Characteristics of patients with panic disorder attended in primary care during the COVID-19 pandemic: A cross-sectional multicenter study / Características de los pacientes con trastorno de pánico atendidos en atención primaria durante la pandemia por COVID-19: un estudio transversal multicéntrico

Objective: To assess the prevalence of panic disorder during the second and third waves of the COVID-19 pandemic. Design: Cross-sectional multicenter study. Setting: Primary care. Participants: Participating primary care physicians selected patients visiting their primary care centers for any reason over a 16-month period. Main outcome measure: Diagnosis of panic disorder was established using The Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument. Results: Of a total of 678 patients who met the inclusion criteria, 36 presented with panic disorder, with a prevalence of 5.3% (95% confidence interval 3.6–7.0). A total of 63.9% of cases occurred in women. The mean age was 46.7±17.1 years. Socioeconomic difficulties, such as very low monthly income rate, unemployment, and financial constraints to make housing payments and to make ends meet were more frequent in patients with panic disorders as compared to patients without panic disorder. A high level of stress (Holmes–Rahe scale>300), concomitant chronic fatigue syndrome and irritable bowel disease, and having financial difficulties in the past 6 months were associated with factors of panic disorder. Discussion: This study characterizes patients with panic disorder diagnosed with a validated instrument during the COVID-19 pandemic and identified risk factors for this disease. Conclusions: In non-selected consecutive primary care attendees in real-world conditions during the COVID-19 pandemic, the prevalence of panic disorder was 5.3%, being more frequent in women. There is a need to enhance primary care resources for mental health care during the duration of the pandemic and beyond.(AU)

Objetivo: Evaluar la prevalencia del trastorno de pánico durante la segunda y tercera olas de la pandemia por COVID-19. Diseño: Estudio transversal multicéntrico. Emplazamiento: Atención primaria. Participantes: Los médicos participantes seleccionaron a pacientes atendidos en atención primaria por cualquier motivo durante 16 meses. Medición principal: Trastorno de pánico diagnosticado usando el cuestionario Primary Care Evaluation Mental Disorders (PRIME-MD).Resultados: De un total de 678 pacientes elegibles, 36 presentaban un trastorno de pánico, con una prevalencia del 5,3% (intervalo de confianza del 95% 3,6-7,0). Un 63,9% de los casos se presentaron en mujeres. La edad media fue de 46,7±17,1 años. Las dificultades socioeconómicas, como bajos ingresos mensuales, falta de empleo y restricciones económicas para pagos de la vivienda y llegar a final de mes eran más frecuentes en los pacientes con trastorno de pánico que en aquellos sin. Los factores asociados al trastorno de pánico fueron un alto nivel de estrés (escala de Holmes-Rahe > 300), síndrome de fatiga crónica concomitante e intestino irritable y dificultades económicas en los últimos 6 meses. Discusión: Este estudio caracteriza a los pacientes con trastorno de pánico diagnosticados mediante un instrumento validado durante la pandemia por COVID-19 e identifica los factores de riesgo. Conclusiones: En pacientes consecutivos no seleccionado en condiciones del mundo real durante la pandemia por COVID-19, la prevalencia del trastorno de pánico fue del 5,3%, siendo más frecuente en mujeres. Es necesario aumentar los recursos para la salud mental durante y más allá de la duración de la pandemia.(AU)

Infección por COVID-19 en el parto y tasas de lactancia materna exclusiva en una maternidad IHAN / COVID-19 infection in childbirth and exclusive breastfeeding rates in a BFHI maternity

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Fetal heart rate changes on the cardiotocograph trace secondary to maternal COVID-19 infection.

