Sleep disorders in healthcare workers

Introduction: COVID-19 has killed more than 5 millions people worldwide. The effects on mental health are also significant, especially among healthcare personnel. Our aim is to determine the prevalence and the factors of sleep disorders on healthcare workers. Method Descriptive and analytical cross-sectional study including 87 healthcare workers during February 2022, using an anonymous online questionnaire containing personal data, the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). Result(s): The average age was 31.71 +/- 5.93 years. Sex ratio was 1.04. The participants were doctors (69.6%) and paramedical staff (30.4%), 23.2% of them had comorbidities: cardiovascular pathologies (27.2%), respiratory pathologies (24.7%) psychiatric pathologies (18.1%), neurological pathologies (13.9%) and immunodeppression (11.2%). 86.3% were working in the public sector. 62.3% had worked in a COVID-19 unit. Severe clinical insomnia was found in 9.7% and moderate severity clinical insomnia in 13.1%. For the PSQI, 41.5% had an overall score>5, which is an indicator of sleep disorders. A sleep latency>30 minutes was observed (22%), nocturnal awakenings (15.9%), a feeling of fatigue at work (61%) and difficulty concentrating was reported in 38%. For behavioral disorders during sleep, participants had nightmares (35.2%), sleep paralysis (17.7%), sleep talking (10.9%), bruxism (1%) and somnombulism (1.2%). Sleep disorders were correlated with the presence of newborns or infants at home (p=0.001), the number of shifts and working hours per week (p=0.034) and the presence of psychiatric comorbidities (p<0.05). Conclusion(s): Sleep disorders among caregivers are quite common, long-term follow-up for better prevention and management is necessary.

Quality of sleep of health care professionals after 3 waves of the COVID-19 pandemic

Introduction: The COVID-19 infection rapidly became a worldwide pandemic and a public health emergency that seriously burdened healthcare systems. Health care professionals (HCPs) were faced with a new difficult and demanding challenge which frequently meant working long h shifts with low staffing members under high pressure environments. This may have had an important impact on sleep quality of HCPs. Aim(s): To evaluate the quality of sleep of HCPs after 3 waves of the COVID-19 pandemic. Method(s): A sleep questionnaire developed by the authors was sent to all HCPs of a tertiary hospital after the first 3 waves of the COVID-19 pandemic. Result(s): We had a total of 651 participants, mostly female (81.3%). Most participants were nurses (38.1%) and doctors (19.1%), with ages between 30 and 50 years. Other HCPs included were technicians, assistants, pharmaceuticals, among others. The majority dealt directly with COVID-19 patients (73.7%). Concerning quality of sleep, a significant proportion of HCPs referred a bad or very bad quality of sleep (41.5%) and only 16.1% stated a good or very good quality of sleep, of the last, 57% did not work night shifts. The majority suffered from night awakenings (88.6%), with 38.2% referring more than 2 awakenings per night;of these, 65% stated difficulty falling back to sleep. Furthermore, 46.2% HCPs referred initial insomnia and 59.9% referred terminal insomnia. Regarding quantity of sleep 16.9% slept less than 5 h, 47.3% slept approximately 6 h and only 7% slept 8 or more hours. Approximately 33% of HCPs resorted to sleeping medication, most frequently anxiolytics. In reference to daily symptoms, 71.3% of HCPs stated daytime sleepiness, most frequently after lunch (50.5%). Nonetheless, a significant proportion mentioned sleepiness during work (24%), and while driving (14.3%). Finally, 50.4% of the HCPs considered that the 3 waves of the COVID-19 pandemic worsened their sleep quality. Conclusion(s): This analysis demonstrates concerning results regarding the quality of sleep of HCPs after the first 3 waves of the COVID-19 pandemic with important daytime repercussions. This may reflect a consequence of the COVID-19 pandemic, as half of the HCPs considered that that the pandemic worsened their sleep quality.

