Baloch et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Objective: To determine whether an educational program on personal protective measures can reduce anxiety and depression in Hospital workers exposed to COVID-19. Study Design: Quasi-experimental study. Place and Duration of Study: COVID Units & Emergency Room, from May to Jul 2020. Methodology: Educational tool based on World Health Organization and Pan American Health Organization guidelines including videos on Personal Protective Equipment usage was delivered to hospital staff assigned to areas with COVID-19 patients. Likert scale, Generalised Anxiety Disorder-7 score and Major Depression Inventory were used. Results: 100 hospital staff were included. About 40% doctors, 41% Nurses. None had preexisting anxiety or depression. 11% reported COVID-19, 46% reported quarantine, and 91% reported contact. About 93% stated insufficient knowledge of usage of personal protective equipment and 35% reported inadequate provision of personal protective equipment. Median score on the likert scale was 5 (IQR 4-7). Mean generalized anxiety disorder score was 6.48 ± 3.4, which improved to 4.65 ± 2.7 post session, p-value <0.001. 41% reported minimal, 34% mild, 24% moderate and 1% severe anxiety. Post session, 62% reported minimal Anxiety, 33% mild, 5% moderate and 0% severe anxiety. Mean major depression inventory score was 16.10 ± 7.05 which reduced to 13.58 ± 5.84, p-value <0.001. Pre-session 59% reported „no/doubtful depression‟, 40% mild, 1% moderate depresssion, while post-session 85% reported „no/doubtful‟, 15% mild and none had moderate/severe depression. Conclusion: We found an educational program that provided information on personal protective measures significantly reduced anxiety and depression in front-line workers during COVID-19 pandemic.

Objective: To measure the point prevalence of delirium in the patients admitted to the cardiac ICU with acute coronary syndromes, with particular attention to the most commonly noted delirium and the impact on ICU mortality and length of ICU stay. Study Design: Prospective cohort study. Place and Study Duration: National Institute of Cardiovascular Diseases, Karachi Pakistan, from Mar and Jul 2021. Methodology: Consecutive adult patients with age >18 years admitted to the cardiac ICU after acute coronary syndromes were assessed for delirium using the confusion assessment method (CAM)-ICU tool and Richmond agitation sedation score (>-3). The types of delirium were also assessed. Results: 201 patients were enrolled, half of patients with ST-elevation MI (51.2%) and shock (45.8%). Delirium was identified in 71 (35.3%) patients, 30 (42.2%) had hypoactive delirium and 41 (57.7%) had hyperactive delirium. In multivariable regression, independent risk factors for delirium were: sepsis 3.19 (1.15-8.87), uremia 4.12 (1.18-14.46), mechanical ventilation 7.58 (1.2-47.99), and non-invasive ventilation 8.55 (2.9-25.2). Overall mortality was 35 (17.4%); 27/71 (38%) vs. 8/130 (6.2%); p 0.001 in patients with and without delirium, respectively. In multivariable regression, delirium was an independent risk factor for mortality at 7.12 (2.16-2.23). The mean ICU stay was 7.772.36 days vs. 3.91.44 days; p 0.001 for patients with and without delirium. Conclusion: The deleterious effect of delirium in terms of higher morbidity and mortality cannot be overemphasised. Hypoactive delirium is as common as the hyperactive type, with the same mortality risk. Assessment for delirium is mandatory for all patients admitted..............

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INTRODUCTION: Delirium has been described as a risk factor for increased mortality and longer stays in the Intensive Care Unit (ICU). There is insufficient information regarding delirium in patients after Acute Coronary Syndrome admitted to the ICU. The objective of this study was to determine the prevalence and the frequency of subtypes (hypoactive and hyperactive) of delirium, identify an at risk phenotype and compute outcomes.