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Coronavirus disease-19 (COVID-19) pandemic is a real challenge to our communities worldwide, exerting a high socioeconomic impact. The disease is associated with a great deal of co-agulation cascade disorder, with a considerable increase in D-dimer concentration in blood. Objec-tives: To assess the impact of dialysis session frequency on blood levels of D-dimer among CKD patients infected with COVID-19. Patients and Methods: The study included 40 CKD patients (22 males and 18 females) infected with COVID-19, who attended the Artificial Kidney Unit at Al Hussein Teaching Hospital, Thi-Qar, Iraq for regular dialysis. They were divided into two groups;Group I: 20 CKD patients who had COVID-19. They underwent one hemodialysis session per week. The second group, which included 20 CKD patients infected with COVID-19 underwent three dialysis sessions per week. Plasma levels of D-dimer were measured one day before the start of the study and one day after three weeks in both groups. Result(s): The results of the present study re-vealed that CKD patients infected with COVID-19 who underwent three dialysis session per week (Group II) had a significant drop in blood D-dimer level at the end of three weeks in comparison to the initial values. Furthermore, the decrease in blood D-dimer level was significantly higher among CKD patients with COVID-19 who underwent three dialysis sessions per week (Group II) in comparison to COVID-19 infected CKD patients who underwent single dialysis sessions per week (Group I). Conclusion(s): CKD patients with COVID-19 have an elevated blood level of D-dimer. Increasing the frequency of hemodialysis plays an essential role in lowering the serum D-dimer level among these patients.Copyright © 2023, Colegio de Farmaceuticos de la Provincia de Buenos Aires. All rights reserved.
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Objectives: To assess protein and energy intake and duration of venous-venous ECMO in critically ill patients with covid-19 Methods: We conducted a retrospective observational analysis on the intensive care units of a large tertiary private teaching Hospital. Adult patients admitted to intensive care unit (ICU) with laboratory confirmed SARS-CoV-2 (RT-PCR), cannulated on venous-venous ECMO and on exclusive enteral feeding were included. Data between march 2020 and june 2021 were collected. Weight and height data were acquired at the time of admission in ICU. Body mass index (BMI) was subsequently calculated. We obtained delivery and adequacy of nutrition data from a enteral nutrition form routinely filled out by nutritionists during hospitalization. Other data were obtained from electronic medical record. For statistical analysis of the data, we used SPSS version 13.0. Result(s): This cohort included 39 patients. 27 (69.2%) were men, mean age was 50 (+/- 12) years and 11 (28,2%) had more than 60 years. The more prevalent comorbidities were obesity in 22 (56%), hypertension in 20 (51,3%) and diabetes in 6 (15,4%) patients. The mean time on ECMO was 24.7 +/- 15.2 days. 29 patients (74%) died. Regarding nutritional support, the average protein intake was 0,9 +/- 0.4 g/kg/day and calories 13.9 +/- 5.2 cal/kg/day. No statistically significant association was observed between the nutritional intake and the duration on ECMO and clinical outcomes of patients. Conclusion(s): There was a high mortality in our cohort. Center;s inexperience may have played a role in these results, in addition to other factors. We observed a high prevalence of obesity. Neither energy nor protein intake were associated with the duration of ECMO and clinical outcomes. These results are similar to other recent observational studies where an insufficient energy and protein intake did not affected mortality or other outcomes. Our small sample and study design prevents a definitive conclusion on the subject. Thus, we propose further studies to elucidate the role of adequate nutrional strategies to improve outcomes and reabilitation of patients on ECMO.
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Background: SARS-Cov-2 infection during pregnancy causes adverse effects on the maternal and foetal outcome. In order to minimize the adverse outcomes of COVID-19 infection, Government of India recommends COVID-19 vaccination during antenatal period with Covaxin and Covishield. Despite the recommendation of vaccination by the Government of India, there are few clinical trials and still there exists a gap in the knowledge and awareness of outcome of pregnant women after COVID-19 vaccination during pregnancy. Material(s) and Method(s): This is a prospective observational study conducted in 50 antenatal women who were already vaccinated at a tertiary care hospital in Southern India from August 2021 to October 2021. All antenatal women who were already vaccinated and attending the OPD were considered for further follow-up. Result(s): This study was conducted among 50 antenatal women who received COVID-19 vaccination during pregnancy. Among these antenatal women, 27 (54%) were multigravida, 23(46%) were primigravida, 32(64 %) completed 2 doses of covid vaccination, and 18(36%) took a single dose in antenatal period. Among the vaccinated 27(54%) pregnant women had no symptoms after vaccination. Though 23(46%) women had symptoms after vaccination, symptoms are mild and resolved within 48 hours. All vaccinated antenatal women were observed till delivery, among them 46 (92%) had term deliveries, 4(8%) had preterm deliveries and 8[16%] new-born babies required NICU admission. Conclusion(s): COVID-19 vaccination was not associated with adverse immediate pregnancy outcomes or new born complications. Hence COVID-19 vaccination is strongly recommended in antenatal period.Copyright © 2023 Dr. Yashwant Research Labs Pvt. Ltd.. All rights reserved.
