Mental health status among COVID-19 patients survivors of critical illness in Saudi Arabia:A 6-month follow-up questionnaire study

BACKGROUND Psychological assessment after intensive care unit(ICU)discharge is increasingly used to assess patients'cognitive and psychological well-being.However,few studies have examined those who recovered from coronavirus disease 2019(COVID-19).There is a paucity of data from the Middle East assessing the post-ICU discharge mental health status of patients who had COVID-19.AIM To evaluate anxiety and depression among patients who had severe COVID-19.METHODS This is a prospective single-center follow-up questionnaire-based study of adults who were admitted to the ICU or under ICU consultation for>24 h for COVID-19.Eligible patients were contacted via telephone.The patient’s anxiety and depression six months after ICU discharge were assessed using the Hospital Anxiety and Depression Scale(HADS).The primary outcome was the mean HADS score.The secondary outcomes were risk factors of anxiety and/or depression.RESULTS Patients who were admitted to the ICU because of COVID-19 were screened(n=518).Of these,48 completed the questionnaires.The mean age was 56.3±17.2 years.Thirty patients(62.5%)were male.The main comorbidities were endocrine(n=24,50%)and cardiovascular(n=21,43.8%)diseases.The mean overall HADS score for anxiety and depression at 6 months post-ICU discharge was 11.4(SD±8.5).A HADS score of>7 for anxiety and depression was detected in 15 patients(30%)and 18 patients(36%),respectively.Results from the multivariable ordered logistic regression demonstrated that vasopressor use was associated with the development of anxiety and depression[odds ratio(OR)39.06,95% confidence interval:1.309-1165.8;P<0.05].CONCLUSION Six months after ICU discharge,30% of patients who had COVID-19 demonstrated a HADS score that confirmed anxiety and depression.To compare the psychological status of patients following an ICU admission(with vs without COVID-19),further studies are warranted.

Dosage and utilization of dexamethasone in the management of COVID-19: A critical review

BACKGROUND The severe respiratory manifestations observed in severe coronavirus disease 2019(COVID-19)cases are often associated with an excessive inflammatory response.Dexamethasone,a synthetic glucocorticoid,exerts its anti-inflammatory effects by inhibiting the transcription of pro-inflammatory genes and suppressing the activity of various immune cells.This mechanism has implications for mitigating the cytokine storm observed in severe COVID-19 cases.Early on in the pandemic,the Recovery Collaborative working group showed a mortality benefit of using dexamethasone in decreasing mortality in patients with COVID-19 requiring respiratory support.However,the optimal dosage of corticosteroids remains debatable.Several studies that compare different doses of dexamethasone in COVID-19 exist,but the results are conflicting.AIM To review the latest evidence regarding dosage,safety,and efficacy of dexamethasone in severe COVID-19.METHODS We followed preferred reporting items for systematic reviews and meta-analysis guidelines.A detailed literature search was conducted across PubMed,Google Scholar,and Medline to include publications up to March 2024.Our keywords included“COVID-19”“SARS-CoV-2”“dexamethasone”“corticosteroid”“steroid”and“glucocorticoid”-along with their combinations.We employed the Cochrane Risk of Bias Tool and the Newcastle-Ottawa scale to evaluate the integrity and potential of bias in the included studies.A meta-analysis was conducted using a random-effects model,assessing pooled odds ratios and mean differences,with heterogeneity gauged by the I2 statistic and theχ^(2) tests.RESULTS No statistical differences were found in 28-day all-cause mortality[pooled odds ratio(OR)=1.109,95%CI:0.918-1.340],60-day all-cause mortality(OR=0.873,95%CI:0.744-1.024;I2=47.29%),mean length of hospital stay(mean difference=-0.08 days,95%CI:-0.001 to 0.161)and adverse events(OR=0.877,95%CI:0.707-1.087).CONCLUSION Differing doses of corticosteroids have no clinical implications on mortality,mean length of hospital stay,and adverse events in COVID-19 patients.Additional research is required in patients requiring invasive or noninvasive ventilation.

