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We propose a reading of the plague in the tragedy of Sophocles Philoctetes, based on the interpretive paradigms of Paul Ricoeur, which emphasizes the role of the mythical model in updating the symbols of origin and especially the presence of evil. We go through the notions associated with dirt as guilt and wound as expiation. From there we offer lines of reflection to think about the non-physical implications of the current pandemic;if the cosmic plane of events connects with an ethical plane, the relationship with present evil demands new community responses.
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Background: Krebs von den Lungen-6 (KL-6) is a mucin glycoprotein mainly produced on the surface of alveolar type 2 epithelial cells. Some case-control studies comparing healty subjects to COVID-19 patients in different stages of severity have documented that serum KL-6 levels predict COVID-19 severity and poor clinical outcomes. However, the relevance of KL-6 in patients with severe and critical COVID-19 have not fully elucidated. Method(s): Retrospective data from consecutive severe to critical COVID-19 patients were collected at UOC Clinical Pnuemologica "Vanvitelli", A.O. dei Colli, Naples, Italy. Study included patients with a positive rhinopharyngeal swab for SARS-COV-2 RNA with severe or critical COVID-19. Result(s): Study population characteristics are reported in Table 1. Among 87 patients 24 had poor outcomes (IOT or death). Median KL-6 value in survivors was significantly lower when compared with patients dead or intubated (530 U/mL versus 1069 U/mL p<0.001). KL-6 was correlated with BMI (r: 0.279, p:0.009), LUS Score (r: 0.429, p<0.001), Chung Score (r: 0.390, p<0.001). KL-6 was associated with risk of death or IOT after adjusting for gender, BMI, Charlson Index, Chung Score, and P/F (OR 1.003 95%IC 1.001-1.004, p <0.001). Serum KL-6 value of 968 has a sensivity of 79.2%, specificity of 87.1%, PPV 70.4%, NPV 91.5%, AUC: O.85 for risk of death or IOT (Figure 1). Conclusion(s): The presented research highlights the relevance of serum KL-6 in severe to critical COVID-19 patients in predicting the risk of death or IOT.
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Serum Amyloid A (SAA) is an acute-phase protein mainly produced by the liver in response to pro-inflammatory cytokines. SAA is primarily produced by hepatocytes in response to the inflammatory cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1beta and IL-6. In healthy individuals, plasma SAA level is within 0.10 mg/L. However, under inflammatory conditions, plasma SAA levels can increase exponentially, even reaching 1000 mg/L or more in some cases. Human SAA expression is upregulated during the acute phase of various viral infections, including cytomegalovirus, herpes simplex virus, measles virus, mumps virus, rubella virus and varicella-zoster virus, and returns to normal during the convalescent phase of infection. Moreover, can be a useful biomarker to predict COVID-19 patient's severity and prognosis.The aim of this study was to evaluate a new chemiluminescence immunoassay for SAA.All serum samples were measured on Maglumi (Snibe platform) and compared with BN ProSpec (Siemens platform), which is used in the routine of the clinical laboratory of the 'Tor Vergata' University Hospital. Analytical precision, correlation coefficient and linearity were assessed. The precision of CLIA system was evaluated by using the commercial normal and high-quality control materials (IQC) recommended by the manufacturer for evaluating precision of SAA. Precision estimation was performed by evaluating triplicate measurements of aliquots of the same samples, performed for a total of five non-consecutive days. Precision data correlated with those declared by the manufacturer. The linearity test was performed using a series of serial dilutions (1/1, 1/2, 1/4, 1/8, 1/16, 1/32, 1/64, 1/128, 1/256 and only diluent) with dilution sample by manufacture. The linearity test showed a correlation coefficient equivalent to 0.997. The results from Snibe platform correlated well with those obtained by Siemens platform with a correlation coefficient of 0.974 (p<0.001). This study demonstrated that the new Snibe SAA test has excellent analytical performance and good reliability and can be used in routine analysis.
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Introduction: To evaluate and validate the use of a remote check application in real life to enable cochlear implant (CI) recipients or parent/caregivers to monitor at home their progress and to help their clinicians to determine and plan for clinical visits based on their needs. Method(s): A total of 110 implanted patients (age range: 6-77 years;12-month implant experience and familiarity with vocabulary for digits 0 to 9) were included in this study, in which each subject served as their own control. The test battery includes an implant-site photograph, impedance measurements, datalogs, questionnaires, speech perception, and aided threshold tests. Chi-square test was used for statistical analysis of the results obtained at home vs clinical setting. Result(s): In all but 2 cases (108/110, 98%) the test battery reached the same conclusion as the clinician in determining whether the recipient required any clinical action. Of recipients and parents/ caregivers, 90% (100/110) reported being "satisfied" or "very satisfied" if their clinic visits were based on results from the selfadministered remote test battery (P<.001). Reasons for satisfaction included the convenience of remote monitoring, the ability to request an appointment if needed, and the continued involvement of their clinician. Satisfaction ratings with the remote monitoring concept were moderately to strongly correlated with perceived improvement in convenience and time involved. Conclusion(s): Most respondents recognized that the remote check battery has the potential to save time, reduce costs, and increase the convenience of aftercare. The clinicians with remote check battery are adequately informed regarding patient management, appointment scheduling, and required clinical actions. This may also further support global case management during COVID-19 pandemic time of recommended social distancing.
