Impact of COVID-19 pandemic on non-COVID patient’s management in urology: a public hospital experience in Mumbai

Abstract Background To evaluate the impact of COVID-19 lockdown on non-COVID urological patient’s management in tertiary care urology centres. Methods This is an observational study in which data of patients visiting the urology department of all the MCGM run tertiary care hospitals were recorded for the duration of 1 April 2020 to 31 July 2020 and were compared to data of pre-COVID-19 period of similar duration. Results There was a decrease of 93.86% in indoor admissions of urology patients during the COVID-19 lockdown. Indoor admissions for stone disease, haematuria, malignancy accounted for 53.65%, 15.85%, 9.75%, respectively. Elective surgeries had the highest percentage decrease followed by emergency and semi-emergency procedures. There was a reduction of more than 80% in patients attending outpatient clinics. Stone disease and its consequences were the main reasons for visiting outdoor clinics (39%). A substantial number of patients presented with flank and abdominal pain (14.8%) and benign enlargement of the prostate (10.23%). Malignancy accounted for a very small number of patients visiting outdoor clinics (1.58%). Conclusions COVID-19 pandemic has a profound impact on patient care and education in Urology. There was more than ninety percent reduction in indoor admissions, operative procedures, and outpatient clinics attendance. Once the pandemic is controlled, there will be a large number of patients seeking consultation and management for urological conditions and we should be prepared for it. Surgical training of urology residents needs to be compensated in near future. Long-term impact on urological patient outcome remains to be defined.

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Paradigm Shift in Clinical Practice of Sexual Health in Men During COVID-19 Pandemic

Journal of Psychosexual Health ◽

10.1177/26318318211032386 ◽

2021 ◽

pp. 263183182110323

Author(s):

Aditya Prakash Sharma ◽

Japleen Kaur ◽

Ravimohan S. Mavuduru ◽

Shrawan K. Singh

Keyword(s):

Health Care ◽

Sexual Health ◽

Surgical Procedures ◽

Care Center ◽

Tertiary Care ◽

Health Care Seeking ◽

Care Seeking ◽

Health Seeking ◽

Number Of Patients ◽

The Impact

Sexual health-care seeking behavior and practices have been affected during COVID-19 pandemic. The impact of COVID-19 on this subspecialty is far reaching. This study aimed to assess the impact of COVID-19 on health-care seeking practice pertaining to sexual health in men in our tertiary care center and review the relevant literature regarding impact of COVID-19 on sexual health seeking practice and challenges faced. Outpatient data was analyzed from January 2019 to April 2021. Patients awaiting surgical procedures due to COVID were documented. A narrative synthesis of literature based on systematic search using the keywords sexual health, sexual health seeking, sexual health practice, andrology, and COVID with operators “AND” and “OR” was carried out in three search engines PubMed, Scopus, and Embase. The study outcomes were obtained by comparing data of outpatient attendance and compiling the reviewed literature. The mean attendance fell significantly from 95.11±11.17 to 17.25±13.70 persons (P <.0001) per outpatient clinic, March 2020 being the reference point. Teleconsultation has taken over physical consultation. In 98/949 cases, teleconsult could not be provided despite registration. Over 25 patients were waiting for surgical procedures pertaining to andrology due to shut down of elective services. Similar trends have been reported from other countries. Number of patients seeking consultation for sexual health problems has dramatically decreased during COVID-19 era. Establishment of data safe teleconsultation facility and its widespread advertisement is needed to encourage patients to seek consult.

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Abstract 14747: Dwindling Trends of Cardiology Admissions Amidst Covid-19 Pandemic in a Tertiary Care Center of Pakistan

Circulation ◽

10.1161/circ.142.suppl_3.14747 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jamshed Ali ◽

Osman Faheem ◽

Pirbhat Shams ◽

ghufran adnan ◽

Maria Khan

Keyword(s):

