Mental health consequences of isolation of patients with COVID-19

BACKGROUND: The COVID-19 pandemic has had a negative effect on the mental health on the population. It is unknown if the different types of patient isolation affect them equally. The objective of the study was to determine if the effect on the psychological discomfort caused by the isolation of the population with COVID-19 in a hotel supervised by health professionals was different compared with those who were isolated at home. METHODS: Patients diagnosed with COVID-19 during the first pandemic wave in Barcelona, consecutively selected from the Primary Care lists. A telephone survey was carried out to collect information about mental health in patients who were isolated in a hotel compared to those isolated at their homes. Descriptive statistics were performed and the study variables were analyzed using mean and standard deviation, count (percentage), Chi-square test, and Student's t-test. Logistic regression models were carried out selecting frustration and anger/irritability as response variables. RESULTS: Of the 89 patients included, 45 (50.6%) were isolated at their homes and 44 (49.4%) at the hotel. Frustration was identified in 48.3% and irritability in 29.2% of the most patients. Most of those who presented frustration were between 45 and 65 years old, while 50% of those who felt irritability were younger. Multivariate models confirmed that patients isolated at home showed a higher risk of frustration (Odds ratio 4,12;95% Confidence interval 1,60-11,49) and irritability (Odds ratio 3,81;95% Confidence interval 1,32-12,10), respectively. CONCLUSIONS: Patients isolated at home show a higher risk of presenting feelings of frustration and irritability than isolated patients in supervised hotels.

[Mental health consequences of isolation of patients with COVID-19.]

OBJECTIVE: The COVID-19 pandemic has had a negative effect on the mental health on the population. It is unknown if the different types of patient isolation affect them equally. The objective of the study was to determine if the effect on the psychological discomfort caused by the isolation of the population with COVID-19 in a hotel supervised by health professionals was different compared with those who were isolated at home. METHODS: Patients diagnosed with COVID-19 during the first pandemic wave in Barcelona, consecutively selected from the Primary Care lists. A telephone survey was carried out to collect information about mental health in patients who were isolated in a hotel compared to those isolated at their homes. Descriptive statistics were performed and the study variables were analyzed using mean and standard deviation, count (percentage), Chi-square test, and Student's t-test. Logistic regression models were carried out selecting frustration and anger/irritability as response variables. RESULTS: Of the 89 patients included, 45 (50.6%) were isolated at their homes and 44 (49.4%) at the hotel. Frustration was identified in 48.3% and irritability in 29.2% of the most patients. Most of those who presented frustration were between 45 and 65 years old, while 50% of those who felt irritability were younger. Multivariate models confirmed that patients isolated at home showed a higher risk of frustration (Odds ratio 4,12;95% Confidence interval 1,60-11,49) and irritability (Odds ratio 3,81;95% Confidence interval 1,32-12,10), respectively. CONCLUSIONS: Patients isolated at home show a higher risk of presenting feelings of frustration and irritability than isolated patients in supervised hotels.

Human immunodeficiency virus pre-exposure prophylaxis: analysis, follow-up and pandemic effect

Background and importanceIn 2019, the National Health System (NHS) approved funding for the indication of pre-exposure prophylaxis (PreP) as an strategy to prevent human immunodeficiency virus (HIV) infection in high-risk populations. The hospital pharmacy (HP), together with the Sexually Transmitted Infection (STI) centre, has created an interdisciplinary circuit where these individuals are closely monitored.Aim and objectivesTo characterise the user population of the HIV PrEP programme and assess the adequacy of the circuit, as well as the impact of the SARS-CoV-2 pandemic.Material and methodsRetrospective observational study of the PrEP programme from November 2019 to April 2021 carried out in the provincial STI treatment centre and the HP.The following were assessed: compliance with inclusion criteria, adherence to treatment and causes of discontinuation, toxicity, acquisition of STIs and interactions. Also variations during confinement and degree of involvement by COVID.Results169 males, aged 39.6±10.0 (range 19–64) years, all met at least one inclusion criterion in the last year: 75.7% (n=128) men who have sex with men (MSM) with more than 10 different sexual partners, 71.6% (n=121) MSM anal sex without condoms, 17.1% (n=29) MSM drug use, 10.7% (n=18) MSM with multiple PreP, 74.0% (n=125) MSM with at least one STI and one engaged in prostitution.30 clients discontinued medication: 33.3% (n=10) stopped risky practices, 20.0% (n=6) digestive toxicity (main adverse effect), 3.3% (n=1) poor adherence, 16.7% (n=5) client choice and 26.7% (n=8) drop out of follow-up. Mean adherence was 94.5±11.4.No patients acquired HIV during treatment, but other STIs were found (several users reported reduced of condom use): 36.7% (n=11) Treponema pallidum, 56.7% (n=17) Chlamydia trachomatis, 63.3% (n=19) Neisseria gonorrhoeae and 36.7% (n=11) Mycoplasma genitalum.This was a young population that does a lot of physical exercise and after the clinical interview it was discovered they were abusing protein shakes and anabolic steroids, therefore they were warned about it.During the confinement, 41 users were in treatment. Of the 37 who continued, 4 suffered from COVID.Conclusion and relevanceThe programme meets the requirements of the NHS, with high adherence to treatment and a good safety profile.Patients continued with PreP during confinement and there was a significant number affected by COVID.Clinical pharmaceutical follow-up has allowed preventive and corrective interventions, but more emphasis should be placed on the use of condoms and avoiding anabolic steroids given the possible renal repercussions.References and/or acknowledgementsConflict of interestNo conflict of interest

