Actualités épidémiologiques des troubles neuropsychiatriques dans un pays en crise structurelle : le cas du Liban

Introduction Avant 2022, le Liban était classé comme pays à revenu intermédiaire supérieur, l'âge de la population était croissant, et les maladies chroniques (dont les troubles neuropsychiatriques tel que l'AVC, l'épilepsie, la schizophrénie, la dépression et l'anxiété) y sont aussi prévalentes que dans les pays avancés (sinon plus). Dès 2020, le Liban connaissait une crise économique et sociale, aggravée par la pandémie COVID-19 et l'explosion accidentelle dans le port de Beyrouth, entraînant une déliquescence du système de santé, jusqu'alors considéré comme l'un des meilleurs du Moyen Orient. Actuellement, le secteur médicamenteux souffre de pénuries sévères, ce qui risque d'entraîner des complications significatives. L'objectif de cette présentation et de montrer l'état des lieux des maladies neuropsychiatriques au Liban, dans le contexte de crise actuelle sans précédent. Méthodes Une revue de la littérature a été menée, visant à évaluer les études épidémiologiques sur les maladies neuropsychiatriques au Liban de 2012–2022. Résultats La majorité des études publiées durant la période de la crise Libanaise, étaient des études transversales menées en ligne ou des études cliniques ;si la prévalence des maladies neuropsychiatriques était difficile à évaluer en raison des méthodes utilisées, les corrélats et facteurs de risque ont été identifiés. Le niveau socioéconomique contemporain affecte non seulement l'incidence de la maladie, mais également la qualité de la prise en charge. De fait, la crise économique a augmenté le stress, et a affecté l'état des patients au Liban, avec une nette augmentation du risque de complication lié au manque d'adhérence au traitement (les patients ayant des difficultés à accéder aux médicaments : pénurie, prix exorbitants, falsification) et la disparition de la couverture assurance médicale. Conclusion Le fardeau des maladies neuropsychiatriques au Liban s'est accentué dans le contexte contemporain du pays ;la prévention primaire y est de première importance, vu que la prise en charge de ces maladies devient de plus en plus difficile et coûteuse.

[Pulmonary rehabilitation, return home: the issues of psychic care for severe Covid-19 patients]. / Réadaptation pulmonaire, retour au domicile : les enjeux du soin psychique des patients Covid-19 sévère.

Upon discharge from the ICU, most severe post-Covid-19 patients are considered out of danger and on the mend. A large proportion of these patients are able to go home, but some continue to be frail and suffer from the side effects of the disease and the past heavy hospitalization. Others do not have the necessary support at home. Pulmonary rehabilitation is becoming a critical step in prognosis and a comfortable return home. It allows many patients to regain confidence in their body and its potential, to bridge the gap between a medically safe passive position and daily life, which should become as independent as possible, and to optimally reduce the risks of regression or relapse.

[Recommendations for the management of long Covid]. / Les recommandations de prise en charge du Covid long.

As we enter the eighth wave of pandemic Covid-19 infection, the disabling persistence of certain symptoms after this viral infection, often trivial with the latest variants, is still a concern. The most effective treatment of these prolonged symptoms after Covid remains a rapid diagnosis, even if it is primarily of elimination, followed by comprehensive, multidisciplinary, specialized management and early but individualized self-help exercises.

The psychological impact of lockdown on psychiatric hospital staff

The Covid-19 pandemic could lead in the long run to depressive disorders, anxiety, or at-risk consumption among health professionals, even those working outside of specialized Covid-19 units. We assessed the experience of 197 staff members in a psychiatric hospital during the first lockdown. The data suggest anxious and depressive symptoms for a significant part of the hospital staff during the lockdown. Women, nurses and assistant nurses, and staff who were off work tended to have higher anxiety and depression scores. A lack of information about the health situation was a significant risk factor for depression and anxiety. Our study points to exhaustion among health professionals during the first wave of the pandemic, even those working outside of specialized Covid-19 units. At-risk healthcare workers need close monitoring during and at the end of the pandemic, in order to prevent anxious, depressive, or post-traumatic stress disorder symptoms, and early treatment should be provided if necessary. All hospital staff seem to require clear and accurate information throughout the health crisis, in order to reduce the risk of psychological distress. © 2021 John Libbey Eurotext. All rights reserved. La crise sanitaire liée à la Covid-19 pourrait entraîner chez les professionnels de santé une détresse émotionnelle et des troubles anxiodépressifs, et cela même en dehors des unités de soins prenant en charge la Covid-19. Nous avons évalué 197 membres du personnel d’un hôpital psychiatrique au moyen d’une enquête en ligne, durant le premier confinement de la pandémie de Covid-19. Les femmes, les infirmiers et aides-soignants et les personnes en arrêt de travail présentaient davantage de manifestations anxiodépressives. Par ailleurs, le manque d’information sur la situation sanitaire était un facteur de risque de dépression et d’anxiété. Les facteurs de risques identifiés suggèrent la nécessité de prendre en charge précocement les personnes à risque et d’assurer un suivi rapproché et une information du personnel soignant afin de prévenir les troubles anxiodépressifs. © 2021 John Libbey Eurotext. All rights reserved.