Care Center ◽

Tertiary Care ◽

Electronic Record ◽

Medical Attention ◽

Care Hospital ◽

Record System ◽

Admission Rates ◽

Cardiovascular Morbidity And Mortality ◽

Number Of Patients ◽

The Impact

Introduction: Social containment measures have been adopted globally to control COVID-19 outbreak. Reduction in hospital visits and inpatient admission rates have become cause for concern. Through this study we aimed to analyze the impact of SARS-CoV-2 virus Outbreak on cardiology inpatient admissions at a tertiary care hospital in Pakistan. Hypothesis: COVID-19 pandemic has resulted in significant decline in cardiology admissions. Methods: We conducted a retrospective study at our center. Admission log was accessed via electronic record system. Comparison was made for same months of 2019 and 2020 with regard to cardiology inpatient admissions. Results: A total of 239 patients were admitted to cardiology services in 2019 period and 106 in 2020 period with resultant reduction of 55.6%. Number of patients admitted to the coronary care unit were 179 and 78 respectively where as the numbers declined to 28 from 60 for cardiac step down. Reduction for admission numbered to 52.4% for males and 38.89% for females. 9.3% patients left against medical advice in 2019 and 3.4% in 2020. Conclusions: Our study concludes that numbers of cardiology admissions have dwindled. Possible explanation for this can be implementation of social containment and fear of acquiring infection. This has raised a question of whether a significant number of cardiovascular morbidity and mortality has occurred without seeking medical attention and has went unrecorded during the pandemic. This calls for stringent diagnostic measures in future to diagnose previously unrecorded burden.

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CLINICAL PROFILE OF OUTPATIENTS ATTENDING DERMATOLOGY DEPARTMENT DURING COVID-19 LOCKDOWN RELAXATION PERIOD IN A TERTIARY CARE CENTRE IN SOUTH INDIA – A CROSS-SECTIONAL ANALYTICAL STUDY

10.36106/ijsr/6906051 ◽

2021 ◽

pp. 13-16

Author(s):

Afthab Jameela Wahab ◽

Pavithra Gunasekaran ◽

P. Mohan ◽

V. Sudha ◽

L. Balamurugan ◽

...

Keyword(s):

South India ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Dermatology Department ◽

Cutaneous Manifestations ◽

Relaxation Period ◽

Number Of Patients ◽

Outpatient Practice ◽

The Impact

Background - The cutaneous manifestations of the novel coronavirus have been well documented. However, there are few studies that relate to the clinical prole of regular dermatology outpatients seeking treatment during the lockdown relaxation period braving the pandemic. With the Aim - view to determine the changes seen in dermatology outpatient practice, this study analysed the clinical prole of new patients attending the Dermatology Outpatient Department (OPD) during the COVID-19 lockdown relaxation period in a tertiary care centre in a metropolitan suburb in South India. New dermatology outpatients during the months of May, June, July and August Method - 2020 were included in the study. Outpatient data for this period was analysed and compared with corresponding data for the same period in the previous two years. There was a Result – decrease in the OP census, number of patients in the extremes of life as well as those with asymptomatic dermatoses. There was an increase in the number of patients with infections, particularly dermatophytosis. There was also a noteworthy absence of dermatological emergencies. Conclusion - In essence, our study shows the impact of COVID-19 pandemic on the routine dermatology outpatient services with signicant changes in the clinical prole of outpatient practice following lockdown relaxation.

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Impact of the COVID-19 pandemic on core surgical training

Scottish Medical Journal ◽

10.1177/0036933020949217 ◽

2020 ◽

Vol 65 (4) ◽

pp. 133-137 ◽

Cited By ~ 1

Author(s):

Khurram Shahzad Khan ◽

Rona Keay ◽

Morag McLellan ◽

Sajid Mahmud

Keyword(s):

