Association of depressive symptoms with incidence and mortality rates of COVID-19 over 2 years among healthcare workers in 20 countries: multi-country serial cross-sectional study.

BACKGROUND: Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic. METHODS: This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants' response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates. RESULTS: A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017). CONCLUSIONS: This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study's findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04352634.

Benefit of intrapleural fibrinolytic therapy in the treatment of complicated parapneumonic effusion and empyema.

Our study aimed to assess the benefit of intrapleural fibrinolysis before resorting to surgery to treat complicated parapneumonic effusion and empyema. We conducted a retrospective and descriptive study, including all patients hospitalized in the intensive care unit (ICU) of the Abderhaman Mami hospital, Tunisia for empyema treated with instillation of intrapleural fibrinolytic therapy between the 1st January 2000 and 31st December 2016. In all patients, empyema was diagnosed on clinical features, imaging findings (chest X-ray, thoracic echography and/or computed tomography (CT), and microbiological data. The fibrinolytic agent used was streptokinase. The efficiency of intrapleural fibrinolytic therapy was judged on clinical and paraclinical results. Among 103 cases of complicated parapneumonic effusion and empyema, 34 patients were included. The mean age was 34 years [15-81] with a male predominance (sex ratio at 2.77). Median APACH II score was 9. Fifty (50%) of the patients (n=17) had no past medical history; addictive behavior was described in 17 patients (50%). All patients were admitted for acute respiratory failure and one patient for septic shock. Pleural effusion was bilateral in 7 patients. Bacteria isolated were Streptococcus pneumonia (6 cases), Staphylococcus aureus (3 cases, including one which methicillin-resistant), Staphylococcus epidermidis (1 case), anaerobes (5 cases), and Klebsiella pneumoniae (1 case). First-line antimicrobial drug therapy was amoxicillin-clavulanate in 20 patients. A chest drain was placed in all cases in the first 38 hours of ICU admission. The median number of fibrinolysis sessions was 4 [2-9] and the median term of drainage was 7 days [3-16]. No side effects were observed. Video-assisted thoracoscopic surgery was proposed in 5 patients. The median length of hospitalization stay was 15 days [6-31]. One patient died due to multi-organ failure.

Comparison of the clinical features and outcomes of severe seasonal influenza and COVID-19 patients in Tunisia between 2021 and 2022.

Background: We compared patients diagnosed at a SARI (severe acute respiratory infections) surveillance site with COVID-19 and those with seasonal influenza to investigate the clinical differences, common features, and outcomes. Methods: We conducted a descriptive, retrospective study in the Medical Intensive Care Unit (ICU) at Abderrahman Mami Hospital between September 2021 and April 2022. Demographic, clinical, and biological data as well as outcomes were recorded for all patients. Results: Among 223 SARI patients, 83 were confirmed COVID-19, and 22 were influenza positive. The distribution according to gender was similar; but patients with influenza were younger than those suffering from COVID-19(mean age 60.36 SD 17.28 vs. 61.88 SD 17.91; P = 0.601). In terms of underlying chronic diseases, the frequency was 84.3% in the COVID-19 group and 72.7% in the influenza group. COVID-19 patients had a longer duration of hospitalization (mean [SD], 9.51 days [8.47 days] vs. 7.33 days [8.82 days]; P = 0.003), and a more frequent need for invasive ventilation (80 [97.4%] vs. 20 [92.3]). Case fatality was also higher among this group compared to the latter (39 [47%] vs. 6 [27.3%], P = 0.01). Conclusion: This exploratory study suggests higher severity of COVID-19 compared to seasonal influenza among SARI hospitalized patients even during the Omicron wave. Further research on higher sample sizes is required to confirm this conclusion.

Interleukin6 prediction of mortality in critically ill COVID19 patients: A prospective observational cohort study.