OBJECTIVE: To determine the cardiotocograph (CTG) changes in women with symptomatic COVID-19 infection. STUDY DESIGN: 12 anonymised CTG traces from 2 hospitals in Spain were retrospectively analysed by 2 independent assessors. CTG parameters were studied based on fetal pathophysiological responses to inflammation and hypoxia that would be expected based on the pathogenesis of COVID-19 patients. Correlation was made with perinatal outcomes (Apgar score at 5 min and umbilical cord pH). RESULTS: All fetuses showed an increased baseline FHR > 10 percent compared to the initial recording, in addition to absence of accelerations. 10 out of 12 CTG traces (83.3 percent) demonstrated late or prolonged decelerations and 7 out of 12 fetuses (58.3 percent) showed absence of cycling. Not a single case of sinusoidal pattern was observed. ZigZag pattern was found in 4 CTG traces (33 percent). Excessive uterine activity was observed in all CTG traces where uterine activity was monitored (10 out of 12). Apgar scores at 5 min were normal (>7) and absence of metabolic acidosis was found in the umbilical cord arterial pH (pH > 7.0) in the cases that were available (11 and 9, respectively). CONCLUSION: Fetuses of COVID-19 patients showed a raised baseline FHR (>10 percent), loss of accelerations, late decelerations, ZigZag pattern and absence of cycling probably due to the effects of maternal pyrexia, maternal inflammatory response and the "cytokine storm". However, the perinatal outcomes appear to be favourable. Therefore, healthcare providers should optimise the maternal environment first to rectify the reactive CTG changes instead of performing an urgent operative intervention.

Perinatal-Neonatal Management of COVID-19 Infection: guidelines of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), National Neonatology Forum of India (NNF), and Indian Academy of Pediatrics (IAP)

During the current rapidly evolving pandemic of COVID-19 infection, pregnant women with suspected or confirmed COVID-19 and their newborn infants form a special vulnerable group that needs immediate attention. Unlike other elective medical and surgical problems for which care can be deferred during the pandemic, pregnancies and childbirths continue. Perinatal period poses unique challenges and care of the mother-baby dyads requires special resources for prevention of transmission, diagnosis of infection and providing clinical care during labor, resuscitation and postnatal period. Process: The GRADE approach recommended by the World Health Organization was used to develop the guideline. A Guideline Development Group (GDG) comprising of obstetricians, neonatologists and pediatricians was constituted. The GDG drafted a list of questions which are likely to be faced by clinicians involved in obstetric and neonatal care. An e-survey was carried out amongst a wider group of clinicians to invite more questions and prioritize. Literature search was carried out in PubMed and websites of relevant international and national professional organizations. Existing guidelines, systematic reviews, clinical trials, narrative reviews and other descriptive reports were reviewed. For the practicequestions, the evidence was extracted into evidence profiles. The context, resources required, values and preferences were considered for developing the recommendations. Objectives: To provide recommendations for prevention of transmission, diagnosis of infection and providing clinical care during labor, resuscitation and postnatal period. Recommendations: A set of twenty recommendations are provided under the following broad headings: 1) pregnant women with travel history, clinical suspicion or confirmed COVID-19 infection; 2) neonatal care; 3) prevention and infection control; 4) diagnosis; 5) general questions.

Detection and classification of infectious bronchitis viruses isolated in Korea by dot-immunoblotting assay using monoclonal antibodies.

Dot-immunoblotting assay (DIA) using five monoclonal antibodies (MAbs) to infectious bronchitis virus (IBV) was used to detect and classify the viruses propagated in embryonated chicken eggs. Using a group-specific MAb 3F5, 10 reference strains and 12 Korean isolates of IBV were successfully detected by DIA, and the lowest virus titer of IBV detected by DIA was approximately less than 10(3.8) mean embryo infective dose/ml. For evaluating the diagnostic efficiency, DIA was compared with the conventional infectious bronchitis (IB) diagnostic method. IBV antigens in allantoic fluid from embryonated eggs inoculated with IB-suspected field samples were specifically detected by DIA within only one or two egg passages, whereas the conventional embryonated egg inoculation method required four to seven egg passages for confirming IBV infection. These results indicated that DIA could significantly reduce time and cost for IB diagnosis. For examining the possibility of classifying IBV by DIA, four strain-specific MAbs, 3A4, 2A3, 6F7, and 2C6, were used. According to the MAb reacting patterns to the IBV antigens, the 10 IBV reference strains were classified into six groups; seven strains belonged to three different groups, and the other three strains each belonged to an individual group. In the case of 12 Korean isolates of IBV, they were classified in six groups. Among the six groups, the MAb reacting patterns of three groups matched those of the IBV reference strains, but the others did not. These data suggest that at least three variant serotypes of IBV exist in Korea.