The effect of Covid-19 on duration of untreated psychosis in first-episode service

Background: During the first months of the COVID-19 pandemic presentations to emergency psychiatric services sharply declined, despite no significant change in the incidence of psychosis. Aim(s): To investigate the impact of COVID-19 on the duration of untreated psychosis (DUP) in a first-episode service. Method(s): Data was collected by the specialized treatment early in psychosis (STEP) clinic to compare the DUP pre vs. early and late pandemic stages. The onset of the pandemic was defined as the 15th of March 2020, based on an analysis of case numbers and the advent of restrictions. Outcome measures were DUP total (the time elapsed between onset of psychosis and enrolment in the STEP clinic), DUP demand (the time from onset of psychosis to first antipsychotic prescription), and DUP supply (the time from first antipsychotic prescription to enrolment into STEP). Result(s): DUP total decreased significantly (p = .008) during the early pandemic compared with pre-pandemic from a median of 208 (IQR, 24-1020.0) to 55.5 days (IQR, 8.0-560.0). During the late pandemic stage, DUP total increased back to a median of 153.5 days (IQR, 1.0- 885.0). DUP demand decreased significantly (p = .001) during the early pandemic compared to pre-pandemic from a median of 117 (IQR, 17.0-714.0) to 35 days (IQR, 2.0-541.0) and then reduced further to 27.5 (IQR, 0.0-690.0) days during the late pandemic. No significant changes were found in DUP supply (p = .24) across the different stages of the pandemic. This is the first study to show a reduction in DUP associated with the pandemic.

Transient plasma viral rebound after SARS-CoV-2 vaccination in an exceptional HIV-1 elite controller woman.

BACKGROUND: Elite controllers are able to control viral replication without antiretroviral therapy. Exceptional elite controllers do not show disease progression for more than 25 years. Different mechanisms have been proposed and several elements of both innate and adaptive immunity are implicated. Vaccines are immune stimulating agents that can promote HIV-RNA transcription; transient plasma HIV-RNA detectability has been described within 7-14 days after different vaccinations. The most reliable mechanism involved in virosuppressed people living with HIV is a generalized inflammatory response that activates bystander cells harboring latent HIV. So far no data about viral load increase in elite controllers after SARS-CoV-2 vaccination are reported in literature. CASE PRESENTATION: We report the case of a 65-year-old woman of European ancestry, diagnosed with HIV-1/HCV co-infection more than 25 years ago. Since then, HIV-RNA remained undetectable and she never received ARV therapy. In 2021 she was vaccinated with mRNA-BNT162b2 vaccine (Pfizer-BioNTech®). She was administered with three doses in June, July and October 2021, respectively. The last available viral load was undetectable in March 2021. We observed an increase of VL at 32 cp/ml and 124 cp/mL, two and seven months after the second vaccine dose, respectively. During monthly follow-up, HIV-RNA gradually and spontaneously dropped becoming undetectable without ARV intervention. COVID-19 serology was positive with IgG 535 BAU/mL, showing response to vaccination. We measured total HIV-DNA at different time-points and we found it detectable both at the time of the higher plasma HIV-RNA (30 cp/10^6 PBMCs) and when it was undetectable (13 cp/10^6 PBMCs), in reduction. CONCLUSIONS: This case is the first report, to our knowledge, describing a rebound of plasma HIV-RNA in an elite controller after three doses of mRNA-BNT162b2 vaccine for SARS-CoV-2. Concomitantly with a spontaneous reduction of plasma HIV-RNA ten months after the third dose of mRNA-BNT162b2 vaccine (Pfizer-BioNTech®) without antiretroviral therapy intervention, we observed a reduction of total HIV-DNA in peripheral mononuclear cells. The potential role of vaccinations in altering HIV reservoir, even in elite controllers when plasma HIV-RNA is undetectable, could be a valuable aspect to take into account for the future HIV eradication interventions.

