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Background: Little is known about the impact of the COVID-19 pandemic on physiotherapists' mental health. The aim of this study was to investigate the impact of the COVID-19 pandemic on physiotherapists' mental health in Belgium. Method(s): A total of 115 physiotherapists from 12 general hospitals in Brussels, working in COVID-19 care units (CCU) or non-COVID-19 care units (NCCU), participated in an electronic survey including validated measurement tools for PTSD, anxiety, insomnia and burnout. Descriptive analyses were performed to assess differences in mental health outcomes between physiotherapists who worked in a CCU and those who worked in an NCCU. Multivariable logistic regression analyses were also performed to assess risk factors for burnout. Result(s): Results showed significant levels of PTSD (9.6%), anxiety (33.9%), insomnia (40%) and burnout (33.9%) among participants. However, no significant differences were found between the 2 groups. It was also found that being isolated during the COVID-19 pandemic was a risk factor for burnout. Conclusion(s): Although no significant differences were found between the two groups, this study highlights a concerning rate of psychopathological symptoms among participants. Hospitals should therefore invest more time and resources into actions aiming at preserving the mental health of physiotherapists.Copyright © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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Introduction: High flow nasal cannula (HFNC) treatment is an efficient treatment for hypoxemia in acute respiratory distress syndrome (ARDS). Before the COVID pandemic, non-invasive ventilation was associated with higher mortality in ARDS, and early intubation was advocated. We hypothesized that HFNC treatment was more restrictive in the first wave of the COVID pandemic compared to the second wave respecting the pre-COVID conceptual consensus of early intubation in ARDS. Method(s): We conducted this retrospective observational singlecenter study in a tertiary ICU in Brussels during the COVID pandemic. The first flare-up ranged from March to May 2020, and the second flare-up from September to January 2021. All patients with COVID pneumonia and HFNC before intubation were included. We considered a delayed intubation a ROXi < 3.85 at the start of HFNC. ROXi is the ratio of SpO2/ FiO2 to the respiratory rate. The primary outcome was delayed intubation based on the ROXi in the number of days. The secondary outcome was mortality. Result(s): We included 60 patients in the first wave and 70 in the second wave. The duration of HFNC treatment before intubation was longer during the second wave, based on ROXi < 3.85: 1.6 days versus 2.8 days, p < 0.05 (Fig. 1). There was no significant difference in mortality, 18% versus 29%. The length of intubation was similar in both groups. The CCI, SOFA, APACHE III and SAPS II scores were similar in both groups. Conclusion(s): The duration of HFNC treatment in COVID-19-related ARDS before intubation has significantly been extended in the second pandemic wave. The delayed intubation based on the ROXi was in this study without significantly increased mortality. However, a trend toward higher mortality after prolonged HFNC was seen in the second pandemic wave.
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Background: ChemR23 knock-out mice displays aggravated viral pneumonia, with similar features as observed in severe COVID-19 patients. Aims and objectives: We evaluated the involvement of the chemerin-ChemR23 system in the physiopathology of COVID-19 with a particular focus on its prognostic role. Method(s): Blood samples from confirmed COVID-19 patients were collected at day 1, 5 and 14 from admission to Erasme Hospital (Brussels - Belgium). Chemerin concentrations and inflammatory biomarkers were analyzed in the plasma. Blood cells subtypes and their expression of ChemR23 were determined by flow cytometry. The expression of chemerin and ChemR23 was evaluated on lung tissue from autopsied COVID-19 patients by immunohistochemistry (IHC). Result(s): 21 healthy controls (HC) and 88 COVID-19 patients, including 40 in intensive care unit (ICU) were included. The concentration of chemerin in plasma was significantly higher in ICU patients vs HC at any time-point (p<.0001) and also when comparing deceased patients vs survivors (p=.02). In line with that, chemerin levels correlated with inflammatory biomarkers such as C-reactive protein, interleukin-6 and tumour necrosis factor alpha. Plasmacytoid dendritic cells and natural killers (NK) cells were strongly decreased in hospitalized and ICU COVID 19 patients. On NK cells of all COVID 19 patients, the expression of ChemR23 was reduced regardless its severity. Moreover, IHC analysis showed a strong expression of ChemR23 on smooth muscle cells and chemerin on myofibroblasts during the organizing phase of acute respiratory distress syndrome (ARDS). Conclusion(s): Chemerin is an early marker of severity in COVID-19 patients and could be involved in lung fibrosis post-ARDS.
