Tele-rehabilitation for people with dementia in the COVID-19 pandemic: A case-study

Introduction The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) is delivering an exercise programme for people with dementia. The Lincolnshire partnership NHS foundation Trust successfully delivered PrAISED through a video-calling platform during the COVID-19 pandemic. Objectives This qualitative case-study identified participants that video delivery worked for, and highlighted its benefits and challenges. Methods Interviews were conducted with participants with dementia, caregivers and therapists, and analysed through thematic analysis. Results Video delivery worked best when participants had a supporting carer, when therapists showed enthusiasm and had an established rapport with the client. Benefits included time-efficiency of sessions, enhancing participants’ motivation, caregivers’ dementia awareness and therapists’ creativity. Limitations included users’ poor IT skills and resources. Conclusions The COVID-19 pandemic required innovative ways of delivering rehabilitation. This study supports that people with dementia can use tele rehab, but success is reliant on having a caregiver and an enthusiastic and known therapist.

Oxidative Stress and Indicators of Brain Damage Following Pediatric Heart Surgery.

Pediatric cardiac surgery induces an increased oxidative stress (OS) response. Increased OS is associated with poor neurologic outcomes in neonatal populations with similar patterns of brain injury. We investigated OS and brain injury in infants undergoing heart surgery. Patients 6 months or younger, undergoing cardiac surgery with or without cardiopulmonary bypass (CPB), were included in this prospective, observational study. Patients were divided into infant (30 days-6 months) and neonatal (<30 days) groups for analysis. Urine OS biomarker 8-iso-prostaglandin F2α (8-iso-PGF2α) was quantified pre-surgery and at 0 and 24 h post-surgery. A serum brain damage biomarker S100B protein was also measured pre-surgery and at 0 and 72 h post-surgery. Amplitude-integrated electroencephalography during surgery was analyzed. Neuropsychological evaluation using the Bayley III or Vineland test was performed in all patients at 24 months of age. Sixty-two patients were included, 44 of whom underwent follow-up neurologic evaluation. 8-iso-PGF2α and S100B levels were increased after surgery. Postoperative levels of S100B were positively correlated with 8-iso-PGF2α levels 24 h after surgery (rho = 0.5224; p = 0.0261). There was also a correlation between immediate post-surgery levels of 8-iso-PGF2α and intra-surgery seizure burden (rho = 0.4285, p = 0.0205). Patients with an abnormal neurological evaluation had increased levels of S100B 72 h after surgery (p = 0.048). 8-iso-PGF2α levels 24 h after surgery were also related to abnormal neurologic outcomes. Levels of 8-iso-PGF2α following pediatric cardiac surgery are associated with several indicators of brain injury including brain damage biomarkers, intra-operative seizures, and abnormal neurological evaluation at follow-up, suggesting the importance of oxidative stress response in the origin of brain damage in this population.

Telemedicine for routinary multiple sclerosis follow-up during SARS-CoV2 pandemic: A single center experience

Background and aims: Telemedicine in multiple sclerosis (MS) is promising, particularly for patients with high disability and difficulties to reach the treating centre. During SARS-CoV2 pandemic, teleconsults are gaining a central role. The aim of the present study was to report our single-center experience and to verify the effectiveness of teleconsults in diagnosing relapses and rating progression. Methods: During the first lockdown phase (March–May 2020) all the pre-planned consults were converted in teleconsults. The evaluation focused on new symptoms or worsening of known symptoms, disability (PDDS), patients’ satisfaction of such assessment modality (rated form 0 to 10). Patients were then re-evaluated in person within 6 months. We verified the changes in disability and the accuracy of teleconsults in diagnosing MS relapses. Results: Eighty-four patients underwent teleconsult and were re-evaluated in person within 6 months after the lockdown (69% female, mean age 50.5 ± 11.0 y, mean disease duration 13.0 ± 9.7 y 78.6% relapsing-remitting disease form, 76.2% on disease modifying treatment). Median pre-lockdown EDSS was 1.5 (range 0–8) median EDSS post lockdown was 2 (1–8) (p = 0.836);median PDDS during lockdown was 1.5 (0–8). A single disease relapse was detected with teleconsults. In the post lock-down in person evaluation no additional undiagnosed relapses were detected. Patients’ reported satisfaction was very high (median 10, range 8–10). Conclusions: Teleconsult in MS patients allowed us to guarantee a regular neurological follow-up during pandemic lockdown. No unreported relapses were missed, no significant disability changes were reported nor detected compared to pre-lockdown evaluation. Finally, patients' satisfaction of this modality was very high.

