University Of Montreal Research Articles

Support Services at a Francophone University in Quebec: Contrasting Viewpoints of Chinese International Students and University Professionals

This qualitative study showcases the viewpoints of Chinese international students and university professionals about the services offered at a francophone university in Montreal regarding “welcoming” and “integration.” Semi-directed interviews were conducted among 22 participants, of which 14 were students and 8 university professionals. Using the concept of care, we conducted a thematic analysis. According to the analysis, students mention the lack of effective support, while university professionals discuss the support offered and its pitfalls. In terms of recommendations, we stress the importance of tackling current structural issues rather than putting the responsibility for the quality of the experience on students’ shoulders. We also emphasize that professionals who provide services directly to students must be given proper training and resources through universities to enable them to change the current paradigm and offer services that reflect the concept of student care.

Nicolas Garel: Combining psychoactive molecules and psychotherapy for patients suffering from mood and substance use disorders: a new therapeutic paradigm

Dr Nicolas Garel is an Assistant Professor in the Department of Psychiatry and Addictology at the University of Montreal and a junior investigator at the Research Center of the Centre Hospitalier de l'Université de Montréal. Dr Garel did his psychiatry residency at McGill University before completing the Clinician-Investigator Program and a Master's degree at McGill University, studying the potential role of ketamine in the discontinuation of benzodiazepines and related drugs. Dr Garel then completed a clinical fellowship in Addiction Medicine at Stanford University. His research program focuses on the integration of psychoactive molecules in conjunction with psychotherapy as a unique potential treatment approach for patients with comorbid mood and alcohol/sedative use disorders. In this “Innovators & Ideas” section, we are excited to feature Dr Garel in our latest Genomic Press Interview. We are thrilled he took the time to answer our questions and share his valuable insights with our readers.

The concept of caring and its contemporary translation: the view of French doctoral candidates

Jean Watson developed, in the United States, a conceptual model of nursing based on caring. Aterm sometimes translated as "to care" without properly reflecting what the concept entails. This theory has been adopted in many countries. Some authors report that it brings satisfaction to students, nurses, and managers of health facilities. Based on Watson's work, Chantal Cara built the humanist model of nursing at Montreal University. The aim of the project is to improve the well-being of patients and caregivers. It is likely to retain existing nurses and attract the next generation to the institutions which implement it.

Inter-season training effects on cardiovascular health in American-style football players

BackgroundRecent studies on American-style football (ASF) athletes raised questions about the impact of training on the cardiovascular phenotype, particularly among linemen players who engage mostly in static exercise during competition and who exhibit concentric cardiac remodeling, often considered maladaptive. We aimed to examine the cardiovascular adaptation to the inter-season mixed-team training program among ASF players.MethodsA prospective, longitudinal, cohort study was conducted among competitive male ASF players from the University of Montreal before and after an inter-season training, which lasted 7 months. This program includes, for all players, combined dynamic and static exercises. Clinical and echocardiographic examinations were performed at both steps. Left atrial (LA) and ventricular (LV) morphological and functional changes were assessed using a multiparametric echocardiographic approach (2D and 3D-echo, Doppler, and speckle tracking). Two-way ANOVA was performed to analyze the impacts of time and field position (linemen versus non-linemen).ResultsFifty-nine players (20 linemen and 39 non-linemen) were included. At baseline, linemen had higher blood pressure (65% were prehypertensive and 10% were hypertensive), thicker LV walls, lower LV systolic and diastolic functions, lower LA-reservoir and conduit functions than non-linemen. After training, linemen significantly reduced weight (Δ-3.4%, P < 0.001) and systolic blood pressure (Δ-4.5%, P < 0.001), whereas non-linemen maintained their weight and significantly increased their systolic (Δ+4.2%, P = 0.037) and diastolic (Δ+16%, P < 0.001) blood pressure ). Mixed training was associated with significant increases in 2D-LA volume (P < 0.001), 3D-LV end-diastolic volume (P < 0.001), 3D-LV mass (P < 0.001), and an improvement in LV systolic function, independently of the field position. Non-linemen remodeled their LV in a more concentric fashion and showed reductions in LV diastolic and LA reservoir functions.ConclusionsOur study underscored the influence of field position on cardiovascular adaptation among university-level ASF players, and emphasized the potential of inter-season training to modulate cardiovascular risk factors, particularly among linemen.

