Memory impairment and concentration problems in COVID-19 survivors 8 weeks after non-ICU hospitalization: A retrospective cohort study.

Studies on the severe acute respiratory syndrome coronavirus 1 have shown long-term effects on health, rehabilitation, and quality of life in patients.To evaluate effects on recovery and mental health in COVID-19 survivors.A single center, retrospective cohort study in (non-ICU admitted) adult patients with COVID-19 infection was conducted. Next to baseline characteristics during hospital admission, data on remaining symptoms and radiographic abnormalities were extracted at the 8-week follow-up at the outpatient clinic. The Hospital Anxiety and Depression Scale (HADS) was used to detect anxiety and depression.Resulting in two hundred and eleven patients were included, median age of 63 years, 61% male, with overweight (average body mass index 28.6 kg/m2 ). At the outpatient clinic 13% of the patients were symptom free, whereas 25% reported more than three symptoms. Persisting physical symptoms were mainly fatigue 68%, dyspnea 56%, and cough 26%. Most patients had normalization of chest X-ray (61.1%) and oxygen saturation (89.9%). Interestingly, 33% reported memory impairment and concentration problems 28%. 7.8% scored for anxiety and 7.1% for depression on the HADS. Correlations were found between the number of physical symptoms and scores on the HADS.In conclusion, only 13% had symptom-free recovery after 8 weeks. Besides physical symptoms memory problems were frequently seen. The number of mental and physical symptoms were correlated.

Older Patients' Perceptions of Medicines and Willingness to Deprescribe.

Introduction Major barriers in deprescribing are the ambivalence of patients, resistance to change, and poor acceptance of alternative treatments. Objective To investigate older patients' beliefs, understanding and knowledge, satisfaction with medicine use, health outcome priorities, their attitude toward deprescribing, and to identify associated patient factors. Methods This multi-center cross-sectional, semistructured survey study involved older outpatients (70 years of age and older) with polypharmacy. The survey comprised three validated questionnaires: Beliefs about Medicines Questionnaire, Patients' Attitudes Towards Deprescribing questionnaire, and the Health Outcome Prioritization tool, with additional questions about understanding and satisfaction. The association between questionnaire outcomes and patient characteristics was investigated. Results Fifty participants were included; they used an average of 9 (+/- SD 2.7) medicines. For most participants (82%), the necessity of using medicines outweighed their concerns. Participants could name 35% of their medicines and 43% of the indications. Overall, 76% were satisfied with the effect of their medicines, but 94% would be willing to stop their medication if advised by their doctor. Maintaining independence (46%) and reducing pain (31%) were the most important health outcome priorities reported by the patients; staying alive had the lowest priority (51%). Participants with higher levels of educational attainment had better knowledge and had more concerns about harmful effects. Conclusions Patients are open to deprescribing but would probably not initiate the conversation themselves because they are generally very satisfied with their medicines. Knowledge about their medicines and their indications is poor. If doctors initiate deprescribing, patients are probably willing to follow their advice. Patients' life priorities should be discussed in deprescribing conversations.

Neuropsychiatric Derangement by Polycythemia Vera: A Case Report of an Unexpected Disease Presentation and Review of the Literature.

Cerebral infarction as well as other thromboses, headaches, and visual complaints are well-known symptoms of polycythemia vera. However, chorea and neuropsychiatric disturbances are less recognized consequences of this chronic disease. Whereas chorea is a rare but acknowledged symptom of polycythemia vera, neuropsychiatric symptoms have only sporadically been reported. We depict 2 patients with an unusual presentation of polycythemia vera. Our first patient presented with right-sided hemiballism and psychosis, and the second patient had a long diagnostic trajectory of unexplained chorea. In both cases diagnosis of JAK2 positive polycythemia vera was established, and in both cases remarkable recovery occurred after the initiation of phlebotomies. The underlying pathophysiology of these symptoms has not been clearly elucidated. Because of the unfamiliarity of the link between especially neuropsychiatric symptoms and polycythemia, current reported numbers are probably an underestimation. Benefit of treatment appears to be large. We seek to create more awareness among physicians about this phenomenon.