The clinical trial of patients improved from COVID-19: the effectiveness of mindfulness-based cognitive therapy on mental health and life expectancy (single-subject study)

Background & Aims: In early January 2020, a new corona virus called corona was identified as an infectious agent by the World Health Organization and caused a viral pneumonia outbreak, the first of which was reported in Wuhan, China in December 2019. The virus has so far infected most countries in the world and has become a global problem. By this time in December 2021, about 265 million people in the world have been infected with this virus and 5 million 270 thousand people have died from this disease. According to the World Health Organization, the incidence of this disease is still increasing and will become the third leading cause of death in the world by 2030. This disease has a special complexity and has multiple dimensions and consequences that have caused many problems in the field of health, social and economic as well as psychological for people. The emergence of this disease is now a public health crisis. According to this research, exposure to news and restrictions caused by this disease can lead to many mental health problems. In fact, one of the situations that puts a lot of stress on people during the outbreak of covid 19 disease is the inability to predict and uncertainty about the control and end of the disease. Mental health is defined as a harmonious and harmonious behavior with society, recognizing and accepting social realities, the power to adapt to them and meeting one's balanced needs and is an important factor for the health of society. The prevalence of the disease can also increase feelings of loneliness, decrease social support, feelings of fear and anxiety to clinical stress and anxiety, obsessive-compulsive disorder associated with the disease, and decreased life expectancy. One of the hopeful factors is health and the disease can cause despair, fear and even despair of the patient. The outbreak of a disease has a much deeper and wider impact and affects not only the affected community and relatives, but the entire community. Because everyone finds themselves at risk, and therefore people's feel of safe and healthy changes, and this situation causes people to despair. Hope is the capacity to imagine the ability to create paths to desirable goals and to imagine the motivation to move in those paths. Hope predicts physical and mental health such as positive response to medical interventions, mental health, effective getting along, and health-promoting behaviors. Covid 19 disease can also lead to psychological problems due to its infectious nature and unpredictable nature. In this regard, various researchers consider the implementation of public health policies, including areas related to individual and collective mental health in accordance with the different stages of the epidemic of this disease is very necessary. Mindfulness can be an effective tool for achieving peace of mind and body that helps people become aware of their current feelings. Mindfulness-based interventions are considered as one of the third generation or third wave cognitive-behavioral therapies. Mindfulness is a form of meditation rooted in Eastern religious teachings and rituals, especially Buddhism. Segal has defined mindfulness as paying attention to specific and purposeful ways, in the present time, without judgment or prejudice. Linhan stressed for the first time the need to pay attention to mindfulness as one of the essential components of psychological therapy. Mindfulness requires the development of three components: judgment avoidance, purposeful awareness, and focus on the present moment. Focusing on the present and processing all aspects of the above experience makes one aware of the daily activities and automatic functioning of the mind in the past and future world and he controls emotions, thoughts, and physical states through moment-to-moment awareness of thoughts. As a result, it is released from the everyday and automatic mind focused on the past and the future. Although general vaccination has reduced the virus in some countries, including Iran, and reduced the number of infected people, a large num

The Relationship of Cognitive Flexibility and Selfcompassion With Depression and Anxiety Among Healthcare Staff During the COVID-19 Pandemic

Objectives: The COVID-19 outbreak has considerably affected various aspects of our lives and different groups of society. In this regard, healthcare staff is more affected by the pressure of heavy workloads and daily exposure to suspected COVID-19 cases. This study aimed to investigate depression and anxiety as two basic factors of mental health among healthcare workers and the role of self-compassion and cognitive flexibility during the pandemic. Methods: A multi-center cross-sectional study was conducted. Healthcare workers were the target group, and the samples were collected through the online groups from healthcare staff of coronavirus hospitalized centers in Tehran. A convenience sampling method was used in this study. The general anxiety disorder-7 scale, patient health questionnaire, cognitive flexibility inventory, and self-compassion short-form scale were used online for data collection. Totally 551 respondents were entered into the analysis process of the current study. Results: A total of 437 respondents (79.3%) had mild to severe anxiety symptoms, and 447(81.1%) had mild to severe depressive symptoms. Cognitive flexibility had a significant negative relationship with anxiety and depression (r=-0.40, r=-0.37, respectively, P<0.001). Similarly, the relationship between self-compassion and anxiety and depression was significantly negative (r=-0.48, r=-0. 47, respectively, P<0.001). Discussion: This study demonstrates the positive effects of cognitive flexibility and selfcompassion on healthcare staff during COVID-19 © 2023, Iranian Rehabilitation Journal.All Rights Reserved.

