Salt steps and sugar checks - Making arterial line use safer in our trust

Introduction: Arterial lines are used within our intensive care unit to allow invasive blood pressure monitoring and regular blood gas analysis. Inadvertent use of dextrose containing fluids in the flush have been associated with falsely high glucose readings. When these are acted on with insulin, it can cause devastating hypoglycaemic brain injury. There have been a number of deaths and other incidents relating to the wrong fluid being used in arterial line set up reported within the UK in recent years. In 2014 the AAGBI released a safety guideline on the use of arterial lines specifically to reduce to the risk of hypoglycaemic brain injury. Objective(s): Our objective was to ensure that 100% of arterial lines in use within Royal Victoria Hospital's intensive care unit were compliant with our trust policy on the management of arterial lines. Method(s): We audited our intensive care unit's compliance with our trust policy and found that we were 80% compliant. We formed a multi-disciplinary arterial line working group in order to tackle the problem. Our quality improvement project consisted of two main approaches: 1. To educate staff on how to manage arterial lines correctly. We divided the management of arterial lines into S.A.L.T steps (a 7 step bundle on "Setting up an Arterial Line Transducer") and SUGAR checks ( a series of red flag moments to prompt staff to review the patient prior to starting or increasing insulin administration).We developed educational posters for key areas in ICU and presented our findings at departmental meetings. 2. To change the system, in order to make it easier to do the right thing. We developed a Universal Adult Arterial Pack (UAAP) containing key components in the setup of an arterial line. This also included aide memoires for the S.A.L.T steps and SUGAR checks. In order to measure the effect of these changes, we: 1. Audited compliance on a regular basis. 2. Monitored serious bundle breaches ( for example no label, wrong fluid used) 3. Assessed usage of the UAAP. Result(s): 1. Bundle compliance improved during the first half of 2021, however then reduced in the second half with the number of serious bundle breaches increasing. This coincided with COVID surge 4 - associated with reduced nursing ratios and staff redeployment. 2. UAAP usage increased throughout the project, from an average of 6 to 9 per day. 86% of staff found the packs useful and 85% thought that they reduced the potential for error. Conclusion(s): The presence of a policy does not ensure that staff will know about it or adhere to it. Although we have not yet achieved our target of 100% compliance, we have seen evidence of how our project has the potential to do so in the near future. We aim to roll out our new e-learning module for staff education, manufacture our UAAP on a bigger scale, and disseminate the project to other departments within the trust.

Features of the course and medical and social aspects of a new coronavirus infection in the Republic of Tajikistan

The aim - to assess some medical and social aspects of the epidemic process during the first wave of a new coronavirus infectious disease - COVID-19 in the Republic of Tajikistan. Material and methods. The retrospective study was conducted on the basis of an epidemiological analysis of official statistics as part of the epidemiological surveillance of COVID-19 from April 2020 to April 2021. Results and discussion. At the beginning of April 2021, a total of 13 308 cases of COVID-19 were registered, of which the proportion of recovered was 99.3% (13 218 cases), and the number of cases with a fatal outcome was 0.68% (90 cases;the average age of the deceased was 62.3+/-0.07 years). The peak of infection during the first wave occurred in May and June 2020, when the average daily increase was 97 people. For 2 months of the epidemic in the republic, 44.6% of the total number of patients with COVID-19 became infected, and the number of deaths reached 52 people or 57.7%. Among the patients, men prevailed (65%). The largest number of deaths (76.7%;n=69) was among older people with comorbidities (diabetes mellitus, cardiovascular disease, chronic lung disease, metabolic syndrome, etc.). An analysis of the age structure showed that the main proportion of cases fell on the age group of 40-60 years (42.6%). It was found that a significant proportion of patients with COVID-19 was detected in the Sughd region (33.0%) and Dushanbe (30.1%). Conclusion. The COVID-19 pandemic showed that the national healthcare system of the Republic of Tajikistan was not sufficiently prepared for such a development of the COVID-19 epidemic process. There was an acute shortage of medical and preventive specialists in the republic. Given the current situation in the Republic of Tajikistan, within the framework of epidemiological surveillance, the features of the course of the COVID-19 epidemic process were analyzed, adequate emergency measures were developed and proposed to limit the spread of the virus and reduce the negative impact of COVID-19 on public health. The number of beds has been reasonably expanded, the capacity of the laboratory service has been increased, mass vaccination of the population has been started according to epidemic indications.Copyright © 2022 Geotar Media Publishing Group