Metabolic dysfunction-associated steatotic liver disease in people with HIV is associated with lower BMI and more liver fibrosis compared to the uninfected population

Aim: People with HIV (PWH) are at high risk of metabolic dysfunction-associated steatotic liver disease (MASLD), defined by the presence of hepatic steatosis plus any among overweight, diabetes, hypertension, or dyslipidemia. There are limited data whether MASLD in PWH differs in clinical presentation from MASLD in the uninfected population. Aim: to compare the severity of metabolic and hepatic dysfunction between MASLD patients with and without HIV. Methods: 212 consecutive HIV mono-infected patients with MASLD at McGill University in Montreal were compared to a sex and age matched MASLD HIV negative control group at Policlinico Hospital in Milan. Fibroscan with controlled attenuation parameter (CAP) was used to define MASLD (CAP≥248 dB/m), severe MASLD (CAP&gt;280 dB/m), and significant liver fibrosis (liver stiffness measurement&gt;7.0 kPa). Results: PWH with MASLD presented lower median BMI (28[25-31] vs 29[27-32] Kg/m2, p=0.002) and lower prevalence of obesity (26% vs 44%, p&lt;0.001) compared to MASLD uninfected patients, along with a lower prevalence of hypertension (21% vs 38%, p&lt;0.001). The prevalence of dyslipidemia (41% vs 26%, p&lt;0.001), hypertriglyceridemia (26% vs 9%, p&lt;0.001) and low HDL cholesterol (34% vs 15%, p&lt;0.001) was higher in MASLD patients with vs without HIV. No difference in cardiovascular events and diabetes prevalence was observed between the two groups. Regarding liver disease, PWH with MASLD had lower prevalence of severe MASLD (54% vs 74% p&lt;0.001) but higher prevalence of significant liver fibrosis (15 vs 7%, p=0.03) compared to MASLD uninfected patients. After adjustment, HIV positivity was an independent factor associated with significant liver fibrosis (figure). Conclusions: Despite having lower BMI, PWH with MASLD have a more severe hepatic presentation and atherogenic lipid profile than MASLD uninfected patients. HIV positivity seems to be independently associated with significant liver fibrosis. Screening and follow-up for MASLD and liver fibrosis is recommended in PWH, even if they are lean.

Barriers and Facilitators to the Implementation of a Peer Support Intervention in Universities

ABSTRACT A growing number of postsecondary institutions offer peer support interventions to promote mental health among their students. However, little is known about the key factors that influence the implementation of this type of intervention. This study explored barriers and facilitators to implementing an online peer support program based on Acceptance and Commitment Therapy aimed at reducing stress and anxiety among students of three universities in Montreal, Canada. Peer supporters were asked to complete a survey containing open-ended questions at the end of each semester. Interviews were also conducted with the program coordinator, three psychologists who acted as supervisors, and 14 peer supporters. The data were analysed with an inductive and a deductive approach using the Consolidated Framework for Implementation Research (CFIR). Perceived barriers to the implementation of the intervention included technical problems with the videoconferencing platform, psychosocial and comorbidity issues among peers, recruitment difficulties, and communication concerns between stakeholders. Key perceived facilitators were the theoretical and empirical foundations of the intervention, the support offered by directors, and the process used to recruit, select, and supervise peer supporters. Based on the results of this study, practical recommendations are provided for researchers and practitioners interested in implementing online peer support initiatives in postsecondary institutions.

Studies of Second-Language Writing in Canada

Canada’s social and educational policies have always involved immigrant settlement and English-French bilingualism. Research on writing in second languages emerged in the 1980s from graduate programs of education and applied linguistics at major universities in Toronto, Montreal, Ottawa, and Vancouver, particularly scholars investigating cognitive and learning processes and rhetorical characteristics of writing in English as a mother tongue. In the 1990s several Canadian scholars established systematic programs of research focused on L2 composing processes, writing for academic purposes, assessment, and innovative educational programs— spawning, in turn, in the 2000s a third generation of L2 writing researchers who have now established themselves across Canada and around the world.

