Non-COVID-19 In-Hospital Admission in a Large Academic Center in Belgium During the First Two Waves of the COVID-19 Pandemic.

BACKGROUND: Preliminary reports described a reduction in non-COVID admissions during the first wave of the pandemic including some of critical diseases such as cancer, myocardial and cerebral infarction. OBJECTIVE: The aim of our study was to evaluate the impact of the COVID-19 pandemic on non-COVID in-hospital admissions in a large academic center in Belgium. MATERIALS AND METHODS: We performed a retrospective study of non-COVID-19 in-hospital admissions during the first two waves of the COVID-19 pandemic. The average number of admissions per week in 2020 has been compared to that of the same period in 2019 and 2018. Comparisons were made first for all admissions, then by disease groups, using the classification of APRDRG, and then by diagnoses using ICD-10-CM classification. RESULTS: Overall in-hospital admissions were reduced by around 39% and 29% during the first and the second waves of the COVID-19 pandemic respectively compared to 2018 and 2019. No significant difference was found between the average number of admissions in the early-COVID and the pre-COVID baseline period during the two waves. The average number of admissions was significantly reduced in the peak-COVID period compared to the baseline (first wave: 332 versus 763 admissions/week, p<0.01, -57%; second wave: 496 versus 788 admissions/week, p<0.01, -37%), as well as in the late-COVID period compared to the baseline (first wave: 412 versus 763 admissions/week, p<0.01, -46%; second wave: 470 versus 788 admissions/week, p<0.01, -40%). Cancer, myocardial and cerebral infarction admissions were not statistically reduced during the the two waves of COVID pandemic compared to the pre-COVID period. CONCLUSION: Our study shows that non-COVID in-hospital admissions rates were substantially reduced during the first two waves of COVID-19 pandemic. In our study, cancer, myocardial and cerebral infarction admissions were not statistically reduced, which was not in accordance to what was described in the literature.

How to optimize the prescription of laboratory tests? Success and failures in an academic hospital.

In the context of the flat-rate reimbursements in healthcare, we reviewed physicians' behavior towards laboratory test ordering. We demonstrated how it could be improved when a specific stage of the patient management is considered. We took a multi-step approach to analyze the laboratory test orders in the context of planned laparoscopic cholecystectomy in a general teaching hospital. A reference order set was defined through a collaborative analysis between clinicians and laboratory physicians. The clinical and financial impacts were then evaluated over a period of 24 months. After the introduction of the reference order set, the number of laboratory tests per order decreased significantly for patients with cholecystitis of low severity. Above the monitoring of repeated orderings during a single stay, the major impacts were achieved by a drastic reduction of inappropriate orders, particularly in the field of bacteriology. The main effects of the order set were maintained throughout a follow-up period of 24 months. Our study demonstrated that, when considering laboratory test ordering optimization, reference order sets could achieve high levels of efficiency. To ensure high compliance to reference order sets, extensive collaboration between clinicians and laboratory physician is mandatory even if very sophisticated information systems are available.

[Iodine concentration in cooking salt consumed in Lubumbashi and the iodine status of vulnerable people: case study of pregnant women living in underprivileged areas]. / La teneur en iode du sel de cuisine consommé à Lubumbashi et le statut iode des personnes vulnérables: cas de femmes enceintes de milieux défavorisés.

INTRODUCTION: Consumption of low iodine salt can cause different types of disorders associated with iodine deficiency. This study aims to determine iodine content in table salt consumed in Lubumbashi and iodine status of pregnant women who are the main target of iodine deficiency. METHODS: aAdescriptive cross-sectional study was devoted to an iodometric iodine analysis of 739 salt samples collected from the households and the markets of Lubumbashi in 2014. Previously, urinary iodine concentrations were determined in 225 pregnant women received for consultation from 15 March 2009 to 25 April 2011 by mineralization technique using ammonium persulphate. RESULTS: Our survey found that 47.5% of the cooking salt samples were adequately iodized (from 15 to 40 ppm), 36,9% of the samples had low iodine levels, 7,4% of the samples had too much iodine and 8,1% of the samples were not iodized. Iodine concentration in the analyzed cooking salt reached an overall average of 54,9%, being clearly below the WHO Standards (90%). By measuring urinary iodine concentration of pregnant women, iodine deficiency (urinary iodine <150 µg/l) was observed in 52%. CONCLUSION: The low availability of iodine from consumed salt in Lubumbashi could be responsible for a large proportion of the observed iodine deficiency in pregnant women, exposing them to the major risks for disorders associated with iodine deficiency.

High prevalence of thyroid dysfunction among pregnant women in Lubumbashi, Democratic Republic of Congo.

