ABSTRACT
Background: Despite concerns on mental health problems related to lockdowns, recent reports revealed a reduction in psychiatric admissions in Emergency Departments (ED) during the lockdown period compared with the previous year in several countries. Most of the existing studies focused on the first lockdown not considering the different phases of the COVID-19 crisis. The present study aimed to analyse differences in ED admissions for psychiatric consultation during three different phases of the COVID-19 in Italy. Method(s): Information on ED admission the Santo Spirito Hospital in Rome for psychiatric consultations were retrospectively collected. The lockdown(March-June 2020) and the post-lockdown period (June 2020-June 2021) were compared to the pre-lockdown period(January 2019-March 2020). Multinomial logistic regression(MLR) was used to assess the risk of accessing ED for psychiatric consultation during the three periods. Result(s): 3871 ED psychiatric consultations were collected. A significant reduction of psychiatric consultations in ED during the lockdown period and the post-lockdown (H 762.45;p < .001) was documented. MLR showed that compared to pre-lockdown during the lockdown and post-lockdown patients were more likely to be men (RRR 1.52;95% CI 1.10-2.12) and more often diagnosed with non-severe mental illnesses (nSMI) (relative risk ratio [RRR] 1.53, 95% CI 1.10-2.15;and 1.72, 95% CI 1.42-2.08);during the lockdown, patients were also more often diagnosed with alcohol/substance abuse(RRR 1.70;95% CI 1.10-2.65). Conclusion(s): Several changes in the clinical characteristics of psychiatric consultations during and after the lockdown emerged;these may inform clinicians and future preventive strategies among community mental health services.
ABSTRACT
SARS-CoV-2 virus disease presents (CAM) has been observed, mainly in patients with diabetes mellitus, diabetic ketoacidosis or under steroids treatment. The highest number of cases have been reported in India, with a prevalence of 0.27 % in hospitalized patients with COVID-19 during year 2020, which implies a 2.1-fold increase in the prevalence of mucormycosis compared to year 2019. Although corticosteroids treatment reduces mortality in patients with severe COVID-19, its prolonged use, in combination with other clinical and immunological factors, could increase the risk of invasive fungal infection. We report a case of CAM in Argentina. This report represents a warning for considering the diagnosis of invasive fungal infection in patients with severe COVID-19.Copyright © 2021, Instituto de Investigaciones Medicas. All rights reserved.
ABSTRACT
SARS-CoV-2 virus disease presents (CAM) has been observed, mainly in patients with diabetes mellitus, diabetic ketoacidosis or under steroids treatment. The highest number of cases have been reported in India, with a prevalence of 0.27 % in hospitalized patients with COVID-19 during year 2020, which implies a 2.1-fold increase in the prevalence of mucormycosis compared to year 2019. Although corticosteroids treatment reduces mortality in patients with severe COVID-19, its prolonged use, in combination with other clinical and immunological factors, could increase the risk of invasive fungal infection. We report a case of CAM in Argentina. This report represents a warning for considering the diagnosis of invasive fungal infection in patients with severe COVID-19. Copyright © 2021, Instituto de Investigaciones Medicas. All rights reserved.
ABSTRACT
Purpose: During a follow-up program of patients admitted for COVID-19 at our non-ICU Unit, we found that 37% of them had decreased diffusing lung capacity for carbon monoxide (DLCO) 3- 6 months after discharge. This prospective observational study aimed to evaluate the evolution of changes in DLCO and respiratory symptoms at the 1-year follow-up visit. Methods: 17 (mean age 71 years;8 males) of 19 eligible patients (DLCO <80% of predicted at the 3-6 months follow-up visit) completed the 1-year follow-up visit. One patient refused to participate and 1 patient had died 3 months earlier from myocardial infarction. The visit included a self-reported structured questionnaire, physical exam, blood tests, ECG, and spirometry with DLCO. Results: Mean DLCO was significantly improved at the 1-year visit (from 64% of predicted at 3-6 months to 74% of predicted at 1 year;P=0.003). A clinically significant increase in DLCO (10% or greater) was observed in 11 patients (65%) with complete normalization (>80% of predicted) in 6 (35%);in the other 6 (35%) it remained unchanged. The prevalence of exertional dyspnea (65 to 35%, P=0.17), cough (24 to 18%, P=1), and fatigue (76 to 35%, P=0.04) decreased at the 1-year visit. Conclusions: These results suggest that DLCO and respiratory symptoms tend to normalize or improved 1 year after hospitalization for COVID-19 in most patients. However, there is also a nonnegligible number of patients (about one third) in whom respiratory changes persist and will need prolonged follow-up.
