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1.
Gastroenterology ; 162(7):S-691, 2022.
Article in English | EMBASE | ID: covidwho-1967365

ABSTRACT

Introduction It is well established that persons with IBD have significantly higher rates of depression and anxiety than the general population, and that mental health symptoms exacerbate disease symptoms and impair quality of life. During the COVID pandemic, the general public has experienced escalating rates of anxiety and depression. Our aim was to determine the mental health impact of the COVID-19 pandemic on adults with IBD, focusing in this study on access to mental health resources. Methods All adults with current contact information in the population-based University of Manitoba IBD Research Registry (n=2833) were invited to participate in a survey via mail regarding their experiences with COVID-19 during autumn 2020, just prior to and during the second pandemic wave in Manitoba. The survey included background sociodemographic and disease information (e.g., symptom severity, medication use), COVID-related personal and health circumstances and coping. Results Response rate was 48.9% (n=1384). The mean age of respondents was 57.8 years, 59.3% were female and 46.9% had Crohn's disease. One in 5 (21.0%) of respondents had a prior diagnosis of a mental health condition. Overall, 11.6% felt they needed help from a mental health professional during the pandemic, with close to half (44.7%) of these individuals feeling they had inadequate access to a mental health professional. 10.0% accessed some type of resource;(of these, 52.5% used the internet, 24.5% used an app to help manage pandemic-related distress or anxiety). The most distressing aspects of the pandemic were concerns about family health (35.8%), concerns for getting infected with COVID-19 (27.2%), and having an IBD flare (9.0%). Trusted sources of information on the pandemic included television programs (64.2%), internet (46.1%), newspaper (27.8%), friends or family (21.7%), and social media (16.9%). Just over half (53.3%) spent 1-5 hours daily consuming information on COVID-19 from various sources, whereas 41.5% spent much less time (1-60 minutes/day). 51.4% tried to limit time spent watching the news or on the internet on the topic of COVID-19;of these, 9.6% found this quite or extremely difficult, and 22.1% had moderate difficulty limiting information consumption. Conclusion Mental health needs were prevalent for individuals with IBD during the first waves of the pandemic, with many of those who identified a need for professional help not feeling they had sufficient access to care. The most common mental health resource accessed was technology-based. A large proportion spent significant time focused on pandemic-related information. Further research is needed to examine changes over time during the pandemic and inter-relationships among mental health, care needs and IBD disease course.

2.
Gastroenterology ; 162(7):S-489, 2022.
Article in English | EMBASE | ID: covidwho-1967323

ABSTRACT

BACKGROUND: Gastrointestinal (GI) symptoms such as nausea and diarrhea have been reported in patients with SARS-CoV-2 coronavirus (COVID-19). However, outcomes of patients with COVID-19 and GI symptoms and risk factors associated with poor outcomes in this patient population have not been assessed. METHODS: The study cohort was derived from the Cerner Real World Data (CRWD) COVID-19 Database inclusive of emergency department and hospital encounters with COVID-19 infection from December 1, 2019, to November 30, 2020. Baseline demographics, comorbidities, hospital characteristics, and GI symptoms were obtained. The outcomes of interest were mortality, acute respiratory distress syndrome (ARDS), sepsis, and ventilator requirement/oxygen dependence. Multivariate logistic regression analysis was performed to assess predictors of poor outcomes in hospitalized COVID-19 patients with GI symptoms. RESULTS: Of 100,902 patients with COVID-19 infection, 19.7% reported GI symptoms. Those with GI symptoms had a significantly higher prevalence of comorbidities and underlying chronic GI conditions (Table 1). In patients with COVID-19 and GI symptoms, advanced age was associated with a higher risk of overall mortality, ARDS, sepsis, and ventilator requirement/oxygen dependence (Table 2);whereas the female gender was associated with a lower risk of mortality (OR 0.68, 95% CI 0.61, 0.76), ARDS (OR 0.68, 95% CI 0.60, 0.77), and sepsis (OR 0.70, 95% CI 0.64, 0.75). A higher Charlson Comorbidity Index was also associated with higher mortality, ARDS, sepsis, and ventilator requirement/oxygen dependence-Table 2. Finally, history of PPI and H2RA use (minimum duration 1 month) was associated with an increased risk of mortality (OR 1.48, 95% CI 1.32, 1.66) and (OR 1.78, 95% CI 1.57, 2.02), ARDS (OR 2.19, 95% CI 1.91, 2.50) and (OR 3.75, 95% CI 3.29, 4.28), sepsis (OR 1.88, 95% CI 1.73, 2.05) and (OR 2.50, 95% CI 2.28, 2.73);and ventilator requirement/oxygen dependence (OR 1.73, 95% CI 1.48, 2.02) and (OR 1.97, 95% CI 1.68, 2.30) respectively. CONCLUSION: GI symptoms are reported by 1 in 5 patients admitted to the hospital with COVID-19. Advanced age, male gender, a higher comorbidity score, and use of acid suppression medications (PPI/ H2RA) were associated with poor outcomes including death

