Assessment of Psychological Needs in an Egyptian Sample of Healthcare Providers during the COVID-19 Pandemic

Objectives: The current study aims to identify the psychosocial needs of frontline Healthcare Workers (HCWs) during the COVID-19 pandemic and investigate the factors contributing to their psychosocial well-being. Methods: We conducted a cross-sectional study using an online survey designed specifically for the aim of this study. Data was collected from 315 frontline healthcare workers during the COVID-19 pandemic. Results: Up to 90 % of the responders reported a range of symptoms related to psychological distress such as worry, insomnia, lack of motivation, negative thoughts, inability to achieve goals, and burnout. Psychological support, religion-based support, communicating with family, and good sleep are among the stress-relieving factors most mentioned by HCWs. The change in work conditions and increased awareness of the need to use different strategies to overcome stress was associated with decreased levels of perceived stress among health care providers. Conclusion: The change in work conditions, the increased awareness of HCWs to their needs, and the use of different strategies to overcome were associated with decreased levels of perceived stress among HCWs. The increased number of working hours per day and younger age of the participants were the only significant independent variables detecting the need for psychological support. This research is a call for designing and implementing tailored needs-based interventions that address the different aspects of HCWs' well-being during public health emergencies. [ FROM AUTHOR] Copyright of Arab Journal of Psychiatry is the property of Arab Federation of Psychiatrists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Post-COVID-19 fibromyalgia syndrome: A report of two case

COVID-19 is a viral infection caused by SARS-CoV-2 that primarily targets the respiratory system. COVID-19 may be followed in some patients by post-COV-ID-19 syndrome, fatigue, anxiety, and musculoskeletal pain. These symptoms may be associated with other symptoms, resulting in a constellation of symptoms consistent with fibromyalgia syndrome (FMS). Two patients were evaluated at the rheumatology outpatient clinic for diffuse persistent musculoskeletal pain after COVID-19 infection. Patients presented with generalized musculoskeletal pain, fatigue, anxiety, depression, headache, hand paresthesia, and non-restorative sleep. General examination and various laboratory investigations, including autoimmune profile and radiological investigation, were normal. After examining eighteen tender points, both patients fulfilled the 1990 ACR classification criteria for FMS. Post-COVID-19 FMS should be considered during the management of post-COVID-19 syndrome to alleviate pain and prevent worsening of symptoms during the COVID-19 pandemic.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Why Does It Take So Long? - from Full Blood Count to Starting a Transfusion

A remark from a parent asking why did it take so long for their child to have the blood transfusion when bloods were taken early in the morning led to an audit of the timings;from the morning full blood count (FBC) to the transfusion being started. Methods 45 in-patients on the 3 haematology oncology wards were randomly selected. Due to the Coronavirus pandemic, there were 2 data collection episodes (30 in October 2019 and 15 in October 2020). Timings were established by retrospectively reviewing the patient's electronic record (Epic) the blood tracking system (Haemonetics) and the blood transfusion LIMS (Bank Manager). FBC taken and result blood request times group & save (G&S) sample times (if required) blood issued and blood collected times were recorded. Results . Time from FBC result to blood order- 2019 average 3 hours 44 minutes compared to 1 hour 41 minutes in 2020 . 35% (n16) needed a repeat G&S. 88% were (n14) taken after the blood was ordered (26 minutes to 4 hours 37 minutes) . Average time from FBC to transfusion in 2019 = 8.6 hours . Average time from FBC to transfusion in 2020 = 9.75 hours . 35% of blood/platelets were administered overnight despite many being 'top up' transfusions Discussion The results were presented to the nursing and medical teams so they could make suggestions for improvements. All agreed that transfusions are better given during the day ('before bedtime') and small changes could help facilitate this. These have included: . G&S samples being taken routinely 3 times a week on certain patients . Doctors verbally informing nursing staff when blood ordered, and it not just being added onto EPIC . Late afternoon huddles to review which patients have blood ordered and need to be transfused before bedtime.

Differences in the diurnal variation of salivary stress biomarkers during the coronavirus (COVID-19) pandemic between telecommuters and office workers

