COVID-19 Knowledge and Pandemic-Associated Distress Among the Hospital Pharmacist Workforce in China.

BACKGROUND: The unprecedented disruption brought about by the global coronavirus disease 2019 (COVID-19) pandemic had produced tremendous influence on the practice of pharmacy. Sufficient knowledge of pharmacists was needed to deal with the epidemic situation; however, outbreak also aggravated psychological distress among health-care professionals. Therefore, this study aimed to determine knowledge about the pandemic and related factors, prevalence and factors associated with psychological distress among hospital pharmacists of Xinjiang Province, China. METHODS: An anonymous online questionnaire-based cross-sectional study was conducted by means of WeChat, a popular social media platform in China, February 23-27, 2020, during the COVID-19 outbreak. The survey questionnaire consisted of 4 parts, including informed consent section, demographic section, knowledge about COVID-19, and assessment of overall mental health through World Health Organization's Self-Reporting Questionnaire (SRQ-20). A score of 8 or above on SRQ-20 was used as cutoff to classify the participant as in psychological distress. SRQ-20 score and related knowledge score were used as dependent variables, demographic characteristics (such as gender, age, monthly income, etc.) were used as independent variables, and univariate binary logistic regression was used to screen out the variables with P < 0.05. Then, the filtered variables were used as independent variables, and multivariate logistic regression models were used to analyze associations with sufficient knowledge of COVID-19 and psychological distress. RESULTS: A total of 365 pharmacists participated in the survey, fewer than half (35.1%; n = 128) of pharmacists attained a score of 6 or greater (out of 10) in overall disease knowledge, and most were able to select effective disinfectants and isolation or discharge criteria. In the multivariable model, age ages 31-40 (odds ratio [OR] = 3.25; P < 0.05), ages 41-50 (OR = 2.96; P < 0.05) versus >50 (referent); primary place of practice in hospitals: drug supply (OR = 4.00; P < 0.01), inpatient pharmacy (OR = 2.06, P < 0.01), clinical pharmacy (OR = 2.17, P < 0.05) versus outpatient pharmacy (referent); monthly income Renminbi (RMB, China's legal currency) 5000-10,000 (OR = 1.77; P < 0.05) versus < 5000 (referent); contact with COVID-19 patients or suspected cases (OR = 2.27; P < 0.01); access to COVID-19 knowledge remote work+ on-site work (OR = 6.07; P < 0.05), single on-site work (OR = 6.90; P < 0.01) versus remote work (referent) were related to better knowledge of COVID-19. Research found that 18.4% of pharmacists surveyed met the SRQ-20 threshold for distress. Self-reported history of mental illness (OR = 3.56; P < 0.05) and working and living in hospital versus delay in work resumption (OR = 2.87; P < 0.01) were found to be risk factors of psychological distress. CONCLUSIONS: Further training of COVID-19 knowledge was required for pharmacists. As specific pharmacist groups were prone to psychological distress, it was important for individual hospitals and government to consider and identify pharmacists' needs and take steps to meet their needs with regard to pandemic and other work-related distress.

Impact of COVID-19 pandemic waves on changes in surgical urgency volumes and severity in the regional hospital network of Trento (Northern Italy): a descriptive epidemiological analysis.

