First episode psychosis related to COVID-19 infection

Introduction: During the course of COVID-19 pandemic, The respiratory system is the most commonly affected while many neuropsychiatric manifestations of the disease have been observed. Objective(s): Emphasize the importance of eliminating the diagnosis of covid 19 infection in a pandemic context face to first episode psychosis. Method(s): Presentation of case report Results: A 29-year-old woman unemployed married with no personal medical history and with psychiatric family history. She wasn't exposed to subject with covid 19 in her family circle. She was admitted in psychiatric care for acute behavioural disorders during five days. On physical examination: she was afebrile, eupneic and tachycardiac. Oxygen saturation was 96% and blood pressure was 100/50 mmHg. Specialized neurological examination was normal and cerebral CT scan was without abnormalities. At the psychiatric interview she was extremely agitated. She was distressed her speech was incoherent. She had auditory and visual hallucinations and a multi-thematic delirium. One day after her admission she died suddenly, the autopsy found positive RT PCR covid test and bilateral basal pneumonia. Conclusion(s): In individuals presenting with new-onset psychosis in areas endemic to COVID-19, consideration should be made for neuropsychiatric manifestations of Covid 19 from where the importance to push the explorations and to test the patients.

Depression among frontline medical and paramedical staff during the coronavirus pandemic

Introduction: The current coronavirus pandemic is a unique and unusual situation. It is putting the general population under severe strain. However, frontline medical and paramedical staff remain particularly vulnerable to depression because of its close contact with patients. Objective(s): The aim of this work was to screen and evaluate depression in the frontline professionals during the pandemic and to study their associated factors . Method(s): In this study , we conducted a national descriptive and analytical cross-sectional study over a 2-month period from September to October 2020. We used "Beck Depression Inventory" to assess depression and "Brief Cope Scale" to detect a possible correlation between depression and coping mechanisms. Result(s): We collected 78 professionals. The mean age was 29.86 years. 2/3 of workers were women. 67.9% of the staff were residents. 39.7% worked in Covid units. 7.7% had personal psychiatric history. 56.4% of the staff worked daily and 76.9% of them provided direct care to patients with Coronavirus. 52.6% of workers did not receive adequate training of protection against Covid-19. The staff reported 66.7% of death among their patients. 42.3% suffered from minor depression and only 2.3% suffered from severe depression. During this period we objectified an increase of 14.1% in the psychoactive substances use. Stigma affected 57.7% of professionals. We didn't objectify a significant correlation between Depression and coping mechanisms . Conclusion(s): Screening depression among healthcare professionals should be considered in order to prevent it, ensure continuity of care and avoid sick leaves.

Coping strategies among medical and paramedic frontline healthcare workers during the coronavirus pandemic

Introduction: The epidemic of COVID-19 has affected the psychological health of people, especially frontline medical and paramedical staff. Several coping strategies have been used to combat the impact of this virus on their lives. Objective(s): Describe the impact of coronavirus on mental health and identify coping strategies Methods: We carried out a cross-sectional, descriptive and analytical study, conducted over a period of two months ( september and october 2020), in 22 hospitals in Tunisia, including frontline medical and paramedical staff. Toevaluate anxiety and depression, we used the Beck Inventory.To identify coping strategies, we used the Brief COPE. Result(s): We collected 78 professionals. The mean age was 29.86+-5.4. The majority were medical residents (67.9%) working in covid units in 39.7% of cases. The rythm of work was daily in almost half of the cases, giving direct care to the patients tested positive in 76.9%. More than half had not received adequate training, and protective equipment was available in only 50% of cases. We found 35.9% of the staff who had to move for fear of infecting their families. More than half of the frontline staff were victims of stigma (57.7%). Depression and anxiety were tested minor in 40%. The most used coping strategy in the face of this distressing virus was social support (64.1%) followed by emotion-focused mechanisms (53,8%). Social support strategy was significantly correlated with prevention of anxiety (p=0.048) Conclusion(s): Participants practiced and recommended various coping strategies to deal with stress, depression and anxiety emerging from COVID-19 pandemic.

