Anxiety and depression played a central role in the COVID-19 mental distress: A network analysis

INTRODUCTION

Psychological, socio-demographics, and clinical factors play an important role in patients with COVID-19, but their relationship is complex. The network approach might be used to disentangle complex interactions in different systems. Using data from a multicentre, cross-sectional, survey among patients with COVID-19 in Spain (July-November 2020), we investigated the network structure of mental disorders symptoms, social support, and psychological resilience, and changes in network structures according to the presence of a pre-existing mental disorder or hospitalization for COVID-19.

METHODS

Subjects completed a survey to evaluate sociodemographic characteristics, COVID-19 infection status, resilience, social support, and symptoms of depression, anxiety disorders, post-traumatic stress disorder, panic attacks, and substance use disorder. 2084 patients with COVID-19 were included in the analysis. Network analysis was conducted to evaluate network and bridge centrality, and the network properties were compared between COVID-19 patients with and without a history of lifetime mental disorder, and between hospitalized and non-hospitalized patients.

LIMITATIONS

Generalization of our findings may be difficult since differences in network connectivity may exist in different populations or samples.

RESULTS

Anxiety and depression showed high centrality in patients with COVID-19 and anxiety showed the highest bridge influence in the network. Resilience and social support showed a low influence on mental disorder symptoms. Global network estimations show no statistically significant changes between patients with and without pre-existing mental disorders or between hospitalized and non-hospitalized patients.

CONCLUSIONS

Anxiety might be a key treatment target in patients with COVID-19 since its treatment might prevent other mental health adverse outcomes.

Antidepressants overuse in primary care: Prescription trends between 2010 and 2019 in Catalonia

INTRODUCTION

There has been an increase in the prescription of antidepressants (AD) in primary care (PC). However, it is unclear whether this was explained by a rise in diagnoses with an indication for AD. We investigated the changes in frequency and the variables associated with AD prescription in Catalonia, Spain.

METHODS

We retrieved AD prescription, sociodemographic, and health-related data using individual electronic health records from a population-representative sample (N=947.698) attending PC between 2010 and 2019. Prescription of AD was calculated using DHD (Defined Daily Doses per 1000 inhabitants/day). We compared cumulative changes in DHD with cumulative changes in diagnoses with an indication for AD during the study period. We used Poisson regression to examine sociodemographic and health-related variables associated with AD prescription.

RESULTS

Both AD prescription and mental health diagnoses with an indication for AD gradually increased. At the end of the study period, DHD of AD prescriptions and mental health diagnoses with an indication for AD reached cumulative increases of 404% and 49% respectively. Female sex (incidence rate ratio (IRR)=2.83), older age (IRR=25.43), and lower socio-economic status (IRR=1.35) were significantly associated with increased risk of being prescribed an AD.

CONCLUSIONS

Our results from a large and representative cohort of patients confirm a steady increase of AD prescriptions that is not explained by a parallel increase in mental health diagnoses with an indication for AD. A trend on AD off-label and over-prescriptions in the PC system in Catalonia can be inferred from this dissociation.

[Bacteriological analysis in the management of conjunctivitis. Comparison of antibiotic resistance between 1982 and 2008]

OBJECTIVE

To demonstrate the need for bacteriological analysis for the rational treatment of infections of the corneal surface, including conjunctivitis.

METHODS

The results of 1,970 consecutive bacteriological analysis obtained from 2001 to 2008 in patients with ocular hyperemia and discharge were analysed and compared with a similar study done in 1982 in the same geographical area.

RESULTS

Bacterial growth was obtained in 1,044 cases (53%). The most frequent bacteria were Staphylococci spp. (56.6%), followed by Streptococci spp. (21.4%), Haemophili spp. (12.1%), and other gram-negative bacteria (9.9%). No antibiotic was effective against all the bacteria isolated. The frequency of resistant bacteria against neomycin, tobramycin, erythromycin and gentamicin was significantly increased with respect to the study of 1982.

CONCLUSIONS

Bacteriological analysis of conjunctival specimens are necessary to ensure the choice of an effective antibiotic against bacteria of the ocular surface when the initial treatment fails.

[Exercise training in chronic obstructive pulmonary disease. Comparative study of aerobic training of lower limbs vs. combination with upper limbs]

A prospective, randomized and controlled study has been performed in 28 patients with severe COPD. A group of 14 has been trained with their lower limbs (LL), while another similar group of 14 patients was also trained with their upper limbs (UL). Results showed improvement in both groups in the endurance test for LL, dyspnea scale, efficiency and muscular working capacity. A considerable improvement was observed in the oxygen uptake at the anerobic threshold (VO2AT) which suggests a training effect, expressed through an improvement in exercise tolerance. Only the group who trained UL showed a remarkable improvement in the dyspnea scale, endurance test and maximal static mouth pressure, showing a better intrinsic working capacity and participation of the UL muscles producing those manoeuvres. At the end of training, quality of life was significantly increased and the hospitalization rate was lower in both groups. According to these findings, it is suggested that patients with severe COPD included in training programmes add UL exercises to the LL usually carried out.

