Analysis of social and psychological factors influencing the treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019.

Objective To explore the sociodemographic and psychological factors influencing the continuity of treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019 (COVID-19). Methods A total of 277 patients with chronic kidney disease who were admitted to Department of Nephrology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. 2020 to Mar. 2021 were enrolled and divided into 3 groups: non-dialysis group (n=102), hemodialysis (HD) group (n=108), and peritoneal dialysis (PD) group (n=67). All patients were investigated by online and offline questionnaires, including self-designed basic situation questionnaire, self-rating anxiety scale (SAS), and self-rating depression scale (SDS). The general sociodemographic data, anxiety and depression of the 3 groups were compared, and the influence of sociodemographic and psychological factors on the interruption or delay of treatment was analyzed by binary logistic regression model. Results There were significant differences in age distribution, marital status, occupation, medical insurance type, caregiver type, whether there was an urgent need for hospitalization and whether treatment was delayed or interrupted among the 3 groups (all P0.05). The average SAS score of 65 PD patients was 38.15+/-15.83, including 53 (81.5%) patients without anxiety, 7 (10.8%) patients with mild anxiety, and 5 (7.7%) patients with moderate to severe anxiety. The average SAS score of 104 patients in the HD group was 36.86+/-14.03, including 81 (77.9%) patients without anxiety, 18 (17.3%) patients with mild anxiety, and 5 (4.8%) patients with moderate to severe anxiety. There were no significant differences in the mean score of SAS or anxiety severity grading between the 2 groups (both P0.05). The mean SDS scores of 65 PD patients were 53.42+/-13.30, including 22 (33.8%) patients without depression, 21 (32.3%) patients with mild depression, and 22 (33.8%) patients with moderate to severe depression. The mean SDS scores of 104 patients in the HD group were 50.79+/-10.76, including 36 (34.6%) patients without depression, 56 (53.8%) patients with mild depression, and 12 (11.6%) patients with moderate to severe depression. There were no significant differences in mean SDS scores or depression severity grading between the 2 groups (both P0.05). The results of intra-group comparison showed that the incidence and severity of depression were higher than those of anxiety in both groups. Multivariate binary logistic regression analysis showed that high school education level (odds ratio OR=5.618, 95% confidence interval CI) 2.136-14.776, P0.01), and unmarried (OR=6.916, 95% CI 1.441-33.185, P=0.016), divorced (OR= 5.588, 95% CI 1.442-21.664, P=0.013), urgent need for hospitalization (OR=8.655, 95% CI 3.847-19.476, P0.01) could positively promote the continuity of treatment in maintenance dialysis patients under the regular epidemic prevention and control of COVID-19. In the non-dialysis group, no sociodemographic and psychological factors were found to be associated with the interruption or delay of treatment (P0.05). Conclusion Education, marital status, and urgent need for hospitalization are correlated with the continuity of treatment in patients with chronic kidney disease on maintenance dialysis.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Analysis of social and psychological factors influencing the treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019

