Mental Impact of COVID-19 - Fear, Stress, Anxiety, Depression and Sequels

Disease pandemics are known to cause mental impact, COVID-19 is not an exception. The ensuing mental health issues are not only restricted to the patients and their relatives/friends but affect the healthcare workers (HCWs) as well. Home isolated/quarantined patients/care takers experience a greater tendency of fear, stress, anxiety, and depression compared to those admitted in the hospital. Similarly, HCWs posted in COVID-19 designated areas of the hospital display higher levels of mental problems in comparison to those posted in non-COVID areas. Furthermore, long COVID-19 syndrome encompasses another large mental impact after 4-12 weeks of acute illness. Several instruments are available to screen for anxiety, fear, stress and depression, including the PSS 10 and DASS 21 questionnaires. These can be used by any HCW and even by educated patients or their care takers with telemedicine guidance from HCW. Treatment is also simple and cognitive behavioral therapy is a major solution and can be markedly practice with tele-consultation. The high degree of uncertainty associated with novel pathogens like COVID-19, both during acute and chronic effects has a profound effect on the mental state of asymptomatic/suspected/confirmed patients, their care takers, friends, as well as HCWs. However, by accepting pandemic with new-normal life of COVID-19 appropriate behaviors, human mankind can overcome these impacts

Pharmacotherapy for COVID-19: A Ray of Hope

Most viral infections have limited treatment options available and the same holds for COVID-19, its causative agent being the SARS-CoV-2 virus. Drugs used in the past against Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) viruses, which belong to the same family of viruses as the novel Coronavirus included ribavirin, interferon (alfa and beta), lopinavir-ritonavir combination, and corticosteroids. There remains controversy regarding their efficacy to date, except for the last one. Hence, large-scale multicentric trials are being conducted involving multiple drugs. Chloroquine and hydroxy-chloroquine were initially taking the race ahead but have now been rejected. Remdesivir was a promising candidate, for which the FDA had issued an emergency use authorization, but now is not recommended by the WHO. Convalescent plasma therapy had promising results in the early severe viremia phase, but the PLACID trial made an obscure end. Only corticosteroids have shown demonstrable benefits in improving mortality rates among severe COVID-19 cases. Many new modalities like monoclonal antibodies and tyrosine kinase inhibitors are discussed. In this chapter, we review the therapeutic drugs under investigation for the COVID-19 treatment, their mode of action, degree of effectiveness, and recommendations by different centers regarding their use in current settings

Mixed invasive fungal infections among COVID-19 patients

Background and Purpose: The healthcare system in India collapsed during the secondwave of the COVID-19 pandemic. A fungal epidemic was announced amid the pandemic with several cases of COVID-associated mucormycosis and pulmonary aspergillosis being reported. However, there is limited data regarding mixed fungal infections in COVID-19 patients. Therefore, we present a series of ten consecutive COVID-19 patients with mixed invasive fungal infections (MIFIs).Materials and Methods: Among COVID-19 patients hospitalized in May 2021 at atertiary care center in North India, 10 cases of microbiologically confirmed COVID-19-associated mucormycosis-aspergillosis (CAMA) were evaluated.Results: All patients had diabetes and the majority of them were infected with severeCOVID-19 pneumonia (6/10, 60%) either on admission or in the past month while twowere each of moderate (20%) and mild (20%) categories of COVID-19; and were treatedwith steroid and cocktail therapy. The patients were managed with amphotericin-B along with surgical intervention. In total, 70% of all CAMA patients (Rhizopus arrhizus with Aspergillus flavus in seven and Aspergillus fumigatus complex in three patients)survived.Conclusion: The study findings reflected the critical importance of a high index ofclinical suspicion and accurate microbiological diagnosis in managing invasive dualmolds and better understanding of the risk and progression of MIFIs among COVID-19patients. Careful scrutiny and identification of MIFIs play a key role in theimplementation of effective management strategies

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Polyglandular Syndrome with Complications and a Rare Co-existence of Hypercortisolism in a Young Girl: An Internist Approach