Initiating Home Parenteral Nutrition Therapy in a Patient at High Risk of Refeeding Syndrome After COVID-19 Infection

Background: An emerging finding about COVID-19 is its effect on nutrition and weight loss. The COVID-19 symptoms of fatigue, altered taste or smell, and lack of appetite are well known. But COVID-19 may have a more profound effect on clinical nutrition status. Two recent studies have identified that approximately one-third of ambulatory COVID-19 patients are at risk of experiencing weight loss >= 5% (Anker, et al;di Filippo, et al). The case study presented here discusses home start total parenteral nutrition (TPN) in a patient recently diagnosed with COVID-19 at high risk for refeeding syndrome. Method(s): N/A Results: Case Study: A 92-year-old patient was diagnosed with COVID-19 on June 8, 2022. Over the next week, she was hospitalized twice to manage symptoms of acute mental status changes, lethargy, aphasia, hypotension, and loss of appetite. The patient received nirmatrelvir/ritonavir, remdesivir, and bebtelovimab to treat COVID-19 at different times between June 9, 2022, and June 18, 2022. She remained COVID positive and continued to deteriorate clinically. On June 20, 2022, the patient began receiving 24/7 homecare, including intravenous (IV) fluids of dextrose 5% in normal saline (D5NS) 1000 mL daily for three days. She continued to experience loss of appetite and had no bowel movement for 3 days. On June 23, 2022, she was referred to this specialty infusion provider to initiate TPN therapy in the home setting. The patient's BMI was 18.2 kg/m2. Lab results revealed potassium 3.0 mmol/L, phosphate 1.6 mg/dL, and magnesium 1.6 mg/dL. High risk of refeeding syndrome was identified by the level of hypophosphatemia and hypokalemia. The specialty infusion provider's registered dietitian recommended to discontinue D5NS and begin NS with added potassium, phosphate, and magnesium. Thiamine 200mg daily was added to prevent Wernicke's encephalopathy. The patient's clinical status and lab values were monitored closely each day until her electrolyte levels stabilized (Table 1). Home TPN therapy was initiated on June 28, 2022, with <10% dextrose and 50% calorie requirement with 85% protein and 1.0 g/kg lipids. Three-day calorie count and nutrition education were performed four days post TPN initiation. Oral intake met only 25% of estimated needs. Over several days, theTPN formula was gradually increased to goal calories and the infusion cycle was slowly decreased. The following week, the patient's oral intake improved to 60%-75% of estimated needs. Her constipation resolved, and she showed improvement in functional status and mobility. Her appetite drastically improved when the TPN was cycled. Another three-day calorie count was performed when TPN calories reached goals. Oral intake demonstrated 100% estimated calorie and protein needs. TPN therapy was ultimately discontinued on July 14, 2022. As of September 30, 2022, the patient has stabilized at her pre-COVID weight of 45 kg with full recovery of appetite, function, and cognition. Discussion(s): The ASPEN Consensus Recommendations for Refeeding Syndrome (da Silva, et al) describe the repletion of electrolyte levels before introducing calories to prevent end-organ damage associated with refeeding syndrome (respiratory muscle dysfunction, decreased cardiac contractility, cardiac arrhythmias, and encephalopathy). Conclusion(s): This case study highlights the successful initiation of home TPN therapy in a patient at high risk of refeeding syndrome post COVID-19 infection. Although home start TPN and the risk of refeeding syndrome are not new concepts, they must be considered in the setting of COVID-19. Given the effects COVID-19 has on taste, smell, and appetite and the recent finding that one-third of patients with COVID infection may experience weight loss of >= 5%, nutrition support and patient education are vital components of overall patient care. (Figure Presented).

Cardiometabolic and psychocognitive features of the post-COVID period in patients with atrial fibrillation

The number of people with long-term consequences of COVID-19 is increasing worldwide. The long-term prognosis for patients remains poorly understood. Objective. To study cardiometabolic and psychocognitive features in comorbid elderly patients with atrial fibrillation (AF), de-pending on the presence of post-COVID syndrome (PCS). Material and methods. The observational analytical cohort study included 223 patients with AF and comorbidity (coronary artery disease, hypertension, obesity, type 2 diabetes mellitus) aged 60-74, who were divided into two groups: group 1 included 123 patients without COVID-19 and group 2 included 110 patients with a history of COVID-19 and the presence of PCS. The study evaluated laboratory and instrumental tests, and a general clinical study assessing psychocognitive disorders using the SPMSQ and HADS questionnaires was conducted. Results and discussion. In COVID-19 survivors, compared with patients of group 1, there were more pronounced atherogenic changes in total cholesterol (TC) (p=0.003), low-density lipoprotein cholesterol (p<0.001), and triglycerides (p=0.011). Lower dia-stolic blood pressure was found in COVID-19 survivors (p<0.001). In addition, patients in group 2 had higher median pulse pressure (p<0.001) and heart rate (p<0.001). In group 2 patients, a larger ascending aorta diameter was observed (p<0.001). The anx-iety-depressive syndrome was more common in COVID-19 survivors with comorbidities, and a statistically significant difference was found in clinical anxiety (24%, p=0.041) and subclinical depression (21%, p=0.015). When assessing cognitive function, mod-erate cognitive impairment was detected in 22% (p=0.005) of patients with PCS and severe cognitive impairment in 2% (p=0.007). Conclusion. In comorbid elderly patients with the post-COVID syndrome, a high prevalence of psychocognitive disorders and adverse cardiometabolic changes were observed, supporting the need for long-term monitoring of the general clinical condition and psychocognitive status of COVID-19 survivors.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Post-COVID syndrome in psychiatric practice