Sars-CoV2 pandemic and lockdown reported consequences on people with multiple sclerosis

Background and aims: During SARS-CoV-2 pandemic people with multiple sclerosis (PwMS) may experience a worsening due to increased anxiety and depression, reduction in rehabilitation, and less strict connection to MS centres. The aim of our study was to describe the self-reported impact of SARS-CoV-2 pandemic and lockdown on PwMS. Methods: On June 2020, we enrolled PwMS who underwent teleconsult during the lockdown phase (March–May 2020). Self-rated worries for pandemic, perception of change in anxiety, depression, fatigue and spasticity was asked, as well as changes in weight, physical activity and food intake. We compared patients with and without reported increase in: spasticity, anxiety, depression and fatigue. Binary logistic regression analyses were applied including significant variables. Statistical significance was set at p < 0.05. Results: Ninety-three MS patients were enrolled (71% female, 77% RR, median age 50.3 y, mean disease duration ≅13 y). Many patients reported an increase of anxiety (36.6%), depression (34.4%), fatigue (26.9%) and, spasticity (18.3%), weight (47.3%) and 63.4% of patients reported e reduction of physical activity;moreover 59.1% and 43% reported particular worries for the pandemic and the perception of greater impact on PwMS of the pandemic compared to general population, respectively. In the multivariate models, anxiety was predicted by depression, particular worries for SARS-CoV2 pandemic and reduction in physical activity;depression by anxiety;fatigue by reduction in physical activity;spasticity by EDSS. Conclusions: The self-reported impact of pandemic on PwMS was deep in terms of increased depression, anxiety, fatigue and spasticity, mainly related to reduction in physical activity and pre-existing disability.

Tele-rehabilitation for people with dementia in the COVID-19 pandemic: A case-study

IntroductionThe Promoting Activity, Independence and Stability in Early Dementia (PrAISED) is delivering an exercise programme for people with dementia. The Lincolnshire partnership NHS foundation Trust successfully delivered PrAISED through a video-calling platform during the COVID-19 pandemic.ObjectivesThis qualitative case-study identified participants that video delivery worked for, and highlighted its benefits and challenges.MethodsInterviews were conducted with participants with dementia, caregivers and therapists, and analysed through thematic analysis.ResultsVideo delivery worked best when participants had a supporting carer, when therapists showed enthusiasm and had an established rapport with the client. Benefits included time-efficiency of sessions, enhancing participants’ motivation, caregivers’ dementia awareness and therapists’ creativity. Limitations included users’ poor IT skills and resources.ConclusionsThe COVID-19 pandemic required innovative ways of delivering rehabilitation. This study supports that people with dementia can use tele rehab, but success is reliant on having a caregiver and an enthusiastic and known therapist.

Fusobacterium nucleatum and alteration of the oral microbiome: from pregnancy to SARS-COV-2 infection.

OBJECTIVE: The human being has evolved in close symbiosis with its own ecological community of commensal, symbiotic and pathogenic bacteria. After the intestinal microbiome, that of the oral cavity is the largest and most diversified. Its importance is reflected not only in local and systemic diseases, but also in pregnancy since it would seem to influence the placental microbiome. MATERIALS AND METHODS: This is a literature review of articles published in PubMed about Fusobacterium Nucleatum and both its implications with systemic and oral health, adverse pregnancy outcomes, flavors perception and its interference in the oral-nasal mucosal immunity. RESULTS: It is in maintaining the microbiome's homeostasis that the Fusobacterium nucleatum, an opportunistic periodontal pathogen of the oral cavity, plays a crucial role both as a bridge microorganism of the tongue biofilm, and in maintaining the balance between the different species in the oral-nasal mucosal immunity also by taste receptors interaction. It is also involved in the flavor perception and its detection in the oral microbiome of children from the first days of life suggests a possible physiological role. However, the dysbiosis can determine its pathogenicity with local and systemic consequences, including the pathogenesis of respiratory infections. CONCLUSIONS: It is interesting to evaluate its possible correlation with Sars-CoV-2 and the consequences on the microflora of the oral cavity, both to promote a possible broad-spectrum preventive action, in favor of all subjects for whom, by promoting the eubiosis of the oral microbiome, a defensive action could be envisaged by the commensals themselves but, above all, for patients with specific comorbidities and therefore already prone to oral dysbiosis.

COVID-19 pandemic: Psychological effects of quarantine on adults and children

In recent months, the majority of nations (at first China) are facing a dangerous threat that has forced governments to adopt and implement drastic restrictive measures such as quarantine. This threat is called "COVID-19 Emergency" (Corona Virus Disease-19). The quarantine condition imposed due to the extensive spread of coronavirus has, in the medium and long term, inevitable repercussions on many psychopathological states characterized by anxiety-depressive symptoms. For children, however, the impact of the traumatic context has different importance and outcomes, depending on their cognitive capacity and emotional competence. When children are experiencing a quarantine period in a state of world emergency such as the current one, his or her ability to manage the cognitive capacity and emotional competence adaptively and functionally has an essential significance. They may also perceive the experience as traumatic or not, through Reflective Function and Affect Mirroring with parents. Family experiences, care, and parenting are formative and preparatory to cope with the many events that life presents. It, therefore, becomes essential to establish in the family a climate of support and containment that facilitates the restructuring of the phenomenon and exorcises the stress arising from the event itself and contributes to the development of agency and resilience skills. © 2020, Scientific Publishers of India. All rights reserved.