Acute gastrointestinal injury in critically ill patients with COVID-19 in Wuhan,China

BACKGROUND The coronavirus disease 2019(COVID-19)is spreading rapidly around the world.Most critically ill patients have organ injury,including acute respiratory distress syndrome,acute kidney injury,cardiac injury,or liver dysfunction.However,few studies on acute gastrointestinal injury(AGI)have been reported in critically ill patients with COVID-19.AIM To investigate the prevalence and outcomes of AGI in critically ill patients with COVID-19.METHODS In this retrospective study,demographic data,laboratory parameters,AGI grades,clinical severity and outcomes were collected.The primary endpoints were AGI incidence and 28-d mortality.RESULTS From February 10 to March 102020,83 critically ill patients out of 1314 patients with COVID-19 were enrolled.Seventy-two(86.7%)patients had AGI during hospital stay,of these patients,30 had AGI gradeⅠ,35 had AGI gradeⅡ,5 had AGI gradeⅢ,and 2 had AGI gradeⅣ.The incidence of AGI gradeⅡand above was 50.6%.Forty(48.2%)patients died within 28 days of admission.Multiple organ dysfunction syndrome developed in 58(69.9%)patients,and septic shock in 16(19.3%)patients.Patients with worse AGI grades had worse clinical variables,a higher incidence of septic shock and 28-d mortality.Sequential organ failure assessment(SOFA)scores(95%CI:1.374-2.860;P<0.001),white blood cell(WBC)counts(95%CI:1.037-1.379;P=0.014),and duration of mechanical ventilation(MV)(95%CI:1.020-1.340;P=0.025)were risk factors for the development of AGI gradeⅡand above.CONCLUSION The incidence of AGI was 86.7%,and hospital mortality was 48.2%in critically ill patients with COVID-19.SOFA scores,WBC counts,and duration of MV were risk factors for the development of AGI gradeⅡand above.Patients with worse AGI grades had a higher incidence of septic shock and 28-d mortality.

Clinical considerations for critically ill COVID-19 cancer patients:A systematic review

BACKGROUND The World Health Organization(WHO)on March 11,2020,had declared the novel coronavirus disease 2019(COVID-19)outbreak a global pandemic.The COVID-19 infection continues to be a pandemic and is currently causing overwhelming challenges to healthcare across the nations.Cancer patients represent a unique population vulnerable to COVID-19 infection due to their advanced age,intrinsic frailty,medical comorbidities,immunosuppression,and frequent health care visits for their underlying disease.Robust analysis of COVID-19 infection among cancer patients is crucial to aid in the optimal management of these patients.AIM To identify contributors of worse outcomes in patients with malignancy and COVID-19 and to describe the role of critical care.METHODS In this review,we summarized the information from seminal articles on the presentation and management of patients with COVID-19 and malignancy that were published before December 10,2020.We searched the Pub Med and Medline database for“COVID-19”and“Cancer”,“Malignancy”.Studies published in English,including adults with malignancy and COVID-19 infection,were eligible to be included in this review.Studies on patients that provided details on malignancy,clinical presentation,management,and outcome were included.Various details of malignancy that were included are the site of cancer,histopathological type,stage,chemotherapy,and immunotherapy.Details of COVID-19 infection that were obtained are clinical presentation,the modality of testing,imaging,management,and outcome.Critical care details that were obtained were the type of the organ dysfunction and the requirement of organ support measures,requirement of noninvasive,invasive ventilation,management of vasopressor support,and outcome.Articles that did not have patient details,opinions,letters,and articles not published in English were excluded.All articles were reviewed by 2 independent clinicians.Articles were screened for the above terminologies by independent clinicians.RESULTS We identified two thousand one hundred eighty-six articles,among which fiftyfive were studies that had included patient details pertaining to COVID-19 and cancer(Figure 1).Among these,eighteen studies were eligible and were included in this review as shown in Table 1.A total of 5199 cancer patients were reported.The mean age of patients across all the studies was 64.3 years with male predominance was noted in 12 studies.The clinical presentation and diagnosis of these patients were similar to the general population.Most commonly reported malignancies with COVID-19 infection were hematological in 44%of patients,followed by thoracic malignancy in 11%of patients.The mean number of cancer patients with COVID-19 requiring critical care was 16%.The mean mortality reported was 27.4%.Among the studies that reported the presence of organ dysfunction,respiratory failure was reported in 52%of patients,of which 11.7%required mechanical ventilation.72%of COVID-19 cancer patients required hospitalization across all the studies.The factors which are associated with the worse outcome from COVID-19 infections among the cancer patients were male gender,age≥65 years,presence of higher comorbidity burden based on Charlson comorbidity index and cumulative illness reporting scale>6,and smoking history.CONCLUSION The majority of the cancer patients required intensive care due to respiratory failure and the need for mechanical ventilation.Appropriate contingency planning for these patients in terms of goals of care and judicious resource allocation in the resource-poor regions is the key.The factors associated with worse outcomes from COVID-19 infections were independent of oncological features such as tumor stage,disease status,or current provision of active anticancer therapy and it could be continued with caution.

