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Introduction: Sars-cov2 infection is commonly associated with acute kidney injury (AKI) which may be observed in up to 40% of cases. Pathogenesis of AKI during COVID-19 is yet not perfectly understood. Many risk factors have been proposed associated with AKI occurrence during COVID-19 infection. To date there is still limited data of AKI progression and long-term outcomes among these patients. We aim to describe risk factors for development of AKI and the progression of their renal function up to six months after hospital discharge. Methodology: This is a retrospective observational study in a tertiary car nephrology department in Barcelona, Spain. We evaluated data from 71 hospitalized patients with AKI occurrence during COVID-19 infection between 1st of March and 30th May 2020. Analysis of baseline characteristic, need of renal replacement therapy (RRT) and inflammatory parameters has been performed. Result(s): Of 71 patients (74,6% males;median age 71,9+/-11,15 years), 43 (60,6%) needed admission in the intensive care unit (ICU) for hemodynamic/respiratory support and 34 (47,9%) died during hospitalization. 13 (18,3%) needed RRT. 3 (23%) patients requiring RRT died during COVID-19 infection and 9 (69,2%) partially recovered renal function. Baseline serum creatinine of patients without RRT need during follow-up was 0,90+/-0,16 mg/dl with a peak serum creatinine 2,8+/-1,5 mg/dl. Patients that needed RRT support had a baseline serum creatinine 0,98+/-0,87 mg/dl and a peak serum creatinine of 4,34+/-3,35 mg/dl. Creatinine at discharge was of 1,5+/-0,59 mg/dl in the group of patients needing RRT and 1,2+/-0,52 mg/dl. At six months follow-up no significant differences were found in creatinine levels from discharge (p=0,65). Very poor correlation was observed between inflammatory parameters and serum creatinine peak levels (Dimer D levels and Serum creatinine peak R2=0,034;C reactive protein and creatinine peak levels R2=0,15 and Interleukin 6 and creatinine peak levels R2=0,042). Conclusion(s): COVID-19 infection is associated with AKI with and increased risk of chronic kidney disease after infection is resolved. No differences between renal function at discharge and at 6 months of follow-up was observed. No correlation between the studied inflammatory parameters and the worsening of renal function was observed.
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Purpose>The meddling of foreign players into the Indian hotel industry has triggered fervent competitiveness, and therefore, consumers' attitude, intention and behavior have been the epicenter of all activities. This study endeavors to explicate enablers of online hotel booking intention (OHBI) in the Indian hospitality industry.Design/methodology/approach>The study examined OHBI of 560 travelers during the first wave of COVID-19 pandemic in India using structural equation modeling and an extended technology acceptance model. Direct and indirect associations were explored using mediation and moderation.Findings>The results manifest that hotel website credibility, perceived website interactivity and perceived ease of use (PEU) aggrandize perceived usefulness (PU), which, in turn, considerably magnifies travelers' OHBI. PEU and PU partially mediate the relationship in the model. Into the bargain, service affordability reinforces the relationship, while perceived pandemic risk enfeebles the relationship between PU and OHBI.Research limitations/implications>The study unfurls pressing determinants of PEU, PU and OHBI that may facilitate hoteliers to lure travelers and enhance profitability.Originality/value>There is a paucity of literature on "hotel website credibility” and "perceived pandemic risk” in the hospitality industry. Hence, the study enriches literature by assimilating underlying constructs through an epigrammatic conceptual model. The study is distinctive because it unearths the possibilities of mediation and moderation amongst the aforementioned constructs and posits the calamitous effects of the COVID-19 pandemic on the tourism and hospitality sector.
