Hospital trainees' worries, perceived sufficiency of information and reported psychological health during the COVID-19 pandemic

INTRODUCTION: The COVID-19 pandemic has been unsurpassed in clinical severity or infectivity since the 1918 Spanish influenza pandemic and continues to impact the world. During the A/H1N1 pandemic, healthcare workers presented concerns regarding their own and their families' health, as well as high levels of psychological distress. We aim to assess hospital trainees' concerns, perceived sufficiency of information, behaviour and reported psychological health during the COVID-19 pandemic. DESIGN: Single 39-point questionnaire. SETTING: A large NHS foundation trust in London. PARTICIPANTS: 204 hospital trainee doctors. RESULTS: 204 trainees participated, of whom 91.7% (n=187) looked after COVID-19 patients. 91.6% (n=164) were worried about COVID-19; the most frequent concern was that of family and friends dying from COVID-19 (74.6%, n=126). 22.2% (n=36) reported being infected with COVID-19. 6.8% (n=11) of trainees considered avoiding going to work. Perceived sufficiency of information about COVID-19 was moderately high. 25.9% (n=42) reported social distancing at work compared with 94.4% (n=152) outside work. 98.2% (n=159) reported using PPE and 24.7% (n=40) were confident the provided PPE protected them. 41.9% (n=67) reported their psychological health had been adversely affected. 95.6% (n=153) supported provision of psychological support services and 62.5% (n=100) stated they would consider using them. CONCLUSIONS: A significant proportion of hospital trainees expressed worries about COVID-19, above all with regards to the wellbeing of their loved ones over their own. Confidence in sufficiency of provided information was high and in utilised infection control measures low. A larger proportion of trainees reported psychological as compared with physical health concerns, with a smaller proportion confirming having been infected with COVID-19 although most perceived their risk of infection as high. Seeking solutions to support hospital trainees in their duties and their wellbeing with their input would help to empower them and improve their health and morale while working during pandemics

Moderate Aortic Stenosis: What is it and When Should We Intervene?

Current guidelines recommend aortic valve replacement in patients with severe aortic stenosis in the presence of symptoms or a left ventricular ejection fraction <50%. However, patients with less than severe aortic stenosis may also experience symptoms and recent literature suggests that the prognosis is not as benign as previously reported. There are no recommendations for patients with moderate aortic stenosis and left ventricular dysfunction, despite the high associated morbidity and mortality. There is also some evidence that these patients may benefit from early aortic valve intervention. It is recognised that aortic stenosis not only affects the valve but also has a complex myocardial response. This review discusses the natural history of moderate aortic stenosis along with the role of multimodality imaging in risk stratification in these patients

Prospective Case-Control Study of Cardiovascular Abnormalities 6 Months Following Mild COVID-19 in Healthcare Workers

OBJECTIVES: The purpose of this study was to detect cardiovascular changes after mild severe acute respiratory syndrome coronavirus 2 infection. BACKGROUND: Concern exists that mild coronavirus disease 2019 may cause myocardial and vascular disease. METHODS: Participants were recruited from COVIDsortium, a 3-hospital prospective study of 731 health care workers who underwent first-wave weekly symptom, polymerase chain reaction, and serology assessment over 4 months, with seroconversion in 21.5% (n = 157). At 6 months post-infection, 74 seropositive and 75 age-, sex-, and ethnicity-matched seronegative control subjects were recruited for cardiovascular phenotyping (comprehensive phantom-calibrated cardiovascular magnetic resonance and blood biomarkers). Analysis was blinded, using objective artificial intelligence analytics where available. RESULTS: A total of 149 subjects (mean age 37 years, range 18 to 63 years, 58% women) were recruited. Seropositive infections had been mild with case definition, noncase definition, and asymptomatic disease in 45 (61%), 18 (24%), and 11 (15%), respectively, with 1 person hospitalized (for 2 days). Between seropositive and seronegative groups, there were no differences in cardiac structure (left ventricular volumes, mass, atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterization (T1, T2, extracellular volume fraction mapping, late gadolinium enhancement) or biomarkers (troponin, N-terminal pro-B-type natriuretic peptide). With abnormal defined by the 75 seronegatives (2 SDs from mean, e.g., ejection fraction 1,072 ms, septal T2 >52.4 ms), individuals had abnormalities including reduced ejection fraction (n = 2, minimum 50%), T1 elevation (n = 6), T2 elevation (n = 9), late gadolinium enhancement (n = 13, median 1%, max 5% of myocardium), biomarker elevation (borderline troponin elevation in 4; all N-terminal pro-B-type natriuretic peptide normal). These were distributed equally between seropositive and seronegative individuals. CONCLUSIONS: Cardiovascular abnormalities are no more common in seropositive versus seronegative otherwise healthy, workforce representative individuals 6 months post-mild severe acute respiratory syndrome coronavirus 2 infection

The immune response to infection in the bladder

International audienceThe bladder is continuously protected by passive defences such as a mucus layer, antimicrobial peptides and secretory immunoglobulins; however, these defences are occasionally overcome by invading bacteria that can induce a strong host inflammatory response in the bladder. The urothelium and resident immune cells produce additional defence molecules, cytokines and chemokines, which recruit inflammatory cells to the infected tissue. Resident and recruited immune cells act together to eradicate bacteria from the bladder and to develop lasting immune memory against infection. However, urinary tract infection (UTI) is commonly recurrent, suggesting that the induction of a memory response in the bladder is inadequate to prevent reinfection. Additionally, infection seems to induce long-lasting changes in the urothelium, which can render the tissue more susceptible to future infection. The innate immune response is well-studied in the field of UTI, but considerably less is known about how adaptive immunity develops and how repair mechanisms restore bladder homeostasis following infection. Furthermore, data demonstrate that sex-based differences in immunity affect resolution and infection can lead to tissue remodelling in the bladder following resolution of UTI. To combat the rise in antimicrobial resistance, innovative therapeutic approaches to bladder infection are currently in development. Improving our understanding of how the bladder responds to infection will support the development of improved treatments for UTI, particularly for those at risk of recurrent infection