Evaluation of the mental health of COVID-19 patients discharged from the intensive care unit

In this editorial,I address the mental health status of patients who have been discharged from intensive care units(ICUs)after battling coronavirus disease 2019(COVID-19).An ICU admission is generally a stressful experience,and for severe COVID-19 survivors prolonged treatment in the ICU can lead to significant psychological consequences.These individuals may experience psychiatric distress,including symptoms such as insomnia,anxiety,depression,and even posttraumatic psychological issues.Research indicates that during the first 6 months to 1 year following an ICU stay,nearly one-third of survivors exhibit symptoms similar to those of depression and post-traumatic stress disorder.Several factors may have contributed to the development of depressive and anxious symptoms during the COVID-19 pandemic,particularly for those who underwent an ICU stay.The ICU environment itself is inherently stressful,filled with the constant noise of various medical devices.Studies have provided strong evidence that the prolonged need for ventilation support and the loss of freedom of movement are key factors in the development of psychological problems among COVID-19 patients who had been treated in the ICU.

Physico-chemical characterization of acid base disorders in patients with COVID-19:A cohort study

BACKGROUND Acid-base imbalance has been poorly described in patients with coronavirus disease 2019(COVID-19).Study by the quantitative acid-base approach may be able to account for minor changes in ion distribution that may have been over-looked using traditional acid-base analysis techniques.In a cohort of critically ill COVID-19 patients,we looked for an association between metabolic acidosis surrogates and worse clinical outcomes,such as mortality,renal dialysis,and length of hospital stay.AIM To describe the acid-base disorders of critically ill COVID-19 patients using Stewart’s approach,associating its variables with poor outcomes.METHODS This study pertained to a retrospective cohort comprised of adult patients who experienced an intensive care unit stay exceeding 4 days and who were diagnosed with severe acute respiratory syndrome coronavirus 2 infection through a positive polymerase chain reaction analysis of a nasal swab and typical pulmonary involvement observed in chest computed tomography scan.Laboratory and clinical data were obtained from electronic records.Categorical variables were compared using Fisher’s exact test.Continuous data were presented as median and interquartile range.The Mann-Whitney U test was used for comparisons.RESULTS In total,211 patients were analyzed.The mortality rate was 13.7%.Overall,149 patients(70.6%)presented with alkalosis,28 patients(13.3%)had acidosis,and the remaining 34 patients(16.2%)had a normal arterial pondus hydrogenii.Of those presenting with acidosis,most had a low apparent strong ion difference(SID)(20 patients,9.5%).Within the group with alkalosis,128 patients(61.0%)had respiratory origin.The non-survivors were older,had more comorbidities,and had higher Charlson’s and simplified acute physiology score 3.We did not find severe acid-base imbalance in this population.The analyzed Stewart’s variables(effective SID,apparent SID,and strong ion gap and the effect of albumin,lactate,phosphorus,and chloride)were not different between the groups.CONCLUSION Alkalemia is prevalent in COVID-19 patients.Although we did not find an association between acid-base variables and mortality,the use of Stewart’s methodology may provide insights into this severe disease.

Nurses'attitude toward patients'safety climate during COVID-19 pandemic:a cross-sectional study

Objective:Patient safety is a fundamental factor in improving the quality of care provided in hospitals.Therefore,it is considered a significant parameter by all healthcare organizations around the world.The present study was conducted to investigate the attitude of nurses toward the patient safety climate during the Coronavirus Disease 2019(COVID-19)pandemic in the southeast of Iran.Methods:This is a cross-sectional descriptive study.Among all the nurses working in one of the hospitals in the southeast of Iran,171 nurses participated in the study through convenience sampling methods.The survey was conducted between June 1 and July 30,2020.A 2-part questionnaire including demographic information and an assessment of nurses'attitudes toward patients'safety climate was used for data collection in 2021.The content validity of the scale is(0.77)and reliability was re-calculated and confirmed by the present study with Cronbach's alpha(α=0.9).Data were analyzed by SPSS 20(IBM Corporation,Armonk,New York,United States)using descriptive and analytical statistical tests.Results:The mean score of safety climates was 3.2±5.20(out of 5 scores).The results showed that among all dimensions of the safety climate,only the education dimension was statistically significant between males and females(P<0.001).Also,there was a significant relationship between the overall average of the safety climate and its dimensions according to the people's position only in the dimension of supervisors'attitude(P<0.01)and burnout(P<0.01).Additionally,a significant correlation between the education level and the overall score of safety climate(P<0.01),as well as the supervisor's attitude dimension(P<0.01),was observed.Conclusions:The results showed that the safety climate was at a relatively favorable level.Considering the impact of nurses'attitudes on the safety climate of patients,its improvement seems necessary.It is recommended to design training courses and educate nurses in order to promote a patients safety climate in hospitals.