3.
Gastroenterology ; 162(7):S-374, 2022.
Article in English | EMBASE | ID: covidwho-1967301

ABSTRACT

Background: Pancreatic involvement in patients with Coronavirus 2019 (COVID-19) has been reported in the literature. The pancreatic injury in COVID-19 patients might be a result of the direct cytopathic effect of viral replication or indirectly related to the immune response to the viral infection. Methods:Westudied 183 patients diagnosed with symptomatic SARS-CoV-2 and admitted to COVID-19 facilities in Qatar. We included only the patients with documented positive SARS-COV-2 PCR and measured lipase levels. The cohort was categorized into two groups based on the serum lipase level. The cutoff was the elevation of the serum lipase more than three times the upper limit of normal. Patients with lipase levels below the cutoff were included in the first group, and those with lipase levels above the cutoff were included in the second group. The primary outcome was mortality. The secondary outcomes were disease severity on presentation and markers of disease progression. Markers of disease progression (Table 1) included the development of acute respiratory distress syndrome (ARDS), shock, multi-organ failure, the requirement for ICU admission, mechanical ventilation, continuous renal replacement therapy (CRRT), and extracorporeal membrane oxygenation (ECMO). Results: Our study population had a mean age of 49 and a mean BMI of 28. There was a male predominance in the study sample (more than 91%), reflecting the country's demographics. There was no statistically significant difference between the two groups in the mean age, BMI, gender distribution, or patients' reported symptoms. There was an increased prevalence of diabetes mellitus (DM) and hypertension (HTN) in our study population (45.4% and 44.8%). Apart from the increased prevalence of chronic liver disease in the second group, there was no statistically significant difference in the prevalence of comorbidities (e.g., DM, HTN) between the two groups (Table 1). The second group showed a statistically significant increase in mean creatinine, troponin, procalcitonin, ferritin, and amylase compared to the first group. On the other hand, the mean hemoglobin, sodium and albumin were lower (Table 2). Interestingly, more patients in the second group received tocilizumab and oseltamivir (Table 1). The mortality rate in our study population was 15.3%, with a higher mortality rate in the second group (Table 1). Almost 50% of the patients developed ARDS. Multiple markers of disease progression, including the development of ARDS, shock, and multi-organ failure;requirement for ICU, mechanical ventilation, and CRRT were increased in the second group compared to the first group. Also, the mean length of stay was higher in the second group (Table 1). Conclusion: Based on our study, hospitalized patients with COVID-19 who had higher lipase levels had a higher mortality rate and higher risk for disease progression. (Table Presented)

4.
Gastroenterology ; 162(7):S-291-S-292, 2022.
Article in English | EMBASE | ID: covidwho-1967287

ABSTRACT

Background: Post-COVID-19 conditions are defined as new, recurring, or ongoing health issues which present weeks after SARS-CoV-2 infection. The gastrointestinal (GI) involvement of COVID-19 suggests that a group of patients with lingering GI symptoms may develop Post-COVID-19 DGBI including irritable bowel syndrome (IBS) (Schmulson M et al. Am J Gastroenterol. 2021;116:4-7). In this study, we aimed to determine the epidemiological features of Post-COVID-19 DGBI. Methods: Subjects with confirmed COVID-19 at least 6 months before the study who had sustained GI symptoms were invited to complete an internet-based survey on Qualtrics, between March and August 2021. The survey included demographics, acute symptoms, comorbidities, as well as Rome IV questionnaire, Generalized Anxiety Disorder questionnaire (GAD-7) and Patient Health Questionnaire (PHQ)-9 for depression. Data was analyzed using ANOVA and multivariate analysis. Findings were reported as percentage or [p-value;(95% odds ratio CI)]. Results: Overall, 164 subjects (70% female, 14% male, and others unknown) with a positive COVID-19 test completed the survey. Among them, 4% were >65 years old and 24% reported hospitalization. Body mass index ³30 was present in 38%, diabetes in 6.7%, and vitamin D deficiency in 11% of the participants. In total, 108 (66%) subjects fulfilled Rome IV criteria for at least one DGBI. Of 108 with DGBI, only 27 (25%) had DGBI before COVID-19;DGBI developed in 81 subjects after COVID-19. The most common Post-COVID-19 DGBI were functional dyspepsia observed in 38 (postprandial distress syndrome n=31, epigastric pain syndrome n=22) followed by IBS in 26 subjects (IBS with Diarrhea n=7, IBS with Constipation n=4, Mixed-IBS n=14, Unsubtyped IBS n=1) (Table-1). The risk factors of severe COVID-19 including age >65, diabetes, and obesity were not associated with developing Post-COVID- 19 DGBI. Seventy (86%) of subjects with Post-COVID-19 DGBI had at least one GI symptom (abdominal pain, nausea/vomiting, and/or diarrhea) in the acute phase of COVID-19. Nausea/ vomiting during the acute illness increased [p-value of 0.02 with 95% OR CI (0.7-10.4)], and BMI less than 25 also increased the odds [p-value of 0.03 (95% OR CI: 0.26-8.4)] for Post-COVID-19 IBS. Anxiety was present in 48% and depression in 65% of subjects with Post-COVID-19 DGBI. Conclusions: Post-COVID-19 DGBI are new entities associated with a high rate of anxiety and depression. Although the majority of those with Post-COVID-19 DGBI reported having GI symptoms in the acute illness, some appeared in subjects without acute GI symptoms. (Table Presented)