Objective To explore the sociodemographic and psychological factors influencing the continuity of treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019 (COVID-19). Methods A total of 277 patients with chronic kidney disease who were admitted to Department of Nephrology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. 2020 to Mar. 2021 were enrolled and divided into 3 groups: non-dialysis group (n=102), hemodialysis (HD) group (n=108), and peritoneal dialysis (PD) group (n=67). All patients were investigated by online and offline questionnaires, including self-designed basic situation questionnaire, self-rating anxiety scale (SAS), and self-rating depression scale (SDS). The general sociodemographic data, anxiety and depression of the 3 groups were compared, and the influence of sociodemographic and psychological factors on the interruption or delay of treatment was analyzed by binary logistic regression model. Results There were significant differences in age distribution, marital status, occupation, medical insurance type, caregiver type, whether there was an urgent need for hospitalization and whether treatment was delayed or interrupted among the 3 groups (all P<0.05). The average SAS score of 65 PD patients was 38.15+/-15.83, including 53 (81.5%) patients without anxiety, 7 (10.8%) patients with mild anxiety, and 5 (7.7%) patients with moderate to severe anxiety. The average SAS score of 104 patients in the HD group was 36.86+/-14.03, including 81 (77.9%) patients without anxiety, 18 (17.3%) patients with mild anxiety, and 5 (4.8%) patients with moderate to severe anxiety. There were no significant differences in the mean score of SAS or anxiety severity grading between the 2 groups (both P>0.05). The mean SDS scores of 65 PD patients were 53.42+/-13.30, including 22 (33.8%) patients without depression, 21 (32.3%) patients with mild depression, and 22 (33.8%) patients with moderate to severe depression. The mean SDS scores of 104 patients in the HD group were 50.79+/-10.76, including 36 (34.6%) patients without depression, 56 (53.8%) patients with mild depression, and 12 (11.6%) patients with moderate to severe depression. There were no significant differences in mean SDS scores or depression severity grading between the 2 groups (both P>0.05). The results of intra-group comparison showed that the incidence and severity of depression were higher than those of anxiety in both groups. Multivariate binary logistic regression analysis showed that high school education level (odds ratio [OR]=5.618, 95% confidence interval [CI]) 2.136-14.776, P<0.01), and unmarried (OR=6.916, 95% CI 1.441-33.185, P=0.016), divorced (OR= 5.588, 95% CI 1.442-21.664, P=0.013), urgent need for hospitalization (OR=8.655, 95% CI 3.847-19.476, P<0.01) could positively promote the continuity of treatment in maintenance dialysis patients under the regular epidemic prevention and control of COVID-19. In the non-dialysis group, no sociodemographic and psychological factors were found to be associated with the interruption or delay of treatment (P>0.05). Conclusion Education, marital status, and urgent need for hospitalization are correlated with the continuity of treatment in patients with chronic kidney disease on maintenance dialysis.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Depression and Anxiety in Medical Students during the COVID-19 Pandemic

Medical students are prone to anxiety and depression, largely due to the nature of their coursework. During the COVID-19 pandemic, many medical students were required to study from home without being involved in clinical practice. The aim of this study was to investigate depression and generalized anxiety disorder (GAD), plus possible risk factors in medical students around the world during the pandemic. A primary search was conducted using PubMed, limited to the period 2020-2021. A second search was conducted to acquire studies published before the pandemic, aiming to have a baseline prevalence value for these disorders in medical students. During the pandemic, the prevalence of depression in the USA (31.7%, 12.5%, and 10.8% for mild, moderate, and severe depression, respectively) was higher than the reported prevalence in Pakistan, Nepal, and Iran, although the four countries used different psychiatric instruments, making comparison difficult (9-item Patient Health Questionnaire, Self-rating Depression Scale, Hospital Anxiety and Depression Scale-Depression [HADS-D], and Beck Depression Inventory [BDI-II). The prevalence of GAD in the USA was also higher (35.3%, 19.5%, and 11.1%, for mild, moderate, and severe GAD) than the prevalence in China (21.3%, 2.7%, and 0.9%, for mild, moderate, and severe anxiety), and the overall prevalence in Brazil, (46.2%), using the same instrument (GAD-7). The prevalence of GAD in the USA was also higher than the prevalence in Nepal, Pakistan, and Iran, although the researchers used a different psychiatric instrument (HADS-A, Self-rating Anxiety Scale, and Beck Anxiety Inventory instruments, respectively). Before the pandemic, the reported prevalence of depression in the USA was lower (11.6%, 9.0%, and 3.0% for mild, moderate, and severe depression), than in Pakistan (31.0%, 13.6%, and 4.8%), using the BDI instrument. In Nepal, the prevalence of depression (5.2%) was higher than in Portugal (2.3%), ascertained with the HADS-D instrument. The prevalence in Egypt (65% using Depression Anxiety Stress Scale DASS-21]) and India (14.7%, 19%, and 17.5% mild, moderate, and severe depression, using DASS 42) were the highest prevalence values reported before the pandemic. For anxiety, the prevalence of overall GAD in Nepal (16.2%) was comparable to the one reported in Portugal (14.2%), both identified with the HADS-A instrument. The prevalence of GAD reported in India and in Egypt were the highest values, determined with the DASS 42 and DASS 21, respectively. Studies have reported that general social isolation and loneliness are risk factors contributing factors toward depression. Other risk factors identified with depression and/or anxiety disorders were being female, having a lower GPA, lower COVID-19 awareness, and having more experience with COVID symptoms. High prevalence of depression and GAD was identified in medical students in various countries. It is imperative that during any crisis such as the one experienced in the present COVID-19 pandemic, vulnerable populations to mental health disorders, such as medical students, are identified and supported. Further research needs to be done to explore other possible factors, such as living conditions, marital status, social-cultural influences, financial issues, and their relationship to depression and anxiety in this population, to further understand the best interventions to support this population.Copyright ©2022 Published by Scientific Scholar on behalf of Global Journal of Medical, Pharmaceutical, and Biomedical Update.

