Physicians' Distress Related to Moral Issues and Mental Health In-Between Two Late Waves of COVID-19 Contagions.

In addition to the sanitary constrains implemented due to the pandemic, frontline physicians have faced increased workloads with insufficient resources, and the responsibility to make extraordinary clinical decisions. In 108 physicians who were at the forefront of care of patients with COVID-19 during the first two years of the pandemic, mental health, moral distress, and moral injury were assessed twice, in between two late waves of COVID-19 contagions, according to their adverse psychological reactions, in-hospital experience, sick leave due to COVID-19, quality of sleep, moral sensitivity, clinical empathy, resilience, and sense of coherence. Three months after the wave of contagions, the adverse emotional reactions and moral distress decreased, while moral injury persisted. Moral distress was related to clinical empathy, with influence from burnout and sick leave due to COVID-19, and moral injury was related to the sense of coherence, while recovery from moral distress was related to resilience. The results suggest that measures to prevent physician infection, as well as strengthening resilience and a sense of coherence, may be helpful to prevent persistent mental damage after exposure to a sanitary crisis.

[Hematological indices associated with mortality in critically ill patients with COVID-19]. / Índices hematológicos asociados con mortalidad en pacientes críticos con COVID-19.

Background: The COVID-19 disease has represented one of the most important threats to health. The most severe form is acute respiratory distress syndrome (ARDS). The inflammatory response can cause hematologic changes. Objective: To determine the association between the Neutrophil/lymphocyte ratio (NLR) and the mean platelet volume (MPV) associated with mortality in critically ill patients with COVID-19 and ARDS. Material and methods: A retrospective study was carried out in an intensive care unit (ICU) in a public hospital, with patients in critical condition due to COVID-19 and on mechanical ventilation. The clinical characteristics of admission and severity of the disease were recorded. The end point was the ICU discharge condition. Results: 162 subjects were gathered, 103 were men, with a mean age of 54.54 ± 13.53 years. 66.7% died in the ICU. The NLR had an area under the curve (aROC) of 0.62, with a cut-off point for mortality of > 7.04, sensitivity of 94.4%, specificity of 29.63%. The VPM had an aROC of 0.65 with a cut-off point > 9.5, sensitivity of 30.84%, and specificity of 92.59%; finally, the APACHE II had an aROC of 0.67 with a cut-off point > 14, sensitivity of 51.4% and specificity of 80%. The NLR presented an odds ratio (OR) of 5.02, the VPM 2.06 and the APACHE II score 1.16. Conclusions: NLR, MPV, and APACHE II at ICU admission are associated with mortality for critically ill patients with COVID-19.

Introducción: la enfermedad por COVID-19 ha representado una de las amenazas más importantes para la salud. La forma más grave es el síndrome de insuficiencia respiratoria aguda (SIRA). La respuesta inflamatoria puede ocasionar cambios hematológicos. Objetivo: determinar la asociación entre el Índice neutrófilo/linfocito (INL) y el volumen plaquetario medio (VPM) asociado con la mortalidad en pacientes críticos con COVID-19 y SIRA. Material y métodos: se hizo un estudio de corte retrospectivo en una unidad de cuidados intensivos (UCI) de un hospital público, con pacientes en estado crítico por COVID y en ventilación mecánica. Se registraron las características clínicas de ingreso y severidad de la enfermedad. El punto final fue la condición de egreso de la UCI. Resultados: se reunieron 162 sujetos, 103 fueron hombres, con edad promedio de 54.54 ± 13.53 años. El 66.7% murieron en la UCI. El INL tuvo un área bajo la curva (aROC) de 0.62, con un punto de corte para mortalidad > 7.04, sensibilidad del 94.4% y especificidad del 29.63%. El VPM tuvo una aROC de 0.65 con un punto de corte > 9.5, sensibilidad de 30.84% y especificidad de 92.59%; finalmente, el APACHE II tuvo una ROC de 0.67, con un punto de corte > 14, sensibilidad de 51.4% y especificidad de 80%. El INL presentó una razón de momios (RM) de 5.02, el VPM una de 2.06 y el puntaje APACHE II una de 1.16. Conclusiones: el INL, el VPM y el APACHE II al ingreso a la UCI están asociados con la mortalidad para los pacientes críticos con COVID-19.