Immunomodulatory therapy for the management of critically ill patients with COVID-19:A narrative review

BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the causative agent of the ongoing coronavirus disease 2019(COVID-19)pandemic.Understanding the physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective therapies.AIM To describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of hyperinflammation and abnormal immune responses to disease progression together with a complete narrative review of the different immunoadjuvant treatments used so far in COVID-19 and their indication in severe and life-threatening subsets.METHODS A comprehensive literature search was developed.Authors reviewed the selected manuscripts following the PRISMA recommendations for systematic review and meta-analysis documents and selected the most appropriate.Finally,a recommendation of the use of each treatment was established based on the level of evidence of the articles and documents reviewed.This recommendation was made based on the consensus of all the authors.RESULTS A brief rationale on the SARS-CoV-2 pathogenesis,immune response,and inflammation was developed.The usefulness of 10 different families of treatments related to inflammation and immunopathogenesis of COVID-19 was reviewed and discussed.Finally,based on the level of scientific evidence,a recommendation was established for each of them.CONCLUSION Although several promising therapies exist,only the use of corticosteroids and tocilizumab(or sarilumab in absence of this)have demonstrated evidence enough to recommend its use in critically ill patients with COVID-19.Endotypes including both,clinical and biological characteristics can constitute specific targets for better select certain therapies based on an individualized approach to treatment.

Challenges in hyperglycemia management in critically ill patients with COVID-19

Hyperglycemia is commonly associated with adverse outcomes especially in patients requiring intensive care unit stay.Data from the corona virus disease 2019(COVID-19)pandemic indicates that individuals with diabetes appear to be at similar risk for COVID-19 infection to those without diabetes but are more likely to experience increased morbidity and mortality.The proposed hypothesis for hyperglycemia in COVID-19 include insulin resistance,critical illness hyperglycemia(stress-induced hyperglycemia)secondary to high levels of hormones like cortisol and catecholamines that counteract insulin action,acute cytokine storm and pancreatic cell dysfunction.Diabetic patients are more likely to have severe hyperglycemic complications including diabetic ketoacidosis and hyperosmolar hyperglycemic state.Management of hyperglycemia in COVID-19 is often complicated by use of steroids,prolonged total parenteral or enteral nutrition,frequent acute hyperglycemic events,and restrictions with fluid management due to acute respiratory distress syndrome.While managing hyperglycemia special attention should be paid to mode of insulin delivery,frequency of glucose monitoring based on patient and caregiver safety thereby minimizing exposure and conserving personal protective equipment.In this article we describe the pathophysiology of hyperglycemia,challenges encountered in managing hyperglycemia,and review some potential solutions to address them.