OBJECTIVES: to analyse both direct and indirect impacts on surgical admissions, surgical rates, and clinical picture severity of the two COVID-19 pandemic waves in a hospital network covering an entire province (Trento, located in Trentino-Alto Adige Region, Northern Italy). DESIGN: retrospective epidemiological study. SETTING AND PARTICIPANTS: data regarding the patient load of the Surgical Urgencies/Emergencies flows (SUEs) of the Local Health Authority of the Autonomous Province of Trento derived from the Hospital Discharge Record (HDR) information flow. The population in study was that of patients hospitalized in the entire Province of Trento. This study compares the volume and characteristics of urgent/emergency surgery during the 2020 COVID-19 pandemic with the homologous period in 2019, subdividing the analysed pandemic period in 3 separated groups: • phase I (March-May 2020); • phase II (June-August 2020); • phase III (October-December 2020). The 3 groups represent, respectively: the 1st pandemic wave proclamation of national lockdown from 9 March to 18 May; the summer pandemic remission; the 2nd pandemic wave with partial restrictions on circulation and commercial activities. Clinical and surgical records of SUE population among these 3 periods (March-May; June-August; October-December) of both 2020 and 2019 were analyzed and compared. MAIN OUTCOME MEASURES: the overall number of admissions and surgical rates for SUEs in the study periods were chosen as primary outcomes. The same outcomes were analysed for the most represented diagnoses in the SUEs population: diverticulitis, intestinal obstruction, appendicitis, cholecystitis, gastrointestinal (GI) perforations, pancreatitis, traumas. To assess the degree of clinical picture severity, variables coming from the hospital discharging charts, commonly associated to worst outcomes in term of mortality and morbidity, such as age, length of hospital stay, DRG weight, and patients not discharged at home were extrapolated from the electronic database. A numerical weight was then assigned to each variable, obtaining a scoring system from 0 to 15 (severity index). RESULTS: the number of admissions for SUEs in the studied period showed a sinusoidal trend, with a dramatic decrease in phase I and III (-46.6% and -31.6%, respectively). This trend was also observed even by stratifying admissions for the most frequent pathologies, except for gastrointestinal perforations and pancreatitis. The surgical rate among hospitalised patients for SUEs was 35.2% in phase, significantly higher than that of 2019 (25.6%). Considering the most frequent diagnoses individually, some had a progressive increase in the surgical rate in phases I and II (diverticulitis, bowel obstructions, cholecystitis), others showed an initial decrease and then settled on values ​​not far from those of 2019 (GI perforations and appendicitis), others again had an initial significant increase and then gradually returned to values ​​similar to those of 2019 in phase III (traumas). The mean patients age was significantly higher in phase I than in 2019 (p-value <0.001) and in phase II (p-value <0.05). Consistently with the trend of the number of urgent admissions, even the severity index calculated on the SUEs population showed a sinusoidal trend with and evident increase during the two pandemic waves. CONCLUSIONS: the effect of the COVID-19 pandemic on SUEs was mainly indirect, manifesting itself with a significant reduction in surgical admissions, particularly in phases I and III. Conversely, in the same phases, the surgical rate showed a significant increase compared to 2019. The stratified analysis confirmed these findings for the most frequent diagnoses except for GI perforations and pancreatitis. The clinical pictures were more severe in the two pandemic waves than in the reference period of 2019. Although with a slight numerical attenuation, in general, the second pandemic wave confirmed the first one findings.

هم هگیری کووید- 19 در شهر رشت در سال 14اختلال استرس پس از آسیب حساسیت اضطرابی و تا بآوری در کارکنان خدمات درمانی طی

Background The coronavirus disease 2019 (COVID-19) pandemic has extensively affected the public physical and mental health, especially the medical staff working in the COVID-19 wards of hospitals. Objective This study aims to evaluate the relationship between post-traumatic stress disorder (PTSD), anxiety sensitivity (AS), and resilience among hospital medical staff in Rasht, during the COVID-19 pandemic. Methods This is an analytical cross-sectional study. The study population consists of all medical staff working in the COVID-19 wards of Poursina and Razi hospitals in Rasht, Iran. Of these, 94 participated who were selected using a convenience sampling method. Weathers et al.'s post-traumatic stress disorder checklist, Reiss et al.'s AS index, and Connor-Davidson resilience scale were used for data collection. The data were analyzed using Pearson correlation test and multiple linear regression analysis. Results There was a significant negative correlation between PTSD and resilience (r = -0.405, P = 0.001). and a significant positive correlation between PTSD and AS (r=0.633, P=0.001). The results of multiple analyses showed that resilience (B=-0.208, P=0.004) and AS (B=0.574, P=0.001) could significantly explain the PTSD in medical staff. Conclusion Resilience can be an important protective factor against PTSD in hospital medical staff during the COVID-19 pandemic. The medial staff with AS may experience the symptoms of PTSD more.

To introduce or not? Strategic analysis of hospital operations with telemedicine

Despite its efficiency in reducing the impact of pandemics (e.g., the COVID-19), whether to introduce telemedicine as an additional way to serve chronically ill patients remains controversial for hospitals in many countries. This paper builds a stylized model to investigate a hospital's telemedicine strategy and the corresponding impacts on its operations regarding outpatient management of chronic diseases. We implement our analysis from three key concerns of the hospital in the presence of a pandemic: the differences in medical consumption and reimbursement between in-person and telemedicine modalities and the effort cost of infection reduction resulting from the pandemic. We find that in the absence of the pandemic, the hospital prefers to introduce telemedicine when the differences in medical consumption and reimbursement are both small. In the presence of the pandemic, we find that the introduction of telemedicine does not always benefit the hospital and that it is better not to introduce telemedicine in some cases since it may exacerbate the negative influence of the pandemic on the hospital's total costs. Furthermore, we surprisingly find that the hospital may set greater in-person capacity but less telemedicine capacity in response to the outbreak of the pandemic under certain conditions, which contradicts public beliefs. Finally, we show that social welfare can be improved by introducing telemedicine when the effort cost of infection reduction and the difference in reimbursement are both of moderate size. The condition under which social welfare is improved tightens with a greater difference in medical consumption. © 2021 Elsevier B.V.

