ABSTRACT
Objective The objective of this study was to investigate the basic needs of medical staff during the coronavirus disease 2019 pandemic in a fever clinic, so as to provide a reference for the global epidemic medical teams. Methods A semi-structured qualitative interview outline was designed, including: (1) work level: Working hours, working intensity, and safety guarantee in a fever clinic;(2)life level: Diet, sleep, and physical comfort;(3)psychological level: Emotion, pressure, coping style, and interpersonal resources. The basic needs of the first batch of the fever clinic in Peking Union Medical College Hospital was studied by open telephone interviews. Results A total of 37 medical staff were interviewed, including 8 males (21.6%) and 29 females (78.4%). Among them, there were 16 doctors (43.2%), 19 nurses (51.4%), and 2 medical technicians (5.4%). In terms of work settings, the ideal continuous working time was 4-6 hours per shift. There should be pro re nata positions during extremely high workload, and sufficient personal protective equipment was the key to safety. In terms of living conditions, providing meals according to different shifts was important for dietary needs, and sleeping pills were temporarily needed for sleep. In terms of psychological reactions, nervousness and worrying were relatively common. Family and colleagues were important resources of support. Sport could help relieve physical and psychological stress, and psychological support from psychologists was helpful in reducing their negative emotions. Conclusions The basic needs of medical staff should be respected so as to keep the efficacy of their work. We suggest that medical staff can rest after each 4-6 h working shift. Personal protective equipment should be sufficient. Psychological support should be noted in all of them and provided when necessary.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.
ABSTRACT
Secondary infections are known complication of viral respiratory infections, often leads to deterioration of the patient. Secondary infections are commonly seen in severe respiratory viral infections.Critically ill novel coronavirus diseased 19 (COVID-19) patients need hospitalization which increases their risk of acquiring secondaryinfections. The practice of empiric antibiotics due to limited diagnostic capabilities of many hospitals has the potential to escalate an already worrisome antimicrobial resistance (AMR) situation. This study is undertaken to find out most effective antibiotic for empirical treatment. We aimed to define the impact of secondary microbial infections on the clinical course inCOVID-19 patients. A retrospective study was carried out for a period of one year at RMCH& RC, Kanpur, and U.P. India. The patients admitted in intensive care units (ICUs) and wards of the hospitals were undertaken. In our study a total of 262SARS CoV-2 positive patient's pulmonary culture were assessed. Out of 262 cases,53 (20.2%) were culture positive.Prevalence of bacterial culture positive was 46(86.8%) and fungal positive culture was 7 (13.2%). The most common bacterial isolate was Klebsiella pneumoniae 18 (39.1%)followed by Acinetobacter baumannii 12(26.1%), Pseudomonas aeruginosa (17.4%), Escherichia coli 6(13.0%), andStaphylococcusaureus2(4.4%).The overall mortality was high among culture positive patients.The antimicrobial susceptibility pattern in K. pneumoniaeshowed highest resistanceagainst commonly used cephalosporins. Predominance of Gram-negative bacteria (GNB) in COVID-19 patients coupled with high rates of resistance to higher generation antimicrobials is an alarming finding. A high rate of mortality in patients with secondary infections warns to improve the infection control practices andantimicrobial stewardship interventions, not only to save patient lives but also prevent drug-resistant, to which the current situation is very conducive. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
BACKGROUND AND AIM: Pediatric Early Warning Systems (PEWS) are evidence-based interventions that improve early identification of deterioration in resource-limited hospitals. While PEWS can be successfully implemented in these settings, little is known about their sustainability postimplementation. This study evaluates staff perspectives on the importance of, and challenges to, sustaining PEWS. METHOD(S): We conducted semi-structured interviews of PEWS implementation leaders and hospital directors at 5 pediatric oncology centers sustaining PEWS in Latin America. Interviews were conducted in Spanish, transcribed, and translated into English. A code book was developed combining a priori and inductively derived codes. Transcripts were independently coded by 2 coders achieving a kappa of 0.8-0.9. Thematic content analyses explored staff perceptions on PEWS sustainability. RESULT(S): We interviewed 71 staff including physicians (45%), nurses (45%), and administrators (10%). Participants emphasized the importance of sustaining PEWS for continued patient benefit. However, participants reported a range of challenges sustaining PEWS, including fluctuations in human and material resources needed for PEWS, staff turnover and insufficient training, difficulty achieving new leadership buy-in, lack of internal systems to promote ongoing monitoring of PEWS, and the COVID-19 pandemic (Table 1). Together, these challenges resulted in multiple impacts, ranging from a small reduction in PEWS quality to complete disruption of PEWS use resulting in loss of benefits to patient outcomes in some units. CONCLUSION(S): While sustainability of evidence-based interventions like PEWS is valued by staff in resourcelimited hospitals, participants reported multiple challenges to sustainability resulting in reduced patient benefit. Future work should focus on identifying factors that promote intervention sustainability in these settings. (Table Presented).