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The aim of this study was to conduct a survey of the fungal species associated with COVID-19 viral infection in 150 patients who were admitted to the intensive care unit (ICU) in Al-Diwaniyah Teaching Hospital in Al-Diwaniyah City, Iraq, for a five-month period from October 2021 to February 2022. The results indicated the dominance of Candida spp. over the rest of the isolated fungal species, with 97 isolates (64.66%). Aspergillus spp., with 15 isolates (10%), came in second. Rhizopus sp. with 2 isolates (1.33%). Then with 1 isolate (0.66%) for each of Penicillium sp., Coccidiodes sp., and Rhodotorula sp., Also, results show that the male has a higher percentage than the female (54.9%) and co-infections with fungi were more common in the 60-69 age group then in the 70-79 age group (34% versus 24%, respectively). Taking a deeper look at the patients' medical histories, it was shown that fungal co-infection was more prevalent in those with chronic sickness than in those without chronic disease (55.66% versus 43.14%, respectively).Copyright © RJPT All right reserved.
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Introduction: Over 200,000 patients survive an intensive care admission each year in the United Kingdom (UK). For patients, survival is frequently beset by a range of chronic disabilities. Approximately 50% must navigate an often complex convalescence, while suffering serious and persistent symptoms of post-traumatic stress disorder (PTSD), anxiety and/or depression.1 Eye-movement desensitisation and reprocessing (EMDR) is a trauma-focussed psychological therapy, recommended for treating PTSD by the International Society for Traumatic Stress Studies2 and NICE.3 However, EMDR has never been systematically investigated for patient benefit following intensive care admission. Objective(s): CovEMERALD4 evaluated the feasibility of delivering a randomised controlled trial (RCT), testing the effect of EMDR on the psychological health of intensive care survivors, following COVID-19 related critical illness. We also provide preliminary evidence of the effect on clinically relevant outcomes. Findings will inform the design of a subsequent fully-powered RCT. Method(s): This feasibility RCT was conducted at a single-centre, teaching hospital in the UK (University Hospital Southampton). Patients were eligible if they were admitted to intensive care for over 24-hours with confirmed COVID-19, were above 18 years of age, were recruited within 3-months of hospital discharge, and had no cognitive impairment or pre-existing psychotic diagnosis. Participants were randomised (1:1) to receive either up to 8 sessions of remotely-delivered EMDR (Recent traumatic events protocol) or standard care alone as the control group (CG). Psychometric evaluation was undertaken at Baseline and 6-months after hospital discharge. Result(s): Seventy-five consecutive patients were screened at hospital discharge, from October 2020 to April 2021. 51 eligible patients approached. 26 (51%) provided consent. Reasons for declining participation were;no psychological distress (n=16), no internet access (n=7) and being physically unready (n=2). Demographic variables were balanced between groups. Of the 13 patients randomised to EMDR, one withdrew prior to intervention: the remaining attended all sessions recommended by the psychological therapists (mean of 3-4 sessions per patient), giving an overall adherence of 93%. One patient from each group declined the 6-month follow-up evaluation, so trial completion was possible in 23 of 26 (88%) participants. No reasons for trial withdrawal were given. There were no attributable adverse events. Mean change in PTSD score (PTSD Checklist-Civilian) from Baseline to 6-months, was -8 (SD=10.49) in the EMDR group vs. +0.75 (SD=15.17) in CG (p=0.126). Mean change in anxiety (Hospital Anxiety and Depression Scale-Anxiety) was -0.45 (SD=2.3) following EMDR vs. -0.83 (SD=4.0) in the CG (p=0.787), and median change in depression (HADS-D) was -2(IQR:-3.0,1.0) following EMDR vs. +1(IQR-1.5,2.0) in the CG (p=0.263). Figure 1. Box-plot of change in PTSD symptoms (PCL-C) from baseline to 6-months post-hospital discharge for control group and EMDR intervention group. Conclusion(s): EMDR can improve psychological recovery following an intensive care admission for COVID-19, and appeared feasible and safe. Although not powered to determine clinical effectiveness, this single-centre feasibility study returned a positive signal, in reducing PTSD and depressive symptoms. A full results manuscript will be submitted prior to congress. CovEMERALD has supported a successful NIHR doctoral fellowship application, during which protocol refinements will be tested, within existing, and recommended rehabilitation pathways. Trial activity and progression will be consistent with the Medical Research Council framework for developing and evaluating complex healthcare interventions.5.