Risk Factors of In-hospital Death in COVID-19 Patients：a Meta-analysis

Background The worldwide COVID-19 pandemic has turned into a global catastrophic public health crisis，and the conclusion about the risk factors of hospital death in COVID-19 patients is not uniform. Objective To explore risk factors of in-hospital death in patients with COVID-19 by a meta-analysis. Methods Case-control studies about risk factors of in-hospital death in COVID-19 patients were searched from databases of the Cochrane Library，ScienceDirect，PubMed，Medline，Wanfang Data，CNKI and CQVIP from inception to October 1，2021. Literature screening，data extraction and methodological quality assessment were conducted. Meta-analysis was performed using Stata 15.1. Meta-regression was used to explore the potential sources of heterogeneity. Results Eighty studies were included which involving 405 157 cases〔349 923 were survivors（86.37%），and 55 234 deaths（13.63%）〕，that were rated as being of high quality by the Newcastle-Ottawa Scale. Meta-analysis showed that being male〔OR=1.49，95%CI（1.41，1.57），P<0.001），older age〔WMD=10.44，95%CI（9.79，11.09），P<0.001〕，dyspnoea〔OR=2.09，95%CI（1.80，2.43），P<0.001〕，fatigue〔OR=1.49，95%CI（1.31，1.69），P<0.001〕，obesity〔OR=1.46，95%CI（1.43，1.50），P<0.001〕，smoking〔OR=1.18，95%CI （1.14，1.23），P<0.001〕，stroke〔OR=2.26，95%CI（1.41，3.62），P<0.001〕，kidney disease〔OR=3.62，95%CI （3.26，4.03），P<0.001〕，cardiovascular disease〔OR=2.34，95%CI（2.21，2.47），P<0.001〕，hypertension〔OR=2.23，95%CI（2.10，2.37），P<0.001〕，diabetes〔OR=1.84，95%CI（1.74，1.94），P<0.001〕，cancer〔OR=1.86，95%CI （1.69，2.05），P<0.001〕，pulmonary disease〔OR=2.38，95%CI（2.19，2.58），P<0.001〕，liver disease〔OR=1.65，95%CI（1.36，2.01），P<0.001〕，elevated levels of white blood cell count〔WMD=2.03，95%CI（1.74，2.32），P<0.001〕，neutrophil count〔WMD=1.77，95%CI（1.49，2.05），P<0.001〕，total bilirubin〔WMD=3.19，95%CI（1.96，4.42），P<0.001〕，aspartate transaminase〔WMD=13.02，95%CI（11.70，14.34），P<0.001〕，alanine transaminase 〔WMD=2.76，95%CI（1.68，3.85），P<0.001〕，lactate dehydrogenase〔WMD=166.91，95%CI（150.17，183.64），P<0.001〕，blood urea nitrogen〔WMD=3.11，95%CI（2.61，3.60），P<0.001〕，serum creatinine〔WMD=22.06，95%CI （19.41，24.72），P<0.001〕，C-reactive protein〔WMD=76.45，95%CI （71.33，81.56），P<0.001〕，interleukin-6 〔WMD=28.21，95%CI（14.98，41.44），P<0.001〕，and erythrocyte sedimentation rate〔WMD=8.48，95%CI（5.79，11.17），P<0.001〕were associated with increased risk of in-hospital death for patients with COVID-19，while myalgia〔OR=0.73，95%CI（0.62，0.85），P<0.001〕，cough〔OR=0.87，95%CI（0.78，0.97），P=0.013〕，vomiting〔OR=0.73，95%CI （0.54，0.98），P=0.030〕，diarrhoea〔OR=0.79，95%CI（0.69，0.92），P=0.001〕，headache〔OR=0.55，95%CI（0.45，0.68），P<0.001〕，asthma〔OR=0.73，95%CI（0.69，0.78），P<0.001〕，low body mass index〔WMD=-0.58，95%CI （-1.10，-0.06），P=0.029〕，decreased lymphocyte count〔WMD=-0.36，95%CI（-0.39，-0.32），P<0.001〕，decreased platelet count 〔WMD=-38.26，95%CI（-44.37，-32.15），P<0.001〕，increased D-dimer〔WMD=0.79，95%CI（0.63，0.95），P<0.001〕，longer prothrombin time〔WMD=0.78，95%CI（0.61，0.94），P<0.001〕，lower albumin〔WMD =-1.88，95%CI（-2.35，-1.40），P<0.001〕，increased procalcitonin〔WMD=0.27，95%CI（0.24，0.31），P<0.001〕，and increased cardiac troponin〔WMD=0.04，95%CI（0.03，0.04），P<0.001〕were associated with decreased risk of in-hospital death due to COVID-19. According to the meta-regression result，the heterogeneity in gender，renal disease，cardiovascular diseases，asthma，white blood cell count，neutrophil count，platelet count，hemoglobin，and urea nitrogen differed siangificnatly by country（P<0.05）. Conclusion The risk of in-hospital death due to COVID-19 may be increased by 25 factors（including being male，older age，dyspnoea，fatigue，obesity，smoking，stroke，kidney disease，cardiovascular disease，hypertension，diabetes，cancer，pulmonary disease，liver disease，elevated levels of white blood cells，neutrophil count，total bilirubin，aspartate transaminase，alanine transaminase，lactate dehydrogenase，blood urea nitrogen，serum creatinine，C-reactive protein，interleukin-6，and erythrocyte sedimentation rate），and may be decreased by 13 factors（including myalgia，cough，vomiting，diarrhoea，headache，asthma，low body mass index，decreased lymphocyte count and platelet count，increased D-dimer，longer prothrombin time，lower albumin，increased procalcitonin and cardiac troponin）. The conclusion drawn from this study needs to be further confirmed by high-quality，multicenter，large-sample，real-world studies. © 2023 Chinese General Practice. All rights reserved.

