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Background: WHO has declared Coronavirus 2019 (COVID-19) as pandemic on 11th March 2020. Hydroxychloroquine (HCQ) chemoprophylaxis has been approved by the Indian Council of Medical Research (ICMR) for asymptomatic healthcare workers treating suspected or confirmed COVID-19 cases and asymptomatic household contacts of confirmed patients. However, there is a scarcity of data regarding the efficacy and safety of HCQ for COVID-19 prophylaxis and treatment. Objective(s): The present study was designed to evaluate the adverse drug reaction (ADR) profile of HCQ prophylaxis among healthcare workers in a tertiary care teaching hospital in India. Method(s): A Descriptive cross-sectional study was conducted in Kalpana Chawla Medical College and Hospital, Karnal for duration of 3 months (April-June 2020). The study was performed on the reported ADRs due to HCQ prophylaxis by the healthcare workers to the ADR monitoring centre of the institute during this period. Result(s): Gastrointestinal disturbance such as loose stool (16.4%) and hyperacidity (14.9%) were the most commonly reported ADRs during the study period. The incident rate of adverse drug reactions was 23.7%. The number of ADRs was found to be significantly (p<0.01) more in female as compared to male. We have observed that most of the reactions were reported following the 1st day loading dose. Conclusion(s): Our results showed that gastrointestinal system was most commonly affected. Loose stool and hyperacidity were most frequently reported ADRs due to HCQ prophylaxis. Larger studies are required to ensure the safety of the use of HCQ as prophylaxis for COVID-19. Copyright © RJPT All right reserved.
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Objectives: The objective of this study was to study the clinical presentation and infection prevention and control (IPC) measures in health-care workers (HCWs) diagnosed with COVID-19 in a Dedicated COVID Hospital (DCH). Materials and Methods: It was a prospective cohort study of HCWs in a DCH. The new cases found in HCWs from December 1, 2020, to January 31, 2021, were interviewed and followed up for 1 month. The study was part of an international multicenter study by the World Health Organization (WHO). The doctors, nurses, housekeeping, and other staff working in this DCH were considered as HCWs. WANTAI severe acute respiratory syndrome coronavirus 2 Ab ELISA provided by the WHO was used for qualitative testing antibody (IgM + IgG). Paired serology samples from cases were collected for serology testing - comprising one baseline serum sample taken during week 1 and another taken in the 6th week. Results: Out of the 1340 HCWs, 25 HCWs (including 15 doctors) developed COVID-19 in 60 days. Most (17, 68%) of the HCWs were from the age group of 21 to 30 years. All the HCWs reported receiving training in IPC. Most (21, 84%) of the HCWs reported following hand hygiene always, as recommended. Most (22, 88%) of the HCWs reported being using recommended personal protective equipment (PPE) always, as recommended. The duration of hospital stay was 10 & PLUSMN;3.6 days (mean & PLUSMN;standard deviation) and the range was 4-18 days. There was no significant difference between infection prevention and control practices of doctors and other HCWs. In our study, all the patients had mild disease and the antibody titer was positive in 7 (28%) patients in the 1st week of illness and in 20 (80%) patients in the 6th week of illness. The most common symptoms were respiratory symptoms (60%), sore throat (52%), fever (48%), cough (44%), and joint ache (20%). Two (8%) HCWs were asymptomatic. Conclusion: The incidence of COVID-19 among HCWs can be kept low by proper IPC measures such as availability of PPE and training of HCWs in IPC.
