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INTRODUCTION: A recent global study including 81 reports reported a significant drop in healthcare utilization mostly outpatient visits, admissions, diagnostics, therapeutics, and emergency services after the COVID-19 pandemic. Interestingly, these reports seldomly address intensive care utilization or mortality. We hypothesized that the pandemic significantly affected the ICU and hospital utilization rates in a comprehensive cancer center located in Houston, Texas. METHOD(S): We conducted an observational study comparing two periods, pre-pandemic (period-A, from 3/01/2019 to 2/28/2020) and first year of the pandemic (period-B, from 3/01/2020 to 2/28/2021). We reviewed the hospital metrics in our electronic health record (EHR). RESULT(S): During the two study periods we found a 22% decrease in the overall number of hospital admissions from 46,725 admissions (period-A) to 36,615 admissions (period-B). Emergency service visits (period-A 28,357 versus period-B 21,229) dropped by 25% in period-B. There was a 15% drop in the absolute number of intensive care unit (ICU) non-COVID admissions from 2,511 (period-A) to 2,147 (ICU admission rate period-B), as well as a 15% drop in surgeries and invasive interventions from 48,687 (period-A) to 41,650 interventions (period-B). However, the ICU admission rate increased from 5.4% (period-A) to 5.9% (period-B) (p=0.001). ICU mean length-of-stay (LOS) (4.14 vs 3.82, p=0.001) and mean intubation days (5.8 vs 4.7, p=0.001) were higher in period-A. The mean hospital LOS was 8 days, the same in both periods. ICU mortality was 14.9% during period-A and 14.2% in period-B (p=0.5). Hospital mortality was 2.6% in both periods. CONCLUSION(S): Our results confirmed that overall hospital utilization rates decreased during the first year of the COVID-19 pandemic. However, despite the lower numbers of patients the proportion of ICU admissions increased, the LOS and ventilator days decreased, and mortality remained the same. These findings highlight the complexity of critical care dynamics during the pandemic.
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Background. The COVID-19 pandemic changed accessibility of care and practices within healthcare environments. This period has been associated with healthcare-associated infection outbreaks and shifts in healthcare-associated infectious disease epidemiology. This study's objective is to describe changes in rates and characteristics of antimicrobial-resistant gram negative and Clostridioides difficile (CD) infections during the COVID-19 pandemic in Bernalillo County, New Mexico. Methods. The NM EIP, a collaboration between University of New Mexico and theNMDOH, conducts ongoing laboratory- and population-based surveillance of infectious disease including Clostridium difficile, extended-spectrum beta lactamase (ESBL-E) and carbapenemase-producing gram negative bacteria (CRE). Stata statistical software was used for retrospective analysis of rates and characteristics on NM EIP data from Bernalillo county, NM between 2016 and 2021. Results. Reported C. difficile rates decreased from 76 to 49 cases/month and ESBL-producing Enterobacterales decreased from 145 to 86 cases/month during the pandemic period from March-December 2020 compared with the prior 14 months. Monthly case counts for 2020 are lowest during initial public health orders for the state of New Mexico. Rates of CRE remained constant between 2018-2021. The proportion of CDI cases originating from long-term care facilities decreased significantly from 17.2% to 10.4% (p=0.006) while the proportion attributable to hospital inpatient and community populations remained constant. The proportion of ESBL-E cases from sterile sample sites increased from 3.1% to 4.9% (p=0.05) and the proportion of patients who died within 30 days or prior to discharge increased from 2.2% to 3.2% (p=0.019). Conclusion. Rates and characteristics of CD and ESBL-E infections in Bernalillo countyNMchanged significantly during the COVID-19 pandemic, while rates of CRE remained constant. It is still unclear whether this is related to changes in actual disease rates due to risk factor exposure (healthcare), or if this trend reflects changes in careseeking behavior and/or reporting of cases. (Figure Presented).
