Clinical characteristics and outcomes of COVID-19 cases admitted to adult intensive care units during the pandemic: A single center experience.

BACKGROUND: COVID-19 is the largest recorded pandemic in history. It causes several complications such as shock, pneumonia, acute respiratory distress syndrome, and organ failure. The objective was to determine COVID-19 outcomes and risk factors in the intensive care (ICU) setting. METHODS: A retrospective review of prospectively collected data was conducted. Adult patients with a positive RT-PCR test for COVID-19 admitted to ICUs of a tertiary care hospital between 2020 and 2022 were included. Patients who had severe complex trauma were excluded. The outcomes examined included ventilation use and duration, length of stay (LOS), and mortality. RESULTS: A total of 964 patients were included. The mean ( ± standard deviation, SD) age was 63.7 ± 16.9 years. The majority of the patients were males (59.0 %) and Saudi (75.7 %). Ventilation use was documented in 443 (57.1 %) patients, with a mean ( ± SD) ventilation duration of 9.7 ± 8.4 days. Death occurred in 361 (37.4 %) patients after a mean ( ± SD) of 33.3 ± 44.5 days from infection. The mean ( ± SD) LOS was 30.6 ± 54.1 days in hospital and 5.2 ± 5.4 days in ICU. Ventilation use was associated with older age, males, longer ICU LOS, mortality, and admission to medical-surgical ICU. Crude mortality use was associated with older age, longer ICU LOS, use of ventilator, shorter ventilation duration, and admission to medical-surgical or respiratory ICUs. CONCLUSIONS: COVID-19 patients admitted to adult ICUs are at high risk of death and mechanical ventilation. The crude risks of both outcomes are higher in older age and longer ICU LOS and are very variable by ICU type.

Stability and removal of spironolactone from wastewater.

Stability and removal of spironolactone (SP) from wastewater produced at Al-Quds University Campus were investigated. Kinetic studies on both pure water and wastewater coming from secondary treatment (activated sludge) demonstrated that the potassium-sparing diuretic (water pill), spironolactone, underwent degradation to its hydrolytic derivative, canrenone, in both media. The first-order hydrolysis rate of SP in activated sludge at 25°C (3.80 × 10(-5) s(-1)) was about 49-fold larger than in pure water (7.4 × 10(-7) s(-1)). The overall performance of the wastewater treatment plant (WWTP) installed in the University Campus was assessed showing that more than 90% of spiked SP was removed together with its newly identified metabolites. In order to look for a technology to supplement or replace ultra-filtration membranes, the effectiveness of adsorption and filtration by micelle-clay filters for removing SP was tested in comparison with activated charcoal. Batch adsorption in aqueous suspensions was well described by Langmuir isotherms, showing a better removal by the micelle-clay material. Filtration of SP water solutions by columns filled with a mixture of sand and a micelle-clay complex showed complete removal of the drug at concentrations higher than in sand/activated-charcoal filled filters.

Stability and removal of atorvastatin, rosuvastatin and simvastatin from wastewater.

Atorvastatin (ATO), rosuvastatin (RST) and simvastatin (SIM) are commonly used drugs that belong to the statin family (lowering human blood cholesterol levels) and have been detected as contaminants in natural waters. Stability and removal of ATO, RST and SIM from spiked wastewater produced at the Al-Quds University campus were investigated. All three statins were found to undergo degradation in wastewater (activated sludge). The degradation reactions of the three drugs in wastewater at room temperature follow first-order kinetics with rate constants of 2.2 × 10⁻7 s⁻¹ (ATO), 1.8 × 10⁻7 s⁻¹ (RST) and 1.8 × 10⁻6 s⁻¹ (SIM), which are larger than those obtained in pure water under the same conditions, 1.9 × 10⁻8 s⁻¹ (ATO), 2.2 × 10⁻8 s⁻¹ (RST) and 6.2 × 10⁻7 s⁻¹ (SIM). Degradation products were identified by LC-MS and LC/MS/MS. The overall performance of the wastewater treatment plant (WWTP) installed in the Al-Quds University campus towards the removal of these drugs was assessed showing that more than 90% of spiked ATO, RST and SIM were removed. In order to evaluate the efficiency of alternative removal methods to replace ultra-filtration membranes, adsorption isotherms for the three statins were investigated using both activated carbon and clay-micelle complex as adsorbents. The batch adsorption isotherms for the three statins were found to fit the Langmuir equation, with a larger number of adsorption sites and binding affinity for micelle-clay composite compared with activated carbon and filtration experiments of the three statins and their corresponding metabolites demonstrated a more efficient removal by micelle-clay filters.