scholarly journals Neurotropism of SARS-CoV-2: COVID-19 presenting with an acute manic episode

2020 ◽  
Vol 13 (6) ◽  
pp. e236123 ◽  
Author(s):  
Jamie A Mawhinney ◽  
Catherine Wilcock ◽  
Hasan Haboubi ◽  
Shahbaz Roshanzamir
Keyword(s):  
Mental Health ◽  
Mechanical Ventilation ◽  
Cerebrospinal Fluid ◽  
Intensive Care ◽  
Manic Episode ◽  
Severe Headache ◽  
Initial Screening ◽  
Heavy Sedation ◽  
Clinical Presentations ◽  
History Of

A 41-year-old man with no significant medical history presented with acute behavioural disruption on the background of a 1-day history of severe headache and a 10-day history of dry cough and fever. He was sexually disinhibited with pressured speech and grandiose ideas. His behaviour worsened, necessitating heavy sedation and transfer to intensive care for mechanical ventilation despite no respiratory indication. Investigations confirmed that he was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neuroimaging and a lumbar puncture were normal. Initial screening for SARS-CoV-2 in the cerebrospinal fluid was negative although no validated assay was available. The patient’s mental state remained abnormal following stepdown from intensive care. Psychiatric assessment found features consistent with acute mania, and he was detained under the Mental Health Act. This case indicates the need to consider COVID-19 in a wider series of clinical presentations and to develop a validated assay for SARS-CoV-2 in the cerebrospinal fluid.

scholarly journals Prognosis of patients with COVID-19 admitted to a tertiary center in Chile: A cohort study

Medwave ◽  
2020 ◽  
Vol 20 (10) ◽  
pp. e8066-e8066
Author(s):  
Miguel Araujo ◽  
Paola Ossandón ◽  
Ana María Abarca ◽  
Ana María Menjiba ◽  
Ana María Muñoz
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Invasive Mechanical Ventilation ◽  
Case Fatality ◽  
Logistic Regression Models ◽  
Reactive Protein ◽  
Tertiary Center ◽  
History Of ◽  
Blood Gas Parameters

Introduction Since the beginning of the COVID-19 pandemic, extensive research has been done on the prognosis of patients with SARS-CoV-2 associated with age, biodemographic conditions, comorbidities, social factors, clinical parameters, inflammatory blood markers, coagulation, biochemical and blood gas parameters, among others. Few studies have addressed this problem in Latin America, so it is of interest to know how the disease plays out in this region. Objective The purpose of our study is to evaluate the course of COVID-19 in patients admitted to a tertiary center in Chile and to assess factors measured close to hospital admission that may be associated with death and the need for invasive mechanical ventilation. Methods We did a retrospective cohort study at Indisa Clinic in Santiago, Chile. We included all patients aged 15 years and older hospitalized between March 11 and July 25, 2020. Hospital mortality and severity of the cases were analyzed, and logistic regression models were applied to identify predictors of outcome variables. Results The sample included 785 subjects. The mean age was 59 years, 59% were men, and 61.3% had comorbidities. Forty five per cent required intensive care, and 24% invasive mechanical ventilation. The overall hospital fatality rate was 18.7%. In intensive care patients, the case fatality was 32.1%, and in those who received invasive mechanical ventilation, it was 59.4%. Independent risk factors for death included age (odds ratio 1.09; 95% confidence interval: 1.07 to 1.12), diabetes (1.68; 1.06 to 2.67), chronic lung disease (2.80; 1.48 to 5.28), increased C-reactive protein, creatinine, and ferritin. No association with sex, public health insurance, history of heart disease, oxygen saturation upon admission, or D-dimer was found. Similar factors were predictors of invasive mechanical ventilation. Discussion The prognosis and predictive factors in this cohort of patients hospitalized in Chile for COVID-19 were comparable to those reported in similar studies from higher-income countries. Male sex was not associated with a poor prognosis in this group of patients.

Ventilator-Associated Pneumonia: Incidence and risk factors six intensive care units in Tunisia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Ben Cheikh ◽  
S Bhiri ◽  
N ketaka ◽  
A Gara ◽  
S Khefacha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
University Hospital ◽  
Ventilator Associated Pneumonia ◽  
Factors Associated ◽  
History Of ◽  
Independent Risk Factors ◽  
The University ◽  
Very High