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Background. Differences in access to specialized medical care services and their overcrowding due to the pandemic could impact clinical outcomes. Availability of newer treatments, vaccination, and emergence of newer SARS-CoV-2 variants could also explain these differences. Methods. We performed a single-centered, observational study comparing clinical outcomes of COVID-19 admitted to the emergency department among the first three waves of the pandemic defined as June to August 2020, November 2020 to January 2021, and May to July 2021, respectively. The primary outcomes included intensive care unit admission, invasive mechanical ventilation requirement, hospital length of stay, and hospital mortality categorized by age groups. Effective COVID 19 antiviral therapy and monoclonal antibodies are not available in Colombia. Vaccination was available after March 2021. Results. Out of a total of 2264 patients were admitted. Fifty-six percent were male, with a median age of 58 years [IQR, 45-70]. A significant increase of patients was seen after each wave: 530 in the first, 568 in the second, and 1166 in the third-wave worsening hospital overcrowding. Patients from the third wave were significantly younger (59 vs. 62 vs. 56 years, p < 0.01). Patients from the first wave had higher proportion of intensive care unit admission (62.83% vs. 51.23% vs. 52.23%, p< 0.01), invasive mechanical ventilation (39.25% vs. 32.22% vs. 31.22%, p< 0.01), and length of hospital stay (9 vs 7 vs 7 days, p< 0.01). Overall, no difference was found inmortalityamong waves (18.4%vs 19% 18.8%, p = 0.974). However, patients of 70-79 and >= 80 had a lower mortality during the third wave (24.4% vs 33.3% vs 19%, p=0.018), (30.6% vs 29.6% vs 23.6%, p=0.018). Vaccination was very low in all the age groups but was higher in elderly patients. Conclusion. Overall mortality did not increase between infection waves, although there was an increase in cases during the third wave. We found a significant decrease in mortality among the elderly. Major efforts of medical teams succeed in containing COVID 19 mortality.
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Introduction: In addition to physical problems, patients with COVID-19 suffer fromconsiderable stress throughout the disease crisis and could present psychiatric consequences even after their remission. Objective(s): To assess anxiety, depression and post-traumatic stress symptoms among patients who had recovered from the acute COVID-19 infection in Tunisia. Method(s): A cross-sectional design included 50Tunisian adults who survived COVID-19 virus infection.Participants have been screened with a telephone interview 1 to 3months after a diagnosis of COVID- 19. We used a questionnaire including socio-psychological variables, presence of close relatives being infected, bereavement due to COVID-19 and post infection physical discomforts.The Impact of Event Scale-Revised (IES-R) was used to investigate post-traumatic stress disorder (PTSD). Depression and anxiety were measured using The Hospital Anxiety and Depression Scales (HADS). Result(s): The age of the participants ranged from 19 to 86 years.38% were female. Twelve percent (12%) of patients required hospitalization during COVID-19 infection. After a mean of 86.60 days (SD = 23) following the diagnosis, 28 % of patients reported clinically significant PTSD. The rates of depression and anxiety disorders in our population are 20% and 30%, respectively. Seventy percent of patients (70%) reported one or more post infection physical discomforts that the most common symptoms included Difficulty breathing and anosmia. Patients with PTSD, depression or anxiety had a more frequent history of a relative diagnosed positive for corona virus, a longer duration of infection, and more frequently post-infection physical discomfort Conclusion(s): Long-term psychological impact of COVID19 should not be ignored and mental health care could play an important role in rehabilitation.
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Background: The COVID-19 pandemic forced policy makers to find solutions to protect hospitals from revenue shortfalls and provide high quality of care for COVID-19 and other patients. In Thailand, hospitals have adjusted the hospital services arrangement to new normal hospital services to prevent the spread of coronavirus while maintaining essential hospital services for non-COVID-19 patients. Objective(s): To describe the COVID-19 patient flow and estimate the costs of the new normal hospital services implemented in six public hospitals across Thailand. Material(s) and Method(s): The authors conducted a cross-sectional study to describe the COVID-19 patient flow in each participating hospital between January and November 2020, representing the first wave of the COVID-19 outbreak in Thailand. Data were collected from hospital staff interviews, hospital historical budget review, and hospital databases. The hospital costs of the new normal hospital services were estimated using an activity-based costing approach from the provider's perspective. Result(s): The COVID-19 patients could access the new normal hospital services through three channels including 1) walk-in, 2) transfer from other hospitals, and 3) active surveillance from communities. The ratio of costs of the new normal hospital services during the COVID-19 outbreak and the normal situation were one to two times and one to five times for patients with mild infection admitted to secondary and tertiary care hospitals, respectively, but one to three times for those with moderate-to-severe infection admitted to tertiary care hospitals. Conclusion(s): The COVID-19 pandemic imposed additional costs to Thai hospitals. The magnitude of the incremental costs depended on COVID-19 severity and hospital level. Copyright © 2022 Medical Association of Thailand. All rights reserved.