Clinical features and risk factors of severely and critically ill patients with COVID-19

BACKGROUND As of June 1,2020,over 370000 coronavirus disease 2019(COVID-19)deaths have been reported to the World Health Organization.However,the risk factors for patients with moderate-to-severe or severe-to-critical COVID-19 remain unclear.AIM To explore the characteristics and predictive markers of severely and critically ill patients with COVID-19.METHODS A retrospective study was conducted at the B11 Zhongfaxincheng campus and E1-3 Guanggu campus of Tongji Hospital affiliated with Huazhong University of Science and Technology in Wuhan.Patients with COVID-19 admitted from 1st February 2020 to 8th March 2020 were enrolled and categorized into 3 groups:The moderate group,severe group and critically ill group.Epidemiological data,demographic data,clinical symptoms and outcomes,complications,laboratory tests and radiographic examinations were collected retrospectively from the hospital information system and then compared between groups.RESULTS A total of 126 patients were enrolled.There were 59 in the moderate group,49 in the severe group,and 18 in the critically ill group.Multivariate logistic regression analysis showed that age[odd ratio(OR)=1.055,95%(confidence interval)CI:1.099-1.104],elevated neutrophil-to-lymphocyte ratios(OR=4.019,95%CI:1.045-15.467)and elevated high-sensitivity cardiac troponin I(OR=10.126,95%CI:1.088-94.247)were high-risk factors.CONCLUSION The following indicators can help clinicians identify patients with severe COVID-19 at an early stage:age,an elevated neutrophil-to-lymphocyte ratio and high sensitivity cardiac troponin I.

Standardization of critical care management of non-critically ill patients with COVID-19

The large global outbreak of coronavirus disease 2019(COVID-19)has seriously endangered the health care system in China and globally.The sudden surge of patients with severe acute respiratory syndrome coronavirus 2 infection has revealed the shortage of critical care medicine resources and intensivists.Currently,the management of non-critically ill patients with COVID-19 is performed mostly by non-intensive care unit(ICU)physicians,who lack the required professional knowledge,training,and practice in critical care medicine,especially in terms of continuous monitoring of the respiratory function,intervention,and feedback on treatment effects.This clinical problem needs an urgent solution.Therefore,here,we propose a series of clinical strategies for non-ICU physicians aimed at the standardization of the management of non-critically ill patients with COVID-19 from the perspective of critical care medicine.Isolation management is performed to facilitate the implementation of hierarchical monitoring and intervention to ensure the reasonable distribution of scarce critical care medical resources and intensivists,highlight the key patients,timely detection of disease progression,and early and appropriate intervention and organ function support,and thus improve the prognosis.Different management objectives are also set based on the high-risk factors and the severity of patients with COVID-19.The approaches suggested herein will facilitate the timely detection of disease progression,and thus ensure the provision of early and appropriate intervention and organ function support,which will eventually improve the prognosis.

Overcoming Adversity:The Severe COVID-19 Illness Experience

This viral outbreak of the novel SARS-CoV-2 has profoundly disrupted lives globally and has placed unparalleled burdens on individual physical and psychological health.It is imperative to comprehend the psychological journey of COVID-19 patients to provide them with effective care.This study aimed to explore the psychological illness experience of severe COVID-19 survivors from the first symptoms,to hospitalization,recovery,and post-discharge adjustment.Semi-structured interviews were conducted from November 2022 to April 2023,with 30 Romanian former COVID-19 patients.Thematic analysis of transcribed interviews identified four major themes:(1)a distant threat;(2)the tipping point;(3)the turning point;and(4)readjustment and growth.Some participants faced denial or uncertainty early on,misattributing symptoms and delaying seeking care.Hospitalization as a last resort brought anxiety,isolation,and closer confrontations with mortality perception.As symptoms improved,and participants received supportive care from both healthcare professionals and family members,hope and optimism appeared.Despite health improvements and feelings of safety,lingering anxiety persisted.Post-discharge adjustment involved managing lasting effects and selectively resuming activities.For some of the participants,reflection afterward prompted greater self-understanding,empathy and connection,and motivation for self-care.The results have implications for healthcare practitioners,policymakers,and researchers.

