Psychological impact of COVID-19 lockdown on a population with serious mental illness. A prospective cohort study.

Introduction: COVID-19 has spread worldwide since its appearance at the end of 2019. In Spain, 99-day long home confinement was set from March 15th 2020. Previous studies about events requiring situations of isolation suggested that mental health problems may occur among the general population and, more specifically, vulnerable groups such as individuals with serious mental illness (SMI). This study aims to assess the psychological effect of confinement in patients with mental illness admitted to an inpatient psychiatric unit. Method: In this longitudinal study, IDER (State-Trait Depression Inventory) and STAI (State-Trait Anxiety Inventory) questionnaires were used at two different times (at the beginning and after the lockdown) of the pandemic to evaluate the depression and anxiety symptoms, respectively, in a population of patients who had been previously admitted to the Psychiatry Unit of the Basurto University Hospital. Results: 95 participants completed the IDER questionnaire in the first measurement, with a mean score of 24.56 (SD = 8.18) for state and 23.57 (SD = 8.14) for trait. In the case of STAI, the mean score was 27.86 (SD = 15.19) for the state and 30.49 (SD = 14.71) for the trait. No differences between the first and the second time were found in anxiety and depression levels. People with personality disorders presented high levels of anxiety. Conclusions: Individuals with a personality disorder showed the highest scores in anxiety and depression. Nevertheless, strict confinement did not affect this population, despite the literature that evidences that the pandemic has worsened people's mental health with SMI.

Introducción: El COVID-19 se ha extendido ampliamente desde su aparición a finales del año 2019. En España se estableció un confinamiento domiciliario que comenzó el 15 de marzo de 2020 y tuvo una duración de 99 días. Estudios previos sobre situaciones que implican aislamiento indican un empeoramiento en la salud mental de la población general, y específicamente en personas con un trastorno mental grave. El objetivo de este estudio es evaluar el efecto psicológico del confinamiento en pacientes con trastorno mental grave. Método: Se emplearon los cuestionarios IDER (State-Trait Depression Inventory) y STAI (State-Trait Anxiety Inventory) al inicio del confinamiento y después del mismo, para evaluar síntomas de depresión y ansiedad, respectivamente, en una población de pacientes que habían precisado previamente un ingreso hospitalario en la unidad de hospitalización psiquiátrica en el Hospital universitario de Basurto. Resultados: En la primera evaluación, 95 participantes completaron el cuestionario IDER, obteniendo una puntuación media de 24,56 (DE = 8,18) para el estado y 23,57 (DE = 8,14) para el rasgo. En el cuestionario STAI se obtuvo una puntuación media de 27,86 (DE = 15,19) para el estado y de 30,49 (DE = 14,71) para el rasgo. No se hallaron diferencias entre los niveles de ansiedad y depresión de las 2 evaluaciones. Los individuos con trastorno de la personalidad presentaron altos niveles de ansiedad. Conclusiones: Los individuos con trastorno de la personalidad obtuvieron los resultados más altos en ansiedad y depresión. El confinamiento estricto no afectó a esta población, a pesar de la evidencia existente sobre un empeoramiento en la salud mental en pacientes con trastorno mental grave durante la pandemia.

COVID-19 pandemic effects on health worker's mental health: Systematic review and meta-analysis.

BACKGROUND: Healthcare workers (HCWs) exposed to coronavirus 19 (COVID-19) are at high risk of developing mental health concerns across several domains. The aim of this study is to determine the updated, global frequency of these outcomes. METHODS: A multistep literature search was performed from database inception until March 1, 2021. PRISMA/MOOSE-compliant systematic review and PROSPERO protocol were used to identify studies reporting on depression, anxiety, acute stress, post-traumatic symptoms, insomnia, and burnout in HCWs exposed to COVID-19. A quantitative meta-analysis with random effects was conducted to analyze the proportion rate of the mental health disorders. Sensitivity analyses were performed to investigate the effect of the different continents and scales. Meta-regression analyses were conducted to examine the effect of gender, age, and work position. RESULTS: 239 articles were included (n = 271,319 HCWs, mean age = 36.08 ± 8.33 (66.99% female). 33% HCWs exposed to COVID-19 reported depressive symptoms (95% confidence intervals [CI] = 28-38%), 42% anxiety features (95% CI = 35-48), 40% acute stress (95% CI = 32-47), 32% post-traumatic symptoms (95% CI = 26-37%), 42% insomnia (95% CI = 36-48), 37% burnout (95% CI = 31-42). Sensitivity analyses did not show statistically significant differences. Meta-regressions found a statistically significant lower prevalence of post-traumatic symptoms in Asia. CONCLUSIONS: HCWs exposed to COVID-19 were found to have a significant prevalence of mental health concerns in all domains analyzed. The effects of COVID-19 on HCWs' mental health could be underestimated and the future consequences dismissed.

Proportion and predictors of remission and recovery in first-episode psychosis: Systematic review and meta-analysis.

