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Gastro-oesophageal reflux disease (GERD) is associated with substantial morbidity in patients with systemic sclerosis. Although the introduction of proton pump inhibitors (PPIs) into clinical care represents a major achievement in the management of gastro-oesophageal problems in systemic sclerosis, PPIs are seldom fully effective in patients with systemic sclerosis, and the use of maximum PPI doses is a very frequent clinical practice. However, there is little evidence to support the empirical use of PPIs in systemic sclerosis. This scarcity of evidence is especially relevant with regards to the safety concerns of long-term exposure, which have been raised in the general population. The purpose of this Viewpoint is to highlight the substantial beneficial impact of PPIs on GERD in patients with systemic sclerosis, while considering the potential adverse effects in this patient population. Furthermore, we highlight the unmet needs of people with systemic sclerosis and GERD and propose an agenda for future research to optimise the safe and effective use of PPIs in systemic sclerosis. Copyright © 2022 Elsevier Ltd
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It is striking that East Asian, South East Asian and South Pacific Populations appear relatively unscathed by the second and subsequent waves of the SARS-CoV-2 pandemic compared to the rest of the world. This is more so with the more infectious G614 mutation of COVID-19. Adherence to social distancing measures and face protection do not explain the almost 30-fold difference in infection incidence between Asian and European/ American populations. The populations in the Indian Subcontinent are an exception, as infections rates were elevated compared to other Asian countries. Differences in immune responses between European and African populations have been alluded to because of archaic introgression of immune-related Neanderthal genes in the European genome. As opposed to the European genome, the Asian genome has a higher introgression of the Neanderthal’s sister species’ genes, the Denisovan genes, which are more commonly found in East and South East Asia and the South Pacific populations. Contrastingly the Denisonvan genes are scantily found in the populations of the Indian Subcontinent. Lockdown in China and bordering nations, led to significant reductions in atmospheric pollution, which itself significantly attenuates pulmonary immunity. Following lockdown in January the G614 variant emerged in China. With improved immunity following lockdown, the Denisovan immunity-related gene may have been allowed to be expressed more effectively, protecting Asian populations against the more infectious G614 variant of SARS-CoV-2 during the subsequent waves of the pandemic. © 2021 Angelo Pontecorboli Editore - EDK. All rights reserved.
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[Figure: see text].
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The study aimed to explain the opinion of school principals regarding the influence of COVID-19 on the socio-emotional-affective aspect of students, teachers, coordinators and the school community in order to contribute to public policies in the field of health and education, in networks teaching institutions. This was a descriptive exploratory cross-sectional study carried out in a public municipal and state education network, in a Brazilian capital, from 06/02/2020 to 07/02/2020. 172 directors participated in the survey, who answered an electronic form via Google Form, sent by email. The data were treated using simple descriptive statistics by the program IBM SPSS Statistics 20.0 for Windows 10. In the perception of the directors of the municipal and state education network, COVID-19 "influenced a lot" in the socio-emotional-affective aspects of students, teachers, coordinators and school community. It is therefore necessary to work in a network with contributions linked to new technologies and emotional health in education.
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Objectives: During the COVID-19 lockdown, temporal artery biopsy (TAB) procedures were not available at ourinstitution for the diagnosis of giant cell arteritis (GCA). For the evaluation of large vessel vasculitis, 18F-fluorodeoxyglucose PET/CT (FDG PET/CT) has good diagnostic performance (pooled sensitivity of 90% andspecificity of 98%). Recently, limited data has been reported that cranial artery inflammation can be detected onnewer generation non-digital PET/CT scanner. With such advancements, it has been suggested that FDG PET/CTmay be able to replace TAB. We hypothesized that digital FDG PET/CT can be used for the diagnosis of GCAthrough the integrated assessment of cranial and extracranial artery inflammation. Methods: We report data from the use of our GE Discovery MI digital PET/CT for the diagnosis of GCA as analternative to TAB during the COVID-19 lockdown. Subjects were included if they were referred for FDG PET/CT forclinically suspected GCA. Exclusion criteria included corticosteroid therapy > 3 days prior to PET/CT or history of known vasculitis. 185-370 MBq of FDG was injected intravenously and imaging acquired 60-90 minutes later.Images were interpreted by two expert readers and a consensus was obtained for every case. Results: Fifteen (9 women, 5 men) subjects were included in the analysis. The mean age was 72 years, mean CRP67.9 mg/L (normal 0-10 mg/L), and mean ESR 56.9 mm/h (normal 2-39 mm/h). Seven subjects were scanned within3 days of corticosteroid initiation and the other 8 had not received corticosteroids. Four of 15 subjects (27%) werediagnosed with GCA by PET with abnormal cranial or large vessel artery uptake (2 subjects with cranial uptakealone and 2 with both cranial and extracranial uptake), and 3 had evidence of PMR on PET without vasculitis. Inthose diagnosed with GCA by PET, vascular inflammation was visualized in the temporal arteries in all 4, maxillaryand occipital arteries in 3 subjects (Fig.1). Alternate diagnoses explaining the clinical presentation were made in 5 of8 remaining subjects (63%) including subacute thyroiditis, active sinusitis, metastatic malignancy and masticatorspace malignancy. During a follow-up period averaging 58 days (range 22 to 94 days), good response to prednisonewas seen in the patients diagnosed with GCA by PET/CT and no evidence of GCA in the remaining non-GCApatients. Conclusions: In conclusion, digital FDG PET/CT appears promising for the diagnosis of GCA through its enhancedsensitivity and resolution to detect small cranial artery inflammation. Further prospective studies comparing digitalFDG PET/CT with current GCA diagnostic modalities is warranted. (Figure Presented).
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BACKGROUND: The ecosystemic approach to children's needs demands a cohesive response from societies, communities, and families. During the COVID-19 pandemic, the choices societies made to protect their community members from the virus could have created contexts of child neglect. With the closure of services and institutions, societies were no longer available to help meet the needs of children. OBJECTIVE: The purpose of this study is to examine parents' reports on the response their children received to their needs during the COVID-19 crisis. METHODS: During the period of the spring 2020 lockdown, 414 parents in the province of Quebec, Canada, completed an online questionnaire about the impact of the crisis on the response their children received to their needs. RESULTS: Compared to parents of younger children, parents of older children reported less fulfillment of their child's needs in three measured domains, namely cognitive and affective, security, and basic care needs. CONCLUSION: These results are discussed in light of the policies and the resources societies have put in place during the crisis to help families meet the needs of their children. Societies must learn from this crisis to put children at the top of their priorities in the face of a societal crisis. Thoughtful discussions and energy must be given to ensure that, while facing a crisis, the developmental trajectories of children are not sacrificed.