Identification of Persistent Sars-Ncov-2 Viral Presence in the Intestines of Multiple Pediatric Patients Suggests Possible Common Etiology of Gi Long Covid

Background: The phenomenon known as "Long Covid," (LC) marked by post-infectious symptoms of a wide variety, and typically not associated with initial infectious severity, has the potential to become a tremendous public health burden as infections continue at a high rate. Variations of LC may impact over 80% of patients, with unclear pathogenesis, although many speculate that persistent viral presence in end-organ tissue may drive local changes. We previously published a case report noting persistent SARS-nCoV-2 activity in the cecum of a patient 3 months after initial infection (Arostegui et al, JPGN Reports, 2022). We have sought to expand that finding by assessing additional patients who have undergone endoscopic evaluation for presence of SARS-nCoV-2 nucleocapsid, seeking to expand our understanding of the clinical effects of persistent infection. Method(s): We identified 6 patients with onset of symptoms in the post-SARS-nCoV-2 window, who had undergone EGD/colonoscopy without histopathological diagnosis. New blank slides were cut and sent for staining at Histowiz inc (Brooklyn, NY), with rabbit monoclonal SARS-CoV-2 nucleocapsid antibody (GTX635686, 1:10,000). Resulting slides underwent blinded pathology review to identify positives. Chart review was completed on patients who were identified as positive, including histopathology data from endoscopy, medical history, presentation, laboratory results and clinical course. Result(s): Including our initial report, we have identified 4 female patients ages 11-16 to date. Viral presence was identified in the duodenum and TI, but only in one patient in the colon (cecum). Patients presented for evaluation of a variety of GI manifestations including chronic abdominal pain (100%), nausea and vomiting (50%), loss of appetite (50%), tenesmus (50%), hematochezia (25%) as well as weight loss (50%). Notably, of the 4 patients identified, only 1 had a known history of confirmed SARS-nCoV-2 infection. Endoscopic findings in the intestine were normal with the exception of edema noted in the cecum of two patients. Mucosal biopsies were also positive for notable (if typically felt to be non-pathologic) lymphoid aggregates in the Colon (75%) as well as in the Terminal Ileum (50%). Clinical information is summarized in Table 1. Conclusion(s): Additional identification of persistent SARS-nCoV-2 presence in patients ranging from 3-18 months after symptom onset demonstrates a high likelihood that persistent viral presence contributes to post-infectious symptoms in many patients. Patients demonstrated "red flag" symptoms like nighttime awakening with pain, weight loss, and elevated inflammatory markers or calprotectin, but symptomatically improved over time and with measures targeted at IBS. Our limited sample size prevents determination of typical location of persistent viral activity, but it is notable that symptoms for colonic vs. SI persistence were clinically consistent, with diarrhea in colonic persistence and early satiety/pain characterizing SI persistence. Most notably, we have identified a tendency for persistent infection to occur, potentially explaining at least a subset of persistent IBS-like symptoms associated with GI LC. Further work is necessary to determine exactly the prevalence of this issue, as well as to characterize the natural history of the clinical course, and possible effective therapies. (Table Presented).

EVALUATION of PATIENTS with RHEUMATOID ARTHRITIS in TELECONSULTATION during the FIRST WAVE of the COVID-19 PANDEMIC

