PSYCHIATRY IN TIME OF COVID-19 PANDEMIC

COVID-19 or Coronavirus pandemic has generated a very serious and grave global concern regarding the health of every person in the whole world. Besides, due to the rapid diffusion of the viral infection, there are already alarms on how to deal with the psychiatric aspects of COVID-19 pandemic in persons with an established diagnosis of psychiatric disorders, staff, and those in selfisolation. What is the influence of COVID-19 on mental health? The current study will review the psychiatric implications of COVID-19 pandemic on the general population, the bearing of social isolation, the prevention behaviours, and clinical cases of people who required psychiatric admission to hospital due to the emotional impact of COVID-19 social circumstances

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Predominant diagnoses, gender, and admission duration in an adult psychiatric inpatient hospital in United Kingdom

Introduction: The study objective was to epidemiologically analyse patients presenting at an adult and mixed-gender psychiatric inpatient unit in Essex, Kingswood Centre, UK, to report the predominant diagnoses, gender, and admission duration. Method and material: Meta-analysis and descriptive statistics analysed the year 2016 discharge data on Excel® for 162 patients. ICD-10 codes classified their mental illnesses. Results: Meta-analysis evidenced statistically significant heterogeneity in numbers admissions (I2=95%; p≤0.001), length (I2=78%; p≤0.001), and gender (I2=76%; p≤0.001). The prevailing diagnosis was borderline personality disorder (BPD) (rate, 95% CI=0.46 [0.38-0.54]). The longest admission was for schizoaffective disorder (mean duration, 95% CI=53 [22.65-83.34], p=0.001). Gender presented a prevalence of male over female admissions for schizophrenia (OR, 95% CI=0.14 [0.05-0.35], p≤0.001) and BPD with prevalence of female over male admissions (OR, 95% CI=2.79 [1.35-5.76], p=0.05). Conclusion: Female patients with BPD were the most represented category in non-forensic psychiatric inpatient wards in the population studied. Male patients with schizophrenia represented the other gender highly represented. The longest admission was recorded for schizoaffective disorder due to the complexity to treat both mood and psychotic symptoms. It is likely that women with BPD will be the future recipients of psychiatric inpatient and outpatient healthcare services

From diabetes remedy to diabetes remission; could single-anastomosis gastric bypass be a safe bridge to reach target in non-obese patients?

Summary: Background/Aims: Type 2 diabetes mellitus (T2DM) is considered a chronic progressive incurable metabolic disease. Single-anastomosis gastric bypass (SAGB) has proved to be effective in obese patients, yet its impact on non-obese diabetics is not extensively studied.The aim is to determine the anthropometric and glycemic outcomes of SAGB as a proposed line of treatment for T2DM patients with body mass index (BMI) 25–30 kg/m2. Methods: From November 2013 to March 2016, a prospective study has been conducted at Ain-Shams University Hospitals on 17 consecutive patients who have undergone SAGB. The demographic and anthropometric data, as well as the relevant laboratory results, were reported. Complete T2DM remission is considered if glycosylated hemoglobin (HbA1c) <6 % for at least 1 year without medication, whereas partial remission is considered if HbA1c<6.5%. Results: The mean age was 42.6 ±13.8 years, mean BMI was 26.7 ± 2.3 kg/m2 and mean duration of DM was 6.3 ± 2.7 years. The mean baseline values of HbA1c, FPG (fasting plasma glucose), and 2-hours postprandial glucose (2-H PPG) were 9.9%, 176.3 mg/dl, and 310.3 mg/dl respectively. These values significantly dropped at the 18th month to reach 5.8%, 93.4 mg/dl, and 156.2 mg/dl, with 13/17 patients became off-treatment (complete remission rate 76.4%). Conclusion: T2DM patients with BMI 25–30 kg/m2 are considered the most controversial group. SAGB is an efficient metabolic procedure and could be integrated into the treatment algorithm of T2DM. Such line of treatment opens new horizons to change the concept of treatment from diabetes remedy to diabetes remission. Keywords: Bariatric/ metabolic surgery, Mini-gastric bypass, Single-anastomosis gastric bypass, Type II diabetes mellitus, Type II diabetes remissio

Use of licensed medicines for unlicensed applications in Psychiatric practice: Psychopharmacology Committee

Pharmacological treatment is an important component of much of psychiatric practice. Many psychotropic medications and psychological interventions are available for patients with mental health problems, but patients often remain troubled by distressing symptoms despite undergoing a series of pharmacological andpsychological treatments. In this situation, doctors may wonder whether they might prescribe a medication outside the narrow terms of its market authorisation (‘product licence’) in an attempt to improve clinical outcomes. Many authorities agree that use of a drug outside the terms of its licence can be a necessary andbeneficial part of clinical practice, whereas others have raised concerns about patient safety and medical liability.The Royal College of Psychiatrists first issued guidance on recommended procedures for the use of licensed medicines for unlicensed applications in psychiatric practice in 2007. In the subsequent decade, evidence on this aspect of practice has increased and other bodies have also provided guidance (e.g. General Medical Council, 2013). The Royal College of Psychiatrists’ Psychopharmacology Committee was therefore asked to consider and, if necessary, revise current College guidance and did so in consultation with representatives from the British Association for Psychopharmacology (BAP). We considered the potential benefits and risks of this aspect ofclinical practice and believe that prescription of a drug outside the narrow terms of its market authorisation can be an appropriate part of overall management and in the best interests of a patient. The Committee strived to make ten balanced recommendations that it judged would be feasible to implement within currentpsychiatric practice