blood components in EDsand inpatient clinics in our country were examined. The total number of transfusions in EDs and all inpatient clinics was calculated, and the frequency changes over time were investigated. In the study, the 4-year period of 2016-2019 was specified as the prepandemic period. The 2-year data for 2020 and 2021 are also stated as the pandemic period. The mean values of the data belonging to both periods were taken, and their significance was evaluated with Fisher's exact test. Blood transfusion statistics for each year were recorded on the tabulation software, and the frequency changes were calculated using the statistical formulas of the tabulation software. Patient consent was waived because of the study. Result(s): The most common types of blood components transfused in Turkey were packed red blood cell (PRBC), fresh frozen plasma (FFP), platelet concentrate, whole blood, and cryoprecipitate. When the blood component transfusion rates in the EDs were evaluated, the most frequently transfused blood component was found to be PRBC, followed by FFP (64.4% and 29.8%, respectively). Platelet concentrate, cryoprecipitate, and whole blood transfusion rates were found to be 5.5%, 0.17%, and 0.13%, respectively. 6.6% of all blood transfusions were administered in EDs. The use of all blood and blood products, except PRBC, has decreased in the ED. In all departments, there was a decrease in the use of platelets and whole blood and an increase in the use of cryoprecipitate. Conclusion(s): Since the current study shows blood and blood product replacement and includes a broad comparison with the pandemic and pre-pandemic periods, it can guide the blood replacement strategies of the ED and all departments. Copyright © 2022 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi.

Optimal D-Dimer Cutoff for Prediction of Ards in Covid-19 Infection

INTRODUCTION: Dynamic monitoring of D-dimer levels is a prognostic tool used for patients with COVID-19 and higher levels are associated with increased mortality. However, optimal D-dimer cutoff models for ARDS have not been previously evaluated. We aimed to determine the optimal D-dimer level for the prediction of ARDS in patients admitted with COVID-19. METHOD(S): We conducted a two-center retrospective study of 502 adult patients hospitalized between 2020 and 2021 with confirmed COVID-19 infection. The D-dimer on admission and peak value during hospitalization were obtained. Differences between groups were determined by one-way ANOVA, Wilcoxon rank-sum, or Fisher exact test. The cutoff D-dimer level and the C-index were obtained using the receiver operating curve (ROC). Univariate and multivariate regression models were used. Statistical analyses were performed using SPSS 28. RESULT(S): The mean age was 65+/-15 and 58.4% (294/502) were males. ARDS developed in 51.3% (258/502) of the patients, and 30.5% (153/502) died. Elevated D-Dimer (>0.5 ug/mL) was present on admission in 84% (423/502) of all patients. Patients who developed ARDS had higher peak (median 3.54 ug/mL, p< 0.001) and admission (median 1.5 ug/mL, p=0.005) D-dimer levels. D-dimer level of >3.05 ug/ ml predicted ARDS with a sensitivity of 71%, specificity of 67% and C-index 0.723 (p=0.001, CI 0.68-0.77). The C-index for D-dimer on admission was 0.59 (p=0.001, CI 0.54-64). Using the peak D-dimer level of 3.05 ug/mL, unadjusted logistic regression models showed a statistically significant effect on ARDS (p< 0.001, OR 4.62, CI 3.12-6.83). This effect persisted after adjusting for other variables (p< 0.001, OR 3.81, CI 2.51-5.79). CONCLUSION(S): Peak D-dimer level during hospitalization with a cutoff of 3.05 ug/mL is a useful tool to predict ARDS in patients admitted with COVID-19. Dynamic monitoring of D-dimer is an adequate and objective measurement during hospitalization for assessment of deterioration. Further studies with better-controlled monitoring on the timeframe of obtaining D-dimer are needed to further evaluate this threshold.

Impact of the COVID-19 Pandemic First Wave on Clostridioides difficile Infection

Background. Clostridioides difficile infection (CDI) is the leading cause of nosocomial diarrhea and a costly burden on the healthcare system. The COVID-19 pandemic brought enhanced infection control measures that could hypothetically decrease CDI transmission. Nonetheless, diarrhea secondary to COVID-19 and increased usage of broad-spectrum antibiotics could potentially increase testing for or frequency of CDI. We aimed to assess variations in CDI testing and frequency during the first surge of the COVID-19 pandemic in a tertiary community medical center in the Southern United States. Methods. Records from adult patients were retrospectively reviewed at Princeton Baptist Medical Center, Birmingham, AL. Three groups spanning equal time periods were created based on the CDC COVID-19 rate curves for Alabama: PPG (pre-pandemic, 03/01/2020 to 05/31/2020), PG (pandemic, 06/01/2020 to 08/ 31/2020), and SCG (seasonal control, 06/01/2019 to 08/31/2019). We included patients >= 18 years old and excluded readmissions and follow-up visits. We determined the frequency, testing rates, and positivity rates for CDI in each group to assess their differences. Also, we measured the rate of coinfection between C. difficile and SARS-CoV-2. CDI cases were defined as positive toxin enzyme-linked immunosorbent assay (EIA) and glutamate dehydrogenase (GDH), or positivity of either in addition to positive nucleic acid amplification test (NAAT). Differences in frequencies and rates across groups were compared with Fisher exact test. Results. Overall, 7,252 hospitalized patients and 29,671 outpatients were included (Figure 1). No outpatient CDI cases were detected. Outpatient testing rates were: PPG 3 (0.05%), PG 4 (0.05%), and SCG 9 (0.06%). Among inpatients, 3,912 (53.9%) were female with a mean +/- SD age of 61.2 +/- 17.5 years. Overall, CDI frequency, testing rates, and positivity rates did not vary significantly among all groups (Table 1). Among those tested, the only case of C.difficile/SARS-CoV-2 coinfection corresponded to PPG. Conclusion. There were no statistically significant differences in CDI frequency, or positivity rate between the pre-pandemic, pandemic, and seasonal control groups for inpatients. No CDI cases were detected in outpatients. This is likely due to a low testing rate in our population.

Sutureless versus purse string with complete sac dissection in laparoscopic inguinal hernia repair in children: a randomized clinical trial

Introduction: Pediatric inguinal hernia is a common surgical condition with a cumulative incidence of 4.2%. Minimal invasive surgery is playing a growing role in the treatment of this condition. We compared the outcomes of laparoscopic sutureless herniotomy and purse string with sac dissection repair with regards to complications and operative time. Method(s): One hundred fifty-two patients were operated on in two centers with two different techniques: sac dissection and purse-string suture, and sutureless repair. Operative time and recurrence were the main outcomes for comparison. Result(s): Sutureless repair has a shorter operative time (29 +/- 10 min) compared to purse string repair (38 +/- 13 min). The recurrence rate showed no statistical significance difference. However, the recurrence rate of sutureless repair was three times higher than that of purse string repair, and all recurrences were in large defects of 10-15 mm. Conclusion(s): Sutureless repair is safe for defects up to 10 mm with excellent operative time. However, it had an unfavorable outcome in larger defects. Copyright © 2022, The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd.