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1.
Clin Infect Dis ; 73(11): e4208-e4213, 2021 12 06.
Article in English | MEDLINE | ID: covidwho-1560475

ABSTRACT

BACKGROUND: Since December 2019, coronavirus disease 2019 (COVID-19), caused by severe adult respiratory syndrome coronavirus 2, occurred in Wuhan, and rapidly spread throughout China. This study aimed to clarify the characteristics of patients with refractory COVID-19. METHODS: In this retrospective single-center study, we included 155 consecutive patients with confirmed COVID-19 in Zhongnan Hospital of Wuhan University from 1 January to 5 February. The cases were divided into general and refractory COVID-19 groups according to the clinical efficacy of treatment after hospitalization, and the differences between groups were compared. RESULTS: Compared with patients with general COVID-19 (45.2%), those with refractory disease were older, were more likely to be male, and had more underlying comorbid conditions, a lower incidence of fever, higher maximum temperatures among patients with fever, higher incidences of shortness of breath and anorexia, more severe disease assessment at admission, higher neutrophil, aspartate aminotransferase, lactate dehydrogenase, and C-reactive protein levels, lower platelet counts and albumin levels, and higher incidences of bilateral pneumonia and pleural effusion (P < .05). Patients with refractory COVID-19 were more likely to receive oxygen, mechanical ventilation, expectorant, and adjunctive treatment, including corticosteroids, antiviral drugs, and immune enhancers (P < .05). Considering the factors of disease severity at admission, mechanical ventilation, and intensive care unit transfer, patients with refractory COVID-19 were also more likely to be male, have manifestations of anorexia on admission, and receive oxygen, expectorant, and adjunctive agents (P < .05). CONCLUSION: In nearly 50% of patients with COVID-19 obvious clinical and radiological remission was not achieved within 10 days after hospitalization. Male, anorexia, and no fever at admission was predictive of poor treatment efficacy.


Subject(s)
COVID-19 , Adult , China/epidemiology , Female , Fever , Hospitalization , Humans , Male , Retrospective Studies , SARS-CoV-2
2.
Front Med (Lausanne) ; 8: 632942, 2021.
Article in English | MEDLINE | ID: covidwho-1264341

ABSTRACT

Background: Since December 2019 the novel coronavirus (SARS-CoV-2) is the center of global attention due to its rapid transmission and toll on health care systems and global economy. Population-based serosurveys measuring antibodies for SARS-CoV-2 provide one method for estimating previous infection rates including the symptom-free courses of the disease and monitoring the progression of the epidemic. Methods: In June 2020 we succeeded in testing almost half of the population of an Austrian township (1,359 inhabitants) with a reported higher incidence for COVID-19 infections (17 PCR positive cases have been officially reported until the date of sample collection, i.e., 1.2% of the total population). We determined the prevalence of SARS-CoV-2-specific antibodies in this population, factors affecting, and symptoms correlated with prior infection. Antibodies were determined using a CE-certified quality-controlled ELISA test for SARS-CoV-2-specific IgG and IgA antibodies. Results: We found a high prevalence of 9% positive antibodies among the town population in comparison to 6% of the neighboring villages. This was considerably higher than the officially known RT-PCR-approved COVID-19 cases (1.2%) in the town population. Twenty percent of SARS-CoV-2-antibody positive cases declared being asymptomatic in a questionnaire. On the other hand, we identified six single major symptoms, including anosmia/ageusia, weight loss, anorexia, general debility, dyspnea, and fever, and especially their combination to be of high prognostic value for predicting SARS-CoV-2 infection in a patient. Conclusions: This population study demonstrated a high prevalence of antibodies to SARS-CoV-2 as a marker of past infections in an Austrian township. Several symptoms revealed a diagnostic value especially in combination.

3.
Psychiatry Res ; 302: 114045, 2021 08.
Article in English | MEDLINE | ID: covidwho-1253498

ABSTRACT

OBJECTIVE: People with mental disorders might be differentially affected by the COVID-19 pandemic. The aim of the current study was to evaluate the impact of the pandemic on patients with various psychiatric disorders who were admitted to inpatient treatment. METHODS: Five-hundred thirty-eight inpatients with mental disorders participated in a survey about psychological consequences of the pandemic between March-December 2020. We examined the perceived burden by restrictions and worries, changes in health care utilization, and helpfulness of coping strategies. RESULTS: More than 50% reported any worsening of symptoms, 40% stated increased need of therapeutic support. High rates of symptom deterioration were observed for depressive symptoms (>55%), anxiety (>40%), and sleeping behavior (>40%). Treatment impairment was stated by 27.9%. Patients with anxiety disorders were less affected by contact restrictions compared with eating disorders and depression. Patients with anorexia nervosa and post-traumatic stress disorder experienced higher helpfulness by daily structuring than patients with depression. DISCUSSION: About half of our sample of psychiatric patients experienced symptom deterioration due to the pandemic and about one quarter reported impairment of treatment modalities. Especially patients with eating disorders and depressive disorders were more frequently affected. The results indicate a needed improvement of treatment options during a pandemic.


Subject(s)
COVID-19/psychology , Inpatients/psychology , Mental Disorders/psychology , Mental Disorders/therapy , Pandemics , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Child , Female , Germany/epidemiology , Hospitals , Humans , Inpatients/statistics & numerical data , Male , Middle Aged , Surveys and Questionnaires , Young Adult
4.
Eur Geriatr Med ; 12(5): 1091-1094, 2021 10.
Article in English | MEDLINE | ID: covidwho-1245803

ABSTRACT

PURPOSE: To analyze factors associated with mortality at 3 months and readmissions, functional and cognitive decline, anorexia and affective disorders in patients aged > 70 years surviving after hospital admission for SARS-CoV-2. METHODS: Patients aged > 70 years, discharged after hospitalization with COVID-19. OUTCOME VARIABLES: mortality, readmissions, functional and cognitive impairment, anorexia and mood disorder. RESULTS: 165 cases at 3 months after hospital discharge, 8.5% died and 20% required at least one hospital readmission. The presence of severe dependence at discharge (BI < 40) was associated at 3 months with a higher risk of mortality (OR 5.08; 95% CI 1.53-16.91) and readmissions (OR 4.53; 95% CI 1.96-10.49). The post-hospitalization functional deterioration was associated with persistence of deterioration at 3 months (OR 24.57; 95% CI 9.24-65.39), cognitive deterioration (OR 2.32; 95% CI 1.03-5.25) and affective (OR 4.40; 95% CI 1.84-10.55) CONCLUSIONS: Loss function in older people after hospitalization by COVID-19 may contribute to identify patients with a higher risk of sequelae in the short term that require closer follow-up.


Subject(s)
COVID-19 , Aged , Follow-Up Studies , Health Status , Hospitalization , Humans , SARS-CoV-2 , Survivors
5.
World J Gastroenterol ; 27(19): 2341-2352, 2021 May 21.
Article in English | MEDLINE | ID: covidwho-1239023

ABSTRACT

Gastrointestinal (GI) symptoms, such as diarrhea, abdominal pain, vomiting, and anorexia, are frequently observed in patients with coronavirus disease 2019 (COVID-19). However, the pathophysiological mechanisms connecting these GI symptoms to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections remain elusive. Previous studies indicate that the entry of SARS-CoV-2 into intestinal cells leads to downregulation of angiotensin converting enzyme 2 (ACE2) receptors resulting in impaired barrier function. While intestinal ACE2 functions as a chaperone for the amino acid transporter B0AT1, the B0AT1/ACE2 complex within the intestinal epithelium acts as a regulator of gut microbiota composition and function. Alternations to the B0AT1/ACE2 complex lead to microbial dysbiosis through increased local and systemic immune responses. Previous studies have also suggested that altered serotonin metabolism may be the underlying cause of GI disorders involving diarrhea. The findings of elevated plasma serotonin levels and high fecal calprotectin in COVID-19 patients with diarrhea indicate that the viral infection evokes a systemic inflammatory response that specifically involves the GI. Interestingly, the elevated proinflammatory cytokines correlate with elevated serotonin and fecal calprotectin levels further supporting the evidence of GI inflammation, a hallmark of functional GI disorders. Moreover, the finding that rectal swabs of COVID-19 patients remain positive for SARS-CoV-2 even after the nasopharynx clears the virus, suggests that viral replication and shedding from the GI tract may be more robust than that of the respiratory tract, further indicating fecal-oral transmission as another important route of viral spread. This review summarized the evidence for pathophysiological mechanisms (impaired barrier function, gut inflammation, altered serotonin metabolism and gut microbiota dysbiosis) underlying the GI symptoms in patients with COVID-19.


Subject(s)
COVID-19 , Gastrointestinal Diseases , Dysbiosis , Gastrointestinal Tract , Humans , SARS-CoV-2
6.
Int J Environ Res Public Health ; 18(9)2021 04 27.
Article in English | MEDLINE | ID: covidwho-1231463

ABSTRACT

Skills trainings for caregivers of patients with anorexia nervosa (AN) have been proven to be effective in improving caregiver skills and reducing caregivers' psychopathology. The effects on patients, especially adolescents, are largely unknown. The aim of this study was to evaluate the effectiveness of a caregivers' skills training program (Supporting Carers of Children and Adolescents with Eating Disorders in Austria, SUCCEAT, workshop or online version) on adolescents with AN delivered as workshops (WS) or online (ONL). Outcomes are Body-Mass-Index (BMI) percentile, eating psychopathology (Eating Disorder Examination, EDE), attitudinal and behavioural dimensions of eating disorders (Eating Disorder Inventory-2), motivation to change (AN Stages of Change Questionnaire), emotional and behavioural problems (Youth Self-Report) and quality of life (KINDL). All outcome variables significantly improved across both SUCCEAT groups (WS and ONL) and were sustained at 12-month follow-up. The online and workshop delivery of SUCCEAT were equally effective. Most effect sizes were in the medium-to-high range. Full or partial remission was observed in 72% (WS) and 87% (ONL) of patients. Caregiver skills trainings, either delivered as workshops or online modules, are highly recommended to complement treatment as usual.


Subject(s)
Anorexia Nervosa , Adolescent , Anorexia Nervosa/therapy , Austria , Caregivers , Child , Feasibility Studies , Humans , Quality of Life
7.
Eur Eat Disord Rev ; 29(4): 670-679, 2021 07.
Article in English | MEDLINE | ID: covidwho-1216170

ABSTRACT

OBJECTIVES: To investigate the validity and reliability of two variants of the Sit Up Squat Stand Test (SUSS) and Hand Grip Strength (HGS) in predicting BMI and BMI risk level in hospitalised patients with Anorexia Nervosa (AN). METHODS: 25 inpatients with AN were tested roughly weekly for up to 16 weeks. Muscle power was assessed by two independent researchers. RESULTS: Intra-class coefficients (ICCs) indicated high Inter-Rater Reliability (IRR) for the HGS (10 participants). Cohen's Kappa showed moderate IRR for the SUSS test (25 participants). Stepwise multiple regression showed that the SUSS tests plus HGS predicted BMI and BMI risk level explaining about two-third of the variance. Each test individually had lower predictive value. There was a little difference between the two versions of the SUSS tested. CONCLUSIONS: HGS and SUSS are valid and reliable measurements of muscle power in AN. Together, the SUSS tests and the HGS represent a useful and effective measure of muscle power and hence one aspect of physical risk in Anorexia Nervosa. In the light of Covid restrictions, the SUSS test is one way that physical state can be monitored on video link in a way that is hard to falsify.


Subject(s)
Anorexia Nervosa , COVID-19 , Anorexia Nervosa/diagnosis , Hand Strength/physiology , Humans , Muscles , Reproducibility of Results , Risk Assessment
8.
Int J Environ Res Public Health ; 18(8)2021 04 16.
Article in English | MEDLINE | ID: covidwho-1194631

ABSTRACT

COVID-19-related restrictions may have a serious impact on patients with eating disorders. We conducted semistructured interviews with female adolescent patients with anorexia nervosa (AN) (n = 13, 13-18 years) currently receiving inpatient or outpatient treatment and their parents (n = 10). We asked for their experiences during COVID-19 confinement regarding everyday life, AN symptoms, and treatment. We used thematic analysis to interpret the data. The main themes identified from the patients' interviews involved restrictions of personal freedom (i.e., leading to tension between patients and family members, reduced motivation to work on recovery), interruption of the treatment routine (emerging risks through self-monitored weight, challenges/opportunities of teletherapy), changes in AN symptoms (more exposure to triggering situations), COVID-19-related fears, and compulsions but also potential opportunities (less stress, better family relationships). The parents discussed changes in daily routines as negative (challenges in maintaining day structures) and positive (more family time, "slowing down"). They expressed reservations about reduced outpatient monitoring and increased teletherapy and discussed challenges in keeping contact with the child and clinicians during inpatient treatment. Moreover, the parents discussed deteriorations and improvements in the patients' psychopathology. Clinical implications from these in-depth insights include the importance of strengthening communication between changing staff cohorts, patients, and parents; motivational work; and joint weight monitoring with the therapist.


Subject(s)
Anorexia Nervosa , COVID-19 , Adolescent , Anorexia Nervosa/therapy , Child , Female , Humans , Motivation , Qualitative Research , SARS-CoV-2
9.
Cureus ; 13(1): e12953, 2021 Jan 28.
Article in English | MEDLINE | ID: covidwho-1115539

ABSTRACT

Gastrointestinal symptoms, such as diarrhea (most common among gastrointestinal symptoms), nausea/vomiting, anorexia, abdominal pain, abnormal liver enzymes, and pancreatitis, are being increasingly recognized in patients with coronavirus disease 2019 (COVID-19). Moreover, COVID-19 has also been implicated in coagulopathy, especially in patients with severe disease. Here, we report a case of acute intestinal ischemia secondary to superior mesenteric thrombosis in a young female patient with mild COVID-19.

10.
Front Psychiatry ; 11: 593720, 2020.
Article in English | MEDLINE | ID: covidwho-1076498

ABSTRACT

Huddles are brief, time-limited, focused meetings to help organize and support clinical teams. Huddles have demonstrated their value and transferable benefits across a range of settings. Based on their transferable nature, their potential could be unacknowledged as a clinical implementation technique, particularly in specific subgroups of patients with anorexia who need a higher level of care. An innovative clinical pathway aimed at supporting autistic patients with eating disorders (PEACE Pathway) evaluated the use of weekly PEACE huddles for the multidisciplinary team as part of the implementation process across a 12-months period. A total of 283 responses evaluated the huddle as useful on average 84/100. Using content analysis, several perceived benefits were found of the huddles which were in line with the underpinnings of traditional huddles, suggesting that huddles are transferable as implementation techniques, as evidence by a team providing higher-level care for eating disorders.

11.
Eat Weight Disord ; 26(8): 2787-2793, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1070974

ABSTRACT

PURPOSE: Due to COVID-19 pandemic, the Italian population lived in quarantine from March to May 2020 (lockdown phase I). Restrictions impacted individuals' psychological health, especially in those with eating disorders (ED). Healthcare providers (HCPs) treating ED provided assistance by telemedicine and/or in walk-in clinics. We hypothesize that social restrictions represented a great stressor for ED patients and HCPs, negatively impacted their therapeutic alliance, and affected the frequency of dysfunctional behaviors. METHODS: This cross-sectional study consisted of an online survey investigating the experience of HCPs involved in ED treatment, with a specific focus on difficulties concerning the therapeutic efficacy. Questionnaire (n. 18 questions) was formulated ad hoc by our research team and sent by e-mail to Italian HCPs registered on online platforms. HCPs included ED experts specialized in psychology, nutrition or medicine. Data were collected during lockdown phase I and referred to patients with Anorexia Nervosa-(AN), Bulimia Nervosa (BN)-and Binge-Eating Disorder-(BED). RESULTS: One-hundred questionnaires were collected; 84 and 76 were included in our qualitative and quantitative analyses, respectively. Thirty-six% of HCPs felt their therapeutic intervention was unsuccessful, 37% complained compromised therapeutic alliance. Changes in frequency of compensatory behaviors (increased in 41% AN and 49,5% BN; reduced in 14,6% AN and 21,8% BN) and binge-eating episodes (increased in 53,3% BN and 30,5% BED; reduced in 30,7% BN and 24,7% BED) were experienced and ascribed to augmented patient's anxiety. Disorders switches and variation in dysfunctional conducts frequency were both significantly related to ED category (p < 0.05 for all). Concentration techniques were recognized as useful to offset such negative outcomes. CONCLUSION: According to HCPs, social restrictions affected the frequency of dysfunctional behaviors in ED patients and the efficacy of their therapeutic intervention. Further long-term studies are needed to confirm our data in a larger sample size. LEVEL IV: Novel results from a cross-sectional study.