Risk Factors Associated with Mortality among Patients with COVID-19: Analysis of a Cohort of 1213 Patients in a Tertiary Healthcare Center.

The presence of cardio-metabolic and respiratory comorbidities, immunosuppression, and chronic kidney disease have been associated with an increase in mortality from COVID-19. The objective of this study is to establish the risk factors associated with 30-day mortality in a cohort of hospitalized patients with COVID-19. This paper conducts a retrospective and analytical study of patients hospitalized for COVID-19 in a tertiary care center. A Cox proportional hazard analysis was performed to estimate the association of comorbidities with 30-day mortality. A total of 1215 patients with a median age of 59 years were included. In the adjusted Cox proportional hazards regression model, hypothyroidism, D-dimer ≥ 0.8 µg/mL, LHD ≥ 430 IU/L, CRP ≥ 4.83 ng/mL, and triglycerides ≥ 214 mg/dL were associated with an increased risk of death. The presence of a history of hypothyroidism and biomarkers (D-dimer, lactic dehydrogenase, CRP, and triglycerides) were associated with an increase in mortality in the studied cohort.

Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients.

BACKGROUND: The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. METHODS: An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. RESULTS: A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52-4.17), fever OR 2.98 (95% CI; 2.47-3.58), dyspnea OR 2.9 (95% CI; 2.39-3.51]) and cough OR 2.73 (95% CI: 2.27-3.28). CONCLUSION: The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. TRIAL REGISTRATION: Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082 .

Burnout, depersonalization, and anxiety contribute to post-traumatic stress in frontline health workers at COVID-19 patient care, a follow-up study.

INTRODUCTION: We designed a follow-up study of frontline health workers at COVID-19 patient care, within the same working conditions, to assess the influence of their general characteristics and pre-existing anxiety/depression/dissociative symptoms and resilience on the development of symptoms of post-traumatic stress disorder (PTSD), while monitoring their quality of sleep, depersonalization/derealization symptoms, acute stress, state anxiety, and burnout. METHODS: In a Hospital reconfigured to address the surge of patients with COVID-19, 204 frontline health workers accepted to participate. They completed validated questionnaires to assess mental health: before, during, and after the peak of inpatient admissions. After each evaluation, a psychiatrist reviewed the questionnaires, using the accepted criteria for each instrument. Correlations were assessed using multivariable and multivariate analyses, with a significance level of .05. RESULTS: Compared to men, women reporting pre-existing anxiety were more prone to acute stress; and younger age was related to both pre-existent common psychological symptoms and less resilience. Overall the evaluations, sleep quality was bad on the majority of participants, with an increase during the epidemic crisis, while persistent burnout had influence on state anxiety, acute stress, and symptoms of depersonalization/derealization. PTSD symptoms were related to pre-existent anxiety/depression and dissociative symptoms, as well as to acute stress and acute anxiety, and negatively related to resilience. CONCLUSIONS: Pre-existent anxiety/depression, dissociative symptoms, and coexisting acute anxiety and acute stress contribute to PTSD symptoms. During an infectious outbreak, psychological screening could provide valuable information to prevent or mitigate against adverse psychological reactions by frontline healthcare workers caring for patients.

Acute Stress in Health Workers during Two Consecutive Epidemic Waves of COVID-19.

