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Background: Transcranial magnetic stimulation (TMS) treatment holds promise for pediatric neurological and psychiatric illnesses, but little is known about the acceptability, feasibility, and uptake of experimental TMS intervention in pediatric populations. The current study aimed to identify successful recruitment strategies and participation barriers in the CBIT+TMS Trial, an ongoing clinical trial testing TMS augmentation of behavior therapy for Tourette Syndrome in 12-21 year olds. Method(s): Participation involves 10 daily treatment sessions over two weeks plus pre/post neuroimaging and clinical assessments through 3-month follow-up. Recruitment data from November 2020 - August 2022 were examined for recruitment status, recruitment source, and reason for ineligibility or non-participation. Result(s): N = 171 individuals expressed interest in participation. Of these, 53% declined or passively declined participation, 45% completed phone screening, 19% were deemed ineligible, and 18% enrolled. The most successful recruitment strategies were community flyering, sharing information through a patient support organization, and provider referrals. The most commonly stated reasons for declining participation were related to time commitment and the need to travel to in-person appointments. Notably, participation was greatest during summer months. All enrolled participants have been retained through follow-up visits. Conclusion(s): TMS treatment is of interest to youth and parents in the TS community. As a comparison, a prior TS therapy trial screened =6 youth/month across three sites (Piacentini et al., 2010), whereas our single site is screening =4 youth/month. Stated reasons for declining participation related to schedule and travel feasibility rather than concerns about TMS. This recruitment period overlapped with the COVID-19 pandemic, which likely heightened these particular barriers. Future pediatric TMS research should include efforts to maximize efficacy within protocol schedules that are feasible for youth. Continued examination of factors contributing to pediatric TMS interest and uptake can help inform developmentally sensitive intervention and clinical trial protocols. Research Category and Technology and Methods Clinical Research: 10. Transcranial Magnetic Stimulation (TMS) Keywords: Tourette, Clinical Trial, Pediatric, FeasibilityCopyright © 2023
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The importance of rapid access to diagnostics tools in the identification of pathogens-including their crucial component, bioreagents-was recently underscored in the COVID-19 pandemic. The currently adopted synthesis of dithiothreitol (DTT) involves four steps in batch with long reaction times and which generates a highly carcinogenic and mutagenic bis-epoxide intermediate. In this work, we have developed an intensified telescoped three-step continuous flow synthesis of DTT involving a base-mediated ring closure epoxidation, a nucleophilic epoxide opening with thioacetic acid, and an acid-mediated deacetylation. One of the key features is that the first two steps are conducted in a telescoped continuous flow fashion, allowing generation and consumption of the hazardous intermediate in situ, suppressing the need for its isolation, and improving the overall safety of the synthesis. The process is completed by an acid-catalyzed deacetylation and a subsequent recrystallization to afford the desired DTT. Flow chemistry allows here to intensify the process by using high temperatures and high pressures while minimizing the number of unit operations and improving the overall safety of the process. Our protocol permits the on-demand production of DTT in case of future outbreaks.
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The importance of rapid access to diagnostics tools in the identification of pathogens-including their crucial component, bioreagents-was recently underscored in the COVID-19 pandemic. The currently adopted synthesis of dithiothreitol (DTT) involves four steps in batch with long reaction times and which generates a highly carcinogenic and mutagenic bis-epoxide intermediate. In this work, we have developed an intensified telescoped three-step continuous flow synthesis of DTT involving a base-mediated ring closure epoxidation, a nucleophilic epoxide opening with thioacetic acid, and an acid-mediated deacetylation. One of the key features is that the first two steps are conducted in a telescoped continuous flow fashion, allowing generation and consumption of the hazardous intermediate in situ, suppressing the need for its isolation, and improving the overall safety of the synthesis. The process is completed by an acid-catalyzed deacetylation and a subsequent recrystallization to afford the desired DTT. Flow chemistry allows here to intensify the process by using high temperatures and high pressures while minimizing the number of unit operations and improving the overall safety of the process. Our protocol permits the on-demand production of DTT in case of future outbreaks. © 2023 American Chemical Society.
