Efficacy and feasibility of awake proning in patients with COVID-19-related acute hypoxemic respiratory failure: an observational, prospective study.

INTRODUCTION: Most of COVID-19 patients present with hypoxemic respiratory failure. Proning is one of the management options proven to improve oxygenation and reduce mortality in non-COVID-19-related acute respiratory distress syndrome. As a response to COVID-19 pandemic surge, a dedicated COVID-19 respiratory ward for the management of mild to moderate ARDS patients who require oxygen therapy, non-invasive ventilation (NIV), or high-flow nasal cannula (HFNC) was established. We adopted a policy of early awake proning in such patients. AIMS: To determine the physiological changes, improvement in  oxygenation, the need for intubation, alongside with the duration, tolerance, and adverse effects of awake proning. STUDY DESIGN AND METHODS: Single-center, prospective observational cohort study. All awake, non-intubated, spontaneously breathing patients with COVID-19, and hypoxemic acute respiratory failure requiring oxygen supplementation, NIV, or HF RESULTS: Fifty patients were enrolled. There was a significant improvement in oxygenation when turning the patients from supine to prone position with mean PFR was 85 (SD 13.76) in supine position which increased to 124 (SD 34.08) in prone position with substantial increase in mean PFR 1-h post proning to 138 (SD 28.01) and P-value 0.0001. Prone positioning was feasible in 41 (82%) patients (mean duration 8.5 (SD 3.13) h), and 38 (76%) patients reported that it was well tolerated. CONCLUSION: Awake proning was feasible, tolerable, and effective in improving oxygenation in patients with COVID-19-related pneumonia and acute hypoxemic respiratory failure in this prospective study.

Physical activity engagement and responses to exercise in plaque psoriasis: a multifactorial investigation of influential factors.

BACKGROUND: Psoriasis may increase the risk of physical inactivity, but few studies have evaluated the etiology. OBJECTIVE: To identify barriers to and predictors of physical activity in psoriasis. METHODS: Twenty individuals with psoriasis (PsO) and 23 controls recorded activity with accelerometers and completed self-paced 20-min treadmill bouts. Questionnaires on self-efficacy for exercise (SEE), pruritus, and dermatology life quality index (DLQI) were completed. Psoriasis severity was measured via body surface area (BSA), psoriasis area and severity index (PASI), and investigator's global assessment (IGA). RESULTS: No differences in moderate-vigorous activity existed between PsO and controls (ANCOVA means: 26 ± 4 versus 27 ± 4 min, p = .802). Relative to controls, PsO selected treadmill speeds that were 13-18% slower and experienced more pruritus while exercising. Among the PsO group, PASI, BSA, IGA, and DLQI showed inverse correlations with vigorous activity (partial rhos= -0.55 to -0.62, p < .05). Likewise, BSA, IGA, DLQI, and pruritus were inversely correlated with footsteps (partial rhos= -0.47 to -0.62, p < .05). SEE was consistently positively correlated with activity levels among PsO (partial rhos ≥0.60 for moderate activity, vigorous activity, and footsteps). CONCLUSION: Individuals with extensive psoriasis and poorer SEE engage in less vigorous activity and take fewer footsteps. Among other factors, pruritus is a novel explanation.

Stress level assessment among health care workers involved in the management of critically ill COVID-19 patients.

BACKGROUND: Intensive care health care workers (HCWs) are frontlines of this crisis as they deal with critically ill COVID-19 patients which can potentially affect their mental well-being and causes different levels of stress. AIM: To determine the prevalence of stress among HCWs involved in the management of critically ill COVID-19 patient, identify the factors associated with stress, and highlight the availability of psychological support provided to HCWs. METHODS: A cross-sectional multicenter, international study using a web-based questionnaire of 27 questions including the Perceived Stress Scale-10 (PSS-10) for assessment of stress level. Questions to identify factors associated with stress, the psychological support provided, and the sociodemographic characteristics were included. RESULTS: We received a total 1649 responses from 59 countries: 550 (34%) were from Europe, 525 (32.36%) from Asia, 283 (17.44%) from Africa, 177 (11%) from America, and 88 (5.42%) from Australia. The average stress level was 22 points on the PSS denoting moderate stress in 1327 (81.8%) respondents, while 239 (14.73%) respondents had a severe level of stress. Female gender, working in high capacity units and remote areas in addition to lack of psychological support, was significantly associated with stress in our study. CONCLUSION: Stress level was moderate to severe among intensive care HCWs during this pandemic, and many factors were associated with stress emphasizing the importance of psychological support during that unprecedented pandemic.