Background The effect of awake prone positioning on intubation rates is not established. The aim of this trial was to investigate if a protocol for awake prone positioning reduces the rate of endotracheal intubation compared with standard care among patients with moderate to severe hypoxemic respiratory failure due to COVID-19. Methods We conducted a multicenter randomized clinical trial. Adult patients with confirmed COVID-19, high-flow nasal oxygen or noninvasive ventilation for respiratory support and a PaO2/FiO2 ratio ≤ 20 kPa were randomly assigned to a protocol targeting 16 h prone positioning per day or standard care. The primary endpoint was intubation within 30 days. Secondary endpoints included duration of awake prone positioning, 30-day mortality, ventilator-free days, hospital and intensive care unit length of stay, use of noninvasive ventilation, organ support and adverse events. The trial was terminated early due to futility. Results Of 141 patients assessed for eligibility, 75 were randomized of whom 39 were allocated to the control group and 36 to the prone group. Within 30 days after enrollment, 13 patients (33%) were intubated in the control group versus 12 patients (33%) in the prone group (HR 1.01 (95% CI 0.46–2.21), P = 0.99). Median prone duration was 3.4 h [IQR 1.8–8.4] in the control group compared with 9.0 h per day [IQR 4.4–10.6] in the prone group (P = 0.014). Nine patients (23%) in the control group had pressure sores compared with two patients (6%) in the prone group (difference − 18% (95% CI − 2 to − 33%); P = 0.032). There were no other differences in secondary outcomes between groups. Conclusions The implemented protocol for awake prone positioning increased duration of prone positioning, but did not reduce the rate of intubation in patients with hypoxemic respiratory failure due to COVID-19 compared to standard care. Trial registration ISRCTN54917435. Registered 15 June 2020 (https://doi.org/10.1186/ISRCTN54917435).
The present study examines the relationship among emotional intelligence, achievement, and gender. The sample consists of 121 participants at a public university in North Upper Egypt called Minia University. The Wong & Law's (2002) emotional intelligence scale has been used in this study. Confirmatory factor analysis has been adopted to verify the structure validity of the EI scale. Results of confirmatory factor analysis showed that the four-factor model fits well and its results meet the criteria for goodness of fit indices (> 0.90) and root mean score residual (< 0.05). Cronbach Alpha indicated high reliability of the scale. Positive correlation was found between academic achievement and self emotional appraisal, regulation of emotion, use of emotions, and total emotional intelligence score. There was no significant difference between males and females in emotional intelligence in the total score of EI scale and its subscales. Only two dimensions (regulation of emotions & self emotions appraisal) predicted academic achievement.
BackgroundIt has been shown that certain hematological conditions, such as lymphopenia and thrombocytopenia, are associated with increased severity and mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, a majority of the previous data came from large institutional centers with high academic output. We aimed to explore the association between patient's characteristics, hematological parameters, and outcomes in admitted persons with coronavirus disease 2019 (COVID-19) at our community hospital in an inner city. MethodsThis study is a retrospective chart review designed to evaluate the potential associations between demographic and clinical characteristics of our patient population and their outcomes when testing positive for SARS-CoV-2. The study population included patients hospitalized in the Saint Francis Medical Center from January 2020 to September 2020. This pilot study included 50 out of the 275 hospitalized patients with a confirmed SARS-CoV-2 infection during this timeframe. Data collection from the patient's chart included age, sex, comorbidities, admission complete blood cell count, and use of Remdesivir, steroids, and plasma. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included the need for mechanical ventilation and ICU admission. ResultsIn this pilot study, there was an overall mortality rate of 32% (16 out of 50 patients). Charlson Comorbidity Index (CCI) of 3 points or above was present in 87.5% of the patients in the mortality group versus 41.1% in patients who survived (p = 0.0021). There was no statistically significant difference in mortality between males and females after adjusting for other variables with an odds ratio (OR) of 0.19 (95% CI 0.02-1.80, p = 0.09). There were no statically significant differences in mortality between Caucasians, non-Hispanic, Black, and Latinx patients (p = 0.466). Admission platelets were lower in the mortality group with a mean of 157.7 ± 43.23 (Thou/ul) versus 250.06 ± 93.95 (Thou/ul) in the survivors (p = 0.0005). Admission white blood cell count in the mortality group was lower than the survivor group with an average of 5.93 ± 2.58 (Thou/ul) versus 9.3 ± 4.14 (Thou/ul) (p = 0.0039), respectively. The plasma D-dimer level of 3 mg/L fibrinogen equivalent unit (FEU) or higher was associated with increased mortality. There was no association of Creactive protein (CRP) with mortality (p = 0.93 and p = 0.54, respectively); however, the CRP level revealed an association with ICU admission (p = 0.03). The use of steroids, Remdesivir, and plasma did not have a statistically significant effect on mortality, ICU admission, or sepsis in our study. ConclusionIn this study, older age, higher CCI, and plasma D-dimer level of 3 mg/L FEU or higher were associated with higher mortality among COVID-19 patients. White blood cell count and platelet count were significantly lower in the mortality group in comparison to the survivor group. However, there was no statistical difference in lymphocyte count b...
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