5.
Gastroenterology ; 162(7):S-287-S-288, 2022.
Article in English | EMBASE | ID: covidwho-1967278

ABSTRACT

Background: Prior studies have shown no additional risk of severe outcomes in patients with inflammatory bowel disease (IBD) from COVID-19 infection unless they are experiencing disease flare or on steroids. Whether COVID-19 infected patients with IBD have worse outcomes than those without IBD is not clear. Aims: To examine risk factors for worse outcomes related to COVID-19 infection in IBD patients. Methods: The study cohort was derived from the Cerner Real World Data (CRWD) COVID-19 Database inclusive of hospitalized patients with COVID-19 infection from December 1, 2019 through November 30, 2020. Baseline demographics, comorbidities, and hospital characteristics were acquired. IBD patients were propensity-matched in 1:2 fashion to controls (those without IBD) to compare proportions of patients who experienced death, or worse outcomes such as acute respiratory distress syndrome (ARDS), mechanical ventilation and sepsis using odds ratio (OR) with 95% confidence intervals (CI). The impact of immune suppressing medications (steroids and biologics) among patients with ulcerative colitis (UC) and Crohn's disease (CD) was also examined. Results: Of 100,902 COVID-19 positive hospitalized patients, 316 (0.3%) were found to have a personal history of IBD: UC=148 and CD=172 (mean age: 49.5±20.9 years, 56% females;Table 1). Overall mortality was not significantly higher in COVID-19 hospitalized patients who had IBD compared to those without IBD (10.8% vs 8.5%;p= 0.79). On propensity-matching, there was no significant difference found between IBD patients on steroids (n=124) and non-IBD patients on steroids (n=161) for mortality (p= 0.45), mechanical ventilation (p=0.68), ARDS (p=0.30) or sepsis (p=0.50) -table 2. IBD patients on biologics (and other immunosuppressors) were not found to have any significant difference in these outcomes when compared to matched non-IBD patients on other immunosuppressors: mortality (p=0.23), ARDS (p=0.056) or sepsis (p=0.19). Conclusion: In this large real-world data of hospitalized COVID-19 patients, IBD accounted for < 0.5% of total admissions and those with IBD did not have worse outcomes or increased mortality compared to those without IBD, including those takings immune suppressive medications (Table Presented) (Table Presented)

6.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S68, 2022.
Article in English | EMBASE | ID: covidwho-1966674