Subject(s)
Anorexia Nervosa , Binge-Eating Disorder , Bulimia Nervosa , COVID-19 , Feeding and Eating Disorders , Communicable Disease Control , Cross-Sectional Studies , Feeding and Eating Disorders/epidemiology , Feeding and Eating Disorders/therapy , Health Personnel , Humans , Italy/epidemiology , Pandemics , SARS-CoV-2
12.
World J Surg Oncol ; 19(1): 8, 2021 Jan 11.
Article in English | MEDLINE | ID: covidwho-1059674

ABSTRACT

BACKGROUND: The long-term physiological consequences of SARS-CoV-2 (severe acute respiratory syndrome coronavirus) infection are not known. The ability of COVID-19 to cause chronic illness, sarcopenia, and physical deconditioning may be underestimated and go beyond the anticipated respiratory sequelae. Myalgia, lethargy, and anorexia are common symptoms even in mild to moderate cases and have the potential to exacerbate frailty. How this impacts on risk-stratification for patients requiring surgery for time-critical conditions, such as malignancy, requires further urgent investigation. MAIN BODY: The deleterious effect of sarcopenia and poor physical capacity are well recognised in cancer surgery. This review commentary highlights current evidence which suggests skeletal muscle as an under recognised cause of COVID-19-related functional deconditioning. The mechanisms behind this are via direct (viral induced myositis, nutritional decline, cytokine-mediated myopathy) and indirect mechanisms (social isolation, inactivity, and psychological consequences). CONCLUSION: Further mechanistic research is required to explore the processes behind the deconditioning effects of SARS-CoV-2 infection and how this impacts on treatment of malignant disease.


Subject(s)
COVID-19/complications , Neoplasms/surgery , Physical Functional Performance , SARS-CoV-2 , Sarcopenia/etiology , COVID-19/physiopathology , Humans , Myalgia/etiology , Surgical Procedures, Operative/adverse effects
13.
Eur Eat Disord Rev ; 28(6): 871-883, 2020 11.
Article in English | MEDLINE | ID: covidwho-1005731

ABSTRACT

Confinement during the COVID-19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational-theoretical structure of the CIES. Adequate goodness-of-fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face-to-face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.


Subject(s)
COVID-19/prevention & control , Feeding and Eating Disorders/epidemiology , Obesity/epidemiology , Social Isolation/psychology , Adolescent , Adult , Aged , Factor Analysis, Statistical , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Psychometrics , Spain/epidemiology , Young Adult
14.
Eur Eat Disord Rev ; 28(6): 826-835, 2020 11.
Article in English | MEDLINE | ID: covidwho-995934

ABSTRACT

OBJECTIVE: This qualitative study explores the ways in which the coronavirus disease 2019 (COVID-19) pandemic and associated lockdown measures have affected the lives of adult patients with anorexia nervosa (AN) and their carers. METHOD: Semi-structured interviews were conducted with patients with AN (n = 21) and carers (n = 28) from the start of UK Government imposed lockdown. Data related directly to the impact of lockdown and COVID-19 were analysed using thematic analysis. RESULTS: Four broad themes were identified for patients and carers separately. Patients experienced: 1. reduced access to eating disorder (ED) services; 2. disruption to routine and activities in the community; 3. heightened psychological distress and ED symptoms; 4. increased attempts at self-management in recovery. Carer themes included: 1. concern over provision of professional support for patients; 2. increased practical demands placed on carers in lockdown; 3. managing new challenges around patient wellbeing; 4. new opportunities. CONCLUSIONS: Reduced access to ED services, loss of routine and heightened anxieties and ED symptoms resulting from COVID-19 and lockdown measures presented challenges for patients and carers. Increased remote support by ED services enabled the continuation of treatment and self-management resources and strategies promoted self-efficacy in both groups.