Anxiety among frontline healthcare professionals during the coronavirus pandemic

Introduction: Anxiety has become a topical issue since the arrival of the coronavirus pandemic, especially for frontline healthcare professionals as they deal with patients affected by the Covid-19. Objective(s): Objectify anxiety in frontline medical and paramedical staff and study its associated factors. Method(s): We conducted a national descriptive and analytical cross-sectional study via a survey over a 2-month period from September to October 2020. We used "Beck Anxiety Inventory" to screen anxiety as well as "Brief Cope Scale" to detect probable correlations between anxiety and coping mechanisms. Result(s): We collected 78 persons. The mean age was 29.86 years. 35.9% moved out of home. 39.7% worked in Covid units. 7.7% had personal psychiatric history. 76.9% provided direct care to patients with Coronavirus. The frontline staff reported that only 29.5% of patients were stables. Only 48.4% received adequate training of protection against Covid-19. 64.1% of professionals did PCR test and only 16.7% of them tested positive. We objectified an increase of 6.4% in the anxiolytics use. Stigma affected 57.7% of professionals. We highlighted a link between anxiety and social support strategy (p=0.048). 92.3%of the staff suffered from anxiety according to Beck Anxiety Inventory. Conclusion(s): Screening anxiety among frontline medical and paramedical staff might enhance their productivty and thus provide patients with the best care.

Thromboembolic Events and COVID-19 Vaccine

Introduction: Thromboembolic events (TE) are a major source of morbidity and mortality. Several risk factors have been associated to this condition such as age over 65 years, obesity, history of venous thromboembolism and hereditary thrombophilias [1]. Otherwise, TE have been associated with SARS-CoV-2 infection. Following the introduction of COVID-19 vaccines, these events were expected to decrease significantly [2]. However, some TE cases appeared after COVID-19 vaccination. Objective(s): The aim of this study was to summarize all the cases of TE that occurred after COVID-19 immunization in Tunisia. Method(s): We conducted a retrospective study involving all cases of TE that occurred after COVID-19 vaccination, from the beginning of the campaign of immunization in March 2021 to May 2022. These cases were notified to the National Center of Pharmacovigilance, Tunisia. Result(s): There were 25 cases of thrombotic events over about 12 million doses of vaccine. The mean age was 51.2+/-15,8 years. The sex ratio (M/F) was 1,27. Symptom onset occurred within 1 to 60 days. Both arterial and venous thrombotic events were reported. Venous thromboembolism was observed in 21 cases (84%). Deep vein thrombosis in 9 cases (36%), superficial vein thrombosis in 3 cases (12%), pulmonary embolism in 3 cases (12%) and the site of venous thrombosis was not specified in 6 cases (24%). Arteriel thromboembolism was reported in 4 patients: splenic infarction (1 case), thrombosis of the renal artery (1 case), thrombosis of the brachial artery (1 case) and femoral artery embolism (1 case). The TE were reported after the first shot in 72% of cases, after the second shot in 24% and after the third shot in one case (4%). The involved vaccines are summarized in table 1. Investigations revealed risk factors for TE in 12 patients. There were: age over 65 years in 25% of cases, thrombophilia in 25%, thromboembolic events histories in 25%, varicose vein thrombosis in 16.7% and immobilization in 8.3% of cases. This data was not provided for the 13 other patients. The outcome was favorable in 19 patients, one patient died and 5 patients were lost to follow up. There were no cases of Thrombotic Thrombocytopenia syndrome. Conclusion(s): Despite a temporal relationship, the vaccine responsibility cannot be retained given the patient's medical histories.

Thromboembolic Events and COVID-19 Vaccine: An International Journal of Medical Toxicology and Drug Experience

Introduction: Thromboembolic events (TE) are a major source of morbidity and mortality. Several risk factors have been associated to this condition such as age over 65 years, obesity, history of venous thromboembolism and hereditary thrombophilias [1]. Otherwise, TE have been associated with SARS-CoV-2 infection. Following the introduction of COVID-19 vaccines, these events were expected to decrease significantly [2]. However, some TE cases appeared after COVID-19 vaccination. Objective: The aim of this study was to summarize all the cases of TE that occurred after COVID-19 immunization in Tunisia. Methods: We conducted a retrospective study involving all cases of TE that occurred after COVID-19 vaccination, from the beginning of the campaign of immunization in March 2021 to May 2022. These cases were notified to the National Center of Pharmacovigilance, Tunisia. Results: There were 25 cases of thrombotic events over about 12 million doses of vaccine. The mean age was 51.2±15,8 years. The sex ratio (M/F) was 1,27. Symptom onset occurred within 1 to 60 days. Both arterial and venous thrombotic events were reported. Venous thromboembolism was observed in 21 cases (84%). Deep vein thrombosis in 9 cases (36%), superficial vein thrombosis in 3 cases (12%), pulmonary embolism in 3 cases (12%) and the site of venous thrombosis was not specified in 6 cases (24%). Arteriel thromboembolism was reported in 4 patients: splenic infarction (1 case), thrombosis of the renal artery (1 case), thrombosis of the brachial artery (1 case) and femoral artery embolism (1 case). The TE were reported after the first shot in 72% of cases, after the second shot in 24% and after the third shot in one case (4%). The involved vaccines are summarized in table 1. Investigations revealed risk factors for TE in 12 patients. There were: age over 65 years in 25% of cases, thrombophilia in 25%, thromboembolic events histories in 25%, varicose vein thrombosis in 16.7% and immobilization in 8.3% of cases. This data was not provided for the 13 other patients. The outcome was favorable in 19 patients, one patient died and 5 patients were lost to follow up. There were no cases of Thrombotic Thrombocytopenia syndrome. Conclusion: Despite a temporal relationship, the vaccine responsibility cannot be retained given the patient's medical histories.

