Background
The coronavirus disease 19 (COVID-19) pandemic has spread rapidly around the globe with considerable morbidity and mortality. Coexistence of comorbidities with COVID-19 had consistently been reported as risk factors for unfavorable outcome. We aimed to evaluate the impact of comorbidities in COVID-19 patients on the outcome and determine predictors of prolonged hospital stay, requisite for intensive care unit (ICU) admission. Four hundred and thirty-nine adult patients who are admitted through (June and July 2020) in our University Hospitals were included in the study. All participants were diagnosed with COVID-19 according to Egyptian Ministry of Health guidance as definite case or probable case.
Results
Patients with comorbidities represented 61.7% of all cases. Constitutional symptoms especially myalgia and lower respiratory tract (LRT) symptoms such as dyspnea were significantly …
Background
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a major cause for hospital admission and COPD(chronic obstructive pulmonary disease) related morbidity. This encouraged clinicians to search for useful and easy inflammatory biomarkers for recognizing AECOPD.
Objective
To evaluate the role of the neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP) in COPD patients for recognition of an acute exacerbation requiring hospital admission.
Patients and Methods
A prospective study included 100 hospitalized AECOPD patients, 88 stable COPD, and 80 sex and age matched healthy subjects. NLR and CRP were measured twice for each patient, first at hospital admission and the second was 3 months later as follow up. NLR was calculated from the complete blood count (CBC).
Results
The total white blood cell count (WBCs), Neutrophils, and NLR ratio were significantly higher in AECOPD group (P< 0.05 for each). CRP and forced expiratory volume in first second (FEV1% predicted) showed a significant correlation with NLR (P˂ 0.05). At cut off value˃ 3.26 for NLR the sensitivity and specificity were 84.7% and 78.0% respectively, whileat cut off value> 4.11 for CRP the sensitivity and specificity were 77.9 % and 68.2% respectively for the prediction of AECOPD.
Conclusion
Elevated NLR can be used as a marker similar to WBCs and CRP, in the detection of increased inflammation in hospitalized acutely exacerbated COPD patients.
Introduction
Cardiopulmonary exercise testing (CPET) is a non-invasive method for the determination of disability and comprehensive evaluation of exercise responses involving the cardiovascular, pulmonary and musculoskeletal systems.
Material and Methods
To assess exercise performance measured by CPET in different chronic obstructive pulmonary disease (COPD) stages and to compare between pulmonary function test (PFT) and CPET in assessing the degree of respiratory impairment. Sixty patients diagnosed with COPD were enrolled in the study. Modified Medical Research Council scale (mMRC) and COPD assessment test (CAT) to evaluate dyspnea symptom. PFT and CPET were performed.
Results
There was a significant decrease in peak VO 2 and anaerobic threshold in patients with stages III, IV (p< 0.001), while COPD stage I, II had significantly higher minute ventilation, tidal volume and oxygen pulse (p< 0.001). 76.67% of patients were similarly classified by CPET and PFT, while 23.33% were found to be less impaired according to CPET when compared to PFT. A significant correlation between both VE/VO2 (r= 0.31, 95% CI 0.19–0.92, p< 0.001) and VE/VCO2 (r= 0.69, 95% CI 0.86–1.08, P< 0.001) with FEV1. Whereas, an inverse correlation were found between both VE/VCO 2 (r=–0.34, 95% CI–0.77–1.11, p< 0.001) and VE/VO 2 (r=–0.55, 95% CI–0.88 to–0.15, p< 0.001), with the degree of air trapping as estimated by RV/TLC ratio. No significant correlation between neither CAT nor MRC and exercise testing parameters.
Conclusion
CPET is an extremely valuable method for the determination of functional capacity and …
Background
Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV.
Methods
This is a substudy of COVIP study—an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality.
Results
Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal …
Post COVID-19 syndrome, that is marked by dyspnea, fatigue, and functional impairment, is best treated with a non pharmacologic aproach entitled a physiotherapy intervention program.
Aim
To evaluate the effect of physiotherapy intervention program through telehealth on dyspnea, fatigue and functional status of post COVID-19 syndrome patients.
Design
The study utilized a one-group pre and posttest Quasi experimental design with a purposive sample of 60 post Covid-19 syndrome patients.
