METHODS: This is an open labelled interventional study of a virtual brief psychosocial intervention, called SANUBARI. The program was conducted among COVID-19 patients hospitalized in the COVID-19 wards of two centres from May 2020 until August 2020. Inclusion criteria include patients aged eighteen years and above, diagnosed with COVID-19, medically stable, speaking and reading Bahasa Melayu or English. All study subjects attended two sessions on OHP via telecommunication method and answered questionnaires (General Self-Efficacy (GSE) Scale, Patient Health Questionnaire and Generalized Anxiety Disorder Questionnaire) via computer-assisted self-interview. Data collection was done before the start of the intervention, at the end of the intervention and a month post-intervention.
RESULTS: A total of 37 patients were recruited and more than half of the subjects were males (62.2%), single (75.5%) and from the Malay ethnicity (78.4%). Seventy-three per cent of subjects had received tertiary education, and most of them were students reflecting a higher unemployment status (73%). Most subjects have no comorbid chronic medical illness (89.2%), and none has a comorbid psychiatric illness. Comparison of the GSE score across 3-time points (preintervention, immediate post-intervention and a month postintervention) showed statistically significant improvement in the mean total GSE score immediate and a month postintervention as compared to the pre-intervention; from mean total GSE score of 29.78 pre-intervention to 34.73 (mean difference 4.946, 95% Confidence Interval 95%CI: 3.361, 6.531) immediate post-intervention and 33.08 (mean difference 3.297, 95%CI: 1.211, 5.348) a month post intervention. There was no significant association between the socio-demographic or clinical data, depressive and anxiety symptoms, and changes in GSE scores over three time points.
CONCLUSION: COVID-19 patients improved their self-efficacy levels after the virtual brief OHP intervention, and it maintained a month post-intervention, protecting them from psychological stress and ultimately enhances wellbeing during this coronavirus pandemic.
CASE PRESENTATION: We present the case of a 37-year-old Malay gentleman with underlying type 2 diabetes mellitus on empagliflozin, who presented to our hospital with symptomatic coronavirus disease 2019 infection and diabetic ketoacidosis. He developed severe rebound euglycemic diabetic ketoacidosis due to the continuous usage of empagliflozin for glycemic control alongside intravenous insulin.
CONCLUSIONS: Physicians should have a high index of suspicion in diagnosing and managing euglycemic diabetic ketoacidosis, including withholding treatment of sodium-glucose cotransporter 2 inhibitors during the acute management of diabetic ketoacidosis.
OBJECTIVE: We aim to perform a systematic review to evaluate the cardiovascular outcomes and mortality associated with IBD patients.
METHODS: A systematic literature search has been performed on PubMed, Embase, Cochrane, and Scopus from inception till May 2022 without any language restrictions.
RESULTS: A total of 2,029,941 patients were included in the analysis from 16 studies. The mean age of the patients was 45.6 years. More females were found compared with males (57% vs 43%). The most common risk factors for cardiovascular disease (CVD) included smoking (24.19%) and alcohol (4.60%). The most common comorbidities includes hypertension (30%), diabetes mellitus (14.41%), dyslipidemia (18.42%), previous CVD (22%), and renal disease (10%). Among outcomes, all-cause mortality among IBD patients was 1.66%; ulcerative colitis (UC): 15.92%; and Crohn disease (CD): 0.30%. Myocardial Infarction (MI) among IBD patients were 1.47%, UC: 30.96%; and CD: 34.14%. CVD events among IBD patients were 1.95%. Heart failure events among IBD patients were 5.49%, stroke events among IBD patients were 0.95%, UC: 2.63%, and CD: 2.41%, respectively.
CONCLUSION: IBD patients are at higher risk for adverse cardiovascular outcomes, especially in women. Although there remains a lack of concrete treatment algorithms and assessment parameters that better characterize IBD risk factors, nutritional modifications and physical activity should be at the forefront of CVD prevention in IBD.