OBJECTIVE: The aim of this study is to explore the role of IL6 in predicting outcome in critically ill COVID-19 patients. Design Prospective observational cohort study. Setting 20-bed respiratory medical intensive care unit of Abderrahmen Mami Teaching Hospital between September and December 2020. METHODS: We included all critically ill patients diagnosed with COVID-19 managed in ICU. IL6 was measured during the first 24 hours of hospitalization. RESULTS: 71 patients were included with mean age of 64 ± 12 years, gender ratio of 22. Most patients had comorbidities, including hypertension (n = 32, 45%), obesity (n = 32, 45%) and diabetes (n = 29, 41%). Dexamethasone 6 mg twice a day was initiated as treatment for all patients. Thirty patients (42%) needed high flow oxygenation; 59 (83%) underwent non-invasive ventilation for a median duration 2 [1-5] days. Invasive mechanical ventilation was required in 44 (62%) patients with a median initiation delay of 1 [0-4] days. Median ICU length of stay was 11 [7-17] days and overall mortality was 61%. During the first 24 hours, median IL6 was 34.4 [12.5-106] pg/ml. Multivariate analysis shows that IL-6 ≥ 20 pg/ml, CPK < 107 UI/L, AST < 30 UI/L and invasive ventilation requirement are independent risk factors for mortality. CONCLUSIONS: IL-6 is a strong mortality predictor among critically ill COVID19 patients. Since IL-6 antagonist agents are costly, this finding may help physicians to consider patients who should benefit from that treatment.

Hemodynamic profile of pulmonary arterial hypertension in a Tunisian center.

INTRODUCTION: Pulmonary hypertension (PH) management can only be conceived in a specialized center. We aimed to report the experience of a Tunisian ICU about PH invasive hemodynamic exploration and to describe consequent therapeutic decisions. METHODS: Retrospective descriptive study including all patients admitted to the medical ICU of Abderrahmen Mami Hospital for right heart catheterization (RHC), between 2005 and 2019 as part of the investigation of PH. Patients' characteristics, procedure safety and arising therapeutic decisions were then reported. RESULTS: Forty patients were admitted for hemodynamic evaluation. RHC confirmed PH in 31 patients and exploration was then completed with NO reactivity test. Mean age was 41.3±15 years, gender ratio M/F was 1.06. PH was classified into: group 1 (n=13), group 2 (n=14), group 4 (n=2) and group 5 (n=2). NO vasoreactivity test was positive in 50% of post-capillary PH and in 28% of pre-capillary PH. The therapeutic decision following the reversibility test was: prescription of calcium channel blockers (n=5), a specific pulmonary vasodilator (n=10), operability (n=6), heart-lung transplant (n=3) and therapeutic abstention (n=7). Two minor complications were reported. CONCLUSION: The medical ICU in Abderrahmen Mami Hospital represents an experienced team in hemodynamic investigations despite low annual RHC number. NO reactivity test is an indispensable tool that enables important decisions during PH management.

A tool for the management of personal protective equipment during COVID-19 pandemic: Abderrahmen Mami Hospital case study.

INTRODUCTION: The COVID-19 pandemic is causing management difficulties in the Tunisian healthcare system inventory management and the supply of Personal Protective Equipment (PPE). AIM: Calculate the number of PPE needed for MAMI Hospital Ariana (dedicated hospital to COVID patients) to avoid stock-outs. METHODS: This study proposed a calculation method of the PPE needs for the intensive care and pneumology departments. We developed a mathematical formulation of the number of PPE needed according to the number of visits per medical and other teams, their types, the number of patients, and the validity of each type of PPE. RESULTS: Considering as input data: the number of visits for the different intervening teams (medical, paramedical, worker or other), the capacity of the different services (number of beds), the average length of stay of patients, the validity duration of an equipment and urgent visits, the developed model generates the required number of PPE (especially surgical masks, FFP2 masks, disposables gowns and coveralls). This allows to calculate the number of personal protective equipment (PPE) needed by the Mami hospital's pharmacy in this period of COVID-19 crisis. CONCLUSION: Our configurable application allowed us to calculate PPE requirements for the intensive care and pneumology departments and estimate their use duration.

Severe influenza A in a Tunisian ICU sentinel SARI centre: Epidemiological and clinical features.