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Objectives: Our study aimed to evaluate the risk factors for the cessation of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) RNA detection in a cohort of inpatients of laboratory-confirmed coronavirus disease 2019 (COVID-19) cases. Materials and Methods: This was a hospital-based, cross-sectional study. All COVID-19 patients positive on the reverse transcription polymerase chain reaction (RTPCR) test of nasopharyngeal samples who were admitted in this Dedicated COVID Hospital (DCH) from April to June 2020 were included in this study. The deceased patients were excluded.Cessation of Viral RNA Shedding (CVS) was considered to have been achieved on the date of the first negative SARS-CoV-2 RTPCR result out of the two consecutive negative SARS-CoV-2 PCR results on nasopharyngeal swabs taken 24 h apart. Results: Of the 4632 COVID-19 patients, 3307 (71.4%) patients achieved CVS. Patients had a median (IQR) time from positive to negative PCR of 16 (11-23) days. In multivariate cox regression analysis, age group 41 - 60 years (hazard ratio [HR], 0.76;95% confidence interval [CI], 0.63-0.91), age > 60 years (HR [CI] = 0.63 [0.53-0.78]), female sex (HR [CI] = 1.08 [1.01-1.16]), cancer (HR [CI] = 1.87 [1.03-3.41]) were the independent risk factors for cessation of viral shedding. Conclusion: Patients older than 40 years, male patients were shedding viral RNA for more duration and can be considered for the isolation for a longer duration.
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Introduction: Mortality data reveals much about the health of the population. Traditionally and universally, most epidemiological studies begin with mortality data. Mortality characteristics and the audit give a myriad of information. This helps to identify trends of mortality. Mortality audit of mortality data is essential to improve hospital services and helps in proper allocation of resources. Hence this study was conducted to identify the mortality characteristics of the patients admitted in the year 2021 in the Tertiary care hospital in South India. Material(s) and Method(s): This retrospective study was conducted after Institutional ethical clearance with mortality records pertaining to the patients admitted to Hangal Sri Kumareshwar Hospital and Medical Research Center, Bagalkot, Karnataka during the year 2021. The data retrieved included demographic characteristics like age and sex, place of residence, ward of admission and causes of death classified according to ICD 10th revision and analysed using percentages and chi-square test and a p value of less than 0.05 was considered as significant in all the tests. Result(s): Out of 592 deaths in 2021, 64.19% were males and 35.81% were females. Majority of the deaths (34.46%) occurred between the ages of 41 to 60 years followed by 61 to 80 years (27.20%). Communicable diseases contributed to 54.56% of the total deaths (p= 0.0022). Conclusion(s): Statistical analysis of causes of death from mortality statistics is the backbone of National health policy and planning of health programs. It monitors the trend in public health issues like infant mortality, maternal mortality, infectious diseases, accidents and suicides. Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.
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Objectives: To compare the severity of COVID-19 infection among known diabetic and known hypertensive patients who were admitted in a tertiary care hospital in Peshawar, Pakistan. Methodology: A cross-sectional clinical study was conducted for comparison in diabetic vs hypertensive patients in the department of medicine of Lady Reading Hospital, Peshawar during the period from April-June 2021. All the patients were admitted in COVID ward and COVID ICU, showed their full consent and active participation in this study. Along with patient's ECG and Echo report, a questionnaire based on Canadian categorization employed for angina grading and NYHA categorization to classify shortness of breath was used. Result(s): The mean age group taken for the sample was (n=140) with maximum age of 84 years. Majority were 102(72.9%) males and females were 38(27.1%). According to laboratory tests performed on patients of COVID-19 about 48(34.4%) of patients showed positive diabetes mellitus findings. Also, patients with positive hypertension found were 67(47.9%). The average stays of patients, at the hospital, was 15-40 days. About 58.3% of mortality was noted in patients with diabetes mellitus, a bulk of patients expired were from ICU-COVID-UNIT and 55.2% was the mortality rate in patients with positive hypertension according to our clinical findings and assessment. About 7.9% of COVID inpatients had cardiac infraction with severe condition and such patients who faced congestive heart failure expired. Almost 56(40%) of the patients were found with severe condition and 63(45%) were diagnosed with moderate condition during their stay at hospital. Conclusion(s): Regardless of age, gender and disease the death rate evaluated was 50%. Moreover, in diabetics and hypertensive patients there should be raised awareness for preventing the severity of disease. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