Subject(s)
Anorexia Nervosa/therapy , COVID-19/epidemiology , COVID-19/prevention & control , Caregivers/psychology , Pandemics , Quarantine , Adult , Anorexia Nervosa/epidemiology , Anxiety/epidemiology , COVID-19/psychology , Caregivers/statistics & numerical data , Female , Health Services Accessibility/statistics & numerical data , Humans , Male , Middle Aged , Qualitative Research , Self-Management/psychology , United Kingdom/epidemiology , Young Adult
15.
Gastroenterol Res Pract ; 2020: 8853922, 2020.
Article in English | MEDLINE | ID: covidwho-999336

ABSTRACT

The incidence of digestive symptoms may vary depending on doctors' professional backgrounds when they inquired suspected COVID-19 patients in a fever clinic. We sought to understand the characteristics of inquiries about digestive symptoms by doctors in different specialties; therefore, inquiry records of 2 gastroenterologists and 6 nongastroenterologists were reviewed. We compared the difference in inquiry of digestive symptoms (diarrhea, vomit, distension, anorexia, and abdominal pain) between these two groups among identified COVID-19 patients. And we further compared the difference of digestive symptoms between confirmed patients and suspected cases who excluded from COVID-19. Among 495 confirmed COVID-19 cases (254 cases by gastroenterologists and 241 cases by nongastroenterologists), 22.83% patients experienced various digestive symptoms in the gastroenterologists' group, while only 4.47% reported digestive symptoms by nongastroenterologists (p < 0.0001). Additionally, among initially suspected 611 patients who presented with similar respiratory symptoms inquired by gastroenterologists, confirmed cases presented far more frequency of digestive symptoms than excluded cases (22.8% vs. 3.64%, p < 0.0001). Furthermore, confirmed patients reported more percentage of watery diarrhea (56% vs. 36%, p < 0.0001) and higher frequent vomit (2.77 ± 0.97 vs. 1.80 ± 0.45 per day, p = 0.041) than excluded cases. We concluded that gastroenterologists could detect a greater proportion of gastrointestinal symptoms in COVID-19 patients during fever clinic inquiries. Moreover, confirmed COVID-19 patients are more likely to have higher severity in digestive symptoms than excluded cases. Therefore, physicians in fever clinic should pay more attention to the triage of gastrointestinal symptoms.

16.
Aging (Albany NY) ; 13(1): 16-26, 2020 12 11.
Article in English | MEDLINE | ID: covidwho-979244

ABSTRACT

We aimed to compare the age-related clinical characteristics between younger and elderly deceased COVID-19 patients. This single-center retrospective study included 163 adult deceased COVID-19 patients who were admitted to Wuhan Union Hospital West Campus from January 12, 2020, to March 30, 2020. Demographic and clinical features were collected by reviewing the medical records. The median age of the 163 deceased patients was 69 (interquartile range [IQR], 62-78) years. They were classified as younger (age 18-69 years; 86/163, 52.8%) and elderly (≥70 years; 77/163, 47.2%) subjects. Younger deceased patients were more likely to develop fever (72/86 vs 54/77, P=0.039) than elderly deceased patients were while anorexia was (29/77 vs 19/86, P=0.029) more common in elderly deceased patients than in younger deceased patients. In multivariate analyses, age was a protective factor for acute cardiac injury of deceased COVID-19 patients (odds ratio [OR] 0.968, [95% confidence interval (CI), 0.940-0.997]; P=0.033) while chronic cardiac disease was a risk factor for acute cardiac injury of deceased COVID-19 patients (OR 2.660 [95%CI, 1.034-6.843]; P=0.042). Our study described the clinical characteristics of younger and elderly deceased COVID-19 patients and demonstrated that younger deceased patients were more likely to develop an acute cardiac injury.