Impact on the pattern of care in Head and Neck Surgery and the regional and institutional policy changes adopted during the first 150 days of the COVID-19 era / Impacto en el patrón de atención en cirugía de cabeza y cuello y las medidas sanitarias adoptadas durante los primeros 150 días de la era COVID-19

Resumen Introducción: La pandemia COVID-19 generó una reestructuración en la atención quirúrgica mundialmente debido a su alta transmisibilidad y la inherente limitación de los recursos humanos y materiales disponibles. Objetivo: Describir el impacto de la pandemia COVID-19 en el Equipo de Cirugía Cabeza y Cuello del Complejo Asistencial Barros Luco Trudeau (CABL) en su ejecución clínico-quirúrgica y la secuenciación organizada de las medidas sanitarias aplicadas a lo largo del tiempo durante los primeros 150 días de iniciada la pandemia en Chile. Materiales y Método: Realizamos una revisión retrospectiva de los pacientes sometidos a cirugía y/o evaluados ambulatoriamente durante el período COVID-19 comprendido entre el 3 de marzo y el 31 de julio de 2020, comparado con el mismo intervalo de tiempo de 2019. Características clínicas y medidas sanitarias empleadas durante este período fueron sintetizadas. Resultados: Detectamos un descenso del 64% en atención ambulatoria y un descenso del 58% en la carga quirúrgica, comparado con el año 2019. Durante el período COVID-19 de 2020, un total de 61 pacientes fueron sometidos a intervención quirúrgica. La principal indicación de cirugía fue cáncer en un 75,4% (46). No se reportaron pacientes contagiados por COVID-19 en los 14 días siguientes a la hospitalización. Se discuten las consideraciones perioperatorias empleadas y restricciones nacionales/institucionales sanitarias. Conclusión: La crisis sanitaria mundial secundaria al COVID-19 generó una reducción en las atenciones ambulatorias y cirugías realizadas por Equipo de Cabeza y Cuello CABL. A pesar de las restricciones sanitarias, organizamos estratificadamente la atención para preservar la resolución de casos críticos no diferibles en cabeza y cuello.

Introduction: The COVID-19 pandemic generated a restructuring of surgical care worldwide due to the disease's high transmissibility and the inherent limitation of available human and material resources. Aim: The study's aim was to describe the impact of the COVID-19 pandemic on the head and neck surgery team at Complejo Asistencial Barros Luco Trudeau (CABL) in clinical-surgical execution and organization of sanitary sequencing measures implemented over time during the first 150 days after the pandemic started in Chile. Materials and Method: We performed a retrospective review of patients undergoing surgery or outpatient evaluation during the COVID-19 period from 03-03-2020 to 07-31-2020, compared to the same time interval in 2019. Clinical characteristics and sanitary measures used during this period were synthesized. Results: We detected a 64% decrease in outpatient care and a 58% decrease in surgical load from 2019. During the COVID-19 period of 2020, a total of 61 patients underwent surgical intervention. The main indication for surgery was cancer, in 75.4% of patients (46). COVID-19 was not reported in any patients in the 14 days following hospitalization. We discussed the perioperative considerations used and the national/institutional sanitary restrictions. Conclusions: The global health crisis to COVID-19 generated a reduction in outpatient care and surgeries performed by the CABL head and neck team. Despite health restrictions, we organized care stratified to preserve critical head and neck non-deferrable cases.

[Moods in critical care units: emotions and moral duties of care providers]. / États d'âme en réanimation COVID-19 : des émotions aux devoirs moraux des acteurs du soin.

