Have we forgotten the non-COVID-19 diabetic patients? Impact of lockdown on daily life, sleep and mental health: cross-sectional study in Moroccan diabetic patients.

The main objective of this work is to describe the impact of lockdown on daily life, sleep and the mental health of Moroccan diabetics patients. The secondary objective is to study the factors affecting compliance with lockdown and deterioration of sleep in diabetic patients while lockdown. It´s a cross-sectional study including diabetic patients followed up at the Endocrinology department of Casablanca. Patients answered a questionnaire about Socio-demographic characteristics, Sleep-related characteristics and predominant activities during the lockdown. The psychological impact was assessed by the score of Anxiety and Depression Assessment Scale (HDAS). Statistical analysis was carried out using SPSS 20 software. Bedtime was shifted by 53 minutes during the lockdown. Waking time was also 1 hour 18 minutes later, while sleep duration increased from 8 hours 20 minutes before lockdown to 8 hours 30 minutes during it (p=0.24) with a deterioration in sleep quality reported by 53 patients. Sleep deterioration was not correlated with anxiety or duration of screen exposure, but was more related to age between 50 and 65 years old. HAD score showed anxiety in 29 patients which were correlated to the female gender. The study included 100 patients with an average age of 48 years. 38 patients had a professional activity before lockdown, 5 of them kept working face-to-face, 3 teleworked and 30 were unemployed. Only 59 % of them respected lockdown. This respect was correlated with female gender, educational level and the number of members under the same roof when it is more than 6. Deterioration in sleep, a change in bedtime and waking time and an increase in anxiety was observed in diabetic patients during the lockdown. Therefore, the psychiatric care system needs to adapt to provide psychological support not only to infected persons but also to other vulnerable communities including diabetic patients.

COVID-19: Patient care after discharge from the Intensive Care Unit.

INTRODUCTION: The Ibn Rochd CHU is a tertiary care structure that provides care for the most severe cases of COVID-19 requiring hospitalisation in intensive care. The objective of study is to describe the complementary medical and psychological care of patients with COVID-19 in the endocrinology department after a stay in intensive care. PATIENTS AND METHODS: This is a descriptive observational study of patients transferred from the intensive care unit to the endocrinology service following a COVID-19 infection during the period from 17 April 2020 to May 26, 2020. Clinical characteristics of the patients and complications related to COVID-19 infection were studied; a nutritional assessment using the MNA nutritional status assessment questionnaire; psychological assessment using quality-of-life questionnaires (Hamilton depression and anxiety, HAD, SF36, PCLS); a treatment satisfaction questionnaire (TQCMII) and an assessment of patient autonomy by the ADL score. RESULT: Our study included 41 patients with an average age of 55 years (19-85 years), a sex ratio M/F of 1.05, 43.9% were diabetic, 34.1% hypertensive, 4.9% asthmatic and 5% obese, and 51.2% were severe and critical cases. The average ICU stay is 8.42 days, requiring intubation in 12.2% of cases. All patients were treated with the Hydroxychloroquine, Azithromycin, vitamin C, zinc and corticosteroid protocol, 14.6% had undernutrition and 65.9% had a risk of undernutrition. The average BMI was 25.34 kg/m2 (17-42), 61% had experienced weight loss, which was greater than 8 kg in 26.1% of cases, 12.2% of patients were not autonomous, 12.2% had moderate depression, 2.4% severe depression, 14.6% mild to moderate anxiety, 12.2% severe anxiety and 29.3% suffered acute post-traumatic stress disorder. CONCLUSION: Patients with COVID-19 are, in addition to the complications from coronavirus infection, vulnerable to undernutrition, psychological and motor complications. Additional care before discharge is essential for better integration of patients into their families.

Nutritional status assessment in patients with Covid-19 after discharge from the intensive care unit.

INTRODUCTION: The nutritional diagnosis and early nutritional management of COVID-19 patients must be integrated into the overall therapeutic strategy. The aim of our study is to assess the nutritional status of patients with COVID-19 after a stay in intensive care, to describe the prevalence of undernutrition, to determine the factors influencing undernutrition and to describe the nutritional management. TOOLS AND METHODS: This is a descriptive observational study of adult patients admitted to the endocrinology service for additional care after a stay in intensive care during the period from April 17, 2020 to May 26, 2020. The assessment tool used was the Mini Nutritional Assessment (MNA). RESULTS: Our study included 41 patients; the average age of the patients was 55 years, 51.2% had a severe or critical form of COVID-19, 75.6% stayed in intensive care, 12.2% had a loss of autonomy. The average BMI was 25.2 kg/m2 (17-42 kg/m2), 42.5% were overweight, 61% had weight loss, 26.2% had weight loss greater than 10%, 14.6% of our patients were undernourished, 65.9% were at risk of undernutrition, 19.5% had hypoalbuminemia, 17.1% had hypoprotidemia, 19.5% hypocalcemia, 34.1% anemia, 12.2% hypomagnesemia and 51.2% had a deficiency in vitamin D. A positive correlation was found between poor nutritional status and a longer stay in intensive care (>5 days) (p = 0.011) and lymphopenia (p = 0,02). CONCLUSION: Despite a personalized diet, 14.6% of patients presented undernutrition. Particular attention should be paid to patients with a long stay in intensive care.