THE THRESHOLD VALUE OF THE NUMBER OF HOSPITAL BEDS IN A SEIHR EPIDEMIC MODEL

To investigate the impact of the number of hospital beds on the control of infectious diseases and help allocate the limited medical resources in a region, a SEIHR epidemic model including exposed and hospitalized classes is established. Different from available models, the hospitalization rate is expressed as a function of the number of empty beds. The existence and stability of the equilibria are analyzed, and it is proved that the system undergoes backward bifurcation, Hopf bifurcation, and Bogdanov-Takens bifurcation of codimension 2 under certain conditions by using the center manifold theory and normal form theory. In particular, our results show that there is a threshold value for the capacity of hospital beds in a region. If the capacity of hospital beds is lower than this threshold value, there will be a backward bifurcation, which means that even if the basic reproduction number, R0, is less than unity, it is not enough to prevent the outbreaks. Before taking disease control measures, one should compare the number of beds with the threshold value to avoid misjudgment and try to increase the capacity of hospital beds above this threshold value. The method to estimate the threshold value is also given. In addition, the impacts of the duration of the exposed period on the basic reproduction number and disease transmission are investigated. © 2023 American Institute of Mathematical Sciences. All rights reserved.

RENIN-ANGIOTENSIN SYSTEM BLOCKER AND THE COVID-19 AGGRAVATION: REPORT BY THE COVID-19 REGISTRY JAPAN

Objective: The role of angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) in the pandemic context of coronavirus disease 2019 (COVID-19) continues to be debated. Patients with hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease, or chronic obstructive pulmonary disease (COPD), who often use ACEi/ARB, may affect risk of severe COVID-19. However, there are no data available on the association of ACEi/ARB use with COVID-19 severity in this population. Design and method: This study is an observational study of patients with a positive SARS-CoV-2 test and inpatient treatment at a healthcare facility, using the registry information of COVIREGI-JP. Our primary outcomes were consisting of in-hospital death, ventilator support, extracorporeal membrane oxygenation support, and ICU admission. Out of the 6,055 patients, 1,921 patients with preexisting hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease, or COPD were enrolled. We also evaluated 1,097 patients with hypertension. Results: Factors associated with an increased risk of the primary outcomes were aging, male sex, COPD, severe renal impairment, and diabetes mellitus. No correlations were observed with ACEi/ARB, cerebro-cardiovascular diseases, or hypertension. Associated factors in male patients were aging, renal impairment, hypertension, and diabetes. In female patients, factors associated with an increased risk were aging, ACEi/ARB, renal impairment, and diabetes, whereas hypertension was associated with a lower risk of the primary outcomes. In patients with hypertension, factors associated with an increased risk of the primary outcomes were aging, male sex, severe renal impairment, and diabetes mellitus, but not ACEi/ ARB, cerebro-cardiovascular diseases, or COPD. Conclusions: Independent factors for the primary outcomes were aging, male sex, COPD, severe renal impairment, and diabetes, but not ACEi/ARB, in the COVID-19 patients with preexisting hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease or COPD. Based on this registry data analysis, more detailed data collection and analysis is needed with the cooperation of multiple healthcare facilities.