The Covid-19 pandemic instills emotions that can be understood in the pathological sense of mental disorder and/or in the heuristic sense of a moral dimension. So what about this distinction in critical care and resuscitation services where caregivers are at the forefront of events? What to do with emotions? The objective of this work is to pose a medico-psychological and ethical perspective on these questions, starting from the hypothesis that emotions have a specific use during the pandemic. The first step will be to show that anguish and fear, although different from an epistemological point of view, arise from the same historical place, which is the discourse of the medical world with death. The awareness of the inevitable makes share the same need of the caregiver and the citizen of a psychic economy which will lead to differentiating two possible reactions to emotions: one to face up and one to come to terms with. This psychic interlacing, inherent to the pandemic context, calls for critical care on a moral dimension related to the issue of abandonment of the human person and the poorly understood notion of "mass death". An answer to this difficulty would be found in the concept of "being-caregiver-close" but its application also supposes an ethical reflection on the outlets and the personal virtues.

A home care programme for the ramp-up and first courses of treatment with venetoclax and hypomethylating agents in the treatment of acute myeloid leukemia

Background: The combination of venetoclax (Ven) with hypomethylating agents (VenHMA) has shown promising results both in newly diagnosed and relapsed or refractory acute myeloid leukaemia (AML) patients, ineligible for intensive chemotherapy. Due to our expertise acquired in at-home management of diverse complex haematological procedures, we initiated in February 2020 an at-home (AH) programme for the VenHMA regimen. This AH-VenHMA programme included the initial dose ramp-up to prevent tumour lysis syndrome (TLS), a phase usually recommended to be performed as an inpatient hospital admission. Aims: Herein we present preliminary results of our AH experience during the first two cycles of VenHMA treatment for AML patients. Methods: Before implementation of AH-VenH programme, ramp-up was performed during a hospital admission (n=29, reference cohort). In Feb 2020, we initiated the VenH programme;outcome of in this patient cohort are compared with the reference cohort. In AH programme, prior to VenHMA initiation, medical evaluation is performed by a haematologist and a liaison nurse. Medical history, potential drug interactions and TLS risk are thoroughly evaluated. Laboratory tests (LT) including blood count and biochemistry are completed. Extensive health education is provided to patient and caregiver before the first cycle. A peripheral insertion intravenous catheter (PICC) is placed to all patients before starting ramp-up. Intravenous (IV) fluids by a portable pump (PP) are started 24hrs before the beginning of VenHMA, as well as uricosurics agents;patients are advised to maintain oral hydration. Daily morning visits during ramp-up are performed by trained nurses who complete vital sign, obtain LT, review therapeutic compliance, replaced PP and administer hypomethylating agent. Patients are started on Ven in an escalation schedule of 100mg on day 1, 200mg on day 2, and 400mg on day 3 of the cycle, they are advised to take Ven after dinner, following an explicit indication of our team given after daily LT review. An appropriate dose reduction is performed in patients receiving concomitantly CYP3A4 inhibitors. After achieving planned Ven full dose, IV fluids are ceased (Image 1). Patients are followed throughout the whole cycle by the AH team. Platelet transfusions are administered at-home while red cell concentrates are administered at the hospital, due to our transfusion policy. Results: Between February 2020 and January 2021, 22 AML patients (40 cycles) received VenHMA at-home. Fourteen patients were men (63.6%), with a median age of 73 years (23-83). Main characteristics were well balance in both patient cohorts. Neutropenia (86.3%), thrombocytopenia (90.9%) and anaemia (86.4%) were the most frequent adverse events (AEs). A trend to a lower proportion of febrile episodes was observed in the AH program (19/29 vs. 8/22, p=0.074). Hospital readmission rate after ramp-up was markedly low in the AH cohort, significantly lower than in the reference cohort (4/22 vs. 19/29, p = 0.001). TLS was not observed in any group. Main AEs are shown in table 1. Median days of at-home treatment were 49 (19-187). Discontinuation was due to refractoriness in 5 (22.7%) patients. Two patients presented SARS-CoV-2 infection in early March 2020, resulting in death in both cases. Summary/Conclusion: Home care during the ramp-up and early phase of VenHEM regimen is a feasible and safe option. An AH programme was followed by a low readmission rate and offers diverse benefits such as optimization of health resources and increase of the comfort and well-being of patients and their caregivers.

Public health response to an outbreak of SARS-CoV2 infection in a Barcelona prison.

An outbreak of SARS-CoV2 infection in a Barcelona prison was studied. One hundred and forty-eight inmates and 36 prison staff were evaluated by rt-PCR, and 24.1% (40 prisoners, two health workers and four non-health workers) tested positive. In all, 94.8% of cases were asymptomatic. The inmates were isolated in prison module 4, which was converted into an emergency COVID unit. There were no deaths. Generalised screening and the isolation and evaluation of the people infected were key measures. Symptom-based surveillance must be supplemented by rapid contact-based monitoring in order to avoid asymptomatic spread among prisoners and the community at large.