A prospective cohort study on cognitive and psychological outcomes in COVID-19 ICU survivors at 3 months of follow up.

Objective: The Outcomes - Short and Long term in ICU patient with COVID-19 "OUTSTRIP COVID-19" study was initiated to assess overall mortality, physical and psychiatric co-morbidities, reduction in lung function, and the ability to return to work post-ICU discharge with a follow-up period of 2 years in COVID-19 patients admitted to ICUs in Qatar. This paper focuses on the prevalence of cognitive impairment, depression, anxiety, and stress at baseline and 3 months after ICU discharge. Methods: This prospective cohort study included 100 ICU survivors reviewed at baseline within 7 weeks of ICU discharge, with a 3-month follow-up. Demographics, clinical characteristics, and relevant medical history were collected at baseline. Cognitive outcomes were assessed using the Montreal Cognitive Assessment-Basic (MoCA-B) tool, while psychological outcomes were evaluated using the Depression Anxiety and Stress Scale-21 (DASS-21). Results: At baseline, 72% of ICU survivors exhibited mild cognitive impairment, which significantly improved to 56% at 3 months. However, severe cognitive impairment persisted in 20% of survivors at 3 months.For psychological outcomes, the mean depression score remained below 9 (5.64 ± 6.90) at both time points, with no significant change. At baseline, 25% of survivors had clinical depression, which reduced to 16% at 3 months.The mean anxiety score at baseline (9.35 ± 8.50) significantly decreased to 6.51 ± 7.74 (p = 0.002) at 3 months. Anxiety was not reported by 48% of survivors at baseline and this increased to 66% at 3 months. Severe to extremely severe anxiety decreased from 19% to 12% during the same period.The mean stress score at baseline (8.34 ± 8.07) did not significantly change at 3 months. At baseline, 18% experienced stress, which decreased to 12% at 3 months, with 5.3% facing severe to extremely severe stress. Conclusion: COVID-19 ICU survivors experience significant cognitive impairment, anxiety, and stress. While cognitive impairment and anxiety showed improvements at 3 months, depression and stress remained unchanged. These outcomes strongly emphasize the requirement for thorough post-ICU care and comprehensive mental health assistance for individuals recovering from COVID-19. Customized interventions and additional research endeavors are crucial to effectively manage the cognitive and psychological consequences faced by these patients. The exploration of telemonitoring and innovative approaches can offer avenues to enhance the overall quality of life for survivors. Further investigation should encompass extended timeframes to analyze prolonged effects and consider the broader socioeconomic impact.

A Prospective Cohort Study (OUTSTRIP-COVID) on Functional and Spirometry Outcomes in COVID-19 ICU Survivors at 3 Months.

Purpose: COVID-19 pandemic resulted in a significant number of critical care admissions secondary to severe pneumonia and acute respiratory distress syndrome. We evaluated the short-, medium- and long-term outcomes of lung function and quality of life in this prospective cohort study and reported the outcomes at 7 weeks and 3 months from discharge from intensive care unit. Methods: A prospective cohort study of ICU survivors with COVID-19 was conducted from August 2020 to May 2021 to evaluate baseline demographic and clinical variables as well as determine lung function, exercise capacity, and health-related quality of life (HRQOL) using spirometry and 6-minute walk test (6MWT) conducted in accordance with American Thoracic Society standards, and SF-36 (Rand), respectively. SF-36 is a generic 36 question standardized health survey. Descriptive and inferential statistics (alpha = 0.05) were used to analyse the data. Results: At baseline, 100 participants were enrolled in the study of whom 76 followed up at 3 months. Majority of the patients were male (83%), Asians (84%) and less than 60 years of age (91%). HRQOL showed significant improvement in all domains of SF-36, except in emotional wellbeing. Spirometry variables also showed significant improvement in all variables over time with greatest improvement in percentage predicted Forced expiratory volume 1 (79% vs 88% p < 0.001). 6MWT showed significant improvement in variables of walk distance, dyspnea, and fatigue with greatest improvement in change in oxygen saturation (3% vs 1.44% p < 0.001). Intubation status did not impact the changes in SF-36, spirometry or 6MWT variables. Conclusion: Our findings suggest that ICU survivors of COVID-19 have significant improvement in their lung function, exercise capacity and HRQOL within 3 months of ICU discharge regardless of intubation status.

Epidemiological and outcome analysis of COVID-19-associated pneumothorax: multicentre retrospective critical care experience from Qatar.

