Impact of the COVID-19 Pandemic on General Hospital Physicians Work and Mental Health: An International Cross Sectional Study

COVID-19 pandemic had an important impact in mental health across all countries and populations. However, health care professionals, particularly those in the front line have been subjected to increased levels of stress, workload, deterioration of work environment and working conditions while potentially being afraid of contracting the infection themselves or infecting love ones due to the higher risk of contagion when dealing with infected patients. Some studies have stressed out this impact showing increased levels of burnout, depression, hopelessness, stress and post-traumatic stress in all physicians however, the impact of the pandemic may have been different depending on the specialty. We intended to study the impact of COVID-19 pandemic for doctors working at general hospitals and liaison psychiatrists dealing with COVID-19 patients in Europe. We developed and applied online questionnaires to physicians working at general hospitals and psychiatrists working at liaison services, in different European countries (Portugal, Italy, Belgium, Greece, Poland, Croatia), in order to determine what were their working conditions and it they reported mental health symptoms during the pandemic. This questionnaire included demographic data, questions about working conditions when dealing with general and COVID patients and the Hospital Anxiety and Depression scale (HADS). It was distributed thought email and social media platforms used by doctors. This work has been approved by each local Ethics committee and all participants signed an informed consent.

Secondary Failure of Tocilizumab in Treating Elderly-Onset Rheumatoid Arthritis With Systemic Symptoms Complicated by Diverticulum Perforation.

The treatment of rheumatoid arthritis (RA) has advanced from the use of steroids to disease-modifying anti-rheumatic drugs (DMARDs) and biologics such as tumor necrosis factor (TNF) and interleukin-6 (IL-6) inhibitors. Historically, steroids have been the mainstream in the clinical treatment of RA; however, the development of DMARDs has changed the RA treatment structure. In addition, biologics can alleviate RA symptoms. This case report describes the secondary failure of tocilizumab in treating RA with fatigue symptoms. Treatment with tocilizumab decreases C-reactive protein (CRP) levels, which may make detecting RA exacerbation difficult; therefore, obtaining the patient's precise history and thorough physical examinations are necessary. This case demonstrates the complexity of treating elderly-onset RA and reports practical methods for effective treatment.

Giant Cell Arteritis Mimicking Polymyalgia Rheumatica: A Challenging Diagnosis.

Giant cell arteritis (GCA) is an autoimmune disease that causes inflammation of the middle and large arteries. Rural areas have many older patients with various symptoms, so large-vessel-type GCA should be managed effectively. Older patients tend to show vague symptoms that cannot be adequately diagnosed and observed. Here, we have encountered a case of a 91-year-old woman with a chief complaint of fatigue diagnosed with large-vessel type GCA in collaboration with a rural clinic. Effective collaboration between physicians in rural hospitals and clinics is necessary for diagnosing and treating large-vessel GCA. In rural areas, without adequate healthcare professionals, physicians should share their abilities and collaborate smoothly to mitigate delays in consultation and treatment. To effectively treat large vessel-type GCA, rural general physicians should be familiar with the clinical course of the disease and treatment for rural comprehensive care.

Clinical Characteristics of Japanese Patients Who Visited a COVID-19 Aftercare Clinic for Post-Acute Sequelae of COVID-19/Long COVID.

Introduction The long-term clinical course, prognosis, and optimal management of symptoms and conditions after the acute phase of coronavirus disease 2019 (COVID-19) remain to be elucidated. The purpose of this study was to clarify the characteristics of patients referred to a COVID-19 aftercare (CAC) clinic established at a tertiary academic hospital in Japan. Methods This study was a descriptive case series study. All patients who visited the CAC clinic between February 15 and September 17 in 2021 were included. Patients' background, chief complaints, and clinical courses after the onset of COVID-19 were described. Results A total of 87 Japanese patients (median age, 40.0 years; interquartile range [IQR], 26.5-53.0 years; 52.9% women) were referred to the CAC clinic. The median interval between the onset of COVID-19 and the visit to the clinic was 79.0 (IQR, 52.5-112.0) days. Referral sources were hospitals (36 patients), clinics (47 patients), a local healthcare center (3 patients), and other (1 patient). The most common chief complaint was general fatigue (50.4%) followed by dysosmia (28.7%), dysgeusia (26.4%), hair loss (18.4%), headache (17.2%), dyspnea (16.1%), and dyssomnia (13.1%). Respiratory symptoms were common in the early stages of the disease but were less common as the chief complaints when visiting the clinic. On the other hand, neurological, psychiatric, and extremity symptoms were predominant one month after the onset of COVID-19. Conclusions Regardless of the severity in the acute phase, patients visiting our CAC clinic suffered from a variety of symptoms. General physicians skilled in using a comprehensive approach would be optimal to see patients with such complex symptoms.