Activated T cells in an animal model of allergic conjunctivitis

The aim of this study has been to determine whether the presence of lymphocytic infiltrates observed in the histology of ocular allergic conditions in humans or in the late phase of ocular anaphylactic reactions in experimental animals is a non-specific event dependent only on the degranulation of mast cells, or is conditioned by a specific response to antigen. With this in mind, responses to antigen and to a non-immunological mast cell degranulator (compound 48/80) were compared in an experimental model of allergic conjunctivitis. Rats were sensitised to ovalbumin and challenged topically in the left conjunctival sac either with ovalbumin or compound 48/80. The presence of T cells and activated T cells in the infiltrate was studied by immunohistochemical staining on conjunctival tissue obtained at 4, 24, and 48 hours after challenge. Ovalbumin sensitised and challenged rats showed increased numbers of T cells in the conjunctival infiltrate, statistically significant when compared with compound 48/80 challenged rats at 48 hours and with controls at 4, 24, and 48 hours. The number of T cells was significantly higher in compound 48/80 challenged rats only at 48 hours when compared with controls. As for the number of activated T cells, only ovalbumin sensitised and challenged rats showed significantly increased levels of these cells compared with both sensitised animals challenged with compound 48/80 and controls at 4 and 24 hours after challenge. These results suggest that the infiltration of the conjunctiva by activated T lymphocytes is, at least in part, dependent on a specific response to antigen.

Hepatoprotective effects of lobenzarit disodium on acetaminophen-induced liver damage in mice

We have studied the effects of the immunomodulator drug lobenzarit in the model of acute hepatotoxicity induced by a high oral dose (600 mg/kg) of acetaminophen in mice. Lobenzarit at doses of 25, 50 and 100 mg/kg i.p. decreased significantly the activity of alanine aminotransferase in serum, which was increased by acetaminophen alone, and increased the concentration of reduced glutathione in mice liver, which is depleted by acetaminophen. Lobenzarit also reduced liver damage induced by acetaminophen in mice, which was observed by electron microscopy. The hepatoprotective effects of lobenzarit were dose-dependent and they were produced when lobenzarit was administered 30 min before acetaminophen or 2 and 4 h after it. It is concluded that lobenzarit exerts some effects which resemble those of an antidote of acetaminophen such as N-acetylcysteine.

Presence of Langerhans cells in the cornea of Klebsiella keratoconjunctivitis mice

Frozen sections of normal Balb/c corneas and corneas from Balb/c mice with Klebsiella keratoconjunctivitis were examined for the expression of class I, class II H-2 antigens and MAC-1 antigens using monoclonal antibodies in an immunoperoxidase technique. Class I antigens were readily detected, in both normal and diseased corneas, mainly in the epithelium. Class II (Ia) and MAC-1 antigens were not detected in the normal corneas. However, these two antigens were found mainly in the epithelium and to a lesser extent in the stroma of corneas from keratoconjunctivitis mice. Both normal and diseased corneas were furthermore shown to be peroxidase-. Since Langerhans cells (LC) are Ia+, MAC-1+, and peroxidase- cells, we conclude that although the normal mouse cornea is devoid of these cells, under bacterial infection LC infiltrate the corneal epithelium.

Sindbis virus-induced ocular immunopathology

The intraocular injection of the Sindbis virus in adult BALB/c mice produces a uveoretinitis with little or no central nervous system involvement. Ocular disease starts on the third day after infection and presents as a mild to moderate iridocyclitis and retinitis, usually accompanied by typical severe dysplastic changes of the retina. The inflammatory infiltrate consists almost exclusively of lymphocytes and histiocytes. Immunosuppression of the mouse with cyclophosphamide on the day after infection markedly reduces or eliminates completely the inflammatory response, suggesting that the virus itself is not cytopathogenic. In the normal host, the virus replicates within the eye for several days but is then completely eliminated by day 8 after infection. In the immunosuppressed animal, virus titers reach greater levels than in the normal animal and then fall, in step with the developing inflammatory response. It would appear that the immunologic mechanisms responsible for clearance of the viral infection from the eye also mediate the ocular disease.

Trichofolliculoma of the eyelid

The clinical and histological features of 2 cases of trichofolliculoma of the eyelid are described. One case presented the typical wool-like wisp of immature hairs and was easily diagnosed clinically. The other one was mistaken for a basalioma. In both cases the histological structure was diagnostic for trichofolliculoma.

Astrocytoma of the retina. Report of a case

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