Pregnant women: psychology, cognitive and behavioral responses, and solutions towards COVID-19.

COVID-19 (Corona Virus Disease 2019) has spread globally and is highly infectious, causing psychological disturbances such as anxiety, depression, or both. Pregnant women, as a vulnerable population, need further attention. This study aims to evaluate the psychological impact of pregnant women during COVID-19 to constitute base data for solution guidance. Using a self-designed questionnaire, self-rated anxiety scale (SAS), and self-rated depression scale (SDS), we conducted a web-based survey on 1160 pregnant women from February 20 to April 30, 2020. The prevalence of anxiety and depression during pregnancy was shown to be 12.93% and 31.21%, respectively. Besides, younger age, housewives, lower education level, and early pregnancy all contributed to psychological disturbance during the COVID-19 pandemic. The results revealed significant variations in cognitive and behavioral responses based on the levels of the COVID-19 pandemic concerns, perceptions of life impacts and family concerns, preparation of personal protection equipment and motherhood, and the need for psychological counseling (P < 0.05). Regarding their primary concerns, 73.2% of the participants worried about the health and safety of childbirth. And 90.6% of respondents anticipated scheduling prenatal appointments to avoid crowds. Pregnant women are susceptible to anxiety/depression during the COVID-19 outbreak, necessitating immediate psychological care and intervention.

MUSCULOSKELETAL PAIN AS A PART of the RHEUMATIC SPECTRUM in COVID-19

Background: Since the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19) (1), our understanding of the underlying pathophysiology is constantly evolving in order to explain the wide range of heterogenic clinical manifestations (2). Nevertheless, limited data are available for the severity and multifactorial causality of musculoskeletal pain in COVID-19 patients (3). Objectives: This study aimed to evaluate the prevalence and intensity of rheumatic pain symptoms-arthralgia and myalgia and their association with anxiety and depression in a cohort of COVID-19 patients, hospitalized at the COVID-19 rheumatology department of the University Hospital St. Marina, Varna, Bulgaria. Methods: In the present single-center cohort study, a prospective analysis was performed among COVID-19 patients who were hospitalized from 1 Oct 2021 to 20 Jan 2022 and self-reported for new-onset of musculoskeletal pain. All 226 patients (age 26-91 years) were treated for moderate or severe SARS-CoV-2 infection confrmed by laboratory tests, including positive antigen test or polymer-ase chain reaction (PCR) test, and imaging modality. Detailed disease history and clinical examination were carried out by a fully certifed rheumatologist. All patients who reported new-onset of musculoskeletal pain during the acute phase of the infection, participated on a voluntary basis in a questionnaire survey, by completed Zung self-rating anxiety scale (SAS), Zung self-rating depression scale (SDS) and visual analogue scale (VAS) for arthralgia and myalgia. The questionnaire form also elicited information on sociodemographic characteristics of the patients. In all patients, infammation and thrombotic biomarkers were assessed. The level of signifcance was set to 0.05. Results: Among all 226 COVID-19 patients with musculoskeletal pain, 46.5% (n =105) were women and 53.5% (n = 121), were men. Mean age was 65.6 years. We found a signifcant correlation of depression and anxiety scales scores with pain intensity (both arthralgia and myalgia), all < 0.001. A multiple regression analysis found that SDS and SAS accounted for signifcant variance in the prediction of muscle pain (β = 0.441, p < 0.001;β = 0.293, p = 0.003, respectively) while SDS signifcantly predicted joint pain (β = 0.341, p = 0.043). On the other hand, musculoskeletal pain does not correlate with any of infammation and thrombotic biomarkers assessed in SARS-CoV-2 patients (p > 0.05). Conclusion: Rheumatic pain manifestations are part of the heterogeneous spectrum of COVID-19 disease. The pain intensity is signifcantly associated with anxiety and depression symptoms and does not correlate with infammation and thrombotic biomarkers.