Equity-Based Optimization for Covid-19 Vaccine Allocation

Background: Despite the development of safe and effective vaccines and antiviral treatments against COVID- 19, marginalized racial/ethnic groups in the United States continue to be disproportionally burdened by COVID-19. In response to this inequity, public health officials in several states designed, usually in an ad-hoc manner, policies aimed to be more equitable in both access and distribution of COVID-19 interventions. Method(s): We constructed an age- and race-stratified mathematical model of SARS-CoV-2 transmission and COVID-19 vaccination. We fit our model to data from Oregon at the beginning of 2021. Next, we explored counterfactual scenarios where we determined the optimal use of limited amounts of vaccine over the first 4 months of 2021 with the goal of minimizing 1) number of deaths or Years of Life Lost (YLL), 2) the inequity in mortality or YYL between race groups, 3) a combination of both. We compared them to a base-case scenario without vaccination. Result(s): When vaccine supply is very limited (enough to cover 10% of the population), there is a trade-off between minimizing mortality or minimizing inequity (Fig.1). For minimizing mortality, it is optimal to allocate vaccine to the oldest age group, irrespective of race. To minimize inequity, vaccine needs to be allocated first to the marginalized populations in the young- and middle-aged groups, incurring significantly more deaths in all groups, including the marginalized ones, compared to minimizing mortality (Fig.1). When minimizing both deaths and inequity, the optimal vaccination strategy achieved a significant reduction in inequity while preserving most of the reduction in mortality (Fig.1). When minimizing YYL and inequity, the optimal allocation resulted in a more equitable distribution of resources and outcomes across race groups. Once vaccine supply was enough to cover 20% of the population, our results suggest that it is possible to minimize both mortality (or YYL) and inequity, by protecting marginalized communities and the oldest populations at the same time. Conclusion(s): With low vaccine supply, there is a trade-off between being more equitable and reducing mortality. This is true because COVID-19 related mortality is concentrated in the oldest population while marginalized populations are predominately young. This trade-off quickly disappears when more vaccine is available. An interdisciplinary approach is needed to address the inequitable distribution of resources and outcomes in public health. Mortality rate (left), Years of Life Lost (center) and Indices of Disparity (right) with no vaccination (top row), minimizing deaths (2nd row), inequity (3rd row) or both (4th row) with enough vaccine to cover 10% of the population.

Deaths by COVID-19 in a hospital from a city from Legal Amazon region: what lessons could be learned?

Objective: Describe the epidemiology of COVID-19 deaths within a hospital in the Amazon region in a period of 64 days, which corresponds to the growth curve of the COVID-19 first-wave pandemic in 2020. Method(s): The data were obtained from medical records of 152 deaths registered for adults and elderly hospitalized. The data were also compared with the number of deaths in previous years during the same period studied to assess the impact of the pandemic on this hospital. The study also assesses the impact of intra-hospital transfers, accounting for the number of times patients who died performed transfers between sectors of the hospital. Result(s): During the period analyzed, there was an increase in deaths compared to the previous years. The majority of dead patients were male, aged between 34 and 96 years. The deaths were associated comorbidities such as arterial hypertension, diabetes mellitus, and kidney disease. The SARS-CoV-2 infection was confirmed in 91 cases. Among them, 15 individuals were admitted without conditions related to SARS-CoV-2 infection;they had a three-fold higher number of hospital transfers than those admitted with SARS-CoV-2 infection symptoms. Sixteen patients with SARS-CoV-2 infection developed respiratory symptoms just after hospitalization. The diagnostic exam for SARS-CoV-2 infection was performed on average 4 (+/- 6) days after the onset of symptoms and 6 (+/- 6) days after admission, and the average time from the onset of respiratory symptoms to death was 4 (+/- 6) days. Conclusion(s): These data suggest the high presence of hospital infection by SARS-CoV-2 in the Brazilian Amazon region, which may be related to the number of sectorial transfers, delay in confirming the diagnosis, and lack of management. We report a serious public health problem, as it demonstrates the fragility of healthcare institutions in the hospital environment.Copyright © 2023 Faculdade de Medicina de Ribeirao Preto - U.S.P.. All rights reserved.