The novel coronavirus SARS-CoV-2 is associated with a significant incidence of neuropsychiatric disorders, which tend to have a long course in the post-COVID period. Objective(s): to study post-COVID mental disorders in clinical psychiatric practice. Patients and methods. 30 patients aged 37.75+/-14.07 years with anamnesis of SARS-CoV-2 infection were examined. Clinical scale assessment was carried out using the Hamilton Depression and Anxiety Scale. The Symptom-Checklist (SCL-90-R) was used to assess the psychopathological status of the patient. Patients' cognitive functioning was assessed using the Mini-Cog Cognitive Assessment Questionnaire. Patients' sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Results and discussion. Mental disorders associated with a previous coronavirus infection are observed in a wide time range from less than 1 month to a year after the previous disease, and in no case did the coronavirus infection have a severe course. Sleep disorders, anxiety and depressive disorders, which did not exceed a moderate degree of severity, and asthenia dominated in the structure of the post-COVID syndrome. The level of mental distress in patients with post-COVID syndrome increased 2 times. Post-COVID mental disorders are interrelated with female gender, age, and psychotraumatic factors associated with the pandemic. Cognitive impairment mediated by mental disorders was observed in approximately 60% of patients and did not reach the degree of dementia. Conclusion. The clinical picture of the post-COVID syndrome is represented by a wide range of mental disorders, the development of which involves not only biological, but also psychosocial factors associated with the COVID-19 pandemic, which determines the specifics of diagnostic approaches and the feasibility of complex treatment of the post-COVID syndrome.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

Assessing COVID-19 and Other Pandemics and Epidemics using Computational Modelling and Data Analysis

This book comprehensively covers the topic of COVID-19 and other pandemics and epidemics data analytics using computational modelling. Biomedical and Health Informatics is an emerging field of research at the intersection of information science, computer science, and health care. The new era of pandemics and epidemics bring tremendous opportunities and challenges due to the plentiful and easily available medical data allowing for further analysis. The aim of pandemics and epidemics research is to ensure high-quality, efficient healthcare, better treatment and quality of life by efficiently analyzing the abundant medical, and healthcare data including patient's data, electronic health records (EHRs) and lifestyle. In the past, it was a common requirement to have domain experts for developing models for biomedical or healthcare. However, recent advances in representation learning algorithms allow us to automatically learn the pattern and representation of the given data for the development of such models. Medical Image Mining, a novel research area (due to its large amount of medical images) are increasingly generated and stored digitally. These images are mainly in the form of: computed tomography (CT), X-ray, nuclear medicine imaging (PET, SPECT), magnetic resonance imaging (MRI) and ultrasound. Patients' biomedical images can be digitized using data mining techniques and may help in answering several important and critical questions related to health care. Image mining in medicine can help to uncover new relationships between data and reveal new and useful information that can be helpful for scientists and biomedical practitioners. Assessing COVID-19 and Other Pandemics and Epidemics using Computational Modelling and Data Analysis will play a vital role in improving human life in response to pandemics and epidemics. The state-of-the-art approaches for data mining-based medical and health related applications will be of great value to researchers and practitioners working in biomedical, health informatics, and artificial intelligence. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Alzheimer's disease and COVID-19

In elderly patients with COVID-19 cognitive functions decline;it has been suggested that SARS-CoV-2 infection may lead to the development of Alzheimer's disease (AD) and other long-term neurological consequences. We review several parallels between AD and COVID-19 in terms of pathogenetic mechanisms and risk factors. Possible mechanisms through which COVID-19 can initiate AD are discussed. These include systemic inflammation, hyperactivation of the renin-angiotensin system, innate immune activation, oxidative stress, and direct viral damage. It has been shown that increased expression of angiotensin-renin receptors (ACE2) may be a risk factor for COVID-19 in patients with AD. When entering the central nervous system, the SARS-CoV-2 virus can directly activate glial cell-mediated immune responses, which in turn can lead to the accumulation of beta-amyloid and the subsequent onset or progression of current AD. The involvement of inflammatory biomarkers, including interleukins (IL): IL6, IL1, as well as galectin-3, as a link between COVID-19 and AD is discussed. The rationale for the use of memantine (akatinol memantine) in patients with COVID-19 in order to prevent the development of cognitive deficits is discussed. Memantine has been shown to have a positive effect on neuroinflammatory processes in the onset or exacerbation of cognitive deficits, in reducing cerebral vasospasm and endothelial dysfunction in viral infections. Memantine therapy may improve everyday activity and reduce the risk of severe SARS-CoV-2 infection.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