Surgical Training ◽

Teaching Hospital ◽

General Surgery ◽

Negative Impact ◽

Outpatient Clinics ◽

Box Trainer ◽

Surgical Trainees ◽

Long Term Impact ◽

The Impact

Background and aims COVID-19 pandemic has caused significant disruption in training which is even more pronounced in the surgical specialties. We aim to assess the impact of COVID-19 pandemic on core surgical training. Methods All core surgical and improving surgical trainees in West of Scotland region were invited to participate in an online voluntary anonymous survey via SurveyMonkey. Results 28 of 44 (63.6%) trainees responded, 15 (53.6%) were CT1/ST1. 14 (50.0%) working in teaching hospital and 15 (53.6%) working in general surgery. 20 (71.4%) felt that due to the pandemic they have less opportunity to operate as the primary surgeon. 21 (75.0%) have not attended any outpatient clinics. 8 (28.6%) did not have any form of access to the laparoscopic box-trainer. 20 (71.4%) felt their level of confidence in preforming surgical skills has been negatively impacted. 18 (64.3%) found it difficult to demonstrate progress in portfolio. 21 (75.0%) trainees have not attended any teaching. 10 (35.7%) trainees have been off-sick. 8 (28.6%) trainees have felt slightly or significantly more stressed. Conclusion COVID-19 pandemic has an unprecedented negative impact on all aspects of core surgical training. The long term impact on the current cohort of trainees is yet to be seen.

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Effect of a Multifaceted Intervention on Adherence to Hand Hygiene among Healthcare Workers: A Cluster-Randomized Trial

Infection Control and Hospital Epidemiology ◽

10.1086/656592 ◽

2010 ◽

Vol 31 (11) ◽

pp. 1170-1176 ◽

Cited By ~ 33

Author(s):

Dominik Mertz ◽

Nancy Dafoe ◽

Stephen D. Walter ◽

Kevin Brazil ◽

Mark Loeb

Keyword(s):

Hand Hygiene ◽

Healthcare Workers ◽

Tertiary Care ◽

Intervention Group ◽

Multifaceted Intervention ◽

Cluster Randomized ◽

Hospital Acquired ◽

Tertiary Care Hospitals ◽

The Impact ◽

Mrsa Colonization

Objectives.Adherence to hand hygiene among healthcare workers (HCWs) is widely believed to be a key factor in reducing the spread of healthcare-associated infection. The objective of this study was to evaluate the impact of a multifaceted intervention to increase rates of adherence to hand hygiene among HCWs and to assess the effect on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) colonization.Design.Cluster-randomized controlled trial.Setting.Thirty hospital units in 3 tertiary care hospitals in Hamilton, Ontario, Canada.Intervention.After a 3-month baseline period of data collection, 15 units were randomly assigned to the intervention arm (with performance feedback, small-group teaching seminars, and posters) and 15 units to usual practice. Hand hygiene was observed during randomly selected 15-minute periods on each unit, and the incidence of MRSA colonization was measured using weekly surveillance specimens from June 2007 through May 2008.Results.We found that 3,812 (48.2%) of 7,901 opportunities for hand hygiene in the intervention group resulted in adherence, compared with 3,205 (42.6%) of 7,526 opportunities in the control group (P < .001; independent t test). There was no reduction in the incidence of hospital-acquired MRSA colonization in the intervention group.Conclusion.Among HCWs in Ontario tertiary care hospitals, the rate of adherence to hand hygiene had a statistically significant increase of 6% with a multifaceted intervention, but the incidence of MRSA colonization was not reduced.

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Outcomes of surgery in patients aged ≥90 years in the general surgical setting

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0203 ◽

2018 ◽

Vol 100 (3) ◽

pp. 172-177 ◽

Cited By ~ 4

Author(s):

A Sudlow ◽

H Tuffaha ◽

AT Stearns ◽

IA Shaikh

Keyword(s):