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Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2022
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Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2022
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Background: Complication and complexity are two aspects that the cancer patient carries with him during the time he spends in cancer treatment. The tumor is to be considered a disease that is part of the biological complications that affect one or more organs of our body, which refer to a very specific treatment, to surgical interventions of a certain type, to any pain therapy, etc. Complexity, on the other hand, represents a term that refers to the description of the ensemble that make up the individuality of the cancer patient. Therefore, within the treatment, various elements that are part of the patient's world and that can represent a strength in the oncological path must be taken into consideration. Material(s) and Method(s): 80 patients from the oncology ward participated in the research, recruited in 2019 (n = 40) and in 2020-2021 (N = 40). The semi-structured clinical psychological interview, lasting one hour, was used as a data collection tool, which examined the evaluation of the patient's depression, anxiety and altered emotional states regarding the presence or fewer family affections during hospitalization, visits from friends, knowledge of one's status as a cancer patient. Result(s): From the analysis of the data it emerges that the oncological patients who suffered from depression, anxiety or elements attributable to altered emotional states in 2019 are 32.50% of the sample examined while in 2020 and 2021 the recorded incidence includes about 90.00% of the sample. This higher incidence derives mainly from the consequence of the closure to visits by family members in the medical oncology ward for the sars-cov-2 pandemic, rather than from the other factors taken into consideration, leading, in the most serious cases, to requests for early discharge by of the patient himself. Conclusion(s): Understanding the worlds within the cancer patient should not be seen as an obstacle to treatment but as a resource to be used to improve patient compliance. Placing the complexity of the individual at the center of the analysis determines a decrease in anxiety, depression and altered emotional states with an increase in the doctorpatient relationship, effectiveness of treatments, circulation of information and trust in care.
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Background. Most adolescents (age 12-17 years) with COVID-19 have mild disease. However, certain comorbidities may be risk factors for disease progression, and hospitalization rates for this age group have increased. Adolescents and adults with mild to moderate COVID-19 are eligible for monoclonal antibody therapy. To identify subgroups likely to benefit from this intervention, we evaluated the relationship between comorbidities and need for hospitalization in US adolescents presenting with mild to moderate COVID-19. Methods. We analyzed presence of comorbidities and need for hospitalization within 28 days of diagnosis for adolescents in the PIDTRAN registry, a multicenter retrospective cohort of US pediatric patients with COVID-19. Comorbidities assessed included obesity, chronic kidney disease (CKD), diabetes (DM), immunosuppressive disease or treatment (IS), sickle cell disease (SCD), congenital/ acquired heart disease (CHD), neurologic disease/neurodevelopmental disorders (ND), medical-related technology dependence (MTD), and pulmonary disease requiring daily inhaled corticosteroids (PD). We used multivariable logistic regression to determine race/ethnicity-adjusted associations between comorbidities and hospitalization. Results. 1574 patients met inclusion criteria, of whom 180 (11.4%) were hospitalized within 28 days of COVID-19 diagnosis. In a race/ethnicity-adjusted model, the following comorbidities were independently associated with increased odds of hospitalization: IS (OR 10.8 [95%CI 5.4 - 21.7]);CKD (OR 5.1 [95%CI 1.0 -25.6]);DM (OR 4.2 [95%CI 1.7 - 10.6]);SCD (OR 3.4 [95%CI 1.1 - 10.6]). ND (OR 3.0 [95%CI 1.7 - 5.4]);and obesity (OR 2.0 [95%CI 1.1 - 3.9]). Notably, CHD, MTD, and PD were not independently associated with hospitalization. There was no effect modification of race/ethnicity on the association between obesity or DM and hospitalization. Conclusion. IS, CKD, DM, SCD, ND, and obesity were associated with increased odds of hospitalization in adolescents presenting with mild to moderate COVID-19. Adolescents with these comorbidities should be prioritized for consideration of treatment with monoclonal antibodies.
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This article documents how the COVID-19 crisis has affected the drinking behavior of Latin European wine consumers. Using a large online survey conducted during the first lockdown in France, Italy, Portugal, and Spain (n = 7,324 individuals), we reconstruct the purchasing and consumption patterns of the respondents. The number of people who maintained their wine consumption frequency is significantly higher than those who increased or decreased their consumption. Wine consumption frequency held up better than other types of alcohol (beer and spirits). We analyze heterogeneities among countries and individuals by employing the Marascuilo procedure and an ordered logit model. The latter identifies the impact of demographic, commercial, and psychosocial factors on wine consumption frequency. The results shed light on changes in wine consumer behavior during the first lockdown and consider possible post-lockdown trends that could be useful to industry players.
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BACKGROUND: The recent emergence of new SARS CoV-2 variants (variants of concern, VOC) that spread rapidly and may lead to immune escape has emphasized the urgent need to monitor and control their spread. METHODS: We analyzed 2018 SARS-CoV-2 positive specimens collected between February 9 and March 22, 2021 using the Thermofisher® TaqPath™ COVID-19 CE-IVD RT-PCR kit (TaqPath) and the ID solutions® ID™ SARS-CoV-2/UK/SA Variant Triplex RT-PCR (ID triplex) assay to screen for VOCs. RESULTS: The ID triplex assay identified 62.8% of them as VOCs: 61.8% B.1.1.7 and 0.9% B.1.351/P.1. The agreement between the ID triplex results for B.1.1.7 and the TaqPath S gene target failure (SGTF)/ S gene target late detection (SGTL) profile for this variant agreed very well (k = 0.86). A low virus load was the main cause of discrepancies. Sequencing discordant results with both assays indicated that the TaqPath assay detected the B.1.1.7 lineage slightly better. Both assays suggested that the virus loads of B.1.1.7 variants were significantly higher than those of non-B.1.1.7 strains. Only 10/20 B1.351/P.1 strains detected with the ID triplex assay were confirmed by sequencing. CONCLUSIONS: We conclude that the SGTF/SGTL profiles identified using the TaqPath assay and ID triplex results are suitable for detecting the B.1.1.7 lineage. The ID triplex assay, which rapidly determines all three current VOCs simultaneously, could be a valuable tool for limiting virus spread by supporting contact-tracing and isolation.