OBJECTIVES: It is necessary to objectively assess the stress state of workers, from the standpoint of holistic palliative care, in order to determine how the rapid change in work styles in the "live with coronavirus era"-in which people will coexist and live with the coronavirus (COVID-19)-will affect their physical and mental health. The aim of this study is to assess the impact of rapid changes in work patterns during the COVID-19 pandemic on the neuroendocrine stress response of workers. DESIGN AND METHODS: A total of sixteen subjects, 9 telecommuters (2 males, 7 females;age, 37.1+/-2.6 years) and 7 office workers (3 males, 4 females;age, 37.3+/-3.0 years) who provided their informed consent were enrolled in this prospective observational study. Saliva was collected four times a day (after waking, noon, evening, and before bedtime) and three times a week (Monday, Wednesday, and Friday) during May and June 2020. The saliva samples were stored at -20degreeC until measurement. Saliva components were analyzed by ELISA for cortisol, melatonin, s-IgA, and oxytocin. RESULT(S): The diurnal variation of salivary components between telecommuting and office work groups was investigated. Cortisol showed diurnal variation with higher secretion during waking hours and lower secretion toward nighttime in both groups, and no modulation was observed. In the office work group Melatonin showed diurnal variation, with increased secretion at night. In contrast, the telecommuting group showed modulation, with higher secretion at waking and lower secretion at night. s-IgA showed diurnal variation with a high level at waking and a low level thereafter in both groups, and no modulation was observed. The telecommuting group showed higher oxytocin levels in comparison to the office work group. CONCLUSION(S): These results suggest that the absence of commuting in the telecommuting group reduces anxiety due to infection, and that the diurnal variation of melatonin may be due to the alteration of circadian rhythm caused by being at home all day.

Impact of COVID-19 pandemic on sleep of undergraduate students: A systematic literature review.

The 2019 coronavirus pandemic forced the shift to distance education aggravating mental and physical vulnerabilities of undergraduate students, including sleep. This review aims to describe sleep problem rates and prevalence, sleep pattern disruption, sleep duration, sleep quality, insomnia symptoms, psychological and socio-economic factors affecting sleep of undergraduates in 22 countries. A systematic search for articles published from 2020 to 2021 using 'COVID-19,' 'Coronavirus,' 'Pandemic,' 'Sleep,' 'Mental Health,' and 'Students' from PubMed, Scopus, and Cochrane yielded 2550 articles, where 72 were included. Selection criteria were: English full-text available articles, undergraduates and not postgraduates, reported sleep outcomes, and participants not from allied health courses. Risk of bias was assessed using various Joanna Briggs Institute checklists and outcomes were descriptively synthesized. Prevalence of sleep problems was notable, while longitudinal studies showed increased rates. There was significantly increased sleep duration, and sleep pattern disruption during lockdowns. Several psychological, behavioural, environmental, demographic, and socio-economic factors were found to be associated with sleep changes. These highlight the pandemic's impact on sleep of undergraduate students and reveal opportunities for institutions to intervene with policies and programs to promote the well-being of undergraduates. Limitations include recall bias and underrepresentation of other countries. This study is self-funded with registration number RGAO-2021-0071.

Emergency Department Nursing Staffing Has Significant Financial Consequences for Patients, Hospitals, and Clinicians

Background: Emergency departments (EDs) have experienced increases in patient boarding, which has resulted in significant challenges to providing quality care. The COVID pandemic has exacerbated ED crowding despite reduced ED volumes nationally, which is in part due to national ED nursing shortages. Nursing-specific operational inefficiencies can have detrimental financial consequences for the ED and hospitals. Study Objectives: There were two primary objectives: 1) To quantify the amount of ED beds unavailable due to nurse-staffing challenges 2) To estimate the financial impact of this reduced capacity on the ED. Method(s): A retrospective, cohort review of all ED encounters from January 1, 2021 - December 31, 2021, was identified at our large, academic, safety-net trauma center. Performance metrics were retrieved from a novel, interactive, digital data dashboard at the Zuckerberg San Francisco General Hospital (ZSFGH). Average daily staffed nursing beds were obtained during two key time points daily: 11am and 7pm from Q4- 2021 (October 1, 2021 - December 31, 2021) and extrapolated for the calendar year. Total unavailable ED bed minutes were determined based on nursing staffing as were total potential missed encounters due to unavailable ED beds. These were estimated using the average LOS for ED encounters. Average institutional ED charges and realized payments were then used to determine a financial estimate of the impact of the nursing shortage during Q4-2021 and annualized for 2021. We assume, based on pre-pandemic census data, that there is sufficient ED demand and volume to occupy all available ED beds. Result(s): The ZSFGH is a 59-bed ED that when maximally staffed has a weighted average of 56.25 beds daily, accounting for nighttime closures. During the review period, the average daily nursing-staffed beds during Q4-2021 were 47.7 (84.7%). From January 1, 2021 - December 31, 2021, there were 57,888 encounters of which 53,012 (91.6%) were included and 4,876 (8.4%) were excluded due to alternative dispositions such as Absent Without Leave (AWOL), Left Without Being Seen (LWBS), Left Without Being Triaged (LWBT) and Nursing Referrals (RN Referrals). The total unstaffed ED bed minutes was an estimated 4,511,400. The average LOS excluding AWOL, LWBS, LWBT, RN Referrals, and Against Medical Advice (AMA) during this time period was 411 minutes resulting in an estimated 10,977 potential missed encounters, an estimated $8.56M in lost potential charges, and $1.97M in potential lost revenue [Figure 1]. During the pre-pandemic period with available data (August 1, 2019 - February 29, 2020) when boarding and nursing staffing weren't as limited, the daily census was 184.1 patients, excluding LWBS, LWBT, and RN Referrals with an average LOS of 407 minutes for a total daily bedtime of 74,929 minutes for a utilization of 92.5%. During this period, the total daily census with LWBS, LWBT, and RN Referrals was 210.1 patients. These additional patients would account for another 10,582 bed minutes for a total bed utilization of 85,511 mins (105.6%). Conclusion(s): The COVID pandemic has resulted in increasing challenges for already strained EDs. Increasing national nursing shortages reduce operational performance and result in a significant financial loss to EDs. Greater attention to the financial consequences of nursing shortages on EDs may allow for improved resource allocation, capacity recovery, and financial performance. [Formula presented] Yes, authors have interests to disclose Disclosure: FujiFilm-SonoSite Consultant/Advisor FujiFilm-SonoSite Disclosure: Inflammatix Consultant/Advisor Inflammatix Copyright © 2022