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Background: Among immunocompromised patients with immune mediated infammatory diseases (IMIDs), those undergoing therapy with B cell depleting agents are among the most vulnerable to both severe COVID-19 disease and sub-optimal response to COVID-19 vaccines(1). Numerous studies have documented suppressed humoral, but relatively maintained cell mediated, responses to COVID-19 vaccines in these patients. However, the clinical signifcance of such immunity in terms of protection from infection and its sequelae are poorly understood. We have analyzed a large cohort of vaccinated IMIDs patients undergoing B cell depleting therapy for the presence of breakthrough infection and assessed their outcomes. Objectives: To defne the frequency and outcomes of COVID-19 breakthrough infection in fully or partially vaccinated IMIDs patients receiving B cell depleting therapies. To assess the characteristics and risk factors for severe outcomes and death. Methods: All pharmacy records from within a large health care system were electronically searched for patients undergoing B cell depleting therapies with approved monoclonal antibodies in 2020. Records with ICD codes for IMIDs but not malignancies were included;patients must also have had at least one documented COVID-19 vaccine. From this cohort all patients with breakthrough COVID-19 disease from time of 1st vaccination through December 15, 2021 were identifed;each record was hand-reviewed to extract clinical data including vaccine history, demographics, comorbidities, use of monoclonal antibodies, dose and timing of B cell depleting therapy, and outcomes as assessed by an 8 point NIH ordinal scale. Univariate and multivariable logistic/proportional-odds regression models were used to examine the risk factors for severe outcomes. Results: A total of 1677 IMIDs patients were identifed who received any B cell depleting monoclonal antibody and at least one COVID-19 vaccine in 2021. From this cohort 74 patients (4.4%) experienced a breakthrough COVID-19 infection. Among the breakthrough patients 34 (46%) had a rheumatic disease (RA 11, AAV 15, SLE 2), 34 (46%) had CNS infammatory disease (MS 32, 2 other), and 6 (8%) had immune hematologic/miscellaneous diseases. Four patients had a previous history of COVID-19 infection. Overall 24 (35%) were hospitalized with 11 patients requiring critical level care (15%) and 6 deaths (8 %). All fatal cases had rheumatic diseases. Monoclonal antibodies were given as outpatient therapy to 21 patients and among these only 1 patient was hospitalized without requiring O2 and none died. In univariate analysis only number of comorbidi-ties had a signifcant positive effect (p=.001) on severe outcomes (i.e. groups 1-4 vs. groups 5-8: Table 1) while monoclonal antibody therapy was associated with more favorable outcomes (p=.005 group 1-2 vs.3-8, Table 1). There were no associations between the dose, duration or timing of the B cell therapy, concomitant therapies including glucocorticoids, vaccine status (incomplete, complete, boosted) or date of vaccination with severe outcomes. Conclusion: In IMIDs patients treated with B cell depleting therapies breakthrough infections are common with many experiencing severe outcomes. Concomitant comorbidities were associated with risk of severe disease. Monoclonal antibody therapy was used in only 28% but was associated with enhanced clinical outcomes with only 1 in 21 requiring hospitalization and zero mortality. This population of immunocompromised patients remains vulnerable to COVID-19 disease despite vaccination. More aggressive use of outpatient management with monoclonal antibody therapy and other preventive and therapeutic measures are urgently needed.