Cause-of-death statistics in 2020 in the Republic of Korea.

Background: This study analyzed the causes of death in the Korean population in 2020. Method(s): Cause-of-death data for 2020 from Statistics Korea were examined based on the Korean Standard Classification of Diseases and Causes of Death, 7th revision and the International Statistical Classification of Diseases and Related Health Problems, 10th revision. Result(s): In total, 304,948 deaths occurred, reflecting an increase of 9,838 (3.3%) from 2019. The crude death rate (the number of deaths per 100,000 people) was 593.9, corresponding to an increase of 19.0 (3.3%) from 2019. The 10 leading causes of death, in descending order, were malignant neoplasms, heart diseases, pneumonia, cerebrovascular diseases, intentional self-harm, diabetes mellitus, Alzheimer disease, liver diseases, hypertensive diseases, and sepsis. Cancer accounted for 27.0% of deaths. Within the category of malignant neoplasms, the top 5 leading organs of involvement were the lung, liver, colon, stomach, and pancreas. Sepsis was included in the 10 leading causes of death for the first time. Mortality due to pneumonia decreased to 43.3 (per 100,000 people) from 45.1 in 2019. The number of deaths due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 950, of which 54.5% were in people aged 80 or older. Conclusion(s): These changes reflect the continuing increase in deaths due to diseases of old age, including sepsis. The decrease in deaths due to pneumonia may have been due to protective measures against SARS-CoV-2. With the concomitant decrease in fertility, 2020 became the first year in which Korea's natural total population decreased.Copyright © Korean Medical Association.

COVID-19 pandemic impact on heart failure epidemiology and outcomes in Poland. National database study

Background: COVID-19 pandemic negatively affected patients' will to seek urgent medical treatment as well as and health service performance. Purpose(s): The aim was to evaluate the impact of COVID-19 pandemic outbreak at the beginning of 2020 on heart failure epidemiology and outcomes in Poland. Method(s): The study is based on the Nationwide Polish Ministry of Health Registry, an administrative nation-wide database covering all heart failure patients in Poland who were beneficiaries of the public health sector between 2013 and 2021. Result(s): After COVID-19 outbreak in 2020, significantly fewer patients presented to health service due to HF than in previous years (Fig. 1). Compared to 2019, the number of HF hospitalisations declined by 21% and outpatient visits by 10% in 2020. Simultaneously, for the first time in the last decade, the trend in heart failure prevalence went down dropping by 3.7% (Fig. 1). The trend was driven by the greater reduction in ischaemic vs non-ischaemic HF prevalence (4.7% vs 1.3%) The longstanding downtrend in heart failure incidence accelerated markedly in 2020, decreasing by 20% between 2019 and 2020, compared to average fall of 8% in the previous decade (ranging between 4.1-12.9%). Likely, the drop was mainly attributable to the decline in the ischaemic HF incidence (23% vs 15.3% drop in nonischemic HF). The average in-hospital mortality due to HF in 2020 was higher compared to 2019 (12.9% vs 11.02%). As many as 1.18% of patients died on the day of admission in 2020, contrary to 0.94% in 2019 which accounts to 25% increase. Monthly distribution of in-hospital mortality aligned with peaks of COVID-19 waves (Fig. 2). Conclusion(s): The study shows unfavorable changes in HF epidemiology and outcomes due to the pandemic. The drop in prevalence and incidence seems to be associated with lower patient influx to the health service. It is unknown whether patient non-occurrence resulted from patients' actions or preoccupation of the health service with the pandemic. At the same time, a marked rise in in-hospital mortality was noted, with an over 25% increase in the number of deaths on the day of admission that could potentially reflect a more advanced disease state.