Patients diagnosed with Type 1 Diabetes Mellitus (T1DM) can sometimes manifest as part of broader clinical presentations known as Autoimmune Polyglandular Syndromes (APS). APS refers to a group of rare autoimmune disorders in which multiple endocrine glands are affected by autoimmune attacks. There are four types of APS described so far, including APS1, APS2, APS3 and APS4. In contrast to APS1 and APS2, APS3 does not involve the adrenal cortex. In APS3, autoimmune thyroiditis occurs with other organspecific autoimmune diseases, excluding Addison’s disease. A 20-year-old female with a known case of T1DM, Chronic Kidney Disease (CKD), hypothyroidism, and hypertension recently presented with a hypertensive emergency. On further evaluation, she was also diagnosed as a possible case of APS3 with a rare presentation of hypercortisolism instead of Addison’s disease. Various challenges were faced while managing her diabetes due to the brittle diabetes pattern she showed, and also there was a dilemma in the conclusive diagnosis of hypercortisolism in this patient due to the co-existing CKD

COVID–19: Guidance Outlines on Infection Prevention and Control for Health Care Workers

Coronavirus are a common family of viruses and there are seven different types of coronaviruses including this new member of coronavirus i.e. 2019 novel coronavirus, which can make the people infected and sick. Some strains of this family of virus cause mild to moderate disease symptoms like common cold while other strains cause very severe disease like Severe Acute Respiratory Syndrome (SARS) and Middle East respiratory syndrome (MERS).(1,2) In late December, in Wuhan Hubei Province, China a number of people suffered with severe respiratory illness including a cluster of pneumonia cases. On 31 December 2019, China notified the World Health Organization (WHO) about cluster of patient with symptoms of respiratory illness of unknown cause, which were connected to an open seafood and animal market of Wuhan city, China.(3

Serum cortisol level in indian patients with severe sepsis/septic shock

Background: The relationship between cortisol level and sepsis is not known in Indian patients of severe sepsis/septic shock. Aims: The study was done to determine the optimal range of cortisol levels, defining the adrenocortical response, and predicting the mortality, if possible, in the above type of patients. Settings and Designs: The study was a single-centered prospective cohort study, conducted in a tertiary referral center, North India. Materials and Methods: Sixty patients with severe sepsis (n = 30) and septic shock (n = 30) were recruited. Basal and postcosyntropin (1 μg)-stimulated cortisol levels were measured, and all patients were closely monitored with daily assessments of clinical and laboratory variables. Western diagnostic criteria were followed for defining adrenal insufficiency (AI). The end point was the survival assessed at day 28 or death, whichever came earlier. Results: The mean basal (T0) and poststimulation (T30) cortisol levels were 31.77 ± 15.9 μg/dL and 37.58 ± 17.31 μg/dL, respectively. In all sepsis patients, 48.33% qualified as AI at T0 ≤ 24 μg/dL, 61.67% at delta cortisol (Δ = T30-T0) ≤7 μg/dL, and 78.33% at Δ ≤9 μg/dL. Using receiver operating characteristic curve, the area under the curve (AUC) was 0.4954, signifying poor prediction to death. Conclusions: Indians have completely different characteristics of cortisol levels in sepsis patients, in comparison to the Western data. They have higher range of basal cortisol levels, higher percentage of AI, and an inability to predict mortality with the cortisol levels. Hence, there is requirement of an international study to confirm the dichotomy of the results

COVID-19 Sample Collection Kiosk in AIIMS Rishikesh: A safe and efficient model

Introduction:  Following the pandemic, screening suspected individuals on a large scale is imperative to curtail the disease's spread to enormous proportions. The walk-in kiosk is an ideal example of an innovation that is time and labour efficient and safe to use. Methodology and review of literature: Embase, Google Scholar, and Pubmed were used to extract scholarly articles about the subject published worldwide. The Walk-in kiosk concept was an idea taken from the biosafety chamber used in the advanced microbiology laboratories. Results: This ergonomic design enables the HCW to perform better without bending forwards or reaching out for the oropharyngeal or nasopharyngeal swab. It avoids a great deal of inconvenience for both the HCW and the patient