Applied Technology to Produce Chlorella Jelly Genki in Order to Increase Human Body Immunity from Covid-19 Illness

The Covid-19 was first confirmed in Indonesia on 2 March 2020.The pandemic has spread to 34 provinces in country with Jakarta,West Java,East Java and Riau being the worst hit.So far,Indonesia has 3,693,272,616 cases,the 6th highest in world behind America,India,Brasil,and Turkey.So it is very important to increase the human body immunity by absorbing CO_(2),haze,dust,tiny particle,and Covid-19,and producing O_(2)in the surrounding area and Chlorella powder as supplement food to prevent fatality of the human being.The Dahril Bottle is a place to culture Chlorella sp.in a closed room to absorb CO_(2),haze,dust,tiny particle,COVID-19,and produce O_(2)in the surrounding area and Chlorella powder that can be used as supplement food to increase the immunity of human body from COVID-19 illness.Based on the result of this study it is indicated that Chlorella with chlorophyll-a inside can grow well in the Dahril Bottle to absorb CO_(2)and produce O_(2)with a chemical reaction as follow,6CO_(2)+6H_(2)O→C_(6)H_(12)O_(6)+O_(2)↑.The high concentration of cell density was found 1.2×10^(7)cells/mL,chlorophyll-a concentration of 184.09μg/L,and Chlorella powder,1.25 g/L,and CO_(2)decreased from 18.36 mg/L to 1.24 mg/L or 93.34%,O_(2)increased from 3.76 mg/L to 6.21 mg/L or 65.15%.The chemical compound of Chlorella powder was also high with a protein level of 45.09%,lipid 10.85%,and carbohydrate 12.77%.They also contain:vitamin E,mineral,beta-carotene,and antioxidant essence.Chlorella Jelly Genki that is made in this study can be used as a supplement food to increase the immunity of the human body to prevent Covid-19 illness.

Heart failure in COVID-19 patients:Critical care experience

Patients with heart failure(HF)may be at a higher risk of coronavirus disease 2019(COVID-19)infection and may have a worse outcome due to their comorbid conditions and advanced age.In this narrative review,we aim to study the interaction between COVID-19 and HF from a critical care perspective.We performed a systematic search for studies that reported HF and critical carerelated outcomes in COVID-19 patients in the PubMed and Medline databases.From a total of 1050 papers,we identified 26 that satisfied the eligibility criteria for our review.Data such as patient demographics,HF,intensive care unit(ICU)admission,management,and outcome were extracted from these studies and analyzed.We reported outcomes in heart-transplant patients with COVID-19 separately.In hospitalized patients with COVID-19,the prevalence of HF varied between 4%and 21%.The requirement for ICU admission was between 8%and 33%.HF patients with COVID-19 had an overall mortality rate between 20%and 40%.We identified that HF is an independent predictor of mortality in hospitalized COVID-19 patients,and patients with HF were more likely to require ventilation,ICU admission and develop complications.Patients with HF with reduced ejection fraction did worse than those with HF with midrange ejection fraction,and HF with preserved ejection fraction.COVID-19 patients with HF should be identified early and managed aggressively in an attempt to improve outcomes in this cohort of patients.

Symptomatic and optimal supportive care of critical COVID-19:A case report and literature review

BACKGROUND Coronavirus disease 2019(COVID-19)severity is classified as asymptomatic,mild,moderate,severe,and critical.Mild cases account for a large percentage of cases in the epidemic and typically exhibit a favorable prognosis.However,a 49%-67%mortality is noted in critical cases.No COVID-19-specific drug has been reported to date,and symptomatic and optimal supportive care,including oxygenation,anti-coinfection treatments,and ventilation,represent the mainstay of treatment for this disease,especially in critical patients.CASE SUMMARY In the above-mentioned context,we share our experience with the treatment of one critical COVID-19 case and review the relevant literature.CONCLUSION Timely tracheal intubation,reasonable mechanical ventilation support,appropriate anti-infection treatment,and early anticoagulation and immunity support are key factors in the successful treatment of this case.