Quetiapine once daily versus twice daily for treatment of icu delirium

Introduction: Although guidelines recommend twice daily (BID) dosing of quetiapine for treatment of intensive care unit (ICU) delirium in most patients, once daily dosing at bedtime (HS) is commonly prescribed to reduce daytime somnolence. No studies have evaluated differences in outcomes. Research Question or Hypothesis: To determine if BID dosing of quetiapine reduces duration of delirium versus HS dosing for treatment of ICU delirium. Study Design: Retrospective analysis of ICU patients treated with BID versus HS dosing of quetiapine for ICU delirium. Method(s): Electronic health records were analyzed between January 1, 2017 and December 31, 2021 for patients prescribed quetiapine for ICU delirium. Patients were excluded for alcohol withdrawal, history of psychiatric conditions, receipt of <24 hours of therapy, alternative dosing variations, and death or transfer from the ICU <24 hours after beginning quetiapine. The primary outcome was recovery of delirium per Confusion Assessment Method (CAM-ICU) evaluated with Mann- Whitney U. Secondary outcomes included lengths of stay, mechanical ventilation duration, in-hospital death, and QTc prolongation. Unpaired t-test, chi-square with yates' correction, and Fisher's exact test were performed as appropriate using Graph-Pad Prism. Result(s): Baseline characteristics differed for sex in BID (38.9% female, n=23) versus HS (61.1% female, n=18) dosing and admission diagnosis (38.9% vs 17.4% COVID-19, respectively). No differences in time to delirium recovery [3 days (interquartile range [IQR], 2-5) vs 2.5 days (IQR, 1-5;p=0.6651)], ICU length of stay [16.9 days (standard deviation [SD], 9) versus 18.5 days (SD=13);p=0.6651)], duration of mechanical ventilation [9.6 (SD=8) vs 13.9 days (SD=12);p=0.2587)], or in-hospital death (60.9% vs 50%;p=0.7047) existed in the BID versus HS dosing group, respectively. Incidence of QTc prolongation was also similar between groups. Conclusion(s): Twice daily versus bedtime dosing of quetiapine did not significantly alter outcomes. These findings suggest similar efficacy without increased adverse events.

The association between self-reported electronic device usage and objectively measured sleep in adults

Introduction: Use of light emitting electronic devices in bed before sleep has been associated with sleep disruption in children and adolescents. Both the wavelength and intensity of the emitted light, and cognitive and emotional engagement with the device, have been proposed as explanations for subsequent sleep disruption. Here, we examined the association between daily self-reported electronic devices usage and objective sleep parameters in an adult population of consumer sleep technology users. Method(s): Data from 231 users without sleep disorders (mean age: 48.8 +/- 16.6 years, 51% female, ages 16-82) across 25,282 nights were included in the analysis. Sleep data was captured between March 3, 2020 and March 3, 2022, using the PSG-validated Sleep Score mobile application, which uses a non-contact, sonar-based method to objectively capture sleep-related metrics. Self-reported data were collected from a cross-sectional survey whereby users were asked, "In a typical week, how often do you use electronic devices in bed before going to sleep?" as per their experience after the COVID pandemic started. A mixed effect model was used for the analysis controlling for age, chronotype, weekend, and gender. Dependent variables included total sleep time (TST), sleep onset latency (SOL), sleep efficiency, WASO percent, bedtime, waking up time and time in bed (TIB). Result(s): Higher electronic device usage was associated with a reduction in TST (min) (beta = -9.2, 95%CI [-15.9, -2.5], p = 0.007), delayed bedtimes (beta = 0.17, 95%CI [0.029, 0.324], p = 0.019), and a reduction in TIB (min) (beta = -8.8, 95%CI [-14.75, -2.87], p < 0.005).There was no significant relationship between electronic device usage screen usage and SOL, sleep efficiency, percentage wake after sleep onset (WASO), and waking up time. Conclusion(s): Self-reported use of electronic devices in bed before sleep was associated with shorter TIB, later bedtime, and shorter TST. Our results suggest that electronic device usage before bed reduces the sleep opportunity window and subsequently shortens the time in bed and total sleep time. Future research is warranted to determine whether consumer sleep technologies may allow users to uncover deleterious pre-sleep behaviours which may contribute to sleep-wake dysfunction through daily logging and personalized feedback.