BACKGROUND: To determine the proportion of patients in symptomatic remission and recovery following a first-episode of psychosis (FEP). METHODS: A multistep literature search using the Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO, and trial registries from database inception to November 5, 2020, was performed. Cohort studies and randomized control trials (RCT) investigating the proportion of remission and recovery following a FEP were included. Two independent researchers searched, following PRISMA and MOOSE guidelines and using a PROSPERO protocol. We performed meta-analyses regarding the proportion of remission/recovery (symptomatic plus functional outcomes). Heterogeneity was measured employing Q statistics and I2 test. To identify potential predictors, meta-regression analyses were conducted, as well as qualitative reporting of studies included in a systematic review. Sensitivity analyses were performed regarding different times of follow-up and type of studies. RESULTS: One hundred articles (82 cohorts and 18 RCTs) were included in the meta-analysis. The pooled proportion of symptomatic remission was 54% (95%CI [30, 49-58]) over a mean follow-up period of 43.57 months (SD = 51.82) in 76 studies. After excluding RCT from the sample, the proportion of remission remained similar (55%). The pooled proportion of recovery was 32% (95%CI [27-36]) over a mean follow-up period of 71.85 months (SD = 73.54) in 40 studies. After excluding RCT from the sample, the recovery proportion remained the same. No significant effect of any sociodemographic or clinical predictor was found. CONCLUSIONS: Half of the patients are in symptomatic remission around 4 years after the FEP, while about a third show recovery after 5.5 years.

Cortactin and focal adhesion kinase as predictors of cancer risk in patients with laryngeal premalignancy.

Novel markers are needed to accurately predict the risk of malignant transformation in laryngeal premalignancies. We therefore investigated the clinical significance of cortactin (CTTN) and focal adhesion kinase (FAK) during laryngeal tumorigenesis and their potential utility as cancer risk markers. CTTN and FAK protein expression and gene amplification were assessed in 82 patients with laryngeal dysplasia and correlated with clinicopathologic parameters and laryngeal cancer risk. Increased CTTN and FAK expression was found respectively in 41 (50%) and 40 (49%) of 82 laryngeal dysplasias; protein expression was maintained or further augmented in the corresponding patient-matched invasive tumors subsequently developed. CTTN and FAK/PTK2 gene amplifications were respectively detected in 10 (12%) and 26 (32%) laryngeal dysplasias. Both CTTN and FAK protein expression increased with the grade of dysplasia; however, CTTN and FAK expression but not histology correlated significantly with increased laryngeal cancer risk (P = 0.009 and P = 0.002, respectively). Patients carrying strong CTTN- or FAK-expressing dysplastic lesions experienced a significantly higher cancer incidence (P = 0.006 and P = 0.001, respectively; log-rank test). Furthermore, FAK expression was an independent predictor of laryngeal cancer development (HR = 3.706, 95% CI: 1.735-7.916; P = 0.001) and the combination of FAK and CTTN showed superior predictive value (HR = 5.042, 95% CI: 2.255-11.274; P < 0.001). Taken together, our findings support the involvement of CTTN and FAK in malignant transformation and provide original evidence for their potential clinical utility as biomarkers for the risk of developing laryngeal cancer.

Anterior cervical abscess as a complication of CO2 laser surgery of the larynx.

Because of the increasing use of laser surgery, new complications appear in patients. Endoscopic procedures bring to patients a kind of surgery with benefits such as avoidance of external incisions, but complications not seen before are happening. We describe the case of a patient who had a big anterior cervical abscess 1 month after having undergone an endoscopic laser CO2 cordectomy to treat an epidermoid carcinoma of the left vocal cord. One month after the surgery, the patient came to the emergency department complaining about progressive anterior cervical inflammation, with odynophagia. Computed tomography scan revealed an extensive anterior cervical abscess. As far as we are concerned, our present case is the first reporting this extremely rare complication, an anterior cervical abscess appearing 1 month after an endoscopic laser CO2 procedure. Reporting this kind of infectious complication, the authors aim to make aware the surgeons about the possibility of this late event.

Podoplanin expression in the development and progression of laryngeal squamous cell carcinomas.

BACKGROUND: Podoplanin expression is attracting interest as a marker for cancer diagnosis and prognosis. We therefore investigated the expression pattern and clinical significance of podoplanin during the development and progression of laryngeal carcinomas. RESULTS: Podoplanin expression was determined by immunohistochemistry in paraffin-embedded tissue specimens from 84 patients with laryngeal premalignancies and 53 patients with laryngeal squamous cell carcinomas. We found podoplanin expression extending from the basal to the suprabasal layer of the epithelium in 37 (44%) of 84 dysplastic lesions, whereas normal epithelium showed negligible expression. Patients carrying podoplanin-positive lesions had a higher laryngeal cancer incidence than those with negative expression reaching borderline statistical significance (51% versus 30%, P = 0.071). Podoplanin expression in laryngeal carcinomas exhibited two distinct patterns. 20 (38%) cases showed diffuse expression in most tumour cells and 33 (62%) focal expression at the proliferating periphery of tumour nests. High podoplanin expression was inversely correlated with T classification (P = 0.033), disease stage (P = 0.006), and pathological grade (P = 0.04). There was a trend, although not significant, towards reduced disease-specific survival for patients with low podoplanin levels (P = 0.31) and diffuse expression pattern (P = 0.08). CONCLUSIONS: Podoplanin expression increases in the early stages of laryngeal tumourigenesis and it seems to be associated with a higher laryngeal cancer risk. Podoplanin expression in laryngeal squamous cell carcinomas, however, diminishes during tumour progression. Taken together, these data support a role for podoplanin expression in the initiation but not in the progression of laryngeal cancers.