Surgical Procedures ◽

Emergency Surgery ◽

Tertiary Care ◽

Gastrointestinal Surgery ◽

Care Facility ◽

Mortality Rates ◽

Emergency Procedures ◽

Risk Of Death ◽

Increased Risk ◽

The Impact

Introduction An increasing proportion of the population is living into their nineties and beyond. These high risk patients are now presenting more frequently to both elective and emergency surgical services. There is limited research looking at outcomes of general surgical procedures in nonagenarians and centenarians to guide surgeons assessing these cases. Methods A retrospective analysis was conducted of all patients aged ≥90 years undergoing elective and emergency general surgical procedures at a tertiary care facility between 2009 and 2015. Vascular, breast and endocrine procedures were excluded. Patient demographics and characteristics were collated. Primary outcomes were 30-day and 90-day mortality rates. The impact of ASA (American Society of Anesthesiologists) grade, operation severity and emergency presentation was assessed using multivariate analysis. Results Overall, 161 patients (58 elective, 103 emergency) were identified for inclusion in the study. The mean patient age was 92.8 years (range: 90–106 years). The 90-day mortality rates were 5.2% and 19.4% for elective and emergency procedures respectively (p=0.013). The median survival was 29 and 19 months respectively (p=0.001). Emergency and major gastrointestinal operations were associated with a significant increase in mortality. Patients undergoing emergency major colonic or upper gastrointestinal surgery had a 90-day mortality rate of 53.8%. Conclusions The risk for patients aged over 90 years having an elective procedure differs significantly in the short term from those having emergency surgery. In selected cases, elective surgery carries an acceptable mortality risk. Emergency surgery is associated with a significantly increased risk of death, particularly after major gastrointestinal resections.

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Impact of the COVID-19 Pandemic on Antimicrobial Consumption and Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections

Antibiotics ◽

10.3390/antibiotics9110816 ◽

2020 ◽

Vol 9 (11) ◽

pp. 816

Author(s):

Ana Guisado-Gil ◽

Carmen Infante-Domínguez ◽

Germán Peñalva ◽

Julia Praena ◽

Cristina Roca ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Tertiary Care ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

Incidence Density ◽

Antimicrobial Consumption ◽

Global Trend ◽

Long Term Impact ◽

Hospital Acquired ◽

The Impact

During the COVID-19 pandemic, the implementation of antimicrobial stewardship strategies has been recommended. This study aimed to assess the impact of the COVID-19 pandemic in a tertiary care Spanish hospital with an active ongoing antimicrobial stewardship programme (ASP). For a 20-week period, we weekly assessed antimicrobial consumption, incidence density, and crude death rate per 1000 occupied bed days of candidemia and multidrug-resistant (MDR) bacterial bloodstream infections (BSI). We conducted a segmented regression analysis of time series. Antimicrobial consumption increased +3.5% per week (p = 0.016) for six weeks after the national lockdown, followed by a sustained weekly reduction of −6.4% (p = 0.001). The global trend for the whole period was stable. The frequency of empirical treatment of patients with COVID-19 was 33.7%. No change in the global trend of incidence of hospital-acquired candidemia and MDR bacterial BSI was observed (+0.5% weekly; p = 0.816), nor differences in 14 and 30-day crude death rates (p = 0.653 and p = 0.732, respectively). Our work provides quantitative data about the pandemic effect on antimicrobial consumption and clinical outcomes in a centre with an active ongoing institutional and education-based ASP. However, assessing the long-term impact of the COVID-19 pandemic on antimicrobial resistance is required.

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Stress gradation of medical practitioners during the pandemic (covid-19) along with ways to de-stress; a cross sectional study at tertiary care hospitals using Kessler’s 10 psychological distress scale.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.09.6238 ◽

2021 ◽

Vol 28 (09) ◽

pp. 1239-1244

Author(s):

Umair Toqueer ◽

Muhammad Usama Zardad ◽

Mahwish Toqueer ◽

Anila Riyaz ◽

Sana Khan ◽

...

Keyword(s):

Psychological Distress ◽

Tertiary Care ◽

Cross Sectional Study ◽

Junior Doctors ◽

Sectional Study ◽

Cross Sectional ◽

Psychological Distress Scale ◽

Tertiary Care Hospitals ◽

Distress Scale ◽

The Impact

Objectives: To determine stress grades of doctors working in tertiary care hospitals by using a standard measuring tool i.e. Kessler 10 psychological distress scale along with finding out different coping methods adopted by doctors during the COVID-19 pandemic. Study Design: Cross Sectional study. Setting: Tertiary Care Hospitals of Khyber Pakhtunkhwa (KPK), Pakistan. Period: 15 March 2020 to 20 June 2020. Material & Methods: A structured questionnaire was sent online to the junior and senior doctors working during the pandemic. The data was automatically collected with the help of Google docs and then analysed using SPSS 26. Results: Of the 219 doctors who completed the questionnaire 142 were males (64.8%) and 77 were females (35.2%). Interestingly, analysis of the score revealed that 38.8% of the doctors were found likely to be well, 16.4% of the doctors were likely to have mild disease and 20.5% were likely to have a moderate disorder while 24.2% were likely to have a severe disorder. Further analysis showed that the mean of Kessler’s score was greater for junior doctors as compared to Consultants which was found to be statistically significant (p=0.044). Conclusion: The impact of Corona virus disease (COVID-19) on the stress levels of health workers warrants considerable attention as it was declared a pandemic. Assessing the psychological impact and ways to tackle them will not only help the health care workers during this pandemic but will be beneficial in future pandemics as well.