Background: The sudden emergence of SARS-CoV-2 onto the world stage has accelerated a major change in the management of patients with chronic rheumatic diseases and has catalyzed the rapid emergence of telemedicine. Objectives: Our aim was to describe which parameters were used by rheumatol-ogists to monitor patients with rheumatoid arthritis (RA) in teleconsultation during the frst wave of the pandemic and identify the most relevant for decision making. Methods: Retrospective monocentric routine care cross-sectional study including RA patients seen in teleconsultation between March and September 2020. Available parameters assessing disease status were collected in teleconsultation files. Clinician intervention was defned by treatment escalation and/or the need for a rapid face-to-face consultation or day hospitalization. Results: 143 RA patients were included (117 females, mean age of 58±16 years, mean disease duration of 14±11 years). The presence or absence of patient self-reported RA fares was mentioned in all medical files, followed by the presence and/or the number of tender joints (76%), the duration of morning stiffness (66%), the number of pain-related nocturnal awakenings (66%) and the CRP value (54%). Patient self-reported RA fares concerned 43/143 patients (30%). The presence of self-reported RA fares was associated with a more detailed evaluation of patient in teleconsultation: The presence (or number) of tender joints and swollen joints were more signifcantly reported in patients who presented a fare (39/43, 91% vs. 70/100, 70%, p=0.008 and 25/43, 58% vs. 23/100, 23%, p<0.001, respectively). Teleconsultation led to a clinician intervention in 22/143 patients (14%), representing 51% of patients with self-reported fares (22/43 patients). Therapeutic escalation was necessary in 13 patients: introduction or dose increase of cor-ticosteroids in 8 patients, introduction or dose increase of methotrexate in 4 patients and introduction of hydroxychloroquine in 1 patient. Face-to-face consultation or day hospitalization were organized for 10 patients. Active disease was confrmed during this next face-to-face visit in 9 patients, with DAS28 ranging from 3.35 to 5.62, leading to therapeutic modifcation. The 133 other patients were seen in face-to-face consultation 6±2 months after the teleconsultation. No DMARD modifcation was recorded during this next face-to-face consultation. The following variables were associated with clinician intervention during the tel-econsultation in univariate analysis: patient self-reported RA fares since the last visit (p<0.001), CRP >10 mg/mL (p=0.012) and a morning stiffness > 30 minutes (p<0.001). Multivariate analysis confrmed RA fares (Odds Ratio, OR: 15.6 95% CI 3.37-68.28) and CRP values >10 mg/L (OR: 3.32, 95% CI % 1.12-13.27) as the variables independently associated with clinician intervention. Conclusion: Our study identifed patient reported RA fares and increased CRP values as 2 red fags in teleconsultation, independently associated with therapeutic modifcation and/or the need for a rapid face-to-face consultation. These indicators may help clinician's decision making in teleconsultation.

Impairment of sleep in children with cri-duchat syndrome and autism spectrum disorder during the covid-19 pandemic

Introduction: Sleep complaints are common in individuals with neurodevelopmental disorders. However, little is known about sleep alterations in children with cri du chat syndrome (CDC) and autism spectrum disorder (ASD) due to the social isolation resulting from the COVID-19 pandemic. Objective: To assess alterations in sleep quality and its associated parameters before and after quarantine resulting from COVID-19, comparing the results between CDC, ASD or neurotypical children. Methods: Sleep was investigated in 53 children with CDC and 106 with ASD using an adaptation of the Brief Infant Sleep Questionnaire (BISQ), assessing sleep patterns both before and during the COVID-19 pandemic. Data were evaluated in comparison to 160 neurotypical (NT) children. Results: Children with CDC and ASD already had higher chances of needing parental assistance to fall asleep, taking more than 30min to fall asleep and having a wake after sleep onset time (WASO) >30min when comparing to neurotypical children in the moment preceding quarantine. Having CDC significantly increased the odds of having awakenings during the night. During quarantine, the proportion of children sleeping in their own bedrooms had decreased and the odds of awakening during the night had increased in all groups. Children with CDC and ASD had significantly higher odds of taking more than 30min to fall asleep. The chance of having a WASO >30min increased in children with ASD but decreased in CDC ones. The quarantine period statistically increased the odds ratio of children having a sleep latency of >30min by nearly 5-fold for all groups. Conclusion: The CDC group presented worse sleep parameters overall, even before quarantine. In both the CDC and ASD group worse sleep indicators were found during the COVID-19 pandemic.

