Introduction We designed a follow‐up study of frontline health workers at COVID‐19 patient care, within the same working conditions, to assess the influence of their general characteristics and pre‐existing anxiety/depression/dissociative symptoms and resilience on the development of symptoms of post‐traumatic stress disorder (PTSD), while monitoring their quality of sleep, depersonalization/derealization symptoms, acute stress, state anxiety, and burnout. Methods In a Hospital reconfigured to address the surge of patients with COVID‐19, 204 frontline health workers accepted to participate. They completed validated questionnaires to assess mental health: before, during, and after the peak of inpatient admissions. After each evaluation, a psychiatrist reviewed the questionnaires, using the accepted criteria for each instrument. Correlations were assessed using multivariable and multivariate analyses, with a significance level of .05. Results Compared to men, women reporting pre‐existing anxiety were more prone to acute stress; and younger age was related to both pre‐existent common psychological symptoms and less resilience. Overall the evaluations, sleep quality was bad on the majority of participants, with an increase during the epidemic crisis, while persistent burnout had influence on state anxiety, acute stress, and symptoms of depersonalization/derealization. PTSD symptoms were related to pre‐existent anxiety/depression and dissociative symptoms, as well as to acute stress and acute anxiety, and negatively related to resilience. Conclusions Pre‐existent anxiety/depression, dissociative symptoms, and coexisting acute anxiety and acute stress contribute to PTSD symptoms. During an infectious outbreak, psychological screening could provide valuable information to prevent or mitigate against adverse psychological reactions by frontline healthcare workers caring for patients.
Phlebography of the inferior vena cava with selective study of the renal veins was performed in 43 patients with systemic lupus erythematosus (SLE). Inferior vena cava thrombosis (IVCT) or renal vein thrombosis (RVT) was found in 3 of 11 patients (27%) with nephrotic syndrome, in 8 of 13 (61.5%) with previous thrombophlebitis, and in 3 of 4 (75%) with suggestive acute clinical picture. In contrast, none of the 20 control patients with SLE had IVCT or RVT. These results show that SLE patients with thrombophlebitis have a very high risk of developing IVCT or RVT; patients with nephrotic syndrome have a smaller risk. Neither IVCT nor RVT was found in SLE patients without antecedent thrombophlebitis or nephrotic syndrome.The first case of renal vein thrombosis (RVT) and inferior vena cava thrombosis (IVCT) in systemic lupus erythematosus (SLE) was described by Hamilton and Tumulty (1) in a patient with nephrotic syndrome. Nineteen more cases (2-15) have been reported since then, all retrospectively and in anecdotal fashion. Until the 1960s the diagnosis of RVT was established only in postmortem studies. Since the development of angioradiographic techniques, RVT has been found in 22% of patients with the nephrotic syndrome (10,16), and it is now recognized that it is a consequence, and not the cause, of this renal conditionIn deep vein thrombophlebitis of the lower extremities there is a certain incidence of IVCT, and thrombophlebitis is recognized as a manifestation of active SLE. This prospective study was begun to test the hypothesis that SLE patients with nephrotic syndrome or with thrombophlebitis of the lower extremities have a higher frequency of RVT or IVCT than those SLE patients who do not have these risk factors.(17-19). PATIENTS AND METHODSPatients. Forty-three patients with SLE were studied prospectively. All patients fulfilled at least 7 of the American Rheumatism Association criteria for classification of SLE (201, and they were divided into 2 groups. Patients in group 1 were considered to be high-risk for RVT or IVCT, and were further divided as follows. Patients with nephrotic syndrome with proteinuria of at least 3.5 gm/liter per 24-hour collection for 6 months or more (21) were designated group la. Patients who, during the period of our observation, had 1 or more episodes of deep thrombophlebitis of the upper or lower extremities for which n o other cause could be found (22) comprised group lb. Patients with a clinical picture suggestive of RVT or IVCT (severe lumbar or flank pain with hematuria) (10) were designated group Ic. Group 2 was a control group of SLE patients, paired by sex, age, and duration of disease, but who did not have the aforementioned risk factors.Methods. All patients underwent simple phlebography of the inferior vena cava with selective study of the renal veins by the Seldinger technique. The catheter tip was positioned exactly at the site of the bifurcation of the renal
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