The Architecture of Multifunctional Prefabricated Hospitals

The paper discusses the principles of planning infectious diseases hospitals of a new type, the need for which arose in connection with the global epidemiological situation and the announcement by the WHO (World Health Organization) of the SARS-CoV-2 pandemic. Using the examples of the projects built in the Russian Federation, the prerequisites are analyzed for the decision-making as to functional zoning, architecture, space-planning and design solutions, as well as within the framework of the SDP (Site Development Plan). Options for the subsequent use of the developed solutions in new projects are proposed. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Evaluation of COVID-19 Vaccine Refusal in Healthcare Workers

Introduction: Healthcare workers are at the frontline of the COVID-19 pandemic and identified as a priority group for COVID-19 vaccines. We aimed to determine to COVID-19 vaccine acceptance rate and reasons for vaccine refusal in healthcare workers in our hospital. Materials and Methods: A questionnaire consisting of eight questions was applied to healthcare workers working at Ankara City Hospital for 7.5 months after the start of the COVID-19 vaccine in our country, including COVID-19 vaccination, previous years' influenza vaccination, and reasons for vaccine rejection. Results: Six hundred twenty-eight healthcare workers participated in the study. Two hundred fifty-six (40%) of them were doctors. Ninenty-nine of the participants were not vaccinated, the rate of vaccine rejection was 15.7%. The rate of vaccine rejection was the lowest (8.2%) among doctors, and lower among doctors working in the fields of COVID-19 (p= 0.041). While the rates of getting the COVID-19 vaccine were significantly higher in those who had regular or intermittent influenza vaccination every year in the previous years, those who had never had the influenza vaccine did not receive the COVID-19 vaccine either (p= 0.000). The most common reason for vaccine rejection was 'fear of the side effects of the vaccine' (24%), while 'I believe the disease is mild' and 'I want to gain immunity naturally' were other common reasons. Conclusion: Vaccination of healthcare workers has gained even more importance in the COVID-19 pandemic, with both risky and severe working conditions and mortality rates. Determining the reasons for vaccine refusal, finding effective solutions, emphasizing the necessity of vaccination with scientific evidence are important for the control of the pandemic. Vaccination of health workers is a guide in community immunization.

Hospitalizations and mortality during the first year of the COVID-19 pandemic in Hong Kong, China: An observational study

Background: Hong Kong followed a strict COVID-19 elimination strategy in 2020. We estimated the impact of the COVID-19 pandemic responses on all-cause and cause-specific hospitalizations and deaths in 2020. Methods: Interrupted time-series analysis using negative binomial regression accounting for seasonality and long-term trend was used on weekly 2010–2020 data to estimate the change in hospitalization risk and excess mortality occurring both within and out of hospitals. Findings: In 2020, as compared to a 2010–2019 baseline, we observed an overall reduction in all-cause hospitalizations, and a concurrent increase in deaths. The overall hospitalization reduction (per 100,000 population) was 4809 (95% CI: 4692, 4926) in 2020, with respiratory diseases (632, 95% CI: 607, 658) and cardiovascular diseases (275, 95% CI: 264, 286) contributing most. The overall excess mortality (per 100,000 population) was 25 (95% CI: 23, 27) in 2020, mostly among individuals with pre-existing cardiovascular diseases (12, 95% CI: 11, 13). A reduction in excess in-hospital mortality (−10 per 100,000, 95% CI: −12, −8) was accompanied by an increase in excess out-of-hospital mortality (32, 95% CI: 29, 34). Interpretation: The COVID-19 pandemic might have caused indirect impact on population morbidity and mortality likely through changed healthcare seeking particularly in youngest and oldest individuals and those with cardiovascular diseases. Better healthcare planning is needed during public health emergencies with disruptions in healthcare services. Funding: Health and Medical Research Fund, Collaborative Research Fund, AIR@InnoHK and RGC Senior Research Fellow Scheme, Hong Kong. © 2022 The Authors