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Background: Chronic obstructive pulmonary disease (COPD) is a prominent cause of illness and mortality on a global scale. In 2019, it was predicted to rank as the sixth largest cause of mortality. COPD is one of the most prevalent non-communicable illnesses in the field of pulmonology. The DECAF score (Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation) is a risk stratification tool for patients with AECOPD that can be used at the bedside to guide treatment, such as hospital at home for low-risk patients. The purpose of this study is to predict the in-hospital mortality in acute exacerbation of COPD patients with modified DECAF scores. Modified DECAF score includes Dyspnea, Eosinopenia, Consolidation, Acidemia and Frequency of Hospitalization. Material(s) and Method(s): A total of 50 patients attending Emergency Medicine Department with Acute Exacerbation of COPD were recruited to this hospital based observational study. This study was conducted at the Department of Emergency medicine & Pulmonary medicine, at APOLLO GLENEAGLES HOSPITALS, Kolkata. Result(s): COPD was more prevalent in the age groups of 41-50 years (28%) and 61-70 years (28%) followed by those having age between 51-60 years (22%). Majority of the COPD patients were males (88%) compared to (12%) females. Majority of the COPD patients were males (88%) compared to (12%) females. Most common co-morbid condition associated with COPD washypertension (16%) followed by IHD (8%), pulmonary hypertension (6%) and diabetes mellitus (4%). Out of 50 patients with COPD, 11 (22%) had previous history of AECOPD, 38 (76%) were regular user of inhaler, 33 (66%) had history of influenza vaccination, 16 (32%) had Pneumococcal Vaccination and 2 (4%) patients had COVID-19 pneumonia. Out of 50 patients, 24 (48%) had Dyspnea (eMRCD) score of 5a whereas 26 (52%) had Dyspnea (eMRCD) score of 5b as well as 7 (14%) had Eosinopenia (<50 cells/mm3) and 20 (40%) had Consolidation. Conclusion(s): We conclude that the Modified DECAF score is both sensitive and specific in predicting in-hospital mortality in AECOPD patients. Modified DECAF is a simple tool that predicts mortality that incorporates routinely available indices. It effectively stratifies COPD patients admitted with acute exacerbations into mortality risk categories. Copyright © 2022 Ubiquity Press. All rights reserved.
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Introduction: The direct and indirect impact of SARS COVID 19 on the health of children was unprecedented. This study was conducted to compare the changing pattern of pediatric disease dynamics and the use of healthcare system before and after the SARS-CoV2 outbreak in a tertiary care hospital. Methodology: This retrospective, observational study was conducted by collecting data from medical records during COVID 19 pandemic from March 2020 till August 2020. This was compared with the data of 2019 during similar months. The impact of COVID 19 on use of paediatric health care service units like outpatient department, casualty, intensive care and immunization clinic were assessed. Results: There was a significant decline in routine OPD (68%) attendance during the COVID 19 period as compared to pre-COVID period. Paediatric ward admissions and PICU admissions were decreased by 55% and 42% respectively. We also observed a significant 43% decline in the number of children attending immunization clinic in the year 2020. Conclusion: The fear of COVID 19 pandemic and the measures taken to control the pandemic has affected the health seeking behaviour of patients. This evaluation of trends in healthcare use may help in planning the delivery of healthcare service delivery in future. @ The Journal retains the copyrights of this article.
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BACKGROUND: To reduce the likelihood of transmission of infection to health-care workers (HCWs), personal protective equipment is used. However, wearing personal protective equipment (PPE) increases the risk of heat stress and loss of dexterity, leads to poor compliance to PPE. To address the issues of poor compliance to PPE, it was necessary to gain a deeper understanding about the factors that influence compliance. Thus this qualitative study was planned to explore barriers faced by HCWs while using PPE during a pandemic situation in a tertiary care hospital, Uttarakhand, India. MATERIALS AND METHODS: A exploratory qualitative study was undertaken among health care workers involved in the care of COVID patients. FGDs were done and an unstructured interview guide with open-ended questions was used which helped to explore the factors which can be potential barriers to the HCWs while working wearing PPE. RESULTS: Organizational and individual factors acting as barriers such as unavailability of essential personal protective equipment, a disharmonious work environment, lack of comfort, inadequate size, and quality of PPE were identified as the major barriers in the present study. CONCLUSION: Future efforts to optimize PPE use should focus on to adequate supplies both in quality and quantity can help in avoidance of such barriers. Resources should be prioritized with the needs of the HCWs in the times of pandemic. Regular training and feedbacks are necessary for the satisfaction of HCWs and improving PPE compliance.