Subject(s)
COVID-19/mortality , COVID-19/pathology , SARS-CoV-2 , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Aging , Female , Humans , Male , Middle Aged , Multivariate Analysis , Retrospective Studies , Risk Factors , Young Adult
17.
Int J Clin Pract ; 75(3): e13725, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-909856

ABSTRACT

BACKGROUND: The 2019 coronavirus disease (COVID-19) has become a global pandemic and the published literature describing the virus has grown exponentially. METHODS: We conducted a systematic review of the literature to identify the symptoms, comorbidities present, radiological features and outcomes for adults testing positive for COVID-19 admitted to hospital. The results across multiple studies were numerically pooled to yield total estimated. RESULTS: A total of 45 studies were included in this review with 14 358 adult participants (average age 51 years, male 51%). The pooled findings suggest that the most common symptom among patients was fever (81.2%) followed by cough (62.9%), fatigue (38.0%) and anorexia/loss of appetite (33.7%). The comorbidities that were most prevalent among patients with the virus were hypertension (19.1%), cardiovascular disease (17.9%), endocrine disorder (9.3%) and diabetes (9.2%). Abnormal chest X-ray findings were present in 27.7% of patients and ground-glass opacity was demonstrated on chest computerized tomography in 63.0% of patients. The most frequent adverse outcomes were acute respiratory distress syndrome (27.4%), acute cardiac injury (16.2%) and acute kidney injury (12.6%). Death occurred in 8.2% of patients and 16.3% required intensive care admission and 11.7% had mechanical ventilation. Bacterial or secondary infections affected 8.5% of patients and 6.9% developed shock. CONCLUSIONS: COVID-19 most commonly presents with fever, cough, fatigue and anorexia and among patients with existing hypertension and cardiovascular disease. It is important as serious adverse outcomes can develop such as acute respiratory distress syndrome, acute cardiac injury, acute kidney injury and death.


Subject(s)
COVID-19 , Adult , Cough/epidemiology , Fever/epidemiology , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
18.
Int J Eat Disord ; 53(11): 1855-1862, 2020 11.
Article in English | MEDLINE | ID: covidwho-734194

ABSTRACT

OBJECTIVE: the aim of this longitudinal study was to evaluate the impact of COVID-19 epidemic on Eating Disorders (EDs) patients, considering the role of pre-existing vulnerabilities. METHOD: 74 patients with Anorexia Nervosa (AN) or Bulimia Nervosa (BN) and 97 healthy controls (HCs) were evaluated before lockdown (T1) and during lockdown (T2). Patients were also evaluated at the beginning of treatment (T0). Questionnaires were collected to assess psychopathology, childhood trauma, attachment style, and COVID-19-related post-traumatic symptoms. RESULTS: A different trend between patients and HCs was observed only for pathological eating behaviors. Patients experienced increased compensatory exercise during lockdown; BN patients also exacerbated binge eating. Lockdown interfered with treatment outcomes: the descending trend of ED-specific psychopathology was interrupted during the epidemic in BN patients. Previously remitted patients showed re-exacerbation of binge eating after lockdown. Household arguments and fear for the safety of loved ones predicted increased symptoms during the lockdown. BN patients reported more severe COVID-19-related post-traumatic symptomatology than AN and HCs, and these symptoms were predicted by childhood trauma and insecure attachment. DISCUSSION: COVID-19 epidemic significantly impacted on EDs, both in terms of post-traumatic symptomatology and interference with the recovery process. Individuals with early trauma or insecure attachment were particularly vulnerable.