Mortality of critical care interventions in the COVID-19:A systematic review

BACKGROUND The novel coronavirus severe acute respiratory syndrome coronavirus 2 is associated with a severe disease known as coronavirus disease 2019(COVID-19).A small percentage of patients with COVID-19 will require intensive care and possibly mechanical ventilation.The mortality of intensive care interventions in patients with COVID-19 remains unclear.AIM To identify mortality rate of COVID-19 patients receiving different interventions in the critical care unit.METHODS We searched OVID Medline,SCOPUS,MedRxIv,preprints.org,and Centers for Disease Control databases from November 2019 to April 10,2020 for articles on COVID-19.Teams of 2 independent reviewers reviewed titles and abstract for studies that reported mortality of human adults with COVID-19 and exposure to a critical care intervention[Intensive care admission,mechanical ventilation,acute hemodialysis,extracorporeal membrane oxygenation,or cardiopulmonary resuscitation(CPR)].We used a descriptive analysis and unweighted averages of mortality across studies.RESULTS Our search identified 6973 articles and 20 met inclusion:17 for intensive care,13 for mechanical ventilation,5 for hemodialysis,2 for extracorporeal membrane oxygenation,and 1 for CPR.Mortality associated with intensive care admission ranged from 9%-83%,with overall mortality 32.5%(95%CI:32.4%-32.6%).Mortality associated with intubation from 16.7%-100%with overall mortality 64.0%(95%CI:62.4%-65.5%).In patients requiring hemodialysis,mortality ranged from 0%-100%,with average mortality 75.3%(95%CI:72.6%-77.4%).CONCLUSION Patients with COVID-19 requiring intensive care have high mortality rates.Authorities can use this data to establish pharmacoeconomic studies to make decisions about allocation of scarce resources if necessary.

Analysis of Antibiotic Usage in Critical COVID-19 Patients with Secondary Infections

Background: Infrequent data exist on the frequency of bacterial co-infections and secondary infection among COVID-19-infected patients admitted to intensive care units (ICU). Objective: To describe the quantity and the quality of antimicrobial usage in COVID-19 with secondary infection, multiple drug resistance organisms and the outcome of antimicrobial treatment. Methods: This study applies observational design with a cross sectional approach. All the patients with laboratory-confirmed severe COVID-19 pneumonia who were discharged from the Intensive Care Unit (ICU) Dr. Ramelan Navy Hospital from February 1st to June 30th 2022 included. The quantity of antibiotics usage was assessed by counting the Defined Daily Dose (DDD). Result: During the study period, 126 patients were referred to the ICU for COVID-19 with severe pneumonia. There were 70.6% (89 patients) treated with antibiotics and 29.4% (37 patients) untreated with antibiotics. Quantitative analysis of 89 patients revealed that levofloxacin was the most common antibiotic prescribed with 43 DDD, followed by Meropenem and Cefoperazone-Sulbactam, which were 17.76 DDD and 16.87 DDD, respectively. Meanwhile, qualitative analysis resulted in 81 antibiotics (43.55%) being used appropriately. No indications of the use of antibiotics were found in 53 antibiotics (28.49%). Klebsiella pneumonia was the main pathogen identified in the blood, sputum. While E. Coli was found to be the main pathogen in urine. Conclusion: A high death rate in patients treated with antibiotics compared to patients not treated with antibiotics.

Predictors of severe and critical COVID-19:A systematic review

BACKGROUND Coronavirus disease 2019(COVID-19)has emerged as a public health crisis that was declared as a global pandemic by the World Health Organization.Although most cases have no or mild symptoms,around 10%of patients develop severe or critical illness that necessitates hospitalization and intensive care unit admission.AIM To assess the literature for the predictive factors that can identify patients having severe/critical COVID-19 disease.METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analysescompliant systematic search of the literature was conducted.Electronic databases including PubMed/MEDLINE,Scopus,and Cochrane Library were queried.The main outcome measures were the predictors of severe/critical COVID-19 and mortality.RESULTS Five studies including 583 patients of a median age of 50.5 years were reviewed.Patients were 346(59.4%)male and 237(40.6%)female.Of 583 hospitalized patients,242(41.5%)had critical illness.Acute respiratory distress disease occurred in 291 patients,accounting for 46.7%of total complications.Onehundred(17.1%)mortalities were recorded.The most commonly reported predictors of severe COVID-19 were older age,medical comorbidities,lymphopenia,elevated C-reactive protein,increased D-dimer,and increased neutrophil ratio.Findings on computed tomography(CT)scanning predictive of severe disease were bronchial wall thickening,CT score>7,linear opacities,consolidation,right upper lobe affection,and crazy paving pattern.CONCLUSION Several demographic,clinical,laboratory,and radiologic factors can help predict severe and critical COVID-19 along with the potential need for mechanical ventilation.Factors that were more commonly reported were older age,medical comorbidities,lymphopenia,increased neutrophil ratio,elevated C-reactive protein,and increased D-dimer.

