Remitting neuropsychiatric symptoms in COVID-19 patients: Viral cause or drug effect?

Numerous reports of neuropsychiatric symptoms highlighted the pathologic potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its relationship the onset and/or exacerbation of mental disease. However, coronavirus disease 2019 (COVID-19) treatments, themselves, must be considered as potential catalysts for new-onset neuropsychiatric symptoms in COVID-19 patients. To date, immediate and long-term neuropsychiatric complications following SARS-CoV-2 infection are currently unknown. Here we report on five patients with SARS-CoV-2 infection with possible associated neuropsychiatric involvement, following them clinically until resolution of their symptoms. We will also discuss the contributory roles of chloroquine and dexamethasone in these neuropsychiatric presentations.

Knowledge, Attitudes, and Practices Regarding COVID-19 Among Healthcare Workers in Venezuela: An Online Cross-Sectional Survey.

Background: The deterioration of Venezuela's health system in recent years undoubtedly contributes to an increased impact of the COVID-19 pandemic. Understanding healthcare workers' (HCWs) knowledge, attitudes, and practices (KAPs) toward COVID-19 in the early stages of the pandemic could inform their medical training and improve their preparedness. Methods: A online national cross-sectional survey was conducted between May 26th and May 30th, 2020, to assess KAPs among HCWs in Venezuela. Results: A total of 1,441 HCWs from all 24 regions of the country responded to the survey. The mean age of the HCWs was 44 (SD [standard deviation] 14) years; most were women (66.4%). Most HCWs were specialized doctors (48%), followed by nurses (13%) and resident doctors (12.3%). The majority of HCWs had good knowledge (76.3%), obtained information mainly from scientific literature (85.4%); had negative attitudes (53.6%), felt uncomfortable with their work during the current pandemic (59.8%); and reported appropriate practices (76.9%). However, participation in COVID-19 related training was absent in more than half of the HCWs. Positive attitudes were significantly more frequent in frontline workers than in non-frontline workers (p = 0.001). Bioanalysts, students, and doctors were more likely to have good knowledge; participating in training was a predictor for positive attitudes and older age was an appropriate practice predictor. Conclusions: HCWs, knowledge in Venezuela could be improved by strengthening education and training programs. Strategies should focus on reducing fear and improving attitudes toward the care of COVID-19 patients, as well as the promotion of preventive practices.

Conocimientos, prácticas y actitudes para la higiene de manos del personal médico durante la pandemia COVID-19 en el Hospital Universitario de Caracas

Introducción: La práctica de la higiene de manos por el personal de salud es un elemento esencial para prevenir la transmisión de las infecciones asociadas a la atención sanitaria. El objetivo es evaluar el conocimiento, las prácticas y la actitud del personal de salud médico para la higiene de las manos y las condiciones sanitarias mínimas durante la pandemia de COVID-19 en el Hospital Universitario de Caracas, mayo 2020. Metodología: Estudio de corte transversal intrahospitalario. Población: Médicos adjuntos y residentes, y estudiantes presentes al momento de la visita al Hospital Universitario de Caracas. Instrumentos: Entrevistas, cuestionarios, inspecciones y observaciones del lavado de las manos en trabajo intrahospitalario. Análisis estadístico. Programa SPSS 21 para las estadísticas descriptivas con tablas de distribuciones de frecuencia, promedios, porcentajes, desviaciones estándar y percentiles. Pruebas de Chi2 con límites de confianza del 95 %. Resultados: 42 autocuestionarios, 32 a adjuntos y residentes, 75,6 % jóvenes menores de 30 años y 59 % femeninos. Conocimiento suficiente 74 %, las prácticas auto reportadas el 69 % correctas, y la actitud positiva 87 %. 51 áreas inspeccionadas con fallas de agua 16 %, lavamanos funcionales en 28 % de los ambientes, y falta de jabón, gel alcoholado o toallas desechables. 59 % de los baños para pacientes en malas condiciones sanitarias. Observaciones de higiene de manos durante el acto médico (100 momentos), solo 9 % correctos. La inspección del área de triaje de COVID-19 muestra que se cumplen con lavado de manos con gel alcoholado. La inspección del hospital (OMS) reporta 95 puntos nivel de higiene inadecuado con prácticas de HM y promoción deficientes. Formulario inspección de la OMS ante la COVID-19 arroja fallas en infraestructura, insumos y disponibilidad de EPP y falta de auditorías. Discusión: El conocimiento y las prácticas en puntajes moderados requieren educación médica continua, y la actitud muy positiva del personal de salud permitirán mejorar las prácticas en el lugar de trabajo, siempre que se disponga de la infraestructura, agua y jabón, y de gel alcoholado para el cumplimiento del lavado de las manos en los 5 momentos del acto médico. Conclusión: El hospital requiere mejoras importantes de la infraestructura y la entrega de materiales para la correcta higiene de las manos. Background: The practice of correct hand hygiene by health workers is a key element in the prevention of health care associated infections. The aim of the study is to assess the knowledge, practice and attitudes of the medical staff on hand hygiene and the minimum sanitary conditions during the COVID-19 pandemic at the Hospital Universitario de Caracas during May 2020. Methods: Transversal study based at the Hospital. Population: medical staff, residents, and medical students present when the inspection team visited the Hospital Universitario de Caracas. Instruments: interviews, questionnaires, inspection and observation of the hand hygiene process during hospital work. Statistical analysis: SPSS 21 software for the descriptive statistics, with frequency distribution tables average, percentage, standard deviation and percentiles. Chi2 test with 95 % confidence limits. Results: 42 self-administered questionnaires, 32 to medical staff and residents, 75,6 % were less than 30 years old and 59 % were female. 74 % had sufficient knowledge, correct self reported practice 69 %, positive attitude 87 %. 51 inspected areas, water failure 16 %, working sinks in 28 % of the areas, lack of soap, alcoholic gel or paper towels. 59 % of patient toilet facilities in bad sanitary conditions. Observations of hand hygiene procedures during medical work (100 moments) were only 9 % correct. Inspection of the COVID-19 triage area showed proper alcoholic gel hand hygiene. Hospital inspection (WHO) reported 95 inadequate hygiene points with deficient hand hygiene and promotion. WHO COVID-19 Inspection Form showed infrastructure failures, lack of supplies and availability of PPE and lack of audits. Discussion: Knowledge and practice had moderate scores which require intervention on the continuous medical education. The staff's positive attitude will allow improvement of practices at the workplace whenever infrastructure and supplies are available, especially soap and water or alcoholic gel, for the 5 moment hand hygiene protocol compliance. Conclusion: The hospital requires important infrastructure and supplies improvements for this purpose.