BACKGROUND: Despite notable progress in the fight against iodine deficiency disorders in the Democratic Republic of Congo, a recent study has shown that pregnant women in Lubumbashi were still iodine deficient. Our objective was to assess thyroid function in this population. METHODS: In a cross-sectional study conducted in maternity units from three different socioeconomic areas in Lubumbashi, serum thyrotropin, free thyroxine, thyroglobulin, and thyroperoxidase antibodies were measured in 225 pregnant women attending antenatal visits, in 75 women who recently delivered, and in 75 nonpregnant controls. The outcome was the prevalence of thyroid dysfunction. RESULTS: Median values in pregnant women, women who recently delivered, and nonpregnant women were 1.80, 2.80, and 1.54 mIU/L for thyrotropin (p<0.001); 0.85, 1.11, and 1.16 ng/dL for free thyroxine (p<0.001); and 13.3, 9.5, and 10.4 ng/mL for thyroglobulin (p=0.01), respectively. The prevalence of thyroid dysfunction in pregnant women, in women who recently delivered, and in nonpregnant women was 31%, 8%, and 20% for isolated hypothyroxinemia (p<0.001); 12%, 24%, and 5% for subclinical hypothyroidism (p=0.002); 8%, 3%, and 3%, for overt hypothyroidism (p=0.09); and 5%, 13%, and 4%, for positive thyroperoxidase antibodies (p=0.03), respectively. In multiple logistic regression, women who were pregnant or who recently delivered, who lived in a poor socioeconomic area, and who had low urinary iodine concentration were more likely to have an increased serum thyrotropin: odds ratio (OR)=3.43 (95% confidence interval [CI] 1.23-9.53) for pregnancy, OR=4.49 [CI 1.66-15.01] for postpartum period, OR=3.68 [CI 1.85-7.35] for semiurban area, and OR=0.44 [CI 0.19-0.96] for urinary iodine concentration ≥ 250 µg/L. CONCLUSIONS: Our results show that there is a high prevalence of thyroid dysfunction in pregnant women of Lubumbashi, and this high prevalence is associated with iodine deficiency. To prevent obstetrical adverse outcomes and neurological damage in children, iodine supplementation is needed before conception or in early pregnancy in Lubumbashi.

Iodine and iron status of pregnant women in Lubumbashi, Democratic Republic of Congo.

OBJECTIVE: Adequate iodine and Fe intakes are imperative during pregnancy to prevent fetal defects, but such data are not available in the Democratic Republic of Congo. We aimed to assess iodine and Fe status in pregnant women from Lubumbashi. DESIGN: Cross-sectional study. We measured urinary iodine concentration (UIC) in random urine samples using a modified Sandell­Kolthoff digestion method; the WHO reference medians were used to classify iodine intake as deficient, adequate, more than adequate or excessive. Serum ferritin concentrations were measured by immunoenzymatic assay and considered insufficient when ,12 ng/ml. SETTING: Maternity units from rural, semi-urban and urban areas of Lubumbashi, Democratic Republic of Congo. SUBJECTS: Two hundred and twenty-five randomly selected pregnant women attending prenatal consultation, seventy-five postpartum women and seventy-five non-pregnant women as controls. RESULTS: Overall median UIC in pregnant women was 138 (interquartile range: 105­172) mg/l, indicating iodine deficiency, whereas postpartum and nonpregnant women had adequate iodine intake: median UIC5144mg/l and 204mg/l,respectively. Median UIC values were lower in late pregnancy than in early pregnancy: in the first, second and third trimester respectively 255mg/l, 70mg/l and 88mg/l in the rural area; 306mg/l, 166mg/l and 68mg/l in the semi-urban area; and 203mg/l, 174mg/l and 99mg/l in the urban area. Fe was insufficient in 39% of pregnant women compared with 21% of non-pregnant and postpartum women. In the third trimester, deficiencies in both iodine and Fe were high: 40%, 12% and 18% in the rural, semi-urban and urban areas, respectively. CONCLUSIONS: Our data suggest that pregnant women are at risk of iodine and Fe deficiencies in Lubumbashi. Country policies fighting against iodine and Fe deficiencies during pregnancy should be reinforced.

Evaluation of iodine content in table salt consumed in Democratic Republic of Congo.

BACKGROUND: DR Congo has adopted universal salt iodization to reduce disorders due to iodine deficiency. Since 1994, only iodized salt can be imported, but there is currently no routine monitoring of the iodine content of distributed salt. It is therefore unclear if iodine deficiency remains a health problem, particularly in pregnant women. OBJECTIVE: To evaluate the iodine content of salt in households of pregnant women in Lubumbashi. METHODS: We conducted a survey of the iodine content of salt consumed by 375 women presenting at prenatal consultations in three socially different areas of Lubumbashi: urban, semiurban, and rural. The women were questioned about where they purchased salt, how it was packaged, and how they stored the salt, and each woman provided a sample of salt for determination of its iodine content by the iodometric method. RESULTS: Most women (84.3%) bought salt in the public markets, mainly in bulk (93.6%); 80.0% stored salt in plastic boxes. The median iodine content was 27.5 ppm (IQR, 16.0-38.1) in urban areas, 19.0 ppm (IQR, 7.4-31.7) in semiurban areas, and 20.1 ppm (IQR, 5.3-31.7) in rural areas. The iodine content was less than 15 ppm (minimum threshold) in 36.3% of samples, including 13.9% without any detectable iodine. The iodine content was above 40 ppm (maximum limit) in 18.9% of samples. Only 44.8% of salt samples had adequate iodine content. CONCLUSIONS: The population of Lubumbashi remain at risk for hypothyroidism and hyperthyroidism. A effective and regular system for the control of iodin content in distributed salt is needed in DR Congo.