Evaluating nurses’ preparedness in critical incidents

Objective: This study aims to evaluate the preparedness and training of Canadian nurses in critical incidents.Methods: Design: An observational cross-sectional survey through a self-administered web-based questionnaire. Setting: The questionnaire was shared with nurses working in emergency departments, intensive care units, and coronary care units at five hospitals affiliated with McGill University in Montreal (Quebec, Canada). Participants: In total, 145 nurses completed the questionnaire. It was sent through email to nurse managers and assistant nurse managers working in the emergency department, adult intensive care unit, and cardiac care unit at four academic hospitals. Main Outcome Measured: level of preparedness and skills of nurses to deal with critical incidents.Results: Most nurses have not participated in a disaster management (code orange) simulation (64.8%, n = 94). Moreover, around half of them knew their specific role in such a simulation (49.6%, n = 72). The vast majority of participants (78.6%, n = 114) never took part in a real code orange scenario. On multiple logistic regression, having &gt; 10 years of experience in nursing, having &gt; 10 years of experience in critical care, participating in a code orange simulation, knowledge of roles and responsibilities during a code orange situation, and having knowledge of the department's code orange plan, were significantly associated with a higher level of preparedness.Conclusions: This study shows a lack of nurses’ preparedness in dealing with critical incidents based on their self-assessment. Confidence and knowledge of skills associated with BLS and ACLS were noted to be essential for a high level of preparedness.

Integrated health system intervention aimed at reducing type 2 diabetes risk in women after gestational diabetes in South Africa (IINDIAGO): a randomised controlled trial protocol

IntroductionSouth Africa has a high prevalence of gestational diabetes mellitus (GDM; 15%) and many of these women (48%) progress to type 2 diabetes mellitus (T2DM) within 5 years post partum....

Hidden in Plain Sight: Fascism in Quebec during the Second World War

My doctoral dissertation on anti-Semitism and extreme right-wing nationalism in 1929–39 Quebec proved to be a thread that, once pulled, would reveal other aspects of Quebec history that had also been hidden in plain sight. The writing of the most prominent nationalists of the 1930s was available in most university libraries in Quebec. While some politicians acknowledged in their memoirs the influence of these intellectuals in their youth, the appeal of fascism and anti-Semitism was never mentioned. Their resounding silence was quickly shattered by reading the Université de Montréal (University of Montreal)’s Le Quartier Latin student newspaper, where articles praising fascism and denouncing the Jewish influence were common, and a little book that claimed that Pierre Elliott Trudeau had been a member of a revolutionary organisation that aimed at toppling the provincial government to establish an independent Quebec freed from democracy. Researching the French Nazi collaborators warmly received in Quebec after the Second World War led to a little-known man who became the personal ambassador to the Vatican of the premier of Quebec, Maurice Duplessis, during the Asbestos Strike of 1949. Combing through the files of some of the leading actors of that conflict in the Jesuits’ archives would reveal that the miners’ health threatened by asbestosis was a significant issue that the historiography of the event had neglected.

Experimental study of a heat recovery ventilator preheated by a Building Integrated Photovoltaic system in a cold climate

The use of heat recovery ventilators (HRVs) in cold climate housing is becoming increasingly common, to provide outside air to the occupied space while recovering heat from the exhausted air. However, frosting of the heat exchanger core impedes HRV operation in cold climate conditions. Strategies for defrosting the core include recirculating the exhaust airstream while stopping the supply of the outside air during the defrost cycle. Preheating the air using heating coils is also used, but its application is limited by the increased energy use of the preheater. This study aims to investigate the impact of a building integrated photovoltaic/thermal (BIPV/T) system on the HRV thermal performance by using it to preheat the outside air. In this experimental study, measurements of a heat recovery ventilator preheated by the BIPV/T system are carried out in a test cell of the Future Buildings Laboratory (FBL) at Concordia University in Montreal, Canada. The results are compared to a HRV without BIPV/T preheating. The relative humidity, temperature and airflow rate of the fresh air and exhaust airstreams are monitored at the inlet and outlet of the HRV. The experiments are conducted during two weeks from January 26th, 2023 to February 08th, 2023. The change of the sensible heat recovery effectiveness ∈ sens of the HRV, outside air outlet temperature T 2 from the HRV and outside air flow rate, ṁ1 and exhaust air flow rate ṁ4 are determined. The primary experimental results indicate that preheating the outside air by the BIPV/T system before entering the HRV can help to increase the outside air outlet temperature T 2 by up to 2.7°C at an outdoor temperature of -25 °C, and the sensible heat recovery effectiveness ∈ sens , outside air flow rate, ṁ1 (23L/s) and exhaust air flow rate ṁ4 (43L/s) of the HRV are kept constant at the same level with preheating by BIPV/T on the HRV at -5 °C to -25 °C of outdoor temperature.

