Mental health outcomes in health care providers during the COVID-19 pandemic: an umbrella review.

As we head into the third year of the COVID-19 pandemic, there is an increasing need to consider the long-term mental health outcomes of health care workers (HCWs) who have experienced overwhelming work pressure, economic and social deprivation, burnout, and post-traumatic stress disorder (PTSD). This scoping umbrella review summarizes the mental health outcomes of published evidence syntheses on HCWs worldwide. We analyzed 39 evidence syntheses representing the findings from 1297 primary studies. We found several persistent fears and concerns (job-related fears, fear of stigmatization, worries about the pandemic, and infection-related fears) that shaped HCW experiences in delivering health care. We also describe several risk factors (job-related, social factors, poor physical and mental health, and inadequate coping strategies) and protective factors (individual and external factors). This is the first scoping umbrella review comprehensively documenting the various risk and protective factors that HCWs have faced during the COVID-19 pandemic. HCWs continue to fear the risk that they may infect their family and friends since they regularly interact with COVID-19 patients. This places HCWs in a precarious situation requiring them to balance risk to their family and friends and potential social deprivation from isolation.

This review summarizes the mental health outcomes of health care workers (HCWs) during the COVID-19 pandemic, including their worries and concerns. The fear of infecting loved ones was one of the essential fears faced by HCWs. Job-related fears included job instability, career uncertainty, the fear of losing control in the workplace, and increased workload. Furthermore, HCWs expressed concerns about stigmatization and uncertainty associated with the pandemic's magnitude, duration, and effects. Several risk factors and protective factors for the mental health of HCWs were identified in this review. Risk factors included the lack of personal protective equipment (PPE), the increased workload, the lack of timely information regarding the pandemic, involuntary conscription, social restrictions, pre-existing physical and mental illnesses, and improper coping strategies. In contrast, protective factors included personal characteristics such as altruism and humor, perceived control and self-efficacy, adequate training and education regarding the pandemic, adequate supply of PPE, and favorable work environments. These findings can serve as a basis for the formulation of interventions by governing bodies that promote the mental health of HCWs.

Congenital Diaphragmatic Hernia With Kidney and Spleen Herniation in the United Arab Emirates: A Case Report.

Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly that leads to herniation of abdominal viscera to the chest, which presents with respiratory distress shortly after birth. Spleen herniation is a rare finding, and kidney herniation is even more exceedingly rare. We hereby report a case of a neonate that developed severe respiratory distress secondary to CDH. After confirming the diagnosis with chest and abdominal X-ray and initial stabilization, the patient underwent laparotomy, which revealed a large diaphragmatic defect with herniation of the ileum, colon, spleen, and left kidney. Contents were reduced to the abdomen, and the defect was repaired. The patient had a complete recovery with no complications. After reviewing the literature, we noticed the paucity of data in the Middle East region regarding the disease burden and the increased rate of complications with delayed diagnosis. Therefore, we believe that this case, which was presented in the United Arab Emirates with kidney and spleen herniation and received prompt management, is a valuable addition to the literature.

CART Cell Toxicities: New Insight into Mechanisms and Management.

T cells genetically engineered with chimeric antigen receptors (CART) have become a potent class of cancer immunotherapeutics. Numerous clinical trials of CART cells have revealed remarkable remission rates in patients with relapsed or refractory hematologic malignancies. Despite recent clinical success, CART cell therapy has also led to significant morbidity and occasional mortality from associated toxicities. Cytokine release syndrome (CRS) and Immune effector cell-associated neurotoxicity syndrome (ICANS) present barriers to the extensive use of CART cell therapy in the clinic. CRS can lead to fever, hypoxia, hypotension, coagulopathies, and multiorgan failure, and ICANS can result in cognitive dysfunction, seizures, and cerebral edema. The mechanisms of CRS and ICANS are becoming clearer, but many aspects remain unknown. Disease type and burden, peak serum CART cell levels, CART cell dose, CAR structure, elevated pro-inflammatory cytokines, and activated myeloid and endothelial cells all contribute to CART cell toxicity. Current guidelines for the management of toxicities associated with CART cell therapy vary between clinics, but are typically comprised of supportive care and treatment with corticosteroids or tocilizumab, depending on the severity of the symptoms. Acquiring a deeper understanding of CART cell toxicities and developing new management and prevention strategies are ongoing. In this review, we present findings in the mechanisms and management of CART cell toxicities.