Setting
Isolation Medical Unit and Post Covid-19 follow up clinic in main Assiut University Hospital.
Tools
Data were collected using a structured interview Patient's assessment questionnaire, Modified Medical Research Council Dyspnoea Scale, Chalder fatigue scale, and Post COVID-19 Functional Status Scale.
Results
statistically extremely significant differences regarding degrees of dyspnea , extent of fatigue, and functional status of post Covid-19 syndrome patients in pre, post (8th wks.), and follow up (12th wk.) of program application with (p=0.001).
Conclusion
Physiotherapy intervention program applied through telehealth had significant improvement clinically and statistically on dyspnea, fatigue, and functional status.
Recommendations
Telehealth is especially important currently, as social distancing measures thus using this intervention program by nurses can be effective in improving post Covid-19 syndrome symptoms.
GeneXpert MTB/RIF (Mycobacterium tuberculosis/rifampicin) assay is a method for detecting rifampicin resistance (RR-MTB) in suspected samples in less than 2 hours with high sensitivity and specificity yield. This study aimed to use the GeneXpert MTB/RIF assay to determine the frequency of RR-MTB and to study the possible influencing correlates associated with positive results.
This is a retrospective cross-sectional study of patients who visited TB clinic in 5 years (2016–2021). According to the data sheet of the patients, all the collected specimens were divided into 2 parts one for diagnosis by Ziehl–Neelsen stain and the other part for GeneXpert analysis. GeneXpert was also used to look for evidence of RR.
Out of the 2605 total samples screened, 718 (27.6%) tested positive for MTB on GeneXpert assay; of them 633 (88.4%) were sensitive to Rifampicin, 83 (11.6%) were resistant to Rifampicin and 2 cases were undetermined. Factors contributing to RR-MTB were: smoker/ex-smoker, with 2.5 times more risk (p = 0.013.0, p = 0.001); recurrence cases had a 4-fold increased risk (p < 0.001); patients with very low M. tuberculosis detected on the GeneXpert MTB/RIF test were 8 times more likely to have RR-TB (P = 0.004).
This study disclosed a high-rate MTB in Egyptian probable TB cases. Smoking, recurrence and cases with a very low M. tuberculosis burden noticed on the GeneXpert MTB/RIF test had augmented risk of RR-TB.
Method: Survey was done and validated to health care worker sectors, patients and judicial workers sectors, to evaluate the telemedicine according to their practice.
Results: about one thousand volunteers shared in this study, 616 (61.3%), 68 (6.8%) judicial workers, and 320 (31.9%) other jobs. Most of doctors 95% of them refuse to use telemedicine in the provisional diagnosis, 77.3% claim that it is very difficult to give accurate diagnosis through media, 75.6% of them convinced that telemedicine and increase the malpractice issues and medical responsibilities. In judicial workers 64.7% of them prove that there is increase in malpractice issues due to use of media. On the other side 55% of the other job sectors agree with the use of telemedicine especially in time of epidemics.
Conclusion: Telemedicine has many pros and cons. The main cons were that the inability to give the actual diagnosis and occurrence of medical errors, while the main pros was that the use of telemedicine to follow up already diagnosed patient. Governments should legalize the using of telemedicine by enacting law that prohibit the use of it except between doctors to take medical decision or exchange opinion.
Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score.
Until now, there are more than two hundred million confirmed cases of COVID-19 including more than seven million deaths. Clinical trials of all three vaccines authorized for use in the UK (Pfizer–BioNTech, Oxford–AstraZeneca, and Moderna) have reported high vaccine efficacy. This rapid systematic review was initiated because no systematic review had been conducted to determine the safety and efficacy of AstraZeneca ChAdOx1 nCoV-19 vaccine.
Evidence acquisition
A systematic search in the following platforms: PubMed, Google Scholar, Scopus, WOS, and MEDLINE databases for all articles in the English language regarding safety and efficacy of SARS-CoV-2 vaccine ChAdOx1 nCoV-19 was performed. Papers published up to end of June were included.
Evidence synthesis
Out of 477 retrieved articles, fifteen are included. All the selected articles are concerned with evaluation of AstraZeneca ChAdOx1
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