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INTRODUCTION: COVID-19, caused by the betacoronavirus SARS-CoV-2, has overwhelmed the world's health systems. OBJECTIVE: To describe the epidemiological characteristics of patients treated in a tertiary care hospital. METHODS: A retrospective cohort study of patients diagnosed with or suspected of having COVID-19 from March 23 to July 31, 2020 was conducted. RESULTS: 4,401 patients were hospitalized at Central Military Hospital, out of which 35 % were beneficiaries, 26 % civilians, 28 % active military personnel, and only 11 %, retired military personnel. Male gender predominated, both in hospitalized patients and in those who died, as well as the O+ group and absence of comorbidities; among the observed comorbidities, the main ones were overweight and diabetes. Hospitalized patients' median age was 49 years, while median age of those who died was 62 years; women older than 51 years had a higher risk of dying. Adjusted case fatality rate was 18.5 %; 50 % died within the first six days. CONCLUSIONS: In this study, the epidemiological characteristics and main comorbidities in Mexican patients with SARS-CoV-2 infection were identified.
INTRODUCCIÓN: COVID-19, causada por el betacoronavirus SARS-CoV-2, ha saturado los sistemas de salud del mundo. OBJETIVO: Describir las características epidemiológicas de los pacientes atendidos en un hospital de tercer nivel. MÉTODOS: Se realizó una cohorte retrospectiva de pacientes con diagnóstico o sospecha de COVID-19, del 23 de marzo al 31 de julio de 2020. RESULTADOS: En el Hospital Central Militar se hospitalizaron 4401 pacientes, 35 % derechohabientes, 26 % civiles, 28 % militares en activo y solo 11 %, militares retirados. Predominó el sexo masculino, tanto en los pacientes hospitalizados como en los que fallecieron, el grupo O+ y la ausencia de comorbilidades; entre las comorbilidades que se observaron, las principales fueron el sobrepeso y la diabetes. La mediana de edad de los pacientes hospitalizados fue de 49 años, mientras que 62 años fue la edad de quienes fallecieron; las mujeres mayores de 51 años tuvieron mayor riesgo de fallecer. La tasa de letalidad ajustada fue de 18.5 %; 50 % falleció durante los primeros seis días. CONCLUSIONES: En este estudio se lograron identificar las características epidemiológicas y se destacaron las principales comorbilidades en pacientes mexicanos con infección por SARS-CoV-2.
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COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Hospitalization/statistics & numerical data , Overweight/epidemiology , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/mortality , Cohort Studies , Female , Humans , Male , Mexico/epidemiology , Middle Aged , Retrospective Studies , Risk Factors , Sex Factors , Tertiary Care Centers , Young AdultABSTRACT
BACKGROUND: The COVID-19 pandemic continues to be a significant public health concern across the whole world, including India. In the absence of any specific treatment or vaccine against COVID-19, the role of efficient testing and reporting has been uncontested so far as the number of cases is rising daily. In order to strengthen the screening activities and to prevent nosocomial infection, facility-based screening centres have been designed and operated at various levels of healthcare, including tertiary care institutions. METHODS: The present study has been planned with an objective to understand the patient profile and evaluate the functioning of COVID-19 screening OPD (CS-OPD) at a tertiary care hospital. In this hospital-based retrospective study, data from individuals visiting the COVID-19 screening OPD during the period from 17th March 2020 to 31st July 2020 were collected. We documented and analysed relevant demographic, epidemiological and clinical characteristics of the patients. RESULTS: A total of 10,735 patients visited the COVID-19 screening OPD during the defined study period of which 3652 individuals were tested. The majority of the patients, i.e., 65.67% (7050) were male and in the 15-59 years age group (84.68%). The most common symptoms among patients visiting CS-OPD was cough (9.86%). Of the total, 17.17% (1843) of patients reported to the CS-OPD with a contact history of COVID-19-positive patient. On the other hand, 13.49% (1448) of patients were with either domestic or international travel history. The overall testing rate and positivity rate for CS-OPD during this period were found to be 34.02% and 7.94%, respectively. CONCLUSION: The clinical, demographic and epidemiological characteristics of patients visiting CS-OPD varied across the study period depending upon the containment and testing strategy. The CS-OPD played a crucial role in preventing nosocomial infection and maintaining non-COVID care at the tertiary care hospital.