INFLUENCING FACTORS on WORK BURNOUT of PRE-EXAMINATION and TRIAGE NURSES under the NORMAL EPIDEMIC PREVENTION and CONTROL

Background: Nurse is a high-risk groups work fatigue feeling, which seriously affects the quality of conventional work efficiency and bureden pressures for contradiction between nurses and patients especially during the COVID-19 pandemic.Normalized epidemic prevention and control during the preview triage nurse need to all patients to the hospital and the accompanying personnel carries on the preliminary screening.COVID-19 fxed point hospital preview triage nurse with an infected person contact, more prone to anxiety,depression, results in the decrease of efficiency, to treat the service object formulation work sense of fatigue performance, etc. Objectives: To explore the influencing factors of work burnout of pre-test and triage nurses under normal epidemic prevention and control. Methods: A total of 110 pre-test and triage nurses from 4 Grade-A hospitals in Shanxi Province were enrolled in this study. The general data questionnaire, Nurse Job Burnout Scale, Pittsburgh Sleep Quality Index Scale, Self-Rating Anxiety Scale and Self-Rating Depression Scale were investigated towork burnout of pre-examination and triage nurses. Comparison between groups using two Independent sample t-test and single factor variance analysis. Multiple regression were applied to analysis factors affecting nurse fatigue feeling dimensions by SPSS22.0. P values<0.05 were considered signifcant. Results: As shown in Table 1, different professional title, department, and the sleep quality of preview triage nurses emotional exhaustion dimension com-parison(P<0.001), different department nurses to personalized level dimension comparison(P<0.05), nurse personal accomplishment dimension comparison of different cultural levels(P<0.05). Professional title, working department, sleep quality and educational level were the influencing factors of job burnout of pretest and triage nurses. Conclusion: In the COVID-19 epidemic, managers should pay more attention to the main factors that affect the sense of exhaustion of pre-test and triage nurses, and take targeted intervention measures to alleviate the sense of exhaustion of nurses, so as to ensure the safety of nursing.

P.0279 Neural underpinnings of depressive and post-traumatic symptomatology in covid-19 survivors: a voxel-based morphometry study

Background: A high prevalence of depression, anxiety, insomnia and PTSD has been reported in COVID-19 survivors [1]. This is similar to what previously observed in other Coronavirus-related diseases such as SARS and MERS [2]. The pathophysiology of post-infection neuropsychiatric symptoms is likely to be multifactorial, with a role played by inflammatory and immunological factors [3], but it is still largely unknown;we thus investigated COVID-19 survivors via 3T MRI imaging to identify neural underpinnings of post-infection neuropsychiatric symptoms in order to further elucidate their complex pathophysiology. Methods: Covid-19 survivors were recruited during an ongoing prospective cohort study at IRCCS San Raffaele Hospital in Milan;psychopathology was initially measured via several self-report questionnaires (Impact of Events Scale-Revised (IES-R), Zung Self-Rating Depression Scale (ZSDS), 13-item Beck's Depression Inventory (BDI));subsequently patients (n=28) underwent 3T MRI scanning (Philips 3T Ingenia CX scanner with 32-channel sensitivity encoding SENSE head coil). T1 weighted images were processed using Computational Anatomy Toolbox (CAT12) for Statistical Parametric Mapping 12 (SPM12) in Matlab R2016b;segmentation into Gray Matter, White Matter and cerebrospinal fluid, bias regularization, non-linear modulation and normalization to MNI space were performed;measures of Total Intracranial Volume (TIV) were obtained and images were smoothed with an 8-mm full width at half maximum Gaussian filter. Multiple regressions were performed using SPM12 software package: with no a priori regions of interest selected, whole-brain gray matter volumes were used as dependent variables, psychometric scales scores as independent variables, and age, sex and TIV as nuisance covariates. Results: After VBM regression analysis covarying for age, sex and TIV, ZSDS Index scores were inversely correlated with gray matter volume in the Bilateral Anterior Cingulate Cortex (MNI 2, 24, 28, cluster level pFWE = 0.045, k=767);furthermore 3 cluster were identified comprising again the anterior cingulate cortex and the insular cortex bilaterally in which IES-R scores were inversely correlated with gray matter volumes (Cluster 1: MNI -30, 9, 3, cluster level pFWE = 0.005, k=1284;Cluster 2: MNI 36, -3, -3, cluster level pFWE = 0.037, k=773;Cluster 3: MNI 9, 30, 28, cluster level pFWE = 0.038, k=766). No other statistical significant result was found. Conclusions: Our study identified an inverse correlation between anterior cingulate cortex volumes and depressive symptomatology, measured via ZSDS, and between bilateral insulae and anterior cingulate cortex volumes and the degree of distress in response to the traumatic event, measured via the IES-R. Analogous findings have already been reported in patients with Major depression [4] and PTSD [5], and our study confirms the role of volumetric reductions of these brain regions in depressive and post-traumatic symptomatology. Given the nature of our study it is not possible to infer whether the reduction of gray matter volume is a consequence of the Covid-19 infection itself or, as it appears more likely, precede the infection acting as predisposing factor for the subsequent development of depressive and post-traumatic symptomatology. No conflict of interest