202. A Mixed Method Investigation of Parent-Adolescent Communication about Mental Health

Purpose: The purpose of this study is to explore how adolescents and their parents/guardians communicate about mental health in order to generate ideas for potential interventions that seek to improve parent-adolescent communication. Methods: Twenty adolescents aged 12 to 19 with a history of depression and/or anxiety were recruited from an adolescent and young adult medical clinic affiliated with an academic medical center in Pittsburgh, PA. Adolescent participants were asked to enroll in the study alongside one parent or guardian. Following enrollment, both adolescents and their parents/guardians completed a survey including a Barriers to Adolescents Seeking Help Scale and Parent-Adolescent Communication Scale. Two sample t-tests were performed to determine if a significant difference existed between overall adolescent and parent/guardian scores. Separate, semi-structured interviews were conducted in person and via Zoom for both adolescents and parents/guardians. Interviews were transcribed verbatim and separate, data-driven codebooks for adolescents and parents/guardians were developed based upon themes that emerged after initial read-through of interview transcripts. Qualitative data was analyzed via template analysis. Double coding was utilized for half of the adolescent and parent/guardian interviews and Cohen's Kappa scores were calculated for each code;the average score was 0.90, indicating substantial agreement. The rest of the interviews were coded by one coder. Results: Qualitative analysis revealed themes concerning adolescents' reluctance to communicate with parents about mental health, including fear of judgement, apprehension about parents' dismissal or misinterpretation of mental health symptoms, and worry about burdening parents. Additionally, a theme of adolescents' preference for communicating with peers was identified, often due to shared experiences. Several themes were identified that promoted parent-adolescent communication, including the disclosure of familial mental health conditions, which led to greater mutual understanding, as well as reduced mental health stigma: "She [mother] talks to me about her own mental health, which makes me feel comfortable talking to her about mine”. Psychotherapy was described by both parents and adolescents as promoting the development of more effective communication strategies. A theme of increased communication about mental health during the COVID-19 pandemic was found, many times due to a greater amount of family time. Both parents and adolescents indicated that an established, trusting relationship was critical to the success of a conversation about mental health. Quantitative analysis revealed that parents reported a significantly higher quality of communication with their child (79.80, p = 0.04) than adolescents reported with their parent (71.75). Additionally, parents reported significantly lower barriers to help seeking (18.60, p = 0.002) than adolescents (24.00). Conclusions: The themes identified in this study lend insight into how communication between parents and adolescents about mental health might be improved and provide targets for potential educational interventions. Anti-stigma campaigns directed at parents may assist in disclosure of familial mental health history and assist in diminishing adolescents' apprehension of parents' dismissal or misinterpretation of mental health symptoms. For parents and adolescents with poor communication, targeted combined psychotherapy sessions can be encouraged as a means to facilitate conversation about mental health and establish trust. Sources of Support: National Institute of Mental Health K23MH111922

Hospital-acquired antibiotic-resistant organisms among patients with COVID-19

Background: We sought to use existing in-patient surveillance data to investigate the risk of hospital-acquired antimicrobial-resistant organisms (ARO) among patients with COVID-19 infection. Methods: Prospective case capture was done for patients admitted with COVID-19, as well as those admitted with ARO and Clostridioides difficile infections (CDI). Odds ratios (OR) were used to measure the strength of association between COVID-19 infection and the risk of acquiring hospital-acquired ARO and CDI. Results: The odds of acquiring ARO/CDI were statistically higher among patients with hospital-acquired and community-acquired COVID-19 infections (OR=2.68 and 1.79 respectively) compared to persons without COVID-19 (OR=0.53). Conclusions: Our results show an association between COVID-19 infection and the acquisition of ARO/CDI in the in-patient setting. This finding suggests that prolonged hospitalization may expose patients to hospital-acquired infections, and this may have relevance in the management of patients requiring hospitalization for extended periods of time.