Comparison of Oral Manifestations in Hospitalized COVID-19 Positive Patients and COVID-19 Negative Dental Outpatients. A Case Series Study and Literature Review

Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that pose a threat to human life. Oral lesions in patients with COVID-19 may appear during or after the illness and may or may not be a consequence of the viral infection. Objective: In this case series we compare the oral manifestations in hospitalized COVID-19 positive patients and COVID-19 negative dental outpatients. Methods: 60 hospitalized COVID-19 patients and 41 control patients, were examined for oral signs and symptoms. The controls were dental patients who visited the hospital for dental care without complaining of any problems related to the oral cavity itself. Results: We have observed a strong association between certain clinical findings and COVID-19, including alterations in taste (ageusia, dysgeusia, and hypogeusia), anosmia, hairy tongue, tongue imprints, red tongue, erythematous candidiasis, pseudomembranous candidiasis, and exfoliative cheilitis. A trend but not statistically significant association at the level of 5% was also noted for colored tongue, linea alba, and pale mucosa. On the contrary, fissured tongue and oral mucosa pigmentation were more frequent in the controls, statistically significant at the level of 5%. Conclusion: COVID-19 has been found to impact the oral cavity, resulting in various oral lesions that can be attributed to either the direct action of the virus or the patient’s immune response.

Retroperitoneal and abdominal bleeding in anticoagulated COVID-19 hospitalized patients:Case series and brief literature review

BACKGROUND Hospitalized and severely ill coronavirus disease 2019(COVID-19)patients necessitate prophylactic or therapeutic anticoagulation to minimize the risk of thrombosis at different sites.Life-threatening bleeding complications include spontaneous iliopsoas hematoma,peritoneal bleeding,and extra-abdominal manifestations such as intracranial hemorrhage.CASE SUMMARY Bleeding in the abdominal wall results in less severe complications than seen with iliopsoas hematoma or peritoneal bleeding.In our case series of 9 patients,we present retroperitoneal and abdominal bleeding complications following anticoagulation in hospitalized COVID-19 patients with severe acute respiratory syndrome coronavirus 2 pneumonia.Contrast-enhanced computed tomography(CE-CT)is the best imaging modality for assessing hematoma secondary to anticoagulation and determines the therapeutic approach,whether interventional,surgical,or conservative management.CONCLUSION We present the role of CE-CT for rapid and precise localization of the bleeding site and prognostic counseling.Finally,we provide a brief review of the literature.

Effect of patient COVID-19 vaccine hesitancy on hospital care team perceptions

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic posed new challenges in patient care worldwide.Vaccinations,which have proven efficacious in lowering the COVID-19 hospital burden,are still avoided by large populations.We,therefore,hypothesized that hospital care teams would have worse perceptions regarding the characteristics and care of patients with vaccine hesitancy.AIM To evaluate whether patient vaccine hesitancy affected the hospital care team(HCT)perceptions.METHODS We performed a prospective clinical study using structured questionnaires.We approached physicians and nurses with previous experience caring for COVID-19patients from 11 medical centers across Israel during the fourth COVID-19 surge(September and October 2021).The participants completed a questionnaire with the following parts:(1)Sociodemographic characteristics;(2)Assessment of anger(STAXI instrument)and chronic workplace stress(Shirom-Melamed burnout measure);and(3)Three tools to assess the effect of patient vaccine hesitancy on the HCT perceptions(the difficult doctor-patient relation questionnaire,the medical staff perception of patient’s responsibility questionnaire and the characterological derogation questionnaire).Results were evaluated according to each part of the questionnaire and the questionnaire as a whole.Associations between HCT perceptions and their baseline characteristics,anger or chronic workplace stress were assessed.RESULTS The HCT experienced their relationship with unvaccinated patients as more difficult(P<0.001,Cohen’s d=0.85),perceived unvaccinated patients as responsible for their medical condition(P<0.001,d=1.39)and perceived vaccinated patients as having a higher character value(P<0.001,d=1.03).Unvaccinated patients were considered selfish(P<0.001),less mature(P<0.001)and less satisfying to care for(P<0.001).The relationship with unvaccinated patients was more difficult among HCT with higher burnout(r=0.37,n=66,P=0.002).No correlations with baseline characteristics were found.All three study tools showed high internal consistency(αbetween 0.72 and 0.845).CONCLUSION Our results should raise awareness of the possible effects of vaccine hesitancy on HCT perceptions regarding unvaccinated patients.In order to minimize the potential negative impact on patient care,designated departments should promote specific patient-centered preparations.Further investigations should assess whether vaccine hesitancy directly affects patient quality of care.