Abstract Background Ventilator-Associated Pneumonia (VAP) continues to cause significant morbidity, mortality, and hospital costs, especially in the intensive care unit (ICU). This study aimed to determine incidence and factors associated with VAP in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018. Methods We conducted a prospective observational cohort study over a three months period in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018. All patients hospitalized with mechanical ventilation (MV) for more than 48 hours in the ICUs were included. Logistic regression with the stepwise method of Hosmer and Lemeshow was used to identify factors associated with VAP. Results Overall, 110 patients were enrolled. The mean age of patients was 44 ± 25 years. Of them, 66.4% were male. The median duration of MV was 5 days [2-16]. The incidence of VAP was 32% and the density incidence was 33/1000 ventilator days. The most common organism were Pseudomonas aeruginosa (n = 14). Of them, 12 were ceftazidime-resistant and thee were resistant to imipenem. Independent risk factors associated with VAP in ICU were history of antibiotic therapy during last 6 months (p = 0.007), tracheotomy (p < 0.001) and reintubation (p < 0.001). Conclusions VAP rates in our ICUs were very high. Antimicrobial stewardship programs involving pharmacists and physicians must be elaborated to optimize the antibiotic prescribing. Mechanical ventilation require more-effective interventions control in our hospital. Key messages Ventilator-Associated Pneumonia rates were very high. Independent risk factors associated with Ventilator-Associated Pneumonia were history of antibiotic therapy during last 6 months, tracheotomy and reintubation.

Risk Factors for Postpartum Disorders

2020 ◽  
pp. 3-10
Author(s):  
Gail Erlick Robinson
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Mental Health Problems ◽  
Social Supports ◽  
Manic Episode ◽  
Poor Sleep ◽  
Hormonal Changes ◽  
Postpartum Disorders ◽  
Women's Lives ◽  
History Of

This chapter on risk factors for postpartum disorders describes how the postpartum period is a time in women’s lives when they are at an especially high risk for developing mental health problems. The massive hormonal changes experienced after birth can interact with other risk factors to result in a postpartum disorder. Poor sleep due to infant care can exacerbate these vulnerabilities. There are many factors that may increase the risk of developing a postpartum disorder. Depression or anxiety during pregnancy, a personal or family history of a psychiatric disorder, current stressors, and lack of social supports may all increase the risk of developing a postpartum depression or anxiety disorder. Women with a history of bipolar disorder are particularly at risk for developing a depression or manic episode postpartum. Recognition of factors that may predispose women to the development of a postpartum disorder can allow preventative factors to be put in place.

History of Sexual Orientation and Mental Health

2020 ◽  
pp. 9-24
Author(s):  
Kristin A. Hancock ◽  
Douglas C. Haldeman
Keyword(s):  
Mental Health ◽  
Psychological Research ◽  
The Political ◽  
Political Movements ◽  
International Policy ◽  
Psychological Science ◽  
Aids Epidemic ◽  
History Of ◽  
And Bisexual ◽  
The Impact

Psychology’s understanding of lesbian, gay, and bisexual (LGB) people has evolved, become more refined, and impacted the lives of LGB people in profound ways. This chapter traces the history of LGB psychology from the nineteenth century to the present and focuses on major events and the intersections of theory, psychological science, politics, and activism in the history of this field. It explores various facets of cultural and psychological history that include the pathologizing of homosexuality, the rise of psychological science and the political movements in the mid-twentieth century, and the major shifts in policy that ensued. The toll of the AIDS epidemic on the field is discussed as is the impact of psychological research on national and international policy and legislation.

scholarly journals Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199153
Author(s):  
Ameer Al-Hadidi ◽  
Morta Lapkus ◽  
Patrick Karabon ◽  
Begum Akay ◽  
Paras Khandhar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Noninvasive Positive Pressure Ventilation ◽  
Pediatric Intensive Care ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Positive Pressure ◽  
P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

scholarly journals Persistent vegetative state: an overview

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Gabriel Alexander Quiñones-Ossa ◽  
Yeider A. Durango-Espinosa ◽  
Tariq Janjua ◽  
Luis Rafael Moscote-Salazar ◽  
Amit Agrawal
Keyword(s):  
Intensive Care ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Clinical History ◽  
Main Body ◽  
Disorder Of Consciousness ◽  
Family Perspective ◽  
Patient Status ◽  
History Of ◽  
State Diagnosis

Abstract Background Disorder of consciousness diagnosis, especially when is classified as persistent vegetative state (without misestimating the other diagnosis classifications), in the intensive care is an important diagnosis to evaluate and treat. Persistent vegetative state diagnosis is a challenge in the daily clinical practice because the diagnosis is made mainly based upon the clinical history and the patient behavior observation. There are some specific criteria for this diagnosis, and this could be very tricky when the physician is not well trained. Main body We made a literature review regarding the persistent vegetative state diagnosis, clinical features, management, prognosis, and daily medical practice challenges while considering the bioethical issues and the family perspective about the patient status. The objective of this overview is to provide updated information regarding this clinical state’s features while considering the current medical literature available. Conclusions Regardless of the currently available guidelines and literature, there is still a lot of what we do not know about the persistent vegetative state. There is a lack of evidence regarding the optimal diagnosis and even more, about how to expect a natural history of this disorder of consciousness. It is important to recall that the patients (despite of their altered mental state diagnosis) should always be treated to avoid some of the intensive care unit long-stance complications.

Sign in / Sign up

Export Citation Format

Share Document