ABSTRACT

Background: Due to COVID pandemic, there have been increased needs for ECMO circuits to support patients with respiratory failure1. Unfortunately, due to pharmacokinetics alteration of commonly used sedative and psychotropic medications by the ECMO circuits2,new sedation approaches to manage delirium and agitation is required. We present a case of COVID pneumonia patient on ECMO support, whose delirium symptoms were managed with a novel psychopharmacotherapy protocol. Case: Mr. M is a 57-year-old male patient with past medical history of obesity, hypertension, admitted to Stanford Hospital due to COVID pneumonia, complicated by respiratory failure, required to be on Veno-Venous ECMO support with bridge to transplant. He had significant hyperactive delirium with Richmond Agitation-Sedation Scale (RASS) score of +3 and ICDSC score of 7 for most of the days, despite heavy conventional pharmacological sedation. We observe the same problems with most patients placed on the ECMO system, leading to an investigation and development of a new protocol. Discussion: Patient on ECMO support requires adequate sedation to prevent clinical deterioration that can result from hyperactive delirium (ie., chugging, blood clots or decannulation)2. Nevertheless, ECMO circuit’s significant alterations of drug pharmacokinetics, such as increased volume of distribution and sequestration of lipophilic and protein bound medications, with no clear guidelines on managing sedation/delirium in patients with ECMO support at this time2, we conducted an extensive literature search and developed a novel protocol. This new sedation approach includes alpha-2 agonists, opioids, barbiturates and calcium channel modulators with the lowest lipophilicity and protein binding potential of each medication in its class4,5,thus overcoming the challenges introduced by ECMO circuits. The new protocol allowed the patient to participate in lung transplant work-up, physical therapy, and eventually facilitated receiving bilateral lung transplantation. Conclusion/Implications: ECMO is a life saving device that can help patient with cardiac-respiratory failure, and its use has been increasing in clinical practice. However, there needs to be an improvement in successful sedation/delirium management to minimize adverse events, and optimize the success of this lifesaving technologies. References: 1. Cho HJ, et al. ECMO use in COVID-19: lessons from past respiratory virus outbreaks-a narrative review. Crit Care. 2020 Jun 6;24(1):301 2. deBacker J, et al. Sedation Practice in Extracorporeal Membrane Oxygenation-Treated Patients with Acute Respiratory Distress Syndrome: A Retrospective Study. ASAIO J. 2018 Jul/Aug;64(4):544-551 3. Lemaitre F, et al. Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood. Crit Care. 2015;19(1):40 4. Hansch C, et al. Hydrophobicity and central nervous system agents: on the principle of minimal hydrophobicity in drug design. J Pharm Sci. 1987 Sep;76(9):663-87 5. Bockbrader HN, et al. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet. 2010 Oct;49(10):661-9

7.
Medicina (Argentina) ; 82(4):487-495, 2022.
Article in Spanish | EMBASE | ID: covidwho-1965451

ABSTRACT

Introduction: the information regarding characteristics and ventilatory results comparing the first (W1) and the second wave (W2) in Argentina are limited. The main objective of this study was to describe general characteristics and ventilatory variables in COVID-19 patients who required invasive mechanical ventilation (IMV) and compare differences between waves. Secondarily, factors associated with mortality in intensive care unit (ICU) were studied. Methods: We conducted a prospective observational cohort study that included patients older than 18 years infected with SARS-CoV-2 consecutively admitted to ICU with IMV between August 1, 2020, and June 30, 2021. We included 412 patients. Results: We found statistically significant differences (p < 0.001) in age [W1 64(55-72) vs W2 59 (50-66) years], presence of COPD [W1 n = 42 (19.8%) vs. W2 n = 13(6.3%)], plateau pressure [W1 27(25-30) cm H2 O vsW2 24 (22-27) cmH2O], driving pressure (ΔP) [W1 15 (13-17) cmH2 O vs. W2 12 (11-14) cm H2O] compliance [W1 40 mL/cmH2O (32-46) vs. W2 = 33 mL/cm H2O (27-40)];reintubation [W1 30.4% (n = 63/207) vs. W2 13.7% (n = 28/205)]. We identified as independent factors associated with mortality the following variables: age [OR 1.07(95% CI 1.05-1.09)], the ΔP in the first 24 hours [OR 1.19(95% CI 1.10-1.28)] and W2 [OR 1.81 (95% IC1.12-2.93);p = 0.015. Discussion: During W2 the patients were younger. It was possible to achieve ventilatory mechanics more adjusted to a protective ventilation strategy. In conclusion, in the patients studied, age and ΔP were independent predictors of mortality.

8.
Hong Kong Journal of Paediatrics ; 27(3):204-214, 2022.
Article in English | EMBASE | ID: covidwho-1965315
9.
Enferm Infecc Microbiol Clin (Engl Ed) ; 2022 Jul 27.
Article in English | MEDLINE | ID: covidwho-1966531

ABSTRACT

OBJECTIVE: To compare the clinical characteristics, treatments, and evolution of critical patients with COVID-19 pneumonia treated in Intensive Care Units (ICU) after one year of pandemic. METHODOLOGY: Multicenter, prospective study, which included critical COVID-19 patients in 9 ICUs in northwestern Spain. The clinical characteristics, treatments, and evolution of patients admitted to the ICU during the months of March-April 2020 (period 1) were compared with patients admitted in January-February 2021 (period 2). RESULTS: 337 patients were included (98 in period 1 and 239 in period 2). In period 2, fewer patients required invasive mechanical ventilation (IMV) (65% vs 84%, p < 0.001), using high-flow nasal cannulas (CNAF) more frequently (70% vs 7%, p < 0.001), ventilation non-invasive mechanical (NIMV) (40% vs 14%, p < 0.001), corticosteroids (100% vs 96%, p = 0.007) and prone position in both awake (42% vs 28%, p = 0.012), and intubated patients (67% vs 54%, p = 0.034). The days of IMV, ICU stay and hospital stay were lower in period 2. Mortality was similar in the two periods studied (16% vs 17%). CONCLUSIONS: After 1 year of pandemic, we observed that in patients admitted to the ICU, CNAF, NIMV, use of the prone position, and corticosteroids have been used more frequently, reducing the number of patients in IMV, and the length of stay in the ICU and hospital stay. Mortality was similar in the two study periods.