P.0691 Mood-congruent cognitive distortion and processing bias in depressed covid-19 survivors: a comparison with major depressive disorder

Introduction. COVID-19 survivors often experience psychiatric sequelae, with depressive psychopathology as the leading cause for needing psychiatric intervention [1]. Depressive cognitive distortion is a core feature of major depression, fostering the experience of negative emotions and hampering recovery [2]. Moreover, cognitive biases are well-documented in patients with inflammatory diseases and associated depressive symptomatology [3]. Considering both the high prevalence of clinical depression among COVID-19 survivors and the critical role of cognitive distortions in depression, we consider of crucial importance to investigate cognitive processing biases in COVID-19 survivors. Methods. We studied 729 participants, divided in three groups: (1) 362 COVID-19 survivors;(2) 73 inpatients with Major Depressive Disorder (MDD);(3) 294 healthy participants (HC). Severity of depression was self-rated on the Zung Self-Rating Depression Scale (ZSDS). Neuropsychological bias toward emotional stimuli and the general negative outlook on the self were tested in a self-description task [4], during which subjects were asked to self-attribute or refuse positive and negative morally tuned adjectives, and latencies and frequencies of attribution were recorded. Depressive dysfunctional attitudes in causal attribution and interpretation of hypothetical events were measured on the Cognition Questionnaire (CQ). We performed homogeneity of slope or separate slopes analysis when appropriate in the context of Generalized linear model (GLMZ), with an identity link function. Likelihood ratio test was computed as a measure of significance for tested effects and Akaike Information Criterion (AIC) was obtained as goodness of fit measure [5]. Results. 22.4% COVID survivors self-rated their depressive symptoms above the clinical threshold. Bias in speed of information processing significantly predicts self-description in all groups (COVID depressed: Wald W2=19.81;COVID non depressed: W2=15.48;MD: W2=13.65;HC: W2=33.54;all p<0.001). Information processing bias and frequencies of attribution of morally negative elements strongly predicted the severity of self-rated depressive psychopathology (ZSDS scores) (Processing bias: LR χ2=40.99, p<0.0001;Frequencies: LR χ2=127.89, p<0.0001). Additionally, the cognitive distortion in causal attribution and interpretation of hypothetical events (CQ scores) in depressed post-COVID patients showed intermediate levels of severity in all dimensions between non-depressed post-COVID patients, and MDD (post-hoc Fisher's least significance test: p<0.05 at all comparisons). Moreover, the CQ total score significantly influenced the ZSDS scores (χ2=84.60, p<0.0001). Interestingly, homogeneity of slope analysis revealed regression slopes were parallel in COVID-depressed and hospitalized MD patient groups in all models, yielding no significant group interaction. Finally, bias in information processing and negative self-description both predicted CQ scores (Latencies ratio: χ2=3.91, p=0.0479;Frequencies: χ2=42.96, p<0.0001). Conclusions. The breadth of moral self-reproach and the severity of cognitive distortion in evaluating events showed the same association with severity of depression in MDD and in post-COVID depressed patients, distributing along a gradient of severity, thus suggesting that these individual features of depressive cognitive distortion are shared in these conditions and should be addressed as treatment targets in depressed COVID-19 survivors. No conflict of interest