OBJECTIVES: To study the incidence, characteristics, treatment, associated risk factors and outcome of COVID-19-associated pneumothorax in intensive care unit (ICU). DESIGN: Retrospective observational data review. SETTING: A multicentre study from ICUs of three tertiary care hospitals in Qatar. PARTICIPANTS: 1788 patients with COVID-19 pneumonia requiring ICU admission from 1 March 2020 to 1 November 2020 were enrolled in this study. INTERVENTIONS: Not applicable. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint was to identify the incidence of COVID-19-associated pneumothorax in patients requiring ICU admission. Secondary endpoints were to determine the associated risk factors, treatment, mortality and morbidity. RESULTS: 1788 patients from 3 centres were reviewed in the study. The total episodes of pneumothorax were 75. Pneumothorax occurred in 4.2% of the patients with COVID-19 pneumonia requiring ICU admission. The majority of the subjects were male (n=72, 96%). The mean age was 55.1 (±12.7 years). The majority of the subjects were nationals of South Asian countries and the Middle East and North Africa regions. 52% (n=39) of the patients were previously healthy without comorbidities before ICU admission. The recurrence rate was 9.3%. The median length of ICU stay was 28 days (20.5-45.8 days). After developing pneumothorax, the length of mechanical ventilation ranged from 6 to 32 days, with a median of 13 days. 44% of patients eventually ended up with tracheostomy. In-hospital mortality in the patients with COVID-19-related pneumothorax was 53.3% (n=40). The odds of mortality in patients with COVID-19 pneumonia with pneumothorax is 7.15 (95% CI 4.45 to 11.48, p<0.0001) compared with those who did not develop pneumothorax. This indicates pneumothorax is a potential independent risk factor associated with mortality in patients with COVID-19 pneumonia requiring ICU admission. CONCLUSIONS: Pneumothorax is a common complication in patients with COVID-19 requiring ICU admission, associated with poor prognosis and outcome. TRIAL REGISTRATION NUMBER: The study was approved by the Medical Research Centre (MRC) Qatar. (MRC-01-20-1116).

Autoimmune hemolytic anemia associated with vitamin B12 deficiency and viral illness in DiGeorge syndrome. Case report and literature review.

Vitamin B12 plays a crucial role in cell maturation and differentiation. Its deficiency can lead to cytopenias and even hemolysis. We suggest regular monitoring and maintenance of Vit B12 levels in DiGeorge syndrome patients to prevent such triggers.

SGLT-2 inhibitors associated euglycemic and hyperglycemic DKA in a multicentric cohort.

Euglycemic diabetic ketoacidosis (EuDKA) secondary to Sodium-glucose co-transporter-2 inhibitors (SGLT2i) in type 2 diabetes mellitus (T2D) is a rare but increasingly reported phenomenon. Not much is known about the burden of EuDKA in patients on SGLT2i or the associated factors. This retrospective cohort study tries to delineate the differences in factors associated with the development of EuDKA as compared to hyperglycemic DKA. We conducted a multicentre, retrospective study across three tertiary care centers under Weill Cornell affiliated-Hamad Medical Corporation, Qatar. The cohort comprised of T2D patients on SGLT2i who developed DKA between January 2015 to December 2020. The differences between the subjects who developed EuDKA or hyperglycaemic DKA (hDKA) were analyzed. A total of 9940 T2D patients were on SGLT2i during 2015-2020, out of which 43 developed DKA (0.43%). 25 developed EuKDA, whereas 18 had hDKA. The point prevalence of EuDKA in our cohort was 58.1%. EuDKA was most common in patients using canagliflozin, followed by empagliflozin and Dapagliflozin (100%, 77%, and 48.3%, respectively). Overall, infection (32.6%) was the most common trigger for DKA, followed by insulin non-compliance (13.7%). Infection was the only risk factor with a significant point estimate between the two groups, being more common in hDKA patients (p-value 0.006, RR 2.53, 95% CI 1.07-5.98). Canagliflozin had the strongest association with the development of EuDKA and was associated with the highest medical intensive care unit (MICU) admission rates (66.6%). In T2D patients on SGLT2i, infection is probably associated with an increased risk of developing EuDKA. The differential role of individual SGLT2i analogs is less clear and will need exploration by more extensive prospective studies.

Cystic poorly differentiated squamous cell carcinoma of the scalp, a rare scalp tumor: Case report and literature review.

INTRODUCTION: Cutaneous cystic lesions have broad differentials ranging from common benign entity to rare malignant lesions. Clinical evaluation of the lesion is the key to differentiation, as some rare malignant entities may simulate benign lesions. A high index of suspicion should be maintained for any aggressive behavior, which may require more thorough evaluation, including histopathology and radiographic imaging studies. We report a rare case of cystic poorly differentiated squamous cell carcinoma (CPDSCC) of the scalp. CASE PRESENTATION: We report a case of a 37-year-old Filipino expatriate male who presented with a scalp swelling which had been gradually increasing in size for four months and was operated upon with a working diagnosis of sebaceous cyst. On post-op excisional biopsy, it turned out to be poorly differentiated cystic squamous cell carcinoma of the scalp. On further workup, no metastasis or other primary was found. Complete re-excision of the lesion with no evidence of residual tumor was achieved. Long-term follow-up was lost, as the patient left for his native country. CONCLUSION: Though cystic cutaneous lesions are very commonly encountered in clinical practice, high suspicion for malignancy should be maintained if the lesion shows any aggressive behavior. Prompt investigation should be done before surgery to determine the nature of the disease and the most effective management for the patient. Poorly differentiated cystic squamous cell carcinoma should also be considered in the differential diagnosis of cystic cutaneous lesions show aggressive behavior.