ABSTRACT
Introduction: The COVID-19 infection rapidly became a worldwide pandemic and a public health emergency that seriously burdened healthcare systems. Health care professionals (HCPs) were faced with a new difficult and demanding challenge which frequently meant working long h shifts with low staffing members under high pressure environments. This may have had an important impact on sleep quality of HCPs. Aim(s): To evaluate the quality of sleep of HCPs after 3 waves of the COVID-19 pandemic. Method(s): A sleep questionnaire developed by the authors was sent to all HCPs of a tertiary hospital after the first 3 waves of the COVID-19 pandemic. Result(s): We had a total of 651 participants, mostly female (81.3%). Most participants were nurses (38.1%) and doctors (19.1%), with ages between 30 and 50 years. Other HCPs included were technicians, assistants, pharmaceuticals, among others. The majority dealt directly with COVID-19 patients (73.7%). Concerning quality of sleep, a significant proportion of HCPs referred a bad or very bad quality of sleep (41.5%) and only 16.1% stated a good or very good quality of sleep, of the last, 57% did not work night shifts. The majority suffered from night awakenings (88.6%), with 38.2% referring more than 2 awakenings per night;of these, 65% stated difficulty falling back to sleep. Furthermore, 46.2% HCPs referred initial insomnia and 59.9% referred terminal insomnia. Regarding quantity of sleep 16.9% slept less than 5 h, 47.3% slept approximately 6 h and only 7% slept 8 or more hours. Approximately 33% of HCPs resorted to sleeping medication, most frequently anxiolytics. In reference to daily symptoms, 71.3% of HCPs stated daytime sleepiness, most frequently after lunch (50.5%). Nonetheless, a significant proportion mentioned sleepiness during work (24%), and while driving (14.3%). Finally, 50.4% of the HCPs considered that the 3 waves of the COVID-19 pandemic worsened their sleep quality. Conclusion(s): This analysis demonstrates concerning results regarding the quality of sleep of HCPs after the first 3 waves of the COVID-19 pandemic with important daytime repercussions. This may reflect a consequence of the COVID-19 pandemic, as half of the HCPs considered that that the pandemic worsened their sleep quality.
ABSTRACT
Introduction - MIS-C is the most relevant complication of SARS-CoV-2 infection and has an incidence of 1 case / 2,200 children and adolescents with previous infection. The clinical picture is characterized by a multiorgan involvement and an insufficiently known response to therapy. Objectives - Retrospective analysis carried out in the Paediatric Department of the Ravenna Hospital from April 2020 to March 2022 of the cases admitted with MIS-C, with description of the presentation characteristics, the differences with respect to Kawasaki disease and the therapeutic strategies adopted also with regard to the clinical response. Results - Thirteen cases diagnosed with MIS-C with an average age of 6 years and four months were hospitalized, 4 cases were of Italian origin, 6 of Balkan and 3 of African. All the cases presented with fever> 39 ° C with severe malaise / irritability, associated with skin rash in 9 cases, conjunctivitis in 7 and cheilitis in 5. The most prominent manifestations of organ involvement were abdominal pain / diarrhoea (N = 9), myocardial dysfunction in the absence of coronary involvement (N = 5), presence of pulmonary thickening (N = 5), painful laterocervical lymphadenitis with reduced neck motility (N = 5), subnephrotic proteinuria (N = 7) and hypertransaminasaemia (N = 8). Two cases with “encephalitic-like” psychomotor slowing, one with important ascites and one with oedema of the para/retropharyngeal tissues were clinically relevant for the severity of the onset. Twelve cases were treated with IVIG and methylprednisolone (2 mg /kg), 4 of them were found to be non-responders and required the use of steroid boluses (4 cases) and anakinra (4 cases), in three of the latter in association with steroid boluses, with rapid and decisive clinical response. Conclusions - The serious clinical manifestations that characterize MIS-C do not concern only cardiac involvement. Therapy with an IL-1 inhibitor, anakinra, must also be envisaged as a possible first-line treatment in case of a particularly severe clinical picture at the onset.