ABSTRACT
The COVID-19 pandemic has had a damaging impact on global health. Post-infection, patients may experience mental health difficulties and therefore require suitable psychological treatment and support. The objective of this study was to identify the psychological impact of COVID-19 on patients who were recovering from the physical effects of the disease, and to examine socio-demographic correlates within one month of treatment at a tertiary healthcare facility in Pakistan. A cross-sectional study was employed that utilized the Depression Anxiety Stress Scale-21 and Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5. A questionnaire was administered to 250 patients, with data collected over three months. Mild to extremely severe scores of depression, anxiety and stress were reported by approximately 43%, 52% and 42% of participants, respectively, and 8% developed PTSD. The incidence of depression, anxiety, stress or PTSD was not significantly associated with gender, age or previous interaction with COVID-19 patients. Depression was significantly associated with levels of education, severity of COVID-19 disease and a patient's current condition. Anxiety was associated with healthcare worker status. The severity of disease and a patient's current condition were also linked to the levels of anxiety, stress and the presence of PTSD. Collectively, these results indicate that a high percentage of patients recovering from COVID-19 experience psychological distress.
ABSTRACT
Objective: To assess the psychological impact of COVID-19 pandemic on healthcare workers. Study Design: Cross sectional study. Place and duration of Study: Armed Forces Institute of Cardiology/National Institute of Health Diseases in June 2020. Methodology: A total of 317 healthcare professionals, of different designations, affiliated with different public and private sector hospitals in Pakistan participated in this project. They were asked to complete Depression, anxiety and stress scales-42 (DASS-42). Results: Out of 317 healthcare workers, 107 (33.75%), 111 (35.02%), 103(32.49%) were depressed, anxious and stressed respectively. Female gender was associated with a higher prevalence of depression, anxiety and stress. Conclusion: More than one third of healthcare workers were depressed, anxious or stressed during the COVID-19 pandemic. Two out of five female healthcare workers were suffering from depression, anxiety or stress.
ABSTRACT
Objective: To provide an insight into the frequency of cutaneous manifestations in patients with Corona Virus Disease of 2019 (COVID-19), along with an association of these findings with the severity of the disease. Study Design: Cross-sectional study. Place and Duration of Study: Tertiary care hospital, Rawalpindi Pakistan, from May to Jul 2020. Methodology: We collected data from 412 confirmed cases of COVID-19 patients directly who were >12 years of age. The data included names of patients, their genders, ages, dates of admission, severity category, presence or absence of symptoms and cutaneous findings along with description of cutaneous findings if present. The data was evaluated using Statistical Package for the Social Sciences (SPSS) version 23. Results: Eleven out of the total 412 patients with COVID-19 included in our study were found to have cutaneous findings. The frequency of cutaneous manifestations associated with COVID-19 was calculated to be 11 (2.7%). Increasing age proved to be positively correlated with increasing severity of the disease whereas no association was found between gender and severity of the disease. Conclusion: Infection with COVID-19 may result in dermatological manifestations with various clinical presentations, which may aid in better understanding and management of the disease.
ABSTRACT
Introduction The clinicopathological description of dermatological manifestations of COVID-19 leaves much to be desired. There is a need to determine their association with disease severity, outcome, and other clinical variables. Objectives The objectives of this study are to record and histopathologically examine the cutaneous manifestations of COVID-19 and correlate these to age, disease severity, and mortality. Methods All confirmed COVID-19 patients admitted to a single tertiary healthcare hospital in Rawalpindi, Pakistan, were included. Their diseases were classified as mild, moderate, severe, and critical. The recent onset skin eruptions in these patients were recorded via photographs along with relevant clinical data. The photographs were independently reviewed by a group of three dermatologists without knowledge of the clinical information. The skin manifestations were divided into disease-specific and nonspecific categories using an already defined algorithm. Histopathological examination of skin manifestations was conducted. Results A total of 23% (n=47) had "new" skin manifestations. Specific skin findings were seen in 21.6% (n=44), which consisted of ecchymosis/purpura in 50% (n=22), maculopapular exanthem in 18% (n=8), livedo reticularis in 16.2% (n=7), ischemia/gangrene in 16.2% (n=7), perniosis in 15.9 % (n=7), vesiculo-bullous rash in 9% (n=4) and urticaria in 4% (n=1). Non-specific findings were seen in 6% (n=13) and included bedsores, dermatitis passivata, dryness, herpes labialis, oral ulcerations, and nasogastric tube-induced ulcerations. There was a significant association (p=0.03) between disease severity and specific skin lesions. Ischemia/gangrene was significantly associated with COVID-19 disease severity and mortality. Vesiculobullous lesions were associated with higher mortality, though not with disease severity. Livedo reticularis had a higher-than-expected count in critical disease, albeit statistically insignificant. The association of maculopapular exanthem and ecchymosis/purpura with severe/critical disease was statistically insignificant. Urticaria was significantly associated with low disease severity. Mean age with specific manifestations was 56.86 ± 15.81 and with nonspecific/without any manifestations was 42.58 ± 16.96, a highly significant difference, with p-value < 0.001. Old age (>60 years) was significantly associated with ecchymosis (p=0.038), maculopapular exanthem (p=0.021), and vesiculo-bullous rash (p=0.029). Histopathology varied according to the type of skin lesion. Conclusions Dermatological manifestations coexist in many patients and tend to appear more in severe cases of COVID-19 among the older age group and only minimally in mild/moderate cases. Their presence could help set prognostic criteria of COVID-19 disease in the future.