10.
Arch Phys Med Rehabil ; 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1966342

ABSTRACT

OBJECTIVE: To describe the function of patients with COVID-19 admitted to an acute care hospital early in the pandemic and to characterize change in function among those admitted to intensive care units (ICU) and to non-critical care services. DESIGN: This descriptive, retrospective cohort study examined patients infected with SARS-CoV-2 admitted to a tertiary care medical center during the first wave of the pandemic in 2020. Included patients were stratified into four cohorts based on whether or not they received therapy during their hospitalization and whether or not their hospitalization included time in the intensive care unit (ICU). Data on demographics, functional impairments, medical interventions, and functional outcomes were collected. SETTING: Hospital PARTICIPANTS: : 432 adult patients were included in this study. RESULTS: ICU patients receiving therapy were more likely to have impaired cognition, impaired strength, and impaired sensation than non-ICU patients receiving therapy. Patients made improvements from evaluation to discharge on the Functional Status Score for the ICU, AM-PAC Daily Activity, and AM-PAC Basic Mobility Short Forms. CONCLUSION: Patients admitted with COVID-19 experienced significant functional impairments, but also demonstrated improvement during the course of their hospitalizations. This study can facilitate healthcare provider awareness of the detrimental functional impacts of COVID-19 and the potential role of rehabilitation services for these patients.

11.
Am J Obstet Gynecol MFM ; : 100703, 2022 Aug 02.
Article in English | MEDLINE | ID: covidwho-1966285

ABSTRACT

SARS-CoV-2 related placentitis shows distinctive histological characteristics and its impact on perinatal outcomes is increasingly coming under scrutiny. We present two such cases in the third trimester, following mild maternal clinical symptoms and associated with maternal coagulopathy, reduced fetal movements and non-reassuring fetal heart rate tracing. Both cases resulted in emergency cesarean deliveries. Our cases and a review of the literature highlight that SARS-CoV-2 undermines placental function and thus greatly impacts late-term pregnancies, even in the absence of severe systemic disease.w.

12.
Sleep Biol Rhythms ; : 1-4, 2022 Jul 27.
Article in English | MEDLINE | ID: covidwho-1966213

ABSTRACT

Purpose: Shift work has detrimental effects on healthcare workers, which may be further compounded by frontline work during the COVID-19 pandemic. We postulated that sleep would worsen and distress would increase during COVID-ward service. Methods: Doctors (n = 18) were recruited from a tertiary centre during the second wave of the COVID-19 pandemic in Melbourne, Australia. Participants had been rostered ON to consecutive 7 day or night shifts and a week OFF over a fortnight. 9 worked on COVID wards managing positive/suspected COVID patients, and 9 were allocated to general MEDICAL wards. Participants wore wrist actigraphy, and completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Kessler Psychological Distress Scale (K10) at baseline and the end of each week. Results: Both the COVID and MEDICAL groups spent less time in bed and had reduced total sleep time during their week ON shift compared to week OFF shift. The COVID group had worse sleep quality (PSQI Δ + 1.0, 6.8 vs 5.8, p = 0.036), daytime sleepiness (ESS Δ + 2.6, 8 vs 5.4, p = 0.014) and greater distress (K10 Δ + 1.7, 17 vs 15.3, p = 0.002) during their week ON compared to BASELINE. Conclusion: During the COVID-19 pandemic shift workers had poorer sleep during their week ON. Those working on COVID wards had greater distress during their week ON than those working on general MEDICAL wards. It is important to recognise the potential for sleep deficits and greater distress in medical workers during the pandemic.