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Background: COVID-19 infection is a contemporary global concern with serious ramifications. This disease is caused by a virus belonging to the Coronaviridae family named SARS-CoV-2. Immunologic and physiologic changes during pregnancy make pregnant women more susceptible to viral infection, especially COVID-19. Objective(s): The present study aimed to identify the clinical manifestations, radiologic findings, indications for cesarean delivery, underlying conditions, and the critical outcome of mothers and newborns regarding COVID-19 women who had cesarean sections and terminated pregnancies. Method(s): This cross-sectional study was conducted on the mortality and morbidity rates of 98 women with terminated pregnancies infected with COVID-19 at the time of their cesarean delivery. The demographic, clinical, and pregnancy data were collected from Razi Teaching Hospital between March 2020 and March 2021 and analyzed using SPSS version 24. Result(s): The mean age was 31.31 +/- 7.16, and the mean gestational age was 36.45 +/- 3.334 weeks. The most prevalent cause of cesarean section was fetal distress (28%), followed by preeclampsia and meconium aspiration. The most common symptoms were sore throat, cough, fever, nausea, diarrhea, and weakness;moreover, hypothyroidism and diabetes mellitus were the most predominant underlying diseases. The mean duration for hospitalization was 5.21 +/- 4.584 days, the maternal death rate was 5.1%, and the neonatal death rate was 2%. Conclusion(s): The majority of women infected with COVID-19 had cesarean sections and terminated pregnancies in the third trimester. This highlights the need for better care and education for mothers in this period. The body mass index (BMI) level and obesity are strongly associated with COVID-19 severity. Furthermore, healthcare workers should pay more attention to underlying diseases during pregnancy.Copyright © 2023, Author(s).
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The proceedings contain 115 papers. The topics discussed include: clinical and genetic predictors of sickle cell nephropathy in Malawi;clinicohematological characteristics of iron deficiency anemia and hemoglobinopathies in Pakistan;an experience of non-hospital based laboratory;assessment of hematological parameters of petrol filling workers at petrol stations in Ethiopia: a comparative cross-sectional study;burden and risk factor to acute myocardial ischemia in children with sickle cell anemia;dyslipidemia in transfusion-dependent-thalassemia patients and its correlation with serum vitamin D level;impact of COVID-19 pandemic to pre-transfusion hemoglobin level and frequency of transfusion in transfusion-dependent thalassemia patients in Indonesia;retinopathy in Egyptian patients with sickle cell disease;and dietary pattern, socio-demographic characteristics and nutritional status of pregnant women attending Barau Dikko teaching hospital and the need to develop recommended dietary allowance and dietary reference intakes for sickle cell disease patients.
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Coronavirus disease 2019 (COVID-19) is one of the updated challenges facing the whole world. To identify the more blood group that positive to COVID19 in male or female. A cross-sectional study was conducted for positively confirmed 265 patients with COVID19 positive in Wasit province at AL-Zahraa Teaching Hospital from the period of March 13th till April 20th. All of them full a question-naire regarded by risk factors and other comorbidities. Data were analyzed by SPSS version 23 using fre-quency tables and percentage. For numerical data, the median, and interquartile range (IQR) were used. Differences between categorical groups were performed by fissure exact test. In this study, the median age of the patients was 43 years old and interquartile range 25-56 years. Majority of the patients were female 60% and 51% of them were from the same region (wasite). The dominant blood group among patients was (O) 40%. The highest percentage of comorbidities among patients was hypertension 40%, and the most presenting symptoms were cough and fever. About 51% of patients were with mild symptoms. Diabetes, coronary heart diseases, and chronic renal diseases were significantly related to disease severity (P-value=0.02, 0.001, 0.01 respectively.Copyright © 2023, Colegio de Farmaceuticos de la Provincia de Buenos Aires. All rights reserved.