Impacts of fighting against COVID-19 on critical care nurses'psychological and physical health:a literature review

Objective:To provide insight into the effects of the coronavirus disease(COVID-19)pandemic on the physical and psychological health of critical care nurses in adult units.Methods:A systematic search through the CINAHL,MEDLINE,and EMbase databases were performed.Studies that addressed“critical care nurses,”“COVID-19,”“physical effect,”and“psychological effect”from different perspectives were reviewed.Results:A total of 42 ar ticles were reviewed based on 2 aspects:critical care nurses'psychological and physical health.Negative emotions were the most common conditions:fear,anxiety,depression,and post-traumatic stress disorder(PTSD).Burnout,falling ill and having thoughts of self-harm,fatigue,physical burden,sleeping disorders,and chronic work overload also adversely affected the nurses'health.The nurses'health deteriorated because of the changes in the unfamiliar working environment and processes,colossal workload and chronic exhaustion,worries about themselves and their families,social response,and witnessing the death toll.Conclusions:Critical care nurses experienced adverse effects of the institutional reaction,social response,and individuals'reply to the COVID-19 pandemic upon their psychological and physical health.Suppor ting services and preparation for other unprecedented situations should be sustainably available.

Characterization and determinant factors of critical illness and in-hospital mortality of COVID-19 patients: A retrospective cohort of 1,792 patients in Kenya

Limited data is available on the coronavirus disease 2019(COVID-19),critical illness rate,and in-hospital mortality in the African setting.This study investigates determinants of critical illness and in-hospital mortality among COVID-19 patients in Kenya.We conducted a retrospective cohort study at Kenyatta National Hospital(KNH)in Kenya.Multivariate logistic regression and Cox proportional hazard regression were employed to determine predictor factors for intensive care unit(ICU)admission and in-hospital mortality,respectively.In addition,the Kaplan-Meier model was used to compare the survival times using log-rank tests.As a result,346(19.3%)COVID-19 patients were admitted to ICU,and 271(15.1%)died.The majority of those admitted to the hospital were male,1,137(63.4%)and asymptomatic,1,357(75.7%).The most prevalent clinical features were shortness of breath,fever,and dry cough.In addition,older age,male,health status,patient on oxygen(O2),oxygen saturation levels(SPO2),headache,dry cough,comorbidities,obesity,cardiovascular diseases(CVDs),diabetes,chronic lung disease(CLD),and malignancy/cancer can predicate the risk of ICU admission,with an area under the receiver operating characteristic curve(AUC-ROC)of 0.90(95%confidence interval[CI]:0.88–0.92).Survival analysis indicated 271(15.1%)patients died and identified older age,male,headache,shortness of breath,health status,patient on oxygen,SPO2,headache,comorbidity,CVDs,diabetes,CLD,malignancy/cancer,and smoking as risk factors for mortality(AUC-ROC:0.90,95%CI:0.89–0.91).This is the first attempt to explore predictors for ICU admission and hospital mortality among COVID-19 patients in Kenya.

Effects of L-carnitine on treatment outcomes of COVID-19 patients hospitalized in intensive care units:A double-blind randomized clinical trial

Objective:To assess the effects of L-carnitine on the outcomes of patients with moderate to severe coronavirus disease 2019(COVID-19)in intensive care unit(ICU).Methods:This double-blind clinical trial was carried out in 2022-2023.64 Patients with COVID-19 were selected from Amiralmomenin and Khansari hospitals in Arak,Iran.They were randomly assigned to the control and the L-carnitine treatment group via block randomization.Venous blood gases,disease severity,and levels of D-dimer,lactate dehydrogenase,ferritin,and C-reactive protein were daily assessed during the seven days of the intervention,and the length of ICU stay,the need for endotracheal intubation,and mortality rate were documented.Results:There were significant differences in length of ICU stay,the need for endotracheal intubation,and levels of D-dimer,lactate dehydrogenase,ferritin,APACHE栻score,and C-reactive protein between the two groups(P<0.05).However,the groups did not significantly differ in mortality rate and venous blood gas indexes(P>0.05).Conclusions:L-carnitine can improve outcomes of patients with COVID-19.Therefore,it can be used as an adjuvant therapy for these patients.