COVID TCL:A Joint Metric Loss Function for Diagnosing COVID-19 Patient in the Early and Incubation Period

Convolution Neural Networks(CNN)can quickly diagnose COVID-19 patients by analyzing computed tomography(CT)images of the lung,thereby effectively preventing the spread of COVID-19.However,the existing CNN-based COVID-19 diagnosis models do consider the problem that the lung images of COVID-19 patients in the early stage and incubation period are extremely similar to those of the non-COVID-19 population.Which reduces the model’s classification sensitivity,resulting in a higher probability of the model misdiagnosing COVID-19 patients as non-COVID-19 people.To solve the problem,this paper first attempts to apply triplet loss and center loss to the field of COVID-19 image classification,combining softmax loss to design a jointly supervised metric loss function COVID Triplet-Center Loss(COVID-TCL).Triplet loss can increase inter-class discreteness,and center loss can improve intra-class compactness.Therefore,COVID-TCL can help the CNN-based model to extract more discriminative features and strengthen the diagnostic capacity of COVID-19 patients in the early stage and incubation period.Meanwhile,we use the extreme gradient boosting(XGBoost)as a classifier to design a COVID-19 images classification model of CNN-XGBoost architecture,to further improve the CNN-based model’s classification effect and operation efficiency.The experiment shows that the classification accuracy of the model proposed in this paper is 97.41%,and the sensitivity is 97.61%,which is higher than the other 7 reference models.The COVID-TCL can effectively improve the classification sensitivity of the CNN-based model,the CNN-XGBoost architecture can further improve the CNN-based model’s classification effect.

Characterization of oral and gut microbiome and plasma metabolomics in COVID-19 patients after 1-year follow-up

Background:Due to the outbreak and rapid spread of coronavirus disease 2019(COVID-19),more than 160 million patients have become convalescents worldwide to date.Significant alterations have occurred in the gut and oral microbiome and metabonomics of patients with COVID-19.However,it is unknown whether their characteristics return to normal after the 1-year recovery.Methods:We recruited 35 confirmed patients to provide specimens at discharge and 1 year later,as well as 160healthy controls.A total of 497 samples were prospectively collected,including 219 tongue-coating,129 stool and 149 plasma samples.Tongue-coating and stool samples were subjected to 16S rRNA sequencing,and plasma samples were subjected to untargeted metabolomics testing.Results:The oral and gut microbiome and metabolomics characteristics of the 1-year convalescents were restored to a large extent but did not completely return to normal.In the recovery process,the microbial diversity gradually increased.Butyric acid-producing microbes and Bifidobacterium gradually increased,whereas lipopolysaccharideproducing microbes gradually decreased.In addition,sphingosine-1-phosphate,which is closely related to the inflammatory factor storm of COVID-19,increased significantly during the recovery process.Moreover,the predictive models established based on the microbiome and metabolites of patients at the time of discharge reached high efficacy in predicting their neutralizing antibody levels one year later.Conclusions:This study is the first to characterize the oral and gut microbiome and metabonomics in 1-year convalescents of COVID-19.The key microbiome and metabolites in the process of recovery were identified,and provided new treatment ideas for accelerating recovery.And the predictive models based on the microbiome and metabolomics afford new insights for predicting the recovery situation which benefited affected individuals and healthcare.