Significantly higher death toll along with COVID-19 mortality than influenza have been reduced by vaccination and restrictions.

The article demonstrates estimated data of influenza and COVID-19 morbidity and infection fatality rate (IFR) mortality in the context of restrictions and vaccination (years 2020-2021 mostly developed countries). A division into two age groups was included: Up to 65 years of age and over 65 years of age. Influenza mortality (IFR) did not change between 2020 and 2021 and was about 0.05% among all, and 0.005 among those under 65 years of age. IFR COVID-19 was on average approx. 0.5% overall, and in groups under 65 years of age a minimum of 0.07%. COVID-19 morbidity varied greatly from about 50/100,000 in Japan to 600/100,000 in Peru during 2020 plus 2021. In the United States and Poland, about 250 per 100 thousand in 2 years. The morbidity rate of COVID-19 in lower risk groups was 70/100 thousand in the United States. The pre-2020 flu morbidity rate in the United States ranged from 1-10 per 100,000 per season. In the 2020/21 season, it decreased to 1/100 thousand. In groups 65 age old and younger, influenza morbidity in the United States was about 0.3 per 100,000 in the 2020/2021 season, and in typical seasons 0.3 to 3/100,000. Examples of absolute numbers. In the United States, in 2021, COVID-19 471,000 victims (a year of available vaccinations). Influenza season 2021 max. 4,500 victims. The average flu season in unrestricted seasons, was about 25,000 victims. Predictions of the consequenc-es of the lack of restrictions and vaccinations are theoretical, because the preliminary ones talk about 2-3 million COVID-19 victims and even more than ten million additional hospitalizations in the United States, which may mean the collapse of the health system, and thus in practice a greater number of victims. The data presented did not result from diagnostic errors. A proper epidemic assessment confirms the effectiveness of vaccination and targeted therapy. COVID-19 vaccination reduced IFR mortality by about 10-fold.Copyright © 2023, Termedia Publishing House Ltd.. All rights reserved.

Psychological Impact Among Newly Diagnosed Covid-19 Positive Cases

Background: India was one of the worst affected countries during the second wave of COVID-19 infection. The pandemic brought in a multitude of psychological problems leading to a negative impact on the mental health of affected individuals. Several studies across the globe have assessed the psychological impact of this pandemic in general and vulnerable populations with a scanty data in the assessment of those found positive for this condition. Material(s) and Method(s): This was a cross-sectional, descriptive and observational study conducted at a tertiary health care centre involved in the management of COVID-19 cases. Cases were assessed using a semi structured proforma for socio demographic and clinical details, Impact of Events Scale Revised (IES-R) and Patient Health Questionnaire- 9 S6(PHQ-9) to assess psychological impact. Descriptive and inferential statistics were used for data analysis. Result(s): A total of 60 individuals participated in the study. The mean age of the participants was 50.8 +/- 14.10 years, with a majority of males (65%). More than half (53%) of the individuals had minimal severity on IES-R while about 9% showed moderate to severe levels. About 32% had minimal depression while 25% had moderately severe or severe depression on PHQ-9 score. A significant positive correlation was observed between number of deaths due to COVID-19 infection in the family and IES-R scores. Conclusion(s): Higher levels of stress and depression were found among those found positive for COVID-19. This highlights the need for early assessment of psychological problems and timely intervention to avoid long term psychiatric sequelae to those affected by COVID-19 infection.

