Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning

BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.

Facilitators and barriers to parent-child communication in pediatric palliative care:An integrative review

Objectives:This study aimed to identify facilitators and barriers to parent-child communication in pediatric palliative care,providing insights for medical professionals developing targeted interventions to enhance parent-child communication and improve its effectiveness.Methods:Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in six databases(Medline,Embase,CINAHL Complete,PsycINFO,Web of Science,and Cochrane Library).Peer-reviewer articles published in the English language from inception to December 2023.All of the identified studies were screened,extracted,and analyzed independently by two researchers.Results:Twenty-four articles were included.Thefindings of the relevant studies were analyzed using thematic analysis.Four themes were identified as facilitators:legacy-making,resilience training programs,guidance from the healthcare team,and positive communication.Seven themes were identified as barriers:denial,being unprepared and evasive,mutual protection,being overwhelmed by painful emotions and overloaded with information,incorrect views of medical professionals and parents,negative communication,and cultural context.Conclusions:Parents and professionals should avoid myths about protecting the child and encourage open communication that respects the child’s wishes.The specialized pediatric palliative care team should carefully monitor parent-child communication,determine if any obstacles exist,and design more interventions to enhance it.

Unveiling significant risk factors for intensive care unit-acquired weakness:Advancing preventive care

In this editorial,we discuss an article titled,“Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning,”published in a recent issue of the World Journal of Clinical Cases.Intensive care unit-acquired weakness(ICU-AW)is a debilitating condition that affects critically ill patients,with significant implications for patient outcomes and their quality of life.This study explored the use of artificial intelligence and machine learning techniques to predict ICU-AW occurrence and identify key risk factors.Data from a cohort of 1063 adult intensive care unit(ICU)patients were analyzed,with a particular emphasis on variables such as duration of ICU stay,duration of mechanical ventilation,doses of sedatives and vasopressors,and underlying comorbidities.A multilayer perceptron neural network model was developed,which exhibited a remarkable impressive prediction accuracy of 86.2%on the training set and 85.5%on the test set.The study highlights the importance of early prediction and intervention in mitigating ICU-AW risk and improving patient outcomes.

BILL Strategy:Points to Consider During the Performance and Interpretation of Critical Care Echocardiography

The growing utilization of critical care echocardiography(CCE)by clinicians necessitates a meticulous review of clinical conditions in critically ill patients,both before and during the examination.The reviewing process of clinical conditions minimizes the risk of overlooking or misinterpreting crucial findings.This article proposes a comprehensive strategy,namely BILL strategy to integrated into the CCE protocol,where“B”represents baseline respiratory and hemodynamic support,“I”signifies information gleaned from invasive monitoring,including central venous pressure and thermodilution-derived cardiac output,the first“L”denotes laboratory results such as central venous oxygen saturation,troponin,and brain natriuretic peptide,and the second“L”refers to lung ultrasound data.xx Combining the BILL strategy with CCE enhances a more comprehensive understanding of critical illness,potentially leading to improved diagnostic accuracy and patient outcomes.

Provision of Preconception Care by Midwives, Nurses and Doctors at Ndola Teaching Hospital in Ndola District, Zambia

Background: The goal of preconception care is to improve the outcome of a mother’s pregnancy and childbirth. Nevertheless, in most developing nations;Zambia included, there are still issues with implementation of preconception care. Therefore, the aim of this study was to establish the provision of preconception care by midwives, nurses and doctors at Ndola Teaching Hospital in Zambia. Methods: A concurrent embedded mixed methodology utilising a descriptive explorative study design, where 107 respondents were randomly selected using the lottery technique for quantitative part and two focused group discussions for qualitative part of the study was used. A self-administered questionnaire was used to collect quantitative data and a focus group discussion guide was used for the focus group discussions. Statistical Package of Social Sciences version 26 with significance set at 0.05 and at 95% confidence level and thematic analysis were used for data analysis. Results: 75% of the respondents in this study were not providing preconception care and only 25% of respondents were providing preconception care;however, this was provided randomly because there were no guidelines to follow. Among the respondents, 81.3% had medium knowledge, 70.1% had good practices and 92.5% had positive attitudes towards preconception care. Further analysis showed that the association between preconception care and knowledge, practices and attitudes was not statistically significant (p = values 0.336;0.344;1.000 respectively). Multivariate logistic regression revealed that participants with high knowledge were five times more likely to provide preconception care (OR = 5.00, CI = 0.42 - 59.7, P = 0.203). Generally, all the participants acknowledged that preconception care was an important package that could prevent maternal and child morbidities and mortalities. Conclusions: The study revealed that most of the respondents were not providing preconception care. Provision of preconception was done by a small fraction of the respondents and it was done in an unorderly manner due to lack of set standards and guidelines. Despite medium levels of knowledge and generally good practices and positive attitudes towards preconception care, its random provision indicates a need for established standards to enhance maternal and child health outcomes.