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Aims: The COVID-19 pandemic impacted surgical practice globally. We aim to study The effects this had on The presentations, practice and results of Biliary Surgery on a unit adopting index admission laparoscopic cholecystectomy (LC) and single session management of bile duct stones for Emergency presentations. Method(s): Prospectively collected data of Biliary Surgery over a period of 12 months pre-COVID (PRE) and 12 months post-COVID (PoST) was analysed. The presentation, type of admission, type of operating list and operative and postoperative data were compared. Result(s): 257 LCs were done PRE and 270 PoSt. All Emergency presentations increased;acute cholecystitis 8.5% to 25.9%, acute pancreatitis 6.2% to 11.8% and jaundice 22.5% to 27.7%. Elective LC decreased from 53% to 20%. With an increase in patients with previous admissions (13.6% PRE vs 20.7% PoST), 87% of PRE vs 80% PoST had index admission LC, utilising 192 Emergency theatre sessions and 29 CEpoD lists. In spite of increased LC difficulty grades (grades 4 and 5 from 20.2% to 30.5%), bile duct explorations (34%), operating time and median total hospital stay The morbidity, mortality and median presentation to resolution intervals were not affected. Conclusion(s): COVID-19 caused an increase in all acute Biliary presentations requiring Emergency admissions, almost certainly The result of a significant decline in elective LC. However, similar numbers of LC PRE and PoST were maintained due to a policy of index admission Surgery and bile duct exploration, utilising Emergency theatre scheduling, optimised clinical outcomes in spite of some logistical parameters being affected.
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Background: Low total CO2 (tCO2) levels are significantly associated with allcause mortality. Lots of factors are related to the poor prognosis of COVID-19, it was a lack of data to evaluate the impact of tCO2. We evaluated the impact of metabolic acidosis on all-cause mortality in patients with COVID-19. Method(s): We retrospectively reviewed the data from two independent hospitals that care for admitted patients with COVID-19 between February 2020 and September 2021. We excluded subjects with underlying end-stage kidney disease, no data of tCO2 value, and age under 18 years old. The primary outcome was in-hospital mortality. We evaluate the impact of tCO2 as a continuous variable on mortality using the Cox-proportional hazard model. In addition, we tried to find the relative value of tCO2 to increase the risk of mortality using a generalized additive model. We also evaluated the impact of such a value of tCO2 and 22mEq/L of tCO2 on mortality. Result(s): A total of 4,423 patients were included, and the mean age was 54.7+/-18.3 years old. Mean tCO2 was 26.2+/-3.6 mEq/L, and there were 792 (17.9%) with tCO2 <22 mEq/L. Increased in 1 mEq/L of tCO2 significantly decreased risk for all-cause mortality after adjustment with age, sex, history of hypertension, diabetes, and laboratory results such as serum white blood count, hemoglobin, platelet, calcium, phosphate, albumin, and eGFR (adjusted HR 0.95, 95% CI 0.91, 0.99). We found that the level of 24 mEq/L of tCO2 as a cut-off value to increase risk of mortality. In the Cox-proportional hazard model, the risk of all-cause mortality was significantly increased by around 1.6 times in subjects with lower tCO2 irrespective of the cut-off value of 22 or 24 mEq/L. Conclusion(s): Decreased tCO2 significantly increased the risk of all-cause mortality in patients with COVID-19. Monitoring of tCO2 could be a good indicator to predict prognosis, and it needs to be considered to encourage in patients with a specific condition.
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Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease-19 (COVID-19), has become a global health issue. Spike proteins from the virus have a vital role in infection. Herbal medicines such as Lagerstroemia, Euphorbia hirta, and Kleinhovia hospita have several pharmacological functions such as anticancer, antiviral, and antioxidant because of their bioactive compound content. Based on an in silico study, this research was conducted on the possibility of phytochemicals from herbal Lagerstroemia, E. hirta, and K. hospita to inhibit spike protein SARS-CoV-2. A three-dimensional (3D) compound structure of each herbal medicine was docked with HR protein using AutoDock Vina software. The docking result, which has the best binding energy value, is continued with the analysis of molecular dynamics simulation. Lagerine, rutin, and nicotiflorin compounds might bind to proteins with lower binding energy. Protein was unstable when complexed with compounds compared with control, as seen from the root-mean-square deviation (RMSD) value. Therefore, this research is pre-experimental to inhibit SARS-CoV-2 spike proteins by herbal medicines.