Circadian misalignment is associated with COVID-19 infection

Background: Circadian system contributes to the regulation of inflammatory processes, but the role of circadian misalignment as a risk factor for contracting Covid-19 has up to now been poorly studied. The aim of this study was to explore the relationship between circadian misalignment (chronic disturbance of the circadian system) and the risk of Covid-19 infection in a population of subjects suspected of contact or infection with SARS-CoV-2. Method(s): Cross-sectional single-center study conducted during a period without lockdown in winter 2021. Recruitment took place in a Covid-19 outpatient testing center. Subjects between 18 and 45 years old were included whether they were symptomatic or not, healthcare workers or not, in contact with a Covid-19 case or not. To determine social jetlag, a proxy of circadian misalignment, they were asked about their usual sleep-wake behaviors. Usual sleep duration and sleep-wake timing were explored on workdays and free days. Social jetlag was defined as at least 2 h shift of circadian alignment (defined as the difference between mid-sleep on workdays and mid-sleep on free days, midsleep as the median between bedtime and rise time). Result(s): One thousand fourteen subjects were included (sampling rate: 10.8%, 39% men, mean age 28 +/- 8) with 56 subjects positive for Covid-19 (positivity rate: 5.5%). Usual mean sleep duration was equivalent in both groups (7 h47 versus 7 h49, p = 0.733). Social jetlag greater than 2 h comprised 33.3% of subjects in the Covid-19 group versus 20.6% in the control group (p = 0.026). After adjustment on age, gender, BMI and work schedules, subjects presenting with social jetlag greater than 2 h had a 2.07-fold higher likelihood to test positive than subjects who had identical sleep-wake timing on workdays and free days (OR = 2.07, 95%CI = [1.12e3.80], p = 0.024). Conclusion(s): Circadian misalignment not only is present in subjects infected by Covid-19 but could also be responsible for a higher likelihood of being infected. The chronobiological impact on the immune system or a higher likelihood of being exposed to social contacts during nocturnal activities could explain our findings, which need to be confirmed in a future large cohort study. Regular sleep-wake timing could ultimately become a target for preventing Covid-19 infection.

Bedtime smartphone use and academic performance: A longitudinal analysis from the stressor-strain-outcome perspective

The penetration of smartphones into human life finds expression in problematic smartphone use, particularly under the Covid-19 home confinement. Problematic smartphone use is accompanied by adverse impacts on personal wellbeing and individual performance. However, little is known about the mechanism of such adverse impacts. Motivated by this, the present study strives to answer (i) how bedtime smartphone use impacts students’ academic performance through wellbeing-related strains;(ii) how to mitigate the adverse consequences of bedtime smartphone use. Drawing upon the stressor-strain-outcome paradigm, the current work presents a comprehensive understanding of how smartphone use indirectly deteriorates college students’ academic performance through the mediators of nomophobia — “the fear of being unavailable to mobile phones” (Lin et al., 2021) — and sleep deprivation. This allows a more flexible remedy to alleviate the adverse consequences of smartphone use instead of simply limiting using smartphones. This study collects a two-year longitudinal dataset of 6093 college students and employs the structural equation modeling technique to examine the stressor‐strain‐outcome relationship among bedtime smartphone use, nomophobia, sleep deprivation, and academic performance. This study finds robust evidence that wellbeing-related strains (i.e., nomophobia and sleep deprivation) mediate the negative relationship between bedtime smartphone use and academic performance. Furthermore, engaging in physical activity effectively mitigates the adverse effects of bedtime smartphone use upon nomophobia and sleep deprivation. This study not only enriches the current literature regarding the indirect effect mechanism of smartphone use but also provides valuable insights for academics and educational policymakers.