[Paranasal sinuses mucoceles. Our experience in 72 patients]. / Mucoceles de senos paranasales. Nuestra experiencia en 72 pacientes.

INTRODUCTION: Traditional treatment for paranasal sinuses mucoceles recommended total removal through external approaches. Since the 90s, endoscopic marsupialization has been proposed as optimal surgical treatment. We present our experience in the treatment of this pathology. MATERIAL AND METHOD: A retrospective review of 72 patients treated for paranasal sinuses mucoceles between 1980 and 2006 in our ENT department was performed. We describe clinical features, surgical approaches employed and recurrence of disease. RESULTS: The sample was composed of 72 patients with average follow-up period of 44 months (range 13-214 months). A total of 81 mucoceles were presented, with 44% affecting the frontal sinus or frontoethmoidal cells, followed in frequency by maxillary sinus mucoceles (35%). Twenty-nine percent of the patients did not present predisposing factors; 31% of patients had a history of nasal polyposis, 35% had undergone previous sinus surgery and 14% suffered previous facial fractures; 48 mucoceles patients were treated endoscopically and 33 were treated with external or combined approaches. Recurrence was found in 7 patients, 2 in the endoscopic surgery group and 5 in the external/combined surgery group. CONCLUSIONS: Endoscopic marsupialization is a safe approach with a low rate of recurrence. The endoscopic approach may be unsuitable for frontal lateral sinus mucoceles or those with significant bone blockage.

Mucoceles de senos paranasales. Nuestra experiencia en 72 pacientes / Paranasal sinuses mucoceles. Our experience in 72 patients

Introducción: El tratamiento tradicional de los mucoceles paranasales consistía en la extirpación mediante abordajes externos. Desde los años noventa se ha propuesto la marsupialización endoscópica como tratamiento de elección. Exponemos nuestra experiencia en el tratamiento de estas lesiones. Material y método: Se revisaron retrospectivamente 72 historias clínicas de pacientes intervenidos de mucoceles nasosinusales entre 1980 y 2006 en nuestro centro. Se describen las características clínicas, los abordajes quirúrgicos empleados y la aparición de recidivas. Resultados: La muestra se compone de 72 pacientes con un seguimiento medio de 44 (intervalo, 13–214) meses. Se presentaron un total de 81 mucoceles, de los que el 44% afectaba al seno frontal o las cedillas frontoetmoidales y el 35%, a los senos maxilares. El 29% de los pacientes no presentaban factores predisponentes. El 31% de los pacientes padecían poliposis nasal; el 35%, antecedentes de cirugía nasosinusal, y el 14%, fracturas faciales previas. Se trataron endoscópicamente 48 mucoceles y mediante abordajes externos o mixtos, 33. Apareció recidiva en 7 pacientes, 2 en el grupo de pacientes tratados endoscópicamente y 5 en el grupo de pacientes tratados mediante cirugía abierta o mixta. Conclusiones: La marsupialización endoscópica es una técnica segura y con bajo índice de recidivas que encuentra como limitación relativa los mucoceles frontales laterales o con tabicación ósea significativa (AU)

Introduction: Traditional treatment for paranasal sinuses mucoceles recommended total removal through external approaches. Since the 90s, endoscopic marsupialization has been proposed as optimal surgical treatment. We present our experience in the treatment of this pathology. Material and method: A retrospective review of 72 patients treated for paranasal sinuses mucoceles between 1980 and 2006 in our ENT department was performed. We describe clinical features, surgical approaches employed and recurrence of disease. Results: The sample was composed of 72 patients with average follow-up period of 44 months (range 13–214 months). A total of 81 mucoceles were presented, with 44% affecting the frontal sinus or frontoethmoidal cells, followed in frequency by maxillary sinus mucoceles (35%). Twenty-nine percent of the patients did not present predisposing factors; 31% of patients had a history of nasal polyposis, 35% had undergone previous sinus surgery and 14% suffered previous facial fractures; 48 mucoceles patients were treated endoscopically and 33 were treated with external or combined approaches. Recurrence was found in 7 patients, 2 in the endoscopic surgery group and 5 in the external/combined surgery group. Conclusions: Endoscopic marsupialization is a safe approach with a low rate of recurrence. The endoscopic approach may be unsuitable for frontal lateral sinus mucoceles or those with significant bone blockage (AU)