13.
Intensive Care Med ; 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1966121

ABSTRACT

PURPOSE: During the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) around the world introduced virtual visiting to mediate the psychological impact of in-person visiting restrictions. Our objective was to evaluate levels of distress, depression, anxiety, and stress among family members experiencing virtual visits. METHODS: Multi-centre prospective observational study recruiting adult family members of critically ill patients in the United Kingdom (UK) using a bespoke virtual visiting solution (aTouchAway). We recruited participants and administered validated questionnaires digitally via their aTouchAway account. Prior to first virtual visit, participants completed the Distress Thermometer (score range 0-10) and the Depression, Anxiety and Stress Scale (DASS)-21. Following first and subsequent virtual visits, participants repeated the Distress Thermometer and completed the Discrete Emotions Questionnaire. RESULTS: We recruited 2166 adult family members of ICU patients in 37 UK hospitals. Most were grown up children (33%) or spouses/partners (23%). Most (91%) were ≤ 65 years. Mean (SD) pre-virtual-visit Distress Thermometer score was 7 (2.6) with 1349/2153 (62%) reporting severe distress. Pre-visit Distress Thermometer scores were associated with relationship type (spouse/partner OR 1.65, 95% CI 1.27-2.12) but not family member age, or length of ICU stay. Mean (SD) post-visit Distress Thermometer score provided by 762 (35%) participants was 1.6 (3.2) points lower than pre-visit (P < 0.001). Of participants experiencing multiple visits, 22% continued to report severe distress. Median (IQR) pre-visit DASS-21 score was 18 (2-42) (1754 participants). Severe-to-extremely severe depression, anxiety, or stress were reported by 249 (14%), 321 (18%), and 165 (9%) participants, respectively. Participants reported a range of emotions with reassurance being the most common, anger being the least. CONCLUSION: Family members exposed to COVID-19 pandemic ICU visiting restrictions experienced severe distress. One fifth of family members reported severe-to-extremely sever anxiety or depression. Distress score magnitude and prevalence of severe distress decreased after undertaking one or more virtual visits.

14.
Respirol Case Rep ; 10(9): e01012, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1966108

ABSTRACT

We report herein a case series of infants, with no comorbidities, who developed a life-threatening illness due to the SARS-CoV-2 Delta variant. We retrospectively reviewed the medical records of children, aged under 15 years, admitted to PICU, during the peak of Delta infection, between June 23 and August 16 2021, with severe and critical forms of SARS-CoV-2 infection, confirmed by RT-PCR. Twenty infants were included, the median age was 47 days (IQR: 26.5-77) and sex ratio was 0.8. No underlying medical conditions were noted. Parents were not vaccinated. Respiratory involvement was the main feature observed. Eleven patients had paediatric acute respiratory distress (PARDS) with a median oxygen saturation index (OSI) of 9 (IQR: 7-11). PARDS was mild in four, moderate in five, and severe in two cases. Hemodynamic instability was observed in 4 cases. The main radiological finding was ground glass opacities in 11 cases. Seventeen patients were mechanically ventilated, and three of them were escalated to high-frequency oscillatory ventilation. The median duration of mechanical ventilation was 6 days (IQR 2.5-12.5). The remaining patients were managed with high-flow nasal cannula. Four patients died.

15.
Malaysian Journal of Medicine and Health Sciences ; 18(8):211-220, 2022.
Article in English | Scopus | ID: covidwho-1965194

ABSTRACT

Introduction: During the COVID-19 pandemic, university students are among those who are at risk of developing psychological problems. The study is therefore aimed to determine university students’ psychological distress (depression, anxiety, and stress) and quality of life (QoL) during the COVID-19 outbreak. Methods: A cross-sectional online survey was conducted, using the 21-item depression, anxiety, and stress scale (DASS-21) to assess the severity of their depressive, anxiety, and stress symptoms and the SF-36 to assess their QoL. Results: In total, 59.2%, 67.0%, and 40.4% of the participants experienced mild to extremely severe depression, anxiousness, and stress, respectively. University students reported a lower mean score in all SF-36 domains compared with the non-pandemic norms of the general Malaysian population. The findings of binary logistic regression demonstrated that most socio-demographic factors, such as faculty type, number of siblings, income, and residential area, had an impact on respondents' stress levels. Meanwhile, depression was only affected by the year of study and the number of siblings, while anxiety was influenced by the year of study and the family's income. All the SF-36 domains were observed to be adversely correlated with depression, anxiety, and stress. The vitality (VT), emotional well-being (EW), and social functioning (SF) domains were strongly correlated with depression. Conclusion: The COVID-19 outbreak exacerbated university students' psychological distress and reduced their quality of life, necessitating involvement from the appropriate authorities to assist them in dealing with the problem. © 2022 UPM Press. All rights reserved.