A Case of Cotard Syndrome and Neurosyphilis

BACKGROUND: Cotard syndrome is a rare neuropsychiatric condition in which individuals have delusions of being deceased or losing their organs. It is often seen in patients with severe depression and is associated with catatonia.1 Neurosyphilis is a severe sequelae of untreated treponema pallidum infection in which the paretic form of this disorder commonly has a psychiatric presentation. 2 We present a rare case of Cotard syndrome in a patient with neurosyphilis with successful treatment. OBJECTIVE: To understand Cotard syndrome and underlying neuropsychiatric conditions, and characterize the diagnosis and management of psychiatric symptoms in a patient with neurosyphilis. METHODS: Review of a case using electronic medical records and relevant literature. Key terms searched: 'Cotard syndrome,' 'neurosyphilis,' 'COVID-19 infection' using Medscape and Google Scholar. RESULTS: We present a 49-year-old male with a history of alcohol use disorder in remission, depression, and history of COVID-19 (asymptomatic) 6 months prior. The patient presented to the emergency department for recent changes in behavior. He was agitated, threatening, and required chemical and physical restraint. Evaluation was notable for illogical thought processes with somatic delusions. He repeatedly stated, 'I am already dead, my organs have died,' and had an episode of catatonia. All tests including drug screen and COVID-19 were negative. Rapid plasma regain (RPR) titer was 1:64. Neurology and Infectious Disease were consulted. Lumbar puncture revealed positive venereal disease research laboratory (VDRL) titer of 1:4. The patient was diagnosed with neurosyphilis and major depressive disorder with psychosis with Cotard syndrome. He was treated with intravenous (IV) penicillin G and was discharged on oral mirtazapine 30 mg and olanzapine 20 mg nightly at bedtime, oral donepezil 5 mg daily, thiamine, and folate. CONCLUSIONS: Cotard syndrome is often seen in depression with psychotic features.1 Neurosyphilis can present with depression, anxiety, psychosis, and dementia. Early identification is the key for successful treatment. This is a unique case of neurosyphilis with features of Cotard syndrome in a patient with a history of depression with treatment noncompliance. Studies show that quetiapine and risperidone improve psychosis in neurosyphilis.5 In this case, neurosyphilis was successfully treated with IV penicillin G for 2 weeks. The patient was also tried on antipsychotics and mood stabilizers ' specifically aripiprazole, valproic acid, and haloperidol ' and was eventually stabilized on oral olanzapine 20 mg taken nightly at bedtime. Our differential diagnosis also included COVID-19 delirium with Cotard syndrome, which was ruled out due to a negative COVID test. To our knowledge, there are 2 cases of COVID-19 delirium with Cotard syndrome.6 We present this case to inform clinicians of rare manifestations of neurosyphilis in patients with comorbid psychiatric illness and to advance research into treatment options for psychosis in neurosyphilis.

COVID-19 Related Emotional Stress and Bedtime Procrastination Among College Students in China: A Moderated Mediation Model.

Purpose: Although bedtime procrastination is prevalent during the COVID-19 pandemic, little is known about the relationship between COVID-19 related emotional stress and bedtime procrastination. Therefore, we investigated the correlation between COVID-19 related emotional stress and bedtime procrastination and examined the mediating role of negative affect and the moderating role of rumination among Chinese college students. Methods: A multicenter, cross-sectional, and quantitative research was conducted in China from August 11, 2021, to August 27, 2021, during the COVID-19 pandemic. The sampling method used in the study is the convenience sampling method. A total of 913 college students (aged 18-24 years) participated and completed online self-reported questionnaires. Their levels of COVID-19 related emotional stress, negative affect, rumination, and bedtime procrastination were measured by the Coronavirus Stress Measure, the Depression Anxiety Stress Scale, the Ruminative Responses Scale, and the Bedtime Procrastination Scale, respectively. The data were analyzed using Pearson correlations and moderated mediation analysis. Results: COVID-19 related emotional stress was positively associated with bedtime procrastination. Meanwhile, the association could be mediated by negative affect (Effect = 0.33, Boot 95% CI = [0.26, 0.39]) and moderated by rumination (Effect = 0.05, Boot 95% CI = [0.03, 0.07]) through its moderation in the link between COVID-19 related emotional stress and negative affect. This indicated that the mediation effect of negative affect was stronger in college students with high levels of rumination than in those with low levels of rumination. Conclusion: The findings of this study shed light on a correlation between COVID-19 related emotional stress and bedtime procrastination. Moreover, this study suggests that interventions could be targeted at alleviating negative affect and rumination to reduce the bedtime procrastination of college students with high levels of COVID-19 related emotional stress.

Racial/ethnic disparities in infant sleep in the COVID-19 Mother Baby Outcomes (COMBO) study.

OBJECTIVE: Investigate racial and ethnic differences in infant sleep and examine associations with insurance status and parent-infant bedtime behavioral factors (PIBBF). METHODS: Participants are part of the COVID-19 Mother Baby Outcomes (COMBO) Initiative, Columbia University. Data on infant sleep (night, day and overall sleep duration, night awakenings, latency, infant's sleep as a problem) were collected at 4 months postpartum. Regressions estimated associations between race/ethnicity, insurance status, PIBBF and infants' sleep. RESULTS: A total of 296 infants were eligible (34.4% non-Hispanic White [NHW], 10.1% Black/African American [B/AA], 55.4% Hispanic). B/AA and Hispanic mothers were more likely to have Medicaid, bed/room-share, and report later infant bedtime compared to NHW mothers. Infants of B/AA mothers had longer sleep latency compared to NHW. Infants of Hispanic mothers slept less at night (∼70 ± 12 minutes) and more during the day (∼41 ± 12 minutes) and Hispanic mothers were less likely to consider infants' sleep as a problem compared to NHW (odds ratio 0.4; 95% confidence interval: 0.2-0.7). After adjustment for insurance status and PIBBF, differences by race/ethnicity for night and day sleep duration and perception of infant's sleep as a problem persisted (∼32 ± 14 minutes, 35 ± 15 minutes, and odds ratio 0.4; 95% confidence interval: 0.2-0.8 respectively). Later bedtime was associated with less sleep at night (∼21 ± 4 minutes) and overall (∼17 ± 5 minutes), and longer latency. Infants who did not fall asleep independently had longer sleep latency, and co-sleeping infants had more night awakenings. CONCLUSIONS: Results show racial/ethnic differences in sleep in 4-month-old infants across sleep domains. The findings of our study suggest that PIBBF have an essential role in healthy infant sleep, but they may not be equitably experienced across racial/ethnic groups.