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The basophil activation test (BAT) is a flow cytometric assay that evaluates the percentage of activation or degranulation of peripheral blood basophils, after “in vitro” exposure to specific allergens. In sensitized patients, the stimulation of peripheral blood basophils with a specific allergen induces or up-regulates the expression of molecules, such as CD63 and CD203c, which represent, markers of degranulation and activation of basophils, respectively. The validity of the BAT requires a negative control (sterile saline) and a positive control (anti-IgE molecules). Several studies have demonstrated the role of the BAT in supporting the diagnosis of drug, food and hymenoptera venom allergy. The BAT has shown a low sensitivity but good specificity in diagnosing allergy to drugs such as NSAIDs, beta-lactam antibiotics, quinolones and muscle relaxants. In food allergy, the sensitivity and specificity of the BAT depends on the food;in the case of peanut allergy the sensitivity reaches 96% while the specificity the 100%. In addition, the BAT is an useful tool to monitor the natural resolution of allergies and the clinical effects induced by either immunotherapy or anti-IgE treatment. Finally, the BAT has been utilized to study the pathogenetic mechanisms underlying several IgE-mediated diseases. For example, in patients affected by severe bronchial asthma, the BAT has demonstrated the ability of Staphylococcus aureus enterotoxins to induce the activation of basophils supporting the role of these enterotoxins as “triggers” of the inflammatory cascade in bronchial asthma. In patients with cystic fibrosis the BAT can be used to dis-criminate allergic bronchopulmonary aspergillosis from Aspergillus colonization. More recently, the BAT has been demonstrated as a potential diagnostic tool to evaluate allergy to the polyethylene glycol (PEG) present in the anti-SARS-CoV-2 BNT162b2 mRNA vaccine.
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The Covid-19 pandemic has spread throughout the world, affecting the psychological well-being of individuals. Drawing on the attachment theory perspective, the present work sought to understand individual differences in response to the Covid-19 pandemic, analyzing the emotional and cognitive factors involved. A cross-sectional study was conducted to examine the complex relationship between attachment anxiety and avoidance, loneliness, Covid-19 risk perception, and perceived stress during the Covid-19 pandemic. Seven hundred sixty-one participants were involved. Data were analyzed using path analysis. Consistent with attachment theory, results showed a direct relationship between attachment anxiety and perceived stress during the Covid 19 pandemic, mediated in part by loneliness and Covid 19 risk perception. Similarly, attachment avoidance was directly related to perceived stress during the Covid-19 pandemic;this relationship was partially mediated by loneliness but not by Covid-19 risk perception. Our results demonstrate the influence of adult attachment on perceived stress during the Covid-19 pandemic through its effect on emotional and cognitive variables, providing useful information for implementing interventions to promote individual well-being during these times of health emergency © 2022. by the Author(s);licensee Mediterranean Journal of Clinical Psychology, Messina, Italy. This article is an open access article, licensed under a Creative Commons Attribution 4.0 Unported License
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Background: Sepsis is an infectious disease (the etiology can be viral or bacterial) with hight mortality, threatening human health. Clinicians need to diagnose the patient's infection in time and look for pathogens in order to develop an effective treatment plan;therefore, a quickly and early screen to diagnose sepsis has become an urgent problem in clinical laboratories. Different inflammatory factors are used to diagnose the sepsis;CRP, IL-6, PCT, ADM, lactate, D-dimer etc., but they also have limitations such as insufficient sensitivity and specificity and requiring additional examination cost. The aim of this study is to use leucocyte counts (neutrophils and monocytes that are activated from pathogenic virus or bacteria) and others morphological change with Mindray BC-6800-plus platform to diagnose sepsis early, quickly, conveniently and at low cost. Methods: A total 957 EDTA-k2 anticoagulant venous whole blood samples were collected: 70 control patients (blood donors) with a normal complete count blood and negative VES, and 887 samples hospitalized at the emergency department with symptoms attributable to sepsis with PCT request. All data was divided in 4 groups: control group, group where sepsis cannot be confirmed, group with confirmed sepsis diagnosis and a group with sepsis from SARS-CoV-2 infection. Morphometric and numeric parameters are reported with Mindray BC-6800 plus: blood count like positional parameters X, Y, Z of neutrophils, lymphocites and monocytes, PLT, NLR (neutrophil lymphocyte ratio) and IMG (index of immature granulocytes). For statistical analysis was used Shapiro Wilk test for distribution analysis and the non parametric Kruskal Wallis test to evaluate significative differences among the groups (p< 0.05) and also examined ROC curve analysis. Results: There is a statistically significant difference between control group and sepsis group for haematological parameters: positional parameters (Neu X, Y, Z;Mon X, Y, Z and Lym X, Y, Z), IMG, NLR, PLT. The roc curves highlight acceptable sensitivity and specificity values for some haematological parameters and suggest a possible cut-off. Conclusions: The BC-6800 plus can help the diagnosis of sepsis upon the admission to the emergency department using some morphological positional parameters.