Patient Experience at Endoscopy Centers in Three West African Countries during the COVID-19 Pandemic

Corona virus infection and the risk of contagiousness to medical personnel or patients during endoscopy necessitated further measures in the endoscopy rooms. The objective of this study was to assess the experience of patients in endoscopy rooms during the COVID-19 epidemic in West Africa. Patients and Methods: This was a multicenter cross-sectional study that took place over a period of 3 months (June to August 2020) in endoscopy centers in Burkina Faso, Benin and Niger. An online questionnaire was sent to patients who had performed upper digestive endoscopies, in 8 digestive endoscopy centers including private, public and religious structures. Depending on the choice of patients, questionnaires were either sent electronically or completed in the endoscopy room with the help of field investigators. The choice of centers was random from the list of centers and descriptive analyses were carried out. Results: A total of 294 patients responded to the online questionnaire. There were 37 lower and 257 upper gastrointestinal endoscopies. The female sex represented 52.1%. The wait times for obtaining an endoscopy appointment were considered satisfactory by 281 patients 95.6%. In the endoscopy departments, 112 patients, or 38.1%, were questioned about the risk factors for contamination of SARS-CoV-2. Among the risk factors found, 6 patients (2.0%) would have traveled abroad in the 2 weeks preceding the examination, 4 patients 1.4% had already been in contact with a subject at risk. The most frequent symptoms were chest pain (80 cases;27.2%), flu-like syndrome (29 cases;9.9%), cough (40 cases;13.6%), fever (46 cases;15.6%). In contrast, ageusia (7 cases;2.4%) and anosmia (5 cases;1.7%) were only found in very few patients. Twenty-two patients (7.5%) felt highly exposed to COVID-19 during the endoscopy examination and 144 patients (48.9%) rated the examination as satisfactory. Conclusion: Gastrointestinal symptoms initially described as rare are being reported with increasing frequency in studies and may motivate the request for endoscopy examinations. However, the risk associated with infection with SARS-CoV-2 does not seem to have been sufficiently taken into account in endoscopy centers in the 3 countries.

Experiences of Social Isolation in Older Hospitalized Patients with COVID-19 and Their Close Relatives: A Qualitative Study

Background: Proximity between older patients and their close relatives is essential during hospitalisation. During the first wave of the pandemic, the Danish Patient Safety Authority restricted no hospital visitors. Aim: To explore how older patients with COVID-19 and their close relatives experienced physical separation during hospitalization. Method: A qualitative study using semi-structured interviews and thematic analysis was employed. Findings: Six interviews were conducted: three patients with a mean age of 81 years and three close relatives—two daughters and one spouse. The patients felt boredom, loneliness, and a sense of imprisonment, yet they felt safe and satisfied. Isolation was known beforehand from the media. Close relatives emphasised that information, involvement, and collaboration with hospital staff were crucial. Conclusion: Although older patients with COVID-19 and their close relatives widely accept their situation during hospitalization, they experience negative consequences from social isolation.

Evaluation of patient safety culture as perceived by nurses during the COVID-19 pandemic

Objectives:A good patient safety culture(PSC)is linked to a reduced risk of patient problems and minimal undesirable occurrences.This study investigated the PSC levels from nurses'perspectives during the COVID-19 pandemic.Methods:A descriptive cross-sectional design was applied.The Hospital Survey on Patient Safety Culture(HSOPSC)questionnaire was administered to 315 nurses working at 2 major hospitals in Jeddah,Saudi Arabia.The data were analyzed using descriptive statistics,a t-test,and a one-way ANOVA test.The statistical significance of the correlation was determined at the 0.05 level.Results:PSC was rated as medium overall according to the nurses,with a weighted mean of 2.88–0.76 and a relative weight of 57.57%.In addition,all PSC composites were rated from medium to high,except organizational learning,which was rated low.The correlation between sociodemographic variables as well as PSC levels was investigated using the t-test and one-way ANOVA test.The association is statistically significant when P≤0.05.The findings revealed a statistically significant correlation between nurse nationality(t=-4.399,P=0.000),age(F=7.917,P=0.000),experience in years(F=3.760,P=0.024),and hospital(t=-0.401,P=0.689).Conclusions:The nurses in this study had a medium overall PSC level,and all PSC composites ranged from a medium to a high level,except organizational learning,which had a low level.In addition,the findings showed that there is a significant relationship between PSC levels,nurses'nationalities,experience in years,and the hospital itself.

