Background: Little is known about end-of-life care among Muslim patients, particularly during Coronavirus disease 2019 (COVID) pandemic, which we report here. Methods: The clinical characteristics, end-of-life care and resuscitation status of Muslim patients who died in the ICU of our tertiary care hospital in year 2020 from COVID were compared to Non-COVID patients. Results: There were 32 patients in COVID and 64 in the Non-COVID group. A major proportion, mainly of Non-COVID patients, already had a hospice eligible terminal disease at baseline (p=.002). COVID patients were admitted to the ICU sooner after hospitalization (2.2 vs. 17 days), had prolonged duration of mechanical ventilation (18.5 vs. 6 days) and longer ICU stay (24 vs. 8 days) than non-COVID patients, respectively (p<.001). Almost all patients were “Full Code” initially. However, status was eventually changed to ‘do-not-attempt resuscitation’ (DNAR) in about 60% of the cohort. COVID patients were made DNAR late in their ICU stay, predominantly in the last 24 hours of life (p=.04). Until the very end, patients in both groups were on tube feeds, underwent blood draws and imaging, required high dose vasopressors, with few limitations or withdrawal of therapies. Family members were usually not present at bedside at time of death. There was minimal involvement of chaplain and palliative care services. Conclusions: Muslim COVID-19 patients had prolonged mechanical ventilation and ICU stay and a delayed decision to DNAR status than non-COVID Muslim patients. Limitation or withdrawal of therapy occurred infrequently. The utilization of chaplain and palliative care service needs improvement.
PURPOSE: We conducted this study to evaluate the characteristics and outcomes exclusively in high-risk coronavirus disease 2019 (COVID-19) tertiary care patients with multiple comorbidities, as very few have reported outcomes in this specific cohort. METHODS: All patients, with two or more risk factors for COVID-19 and Charlson Comorbidity Index (CCI) of >2, who were admitted to intensive care unit (ICU) between March and December 2020 were included. Their characteristics, ICU course, and outcomes as well as differences between nonsurvivors and survivors were evaluated. The primary outcome was all-cause 28-day mortality. RESULTS: Out of 1152 COVID-19 patients, 101 met the inclusion criteria. The patients had an average of 4 or more comorbidities with a very high CCI of 5. The 28-day all-cause mortality was 23% and inhospital mortality was 32%. Among all risk factors, only age > 70 years, male gender, and chronic kidney disease were significant determinants of mortality ( P < 0.03). Admission PaO 2 /FiO 2 ratio and elevated inflammatory markers were same among survivors and nonsurvivors ( P > 0.66). The mean time from presentation to ICU admission (59 vs. 38 h), APACHE II score (20.5 vs. 17), ICU length of stay (25 vs. 12 days), and hospital length of stay (28 vs. 20 days) were all higher in nonsurvivors as compared to survivors, respectively ( P < 0.03). Fifty-four percent of the patients were intubated and had higher 28-day (40%) and inhospital (55%) mortality. CONCLUSION: Tertiary care patients with multiple comorbidities have higher mortality than what is reported for mixed populations. Further studies are needed to determine realistic mortality benchmarks for these patients.
Objective: Both Middle East Respiratory Syndrome (MERS) and Coronavirus Disease 2019 have an emotional toll on healthcare workers (HCWs), but the difference of the impact between the two diseases remains unknown. Design: A cross sectional descriptive survey.Setting: A tertiary care hospital.Participants: 125 HCWs who worked during the 2014 MERS as well as the 2020 COVID-19 outbreaks in high-risk areas of the hospital including critical care, emergency room and COVID-19 clinics. Methods:The comprehensive survey comprised 5 sections and 68 questions and was administered to HCWs before availability of the COVID-19 vaccine. The survey evaluated hospital staff emotions, perceived stressors, external factors that reduced stress, personal coping strategies, and motivators for future outbreaks. The participants rated each question for MERS and COVID-19 simultaneously on a scale from 0-3. The responses were reported as mean and standard deviation, while Wilcoxon signed-rank test was used to calculate the difference in responses.Results: There were 102 (82%) participants who returned the questionnaire. The ritual of obsessive hand washing, emotional and physical fatigue, ongoing changes in infection control guidelines, fear of community transmission, and limitations on socialization and travel were the major stressors that were significantly worse during COVID-19 compared to MERS (P<0.05) and led to HCWs adoption of additional 'personal' coping strategies during COVID-19. There was no difference between COVID-19 and MERS, however, among preferences for 'external' factors made available to HCWs that could reduce stress or in their preferences for motivators to work in future outbreaks (P>.05). Conclusion:Both the MERS and COVID-19 outbreaks were emotionally draining for HCWs. However, COVID-19 was a relatively more stressful experience than MERS for HCWs and led to greater personal, behavioral, and protective adaptations by the hospital staff.
Urbanization and modern development of expanding infrastructure have resulted in large construction activities. With the expeditious growth in the construction industry, the rate of demolition has also increased. This is causing considerable increase in Construction and Demolition (C&D) waste all around the globe. To minimize its impact on society and environment, preventive measures are required to be taken on urgent basis, and for this reason construction industry has proposed the use of recycle concrete aggregates in different applications and there is dire need to investigate experimentally the properties of concrete products made using Recycled Aggregate Concrete (RAC). In this regard, this study focused to investigate the mechanical properties of 100% RAC bricks prepared with two different compositions with respect to coarse to fine aggregates ratio (i.e., 70:30 and 60:40), cement dosage (i.e., 10% and 15% by weight of total aggregates) and casting pressure (i.e., 25 MPa and 35 MPa). Recycled concrete aggregates required for this study were produced by crushing tested concrete samples having compressive strength of 21 MPa to 28 MPa. Mechanical tests were performed on bricks to determine their compressive strength, flexural strength, shear strength, impact energy in compression and flexure. In addition to these destructive tests, non-destructive (rebound hammer and ultra-sonic pulse velocity) tests were also performed. To draft a comparison, Natural Aggregate Concrete (NAC) bricks and first class burnt clay bricks were also tested. The results indicated that the compressive strength of NAC bricks was about 30% higher than the compressive strength of RAC bricks. However, RAC bricks exhibited higher compressive strength as compared to burnt-clay bricks. The flexural strength of RAC bricks containing 60% coarse aggregates and 40% fine aggregates and RAC bricks containing 70% coarse aggregates and 30% fine aggregates was found to be almost similar but their flexure strength was 37.3% and 20.7% lesser than their corresponding NAC bricks. Flexure strength of RAC bricks and burnt clay bricks was found to be almost same. Qualitative assessment by ultrasonic pulse velocity (UPV) tests showed that the NAC and RAC bricks were of good quality as per the standard criteria. The findings of this study indicated that RAC bricks satisfied the strength requirements as stated by local and international standards. Further, RAC bricks performed better than commonly used first class burnt clay bricks. Production and use of RAC bricks in masonry structures will not only help to conserve the depleting resources of natural aggregates and clay but also help to protect our environment from pollution by reducing CO2 emission caused by the coal-burning as fuel in kilns for the manufacturing of burnt-clay bricks.
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