Tuberculosis related lethality structure in Kharkiv, Ukraine: impact of COVID 19

Ukraine is one of the leading countries with the highest tuberculosis (TB) burden in the world, and in 2020 we had met with the decrease of TB incidence rates (42,2 compare to 53,7 per 100000 population in 2019). We aimed to analyze the impact of COVID 19 on the structure of the TB lethality. Materials and methods. We compare the following indicators: 1) number of deaths and TB-inpatient lethality, 2) number of days spent in the hospital before the lethal outcome, 3) HIV-TB co-infection among the given cases. All the indicators were for 2019, 2020 and 2021 of TB dispensaries which collect TB-related data from the whole 2,5 million city Kharkiv, Ukraine. Result(s): During 2019 there were hospitalized and treated 942 TB patients, 70 were died (7,4 %), and among them 18 (25,7 %) - HIV-TB co-infected, in 2020 hospitalizations were decreased - 708, with 47 (6,6 %) lethality and 13 (27,7 %) HIV-TB co-infected deaths. In 2021, than the quarantine restrictions almost lifted, the number of hospitalizations decreased again - 588 patients were treated in TB hospitals, lethality extremely increased - 68 (11,7 %) with 27 (39,7 %) HIV-TB co-infection deaths. The survival curve analysis, made by life expectancy in days or weeks after hospitalization, are approximately the same in 2019 and 2020, but are quite different in 2021 - among the lethal outcomes, there is a slightly higher proportion of patients who died after at least 30 days of the treatment (17 % in 2019 versus 25 % in 2021). Thus, increasing lethality and proportion of TB-HIV coinfection together with the decrease in the number of treated patients may indicate on hidden process of TB increased incidence. Active TB case-finding is urgently needed in Ukraine.

Care and support for the covid - 19 bereaved family members: The counselor's role

Worldwide, COVID-19 outbreak has been impacting people. The death toll from Covid-19 has reached 57,50,868 globally, with 39,72,59,234 verified cases. In India, there are 4,24,10,976 confirmed cases of COVID-19, and the death toll has risen to 5,05,279. Everyone experiences bereavement at some point during their lifetime. It is a universal sensation. Many find that when they adjust and integrate their loss into their daily life, their level of sadness lessens over time. The grievers or carers may go through deep, persistent, and crippling grief that satisfies the DSM V criteria for Prolonged Grief Condition, a recognised mental disorder. The majority of people adjust after a loss, with two-thirds saying that their financial, emotional, and physical conditions remained unchanged. Severe dyspnea, patient seclusion, visitation limitations, death in intensive care units, anguish of patients/family members, and disruption of relatives' social support networks are the mourning risk factors. The following psychological interventions will be used in this study to attempt to illustrate the treatment, emotional support, and counselling available to bereaved family members and caregivers (Cognitive Behavior Therapy, Acceptance and Commitment Therapy, Art based therapy, Group Therapy, Traumatic Grief Therapy, Complicated Grief Therapy).Copyright © 2023, Anka Publishers. All rights reserved.

Scenarios of COVID-19 Epidemic Effects on Socioeconomic and Health Status of Iran.

Background and Objectives: The COVID-19 epidemic and its subsequent effects have become a significant global challenge. In addition to being affected by this crisis, Iran is also facing many other problems, including sanctions and economic problems. So, there is a concern that it will suffer more severe consequences. Method(s): Scenario planning is one of the ways to recognize future changes and environmental uncertainties. This study used the so-called global business network (GBN) method, also known as the scenario matrix method. This method is based on two key uncertainties and six steps have been taken to examine variables related to health and socio-economic factors and use the opinions of relevant experts. Result(s): To be expected, Iran's health system will be able to manage the epidemic in the face of various conditions with severity and weakness, and only in the pessimistic scenario or in Worst-case scenario with the default assumption of the continuation of sanctions and the spread of the epidemic. It leads to global restrictions, loss of foreign exchange reserves, loss of performance or collapse of the health system, increasing the number of deaths and diminishing the quality of life. Conclusion(s): Regarding the COVID-19 epidemic and the existing background factors, scenarios of Iran's health and economic conditions were narrated. Given the ability of the scenarios to understand the complexity and help in decision-making, it is considered a useful tool for policy makers to have a broader, comprehensive and reasonable look to achieve a correct consensus. This situation leads to the preservation and continuation of society health and conventional economic decisions.Copyright © 2022 The Authors. Published by Tehran University of Medical Sciences.

SARCOPENIA: FEATURES OF PATHOGENESIS, DIAGNOSIS, TREATMENT AND REHABILITATION IN COVID-19 PATIENTS.