Impact of School Closure on Children'S Sleep Pattern During the COVID-19 Pandemic

Background: School closure is one of the main global health policies performed worldwide during the coronavir us di sease 2019 (COVID-19) outbreak. Despite all of the advantages, there may be some risks for children who are quarantined. This study aimed to objectively measure and compares the sleep patterns of Hong Kong school students before and during the COVID-19 outbreak. Methods: Baseline assessment was performed before the first wave of the COVID-19 outbreak in Hong Kong. The sleep pattern was recorded by a physical activity monitor (Actigraph wGT3X-BT, Pensacola, Florida, USA). The follow-up assessment was conducted in early 2020. Findings: In total, 718 students were collected in the baseline . Sub sequently 1 40 students joined t he reassessment between March and April 2020. Analysis of sleep timing shows that 98.0% primary students, 78.0% secondary students and 79.9% primary school students and 58.8% secondary school students go to bed before midnight before and after the outbreak, respectively (p<0.001). Mean sleep duration (hours) was 6.81 (0.62) and 8.09 (0.07) at baseline and during the outbreak, respectively. The differences in the mean sleep features for total sleep time, sleep fragmentation index and sleep fragmentation were 0.92 (1.64), 1.64 (6.95) and 2.49 (9.18), respectively. The overall sleep quality was poorer as evidenced by delays in bedtime and wake up time, increased duration in bed, longer sleep latency, increases in the movement and fragmentation indices. Conclusion: This exceptional longitudinal study reported objective data on the change in sleep patterns before and during the COVID-19 outbreak with school closures.

Intubation Performance with Stylet and Preloaded Bougie for Rapid Sequence Intubation in Patients Undergoing General Anaesthesia: A Randomised Clinical Trial

Introduction: Rapid sequence induction requires quick and single attempt intubation to secure airway without any untoward complications. As the number of attempts increase, risk of desaturation and aspiration increase which is potentially life threatening. In such circumstances, miscalculation may cost loss of time which may prove fatal. Various adjuncts and techniques have been devised to prevent such calamities. Aim: To compare ease of intubation with angulated stylet versus distally preloaded bougie for rapid sequence intubation in elective general anaesthesia procedures. Materials and Methods: This randomised trial was conducted in 100 patients belonging to 18-60 years of age from November 2019 to October 2020. Patients were intubated using rapid sequence including cricoid pressure by either styletted endotracheal tube (Group S) or distally preloaded bougie (Group B), for surgeries performed under general anaesthesia. The primary outcome was to determine mean time to intubation (TTI) and number of attempts, while secondary outcomes were haemodynamic responses to intubation and complications. Data comparison between independent groups in this normally distributed data was done using student -t test while intragroup analysis was done using chi-square test. Results: A total of hundred patients were randomized into two groups- group S (mean age: 41.12 years) and group B (mean age: 37.34 years), of 50 patients each. Number of intubation attempts with stylet were single in 82%, two in 18% cases while with preloaded bougie, it was 80% and 14%, respectively (p-value=0.196). Time to intubation was 22.16 seconds (group S) versus 33.78 seconds (group B) (p-value <0.05). The haemodynamic assessments revealed that tachycardia, hypertension and increased End tidal carbon dioxide (EtCO2) was seen for 10 minutes immediately post induction in both the groups, though the intergroup difference was non significant. The incidence of sore throat was higher with stylet than bougie, though non-significant (p-value=0.118). Conclusion: Stylet should be preferred for ease of intubation in rapid sequence inductions. However, the insertion and removal of stylet must be done cautiously to prevent postoperative sore throat.