The COVID-19 pandemic has provoked generalized uncertainty around the world, with health workers experiencing anxiety, depression, burnout, insomnia, and stress. Although the effects of the pandemic on mental health may change as it evolves, the majority of reports have been web-based, cross-sectional studies. We performed a study assessing acute stress in frontline health workers during two consecutive epidemic waves. After screening for trait anxiety/depression and dissociative experiences, we evaluated changes in acute stress, considering resilience, state anxiety, burnout, depersonalization/derealization symptoms, and quality of sleep as cofactors. During the first epidemic wave (April 2020), health workers reported acute stress related to COVID-19, which was related to state anxiety. After the first epidemic wave, acute stress decreased, with no increase during the second epidemic wave (December 2020), and further decreased when vaccination started. During the follow-up (April 2020 to February 2021), the acute stress score was related to bad quality of sleep. However, acute stress, state anxiety, and burnout were all related to trait anxiety/depression, while the resilience score was invariant through time. Overall, the results emphasize the relevance of mental health screening before, during, and after an epidemic wave of infections, in order to enable coping during successive sanitary crises.

Evaluation of predictive value of olfactory dysfunction, as a screening tool for COVID-19.

OBJECTIVES: At the end of 2019, SARS-CoV-2 was identified, the one responsible for the COVID-19 disease. Between a 5.1% and a 98% of COVID-19 patients present some form of alteration in their sense of smell. The objective of this study is to determine the diagnostic yield of the smell dysfunction as screening tool for COVID-19. METHODS: Cross-sectional, observational, and pro-elective study was performed in a tertiary care hospital from May 25th to June 30th, 2020. One hundred and thirty-nine patients were included in the study. Demographic characteristics were collected from anamnesis. A Self-Perception Questionnaire and psychophysical olfactory test (POT) were applied to all participants. The presence of SARS-CoV2, was detected by RT-PCR methods. RESULTS: 51.7% of patients were SARS-CoV-2 positive. A sensitivity of 50% was obtained for the self-perception questionnaire as a screening tool for SARS-CoV2, with a specificity of 80.59%. The positive predictive value (PPV) was of 73.46%, the negative predictive value (NPV) was of 60%. The POT as a screening tool had a PPV of 82.35%, a NPV of 52.45%, a LR+ of 4.34, a LR- 0.84. The combination of anosmia (according to the POT) plus cough and asthenia got an OR of 8.25 for the SARS CoV-2 infection. CONCLUSION: There is a strong association between olfactory dysfunction and COVID-19. However, it is not really efficient in the screening of SARS-CoV-2 infection and thus, they should not be considered as a single diagnostic instrument. LEVEL OF EVIDENCE: 4.

Double-task exercise programmes to strengthen cognitive and vascular health in older adults at risk of cognitive decline: protocol for a randomised clinical trial.

INTRODUCTION: Cognitive and physical declines are frequent causes of disability among older adults (OAs) in Mexico that imposes significant burden on the health system and OAs' families. Programmes to prevent or delay OAs' cognitive and physical decline are scarce. METHODS AND ANALYSIS: A double-blind randomised clinical trial will be conducted. The study will aim to evaluate two 24-week double-task (aerobic and cognitive) square-stepping exercise programmes for OAs at risk of cognitive decline-one programme with and another without caregiver participation-and to compare these with an aerobic-balance-stretching exercise programme (control group). 300 OAs (100 per group) affiliated with the Mexican Institute of Social Security (IMSS) between 60 and 65 years of age with self-reported cognitive concerns will participate. They will be stratified by education level and randomly allocated to the groups. The intervention will last 24 weeks, and the effect of each programme will be evaluated 12, 24 and 52 weeks after the intervention. Participants' demographic and clinical characteristics will be collected at baseline. The outcomes will include: (1) general cognitive function; (2) specific cognitive functions; (3) dual-task gait; (4) blood pressure; (5) carotid intima-media thickness; (6) OAs' health-related quality of life; and (7) caregiver burden. The effects of the interventions on each outcome variable will be examined using a repeated-measures analysis of variance (ANOVA), with study groups as the between-subjects variable and time as the within-subject variable. ETHICS AND DISSEMINATION: The study was approved by the IMSS Ethics and Research Committees (registration number: 2018-785-095). All participants will sign a consent form prior to their participation. The study results will be disseminated to the IMSS authorities, healthcare providers and the research community. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT04068376).