Effect of COVID-19 Pandemic on Patient Adherence to Chronic Medications in Sudan in 2021

Background: As the coronavirus spared accelerated, various sectors began to deteriorate since the early stages of the COVID-19 pandemic. The health sector as one of the major areas where the pandemic put a huge strain was also affected in different ways. Precisely, patient adherence to medication despite difficulties was a point of a question for health staff. Thus, this survey aims to distinguish and discuss the possibility of patients with chronic medications receiving their drugs and taking them regularly as prescribed. Method: Two online questionnaires were generated using Google forms and distributed among patients with chronic illnesses and pharmacists in the Khartoum locality. The survey was conducted during the period of the study to get the most recent data. Results: 81.4% of the population stated that they did encounter difficulties in obtaining their chronic medication during the pandemic. Pharmacists reported that drug availability decreased by 87% in pharmacies, but a considerable proportion of patients adhered to their medications (84%), and obtained their medications through a variety of means. More than half of the patients ordered their medication illegally, in addition to another approach discussed in the paper.

Non-Operating Room Anesthesia and the COVID-19 Patient: Evidence Based Strategies

As non-operating room anesthesia (NORA) vastly increases, so does the complexity of both the patients and the procedures. Unfamiliar environment, remote locations, and limited access to resources are some of the many challenges faced by the anesthesiologist in this environment. Understanding the environmental factors such as the room layout, machine placement and patient positioning needs advanced planning in the COVID-19 patient to determine airway management, intravenous access and overall patient safety. Communication with the proceduralist and healthcare workers (HCW) is of essence as both the procedure and anesthetic requirements may need to be altered as the case progresses. Standard monitoring guidelines should apply to all patients regardless of depth of anesthesia. The COVID-19 patient adds to these challenges. Aerosol generating medical procedures (AGMP’s) need to be identified ahead of time in order to ensure the safety of both the staff and patients. This allows for planning and preparation required for transportation of the patient to the room. HCWs may need to be identified and be available to assist with the procedure. Time should be allocated for transportation, briefing, room preparation, personal protective equipment needs of the staff and donning and doffing procedures as per institutional protocol. Communication means with staff outside of the room should be discussed in advance should an emergent situation arise during the procedure. Debriefing should be performed at the end of every procedure to improve patient safety and outcomes.

Standardization of critical care management of non-critically ill patients with COVID-19

The large global outbreak of coronavirus disease 2019(COVID-19)has seriously endangered the health care system in China and globally.The sudden surge of patients with severe acute respiratory syndrome coronavirus 2 infection has revealed the shortage of critical care medicine resources and intensivists.Currently,the management of non-critically ill patients with COVID-19 is performed mostly by non-intensive care unit(ICU)physicians,who lack the required professional knowledge,training,and practice in critical care medicine,especially in terms of continuous monitoring of the respiratory function,intervention,and feedback on treatment effects.This clinical problem needs an urgent solution.Therefore,here,we propose a series of clinical strategies for non-ICU physicians aimed at the standardization of the management of non-critically ill patients with COVID-19 from the perspective of critical care medicine.Isolation management is performed to facilitate the implementation of hierarchical monitoring and intervention to ensure the reasonable distribution of scarce critical care medical resources and intensivists,highlight the key patients,timely detection of disease progression,and early and appropriate intervention and organ function support,and thus improve the prognosis.Different management objectives are also set based on the high-risk factors and the severity of patients with COVID-19.The approaches suggested herein will facilitate the timely detection of disease progression,and thus ensure the provision of early and appropriate intervention and organ function support,which will eventually improve the prognosis.

Relationship between perceived social support and post-traumatic growth in coronavirus disease 2019 patients discharged from the hospital

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has affected mental health and physical health negatively in some individuals.Examining perceived social support and post-traumatic growth(PTG)in COVID-19 patients could facilitate our understanding of how patients maintain their mental health.AIM To examine the relationship between the level of perceived social support and PTG in COVID-19 patients discharged from the hospital.METHODS This descriptive study was carried out between August and September 2022 with patients who were hospitalized due to COVID-19 in a university hospital in Erzurum and who were discharged at least 3 mo prior to the beginning of the study.The study was completed by 196 patients.Study data were collected faceto-face using a personal information form,multidimensional scale of perceived social support and PTG inventory.RESULTS The total mean score of the multidimensional scale of perceived social support was 63.82±15.72.The PTG inventory total mean score was 47.77±19.85.In addition,a direct significant correlation was found between perceived social support in COVID-19 patients and PTG.CONCLUSION The study results showed that perceived social support variables affected PTG significantly.Therefore,it is recommended for healthcare professionals to implement interventions to promote social support from healthcare professionals and the patient’s family and friends.Considering the negative effects of the ongoing COVID-19 pandemic,it is very important and necessary to implement effective public health interventions to promote PTG to reduce mental health problems.