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Impact on Utilization and Shift in Treatment Needs Post-COVID Lockdown of Pediatric Dentistry in a Tertiary Care Hospital

Frontiers in Dental Medicine ◽

10.3389/fdmed.2021.722292 ◽

2021 ◽

Vol 2 ◽

Author(s):

Bhojraj Nandlal ◽

Birti Singh ◽

Arun Gopi

Keyword(s):

Linear Regression Analysis ◽

Tertiary Care ◽

Pediatric Dentistry ◽

Care Hospital ◽

Dental Disease ◽

Care Seeking ◽

Treatment Needs ◽

Dental Services ◽

Number Of Patients ◽

The Impact

Background: The COVID-19 pandemic has brought all treatments other than emergencies to a halt. Dental disease, being a multifactorial microbial disease, is capable of progressing to pulpits and its sequelae. The purpose of this study is to predict the impact of utilization of dental services and the progression of treatment needs in children during the lockdown and partial lockdown.Methods: Outpatient department data from the year 2017–2019 from the Department of Pediatric and Preventive Dentistry, JSS Dental College was collected. A table of treatments provided was prepared. Utilization of services as care-seeking rates at 10, 25, and 50% were assumed and modeled corresponding to each stage of the lockdown using linear regression analysis. Dental caries progression was calculated as shifts in treatment needs from permanent restorations to temporary restorations, pulpectomies, or extraction, assuming a 10% progress to each sequela.Results: The p-values for 10, 25, and 50% care-seeking rates were 0.021, <0.001, and <0.001, respectively.Conclusion: The number and severity of cases were predicted to have increased. However, after removal of lockdown, it was noted that the number of patients seeking care was significantly less. The advancement in progression of dental disease further adds to the burden of society and caregivers.

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Comparative assessment of the efficacy of voglibose and metformin combined with insulin in patients with type 2 diabetes mellitus

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v10i3.1462 ◽

2019 ◽

Vol 10 (3) ◽

pp. 2255-2258 ◽

Cited By ~ 1

Author(s):

Kothai Ramalingam ◽

Veenah Ganesan ◽

Sooraj Sasi ◽

Surya Shanmugam ◽

Arul Balasubramanian

Keyword(s):

Diabetes Mellitus ◽

Tamil Nadu ◽

Tertiary Care ◽

Type Ii Diabetes Mellitus ◽

Care Hospital ◽

Number Of Patients ◽

Group A ◽

Group B ◽

Tertiary Care Hospitals ◽

Salem District

The present study was conducted to assess the efficacy of metformin and voglibose combined with insulin in patients with type II diabetes mellitus. It is a retrospective study was conducted in tertiary care hospitals of Salem district Tamil Nadu with 120 patients who are taking either metformin and insulin or voglibose and insulin according to the inclusion and exclusion criteria. The total number of patients were divided into two groups each consist of 60. Group A was the patients prescribed with metformin and insulin and group B was the patients prescribed with voglibose and insulin. The average efficacy of metformin and voglibose combined with insulin for 10 days, 20 days, 30 days & 40 days were compared using FBS, PPBS, RBS and HbA1C values. The result shows that patients treated with metformin and insulin, the average efficacy of FBS levels on 10, 20, 30 and 40 days were 22.96%, 27.46%, 30.49% and 36.78% respectively. Whereas in the case of voglibose and insulin the efficacy was 23.48%, 28.38%, 32.57%, 40.47% for 10, 20, 30 and 40 days respectively.In the same way, the PPBS, RBS and HbA1C levels were also calculated. While comparing both the groups of patients, the average efficacy of treatment with voglibose and insulin was more effective than metformin and insulin in the tertiary care hospital of Salem district.

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