Les formes prolongées de la COVID-19 ou COVID long : formes cliniques et prise en charge

Résumé Au décours d'un épisode aigu de COVID-19 symptomatique, plus de 30 % des patients adultes ont encore des symptômes à 1-2 mois et 10 à 15 % à 6-8 mois. Il peut s'agir de symptômes persistants ou de nouveaux symptômes. Si les plus fréquents sont une fatigue sévère, une dyspnée et des signes neurocognitifs, de nombreux autres organes peuvent être atteints. Ces symptômes évoluent en général de façon fluctuante et sont souvent majorés par l'effort physique ou intellectuel. Avec le temps, ils évoluent de façon lente vers l'amélioration. L'absence de documentation virologique de l’épisode aïgu (la PCR n'ayant pu être faite et/ou la sérologie étant négative) n'exclut pas ce diagnostic. L'origine de ces symptômes n'est pas encore élucidée et certaines hypothèses sont en cours d'exploration, comme par exemple une persistance virale qui a été démontrée dans certains cas, une réponse inflammatoire notamment mastocytaire excessive, ou bien un défaut de l'immunité innée ou adaptative. Des facteurs génétiques et hormonaux sont possiblement associés. La prise en charge des patients doit être initiée dès le premier recours aux soins. Suite à une analyse approfondie des symptômes, des diagnostics seront portés et feront l'objet d'une prise en charge multidisciplinaire où les traitements symptomatiques et la rééducation tiennent une place importante. Si le recours à l'hospitalisation est rare, ces formes prolongées, maintenant appelées « COVID long », vont avoir un impact sociétal majeur nécessitant la mise en place de politiques publiques adaptées. As a result of an acute symptomatic COVID-19 episode, more than 30% of adult patients still have symptoms at 1-2 months and 10-15% at 6-8 months. These may be persistent symptoms or new symptoms. If the most common are severe fatigue, dyspnea and neurocognitive signs, many other organs may be affected. These symptoms generally evolve in a fluctuating manner and are often aggravated by physical or intellectual effort. Over time they evolve slowly towards improvement. The lack of virological documentation (PCR could not be made at the initial episode and/or serology is negative) does not exclude this diagnosis. The origin of these symptoms is not yet clear: a viral persistence has been demonstrated in some cases, an inflammatory response including excessive mastocyte activation, a defect of innate or adaptive immunity are hypotheses being explored. Genetic and hormonal factors may be associated. Patient management must be initiated at the first point of care. Based on a thorough analysis of the symptoms, diagnoses will be made which leads to a multidisciplinary management where symptomatic treatments and rehabilitation are important. While hospitalization is rare, these protracted forms, now known as” long COVID”, will have a major societal impact requiring the implementation of appropriate public policies.

[Understanding and caring for patients with smelly wounds]. / Prise en charge des troubles de l'odorat liés à la Covid-19.

Sudden loss of smell is a very common symptom that can be observed in two-thirds of patients with Covid-19, and may be the only symptom of this disease. A study has demonstrated that 80% of infected patients have sudden loss of smell without nasal obstruction. This suggests that anomalies of the olfactory epithelium are a key element of pathogenesis and local involvement. Management of odor disorders related to Covid-19 is still being debated. Share of experience of the ear, nose and throat team at the University Hospital of Nancy (54).

La rééducation olfactive: bénéfices d’une prise en soins pluri-professionnelle

Résumé Près d’un français sur cinq souffre de troubles de l’odorat (TO), ou dysosmie. Cette prévalence a augmenté depuis l’apparition de la COVID-19 dont la dysosmie est un symptôme très fréquent et possiblement persistant. Pourtant, la prise en soin des personnes dysosmiques reste insuffisante. Cet article ouvre des pistes pour développer les rééducations olfactives (RO) sur la base de protocoles déjà éprouvés, mais aussi pour améliorer l’accompagnement des patients dysosmiques. Pour cela, une stratégie de prise en charge pluri-professionnelle est préconisée, alliant l’intervention de scientifiques, de médecins (généralistes, ORL) et de professions paramédicales. Summary Nearly one in five French people suffer from olfactory disorders (TO), or dysosmia. This prevalence has increased since the onset of COVID-19, for which dysosmia is a very common and possibly persistent symptom. However, the care of people with dysosmia remains insufficient. This article opens up avenues for developing olfactory rehabilitation (OR) on the basis of existing protocols, but also for improving support for dysosmic patients. For this purpose, a multi-professional care strategy is recommended, combining the intervention of scientists, doctors (general practitioners, ENT) and paramedical professions.