A global problem in all countries is the aging of the population due to the lengthening of the life span. The number of age-related diseases, including sarcopenia, rises with increasing age. People of the elderly and senile age were especially vulnerable in terms of the number of infections, the severity of the course of the disease, the number of deaths, for 2 years of the COVID-19 pandemic. The pandemic requires restrictive measures on the movement of citizens up to the introduction of a lockdown. This entails a decrease in physical activity and a rapid progression of sarcopenia, which worsens the prognosis of COVID-19 in this category of citizens, not only in the acute stage of the disease, but also in the following months due to an exacerbation of cardiovascular diseases, kidney diseases.Copyright © 2022 Stavropol State Medical University. All rights reserved.

Pandemic Efficiency Index effective epidemiological tool for COVID-19 mortality: Worldwide and in India

The global is as of now seeing an emotional interruption of typical ways of life on account of the quick progression of the COVID-19 disease. There is an urgent need to develop a technical tool or algorithm to know about the epidemiology, impact and mortality of the pandemic. This algorithm will help the health experts to make the policy to prevent the death rate associated with COVID-19. We conclude that Saudi Arabia currently has the highest absolute PEI (9.6) which is too high more than 10,000 recorded cases of the infection. Measurements show the number of deaths during this pandemic. PEI related to COVID-19 is gradually low in UK (0.3), Spain (0.4) and other countries.Copyright © 2022 Authors. All rights reserved.

Overview of COVID-19 Pandemic: Its Management and Prevention in Light of the Indian Traditional Medicine System

With the global death toll nearing 3.3 million, India being amongst the top 4 countries, the condition is more than fearsome. World Health Organization (WHO) recommends one doctor per 1000 population ratio, but India lags it by one doctor to 1456 people, which sets a lot of pressure on the healthcare system. Traditional remedies are becoming increasingly popular in India as a re-sult of the lack of a proper medical system. Due to the rich diversity of medicinal herbs and drugs, India has been managing health issues with its 5000 years old medication system. Amidst all this, the traditional medicine system has given relief to plenty of diseases and remains the primary de-fence system against COVID-19. Therefore, COVID-19 is also managed by its different medicinal systems, which are collectively known as the AYUSH regime. It had been a recognized system to tackle diseases in the past. In this mini-review, we performed a deep study of the Indian traditional medicine system in managing the COVID-19 situation.Copyright © 2023 Bentham Science Publishers.

Non Suicidal Self Injury and Suicidal Behaviour: Indian Perspective

The major risk factor for suicide is mostly an untreated and frequently undiagnosed mental disorder. Dr Anitha Gautam will be talking about hidden epidemiology of suicide in India during COVID -19 pandemic. In India, for the past 5 years the number of deaths due to suicide has increased from approximately 1.3 lakhs in 2017 to 1.65 in 2021 (Suicide rate increasing from 9.9 to 12 per 1,00,000 population). Hence, there is need for developing a cost effective module which can address individual specific psychological stressors which are prevailing in Indian context. These psychological aspects can be delivered by non-specialist trained person. Dr.Hemendra Singh will discuss about association of Non- Suicidal Self Injury (NSSI) and suicide attempts among psychiatric patients based on his research and also need of developing a brief suicide prevention module for suicide attempters. As history of past suicide attempt is an important risk factor for future suicide, it is high time that the various factors associated with suicide attempt are to be identified to prevent future suicide. Dr Manaswi Gutam discusses on various strategies for suicide prevention along with highlights on NSSI. Dr Swati C would be discussing her experience of delivering brief intervention module for suicide prevention at a tertiary care hospital. Key Words: Non -Suicidal Self Injury, Suicide attempts, Psychiatric patients, Suicide Prevention.

Impact of a new coronavirus infection on causes of death in Moscow and St. Petersburg.