ABSTRACT
Health care organizations have been challenged by the COVID-19 pandemic since the first half of 2020. Both hospitals (especially emergency and intensive care departments) and ambulance services were overwhelmed by surging patient numbers during the 2 pandemic waves in 2020. In this study, the data of the 2016 multisite terrorist bombing attacks in Zaventem (Brussels International Airport) and Maalbeek (subway) are reviewed. It is simulated what the impact of similar attacks would be on an already challenged health care system and which COVID-19-specific measures would be favourable for the outcome. The limited access of ICU beds, operating rooms and surge capacity, as well as the number of COVID-positive victims are cardinal features challenging the medical response to mass casualty incidents of this magnitude. During the COVID-19 pandemic, disaster management is affected by the limited availability of intensive care beds and operation rooms, and the faltering reverse triage negatively influencing the response capacity. On the other hand, the impact of the COVID pandemic can also be favourable. Special concerns on a COVID-19-safe response are discussed. It must be avoided that the medical response and gathering of stranded passengers would become a superspreading event. Multisite terrorist attacks during a pandemic are possibly catastrophic for a health care system which is already beyond its limit in terms of surge capacity. COVID-19-specific recommendations for disaster management in case of terrorist attacks are provided.
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This retrospective cohort study analyses the impact of the COVID-19 pandemic on the prehospital pathology in 1 emergency response unit of Brussels. Three months of prehospital data with in total 1,030 interventions were analysed: 1 month in the first and second COVID-19 outbreak (April and November 2020 respectively) and 1 in the intermediate period (June 2020). The subtracted data contained altered respiratory signs as primary outcome parameter. Secondary outcome parameters were mean age, time from call to arrival of the intervention team, oxygen administration, medication administration, artificial ventilation and prehospital death. Statistical analyses are performed using SPSS, the cross table, the Chi-squared test and the Kruskal-Wallis test. Altered respiratory signs appeared in 31.9, 24.6 and 32.9% of the cases in April, June and November respectively (p-value: 0.039). Mean age was 59, 57 and 60 years (null hypothesis retained). Time from call to arrival of the intervention team was 11 minutes in all 3 periods (null hypothesis retained). Oxygen was administrated in 31.4, 27.4 and 32.6% of the cases (p-value: 0.315). Medication was given in 41.1, 39.7 and 41.2% (p-value: 0.908). Artificial ventilation was necessary in 2.8, 5.5 and 5.8% of the interventions (p-value: 0.115). Prehospital death was declared in 6.1, 4.9 and 6.9% of the cases. The COVID-19 pandemic had a significant impact on the prevalence of prehospital altered respiratory signs. Furthermore, no significant difference has been observed in the secondary outcome parameters. Copyright © 2022 The authors.
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Introduction: Viral infections have been implicated in the development of type 1 diabetes. There have been reports of COVID-19 induced new-onset diabetes. Objective(s): In this context, this study aimed to describe and compare the characteristics at diagnosis of children who develop type 1 diabetes before and during the COVID-19 pandemic in Belgium. Method(s): This observational study compares two groups of children and adolescents who develop type 1 diabetes: the first includes newonset diabetes before the pandemic (1 March 2018 and 31 December 2019) and the second during the pandemic (1 March 2020 and 31 December 2021) in HUDERF, Brussels, Belgium. Result(s): In our center, the number of new-onset type 1 diabetes in the pre-pandemic period was 87 and in the pandemic period was 147 (p = 0.010). During the COVID-19 pandemic, patients with newonset diabetes were more often male (62% vs. 44%;p = 0.010) and had a slightly higher pH at admission [7.35 (7.22-7.41) vs. 7.34 (7.18- 7.38);p = 0.043] than before the pandemic. There was no difference in age, BMI SDS, HbA1c or severity of ketoacidosis at type 1 diabetes diagnosis. During the pandemic, 2 children (2%) had a positive SARSCoV2 PCR test on admission but were asymptomatic. Conclusion(s): The number of new cases of type 1 diabetes in our center during the COVID-19 pandemic was significantly higher than before the pandemic. These new patients were mainly male. Longerterm and national follow-up is needed to assess the role of COVID-19 in the development of type 1 diabetes.