P.0086 Clinical and psychopathological predictors of fatigue in COVID-19 survivors: a machine learning study

Introduction: The COVID-19 pandemic has led to profound mental health consequences observed during acute infection and at short, medium, and long-term follow-up [1–3]. When considering long-term sequelae, a prevalent proportion of patients infected by SARS-CoV-2 experience a “Post-COVID-19 Syndrome” characterized by fatigue, depressive symptoms, sleep disturbances, and myalgia. In this context, fatigue is recognized as one of the leading complaints in COVID-19 survivors [4]. Long-term health consequences following COVID-19 and their impact on daily quality of life are largely unknown and need further investigation. Thus, questions about possible effects of mental health on fatigue, and of COVID-19 clinical severity on both, remained unanswered. We aim to predict long-term fatigue symptoms basing on clinical and psychopathological predictors through a machine learning approach. Methods: We evaluated the fatigue syndrome and the psychopathological status of 122 adult COVID-19 survivors (80 male, mean age 59.8±12.9) six months after hospital discharge for COVID-19. Clinical and psychopathological predictors were collected for the entire sample. Fatigue at six months was assessed using the Fatigue Severity Scale (FSS). Descriptive statistical analyses to compare means and frequencies were performed. To better disentangle the relationship between somatic and psychopathological predictors and the development of fatigue, we explored the effect of each predictor in affecting fatigue by implementing 5000 non-parametric bootstraps enhanced elastic net penalized logistic regression. The model's accuracy was estimated by 5-folds stratified nested cross-validations in the outer loop to define balance accuracy value (BA), class accuracies, and area under the receiver operator curve (AUC) (for a complete description of the method see [5]). Results: Six months after hospital discharge, 28%, 29%, and 24% of the total sample showed respectively depression (according to Zung Self-Rating Depression Scale), anxiety (according to State-Trait Anxiety Inventory form Y), and sleep disturbances (according to Women's Health Initiative Insomnia Rating Scale). Fatigue was present in 19% of the patients. When entering demographical, clinical, and psychopathological predictors in the elastic net penalized logistic regression, only depressive symptomatology significantly predicted the presence of fatigue at six months (Log Odds Ratio: 2.33;Standard deviation: 1.58;Lower and Upper 95% CI: -0.78 - 5.43;Variable Inclusion Probability: 96.7%). The 10-folds cross-validated elastic net model predicted fatigue with a BA of 65%, an AUC of 77%, and a specificity for the absence of fatigue of 74%, and a sensitivity for the presence of fatigue of 55%, showing good performances in excluding fatigue syndrome. Discussion: Besides confirming a high rate of long-term neuropsychiatric sequelae, our main finding is the strict association between fatigue and depression. We fear that, rather independent of pneumonia severity, major depression after COVID-19 is associated with persistent fatigue, thus worsening the burden of a non-communicable condition triggered by infection and by infection-related systemic inflammation, but then persisting on its own. Post-COVID syndrome, mainly characterized by fatigue, depression, and sleep disturbances, will affect COVID-19 survivors' daily functioning and place additional burden on the healthcare system. Clarifying the mechanisms and risk factors underlying such long-term symptomatology is essential to identify target population and to tailor specific treatment and rehabilitation interventions to foster recovery. No conflict of interest