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Coronavirus disease 2019 (COVID-19) is one of the updated challenges facing the whole world. To identify the more blood group that positive to COVID19 in male or female. A cross-sectional study was conducted for positively confirmed 265 patients with COVID19 positive in Waist province at AL-Zahraa Teaching Hospital from the period of March 13th till April 20th. All of them full a questionnaire regarded by risk factors and other comorbidities. Data were analyzed by SPSS version 23 using frequency tables and percentage. For numerical data, the median, and interquartile range (IQR) were used. Differences between categorical groups were performed by fissure exact test. In this study, the median age of the patients was 43 years old and interquartile range 25-56 years. Majority of the patients were female 60% and 51% of them were from the same region (waist). The dominant blood group among patients was (O) 40%. The highest percentage of comorbidities among patients was hypertension 40%, and the most presenting symptoms were cough and fever. About 51% of patients were with mild symptoms. Diabetes, coronary heart diseases, and chronic renal diseases were significantly re-lated to disease severity (p-value = 0.02, 0.001, 0.01 respectively.Copyright © 2023, Colegio de Farmaceuticos de la Provincia de Buenos Aires. All rights reserved.
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Background: The ubiquitous elixir for mortality and morbidity inflicted by severe acute respiratory syndrome virus (SARS-CoV-2) has been a vaccine. These vaccines were approved for emergency use authorization by health authorities based on limited data from clinical trials. Hence, there was a need for active surveillance of vaccinees to monitor for safety. Objective(s): This study reports adverse events following immunization with Oxford-AstraZeneca's COVID-19 vaccine (COVISHIELD). Material(s) and Method(s): The present study is an observational follow- up study to assess any adverse event occurrence following immunization (AEFI) within 7 days of vaccination among all eligible participants who were vaccinated. A structured safety surveillance questionnaire was administered consecutively to 714 participants. Vaccinees were observed for thirty minutes and followed telephonically for adverse events. Result(s): The overall incidence of any AEFI within 7 days was found to be 136/1000 vaccinations for the first dose. Out of total, 97 recipients reported with adverse events, 76.3% had AEFI within 24 h with fever as the most common symptom reported. The incidence of AEFI's was found to be associated with gender (P<0.02), age group (P<0.05) and occupation (P<0.05). No cases of hospitalization, disability or death were reported. Conclusion(s): Most of the adverse events were short-lived and observed in the first 24 h of vaccination. Incidence decreased in subsequent days and as no significant life-threatening adverse event was observed, this study might help reduce hesitancy for vaccination among the population and thus help reduce transmission of this highly contagious disease.
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Background: The objective of this study is to assess the knowledge, attitude, and practice of health staff in a teaching hospital in Erbil city in Iraq. Method(s): This cross-sectional study was carried out from 1st June 2021 through 31st December 2021, involving 1200 participants of health staff. Result(s): A total of 1200 participants were included in the study. 631 (52.6%) were females (72.4%) was married, (51.9%) Physician, and (48.1%) nurses, the majority of health staff qualifications was having Bachelor's (40.1%), 934 (77.8%) of participants had been vaccinated against hepatitis B, 771 (64.3%) had a history of vaccination against covid 19 infection, half (57%) of participants had Medium knowledge about infection control while 38.8% had Good knowledge and 4.3% had poor knowledge. (78.3%) had a medium attitude about infection control while 20% had a poor attitude and 1.7% had a good attitude. More than half of the study participants (69.2%) had good practice in infection control while 26.9% had medium practice and 3.9% had poor practice. There was a significant statistical association between Knowledge level among health staff and their attitude level (P value < 0.001). A statistically significant variation between knowledge level and practice level (P value < 0.001). A statistically significant variation between attitude level and their practice level (P value < 0.001). Conclusion(s): Results of our study showed (that 57%) of participants had Medium knowledge, (78.3%) had medium attitude, (and 69.2%) had a good practice, a significant statistical association between Knowledge level and their attitude level, and a significant variation between knowledge level and their practice level, a statistically significant variation between attitude level among health staffs and their practice level (P value < 0.001).Copyright © 2023, Bahrain Medical Bulletin. All rights reserved.