The distribution of causes and mortality rates in Moscow and St. Petersburg (SPb) are different. Objective. To analyze changes in the distribution of causes of death in Moscow and St. Petersburg related to the COVID-19 pandemic. Material and methods. The data were used on the annual average population and the annual number of deaths in one-year age groups according to Rosstat for 2019-2021. Standardized mortality rates based on the European standard were calculated. An ABC analysis of the deaths and causes of death in the two cities was performed. Results. Despite the new coronavirus infection, mortality rates in St. Petersburg exceeded those in Moscow by 20% for three years. ABC analysis of the cause of death distribution showed a sharp decrease in the number of causes responsible for 80% of deaths. The 50 leading causes of death in St. Petersburg were more consistent. In the list of causes, mortality due to malignant neoplasms of various localizations in Moscow has shifted down by 3-11 positions, and in St. Petersburg, it increased by 10 positions. The proportion of malignant neoplasms exceeds half of the deaths due to gastrointestinal and respiratory diseases. Mortality from cardiovascular diseases in Moscow was 30% lower in 2021. Mortality from diseases associated with the gastrointestinal tract tended to decrease in both cities. Mortality from respiratory diseases was 15-20% lower in Moscow. The changing distribution of causes of death during a pandemic was expected for several reasons. In Moscow, compared to St. Petersburg in 2020, the <<coronavirus infection>> diagnosis was apparently used more <<cautiously>> as a cause of death. Conclusion. The coronavirus pandemic had a significant impact on mortality rates and distribution. The trends of mortality changes during the analyzed period were often inconsistent;however, mortality from leading causes in St. Petersburg remained higher than in Moscow.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Comparison of clinical features, risk factors and outcome of invasive pulmonary aspergillosis in critically ill COVID19, influenza and community acquired pneumonia patients

Objective: To determine the frequency and outcomes of invasive pulmonary aspergillosis (IPA) in patients with influenza, COVID-19 and community acquired pneumonia (CAP) admitted in critical care units of a tertiary care hospital in Pakistan. Method(s): A prospective cross sectional study was conducted at the Aga Khan University from Nov 2019-June 2020. Adult patients admitted in critical care units with CAP, influenza and COVID-19 pneumonia were included. IPA was diagnosed as per EORTC/MSG criteria. Clinical information and outcome were collected on predesigned performa. Result(s): A total of 140 patients [70 Influenza, 35 COVID-19 and 35 CAP] were included. Of total, 20(14.2%) patients were found to have invasive aspergillosis with 10/35(28.5%), 9/75(12.8%) and 1/35(2.8%) patients in COVID-19, influenza and CAP groups, respectively. Duration of symptoms was 12.5+/-12.13 days in CAPA and 7.56+/-4.0 days in IAPA patients (p=0.24). Mean APCHE II score was 17.4+/-8.42 and 16.6+/-6.27 in patients with CAPA and IAPA respectively (p=0.85). 9(90%) CAPA patients required vasopressor support compared to 3(33%) patients in IAPA (p=0.020). 7(70%) CAPA patients required invasive mechanical ventilation compared to 4(44%) IAPA patients (p=0.37). Length of stay in hospital was highest in CAPA patients (18.3+/-7.28 days) compared to IAPA patients (11.7+/-5.33 days) (p=0.036). The number of deaths in IAPA patients and CAPA patients was 3(33.3%) and 5(50%), respectively (p=0.526). Conclusion(s): A higher proportion of patients with COVID-19 developed IPA compared to influenza and CAP. CAPA patients had a significantly longer stay in hospital and mortality.

Covid-19 Pandemic: Global Scenario, Socialdeterminants and Its Socio-Economic Impact

Background: The COVID-19 pandemic has resulted in about 75.2M cases and 1.67M deaths worldwide, as on 18th December 2020 data live updates of World Health Organizations. In response to this pandemic, this study analyzes the global issue of rising and falling of COVID-19 cases and changing scenario of economies. Method(s): The data has been extracted from January 2020 to December 2020 from some of the reliable sources of the World like WHO Coronavirus disease (COVID-19) dashboard, Worldometer, and Centers for Disease Control and Prevention (CDC). It also represents the global scenario of the COVID-19 pandemic and its social determinants around the world. Result(s): There has been spatial heterogeneity in the number of cases and the number of deaths among regions worldwide. There is a great impact on the countries economy, both on the supply and demand side. It shows that several factors affect the determinants of health at various levels like income, healthcaresystem, education, etc also play a major role in it. Conclusion(s): The increasing cases worldwide have adversely affected the economy and have led to a scarcity of resources which further caused the collapse of the economy and trade.Copyright © 2020 Ubiquity Press. All rights reserved.