Food Insecurity and Food Allergy in Children of an Urban Minority Community: A Cross-Sectional Study

Rationale: Childhood food insecurity was exacerbated during the COVID-19 pandemic, with burdens falling disproportionately on minority children. This study aims to describe the prevalence of food insecurity in food-allergic children of an urban minority community and examine the association between food insecurity and food allergy. Methods: We conducted a retrospective review of electronic medical records of all patients aged 6 months to 18 years seen in a primary care pediatric clinic at NYC Health + Hospitals/Kings County, from 10/2020 to 06/2022. Pediatricians at this clinic in Central Brooklyn routinely screen for food insecurity using the Hunger Vital Sign™, a validated tool recommended by the American Academy of Pediatrics. Data was collected based on ICD-10 diagnosis codes for food insecurity (Z59.41) and food allergy (Z91.01). Logistic regression was used for analysis. Results: Among 7,856 children included in the study, 84.9% were Black or African American, 6.0% Hispanic/Latinx, 1.2% white, and 1.1% were Asian/Pacific Islander. Of 275 children diagnosed with a food allergy by a primary care pediatrician, 4.7% screened positive for food insecurity. Of 7,581 children without a diagnosed food allergy, 2.6% screened positive for food insecurity (p=0.029). Children with food allergy (adjusted odds ratio: 2.14, 95% confidence interval: 1.19-3.85) were significantly more likely to be food insecure than those without a food allergy, adjusted for age, gender, and race/ethnicity. Conclusions: Childhood food allergy is associated with increased odds of food insecurity. This study highlights the importance of assessing and addressing food insecurity in children with food allergies.

Coronavirus Disease 2019 in Pediatric Emergency Room: The Dilemma of Cycle Threshold Value

Objective The havoc caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic could not have been predicted, with children being affected worldwide. Testing for SARS-CoV-2 infection helped to define the interventions against the spread of the disease. A polymerase chain reaction (PCR) test has been the mainstay of diagnostic testing. Cycle threshold (Ct) is a semiquantitative value that indicates approximately how much viral genetic material was in the sample. The aim of this study was to evaluate the impact of Ct values among children with SARS-CoV-2 infection. Methods Between May 3, 2020 and August 3, 2020, clinical laboratory input and the data of patients with positive SARS-CoV-2 PCR tests were retrospectively studied. Results There was no statistical significance between Ct values and the patient's status, symptoms other than fever, or other laboratory findings. However, the Ct value of patients who had symptoms at the time of admission to the hospital was significantly lower. Conclusion In this study, symptomatic patients had lower Ct than asymptomatic patients that reflected higher viral loads. In evidence-based medicine applications, it might be useful to correlate the clinical history with laboratory test results. Even symptomatic patients with high Ct value coinfections, or an alternative acute infection, should be considered. © 2022. Thieme. All rights reserved.

Short-course remdesivir for healthcare-associated COVID-19: Case series from a non-acute care hospital

Healthcare-associated COVID-19 among vulnerable patients leads to disproportionate morbidity and mortality. Early pharmacologic intervention may reduce negative sequelae and improve survival in such settings. This study aimed to describe outcome of patients with healthcare-associated COVID-19 who received early short-course remdesivir therapy. We reviewed the characteristics and outcome of hospitalized patients who developed COVID-19 during an outbreak that involved two wards at a non-acute care hospital in Japan and received short-course remdesivir. Forty-nine patients were diagnosed with COVID-19, 34 on a comprehensive inpatient rehabilitation ward and 15 on a combined palliative care and internal medicine ward. Forty-seven were symptomatic and 46 of them received remdesivir. The median age was 75, and the median Charlson comorbidity index was 6 among those who received it. Forty-one patients had received one or two doses of mRNA vaccines, while none had received a third dose. Most patients received 3 days of remdesivir. Of the patients followed up to 14 and 28 days from onset, 41/44 (95.3%) and 35/41(85.4%) were alive, respectively. Six deaths occurred by 28 days in the palliative care/internal medicine ward and two of them were possibly related to COVID-19. Among those who survived, the performance status was unchanged between the time of onset and at 28 days. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

The platelet-to-lymphocyte ratio versus neutrophil-to-lymphocyte ratio in prediction of COVID-19 outcome