[Impact de la pandémie de COVID-19 sur la charge des patients atteints d'insuffisance cardiaque chronique en France]. / Impact of the COVID-19 pandemic on the burden of chronic heart failure patients in France.

CONTEXT: The COVID-19 pandemic in France has led to the implementation of containment measures, limiting medical activity to urgent care. Heart Failure (HF) patients should have particularly been concerned. During the pandemic, movement restrictions and fear of contamination could have worsened HF patients. METHODS: We conducted two dedicated anonymous questionnaire completed at the end of the first lockdown period in France about the HF patients'symptoms and the cardiologists'pratice. In parallel, data from the SNDS (Système National des Données de Santé) were collected concerning the practices of cardiologists. RESULTS: Regarding HF patients, 1156 participated and filled the questionnaire. 53% were men, aged 61± 15 yo in men and 53±12 yo in women; 13% declared feeling bad during the pandemic period. 36% declared they had more dyspnea, 14% more oedema, 45% a gain of weight and 57% were more tired. 45% of patients declared having spent more than 4 weeks without any appointment with a medical doctor. Regarding Cardiologists, they proposed to perform a remotely follow-up (teleconsultation including visio, phone call management) in 23% of cases. In parallel, data from the SNDS showed that 19% of cardiologist used teleconsultations. CONCLUSION: Through this original survey, it emerges that despite the HF patients being more symptomatic, cardiological follow-up was difficult and challenging. We suggest that during pandemic, teleconsultations could improve the efficiency and quality of care, reduce demands on patients, and reduce healthcare costs.

Perceptions and Correlates of Distress Due to the COVID-19 Pandemic and Stress Management Strategies Among Adults With Diabetes: A Mixed-Methods Study.

BACKGROUND: Greater risk of adverse health outcomes and public health measures have increased distress among people with diabetes during the coronavirus-2019 (COVID-19) pandemic. The objectives of this study were to explore how the experiences of people with diabetes during the COVID-19 pandemic differ according to sociodemographic characteristics and identify diabetes-related psychosocial correlates of COVID distress. METHODS: Patients with type 1 or 2 diabetes were recruited from clinics and community health centres in Toronto, Ontario, as well as patient networks. Participants were interviewed to explore the experiences of people with diabetes with varied sociodemographic and clinical identities, with respect to wellness (physical, emotional, social, financial, occupational), level of stress and management strategies. Multiple linear regression was used to assess the relationships between diabetes distress, diabetes self-efficacy and resilient coping with COVID distress. RESULTS: Interviews revealed that specific aspects of psychosocial wellness affected by the pandemic, and stress and illness management strategies utilized by people with diabetes differed based on socioeconomic status, gender, type of diabetes and race. Resilient coping (ß=-0.0517; 95% confidence interval [CI], -0.0918 to -0.0116; p=0.012), diabetes distress (ß=0.0260; 95% CI, 0.0149 to 0.0371; p<0.0001) and diabetes self-efficacy (ß=-0.0184; 95% CI, -0.0316 to -0.0052; p=0.007) were significantly associated with COVID distress. CONCLUSIONS: Certain subgroups of people with diabetes have experienced a disproportionate amount of COVID distress. Assessing correlates of COVID distress among people with diabetes will help inform interventions such as diabetes self-management education to address the psychosocial distress caused by the pandemic.

[Impact of the pandemic on students]. / Impact de la pandémie sur les étudiants.

French society has become aware of the distress of students, to the point of setting up systems dedicated to their mental health. To avoid confusion, it is important to qualify the mental health of students and to suggest ways to understand why this is a vulnerable population facing the health crisis.

[Therapeutic education and telemonitoring of heart failure patients]. / Éducation thérapeutique et télésuivi des patients insuffisants cardiaques.

At the Jean-Minjoz regional University Hospital Center in Besançon (25), the therapeutic education of patients with heart failure is carried out by a multidisciplinary team. The education nurse conducts the individual interview. The COVID-19 epidemic has changed the organization of care. Tele-monitoring is becoming the norm, the service nurse contacts patients by telephone and registers them on one of the platforms after they have given their agreement.

[Feedback from a COVID-19 acute geriatric unit]. / Retour d'expérience d'une unité de gériatrie aiguë Covid-19.

Following the outbreak of coronavirus disease, many experience feedbacks have been set up, at the level of departments, hospitals or crisis units. In a geriatric ward, this helped to understand what had happened to each of the caregiver and to the community. In the event of a new wave, this will allow them to anticipate. This period strengthened the sense of belonging and the interest in the well-being of the care receiver.

[Guidelines for surgical management of gynaecological cancer during pandemic COVID-19 period - FRANCOGYN group for the CNGOF]. / Prise en charge chirurgicale des cancers gynécologiques en période de pandémie COVID-19 ­ Recommandations du Groupe FRANCOGYN pour le CNGOF.

INTRODUCTION: Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period. MATERIAL AND METHOD: Recommendations based on the consensus conference model. RESULTS: In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies. CONCLUSION: During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.