Optimized Layout: A Genetic Algorithm for Industrial and Business Application

Covid-19 epidemic has harmed the global economy. Particularly, the restaurant sector has been severely impacted by the rapid spread of the virus. The use of digital technology (DT) has been utilized to execute risk-reduction methods as service innovation tools. In this work, a genetic algorithm optimization is used to cope with the problems caused by the restrictions due to Covid-19 to optimize the management of the spaces in commercial and industrial structures. The approach through the GA involves the selection of the best members of a population that change genome based on the epochs. The digitization of a commercial or industrial environment becomes an optimal methodology for carrying out virtual design of work environments. Digitization thus becomes a strategy for the reduction of both monetary and time cost. Focusing on the case study, satisfactory results emerge supported by tests that reveal an appreciable robustness and open new scenarios for different applications of the methodology developed in this work, always in the context of optimal management of industrial and commercial spaces. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Two years later: Reassuring longitudinal trajectories of sleep quality, insomnia, and mental health over the endless pandemic

Objectives/introduction: Since the first lockdown period of Spring 2020, the several COVID-19 contagion waves deeply impacted the sleep and mental health of the general population. Notwithstanding the largest vaccination campaign in human history, the pandemic has continued to disrupt the daily life of the worldwide population for two years now. Here, we report preliminary results on the longitudinal trajectories of sleep quality, insomnia, and mental health throughout the pandemic in Italy. Method(s): A total of 1039 Italians (mean age +/- standard error, 35.37 years +/- 0.39;18-81, 201 males) participated in a longitudinal study consisting of three survey waves. Subjects were evaluated during the first two contagion waves (T1: April 2020, T2: December 2020) and after two years from the first lockdown period (T3: April 2022). The survey comprised: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Depression Inventory-second edition (BDI-II), and the state-anxiety subscale of the State-Trait Anxiety Inventory (STAIX1). Longitudinal data were analysed using linear mixed models. Result(s): Analysis showed unchanged PSQI overall score (p = 0.20;T1: 6.69 +/- 0.11;T2: 6.70 +/- 0.11;T3: 6.54 +/- 0.11). Comparisons on PSQI sub-components revealed improved subjective sleep quality, sleep latency, and sleep disturbances at T3 than at T1 (all p < 0.002). Conversely, participants reported shorter sleep duration and higher daytime dysfunctions at T3 than at T1 (both p < 0.001). Finally, the analyses highlighted differences in ISI (p < 0.001), BDI-II (p = 0.03), and STAI-X1 scores (p < 0.001) between the three assessment points. Bonferroni post hoc showed reduced ISI (T1: 8.05 +/- 0.16;T2: 7.42 +/- 0.16;T3: 6.96 +/- 0.16), and STAI-X1 scores (T1: 48.14 +/- 0.30;T2: 46.24 +/- 0.30;T3: 45.23 +/- 0.30) over time (all p < 0.01), and lower BDI-II scores (T1: 11.80 +/- 0.28;T2: 11.69 +/- 0.28;T3: 11.15 +/- 0.28) at T3 than at T1 (p = 0.03). Conclusion(s): Our study described a reassuring scenario after two years of the pandemic. We demonstrated relieving sleep disturbances, insomnia, depressive, and anxiety symptoms in a context of shorter sleep duration and more severe sleep-related daytime dysfunctions. Further long-term monitoring of sleep and mental health time course is necessary to claim the end of the pandemic emergency on sleep and psychological status of the general population.

The evolution of the autopsy over the years.

Abstract: Autopsy has played an extremely important role in both the forensic and clinical fields for many years. In recent years, clinical autopsy has become less important, but today, thanks to the pandemic, this importance has been rediscovered. Conversely, forensic autopsy has never lost its importance, but it would need to be updated.

Maintaining therapeutic continuity in adolescent psychiatric day hospital programs during the COVID-19 lockdown

IntroductionThe COVID-19 social lockdown imposed important limitation to non-emergency health care services in Italy, between March and May 2020, with many difficulties in the mental health assistance of those chronic conditions needing a continuative therapeutic support.ObjectivesOur study aimed to describe how therapeutic activities have been carried on by remote services in two Adolescent Psychiatric Day Hospital Units (Rome and Turin) and the outcome of these assistance interventions in youths with subacute psychopathology.MethodsThe patient cohort includes 162 adolescents (12-19 years old;QI>70) DH outpatients presenting a complete clinical and neuropsychiatric assessment before the lockdown. During the several phases of COVID-19 quarantine all patients were monitored and supported by telemedicine interventions. All data were recorded and standardized every 15 days: symptom severity was rated by global severity (CGI-S) and stress level by self-reported measures of stress (IES-R).ResultsAmong patients, CGI score remained stable, IES-R score declined over time: higher IES-R score was significantly associated with female gender and but no differences was observed related with the primary diagnosis. 5 patients presented a clinical acute state needing a hospitalization. The rate of hospitalization was not significantly different compared with the rate observed in the same period of 2019.ConclusionsIn youth with psychopathological conditions, remote assistance for psychiatric cares resulted effective and it was associated with a clinical stability with decreasing stress levels.DisclosureNo significant relationships.