The POPI-Plus tool: prediction model of outcome of pregnancy in in vitro fertilization from a large retrospective cohort

To create a tool that accurately predicts live birth chances after a positive pregnancy test after elective single embryo transfer (ET). Retrospective cohort. CHUM hospital and Ovo clinic in Montreal, Canada. Patients with a positive pregnancy test result who underwent their first single ET after invitro fertilization (IVF) at the CHUM hospital and Ovo clinic in Montreal, Canada, from 2012 to 2016 were selected. A total of 1,995 patients were included in this study. The data from both centers were combined and divided into training (70%, n = 1,398) and validation (30%, n = 597) sets. The predictive model was developed using backward selection method for the following variables: age of patient at egg retrieval; log β-human chorionic gonadotropin (β-hCG) (β-hCG) 1; log β-hCG 2; and IVF treatment type. Moreover, the classification tree, random forest, and neural network models were generated. The measured outcomes were live birth (live fetus ≥24 weeks of gestation) and nonviable pregnancies. The performance of all models was evaluated by area under the receiver operating characteristic curve (AUC). Advancing age was negatively correlated with live birth. The odds ratio (OR) of age of patient at the time of egg retrieval was 0.95 (95% confidence interval [CI], 0.91-0.99). The log β-hCG 1 and log β-hCG 2 were positively correlated with live birth in the univariate analysis (OR, 4.15 [95% CI, 3.19-5.39], and OR, 3.84 [95% CI, 2.99-4.93], respectively). The β-hCG 1 level needed for a successful pregnancy was lower in frozen ET and modified natural IVF than in simulated IVF (OR, 0.55 [95% CI, 0.34-0.91], and OR, 0.49 [95% CI, 0.26-0.95], respectively). The best performance in terms of the AUC was the updated logistic model: POPI-Plus. The AUC values were 0.76 (95% CI, 0.73-0.79) and 0.78 (95% CI, 0.74-0.82) for the training and validation data, respectively. The other models (classification tree, random forest, and neural network) also performed adequately, with an AUC of ≥0.7, but remained below POPI-Plus. An open-access calculator was generated and can be found on the website of the University of Montreal on the following link: https://deptobsgyn.umontreal.ca/departement/divisions/medecine-et-biologie-de-la-reproduction/the-popi-plus-tool/. The POPI-Plus tool offers individualized counseling for patients after an initial positive β-hCG test result. Future studies will assess its impact on patient anxiety while awaiting viability ultrasound and perform prospective validation on new patients.

Financial Inequities in Optometric Education in Canada: A Comparison of Two Optometry Programs.

The advancing age of the population will require increased access to eyecare services to manage eye diseases and vision correction. Optometric education requires a sound financial plan to manage student debt. This study evaluates the financial inequalities of optometric programs in Canada, and how this may impact the provision of eyecare professionals. The objective of this study was to compare the financial inequities in Optometric education in Canada from the 2020 graduating class. A cross-sectional study assessed monetary variables related to the study of optometry in Canada, including academic and personal expenses, and overall debt and expenses related to the COVID-19 lockdown for the 2020 graduating class. 108 optometry students from the 2020 graduating classes of the University of Montreal and the University of Waterloo responded, with 68 (53 F:15 M, age 25.66, SD = 2.01) completing the study. Waterloo students spent more years in university (P < .001); had higher academic fees (P < .001); spent more on travelling to their family residence (P = .007) and received more provincial (P = .002) and federal (P < .001) loans than Montreal students. Overall debt prior to optometry was similar amongst students but differed (P < .001) at the end of their program, with Waterloo students having a higher debt burden. There is a financial inequity in optometric education in Canada depending on the chosen program. Cumulative optometry student debt for the 2020 graduating class in Canada ranges from $CAN 0 to 189,000 with an average of $CAN 65,800 and a median of $CAN 50,000. The results of this study can assist financial, government agencies and future optometry students to better understand the financial burdens and establish a financial plan to study optometry in Canada, to respond to the growing eyecare needs of the public.

The Montreal Plastic Surgery Residency Bootcamp: Structure and Utility.