COVID-19: abordaje terapéutico y recomendaciones de la Sociedad Venezolana de Infectología

Alrededor del 80 % de los casos sintomáticos de COVID-19 tienen una enfermedad leve a moderada, que no suele progresar a fases más avanzadas. El 14 % de los casos pueden progresar en unos 7 a 10 días a un cuadro severo pulmonar, mientras que un 6 % siguen deteriorándose en el tiempo ante una respuesta hiperinflamatoria o de tormenta de citoquinas, que conlleva a shock y falla de múltiples órganos. En general tienen mayor riesgo de progresión los individuos con factores de riesgo como edad mayor de 60 años, género masculino, obesidad, diabetes, hipertensión, inmunosupresión, trasplante de órganos sólidos, enfermedad renal, tabaquismo;pero eso no descarta la posibilidad aislada que individuos aparentemente sanos puedan presentar una evolución severa o diversas complicaciones pulmonares, renales, cardiovasculares, neurológicas, endocrinológicas, entre otras. Este consenso busca orientar al personal de salud en Venezuela en el abordaje terapéutico y la atención de las personas con COVID-19, estableciendo recomendaciones con base a la mejor evidencia para la fecha. Las recomendaciones no solo se limitan a definir qué opciones terapéuticas han mostrado mayor eficacia y seguridad, sino que determina cuáles drogas carecen todavía de suficiente evidencia, y qué alternativas no deberían utilizarse por carecer de beneficios y/o de seguridad establecida. La medicina basada en la evidencia busca fundamentar las decisiones clínicas con base en evidencias;que son todos los elementos y hechos que demuestran jerárquicamente el nivel de veracidad y validez de diversos planteamientos en medicina. El mayor nivel de evidencia terapéutica se construye por medio de metaanálisis y revisiones sistemáticas de la literatura con base en estudios clínicos controlados, prospectivos, con asignación al azar por doble ciego, y con una muestra lo suficientemente importante;y es este tipo de evidencia la que se ha considerado más relevante para establecer las recomendaciones. About 80 % of symptomatic COVID-19 cases have mild to moderate illness, which does not usually progress to more advanced stages. 14 % of cases can progress in about 7 to 10 days to a severe pulmonary condition, while 6 % continue to deteriorate over time in the face of a hyperinflammatory response or cytokine storm, which leads to shock and failure of multiple organs. In general, individuals with risk factors such as age over 60 years, male gender, obesity, diabetes, hypertension, immunosuppression, solid organ transplantation, kidney disease, smoking, generally have a higher risk of progression. but that does not rule out the isolated possibility that apparently healthy individuals may present a severe evolution or various pulmonary, renal, cardiovascular, neurological, endocrinological complications, among others. This consensus seeks to guide health personnel in Venezuela in the therapeutic approach and care of people with COVID-19, establishing recommendations based on the best evidence to date. The recommendations are not only limited to defining which therapeutic options have shown greater efficacy and safety, but also determine which drugs still lack sufficient evidence, and which alternatives should not be used due to lack of benefits and / or established safety. Evidence-based medicine seeks to base evidencebased clinical decisions;which are all the elements and facts that hierarchically demonstrate the level of veracity and validity of various approaches in medicine. The highest level of therapeutic evidence is constructed through meta-analysis and systematic reviews of the literature based on controlled, prospective clinical studies, with double-blind randomization, and with a sufficiently large sample;and it is this type of evidence that has been considered most relevant to establish the recommendations.