Risk Factors for Mortality in Acute Kidney Injury in Intensive Care Units in Togo

Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.

Prevalence and Factors Associated with Hypertension among People Living with HIV Receiving Care in Three Large HIV Clinics in Nasarawa State, Nigeria

In the last decade, the long-term survival among people living with HIV (PLHIV) has significantly improved. This is accompanied by an increased burden of non-communicable diseases such as hypertension due to the combined effect of the aging population and the metabolic effect of the Human Immuno-deficiency Virus (HIV) virion and antiretroviral therapy. This study aims to assess the prevalence and factors associated with hypertension among people living with HIV in three large health facilities in Nasarawa State, Nigeria. A descriptive cross-sectional study employed a multistage sampling technique to select 309 adults with HIV, 18 years and above, receiving HIV care in three large health facilities in Nasarawa State. The outcome variable was the participants’ self-reported history of hypertension, confirmed through a positive history of hypertension treatment. Exposure variables included the participant’s socio-demographic characteristics, lifestyle factors, and HIV care and treatment history. Data were presented using frequency tables. Factors associated with hypertension were assessed using binary logistic regression at a 0.05 level of statistical significance. A total of 309 adults living with HIV were sampled. A larger percentage of the participants were married 228 (73.8%), female, 191 (61.8%), within the age group 41 - 50 years, 141 (45.6%). Most of the participants had no family history of hypertension, 188 (60.8%). The prevalence of self-reported hypertension was 11.0% (34/309). Factors associated with hypertension at the bivariate level were age group 21 - 30 years, 41 - 50 years, being widow/widower, divorced, retired from employment or with family history of hypertension. Only participants age group 31 - 40 years [Adjusted Odd Ratio (AOR): 0.18, 95%CI: 0.04 - 0.91, p = 0.04] and family history of hypertension [(AOR): 83.44, 95%CI: 15.75 - 442.11, p < 0.01] were found to predict hypertension among the study participants after adjusting for confounders. In conclusion, Hypertension remains a public health issue among PLHIV. Factors associated with hypertension among PLHIV include age and family history of hypertension. Regular screening for hypertension, its appropriate treatment and optimal control are essential in PLHIV.

Analysis on the Way of Integrating Educational Drama into Patriotism Education for Primary School Students

In the process of patriotism education for primary school students,educational drama can play a very important role.However,the premise is that educational drama should be successfully integrated into the process of patriotism education of primary school students,instead of simply and mechanically stuffing educational drama into patriotism education of primary school students.As far as the integration mode of educational drama is concerned,educational drama can be divided into three kinds,namely,discipline-oriented drama education,infiltration-oriented drama education and activity-oriented drama.Therefore,the integration methods are also divided into three categories,namely,setting up educational drama courses,using educational drama to infiltrate patriotic education into other disciplines and carrying out activity-oriented drama education.

Investigation of Student Nurses’Attitudes towards End-of-Life Care and Their Influencing Factors

Background: This cross-sectional investigative study aimed to determine student nurses’ attitudes towards end-of-life care. Methods: This study used a descriptive research design with stratified sampling to survey student nurses enrolled in one of four nursing colleges in China from January 2023 to December 2023. Student nurses’ general demographic and prior related information, attitudes towards death and attitudes towards end-of-life care were determined using a general information questionnaire, the Death Attitude Profile—Revised scale and the Professional End-of-Life Attitude Scale (PEAS), respectively. Results: The total PEAS score was 122.91 ± 16.123. Significant differences were noted in the attitude towards end-of-life care scores according to sources of end-of-life care knowledge (P Conclusions: Student nurses lacked an optimistic attitude towards end-of-life care, which was influenced by differences in the sources of end-of-life care knowledge.