Clinical presentation is an undependable prognostic indicator of COVID-19 (COronaVIrus Disease 2019). So, a more objective predictor is needed to precisely evaluate and classify the prognosis. Immune dysregulation to lymphocytes, mainly T-lymphocytes, have been noticed between COVID-19 patients. The aim. This study was planned to determine the role of platelet-to-lymphocyte count ratio and neutrophil-to-lymphocyte ratio in assessment of COVID-19 prognosis. Methods. 70 hospitalized patients with confirmed COVID-19 were included in this study. All included patients underwent a consistent clinical, radiological and blood examination. Laboratory analysis was made by means of a commercially accessible kit. Blood cells ratios were computed by dividing their absolute counts. Results. Non-significant association was found between laboratory data and COVID-19 clinical severity. A significant association between CT classification and platelet-to-lymphocyte count ratio (higher value in L type;p = 0.001) was detected. Platelet-to-lymphocyte count ratio was significantly higher among intubated cases. However, Non-significant association was found between neutrophil-to-lymphocyte ratio and need of endotracheal intubation. Conclusion. Routine blood values are abnormal in patients with COVID-19. Platelet-to-lymphocyte count ratio ratios could be used as more meaningful biomarker than other values in predicting the prognosis of COVID-19. LMR helpful in COVID-19 severity.

Recommendations for the transformation of patient rooms into isolated patient rooms in the process of the COVID-19 pandemic

In order to prevent the spread of Covid-19 and improve the treatment process, interest in hospital design and in-hospital transformation has increased worldwide. Since Covid-19 is not believed to be the last infectious health threat for communities around the world, it is of great importance to study existing hospital adaptations and work on obtaining more planning and design strategies for treatment and wellbeing areas. In this study it is aimed to make constructive recommendations on the basis of in-space planning and mechanical ventilation, which can be applied in hospital transformations for pandemic processes. Published guidelines and literature studies for hospitals to prevent the spread of infection have been examined, structured and unstructured interviews were conducted with architects and engineers specialized in hospital design. Also, a survey was conducted with 35 hospital workers and 4 people from the hospital management to analyze the changes made in the hospital during the Covid-19 process. Afterwards, the design plans of one of the two private hospitals studied in Turkey and the steps that can be applied in the transformation of patient rooms were explained in this article with the case study. Interdisciplinary work was carried in order to ensure infection control in hospital transformations, since it is required to make in-hospital space planning (separation/ transformation of spaces, interior zoning) and ventilation (filtration, zoning of mechanical ventilation) in harmony. Suggestions were developed that could play a role in ensuring the consistency of mechanical and architectural planning in order to successfully complete hospital transformation practices to prevent the spread of infections in pandemic processes. As the transformation scenarios in this study were performed through an exemplary private hospital room in accordance with the criteria of the Turkish Ministry of Health, ventilation plans on the standard room project were detailed and shown in the conclusion section, where the transformation steps can also be adapted to other hospitals. © 2023 Gazi Universitesi Muhendislik-Mimarlik. All rights reserved.

PREVALENCE AND HOSPITAL OUTCOME OF BACTERIAL CO-INFECTION IN RESPIRATORY TRACT SPECIMEN AMONG COVID 19 PATIENTS WITH SARS-COV-2 PNEUMONIA

Introduction: COVID-19, a zoonotic disease caused by the novel coronavirus SARS-CoV-2, is a highly transmittable pathogenic viral infection, infecting millions of people globally. Guidelines recommendthe use of empiric antimicrobials based on clinical judgment, patient host factors and local epidemiology in patients suspected or confirmed severe COVID-19. However, current evidence does not support a high rate of bacterial respiratory co-infections in patients with SARSCOV- 2 infection. At present, there is no known study regarding the prevalence of bacterial co-infection in COVID-19 patients in the Philippines Methods: This research is a cross-sectional hospital-based study that utilized hospital electronic and printed medical records, chest radiograph and microbiologic results. All respiratory specimen bacteriologic results for the year 2020 and 2021 were collected from the hospital laboratory unit followed by review of the hospital electronic records, printed medical records and chest radiograph results. Data were analyzed using Two-tailed Z-test for significance test for proportions and Chi-square test. Results: Among 100 subjects, only 22% (n = 22) of the subjects were found to have bacterial isolates. the only demographic that is dependent with presence of bacterial infection is gender. The three most common bacterial isolate among COVID confirmed patients are Klebsiella pneumoniae (n = 9), Pseudomonas aeruginosa (n = 5), and Acinetobacter baumannii (n = 3). Although the most common bacterial isolate is Klebsiella pneumoniae, the most common bacterial co-infection in patients who died are Acinetobacter baumannii (n = 2, 29%)and Pseudomonas aeruginosa (n = 2, 29%). Conclusion: The prevalence of bacterial co-infection among COVID confirmed patients is relatively low, hence appropriate guidelines regarding antibiotic use should be formed taking into consideration local data on antimicrobial resistance.