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Background: Over 5 million deaths from the COVID-19 disease have been reported in the world. Patients (pts) living with rheumatoid arthritis (RA) affecting the immune system or under immunosuppressive agent are considered as a high risk population for a SARS-CoV-2 infection. Since no antiviral treatment is available, the vaccination is a major option. Objectives: The aim of this study is to evaluate in our RA cohort a questionnaire about the COVID-19 vaccination willingness, to analyse the vaccination rate, the number of COVID infection, the RA fares and the side effects. Methods: We included pts with RA from the UCLouvain Brussels cohort who met the ACR/EULAR 2010 classifcation criteria. A simple and standard questionnaire about the vaccine willingness was distributed in 2020 before the vaccination. From January to December 21, the rate of vaccination was calculated. The number of Covid infections, RA fares, therapy switches and side effects were also collected. All patient and RA characteristics were analyzed. Results: 605 eligible RA pts were included. The average age of the population is 58.21 years. 72% of the patients are women. 21% are smokers and 65% are positive for anti-citrullinated protein antibody (ACPA) with a mean DAS28-CRP of 2.39 and a mean HAQ of 0.821. In 2020, 460 pts flled the questionnaire and 61% indicated they would receive the vaccine as soon as it is available. For the 179 pts (39%) who decline, the reasons for not having vaccine were no trust in the vaccine at this time (53%), fear of side effects (28%), opposition to vaccine (4%), previous SARS-CoV-2 infection (2%) and unknown (5%). Pts under the age of 50, women, low education grade, smokers, presence of RF/ACPA and treatment with a bioDMARD were less willing to receive the vaccine. In 2021, 538 pts were vaccinated and only 67 pts (11.1%) not. The majority received a mRNA vaccine (81.8%). 72 and 21 pts developed a SARS-CoV-2 infection before and after the vaccination, respectively. Among them, 5 were admitted to intensive care unit leading to 4 deaths. Only, 7 RA fares were observed and 17 pts switched the therapy. 101 adverse events were reported. All of them were mild and transient except 2 cases with pulmonary embolism and one case with Herpes Zooster infection. Conclusion: The SARS-COV-2 global pandemic is responsible of many medical dramas. In our RA cohort, we observed frst hesitation followed by a high rate of vaccination. The safety was reassuring with a minimal number of RA fares and serious adverse events including only 4 deaths.
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Introduction : The pandemic caused by the SARS-CoV-2 virus has affected nearly 240 million people around the world. This pandemic has had a great impact on individual and collective clinical practice. Objective : Impact of SARS-CoV-2 on out-of-hospital cardiac arrest (OCAH), through gender, context, initial rhythm, survival and neurological recovery. Design, settings, and participants : A retrospective analysis of a cohort of OCAH patients who were treated by the mobile emergency and intensive care unit (MICU) of the Erasme hospital - University clinics of Brussels was conducted. All interventions concerning an OCAH, from 01/01/2019 to 12/31/2019, reflecting a non-pandemic period and from 01/01/2020 to 12/31/2020, reflecting a period of SARSCoV-2 pandemic were analyzed. Main results : This study shows an increase in the male/ female ratio, as well as an increase in the number of OCAH. During the second wave, more than half of OCAHs had a suspected respiratory etiology. This period indicate an increase in ventricular fibrillation, as well as better autonomy and neurological sequelae, despite the statistical tests between a non-pandemic and a pandemic SARS-CoV-2 period were not significant. Conclusion : This retrospective cohort of patients who used MICU of HE-CUB during a non-pandemic and a pandemic period, highlights the impact of SARS-CoV-2 in absolute numbers on OCAH.