Mental Health Outcomes Among British Healthcare Workers-Lessons From the First Wave of the Covid-19 Pandemic.

OBJECTIVE: To ascertain the level of psychological distress, using validated psychology tools, among British National healthcare workers (HCW) during the first wave of the Covid-19 crisis. METHODS: A multi-centre, anonymized, all-comer staff survey across 3 hospitals in Lancashire, England during the Covid-19 first wave (April to June 2020), consisting of Patient Health Questionnaire (PHQ-9), Perceived Stress Scale-10 (PSS-10), Generalized Anxiety Disorder-7 (GAD-7), and Impact of Events Scale (IES-6). RESULTS: Among 1113 HCW, median (IQR) PHQ-9, GAD-7, PSS-10, and IES-6 score was 7 (3 to 11), 6 (3 to 11), 19 (13 to 24), and 9 (5 to 14), respectively. Potential predictors of higher levels of psychological distress included living alone, disabled dependents, history of depression/anxiety, and being female. CONCLUSIONS: The study indicates a high prevalence of psychological distress during the acute Covid-19 period among HCW, identifies groups at risk and areas of future research.

Etiology and Outcomes of ARDS in a Resource Limited Urban Tropical Setting.

BACKGROUND: Several studies have been published in the western literature on the incidence, clinical course and outcome of patients with ARDS. However, there is limited data about ARDS in the tropics and moreover, the etiology and outcomes of ARDS in tropical countries are different from those of western nations. In tropical countries like India, resources are limited and costs of therapy play a major role in deciding treatment options. This prospective observational study was designed to analyze the clinical profile, outcomes and predictors of mortality of patients with ARDS in an urban tropical setting. METHODS: 75 patients ≥13 years, admitted in the medical intensive care unit of a teaching hospital in Kerala, India between March 2013 and February 2014, satisfying Berlin definition for ARDS were enrolled in the study. Lung protective ventilation strategy as laid by ARDS Network protocol was followed for every patient on mechanical ventilation. Due to scarcity of ventilators in our institution, invasive ventilation could not be provided for all ARDS patients. The criteria used for patient selection for non-invasive ventilation were hemodynamic stability, well compliant to the use of NIV mask and PaO2/FiO2 ratio >180 at the time of admission. RESULTS: Out of the 75 patients, 51% were females and the mean age of the study population was 39.8 ± 3.3 years. Common aetiologies were leptospirosis (18.7%), bronchopneumonia (17.3%), scrub typhus and dengue (12% each). Lung injury score and sequential organ failure assessment score scores had statistically significant association with the severity of ARDS. Forty patients (53.3%) received invasive mechanical ventilation and 35 patients were managed with non-invasive ventilation at the time of admission. The mortality in our study was 45%. Altered sensorium (p-0.002), central cyanosis (p-0.024), elevated creatinine (p-0.036), acidosis (p < 0.001), hypotension (p < 0.001), multiorgan dysfunction (p-0.017), PEEP >12 cm H2O (p-0.036), days on ventilator <7 (p-0.014), PaO2/FiO2 Ratio <100 (p < 0.001), LIS>2.5 (p < 0.001) and SOFA score>11 (p < 0.001) were individual predictors of mortality. CONCLUSION: Tropical infections form a major etiological component of ARDS in a developing country like India. More studies are required for determining criteria for using NIV in mild ARDS patients which would be helpful in resource limited countries. Timely administration of effective antimicrobial therapy in patients in the rural tropics may help to reduce mortality and financial burden due to ARDS.

Pioneering health care. Interview by Carol Davis.

A major overhaul of services means patients in Lancashire can have their heart conditions diagnosed at a single clinic visit.

An aberrant donor pulmonary vein during lung transplant: a surgical challenge.

Aberrant pulmonary veins are uncommon. Anastomosis of such a vein during a lung transplant operation may provide a surgical challenge. We report the first case of an aberrant pulmonary vein anastomosed to the left atrial appendage during the implantation of the left lung.