Factors influencing the employed caregiver burden for patients with dementia residing in nursing homes:A cross-sectional study from China

Objective:The institutionalization of care for patients with dementia is becoming a trend.Understanding the burden on employed caregivers and exploring associated factors are of great importance in practice.Therefore,this study aimed to examine the relationship between basic attributes,caring ability,and caregiver burden in employed caregivers practicing in nursing homes.Methods:This cross-sectional study included 541 employed caregivers in 11 four-star nursing homes in Zhejiang Province from April to December 2022.Caregiver burden was assessed using the Zarit Burden Interview(ZBI).Demographic characteristics of participants,characteristics of the older patients with dementia,caring characteristics,training in dementia care,and caring abilities were collected for analysis of influencing factors.A hierarchical multiple regression analysis was conducted to explore the factors influencing the burden on employed caregivers in nursing homes.Results:The ZBI score of employed caregivers in nursing homes was 40.42±10.18,representing a moderate caregiver burden.Factors such as age(U=27.82,P<0.001),residence(U=7.89,P<0.001),educational level(H=55.81,P<0.001),self-care of older patients with dementia(H=85.21,P<0.001),daily care hours(H=73.25,P<0.001),number of older people with dementia cared for(H=14.56,P<0.012)and training in dementia care(U=-9.43,P<0.001)were significantly associated with caregiver burden.Caring ability was negatively associated with caregiver burden(r=-0.22,P<0.01).Furthermore,after controlling for demographic characteristics,the characteristics of older people with dementia,caring characteristics,training in dementia care,and caring ability explained 8.5%,5.8%,and 4.8%of the caregiver burden,respectively.Conclusion:The burden of employed caregivers on patients with dementia in nursing homes can be attributed to various factors.We recommend tailored interventions,such as dementia care training and reviewing the number and duration of hours worked to reduce the burden experienced by caregivers.

Ozone Sterilizer for Treatment and Health Care

Ozone is a green broad-spectrum bactericidal disinfectant, and a trace amount of ozone in the atmosphere makes many viruses and bacteria lose their biochemical activity and infectivity. Nature produces trace amounts of ozone in the air through lightning to purify the ecological environment. The product of ozone decomposition is oxygen, without secondary pollution. Ozone sterilizer is widely used in the epidemic prevention and control of intensive breeding farms and achieved remarkable results. If the concentration and action time of ozone can be accurately controlled, then ozone can quickly eliminate pathogens, without harming the normal cells in the human body. How to use medical ozone for epidemic prevention, treatment and health care is a subject worthy of serious study, which should arouse the attention of the experts in the field.

In-hospital new-onset seizures in patients admitted to the medical intensive care unit:An observational study and algorithmic approach

BACKGROUND Seizures are one of the most common neurological complications encountered in the intensive care unit(ICU).They can occur in the background of exacerbation of a known neurological disease or secondary to non-neurological conditions such as sepsis and metabolic disturbances.However,there is a paucity of literature on the incidence and pattern of new-onset seizures in ICUs.AIM To study the incidence and patterns of new-onset seizures in patients admitted to the medical ICU.METHODS This was a prospective,multicenter,observational study performed in two tertiary care centers in Hyderabad,India over a period of 1 year.Patients upon ICU admission,who developed new-onset generalized tonic clonic seizures(GTCS),were enrolled.Those with a pre-existing seizure disorder,acute cerebrovascular accident,head injury,known structural brain lesions,or chronic liver disease were excluded as they have a higher likelihood of developing seizures.All enrolled patients were subjected to biochemical routines,radiological imaging of either computed tomography or magnetic resonance imaging,and other relevant laboratory tests as per clinical suspicion according to the protocol,and their data were recorded.Statistical analyses were conducted using descriptive statistics,χ2 tests,and linear regression.RESULTS A total of 61 of 2522 patients developed GTCS.Among all etiologies of seizures,metabolic causes were most frequent(35%)followed by infective causes(27%)and others(new-onset structural,drug withdrawal,druginduced,toxicology-related,and miscellaneous factors).Logistic regression analysis showed that increased sodium and calcium levels were associated with a lower likelihood of developing seizures.CONCLUSION This study identified the etiology of new-onset seizures developing in critically ill patients admitted to the ICU.These findings highlight the need for targeted monitoring of those at risk of developing seizures.

Wearable Healthcare and Continuous Vital Sign Monitoring with IoT Integration

Technical and accessibility issues in hospitals often prevent patients from receiving optimal mental and physical health care,which is essential for independent living,especially as societies age and chronic diseases like diabetes and cardiovascular disease become more common.Recent advances in the Internet of Things(IoT)-enabled wearable devices offer potential solutions for remote health monitoring and everyday activity recognition,gaining significant attention in personalized healthcare.This paper comprehensively reviews wearable healthcare technology integrated with the IoT for continuous vital sign monitoring.Relevant papers were extracted and analyzed using a systematic numerical review method,covering various aspects such as sports monitoring,disease detection,patient monitoring,and medical diagnosis.The review highlights the transformative impact of IoTenabled wearable devices in healthcare,facilitating real-time monitoring of vital signs,including blood pressure,temperature,oxygen levels,and heart rate.Results from the reviewed papers demonstrate high accuracy and efficiency in predicting health conditions,improving sports performance,enhancing patient care,and diagnosing diseases.The integration of IoT in wearable healthcare devices enables remote patient monitoring,personalized care,and efficient data transmission,ultimately transcending traditional boundaries of healthcare and leading to better patient outcomes.