16.
Malaysian Journal of Medicine and Health Sciences ; 18(8):168-175, 2022.
Article in English | Scopus | ID: covidwho-1965191

ABSTRACT

Introduction: Environmental Health Officers (EHO) and Assistant Environmental Health Officers (AEHO), are among the front liners involved in combating COVID-19 pandemic in Malaysia. The overburdening strain, prolonged working hours, and inability to take time off have had an indirect psychological impact on them, resulting in a quality-of-life imbalance. Hence, the aim of this study was to investigate the likelihood and associated factors contributing to depression, anxiety, stress, and Quality of Life (QoL) of EHO and AEHO in Selangor during the COVID-19 pandemic. Methods: A cross-sectional study involving 170 participants was conducted in Selangor through the distribution of an online survey. The survey comprised of sociodemographic data, Depression, Anxiety and Stress Screening 21 Item Questionnaire (DASS-21) and Short Form 36 Health Survey Questionnaire (SF-36). Results: Approximately, 54.7%, 68.8% and 25.9% of respondents suffered from depression, anxiety, and stress, respectively. Marital status was the only factor associated with stress among the respondents. The tested domains of QoL such as physical functioning, social functioning and emotional well-being showed a decrease in mean value when compared to Malaysian norm. It was observed that the QoL was afflicted with gender, marital status, and number of children. The study also proved that there are significant negative correlations between QoL with depression, anxiety, and stress. Conclusion: Reduced QoL among environmental health practitioners was associated with depression, anxiety, and stress during the COVID-19 pandemic. Government agencies or employers should impose an intervention programme, such as work rescheduling or a day off, to restore balance. © 2022 UPM Press. All rights reserved.

17.
Journal of People, Plants, and Environment ; 25(3):263-272, 2022.
Article in English | Scopus | ID: covidwho-1964615

ABSTRACT

Background and objective: The mental health and wellness of university students has been a pressing concern in recent years in the US and is becoming an even larger issue due to the COVID-19 Pandemic. Numerous studies have supported the idea that the natural environment can have a positive impact on mental health, but only a few studies focus on the role of university outdoor campus environments on student's mental health. The main purpose of this study is to investigate the correlations between university student mental health and their campus's outdoor environment. Methods: An online survey was designed and distributed to students at Michigan State University, USA. Students were asked questions about their overall mental well-being, as well as questions about their environmental perceptions, outdoor activity, views to nature through windows and safety concerns regarding their outdoor campus environment. Results: The major findings indicate a significant difference in mental health scores for windows in living quarters, where students with living quarter windows had better mental health scores (MHS) than students without living quarter windows. This study also found a marginally significant difference in MHS for students with classroom windows. Other results of this study include a significant difference in MHS for students' perception of safety on campus, outdoor work time, and perception of greenspace on campus. Conclusion: Future campus planner, landscape architects, university planners, and student counselors will use this study to determine what kinds of outdoor spaces should be created and used to improve the well-being of students. © 2022 by the Society for People, Plants, and Environment.

18.
Italian Journal of Gender-Specific Medicine ; 8(2):112-122, 2022.
Article in English | Scopus | ID: covidwho-1963181

ABSTRACT

In recent years, in light of the growing gaps in the economic and social conditions, the issue of inequalities has become increasingly topical. Each of the dimensions of the social inequalities (economic, geographic, educational, gen-der, health and life expectancy, ethnic and intergenerational) is linked to all the others, but there is no doubt that the lack of equality in health and access to treatment is one of the most important critical issues. In this context, the various forms of privation and discrimination affecting the female component of the population represent an important factor, to which the recent investment and planning lines following the pandemic crisis rightly dedicate some importance. The paper examines the state of the art of gender inequalities related to health and well-being, both the long-standing and the most recent ones, related to the coronavirus pandemic. At present, there is still a long way to go in order to achieve adequate levels of gender equality in the field of health and healthcare. © 2022, Il Pensiero Scientifico Editore s.r.l.. All rights reserved.

19.
Bol Med Hosp Infant Mex ; 79(3): 170-179, 2022.
Article in English | MEDLINE | ID: covidwho-1964981

ABSTRACT

BACKGROUND: There are only a few reports of acute respiratory distress syndrome (ARDS) in patients with SARS-CoV-2 in pediatrics. This study aimed to describe the characteristics of critically ill pediatric patients with COVID-19, the frequency of ARDS, ventilatory mechanics and results of prone position. METHODS: We conducted a retrospective, observational study of patients admitted to the pediatric intensive care unit (PICU) between April 1 to September 30, 2020. RESULTS: Thirty-four patients were admitted to pediatric intensive care unit, 31.7% were SARS-CoV-2 positive. 13 presented ARDS, 11 required invasive mechanical ventilation, and seven were pronated as an oxygenation strategy. All patients classified as severe ARDS were pronated. Obesity was the most important comorbidity. The complications associated with ARDS were multisystemic inflammatory syndrome (8 vs. 4; p < 0.05) and acute kidney injury (8 vs. 3; p < 0.05). Procalcitonin was higher in patients with ARDS, as were the days of stay in PICU (p < 0.05). The success of the pronation maneuver was achieved 8 hours later , with the following results: arterial oxygen partial pressure to fractional inspired oxygen ratio 128 vs. 204, oxygenation index 8.9 vs. 5.9, static lung compliance 0.54 vs. 0.70 ml/cmH2O/kg, plateau pressure 24 vs. 19 cmH2O (p < 0.05). The use of narcotics was higher in the group with ARDS plus pronation 124 vs. 27 hours in the non-pronated (p < 0.01). Mortality associated with SARS-CoV-2 was 5.8%. CONCLUSIONS: ARDS was presented in 38.2% of the children admitted to PICU and was more frequent in obese patients. Pronation, performed in severe cases, improved oxygenation and lung mechanics indexes. No patient died of ARDS.