Sleep disturbances in craniopharyngioma: a challenging diagnosis

Introduction: The hypothalamus plays a crucial role in regulating vital functions and circadian rhythms. Both the tumor involving the hypothalamic area and its treatment can lead to hypothalamic dysfunction, resulting in disturbances in sleep-wake patterns, sleep fragmentation, and increased daytime sleepiness. We describe two patients with craniopharyngioma who came to our attention due to the occurrence of episodes characterized by psychomotor slowing and afinalistic limb movements, temporal and spatial disorientation, psychomotor agitation, and oneiric stupor like episodes diagnosed as severe sleep disturbances. Case reports: Patient 1 is a 19-year-old male diagnosed with surgically treated craniopharyngioma. Subsequently, episodes of psychomotor slowing, afinalistic movements of the upper limbs diagnosed as seizures in another neurological center appeared;antiepileptic treatment was started without improvement. At the first examination in our center, excessive daytime sleepiness (EDS), fragmented nighttime sleep, episodes characterized by bimanual automatic gestures occurring during drowsy state, hypnagogic hallucinations, and sudden loss of muscle tone while awake were recognized. Actigraphy demonstrated irregular bedtimes, frequent nocturnal activity, and inappropriate daytime rest episodes. The Epworth Sleepiness Scale (ESS) showed subjective EDS (ESS=19). At PSG, hypersomnolence, severe sleep-related breathing disorder (SRBD), and no interictal and ictal seizure abnormalities were found. A BiPAP NIV was started, and antiepileptic therapy was discontinued. In the following months, PSG revealed marked improvement in SRBD and 1 SOREMP, and the MSLT a mean SOL of 6 min and 10 sec and 3 SOREMPs. These data allowed the diagnosis of secondary narcolepsy, and treatment with pitolisant was initiated with clinical improvement and reduced daytime sleepiness (ESS=9). Patient 2 is a 12-year-old male, surgically treated for craniopharyngioma at the age of 4 years, who developed episodes of myoclonic jerks, temporal and spatial disorientation, and psychomotor agitation during the lockdown period for COVID-19 emergency. Surmising paroxysmal epileptic episodes, the patient was hospitalized. The anamnestic data collection revealed a sleep-wake rhythm dysregulation, fragmented nighttime sleep, EDS, oneiric stupor-like episodes during which the patient performed simple automatic gestures mimicking daily-life activity, and severe impairment of alertness. The Long-term video-EEG, including polygraphic measurements, showed destruction of the wake-NREM sleep-REM sleep boundaries, episodes of undetermined state of vigilance, and concurrence of elements typical of different sleep stages. Moreover, a severe SRBD (AHI 19/h) has been observed. The MRI showed a volumetric increase in the post-surgical interpeduncular fossa and right paramedian cysts. Therefore, a multifactorial therapeutic plan including sleep hygiene and slow-release melatonin was started with improvement in nighttime sleep, but EDS persisted. Surgical treatment of cyst fenestration improved sleep-wake rhythm and behavior;BiPAP NIV was initiated with very poor adherence. Discussion: We aim to focus on sleep disorders as a possible complication of tumors involving the hypothalamic region. Our cases highlight that the clinical manifestation of these dysfunctions can be challenging to diagnose and can lead to misdiagnosis and inappropriate treatment that can harm patients' health and the quality of life of patients and their families. Conclusion: These findings support the need to incorporate comprehensive sleep assessment in survivors from childhood brain tumors involving the suprasellar/hypothalamic region.

How does Austria sleep? Sleeping habits and sleep problems before and during Corona

In the talk I discuss the sleeping habits and sleep problems before and during the Corona pandemic. An alarming increase in sleep problems from 6-year-old primary school children to adolescents and older adults is shown. Half of the interviewed adult Austrians (N=968) sleep less than 7 hours and only 31% classify themselves as "good sleepers". Changes due to the Corona pandemic and lockdown measures are also found across different cultural groups (Austria/Germany, Brazil, Greece, Cuba, Ukraine) and show, on the one hand, a high level of anxiety due to the pandemic (78% of respondents). In addition, in non-system-relevant jobs we see a consistent later going to bed and an extension of sleep times on working days (13 min daily), which in total lead to a reduced "social jetlag". People in system-relevant jobs also go to bed later and get up later, but show no increase in sleep time on weekdays and even a reduction in sleep time on days off (cf. Florea et al., 2021);overall, they also show a reduction in social jetlag, albeit to a lesser extent. We find cultural differences only of a general nature in the sense that people in Greece and Ukraine go to bed and get up later than the other cultural groups studied. Among children and adolescents (N= 2,232), we find 74.8% less physical activity during the Corona pandemic, 44.2% less exposure to daylight and 85% a strong increase in smartphone/tablet use during the pandemic or lock-downs. In addition, a shift of the sleep-wake rhythm to later times (for 94%) & more bedtime, and yet a subjective deterioration in sleep quality is also evident in that data. An alarming number of 33.3-45.3% depending on the age group now even subjectively report sleep problems during the pandemic (cf. Bothe et al., in preparation).