Dermatoses bulleuses post vaccin Covid-19 : à propos de quatre cas

Les dermatoses bulleuses auto-immunes sont des maladies peu fréquentes. Elles ont été associées à certains vaccins. De rares cas ont été décrits avec le vaccin Covid-19. Nous rapportons quatre cas de dermatoses bulleuses post vaccin Covid-19. Nous avons retenu les patients qui ont présenté, soit une poussée de dermatose bulleuse, soit une dermatose bulleuse inaugurale suite à la vaccination anti-covid-19. Le diagnostic a été basé sur des critères cliniques, histologiques et immunologiques. Notre série était constituée de 4 femmes. L'âge moyen était de 64,7 ans. Nous avons retrouvé deux poussées de pemphigus et deux pemphigoïdes bulleuses inaugurales post vaccins covid-19. 1er cas : une patiente âgée de 43 ans, suivie pour pemphigus séborrhéique depuis mars 2014, a présenté 24 h après la 1ère dose de vaccin ChAdOx1-S une poussée de son pemphigus. À l'examen, elle présentait des plaques érythémato-croûteuses au niveau du cou, tronc et des membres avec des érosions post bulleuses motivant une augmentation de la dose de corticothérapie générale pour stabiliser sa maladie avec une bonne évolution après deux mois de suivi. 2e cas : une patiente âgée de 53 ans, suivie pour pemphigus vulgaire depuis 2018 nous a consulté pour poussée de son pemphigus. Elle a reçu une première dose de tozinaméran le 10/06/21 sans incidents et une deuxième dose le 05/07/21. Deux jours après avoir reçu le vaccin, il y a eu apparition de nouvelles bulles et d'érosions au niveau du tronc, des membres avec issue de pus. Cette patiente a été traitée par corticothérapie 1,5 mg/kg/j, azathioprine 50 mg 1cp*2/j pour stabiliser sa maladie avec une dégression progressive de la corticothérapie sur des mois avec une bonne évolution. 3e cas : une patiente âgée de 79 ans aux antécédents de diabète, d'hypertension artérielle et d'hyperthyroïdie s'est présentée à notre consultation pour éruption bulleuse 24 h après le la première dose de vaccin tozinaméran. A l'examen, la patiente présentait des bulles tendues à contenu hémorragique diffuses. La biopsie a montré un décollement bulleux siégeant au niveau de la jonction dermo-épidermique. L'immunofluorescence directe était en faveur d'une pemphigoïde bulleuse. Cette patiente a été traitée par corticothérapie générale avec dégression progressive et une bonne évolution.4e cas : une patiente âgée de 84 ans aux antécédents de diabète, dyslipidémie, hypertension artérielle et d'accident vasculaire cérébral nous a été adressée pour éruption bulleuse survenue 7 jours après la vaccination par BBIBP-CorV. À l'examen, elle présentait de multiples bulles tendues reposant sur une base érythémateuse et des érosions post bulleuses siégeant au niveau du tronc et des membres. L'étude histologique et l'immunofluorescence directe était en faveur d'une pemphigoïde bulleuse. La patiente était mise sous dermocorticoïdes avec une évolution favorable et cicatrisation complète des lésions au bout d'un mois. Chez nos patientes, la survenue de la dermatose bulleuse ou d'une poussée sévère et étendue dans un délai court après la vaccination avec une évolution rapidement favorable sous corticothérapie sans récidive fait suspecter la responsabilité du vaccin Covid-19. Toutefois, compte tenu des risques liés au Covid-19 pour les patients atteints de dermatoses bulleuses et de la rareté de ces évènements, les cliniciens doivent encourager la vaccination complète. (French) [ FROM AUTHOR] Copyright of Revue de Médecine Interne is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)