Negative changes in sleep patterns are observed in patients admitted by COVID 19

Introduction: Sleep is the main determinant of human wellbeing, mental and physical health. Sleep effectiveness can be reported through its quality and depth. Based on this principle, individuals infected by the SARS - CoV-2 virus from the family of coronavirus viruses, develop tissue inflammation and cell damage, causing an increase in inflammatory cytokines in the organism of the infected. There are several common causes of sleep disorders in hospitalized patients, including medical conditions and underlying psychological problems. There are also several modifiable factors that promote sleep disturbances in critically ill patients, such as noise, light, interactions with patient care, medications, mechanical ventilation and very commonly pain. The lack of sleep, therefore, can negatively compromise immunity, increasing the chances of disease onset. There is also the influence of sleep on emotional processing, with a role in maintaining mood and emotional state. Sleep deprivation also has a strong negative impact on daily behavior and, consequently, on daily mental health. Objective: The aim of the present study was to evaluate the sleep characteristics of patients during hospitalization, with a confirmed diagnosis of COVID. Methods: This is a quantitative, descriptive study, carried out from July to September 2020 in patients with positive SARS-CoV-2 infection through the RT-PCR test of nasopharyngeal swabs, aged ≥ 18 years, of both sexes, admitted to the hospital's infirmary in the north of Rio Grande do Sul. The evaluation methods used were the sleep diary and a free application (Sleep As Android) available for smartphones. Results: Thirty patients were evaluated, the majority of whom were male (53%) and the average age was 52 years. Only 1 patient was previously healthy and the main associated comorbidities were hypertension and obesity. Less than 50% of individuals used sleeping pills. However, C-reactive protein levels were altered in most patients. As for the outcomes related to sleep characteristics, significant correlations were observed between increased nighttime awakenings and prolonged hospital stay. In addition, patients diagnosed with depression (23%) had a greater total sleep deficit in a hospital setting. Conclusion: Patients with COVID admitted to hospital nurse units destined for a pandemic have important changes in sleep which are directly related to their lower quality.

Gaisbock in 2021

Case Report The purpose of the study is to explore the possible diagnosis of Gaisbock in a patient with long-standing erythrocytosis and hypertension. Methods Used Case Study Summary of Results A 40-year-old Caucasian man with obesity was admitted with recurrent leg swelling and increasing oxygen requirements two weeks after hospitalization with COVID-19 pneumonia. Upon review of the patient's history, he was found to have untreated hypertension over several medical encounters and an erythrocytosis spanning ten years. Recent medical history included a diagnosis of deep vein thrombosis (DVT) in the same leg two and a half months prior and was treated with Xarelto. The patient reported a history of low testosterone for 12 years. However, he had not used any testosterone supplementation for the last nine months. He reported daytime fatigue, frequent bouts of nighttime awakenings, and frequent snoring. The patient never had a sleep study or used a CPAP. The patient used half a can of chewing tobacco daily for thirteen years, and he smoked one pack per day for ten years but quit 12 years ago. He worked strenuous jobs in the construction industry most of his life. On this admission, the patient's lab work was notable for hemoglobin of 18.7 gm/dL (13.7-17.5) and a normal erythropoietin level of 5.7 MIU/mL (2.6-18.5) without thrombocytosis or leukocytosis and a positive factor V Leiden mutation. His blood pressure was 132/91 mmHg. On review of previous records, the patient was found to have consistently elevated hemoglobin The patient had a stocky, ruddy appearance without hepatosplenomegaly. Conclusion Erythrocytosis can be categorized as primary, secondary, or relative. Patients with relative erythrocytosis have a decreased plasma volume with a relative increase in hemoglobin. Additionally, elevated hemoglobin levels have been associated with hypertension. Gaisbock's syndrome, first described in 1905, is characterized by hypertension and erythrocytosis without splenomegaly, leukocytosis, or thrombocytosis. It is associated with mild obesity, elevated blood pressure, and increased blood viscosity, which may explain why these patients often develop cardiovascular complications. Patients with relative erythrocytosis are at a higher risk for thromboembolic complications. In this case, Gaisbock's syndrome was suspected because the patient had had a stocky, plethoric appearance with persistently elevated hemoglobin and blood pressure with a normal erythropoietin level. Gaisbock's syndrome establishes a relationship between benign erythrocytosis, hypertension, and an increased risk for cardiovascular events. (Table Presented).