INTRODUCCIÓN: Existen pocos reportes de síndrome de dificultad respiratoria aguda (SDRA) con COVID-19 en pacientes pediátricos. El objetivo de este estudio fue describir las características de los pacientes pediátricos críticamente enfermos con COVID-19, la frecuencia del SDRA, la mecánica ventilatoria y los resultados de la posición prona. MÉTODOS: Se llevó a cabo un estudio retrospectivo y observacional de los pacientes ingresados del 1 de abril al 30 de septiembre de 2020. RESULTADOS: Ingresaron 34 pacientes a la unidad de terapia intensiva pediátrica (UTIP) con prueba positiva para SARS-CoV-2. De ellos, 13 presentaron SDRA, 11 requirieron ventilación mecánica invasiva y siete fueron pronados como estrategia de oxigenación. Todos los pacientes clasificados como SDRA graves fueron pronados. La obesidad fue la comorbilidad más importante. Las complicaciones asociadas con SDRA fueron el síndrome inflamatorio multisistémico (p < 0.05) y la lesión renal aguda (p < 0.05). La procalcitonina fue mayor en los pacientes con SDRA, al igual que los días de estancia en la UTIP (p < 0.05). El éxito de la maniobra de pronación se alcanzó 8 horas después.Los resultados observados fueron los siguientes relación presión arterial de oxígeno/fracción inspirada de oxígeno 128 vs. 204, índice de oxigenación 8.9 vs. 5.9, distensibilidad pulmonar estática 0.54 vs. 0.70 ml/cmH2O/kg, y presión meseta 24 vs. 19 cmH2O (p < 0.05). El uso de narcóticos fue mayor en el grupo de SDRA más pronación que en los no pronados (124 vs. 27 h; p < 0.01). La mortalidad asociada con SARS-CoV-2 fue del 5.8%. CONCLUSIONES: El SDRA se presentó en el 38.2% de los niños admitidos a UTIP, y con mayor frecuencia en los pacientes con obesidad. La maniobra de pronación aplicada en los casos severos, mejoró la oxigenación de la mécanica pulmonar. Ninguno de los pacientes falleció por SDRA.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , COVID-19/complications , COVID-19/therapy , Child , Humans , Oxygen , Prospective Studies , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Retrospective Studies , SARS-CoV-2
20.
Hu Li Za Zhi ; 69(4): 20-26, 2022 Aug.
Article in Chinese | MEDLINE | ID: covidwho-1964511

ABSTRACT

Cervical cancer, uterus cancer, and ovarian cancer are three common gynecological cancers. After diagnosis, the three therapeutic modalities available for treating gynecological cancers include surgery, chemotherapy, and radiotherapy. During the diagnostic and treatment periods, these patients usually suffer from physical and psychologic distresses, including menopausal symptoms, infertility, sexual dysfunction, incontinence, anxiety, depression, and relationship changes, among others. Support from family members and significant others has the potential to buffer the psychological distress perceived by patients with gynecological cancers. However, those patients who undergo invasive treatment modalities or have intimate issues such as brachytherapy, the need to use a vaginal dilator, and sexual dysfunction tend to conceal relevant information from their families or friends, which may increase self-perceived loneliness when facing the impacts of the disease and treatments. Healthcare providers may help alleviate patients' psychological stresses by providing psychological support in a timely manner, initiating discussions of intimate issues, and fulfilling patient needs for related information. In addition, healthcare providers may provide one-on-one counseling and individualized care information to increase patients' understanding of their health status. Furthermore, during the COVID-19 pandemic, patients may self-isolate to avoid becoming infected or to recuperate from a COVID-19 infection, causing social isolation or delays of cancer treatment. Healthcare providers may further place caring phone calls and provide treatment information to increase patients' social support and lessen their psychological distress.


Subject(s)
COVID-19 , Neoplasms , Psychological Distress , Female , Humans , Neoplasms/therapy , Pandemics , Social Support , Stress, Psychological/etiology
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