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Introduction: COVID-19 infection is associated with marked inflammatory response and the patients who are admitted to the hospital are at increased risk of developing venous thromboembolism. sRAGE (soluble receptor for advanced glycation end-products) are acutely elevated in host inflammatory response to infections [1]. Fractal dimension ( df), the biomarker of clot microstructure that measures thrombogenicity has shown to be elevated in acute inflammatory conditions such as sepsis and severe sepsis. The aim of the study was to analyse these biomarkers in COVID-19 infection and whether these biomarkers help to predict mortality. Method(s): 120 suspected COVID-19 patients were recruited from the Emergency Department of a tertiary teaching hospital. One patient was excluded because they were anticoagulated, blood samples were taken to perform fractal dimension ( df) and sRAGE. Result(s): When compared to PCR -ve group, 95 patients in the PCR + ve group had significantly elevated sRAGE (p < 0.001), but not df (p = 0.43). When compared to those who survived, sRAGE was significantly elevated (p = 0.01) in 14 patients who died in PCR + ve group, but not df (p = 0.08). No significant correlation existed between sRAGE levels and df in those patients who survived (p = 0.72) or died (p = 0.92). Logistic regression analysis showed that sRAGE and df in combination acted as highly significant predictors of mortality in COVID-19 (p = 0.009) in PCR + ve group. Conclusion(s): COVID-19 patients had a profound inflammatory response as evidenced by significantly elevated sRAGE levels. This inflammatory process was more profound in those who died. The thrombogenicity in COVID-19 patients and those who died with COVID-19 appears to be not significant as measured by df. sRAGE in combination with df can be utilised as significant predictors of mortality in COVID-19 patients.
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Objective: The primary objective was to assess the difference in rates of hypoglycemia (blood glucose (BG) <=70 mG/dL) when using reduced-dose (5 units) vs. standard-dose (10 units) of IV regular insulin for hyperkalemia treatment in renal insufficiency. Secondary objectives include the efficacy of insulin dose on potassium reduction and evaluating the difference in rates of severe hypoglycemia (BG <=54 mG/dL) between the groups. Method(s): This was a retrospective chart review of patients with renal insufficiency treated with IV regular insulin for hyperkalemia at a tertiary care teaching hospital from June 2020 to June 2021, with institutional review board approval. Inclusion criteria encompassed patients aged 18 years and older with elevated baseline potassium (>=5.5 mEq/L), estimated glomerular filtration rate < 30 mL/min/1.73m2, end stage renal disease, or presence of acute kidney injury, having received either 5 or 10 units of IV regular insulin for hyperkalemia, and had documented glucose and potassium levels after insulin administration. Patients who were pregnant, had diabetic ketoacidosis, or a baseline BG <=70 mG/dL were excluded. Data collection included patient demographics, diabetes history, relevant labs at time of elevated potassium, doses of insulin and dextrose administered for hyperkalemia treatment, presence of coronavirus-19 infection, glucose levels within 6 hours and first potassium level within 24 hours following insulin administration, concurrent use of potassium-lowering agents, insulin outside of hyperkalemia treatment, or steroids, and mortality. Result(s): Out of 409 patients included, 92 were in the 10-unit group and 317 in the 5-unit group. The rate of hypoglycemia in the 5-unit arm vs. the 10-unit arm was 6.9% vs. 8.7% (p=0.649), respectively. The rate of severe hypoglycemia between the 5-unit arm and the 10-unit arm was 3.2% vs 5.4% (p=0.682), respectively. The percent normalization of potassium was not statistically different between the 5-unit group and the 10-unit group (59% vs. 68%;p=0.115), with the same mean reduction in potassium from baseline (0.8 mEq/L (p=0.947)). Administration of concurrent treatments for hyperkalemia was similar between the groups, with dialysis being the only one with statistical significance in normalization of potassium. Patient characteristics that could have an impact on risk of hypoglycemia were studied and analyzed, including pre-treatment BG, history of diabetes mellitus, insulin naive, and patient weight. In patients with hypoglycemia (n=30) vs. those without hypoglycemia (n=379), there was a significantly different mean pre-treatment BG (113 mG/dL vs. 178 mG/dL, p<0.001). Discussion/Conclusion: There was no significant difference in rates of hypoglycemia and severe hypoglycemia between the 5-unit vs. 10-unit groups. There was no significant change in potassium normalization between the two insulin doses. Because of the small number of hypoglycemia events, larger studies are needed to better understand if 5 units of regular insulin is a safer option for the treatment of hyperkalemia in renal insufficiency.Copyright © 2023