Comparison of demographic features and laboratory parameters between COVID-19 deceased patients and surviving severe and critically ill cases

BACKGROUND Coronavirus disease 2019(COVID-19) has been far more devastating than expected, showing no signs of slowing down at present. Heilongjiang Province is the most northeastern province of China, and has cold weather for nearly half a year and an annual temperature difference of more than 60℃, which increases the underlying morbidity associated with pulmonary diseases, and thus leads to lung dysfunction. The demographic features and laboratory parameters of COVID-19 deceased patients in Heilongjiang Province, China with such climatic characteristics are still not clearly illustrated.AIM To illustrate the demographic features and laboratory parameters of COVID-19 deceased patients in Heilongjiang Province by comparing with those of surviving severe and critically ill cases.METHODS COVID-19 deceased patients from different hospitals in Heilongjiang Province were included in this retrospective study and compared their characteristics with those of surviving severe and critically ill cases in the COVID-19 treatment center of the First Affiliated Hospital of Harbin Medical University. The surviving patients were divided into severe group and critically ill group according to the Diagnosis and Treatment of New Coronavirus Pneumonia(the seventh edition).Demographic data were collected and recorded upon admission. Laboratory parameters were obtained from the medical records, and then compared among the groups.RESULTS Twelve COVID-19 deceased patients, 27 severe cases and 26 critically ill cases were enrolled in this retrospective study. No differences in age, gender, and number of comorbidities between groups were found. Neutrophil percentage(NEUT%), platelet(PLT), C-reactive protein(CRP), creatine kinase isoenzyme(CK-MB), serum troponin I(TNI) and brain natriuretic peptides(BNP) showed significant differences among the groups(P = 0.020, P = 0.001, P < 0.001, P = 0.001, P < 0.001, P <0.001, respectively). The increase of CRP, D-dimer and NEUT% levels, as well as the decrease of lymphocyte count(LYMPH) and PLT counts, showed significant correlation with death of COVID-19 patients(P = 0.023, P = 0.008, P = 0.045, P = 0.020, P = 0.015, respectively).CONCLUSION Compared with surviving severe and critically ill cases, no special demographic features of COVID-19 deceased patients were observed, while some laboratory parameters including NEUT%, PLT, CRP, CK-MB, TNI and BNP showed significant differences. COVID-19 deceased patients had higher CRP, D-dimer and NEUT% levels and lower LYMPH and PLT counts.

Investigating the Effect of COVID-19 Infection on Professional Athletes’ Post-Infection with a Focus on Fatigue and Chronic Fatigue Syndrome

Introduction and Objectives: COVID-19 has been reported to cause long-term sequela including persistent fatigue and Chronic Fatigue Syndrome (CFS) in the general population. However, it remains to be seen if similar effects are observed in an athlete population. The aetiology and pathophysiology are poorly understood but is thought to be multi-factorial. Patient reported outcome measures are commonly used to improve patient-centred outcomes (PROMs). They are essential to assess patient quality of life post-COVID infection. This paper aims to assess the effect of COVID-19 on athletes’ long-term fatigue and CFS and identify the PROMs used to characterise this. Methodology: Articles were selected for extraction based on the eligibility criteria and PRISMA guidelines. The inclusion criteria required papers to assess competitive athletes over eighteen years of age who were clinically diagnosed with COVID-19. Articles were extracted to assess different variables including type of sport, type of athlete and ethnicity. Key terms were obtained using MeSH trees and utilised with Web of Science and NCBI Pubmed. Papers were graded by quality using the Hawker quality assessment tool. Results and Discussion: Forty articles (N = 40) were identified for full-text screening (N = 8). Eight were selected for extraction based on the eligibility criteria. Data was obtained on athlete characteristics, sport characteristics, properties of PROM measurement techniques and fatigue presentation. Male athletes were found to be 10% - 50% more likely than female athletes to suffer from persistent fatigue symptoms (N = 2). Persistent fatigue was present in 9% - 10% Athletes from mixed backgrounds and genders (N = 2). Initial fatigue was documented to be between 47% - 56% (N = 2). A heterogenous range of PROMs were utilised to assess symptoms including fatigue and excluded emotional or mental fatigue. Conclusion: COVID-19 is associated with signs of persisting fatigue and potentially CFS in athlete populations. More work needs to be done to develop standardised and validated PROMs specific to CFS.