Risk factors for intensive-care-unit-acquired weakness

Wang et al reported 1063 cases from the initial 14 d of intensive care unit(ICU)stay,and analyzed relevant data such as age,comorbidities,recent dosages,vapor pressure dosages,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,which are closely related to ICU-acquired weakness(ICUAW).It is suggested that the length of ICU stay and the duration of mechanical ventilation are the main factors.ICU-AW is the most common neuromuscular injury in the ICU,which affects clinical progression and outcomes of patients.This manuscript helps to improve the early recognition of ICU-AW,thereby reducing mortality and improving prognosis.

Intensive care unit-acquired weakness:Unveiling significant risk factors and preemptive strategies through machine learning

This editorial discusses an article recently published in the World Journal of Clinical Cases,focusing on risk factors associated with intensive care unit-acquired weak-ness(ICU-AW).ICU-AW is a serious neuromuscular complication seen in criti-cally ill patients,characterized by muscle dysfunction,weakness,and sensory impairments.Post-discharge,patients may encounter various obstacles impacting their quality of life.The pathogenesis involves intricate changes in muscle and nerve function,potentially leading to significant disabilities.Given its global significance,ICU-AW has become a key research area.The study identified critical risk factors using a multilayer perceptron neural network model,highlighting the impact of intensive care unit stay duration and mechanical ventilation duration on ICU-AW.Recommendations were provided for preventing ICU-AW,empha-sizing comprehensive interventions and risk factor mitigation.This editorial stresses the importance of external validation,cross-validation,and model tran-sparency to enhance model reliability.Moreover,the application of machine learning in clinical medicine has demonstrated clear benefits in improving disease understanding and treatment decisions.While machine learning presents oppor-tunities,challenges such as model reliability and data management necessitate thorough validation and ethical considerations.In conclusion,integrating ma-chine learning into healthcare offers significant potential and challenges.Enhan-cing data management,validating models,and upholding ethical standards are crucial for maximizing the benefits of machine learning in clinical practice.

Effect of information-motivation-behavioral skills model based perioperative nursing on pain in patients with gallstones

BACKGROUND The incidence of cholecystolithiasis is on the rise.Use of information,motivation,and behavioral skills can play a positive role in promoting changes in individual health behaviors.However,reports on the effects of information-motivationbehavioral(IMB)skills model based high-quality nursing as a perioperative nursing intervention for patients with gallstones are nonexistent.AIM To explore the application of IMB skills model based high-quality nursing in patients with gallstones.METHODS Two hundred and sixteen patients with cholecystolithiasis treated at our hospital from January 2022 to January 2023 were enrolled and divided into a control,highquality,and combined nursing groups,with 72 patients in each group.The control,high-quality,and combination groups received conventional,high-quality,and IMB skills model based perioperative nursing services,respectively.Differences in clinical indicators,stress levels,degree of pain,emotional state,and quality of life were observed,and complications and nursing satisfaction among the three groups were evaluated.RESULTS After nursing,the time to recovery of gastrointestinal function in the high-quality and combined nursing groups was significantly shorter than that of the control group,with the recovery of gastrointestinal function being the fastest in the combined nursing group(P<0.05).After nursing intervention,cortisol and norepinephrine levels in the high-quality and combined nursing groups were closer to normal than those of the control group 24 h after surgery,with the combined nursing group having the closest to normal levels(P<0.05).After 3 and 7 d of intervention,the patients’pain significantly improved,which was more prominent in the highquality and combination groups.Meanwhile,the pain score in the combination group was significantly lower than those of the control and high-quality nursing groups(P<0.05).After nursing intervention,the emotional states of all patients improved,and the scores of patients in the combination group were significantly lower than those of the control and high-quality nursing groups.The quality of life of patients in the high-quality and combined nursing groups significantly improved after nursing intervention compared to that of the control group,with the combined nursing group having the highest quality of life score.After intervention,the incidence of complications in the high-quality and combination groups was significantly lower than that of the control group(P<0.05),but the difference between the combination and high-quality nursing groups was not significant.Nursing satisfaction of patients in the high-quality and combination groups was significantly higher than that of the control group,with the nursing satisfaction being the highest in the combination group(P<0.05).CONCLUSION IMB skills model based nursing can improve surgical stress levels,degrees of pain,emotional state,quality of life,and nursing satisfaction of patients with gallstones and reduce the incidence of complications.