Transitioning from medical school to surgical residency is a difficult endeavor. To facilitate this period, the University of Montreal's plastic surgery program developed and implemented an intensive 1-month bootcamp rotation. It is the only one of its kind and length amongst plastic surgery residency programs in North America. It includes didactic teachings in anatomy, cadaveric dissections, and surgical approaches for an array of procedures. Clinical and technical skills are reviewed with senior residents and attending surgeons. Research opportunities and case scenarios are also covered. An anonymous online 30-question survey was sent to all residents who participated in the bootcamp rotation between 2013 and 2020. Questions evaluated residents' knowledge of anatomy, basic surgical skills, common approaches, flap knowledge, and on-call case management, before and after the bootcamp. Seventeen plastic surgery residents responded to this questionnaire (81%). The majority confirmed that the bootcamp helped them prepare for residency, research, and on-calls, and also helped them expand their knowledge of anatomy and surgical skills. The residents responded positively to the bootcamp's structure and implementation. This study proposes that surgical programs could benefit from a bootcamp rotation at the beginning of their curriculum. The purpose is to facilitate the transition between medical school and postgraduate training, and to ensure a basic level of competence for all junior residents. Further prospective studies could demonstrate the bootcamp's impact in board certification rates and acceptance into fellowship training programs.

Research Showcase Early Bird Abstracts

The 2023 Dietitians of Canada (DC) National Conference held on 25–26 May 2023 was our first in-person conference since June 2019 and celebrated our unity and resiliency as a profession. It was amazing! The Canadian Foundation for Dietetic Research (CFDR) showcased a diverse array of experience sharing and research abstracts through oral and poster presentations, and virtual sessions. There were 23 Early Bird (EB) research abstracts, in which 10 were selected for in-person presentations during the conference, and 19 Late Breaking research abstracts which were posters. Thank you to all who submitted abstracts! Thanks to the dedication and commitment of the Abstract Review Committee members. Early Bird Abstract Review Committee: Susan Campisi (University of Toronto); Andrea Glenn (University of Toronto); Mahsa Jessri (University of British Columbia); Louise St-Denis (University of Montreal). Late Breaking Abstract Review Committee: Lesley Andrade (University of Waterloo); Carla D’Andreamatteo (Consultant, Winnipeg); Laura Forbes (University of Guelph); Billie Jane Hermosura (University of Ottawa); Christine Nash (University Health Network); Louise St-Denis (University of Montreal). Thanks to the CFDR Board, DC Conference team, digital partners, all of the moderators, and conference attendees for supporting the research presentations. Warm regards, Christina Lengyel, PhD, RD Chair, 2023 EB/LB Abstract Committees Professor Food and Human Nutritional Sciences University of Manitoba Ravi Sidhu Managing Director Development &amp; Operations CFDR

The exploration of remote simulation strategies for the acquisition of psychomotor skills in medicine: a pilot randomized controlled trial

BackgroundProgress in remote educational strategies was fueled by the advent of the COVID-19 pandemic. This pilot RCT explored the efficacy of a decentralized model of simulation based on principles of observational and peer-to-peer learning for the acquisition of surgical skills.MethodsSixty medical students from the University of Montreal learned the running subcuticular suture in four different conditions: (1) Control group (2) Self-learning (3) Peer-learning (4) Peer-learning with expert feedback. The control group learned with error-free videos, while the others, through videos illustrating strategic sub-optimal performances to be identified and discussed by students. Performance on a simulator at the end of the learning period, was assessed by an expert using a global rating scale (GRS) and checklist (CL).ResultsStudents engaging in peer-to-peer learning strategies outperformed students who learned alone. The presence of an expert, and passive vs active observational learning strategies did not impact performance.ConclusionThis study supports the efficacy of a remote learning strategy and demonstrates how collaborative discourse optimizes the students’ acquisition of surgical skills. These remote simulation strategies create the potential for implantation in future medical curriculum design.Trial Registration: NCT04425499 2020-05-06.

Young Investigator Interview with CSCI Distinguished Scientist Awardee Dr. Caroline Quach-Thanh.

Dr. Caroline Quach-Thanh is a Professor in the Departments of Microbiology, Infectious Diseases and Immunology and of Pediatrics at University of Montreal. She is in charge of Infection Prevention and Control at CHU Sainte-Justine where she works as a pediatric infectious diseases specialist and medical microbiologist. Dr. Quach is a clinician-scientist and the Canada Research Chair, Tier 1 in Infection Prevention and Control. In 2022, Dr. Quach-Thanh received the Distinguished Scientist Award 2022 from the Canadian Society for Clinical Investigation. In the same year, she received a Women of Distinction Award-for public service-from the Women's Y Foundation. Dr. Quach-Thanh is the former president from the Association for Medical Microbiology and Infectious Diseases Canada (AMMI), a past Chair of the National Advisory Committee on Immunization (NACI) and is the current chair of the Quebec Immunization Committee. She was named Fellow of the Canadian Academy of Health Sciences and of the Society for Healthcare Epidemiology of America. Dr. QuachThanh was selected as one of the 2019 most Powerful Women in Canada. In 2021, she received the Order of Merit from Université de Montréal and was made Officière de l'Ordre national du Québec in 2022.