Meaning in challenging times: Sense of meaning supports wellbeing despite pandemic stresses

The COVID-19 pandemic created stress and trauma for many individuals. Traumatic experiences often trigger reflection on meaning in life, with subsequent growth or despair. This study evaluates the role of meaning in life in buffering stressors in the early stages of the COVID-19 pandemic. The purpose of this study was to determine the extent to which the negative effects of COVID-19 stressors (self-perceived stress, emotional state, and cognitive adaptation to stress in the pandemic) are influenced by meaning in life in the context of the early stages of the pandemic. Further, this study described differences in meaning in life observed across demographic groups. Web-based surveys were completed by 831 Slovenian participants in April of 2020. Demographic data;perceptions of stressors related to lacking necessities, movement restrictions, and concerns at home;meaning in life;perceived overall health status;anxiety;emotional state;and perceived stress were measured. A moderately strong sense of meaning in life (M = 5.0, SD = 0.74, range 1–7) was reported by participants, and meaning in life was associated with enhanced wellbeing (B = 0.06-.28, p < .01). Both direct and indirect relationships were observed between stressors and wellbeing outcomes. The indirect effects of meaning in life were especially prominent in the relationship between stressors related to lacking necessities and concerns at home and outcomes of anxiety, perceived stress, and negative emotions, contributing 13–27% of the total observed effects. Increased meaning in life was observed across older age groups (F(5, 825) = 4.8, p < .001) and for those in partnered relationships (t(829) = -3.397, p <.001). A strong sense of meaning in life was associated with improved well-being, even for individuals who experienced pandemic-related stressors. Public health initiatives and media may help improve resilience to pandemic trauma by emphasizing the collective meaning in challenging situations.

Inflammatory and mental health sequelae of COVID-19.

The COVID-19 pandemic has caused significant negative consequences to mental health. Increased inflammatory factors and neuropsychiatric symptoms, such as cognitive impairment ("brain fog"), depression, and anxiety are associated with long COVID [post-acute sequelae of SARS-CoV-2 infection (PASC), termed neuro-PASC]. The present study sought to examine the role of inflammatory factors as predictors of neuropsychiatric symptom severity in the context of COVID-19. Adults (n = 52) who tested negative or positive for COVID-19 were asked to complete self-report questionnaires and to provide blood samples for multiplex immunoassays. Participants who tested negative for COVID-19 were assessed at baseline and at a follow-up study visit (∼4 weeks later). Individuals without COVID-19 reported significantly lower PHQ-4 scores at the follow-up visit, as compared to baseline (p = 0.03; 95% CI-1.67 to -0.084). Individuals who tested positive for COVID-19 and experienced neuro-PASC had PHQ-4 scores in the moderate range. The majority of people with neuro-PASC reported experiencing brain fog (70% vs. 30%). Those with more severe COVID-19 had significantly higher PHQ-4 scores, as compared to those with mild disease (p = 0.008; 95% CI 1.32 to 7.97). Changes in neuropsychiatric symptom severity were accompanied by alterations in immune factors, particularly monokine induced by gamma interferon (IFN-γ) (MIG, a. k.a. CXCL9). These findings add to the growing evidence supporting the usefulness of circulating MIG levels as a biomarker reflecting IFN-γ production, which is important because individuals with neuro-PASC have elevated IFN-γ responses to internal SARS-CoV-2 proteins.

Social emotional processes during the third wave of COVID-19: Results from a close replication study in a Turkish sample.

Until recently, for almost 3 years, we used face masks to protect against COVID-19. Face masks disrupted our perception of socially relevant information, and impacted our social judgements as a result of the new social norms around wearing masks imposed by the pandemic. To shed light on such pandemic-induced changes in social emotional processes, Calbi et al. analysed data from an Italian sample collected in Spring 2020. They assessed valence, social distance and physical distance ratings for neutral, happy and angry male and female faces covered with a scarf or a mask. A year later, we used the same stimuli to investigate the same measures in a Turkish sample. We found that females attributed more negative valence ratings than males to angry faces, and that angry and neutral faces of females were rated more negatively than those of males. Scarf stimuli were evaluated more negatively in terms of valence. Participants attributed greater distance to more negative faces (angry > neutral > happy) and to scarf than the mask stimuli. Also, females attributed greater social and physical distance than males. These results may be explained by gender-stereotypic socialisation processes, and changes in people's perception of health behaviours during the pandemic.