ABSTRACT
Messenger RNA (mRNA) vaccine has emerged as an attractive agent for prevention of infectious disease and anti-cancer therapy. However, there is a fatal risk that the safety evaluation for mRNA vaccine have not been fully studied yet. In this study, we evaluated the safety of four type of COVID-19 S-protein targeting mRNA vaccines with different compositions (C2/ LNP90, C2LNP128, C3LNP90 and C3LNP128). Theses vaccines were intramuscularly injected to 6-wk old male and female ICR mice with twice at an interval of 2 wks. The necropsy was carried out on 2 days or 14 days after secondary injection. The results showed that the body weight was decreased for 2days after the first injection in C2/LNP128 and C3/LNP128-injected mice, but it was almost recovered at 7day post injection (dpi). At 2 dpi after secondary injection, the endpoint blood analysis of demonstrated that C2/LNP128 and C3/LNP128 decreased the number of lymphocytes, monocytes and reticulocytes carrying the abnormal level of liver function indicator such as albumin, AST, ALT and total protein. Additionally, C2/LNP128 decreased the number of platelet and C3LNP128 decreased the number of red blood cells, respectably. Spleen and inguinal lymph node were enlarged in all experimental group. Notably, C2/LNP128 and C3/LNP128 induced severe edema in injection site, femoris muscle. At 14 dpi after secondary injection, the toxicity that was observed at 2 dpi after secondary injection was recovered. These results suggest that the potential side effects of mRNA vaccines must be systematically evaluated with multiple aspect of toxicology.
ABSTRACT
Objective: To explore the material basis of potential effect and possible molecular mechanisms of Qingre huashi kangdu prescription proposed by Chinese medicine master Wu Bing-cai on the treatment of Corona Virus Disease 2019(COVID-19), and to provide reference for the treatment and scientific research of COVID-19 in traditional Chinese medicine. Method(s): TCMSP, Batman and other databases were used to search chemical components and action targets in traditional Chinese medicines of Qingre huashi kangdu prescription.The disease targets of COVID-19 were screened out by GeneCards, OMIM, GEO databases.Cytoscape software was used to construct the "drugs-components-targets-diseases" network and the interaction relationship between potential targets.Metascape enrichment analysis was used to predict the core modules and mechanism of action, and ACE2 was docking with the main components. Result(s): 202 kinds of chemical components and 301 drug targets in the Qingre huashi kangdu prescription were excavated, there were 360 COVID-19 related disease targets, and 64 intersections of the two.Nine main chemical components were found in the formula, and the key targets involved PTGS2, NOS2, PPARG, MAPK14, NOS3, RELA, etc.Three core modules were predicted, and the core terms mainly included infectious diseases, immune diseases and pathways, immune and inflammatory pathways.A total of 196 items were obtained by GO enrichment analysis, which mainly involved cytokine-mediated signaling pathway, response to oxidative stress, apoptosis signaling pathway, regulation of protein localization establishment, reactive oxygen metabolism, 147 signaling pathways were screened out by KEGG pathway enrichment, including AGE-RAGE signaling pathway in diabetes complications, toxoplasmosis, apoptosis, MAPK signaling pathway, amoebiasis, HIF-1 signaling pathway and RIG-I-like signaling pathway.Molecular docking showed that luteolin, quercetin, baicalein, kaempferol, robinin, wogonin and naringenin had good binding abilities with ACE2, and the combination of quercetin, baicalein and kaempferol with ACE2 was more stable. Conclusion(s): Qingre huashi kangdu prescription treats COVID-19 through multi-components, multi-targets and multi-pathways. Copyright © 2021, Central Station of Chinese Medicinal Materials Information, National Medical Products Administration. All right reserved.
ABSTRACT
Objective: To describe the impact of a Specialized Pharmaceutical Care model that includes pharmacotherapeutic monitoring of patients through an Telepharmacy platform and home medication dispensing. Method(s): A descriptive and retrospective study conducted in the Pharmacy Service of a tertiary hospital, between 23 March 2020 and 31 December 2021. A new pharmaceutical care model for chronic ambulatory patients was developed, including: (i) definition of criteria for selecting Telepharmacy candidate patients;(ii) stratification of patients by risk level;(iii) definition of individualized pharmacotherapeutic monitoring;(iv) adaptation of the Pharmacy Service app platform to ensure continuous pharmacotherapeutic monitoring and patient monitoring (e-Oncohealth, e-Midcare and farMcuida), (v) implementation of an appointment system;and (vi) development of a software module for the management of home medication delivery. The impact of this pharmaceutical care model was assessed by analyzing indicators of activity, safety, adherence and perceived quality. Moreover, an additional study on the impact of COVID-19 was developed in order to assess the accessibility of medical care and continuity of treatment through a survey conducted on a random sample of 100 patients. Result(s): During the study period, 2, 737 patients benefited from the new remote pharmaceutical care model. A total of 7, 758 Telepharmacy consultations were performed. Pharmacotherapeutic monitoring prevented 1, 043 adverse drug reactions, which affected 10.4% of patients (3.6 adverse drug reactions/patient). Mean adherence to treatment was 95.2%. Overall satisfaction with the new model was 9.8/10. All patients would recommend this model to other patients. Conclusion(s): The new Pharmaceutical care model increases patient safety and improves treatment adherence, with a high perceived quality. Patient stratification and individualized follow-up via an Telepharmacy platform were crucial to the development of this model. Copyright © 2022 Grupo Aula Medica S.L.. All rights reserved.