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Background: COVID-19 vaccines have demonstrated excellent efficacy and safety profiles among the general population. However, studies have shown that vaccine hesitancy remains a significant problem especially in patients with chronic diseases, in part because of a lack of data regarding vaccine safety in these special populations. With this in mind, we investigated rates of vaccine-related side effects and disease flares in patients with inflammatory bowel disease (IBD). Methods: We conducted an online survey of patients with Crohn's disease (CD) and ulcerative colitis (UC) who were vaccinated from January 23 to October 15, 2021 with COVID-19 vaccines approved in Europe. We collected data regarding patient demographics, disease type, treatment and activity at the time of vaccination, patient-reported systemic side effects, and rates of disease flares and outcomes within 15 days of both vaccine doses. Results: A total of 329 (179 M, 150 F) patients participated in the survey, 162 with CD and 167 with UC. Mean age was 47.1 years (range 19-80). Patients were vaccinated with Pfizer-BioNTech (46.8%), Moderna (51.7%) or Oxford/AstraZeneca (1.5%). Three patients received only one dose because of recent prior infection, and one patient received a single dose dose due to infection before vaccine cycle completion. At the time of vaccination most patients (63.8%) reported disease remission, 22.8%= mild activity, 12.8%= moderate, 0.6%= severe. Mesalazine monotherapy was reported in 174 patients, 89 were on biologics, 8 were on azathioprine, and 58 were not undergoing treatment at the time of vaccination. Nineteen were on concomitant corticosteroid treatment. After the first dose, the most common side effects were mild: fatigue (38.6%), arthromyalgia (16.7%), headache (14.3%), fever (6.7%) and nausea (1.8%). Side effects after the second dose were more frequent but similar in nature (fatigue= 54.8%, fever= 34.8%, arthromyalgia= 31.7%, headache= 22.8%, nausea= 2.5%). Fourteen patients (4.3%) reported disease flare after the first dose and 26 patients (8%) after the second dose. Characteristiscs of these patients are summarized in Table 1. Most flares were self-limiting and did not require modification in treatment. In the five cases where treatment modification was required, two already had moderate/severe disease at the time of vaccination, one had suspended biologic treatment, and two patients had autonomously suspended maintenance therapy. Conclusion: Disease flares are infrequent and generally self-limiting after COVID-19 vaccination in patients with IBD. Other side effects are mild and comparable to the general population. Vaccination is strongly recommended in patients with IBD, and patients should be reassured about their safety.
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Background: As secondary bacterial infections have been associated with increased mortality in respiratory virus pandemics, we sought to determine if prior pneumococcal vaccination improves clinical outcomes in COVID-19 patients. Methods: We analyzed an observational registry of patients tested for COVID-19 at the Cleveland Clinic because of symptoms or other qualifying criteria from 3/8/2020-5/8/2020. Overlap propensity-score weighted logistic/linear regressions investigated associations between pneumococcal vaccination status and COVID-19- related clinical outcomes. Results: 18,197 patients (median age 50.2 yrs [IQR 30.4], 40% male, 67% white) were included. 2785 (15.3%) tested SARS-CoV-2-positive and 738(26.5%) were hospitalized. Prior pneumococcal vaccination in SARS-CoV-2 positive patients did not reduce ICU admission, oxygen usage, radiographic infiltrates, or need for mechanical ventilation. Pneumococcal vaccine recipients were less likely to test positive for SARSCoV- 2 (OR 0.77, 95% CI [0.68,0.87]). Pneumococcal vaccine recipients aged 15-65 years testing positive for SARS-CoV-2 had increased risk of hospitalization (OR 1.54 [1.001, 2.38] and death (OR 12.51 [1.92,81.36]) compared to non-recipients, and those >65 years were more likely to develop pneumonia (OR 8.45, 95% CI [1.77,40.42]). Conclusions: Pneumococcal vaccination status serves as a marker of underlying co-morbidities with greater risk of hospitalization and death from COVID-19 for those age 15-65 and of pneumonia for those >65, with no impact on other important adverse outcomes. The reduced prevalence of SARS-CoV-2 among pneumococcal vaccine recipients could reflect off-target vaccine effects or patterns of health behavior that persist despite propensity score adjustments. Our study supports evaluation of vaccination status, and vaccination of those at risk.
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Viral infections have historically had a complex relationship with autoimmune diseases. For patients with preexisting autoimmune disorders, often complicated by immunosuppressive therapies, there are numerous potential effects of COVID-19, a disease of complex immunobiology, including the potential for an altered natural history of COVID-19 when infected. In addition, individuals without recognized autoimmune disease may be vulnerable to virally induced autoimmunity in the forms of autoantibody formation, as well as the development of clinical immune-mediated inflammatory diseases. Until quite recently in the pandemic, this relationship between COVID-19 and autoimmune diseases has been relatively underexplored; yet such investigation offers potential insights into immunopathogenesis as well as for the development of new immune-based therapeutics. Our review examines this relationship through exploration of a series of questions with relevance to both immunopathogenic mechanisms as well as some clinical implications.