Subject(s)
Coronavirus Infections/prevention & control , Feeding and Eating Disorders/psychology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Quarantine/psychology , Adolescent , Adult , COVID-19 , Case-Control Studies , Exercise/psychology , Feeding Behavior/psychology , Feeding and Eating Disorders/therapy , Female , Humans , Italy , Longitudinal Studies , Middle Aged , Object Attachment , Psychological Trauma/psychology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires , Young Adult
19.
Int J Eat Disord ; 53(11): 1791-1800, 2020 11.
Article in English | MEDLINE | ID: covidwho-728078

ABSTRACT

OBJECTIVE: The COVID-19 pandemic and the resulting public restrictions pose a psychological burden for humans worldwide and may be particularly detrimental for individuals with mental disorders. Therefore, the current study explored effects of the COVID-19 pandemic on eating disorder (ED) symptoms and other psychological aspects in former inpatients with anorexia nervosa (AN). METHOD: One-hundred and fifty-nine patients with AN-discharged from inpatient treatment in 2019-completed an online survey on contact history with COVID-19, changes in ED symptoms and other psychological aspects, health care utilization, and strategies patients employed to cope during the pandemic. RESULTS: Approximately 70% of patients reported that eating, shape and weight concerns, drive for physical activity, loneliness, sadness, and inner restlessness increased during the pandemic. Access to in-person psychotherapies and visits at the general practitioner (including weight checks) decreased by 37% and 46%, respectively. Videoconference therapy was used by 26% and telephone contacts by 35% of patients. Patients experienced daily routines, day planning and enjoyable activities as the most helpful among the most used coping strategies. DISCUSSION: The COVID-19 pandemic poses great challenges to patients with AN. ED-related thoughts and behaviors may be used as dysfunctional coping mechanisms to regain control over the current circumstances. E-mental health interventions appear to be promising for supporting AN patients during these hard times. Furthermore, interventions addressing symptoms of depression and anxiety, as well as intolerance of uncertainty might help them manage their ED symptoms.


Subject(s)
Anorexia Nervosa/psychology , Coronavirus Infections , Pandemics , Pneumonia, Viral , Adaptation, Psychological , Adolescent , Adult , Anorexia Nervosa/therapy , Anxiety/etiology , COVID-19 , Cross-Sectional Studies , Depression/etiology , Exercise/psychology , Female , Germany , Health Behavior , Health Services Accessibility , Health Surveys , Humans , Mental Health , Middle Aged , Patient Acceptance of Health Care , Severity of Illness Index , Sickness Impact Profile , Young Adult
20.
Clin Infect Pract ; 7: 100033, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-343694

ABSTRACT

BACKGROUND: The potential risk of cytokine storm in patients with coronavirus disease 2019 (COVID-19) has been described [1]; we write to share our experience treating a 17-year-old male with haemophagocytic lymphohistiocytosis (HLH) secondary to COVID-19 infection. CASE REPORT: This patient presented with cough, sore throat, anorexia and pyrexia. On examination, he had gross cervical lymphadenopathy and palpable splenomegaly. Nose and throat swab for SARS-CoV-2 was positive and blood tests revealed pancytopaenia with very high ferritin, triglyceride and d-dimer levels. The patient's H-Score [2] was calculated at 220, suggesting probability of HLH of 93-96%. Considering Russell and colleagues' [3] comments about potential harm of corticosteroid use in patients with COVID-19 infection, the patient was commenced on treatment with the selective IL-1 receptor antagonist drug, Anakinra, and a two-day course of intravenous immunoglobulin. RESULTS: The patient responded rapidly to treatment, becoming apyrexial after 24 h. His lymph nodes and spleen began to normalise after the first 48 h, at which time point the ferritin also started to decrease. He was discharged after 11 days feeling fit and well. CONCLUSION: This case certainly illustrates the importance of hyperinflammation syndromes in COVID-19. It also raises the question - is the severe pneumonitis seen in patients with COVID-19 an immunological phenomenon? We know that the viral load of patients with COVID-19 seems to peak in the early stages of illness [4,5]; however, patients deteriorate later in the disease course, at around days 10-14. This patient, who had risk factors for deterioration (male, pancytopaenic), did not develop an oxygen requirement and clinically and biochemically improved rapidly on Anakinra with no adverse events. We might suggest Anakinra to the scientific community as a treatment option in COVID-19 infection.

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