ABSTRACT
Background: Data on thrombosis and current real-world management strategies for anticoagulation therapy are important for an optimal management of patients with coronavirus disease 2019 (COVID-19) Methods: The CLOT-COVID Study (thrombosis and antiCoaguLatiOn Therapy in patients with COVID-19 in Japan Study) was a retrospective, multicenter cohort study enrolling consecutive hospitalized patients with COVID-19 among 16 centers in Japan from April 2021 to September 2021. Also subanalysis is performed for D-dimer at the admission and influence of sex with adjustment confounders with multivariable logistic regression model. Result(s): Among 2894 patients with COVID-19, 1245 (43%) received pharmacological thromboprophylaxis. The proportion of pharmacological thromboprophylaxis increased according to the severity of the COVID-19 in9.8% with mild COVID-19, 61% with moderate COVID-19, and 97% with severe COVID-19. During the hospitalization, 38 patients (1.3%)and 126 (4.4%) underwent ultrasound examinations for the lower extremities and contrastenhanced computed tomography examinations, respectively, and 55 (1.9%) developed thrombosis, mostly venous thromboembolism(71%). The incidence of thrombosis increased according to the severity of the COVID-19 in 0.2% with mild COVID-19, 1.4%withmoderate COVID-19, and 9.5%with severe COVID-19. Major bleeding occurred in 57 patients (2.0%) and 158 (5.5%) died, and 81% of them were due to respiratory failure from COVID-19 pneumonia. The higher D-dimer levels in the 3rd tertile (>=1.1 mug/mL) in 2,771 patients who had D-dimer levels measured at admission. were independently associated with a higher risk of VTE during hospitalization (adjusted odds ratio 4.83 [95% confidence interval 1.93-12.11;P<0.001];reference=1st tertile).Men had more severe status of the COVID-19 at admission compared with women (Mild: 57% versus 66%, Moderate: 34% versus 29%, and Severe: 9.1% versus 5.7%, P < 0.001). During the hospitalization, men more often developed thrombosis than women (2.5% [95%CI, 1.9-3.3%] versus 0.8% [95%CI, 0.4- 1.6%], P = 0.001). Men had numerically higher incidences of thrombosis than women in all subgroups of the worst severity of COVID-19during the hospitalization (Mild: 0.3% versus 0.0%, Moderate: 1.6% versus 1.0%, and Severe: 11.1% versus 4.3%) Conclusion(s): In the large-scale observational study, pharmacological thromboprophylaxis for hospitalized patients was common especially in patients with severe COVID-19. The overall incidence of thrombosis was substantially low with an increased incidence according to the severity of the COVID-19 in Japan. In contrast to previous studies outside Japan, the risk of thrombosis in Japanese patients with COVID-19 may be relatively low, and racial differences may have to be considered. In subanalysis higher D-dimer levels at admission were associated with a higher risk of VTE events during hospitalization. Men had more severe status of the COVID-19 than women, and the risk of development of thrombosis was higher in men compared with women.
ABSTRACT
Background: Immune hemolytic anemia (AIHA) and thrombocytopenia (ITP) may rarely coexist with autoimmune disorders. Primary IHA and ITP usually respond to steroids and intravenous immunoglobulins. However, IHA+ITP may be difficult to treat when associated with autoimmune disorders. Aim(s): We report a case of a 57-year- old man diagnosed with AIHA and ITP and also found to have thyroiditis. Method(s): A retrospective review of the patient's medical history was performed. Result(s): A 57-year- old- woman with bruises, weakness, fatigue, and dizziness was admitted to the hematology center. This time CBC test was revealed hyperchromic macrocytic anemia with anisocytosis, thrombocytopenia, lymphocytosis and high level of ESR. Coomb's reactions were positive. The patient had been on autoimmune thyroiditis for about 5 years and was receiving 50 mg of L-thyroxin. Laboratory testing revealed only slightly elevated LDH level in serum and no other significant abnormalities. Instrumental examination were also normal. Our differential diagnosis included TTP, Evans and marrow infiltrative disorders. Direct antiglobulin test positive (IgG, IgG + C3d). We made a diagnosis of immune hemolytic anemia and thrombocytopenia and started treatment with Prednisolone 65mg per day. In about six months Duplex scan showed acute thrombosis of right external iliac vein. October 2021. The patient was diagnosed with COVID-19, Bilateral interstitial pneumnonia. On the way home ischemic stroke occurred. Thrombectomy -within 12 h Conclusion(s): ITP can rarely coexist with thyroiditis and Thrombosis episode. In such cases, we involuntarily deviate from the contraindications of standard anticoagulant therapy, and, regardless of the low platelet count, administer anticoagulant therapy and combine it with steroid medication. The clinical case is evidence that the treatment of concomitant immune system disorders improves the course of treatment for all pathologies but poses a thrombotic complication.