A biopsychosocial perspective of the effects of stress during development and its relationship to one’s vulnerability to psychopathology

Various stress-related psychopathologies, for which the prevalence is known to increase during late childhood and early adolescence, have been associated with dysregulated patterns of cortisol secretion and distinct cognitive profiles. Most studies have been performed in clinical populations and utilize cross-sectional designs. As such, this has prevented researchers from drawing clear conclusions regarding the temporality of the observed effects. Importantly, different individual, familial, and societal factors are known to impact the regulation of the HPA axis activity. Therefore, these factors may moderate one’s risk of developing certain psychopathologies and/or modulating symptom severity or cognitive profiles that characterize various stress-related psychopathologies. This symposium is composed of four young investigators and will focus on the cognitive and clinical correlates of stress exposure in childhood, as well as the various individual, familial, and societal influences that moderate these effects. First, Catherine Raymond (Université du Québec à Montréal) will present data on cortisol reactivity and emotional cognitive processes in healthy children exhibiting high levels of vulnerability to anxiety, as assessed by various personality traits known to be predictive of clinical anxiety. Then, the two following presentations will address COVID-related stress in children. Alexe Bilodeau-Houle (Université du Québec à Montréal) will first discuss how cortisol levels prior to and following the first COVID-19 lockdown are related to psychological distress symptoms in healthy children. Thereafter, Sydney Yi (University of California) will present data related to the pandemic from a family-related perspective. Of note, she will comment on the effect of COVID-19-related parental job loss and financial stress on executive functioning performance and mental health in a parent and their child. Finally, Christina Cantave (University of Montreal) will present data pertaining to socio-economic status mobility during childhood and adolescence and how this relates to HPA axis activity in twin dyads. Altogether, this data will present a biopsychosocial perspective of how stress during childhood modulates one’s vulnerability to develop stress-related psychopathologies.

In lieu of flowers: An a/r/tographic journey of apology and forgiveness

This research-creation project explored the tension and evolving relationship between the author and the public memorial to the victims of the Montreal massacre, a space she had been avoiding for over twenty years. The victims were fourteen women, who, in 1989, were gunned down at their university in Montreal in a violent act of misogyny. A public green space, the Place du 6-décembre-1989, was inaugurated on the tenth anniversary of the shooting and houses a monument titled, Nef pour quatorze reines. The project stemmed directly from the author’s first-time visit. The creative process enabled a conversation with matter, allowing the author to reconcile her unsettling relationship with the site and its memorial. Discomfort and vulnerability evolved into an emergent pedagogical story, and an apology in the form of tracings, or visual letters, as peace offerings to each of the fourteen women and as an act of self-forgiveness.

The post-COVID stress syndrome: from the three-stage stress response of Hans Selye to COVID-19.

Stress is the nonspecific response of the body to any demand made upon it, as defined by Hans Selye more than 80years ago, based on his animal experiments at McGill University in Montreal, Canada. By emphasizing 'nonspecificity' he tried to underline that stress response is elicited my several factors, like nowadays in COVID-19, e.g., fear of infection, social isolation, death in family, loss of employment, etc. Thus, COVID-19 has been the largest new human stressor in the twenty-first century. Selye's studies in rats also revealed 3 stages of stress response: the short initial "alarm reaction" is followed by a longer "stage of resistance", associated with increased levels of corticosterone that is often terminated by a "stage of exhaustion", referring to an exhausted adrenal cortex when the secretion of glucocorticoids drops. Fast forward, that is exactly what has been documented in severe cases of infections caused by the SARS-CoV-2 virus: in hospitalized COVID-19 patients initially the blood levels of cortisol not only have been elevated, but only those with high concentration of this natural anti-inflammatory corticosteroid survived vs. those who had low levels of cortisol, suggesting diminished adrenocortical functions. Furthermore, patients with very severe cases of COVID-19 who ended up in intensive care units had significantly low cortisol blood levels, compared to patients with equal severity of diseases due to other causes. Thus, these 'natural phenomena' in clinical medicine, unfortunately confirmed Selye's studies in experimental animals several decades ago. Still, the good news is that astute clinicians empirically recognized this and started to give potent synthetic glucocorticoids such as dexamethasone to severe COVD-19 patients and this beneficial effect of exogenous corticoids has been extensively confirmed in the scientific literature.