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Background: Acute sinusitis is not an uncommon disease that manifests with inflammation of the mucosal lining of the paranasal sinuses. It has varied etiologies including viral, bacterial, fungal, and allergic. Anatomical variations, trauma, auto-immunity, diabetes mellitus, and dental procedures are predisposing factors. With the wide variation in the etiological factors, the management could be tricky. This study is quite relevant with the advent of the relentlessly persisting COVID-19 pandemic which affects the upper respiratory tract as well. Method(s): This is a descriptive hospital-based prospective study conducted at the Khartoum ENT Teaching Hospital, Ibnsina Teaching Hospital, Omdurman Military Hospital, and Omdurman Teaching Hospital in Khartoum State in the period from March 2020 to February 2021. The study included all patients 18 years and older diagnosed with acute sinusitis. The data was collected by a well-structured questionnaire designed to meet the objectives of the study and analyzed using SPSS 20. Any COVID-19 suspect is excluded from the study. Result(s): The total number of patients was 109;of them, 59 (54.1%) were females and 50 (45.9%) were males, and the female to male ratio was 1.18:1. One hundred seven (98.2%) patients received medical treatment and two patients (1.8%) did take the medications. Eighty-one patients (74.3%) were cured with medical treatment and only 28 patients (25.7%) needed surgical intervention. The age group from 25 to 40 years old was the most affected, accounting for 68 patients (62.4%), and the above 60 years old (3.7%) was the least affected group. Conclusion(s): Acute sinusitis is not an uncommon disease, if addressed properly and timely is medically treatable in most cases apart from complicated cases. This study shows that the active working ages (25-40) were the most affected. Few patients needed surgery (FESS). Negligence could result in complications. Diseases like COVID-19 affect the upper respiratory tract, and there is a similarity in symptoms, and in the advent of the COVID-19 pandemic nowadays, differentiation is of paramount importance.Copyright © 2022, The Author(s).
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Background Targeted screening for Gestational Diabetes Mellitus (GDM) occurs routinely at 24-28 weeks gestation using the oral glucose tolerance test (OGTT). During the COVID-19 pandemic, the Health Service Executive (HSE) and the Royal College of Obstetricians and Gynaecologists recommended discontinuing the OGTT to minimise hospital visits. Fasting plasma glucose (FPG), random plasma glucose (RPG), and glycated haemoglobin (HbA1c) were instead proposed for diagnosing GDM. This study retrospectively compared testing patterns and putative diagnostic rates for GDM in pregnancies using the HSE guidelines pre- and post-pandemic. Methods Pregnancies with complete gestation in the 18 months before (Group1) or 18 months after (Group2) adoption of revised HSE guidance at CUMH (01/05/2020) were included. Women with pre-existing diabetes mellitus were excluded. Results were extracted from databases at the Departments of Clinical Biochemistry and Haematology at CUH. Diagnostic cut-offs for GDM were: OGTT (FPG >=5.1 mmol/L or 2-h plasma glucose >=8.5 mmol/L), FPG (>=5.1 mmol/L), RPG (>=9 mmol/L), and HbA1c (>=39 mmol/mol). Diagnostic rates were compared using Chi-square analysis. The study was approved by the Cork Teaching Hospitals Clinical Research Ethics Committee. Results In Group1, 43.8% of 6,737 pregnancies had an OGTT, compared with 20.5% of 6,743 pregnancies in Group2. After implementing the revised guidelines, OGTT requests were 34.5% and 79.7% lower for primary and secondary care, respectively. Comparing Group1 with Group2, FPG was measured in 46.9 vs 49.8%, RPG in 13.3 vs 11.8%, and HbA1c in 23.7 vs 51.9%. The positive rate for GDM testing was 15.9% in Group1 and 22.0% in Group2 (p<0.00001). Conclusions OGTT use fell significantly with revised HSE guidelines, although only a modest reduction was observed in primary care. HbA1c use in pregnancy doubled during the pandemic. The proportion of pregnancies with biomarkers positive for GDM showed a small but significant increase upon adopting the new diagnostic guidelines.