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COVID-19 , SARS-CoV-2 , Humans , Multiplex Polymerase Chain Reaction , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
Background: Vaccination is an important and effective tool to prevent infections in the general population as well as in patients with systemic autoimmune or inflammatory rheumatic diseases (AIIRDs) who may be at increased risk of serious infection. While the global race for vaccines against COVID-19 has already lead to first authorizations and vaccinations in some countries, multiple questions arise for access and provisions as well as for the acceptance of vaccine policies by immunocompromised patients. Objectives: We conducted an international survey about expectations and potential concerns regarding SARS-CoV-2 vaccine in patients with AIIRDs and healthcare professionals. Methods: The online study consisted of 57 questions which addressed determinants associated with SARS-2-CoV-2 vaccine willingness. Dissemination was ensured through social media and patient associations between December 12 and December 21, 2020. Results: The study included 1266 patients with AIIRDs and 265 healthcare professionals from 56 countries. SARS-CoV-2 vaccine willingness was reported by 54.2% of AIIRD patients (uncertainty in 32.2% and unwillingness in 13.6%) and 74.0% of healthcare professionals. In patients, the willingness to get vaccinated increased significantly with age (p<0.0001) and was strongly associated with the fear to be infected by SARS-CoV-2 (p<0.0001) or to develop severe COVID19 (p<0.0001) but not with presence of additional comorbidities (p=0.71) or immunocompromised status (p=0.94). The most trusted healthcare professional regarding the recommendation to get vaccinated against COVID-19 was their specialist (rheumatologist, internist, etc.) for 69.9%. Vaccine unwillingness was low (7.9%) among healthcare professionals and willingness was significantly increased in those who had been vaccinated against influenza in the last 3 years (p=0.01). Conclusion: Data from this study are crucial to understand the main expectations and concerns regarding SARS-CoV-2 vaccination in patients with AIIRDs and healthcare workers and allow the identification of valuable strategies to increase vaccine coverage in those populations.
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Background: Multisystem inflammatory syndrome in children (MIS-C) has been described in areas with high Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) burden. Clinical features included in the MIS-C case definition (e.g fever, elevated inflammatory markers) overlap with features of other childhood infections. The prevalence of non-SARS-CoV-2 infection in patients evaluated for MIS-C has not been described. Methods: Retrospective cohort study of patients < 21 years of age admitted to a freestanding children's hospital in Boston, MA from May 14-June 6, 2020 who were evaluated for MIS-C. We identified patients undergoing Rheumatology consultation and echocardiogram (per the hospital's protocol for evaluating children with suspicion for MIS-C). We tabulated patients evaluated for MIS-C found to have non-SARS-CoV-2 infection detected on standard microbiologic testing. Results: 39 patients met inclusion criteria. Median age was 5 years (IQR 2-12 years). Of evaluated patients, 19/39 (49%) were diagnosed with MIS-C according to the Massachusetts Department of Public Health case definition;10/39 (26%) required ICU admission. Non-SARS-CoV-2 infections were identified in 7/39 (18%), of whom 5/7 (71%) had bacterial infections, 1/7 (14%) had viral infection, and 1/7 (14%) had viral and bacterial co-infections;no fungal or parasitic infections were identified. Of patients diagnosed with MIS-C, 2/19 (11%) were found to have non-SARS-CoV-2 infection. Additionally, 5/19 (26%) had a positive polymerase chain reaction test for SARS-CoV-2 at time of MIS-C diagnosis, of whom 4/5 (80%) received remdesivir. Of patients evaluated for MIS-C, 17/39 (44%) received intravenous immune globulin, 14/39 (36%) aspirin, 4/39 (10%) anakinra, and 14/39 (36%) methylprednisolone. Additionally, 21/39 (54%) received antibacterial and 5/39 (13%) antiviral therapy (Table). Conclusion: In this study, non-SARS-CoV-2 infections were diagnosed in 18% of children evaluated for MIS-C. Clinicians should consider alternative or concomitant infectious diagnoses in patients undergoing MIS-C evaluation. Research is needed to identify clinical and laboratory features that may distinguish patients with MIS-C from those with non-SARS-CoV-2 infection. (Figure Presented).