INTRODUCTION: Influenza A virus infection is a contagious acute respiratory infection which mostly evolves in an epidemic form, less frequently as pandemic outbreaks. It can take a severe clinical form that needs to be managed in intensive care unit (ICU). The aim of this study was to describe the epidemiological and clinical aspects of influenza A, then to determine independent predictive factors of ICU mortality in Abderrahmen Mami hospital, Ariana, Tunisia. METHODS: It was a single-center study, including all hospitalized patients in intensive care, between November 1st, 2009 and October 31st, 2019, with influenza A virus infection. We recorded demographic, clinical and biological data, evolving features; then multivariate analysis of the predictive factors of ICU mortality was realized. RESULTS: During the study period (10 consecutive seasons), 120 patients having severe Influenza A were admitted (Proportion = 2.5%) from all hospitalized patients, with a median age of 48 years and a gender-ratio of 1.14. Among women, 14 were pregnant. Only 7 patients (5.8%) have had seasonal flu vaccine during the year before ICU admission. The median values of the Simplified Acute Physiology Score II, Acute Physiologic and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment were respectively 26, 10 and 3. Virus strains identified with polymerase chain reaction were H1N1 pdm09 (84.2%) and H3N2 (15.8%). Antiviral therapy was prescribed in 88 (73.3%) patients. A co-infection was recorded in 19 cases: bacterial (n = 17) and aspergillaire (n = 2). An acute respiratory distress syndrome (ARDS) was diagnosed in 82 patients. Non-invasive ventilation (NIV) was conducted for 72 (60%) patients with success in 34 cases. Endotracheal intubation was performed in 59 patients with median duration of invasive mechanical ventilation 8 [3.25-13] days. The most frequent complications were acute kidney injury (n = 50, 41.7%), shock (n = 48, 40%), hospital-acquired infections (n = 46, 38.8%) and thromboembolic events (n = 19, 15.8%). The overall ICU mortality rate was of 31.7% (deceased n = 38). Independent predictive factors of ICU mortality identified were: age above 56 years (OR = 7.417; IC95% [1.474-37.317]; p = 0.015), PaO2/FiO2 ≤ 95 mmHg (OR = 9.078; IC95% [1.636-50.363]; p = 0.012) and lymphocytes count ≤ 1.325 109/L (OR = 10.199; IC95% [1.550-67.101]; p = 0.016). CONCLUSION: Influenza A in ICU is not uncommon, even in A(H1N1) dominant seasons; its management is highly demanding. It is responsible for considerable morbi-mortality especially in elderly patients.

Extent and pattern of intensive care unit refusal in Tunisian 3rd line hospitals.

BACKGROUND: Rationing in intensive care unit (ICU) beds is common and can leads to admission refusal. Understanding factors involved in triage practices is the first step towards an ethically optimal decision-making process. AIM: To identify determinants and patients' characteristics associated with decisions to deny ICU admission. METHODS: This prospective observational study was conducted in AbderrahmeneMami Hospital's medical ICU, in Ariana, between 1st January and 31th December 2016. No predefined admission criteria were determined. All consecutive patients referred to ICU for admission during the study period were included. Two groups were defined GI: Admitted patients and GII: Refused patients. The reasons for refusal were categorized as follows: full unit, necessity of reorientation, patient too well to benefit, patient too sick to benefit and patient or family refusal. RESULTS: During the study period, ICU admission was requested for 1081 patients of whom 491 (45.4%) were refused. Logistic regression identified factors positively associated with ICU refusal. A surgical status (AOR 15,80 ; IC95% 1,34-186,17 ; p=0,028), was found to be the main factor, followed by cardiopulmonary arrest (AOR 5,91 ; IC 95% 2,54-13,76 ; p<0,001) and hematologic malignancies (AOR 2,82 ; IC 95% 1,32-6,02 ; p=0,007). In contrast, other factors were shown to be negatively associated with ICU refusal; it was essentially ICU admission requested from our hospital (AOR 0,06; IC 95% 0,04-0,08 ; p<0,001). Full unit was the predominant reason for refusal (76.2%). CONCLUSION: Our study confirms that ICU refusal is common. It depends on both organizational and patient-related factors.

Interstitial pneumonia in a glassblower: think to chronic beryllium disease!

Chronic beryllium disease (CBD) is an occupational illness with varying severity. In this report, we describe a 27 year old man, glassblower, who developed a fatal CBD after six months of unknown Beryllium's exposure. The diagnosis was suspected on histological examination and then consolidated by confirmation of Beryllium's exposure at the working area. Physicians should be aware of the potential risk to develop CBD in glassblowers. These workers should benefit from early medical surveillance using the Beryllium lymphocyte proliferation test (BeLPT) and therefore from suitable management.