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Collection of peripheral blood stem cells (PBSCs) for autologous stem cell transplant (ASCT) requires mobilization from the bone marrow. There is variation in mobilization choice;during the COVID-19 pandemic BSBMT&CT guidelines recommended using granulocyte-colony stimulating factor (G-CSF) alone to minimize the use of chemotherapy. We report on the impact of mobilization regimen on stem cell collection, and whether IMiD-containing induction therapy impacts on mobilization and consequently transplant engraftment times for 83 patients undergoing ASCT at Leeds Teaching Hospitals. Cyclophosphamide plus G-CSF (cyclo-G) mobilization yielded more CD34+ cells (8.94 vs. 4.88 x106/kg, p = < 0.0001) over fewer days (1.6 vs. 2.4 days, p = 0.007), and required fewer doses of salvage Plerixafor than G-CSF only (13.6% vs. 35%, p = 0.0407). IMiD-containing induction impaired all of these factors. CD34+ doses > 8x106/kg were more frequent with Cyclo-G (62% vs. 11%, p = 0.0001), including for those receiving IMiD 1st line induction (50% vs. 13.3%, p = 0.0381). Note that 92.6% of those receiving IMiD-free inductions were mobilized with Cyclo-G. The novel agents used in modern induction regimens (e.g Daratumumab) have been shown to impair yields, increasing the importance of optimizing mobilization regimens in the first instance. Furthermore, as cellular therapies become established in the management of multiple myeloma emerging data highlights the potential benefits of stem cell top up in the management of the haematological toxicities of these therapies. Our findings support re-adoption of Cyclo-G as the gold standard for mobilization to optimize PBSC harvesting and ensure sufficient cells for subsequent ASCTs.Copyright © 2023 The Authors. eJHaem published by British Society for Haematology and John Wiley & Sons Ltd.
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Purpose of Study: Between September 2020 and November 2021, a survey was developed in partnership with children, youth, and community members experiencing vulnerabilities in a Vancouver Inner City Neighbourhood (ICN) to explore challenges encountered during the COVID-19 pandemic. In the survey, participants were asked questions about their financial status, housing security, food accessibility, and other social determinants of health. Other equity-seeking groups in Vancouver, including youth experiencing developmental and/or other medical diversity, wished to adapt the ICN COVID-19 survey to explore the impact of the pandemic in their community. These youth are active members of the province's pediatric tertiary care teaching hospital's Youth Advisory Committee (YAC), and in sharing their lived experience as patients, they strive to improve the quality of healthcare for children and youth throughout British Columbia. The objectives of this study were to: 1) adapt the COVID-19 survey to capture the views and needs of youth experiencing developmental and/or other medical diversity;and 2) identify how the COVID-19 pandemic impacted this group's social determinants of health. Methods Used: Ethics board approval was obtained for this observational, cross-sectional study (H20-00987). The research team and YAC co-constructed an adapted COVID-19 survey via Zoom dialogues. YAC members completed the survey online via Qualtrics from May 2022-August 2022. Demographic information and survey results were analyzed using descriptive statistics. Summary of Results: In total, 12 participants completed the survey, including 11 youth and 1 staff member. The median age of the youth participants was 23 years (n=11, min=14, max=29). During the COVID-19 pandemic, 82% (9/11) of youth reported changes in their ability to attend work or school, 36% (4/11) reported concern around reliable and affordable access to medications/medical treatment, and 46% (5/11) reported difficulty in caring for themselves. 46% (5/11) of youth also reported difficulty in caring for older adults or people in their families with disabilities. Many youth (6/11;55%) reported they had less than five people to turn to for support in times of stress, and 46% (5/11) of youth reported the pandemic changed their ability to connect with these people. Furthermore, 82% (9/11) of youth reported experiencing some level of distress related to the pandemic. 73% (8/11) of youth reported heightened anxiety, 82% (9/11) reported worsened mood, 55% (6/11) reported difficulty sleeping, and 64% (7/11) reported difficulty exercising. Conclusion(s): Youth with developmental and/or other complex medical diversity experienced difficulties accessing work and education, reliable and affordable medical care, and social support due to the COVID-19 pandemic. The pandemic negatively impacted the social, emotional, and physical wellbeing of these youth, indicating a need for future dialogue and advocacy to ensure the views and voices on rights of children and youth are honoured.