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INTRODUCTION: this report is a documentation of a staff risk stratification programme, undertaken in University of Benin Teaching Hospital, with outcomes, and the actions taken to protect staff. METHODS: an adapted risk stratification tool was circulated to all staff through their respective heads of departments/units. Staff were expected to voluntary assess their health and risk status in the context of COVID-19, using the tool. A central multi-disciplinary screening committee assessed submissions and invited staff who required further evaluation for physical interviews. Respondents were categorized into three risk/exposure groups from lowest to highest - A, B, and C, based on their individual health assessments, occupational exposures, and information obtained from direct interviews. RESULTS: the committee received submissions from 746 staff, representing 19.4% (about a fifth) of the hospital's 3,840 staff. One hundred and twenty two of these were invited for physical interviews, of whom 88 (72.1%) were categorized as high risk (Category C): pregnancy (53.4%); bronchial asthma (19.3%); hypertension (11.4%); cancer (3.4%) and sickle cell disease (2.3%); fractures and pulmonary tuberculosis (1%, respectively). These staff were recommended for redeployment from areas of high risk exposure to COVID-19. CONCLUSION: a management-driven risk assessment of hospital staff in preparation for the COVID-19 pandemic revealed that a fifth of staff assessed themselves as being vulnerable to adverse outcomes from exposure. It is our hope that similar risk stratification programmes will become standard practice in healthcare facilities during disease outbreaks, especially in Africa.
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COVID-19/transmission , Health Personnel , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , SARS-CoV-2 , Female , Humans , Male , Nigeria/epidemiology , Risk , Tertiary HealthcareABSTRACT
The Aga Khan University is the largest tertiary care hospital in the biggest metropolis of Pakistan, in this paper six weeks of experience during the COVID-19 pandemic is shared, we will discuss the measures that were taken to mitigate the spread of COVID-19 amongst dental health care providers (DHCPS) and provide a neoteric workflow for the provision of safe dental care as dental services move towards normalcy. Furthermore topic such as fit testing, contact tracing, employee health and training are discussed and experience of such measures is shared. It is hoped that till the time new evidence based data is generated these communications may help spread awareness to help setup clinical protocols for other tertiary care settings.
Subject(s)
Betacoronavirus , COVID-19 , Coronavirus Infections , Dental Care , Pneumonia, Viral , Coronavirus Infections/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Tertiary Care CentersABSTRACT
BACKGROUND: India has reported more than 70,000 cases and 2000 deaths. Pune is the second city in the Maharashtra state after Mumbai to breach the 1000 cases. Total deaths reported from Pune were 158 with a mortality of 5.7%. To plan health services, it is important to learn lessons from early stage of the outbreak on course of the disease in a hospital setting. OBJECTIVES: To describe the epidemiological characteristics of the outbreak of COVID-19 in India from a tertiary care hospital. METHODS: This was a hospital-based cross-sectional study which included all admitted laboratory confirmed COVID19 cases from March 31, to April 24, 2020. The information was collected in a predesigned pro forma which included sociodemographic data, duration of stay, family background, outcome, etc., by trained staff after ethics approval. Epi Info7 was used for data analysis. RESULTS: Out of the total 197 cases, majority cases were between the ages of 31-60 years with slight male preponderance. Majority of these cases were from the slums. Breathlessness was the main presenting symptom followed by fever and cough. More than 1/5th of patients were asymptomatic from exposure to admission. The case fatality rate among the admitted cases was 29.4%. Comorbidity was one of the significant risk factors for the progression of disease and death (odds ratio [OR] = 16.8, 95% confidence interval [CI] = 7.0 - 40.1, P < 0.0001). CONCLUSION: Mortality was higher than the national average of 3.2%; comorbidity was associated with bad prognosis.