P.0267 Persistent psychopathology in covid-19 survivors at one-year follow-up

Introduction: The effects of COVID-19 are highly variable, with potential involvement of almost all organs and systems. While the acute and sub-acute symptoms have been well described, the possible long-term sequelae of COVID-19 have become an increasing concern [1]. One, three, and six-months follow-up studies have reported highly prevalent post COVID neuropsychiatric sequelae [2,3,4,5]. The aim of the present study is to investigate the psychopathological impact of COVID-19 in survivors at one-year follow-up, also considering the effect of possible risk factors. Methods: We prospectively evaluated the psychopathological status of 160 COVID-19 survivors one year after hospital discharge during an ongoing prospective cohort study. To keep a naturalistic study design, exclusion criteria were limited to patients under 18 years. Sociodemographic and clinical data were collected. Current psychopathology was measured using the following self-report questionnaire: Zung Self-Rating Depression Scale (ZSDS), Impact of Events Scale-Revised (IES-R), State-Trait Anxiety Inventory form Y (STAI-Y), and Fatigue Severity Score (FSS). Need of antidepressant or anxiolytic treatment in the last year was collected. Statistical analyses to compare group means and frequencies (Student's t-test, Pearson χ2 test) exploring effects of sex, psychiatric history, and hospitalization for COVID-19 were performed. Results: Overall, 77 patients (48%) scored in the clinical range in at least one psychopathological dimension among depression, anxiety, and PTSD. Females and patients with a positive previous psychiatric diagnosis showed an increased score on most measures (Table). Hospitalization for COVID-19 did not affect psychopathology. During the year after COVID-19, 25 (16%) and 23 (14%) patients started an antidepressant or anxiolytic treatment respectively.Discussion: This is the first study that investigates psychopathology in a sample of COVID-19 survivors at one-year follow-up after hospital treatment. We reported high rates of persistent psychopathology consistently with previous coronavirus outbreaks. Psychiatric consequences to SARS-CoV-2 infection can be caused by the immune-inflammatory response to the virus itself or by psychological stressors such as social isolation, concerns about infecting others, and stigma. Considering that neuropsychiatric sequelae associates with a markedly increased risk of all-cause mortality, and given the alarming prevalence of post-COVID psychopathology, we now suggest to routinely asses psychopathology of COVID-19 survivors in order to promptly diagnose emergent disorders and to treat them to reduce the disease burden and related years of life lived with disability. No conflict of interest

Comprehensive Nursing Care for COVID-19: It's Effect on Prognosis of Patients with Chronic Diseases

Background: COVID-19 is severe in patients who have chronic diseases as hypertension, ischemic heart disease, diabetes mellitus, chronic obstructive pulmonary disease, renal and liver diseases, additional cancer, and the risk of mortality rate increases among elderly people. Aim of the study: To evaluate the effect of comprehensive nursing care for COVID-19 on prognosis of patients with chronic diseases. Design: Quasi Experimental design. Setting: The current study was carried out at isolation medical ward for COVID-19 patient (6th floor) at Menoufia University Hospital, Egypt. Subject: Purposive sample of 300 COVID-19 patients who fulfilled the inclusion criteria. They were divided randomly and alternatively into two equal groups 150 in each group: Study group (1): COVID-19 patients who received the hospital routine care and comprehensive nursing care provided by researchers. Control group (2): COVID-19 patients who received only protocol of care provided by the hospital. Tools of the study: Three tools were used to collect the data;as follows: Tool I: Interview questionnaire sheet;it developed by researchers it divided into four parts: Part (1): Sociodemographic data, Part (2): Questionnaire for medical data, Part (3): Laboratory and diagnostic data and Part (4): Clinical manifestation with categories of COVID-19. Tool (II): Chalder fatigue scale. Tool (III): Zung Self-Rating Depression Scale. Results: There was a statistically significant difference between the study and control group concerning to the duration of hospitalization, Sao2, vital signs post one week and before patients 'discharge from hospital. There was a statistically significant difference in study group at different intervals related to categories of clinical manifestations, reduction in mean score of fatigue and depression compared to control group post intervention. Recommendations: Integrate comprehensive nursing care in the protocol of care for COVID-19 patients. Establish multidisciplinary rehabilitation programs to determine discharge readiness and needs of patients recovering from Covid-19. Conclusion: Comprehensive nursing care has a positive effect on reducing the length of patients' hospitalization stay and enhanced patients' prognosis.

Analysis of risk factors for early clinical recurrence of inflammatory bowel disease after fecal microbiota transplantation