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Background: Nurses who are occupied in emergency departments play a critical role in health services provision and patient care. Considering the importance of providing appropriate and immediate care in emergency departments, nurses need to acquire sufficient skills and up-to-date knowledge. Objective(s): This study aimed to identify the educational needs of nurses working in the emergency department and explore strategies to meet challenges against the elimination of these needs. Method(s): This qualitative study was conducted using a content analysis approach. This study selected the emergency departments of two large educational hospitals affiliated with Shiraz University of Medical Sciences, Shiraz, southern Iran. This study was conducted on 15 emergency department nurses selected via purposive sampling with maximum variation within January 2020 and March 2021.The data were collected by performing 15 in-depth, semi-structured interviews (11 face-to-face and 4 telephone interviews due to the coronavirus disease 2019 pandemic) and making field notes. Then, the recorded interviews were transcribed verbatim and analyzed using the qualitative content analysis approach proposed by Graneheim and Lundman. The consolidated criteria for reporting qualitative studies (COREQ) was used to report the findings of this study. Result(s): Three main themes, namely the need for comprehensive and continuous education, challenges of managing educational needs, and strategies to meet educational needs, were extracted following data analysis. Conclusion(s): Clarifying the educational needs of nurses and exploring strategies to solve these challenges can be effective by providing continuous practical training and adopting effective teaching-learning strategies to promote nurses' education and improve their performance in clinical skills. Accordingly, the provision of appropriate infrastructure for mobile health applications and utilization of mobile-based educational applications in emergency departments have to be taken into account by hospital managers and health policymakers.Copyright © 2023, Author(s).
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Introduction: COVID-19 pandemic infection has affected over 650 million people with over 6 million deaths. Critically unwell patients are at increased risk of developing invasive fungal infections [1]. The aim of this study was to identify the number of patients admitted to ICU with COVID-19 who developed fungal infections and to compare these patients (fungal group) with those without fungal infections (non-fungal group) to investigate which factors may have contributed to increased risk of infection. Method(s): Retrospective study undertaken in a tertiary teaching hospital ICU. 174 patients admitted with severe COVID-19 infection during March 2020 until May 2021 were included. Result(s): 81(47%) patients developed fungal infections of which 94% had Candida and 6% had Aspergillus infection. Age and smoking history did not appear to be a contributing factor. The nonfungal group had significantly higher body mass index (33 +/- 8 vs 31 +/- 7, p = 0.01). ICU length of stay [23(1-116) vs 8(1-60), p < 0.001], hospital length of stay [30(3-183) vs 15(1-174) +/- 7, p < 0.001], steroid days [10(1-116) vs 4(0-28), p = 0.02] and ventilation days [18(0-120) vs 2(0-55), p < 0.001] were significantly higher in the fungal group. The mortality rate in both groups were similar (51% vs 51.6%). Conclusion(s): Fungal infections are extremely common in COVID- 19 patients admitted to ICU, seen in almost half of patients in this cohort (47%). Longer treatment with corticosteroids appears to increase the risk of developing fungal infections. Increased length of ICU stay, and a greater length of mechanical ventilation significantly increase the risk of fungal infections in COVID-19 patients in intensive care. Fungal infection, however was not associated with increase in mortality.
ABSTRACT
Introduction Over 50% of stroke survivors have cognitive impairment. National guidelines promote early cognitive testing however, current pen-and-paper based tests are not always appropriate, typically take place in hospital and are time costly for busy clinicians. This project aimed to create an easy-to-use cognitive assessment tool specifically designed for the needs of stroke survivors. We used a computerised doctor utilising automatic speech recognition and machine learning. Methods Patients are approached if they pass the eligibility criteria of having recent acute stroke/TIA, and do not have preexisting condition i.e dementia, severe aphasia Participants could speak to the digital doctor on the ward or at home via a web-version. Results Recruitment started on 8th December 2020;We have screened 614 people assessed for suspected acute stroke/TIA at Sheffield Teaching Hospitals. Of those we have recruited 71 participants (13 with TIA) Mean NIHSS of 4.5 and mean MoCA of 24.6. We will present initial results of factors affecting participant recruitment. We will also compare the mood and anxiety screening scores used in this study to those collected via the SNAPP database. Discussion Screening was adapted due to Covid pandemic and utilising remote consent and participa- tion allowed the project to continue.