Experiences and Challenges While Managing the Inpatient Psychiatry Unit Dedicated for COVID-19 Patients

The COVID-19 pandemic has significantly changed the mental health care. Treating psychiatric patients with COVID-19 poses multiple challenges in the inpatient psychiatric setting in terms of mitigating transmission of the virus. Gracie Square Hospital, a freestanding psychiatric hospital located in New York City, devoted a unit to treating COVID-19 patients requiring inpatient psychiatric treatment. This paper describes our experiences and challenges while managing the psychiatric COVID-19 unit that may serve as a model for other health care facilities during the COVID-19 pandemic.

Immunomodulatory therapy for the management of critically ill patients with COVID-19:A narrative review

BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the causative agent of the ongoing coronavirus disease 2019(COVID-19)pandemic.Understanding the physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective therapies.AIM To describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of hyperinflammation and abnormal immune responses to disease progression together with a complete narrative review of the different immunoadjuvant treatments used so far in COVID-19 and their indication in severe and life-threatening subsets.METHODS A comprehensive literature search was developed.Authors reviewed the selected manuscripts following the PRISMA recommendations for systematic review and meta-analysis documents and selected the most appropriate.Finally,a recommendation of the use of each treatment was established based on the level of evidence of the articles and documents reviewed.This recommendation was made based on the consensus of all the authors.RESULTS A brief rationale on the SARS-CoV-2 pathogenesis,immune response,and inflammation was developed.The usefulness of 10 different families of treatments related to inflammation and immunopathogenesis of COVID-19 was reviewed and discussed.Finally,based on the level of scientific evidence,a recommendation was established for each of them.CONCLUSION Although several promising therapies exist,only the use of corticosteroids and tocilizumab(or sarilumab in absence of this)have demonstrated evidence enough to recommend its use in critically ill patients with COVID-19.Endotypes including both,clinical and biological characteristics can constitute specific targets for better select certain therapies based on an individualized approach to treatment.

COVID-19 Pandemic: Psychosocial Distress and Social Burdens Experienced by Cancer Patients at Cancer Diseases Hospital, Lusaka, Zambia

Background: Cancer diagnosis has been reported in some studies to have a significant psychosocial impact on both the patients and their caregivers. The estimated prevalence of psychosocial distress is between 35% and 55%. Commonly encountered psychological issues include and are not limited to fear, anxiety, and emotional distress. Many sources of emotional distress in patients with cancer during the COVID-19 pandemic have been reported to include poorly controlled symptoms arising from a lack of access to symptom control services and treatment. Social distress is associated with social isolation, separation from family and loss of employment. Cancer patients and society have been reported to experience anxiety, despair, and stress due to the COVID-19 restrictions on community movement and hospital appointment rescheduling. The objective of this study was to explore psychosocial distress and social burdens experienced by cancer patients during the COVID-19 pandemic. Methods: A descriptive phenomenological design was employed to describe “lived experiences of patients with Cancer” during the COVID-19 Pandemic. A total of 20 participants with Cancer and COVID-19 positive were purposefully selected and interviewed. Thematic analysis was utilized for data analysis by the use of themes generated from participants’ responses. Findings: Five major themes emerged: fear, self-isolation compliance, anxiety, low income and emotional distress. The findings of the study indicated that participants experienced fear, emotional distress and anxiety when diagnosed with COVID-19. Conclusion: The experiences of psychosocial distress and social burdens were a result of a lack of psychosocial support by both caregivers and health care workers. This study recommends appropriate health education concerning psychosocial support for cancer patients and the need to have appropriate clinical protocols and materials in allaying anxiety and fear in cancer patients during the COVID-19 pandemic.