Factors Defining the Development of Severe Illness in Patients with COVID-19:A Retrospective Study

Objective Early triage of patients with coronavirus disease 2019(COVID-19) is pivotal in managing the disease. However, studies on the clinical risk score system of the risk factors for the development of severe disease are limited. Hence, we conducted a clinical risk score system for severe illness, which might optimize appropriate treatment strategies.Methods We conducted a retrospective, single-center study at the JinYinTan Hospital from January 24,2020 to March 31, 2020. We evaluated the demographic, clinical, and laboratory data and performed a10-fold cross-validation to split the data into a training set and validation set. We then screened the prognostic factors for severe illness using the least absolute shrinkage and selection operator(LASSO)and logistic regression, and finally conducted a risk score to estimate the probability of severe illness in the training set. Data from the validation set were used to validate the score.Results A total of 295 patients were included. From 49 potential risk factors, 3 variables were measured as the risk score: neutrophil to lymphocyte ratio(OR, 1.27;95% CI, 1.15–1.39), albumin(OR,0.76;95% CI, 0.70–0.83), and chest computed tomography abnormalities(OR, 2.01;95% CI, 1.41–2.86)and the AUC of the validation cohort was 0.822(95% CI, 0.7667–0.8776).Conclusion This report may help define the potential of developing severe illness in patients with COVID-19 at an early stage, which might be related to the neutrophil to lymphocyte ratio, albumin, and chest computed tomography abnormalities.

Physico-chemical characterization of acid base disorders in patients with COVID-19:A cohort study

BACKGROUND Acid-base imbalance has been poorly described in patients with coronavirus disease 2019(COVID-19).Study by the quantitative acid-base approach may be able to account for minor changes in ion distribution that may have been over-looked using traditional acid-base analysis techniques.In a cohort of critically ill COVID-19 patients,we looked for an association between metabolic acidosis surrogates and worse clinical outcomes,such as mortality,renal dialysis,and length of hospital stay.AIM To describe the acid-base disorders of critically ill COVID-19 patients using Stewart’s approach,associating its variables with poor outcomes.METHODS This study pertained to a retrospective cohort comprised of adult patients who experienced an intensive care unit stay exceeding 4 days and who were diagnosed with severe acute respiratory syndrome coronavirus 2 infection through a positive polymerase chain reaction analysis of a nasal swab and typical pulmonary involvement observed in chest computed tomography scan.Laboratory and clinical data were obtained from electronic records.Categorical variables were compared using Fisher’s exact test.Continuous data were presented as median and interquartile range.The Mann-Whitney U test was used for comparisons.RESULTS In total,211 patients were analyzed.The mortality rate was 13.7%.Overall,149 patients(70.6%)presented with alkalosis,28 patients(13.3%)had acidosis,and the remaining 34 patients(16.2%)had a normal arterial pondus hydrogenii.Of those presenting with acidosis,most had a low apparent strong ion difference(SID)(20 patients,9.5%).Within the group with alkalosis,128 patients(61.0%)had respiratory origin.The non-survivors were older,had more comorbidities,and had higher Charlson’s and simplified acute physiology score 3.We did not find severe acid-base imbalance in this population.The analyzed Stewart’s variables(effective SID,apparent SID,and strong ion gap and the effect of albumin,lactate,phosphorus,and chloride)were not different between the groups.CONCLUSION Alkalemia is prevalent in COVID-19 patients.Although we did not find an association between acid-base variables and mortality,the use of Stewart’s methodology may provide insights into this severe disease.