ABSTRACT
Background: The benefits of prior vaccination in patients hospitalized for SARS-CoV-2 infection during the Omicron surge are not well understood. We aimed to assess the characteristics and outcomes of a cohort of COVID-19 inpatients by their vaccination status. Methods: All patients with a diagnosis of moderate-severe COVID- 19 admitted to the COVID-19 ward of the San Giovanni di Dio hospital, Florence, between December 28, 2021 and February 3, 2022 were enrolled. Patients were divided into 2 groups according to vaccination status: 1) unvaccinated, and 2) fully vaccinated (completed primary series±booster). The study outcomes were: need for supplemental oxygen, need for noninvasive ventilation (NIV), and in-hospital death. Results: We enrolled 95 patients (57 males), of which 28 (29.5%) unvaccinated and 67 fully vaccinated. Patients in group 1 were younger (71.3±15.6 vs 74.4±13.9;p=0.33) and had a lower Charlson comorbidity index (3.6±2.4 vs 4.8±2.4;p=0.03) compared to group 2 patients. Oxygen therapy was required in 89.3% (25/28) of unvaccinated patients and 88.1% (59/67) of vaccinated patients (p=1). NIV was applied in 35.7% (10/28) of the unvaccinated patients and in 26.9% (18/67) of the vaccinated (p=0.39). 6 of 28 (21.4%) unvaccinated patients died during hospital stay, compared with 13 of 67 (19.4%) vaccinated patients (p=0.82). Conclusions: Vaccinated patients hospitalized for COVID-19 showed a trend toward reduced need for respiratory support and in-hospital death compared to unvaccinated patients, despite being older and having a higher comorbidity burden.
ABSTRACT
SARS-CoV-2 virus disease presents variable severity. Recently, an increasing report of cases of COVID-19 associated mucormycosis (CAM) has been observed, mainly in patients with diabetes mellitus, diabetic ketoacidosis or under steroids treatment. The highest number of cases have been reported in India, with a prevalence of 0.27 % in hospitalized patients with COVID-19 during year 2020, which implies a 2.1-fold increase in the prevalence of mucormycosis compared to year 2019. Although corticosteroids treatment reduces mortality in patients with severe COVID-19, its prolonged use, in combination with other clinical and immunological factors, could increase the risk of invasive fungal infection. We report a case of CAM in Argentina. This report represents a warning for considering the diagnosis of invasive fungal infection in patients with severe COVID-19.
ABSTRACT
Background: CoViD-19 has been shown to impact a variety of organs, including the CNS. The definition of Neuro-CoViD encompasses different pathologic conditions on a clinical, pathophysiological and prognostic level, which need a timely and accurate diagnosis. Presentation of the case: A 69-year-old woman was admitted 6 days after a diagnosis of SARS-CoV-2 infection with fever, moderate hypoxemic respiratory failure, and altered mental status (disorientation, lethargy, aphasia). No focal neurologic signs or nuchal rigidity were present. Brain MRI was unremarkable. The patient underwent EEG (generalized slowing) and CSF sampling, which showed hyperproteinorrachia (70mg/dl) and pleocytosis (9 cells/μl), with negative Gram staining. A diagnosis of encephalitis was made, and empiric treatment with dexamethasone, remdesivir, acyclovir, ampicillin was started. Screening for HIV and syphilis were negative. The day after the patient presented partial seizure and levetiracetam was added. A negative result was obtained from CSF culture and molecular testing for herpesvirus, Toscana virus, and SARS-CoV-2. The patient experienced gradual improvement in 10 days, obtaining normalization of mental status (Rankin scale 0). Conclusions: The present case adds to several reports of CoViD- 19-related encephalitis. The disease course is variable, with different patterns in neuroimaging and clinical presentation. Testing for SARS-CoV-2 on CSF is often negative, and neuroinflammatory or autoimmune responses could play a major role in brain damage. However, a direct viral CNS invasion cannot be excluded.
ABSTRACT
Background: Inpatients with hospital-acquired (HA) CoViD-19 have mortality rates above 30%. Subjects with early diagnosis of HA-CoViD-19 and risk factors for disease progression are suitable for treatment with anti-SARS-CoV-2 neutralizing monoclonal antibodies (MAB). We assessed the outcome of patients with HACoViD- 19 treated with the casirivimab-imdevimab MAB cocktail. Methods: Retrospective study of patients admitted between October 25, 2020 and April 30, 2021, and diagnosed with early HACoViD- 19 during hospital stay, by PCR on nasopharyngeal swab. The patients who received combination treatment with casirivimab 1200mg and imdevimab 1200mg were compared with patients treated with standard care. Results: Of 34 patients included in the study, 11 (mean age, 73.1;9 males) received MAB treatment. The 23 patients in the standard care group were matched for age, sex and comorbidity index with the MAB treatment group. All MAB-treated patients had at least one risk factor for progression to severe disease, and none required oxygen therapy. The MAB cocktail was infused an average of 48.7 hours after symptom onset. During follow-up, no MABtreated patients required supplemental oxygen for CoViD-19 compared with 14 (60.9%;p 0.0007) untreated patients. There were no deaths at 28 days in the MAB treatment group, compared with 9 (39.1%;p 0.0172) in the standard care group. No serious adverse events related to MAB infusion were recorded. Conclusions: Casirivimab-imdevimab treatment appears safe and might prevent disease progression in high-risk inpatients with early diagnosis of HA-CoViD-19.