Advancing adolescent bedtime by using motivational interviewing and text reminders – a randomized controlled trial

Introduction: Chronic sleep deprivation is a prevalent sleep prbolem in school-aged adolescents. The natural delay of circadian rhythm combined with early school schedule leading to significant sleep loss during school days. In particular, adolescents in Hong Kong not only sleeping less than their Shanghai counterparts but also having later bedtime. Delaying school start time is an effective strategy but has met numerous constraints. While previous sleep education programs have successfully improved sleep knowledge but failed to increase sleep practice. Intervention with specific focus on late bedtime might be an potential approach to improve adolescent sleep. Current study explores the possibility of advancing adolescent bedtime by group-based motivational enhancement approach and text message reminders. Materials and Methods: Healthy adolescents (12-18 yrs old) with schoolday sleep duration <7 hours and without other sleep disorders such as insomnia and delay sleep phase disorder were randomly allocated to intervention or non-active control group. The intervention consists of four weekly, group-based therapy delivered using motivational interviewing approach and 3 week daily text reminders. Assessments were conducted at baseline, post-intervention, 3-month and 6 -month follow up. The primary outcomes were sleep-wake pattern captured by 7-day sleep dairy. The intervention effect was evaluated by linear mixed model. The trial was registered with the Clinical Trial Registry (NCT03614572). Results: A total of 212 adolescents (mean age: 15.8±0.98;female:60.1%) were recruited from Aug 2018 to Apr 2021. Approxiamtely 80% of the adolescents attended all the follow up assessments. Adolescents in the intervention group have significantly earlier schoolday bedtime at post-intervention (intervention vs. control:(-14 mins vs +19 mins) and 6-month follow up(-14 mins vs + 21 mins) compared to the control group(F=4.6, P = 0.004). They also had a tendency of increased sleep duration throughout the follow up period, but the difference was not significant(F=2.22, P = 0.089). This is explained by the difference in schoolday wakeup time as control group had a significant later wakeup time at post-intervention (intervention vs. control: -2 mins vs +23 mins) in relative to the intervention group. It is not common to observe a change in schoolday wakeup time as wakeup time is largely determined by early school schedule. The outbreak of Coronavirus in 2020 has forced schools to close and adopted an online study mode. The online class schedule varied significantly between schools, which might explain the difference in wakeup time at follow up assessment. Despite there is no significant difference in schoolday sleep duration, adolescents in the intervention group reported greater intention to behavioral changes(P=0.043), and lower level of daytime sleepiness(P=0.001). However, there is no difference observed in sleep knowledge, mood symptoms and quality of life. Conclusions: This study supports that motivational interviewing in combined with text reminders are effective approach in advancing adolescent bedtime, improving their motivation and daytime functioning. Adolescents were able to maintain earlier bedtime regardless of the school schedule. We suggest that advancing bedtime protocol should be incorporated at school-level to benefit more adolescents. Acknowledgements:Supported by Health Medical Research Fund (#15163071), Hong Kong SAR, China.

Dysgeusia and Appetite Loss: Thinking Beyond MDD and COVID-19

Background: Dysgeusia is a distortion of taste sensation. Etiologies can include medications and Covid-19, among others. Dysgeusia may lead to appetite loss which is nonspecific and can have multiple causes, including major depressive disorder (MDD) (Coulter, 1988). Although post-marketing data revealed no association between nifedipine and dysgeusia (Ackerman, 1997), case reports of dysgeusia from nifedipine exist (Ackerman, 1997). We present a case of nifedipine-induced dysgeusia mistaken for depression. Case Report: A 42-year-old man with hypertension and diabetes was admitted to the hospital following right thalamocapsular and intraventricular hemorrhages. Hypertension was managed with metoprolol, lisinopril, nifedipine, and chlorthalidone. Levetiracetam was started for seizure prophylaxis. Medications included pantoprazole, simethicone, transdermal lidocaine, insulin, metformin, docusate, senna, and subcutaneous heparin. Psychiatric consultation was requested out of concern that appetite loss indicated depression. The day before psychiatric evaluation, mirtazapine 15 mg at bedtime for mood and appetite was started. Nifedipine 90 mg daily had been started 9 days prior to his first complaint of decreased appetite. The patient reported feeling disconnected from his family and “sad" for ∼10 years, complaining that family members “talk behind his back.” He was otherwise without paranoia. He denied insomnia, anhedonia, hopelessness, poor concentration, suicidal ideation, homicidal ideation, guilt, mania, or hallucinations. He reported poor appetite due to epigastric discomfort and bad taste to foods. Covid-19 testing was not yet widely available. No other signs or symptoms suggestive of Covid-19 were present. Although alert and fully oriented, concentration was impaired with sometimes tangential thought processes. Affect was full without depression. A diagnosis of adjustment disorder was made. The psychiatry team suspected nifedipine-induced dysgeusia and advised discontinuing nifedipine. Appetite improved two days later. Discussion: This case highlights the importance of considering alternative causes of nonspecific symptoms of depression, including decreased appetite, that may have non-psychiatric causes. Dysgeusia is widely recognized as a symptom of Covid-19. Other causes, including medications may be underrecognized and amenable to intervention. Conclusion: It would be helpful to consider medication side-effects as potential causes for taste distortion alongside psychiatric diagnoses, and COVID-19. References: 1. Coulter DM: Eye pain with nifedipine and disturbance of taste with captopril: a mutually controlled study showing a method of post marketing surveillance BMJ 1988;296: 1086–8. 2. Ackerman BH, Kasbekar N: Disturbances of taste and smell induced by drugs. Pharmacotherapy 1997;17(3):482-96.