Future of neurocritical care:Integrating neurophysics,multimodal monitoring,and machine learning

Multimodal monitoring(MMM)in the intensive care unit(ICU)has become increasingly sophisticated with the integration of neurophysical principles.However,the challenge remains to select and interpret the most appropriate combination of neuromonitoring modalities to optimize patient outcomes.This manuscript reviewed current neuromonitoring tools,focusing on intracranial pressure,cerebral electrical activity,metabolism,and invasive and noninvasive autoregulation moni-toring.In addition,the integration of advanced machine learning and data science tools within the ICU were discussed.Invasive monitoring includes analysis of intracranial pressure waveforms,jugular venous oximetry,monitoring of brain tissue oxygenation,thermal diffusion flowmetry,electrocorticography,depth electroencephalography,and cerebral microdialysis.Noninvasive measures include transcranial Doppler,tympanic membrane displacement,near-infrared spectroscopy,optic nerve sheath diameter,positron emission tomography,and systemic hemodynamic monitoring including heart rate variability analysis.The neurophysical basis and clinical relevance of each method within the ICU setting were examined.Machine learning algorithms have shown promise by helping to analyze and interpret data in real time from continuous MMM tools,helping clinicians make more accurate and timely decisions.These algorithms can integrate diverse data streams to generate predictive models for patient outcomes and optimize treatment strategies.MMM,grounded in neurophysics,offers a more nuanced understanding of cerebral physiology and disease in the ICU.Although each modality has its strengths and limitations,its integrated use,especially in combination with machine learning algorithms,can offer invaluable information for individualized patient care.

Analysis of Distribution of Public Toilets within Walking Range around Communities of the Elderly under the Model of Community Home-based Care for the Elderly: A Case Study of Changxindian, Fengtai District, Beijing

In recent years,under the influence of multiple factors such as traditional ideas and living economic conditions,the aging population in China continues to increase.Most of the elderly are more inclined to aged at home,and the first places for elderly activities are communities and the surrounding environment,which greatly affects the convenience of life and happiness of the elderly.In this paper,Changxindian area in Fengtai District of Beijing was as the research object,and detailed calculation and analysis were carried out by using POI data and arcGIS software.The relative location of residential areas and surrounding public toilets was explored,and the best location of public toilets in the daily walking area under the model of community home-based care for the elderly was further studied.

Morbidity and Mortality of Acute Renal Failure in COVID-19 Patients in Intensive Care According to Waves/Variant: Case of the Grand Hôpital de l’Est Francilien Site de Meaux

Introduction: The incidence of acute renal failure (ARF) varies between 20% and 40% of cases for COVID-19 patients admitted to the intensive care unit, with very high mortality, but heterogeneous according to the different epidemic waves, probably due to the genetic variant phenomenon of the virus. The aim of this study is to determine the morbidity and mortality of COVID-19 patients admitted with ARF to the intensive care unit of the Grand H?pital Est Francilien (GHEF) according to the waves and variants. Methods: Cross-sectional observational study of COVID-19 patients with ARF admitted to the intensive care unit of the GHEF site in Meaux covering the period from March 1st 2020 to December, 31st 2021. Per-hospitalisation and outcome data were collected and analysed with SPSS version 25.0 software using the Chi-square or Fischer’s exact test or Student’s t-test and logistic regression for p Results: A total of 86 patients were included. The mean age was higher (70 ± 8.5) in patients in the fourth wave than in the other waves (p = 0.015), with male predominance in all waves without significant difference. Co-morbidities: hypertension, diabetes, heart disease, dyslipidaemia and arrhythmia complete with fibrillation were present in all waves. The majority of patients were classified as KDIGO 1 for the different waves (1st: 61.9%, 2nd: 86.5%, 3rd: 80%, and 4th: 75%), with the same trend according to variant (alpha: 80%, beta: 75%, delta: 81.3%, omicron: 75%). Mortality by the wave was: 1st: 28.5%, 2nd: 37.5%, 3rd: 23% and 4th: 11%) and by variant: alpha: 24.2%, beta: 44.8%, delta: 20.7%, omicron: 10.3%). Overall mortality was 33.7%. Case fatality was higher in the fourth wave. Hypertension, shock, failure to recover renal function, acute lung oedema, ventilator-associated lung disease and hyperkalaemia were factors associated with mortality (p Conclusion: Acute renal failure is common in COVID-19 patients admitted to the intensive care unit, and mortality is not negligible. The beta variants and the second wave presented more cases of renal impairment, although the mechanism is still unknown. Further studies are needed to understand this mechanism and perhaps to be able to identify the cause.