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Objectives: This study was designed to evaluate compliance with the goals provided by the Enhanced Recovery After Surgery (ERAS) program and how this affects patient outcomes. Method(s): We relied on the surgical case history of the Operative Unit of General Surgery of the Hospital of Fidenza, we retrospectively analysed the data related to patients included in the ERAS program and undergoing elective surgery of the colon-rectal district from July 2019 to September 2021. The time considered was characterized by the appearance of the global pandemic for the SarsCoV-2 virus. During the study period, 54 patients were selected and divided into two macro groups: PreCov19 and PostCov19, corresponding respectively to the initial and final period of application of the ERAS protocol. We made a comparative evaluation between the two groups taking as evaluation criteria the three macro-indicators of the effectiveness of the ERAS protocol: Length of hospitalization (LOS), postoperative complications (POC), and re-hospitalization within 30 days of discharge (RHD). We analysed for each macro group the compliance with the goals in the ERAS protocol divided into the three categories: preoperative, intraoperative, and postoperative. Result(s): Firstly, we observed the presence of a trend of improvement, for LOS and RHD, in the patients of the PostCov19 group. The POC as well as the characteristics of the patients admitted to the study were unchanged in the two periods. We focused on the analysis of the single items of the protocol. We found that compliance with preoperative and intraoperative goals in the two groups was substantially identical. We have shown improvement in complying with the postoperative items with a particular attention to the precocity of NG Tube removal, suspension of postoperative intravenous fluid therapy and start of early oral nutrition (p < 0.05). Conclusion(s): We highlighted how the low number of patients enrolled in the study affect the possibility of obtaining large statistically relevant data. However, the achievement of postoperative items improved in a statistically significant manner, which may partially explain the positive trend of LOS and RHD. The impact of the SarsCov2 pandemic and the subsequent reorganization of the hospital on the ability of the multidisciplinary team to follow the indications of the ERAS protocol remains to be evaluated. Disclosure of Interest: None declared Copyright © 2022
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Objective: To investigate the epidemiological, clinical and imaging characteristics of SARS-CoV-2 infection caused by Omicron variant.
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Introduction: On January 2021 the Department of Psychiatry became the only unit exclusively dedicated to COVID patients with severe mental illness in acute decompensation. Only patients in risk of rapid medical deterioration were excluded and forwarded to intensive care. Objective(s): Discussion of this unprecedented experience. Method(s): Analysis of 28 patients hospitalized during 3 months with both an acute psychiatric disorder and an SARS-CoV-2 infection;description of the multidisciplinary intervention made. Result(s): Our samplewas characterized by a majority of patients with an acute psychotic episode derived from a schizophrenia spectrum disorder (42%) or a bipolar affective disorder (21%). Only 3% of the patients had a diagnosis of severe major depressive disorder. And 10% of patients developed severe respiratory symptoms requiring oxygen or urgent transfer to COVID medical wards. Most patients presented periods of psychomotor agitation, lack of impulse control and self-aggression. Psychopharmacological and psychotherapeutic interventions had to be adapted to these unusual conditions. Most of them had already gone through a period of isolation in the buffer ward created to exclude false negatives, which promoted atypical deliriums and symptoms of post-traumatic stress. The psychiatric team was faced with the emergent need to adapt an intervention model based on trust to a model that had to prioritize physical safety. Conclusion(s): The pandemic experience was transformative forall who lived through it. From the challenge perspective, it may have been enriching. But the maintained confrontation with the antithesis of therapy, defined by "caring, supporting, communicating, approaching", was devastating in ways that we consider essential to be debated.
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The SARS COVID-19 virus has arisen as a major hazard to mankind, posing harm to the whole world population. During the second COVID wave, mucormycosis has emerged as one of the deadliest and most devastating illnesses. Mucormycosis is strongly associated with diabetes, prolonged use of steroids, prolonged hospitalisation and immunocompromised states. Children have also been affected by this badly. Hyperbaric oxygen therapy is a non-invasive, cost-effective and painless therapy where 100% oxygen is given to patients under high atmospheric pressure in small tents or chambers. It helps in tissue regeneration and angiogenesis. Hyperbaric oxygen has proved to be effective in the treatment of oculo-rhino-cerebral mucormycosis. Various studies have proved its role in the management of mucormycosis and acute respiratory distress syndrome associated with COVID-19 infection. The advantages of hyperbaric oxygen are same in children as in adults with minimum side effects. Hyperbaric oxygen therapy can be one of the good adjunctive therapies in the management of mucormycosis. It is found to be safe in the treatment of COVID-19 infection, but data is still limited on its use and further studies are needed. This article is all about its use, its efficacy, and future perspectives in the management of mucormycosis and COVID-19 in view of the arrival of the third COVID wave in developing countries like India. Copyright © 2022 by author(s).