Objective: To explore the risk factors for early clinical recurrence of inflammatory bowel disease (IBD) after fecal microbiota transplantation (FMT). Methods: A retrospective study was conducted on 192 patients with IBD who received FMT treatment in the Colorectal Disease Specialty/Intestinal Microecology Treatment Center of the Tenth People’s Hospital Affiliated to Tongji University from February 2017 to June 2020. Univariate and multivariate logistic regression models were used to analyze the risk factors for early recurrence of inflammation. Feces from all participants were collected to extract the total bacterial genomic DNA. The V6-8 regions of the bacterial 16S rDNA gene were amplified by polymerase chain reaction (PCR), the PCR products were detected by the denaturing gradient gel electrophoresis (DGGE) method, and the intestinal flora was analyzed by DNA fingerprinting. Stool samples from all patients were tested for 9 bacteria, white blood cells (WBC) and platelet (PLT) counts, as well as the erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) level. Results: Of the 192 patients, 15 cases had inflammation recurrence during FMT and within one week after treatment, including 11 cases of ulcerative colitis (UC) and 4 cases of Crohn’s disease (CD), with a total recurrence rate of 7.8%. High Mayo inflammatory activity score, Mayo endoscopic sub-item score (MES) =3 points, CRP>10 mg/L, anemia, albumin <30 g/L, absolute value of peripheral blood lymphocytes (PBL) <500/mm3, and intolerance to enteral full nutrition were independent risk factors for recurrence during and after FMT in UC patients (P<0.05). Albumin <30 g/L and simultaneous use of immunosuppressive agents were associated with disease recurrence during and after FMT in CD patients. WBC, PLT, and CRP were all negatively correlated with Enterococcus (EC), and ESR was positively correlated with Saccharomyces boulardii (SB) (P<0.01). Conclusion: The low recurrence rate of IBD after FMT indicates the safety of FMT, but this procedure should be cautiously used in patients with severe intestinal barrier dysfunction and/or severe intestinal dysfunction.

Patients With Epilepsy Who Underwent Epilepsy Surgery During the COVID-19 Pandemic Showed Less Depressive Tendencies.

Introduction: Our hypothesis in this study was that differences might exist between patients with epilepsy (PWE) who underwent epilepsy surgery before and within the period of the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this study was to compare results of the Zung Self-Rating Depression Scale (SDS) between PWE who underwent epilepsy surgery before and during the pandemic period. Methods: Participants were PWE who underwent open cranial epilepsy surgery between February 2019 and February 2021 in our hospital. Patients who underwent surgery in the first half of this period, between February 2019 and January 2020, were defined as the pre-pandemic period group (pre-Group) and those treated in the second half, between February 2020 and February 2021, were categorized as the pandemic period group (within-Group). All patients completed the SDS before surgery, and scores were compared between groups. Results: SDS score was significantly higher in the pre-Group than in the within-Group (p = 0.037). Other factors, including age (p = 0.51), sex (p = 0.558), epilepsy duration from onset to SDS score evaluation (p = 0.190), seizure frequency (p = 0.794), number of anti-seizure medications (p = 0.787), and intelligence quotient (p = 0.871) did not differ significantly between groups. Conclusion: SDS score was higher in the pre-pandemic group than in the within-pandemic group, which may indicate that PWE with less-positive outlooks may be less likely to seek medical attention during stressful periods.

[Investigation of anxiety and depression in patients from the emergency department during COVID-19 epidemic].

OBJECTIVE: To investigate the status of anxiety and depression in patients requiring emergency treatment during the epidemic of COVID-19 to identify the patients with acute psychological stress disorder. METHODS: During the COVID-19 epidemic, the medical staff divided the patients visiting the emergency department into suspected group, fever group and control group through interview of the patients at triage. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were distributed to each patient, and a trained medical staff was responsible for assisting the patient to complete the scales. RESULTS: A total of 557 sets of scales were distributed, including 211 in suspected COVID-19 case group, 167 in fever group and 179 in the control group. A total of 516 scales were retrieved, including 197 in suspected case group, 151 in fever group and 168 in control group. In the 3 groups, the incidence rates of anxiety and depression were 57.87% and 58.88%, 48.34% and 43.71%, and 18.31% and 18.99%, respectively, and the rates were significantly higher in suspected group and fever group than in the control group (P < 0.01), and significantly higher in suspected group than in fever group (P < 0.05). The standardized anxiety and depression scale scores in suspected case group, fever group and control group were 57.38±16.25 and 42.58±14.27, 51.23±15.29 and 38.32±15.39, and 32.58±17.8 and 12.25±12.94, respectively. Compared with the control group, both suspected case group and fever group had significantly higher standard scores for anxiety and depression (P < 0.01), and suspected case group had significantly higher standardized scores than fever group (P < 0.01). CONCLUSIONS: Among the patients visiting the emergency treatment, the patients with suspected COVID-19 and common fever are more likely to develop anxiety and depressive symptoms.