Impact of a new coronavirus infection on causes of death in Moscow and St. Petersburg

The distribution of causes and mortality rates in Moscow and St. Petersburg (SPb) are different. Objective. To analyze changes in the distribution of causes of death in Moscow and St. Petersburg related to the COVID-19 pandemic. Material and methods. The data were used on the annual average population and the annual number of deaths in one-year age groups according to Rosstat for 2019—2021. Standardized mortality rates based on the European standard were calculated. An ABC analysis of the deaths and causes of death in the two cities was performed. Results. Despite the new coronavirus infection, mortality rates in St. Petersburg exceeded those in Moscow by 20% for three years. ABC analysis of the cause of death distribution showed a sharp decrease in the number of causes responsible for 80% of deaths. The 50 leading causes of death in St. Petersburg were more consistent. In the list of causes, mortality due to malignant neoplasms of various localizations in Moscow has shifted down by 3—11 positions, and in St. Petersburg, it increased by 10 positions. The proportion of malignant neoplasms exceeds half of the deaths due to gastrointestinal and respiratory diseases. Mortality from cardiovascular diseases in Moscow was 30% lower in 2021. Mortality from diseases associated with the gastrointestinal tract tended to decrease in both cities. Mortality from respiratory diseases was 15—20% lower in Moscow. The changing distribution of causes of death during a pandemic was expected for several reasons. In Moscow, compared to St. Petersburg in 2020, the «coronavirus infection» diagnosis was apparently used more «cautiously» as a cause of death. Conclusion. The coronavirus pandemic had a significant impact on mortality rates and distribution. The trends of mortality changes during the analyzed period were often inconsistent;however, mortality from leading causes in St. Petersburg remained higher than in Moscow.

COURSE OF ACS IN PATIENTS CO-INFECTED WITH COVID-19

Aim: To study and compare the features of the course of ACS in patients who underwent COVID19 infection. Material and Methods: The study included ACS patients with ST segment elevation admitted from January 2021 to February 2022. Patients were compared with a group of patients who did not suffer from COVID 19 infection and were hospitalized for ACS in a similar period of time. The study included 114 patients. In all patients, the presence of IgG antibodies to the agent of the coronavirus infection COVID-19 was determined, which indicates that the person has already had a coronavirus infection or not. Patients were divided into 2 groups: 1 - patients who had COVID19 infection;2 - not recovered from coronavirus infection. All patients were assessed the following indicators: the presence of coronary artery disease before hospitalization, the incidence of cardiogenic shock, the presence of STEMI, as well as the number of deaths during hospitalization. Results: In the first group, only 39.5% (45) of patients were examined, of which men - 80.0% (36). Prior to hospitalization, coronary artery disease was present in 64.4% (29) of patients. STEMI was present in 75.5% (34) of patients. The incidence of cardiogenic shock in 4.4% (2) of patients. The number of deaths during hospitalization is 4.4% (2). In the second group, only 60.5% (69) of patients were examined, of which 78.3% (54) were men. Prior to hospitalization, CAD was present in 55.07% (38) of patients. STEMI was recorded in 59.4% (41) of patients. The incidence of cardiogenic shock is 1.45% of patients. The number of deaths during hospitalization was 1.45%. Conclusion: Before hospitalization, CAD was present in the majority of patients 39.5% (45) who had COVID 19, who did not have COVID19 patients 60.5% (69). STEMI was present in 75.5% (34) of patients who had COVID19 and 59.4% (41) of those who did not have COVID 19 infection (p < 0.05). During the pandemic, there is a high incidence of cardiogenic shock in 4.4% (2) of patients who have had COVID19 and 1.45% (1) of those who have not been ill. The percentage of deaths during hospitalization in COVID19 survivors is higher compared to 4.4% with 1.45% who did not recover.