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Aims: The COVID-19 pandemic presented new difficulties for integrated healthcare worldwide. Our study aims to highlight developing needs for cooperation while describing structures and practices of consultation liaison (CL) services established during pandemic across Europe. Method(s): The cross-sectional survey used an ONLINE self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies cooperating in EAPM, and heads of CL services from June to October 2021 Results: 259 hospital CL services took part in the study (28.0% response rate). 222 (85.7%) of these services reported providing COVID-19-related mental health care (COVIDpsyCare). Among them, 192 services (86.5%) reported the development of specialized COVID-psyCare co-operation arrangements. 135 services (50.8%) provided specific COVID-psyCare for patients, 85 (38.2%) for relatives, and 171 (77.0%) for staff, with 56.3%, 14.6%, and 23.7% of time resources invested for these groups, respectively. Interventions for hospital staff, commonly related to the liaison function of CL services, were rated as being the most helpful. Regarding newly emerging demands, 129 (58.1%) CL services stated a need for communication and support among themselves concerning COVID-psyCare, and 142 (64.0%) suggested certain adjustments or enhancements that they thought were crucial for the future. Conclusion(s): Specific structure to provide COVID mental health care for patients, their relatives, or staff were implemented in over 80% of the participating CL services. Resources were primarily allocated for patient care, and staff assistance was mostly achieved through the implementation of specialized interventions. COVID psyCare's development calls for further intra- and interinstitutional cooperation.Copyright © 2023
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Aims: The aim of the present study was to study the prevalence of depression, anxiety, stress, and post-traumatic symptoms in Health-Care Workers (HCWs) of three Health Authorities of Emilia-Romagna, Italy during the COVID pandemic. Material(s) and Method(s): An online questionnaire was spread to the staff of the University Hospital of Modena and the Local Health Agencies of Modena and Romagna, including the Depression Anxiety Stress Scale (DASS-21), the Impact of Event Scale - Revised (IES-R), and the Utrecht Work Engagement Scale - Short Version (UWES-9). The scores at DASS-21 and IES-R were used as dependent variables in multivariate logistic regression models. Result(s): A total of 5868 HCWs were reached (response rate of 22.4%), 76.1% of which were women, mostly aged between 45 and 54 years. Rates of positive scores were: 27.9% DASS-21 Depression;28.4% DASS-21 Anxiety;34.7% DASS-21 Stress;21.9% IES-R. At the multivariate logistic regression, the following were statistically significant risk factors for positive scores: female sex, young age, and working at the front line. An increase in alcohol and tobacco consumption and worsening of eating habits were also strongly associated with symptoms. At UWES-9, the three samples reported lower vigor than dedication and absorption, which are at a medium-high level. Conclusion(s): HCWs have experienced high levels of emotional distress related to the COVID-19 pandemic. Significant improvements are needed not only in terms of organization and distribution of resources, but also in provision of dedicated psycho-social interventions.Copyright © 2023
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Aims: Health Care Workers (HCW) have had to deal with mental health-related stressors during the COVID-19 pandemic and exhibited higher rates of anxiety, depression, insomnia, and post-traumatic stress symptoms. The impact of the COVID-19 pandemic on mental health of a sample of hospital HCWs was assessed over time, relating to quality of life, post-traumatic growth, burnout, sleep changes, and resilience. Method(s): An online, three-phase, survey was sent to the whole working population of the University Hospital of Modena, covering 12 months (baseline questionnaire sent in June 2020). Sociodemographic and behavioral information related to COVID-19 were collected, together with screening for anxiety, depression, stress, and post-traumatic symptoms. A multivariate analysis was conducted to analyze changes across time. Result(s): 457 HCWs completed all three stages of the survey, M/F ratio: 28.0/71.9%. Anxiety and stress were significantly associated to having been in direct charge of COVID+ patients (anxiety OR = 2.22, 95% C.I. = 1.06-4.78, p-value = 0.04;stress OR = 2.03, 95% C.I. = 1.05-3.95, p-value = 0.04). Stress was associated to perception of increased workload both at baseline (OR = 1.79, 95% C.I. = 1.02-3.18, p-value = 0.05) and at first follow-up (OR = 1.97, 95% C.I. = 1.08-3.73, p-value = 0.03). Significant changes over time were registered as to increased alcohol consumption and a more imbalanced diet. Conclusion(s): Results are helpful to guide support interventions and organizational actions to improve the well-being and functioning of HCWs.Copyright © 2023
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Infectious diseases frequently affect the peripheral nervous system by direct infiltration or indirect inflammatory response induced by the microorganisms. Peripheral neuropathies are commonly observed in the course of HIV infection and represent the major neurological complication of the disease. The heterogeneous spectrum makes the diagnosis challenging even for the expert neurologist and includes distal symmetric neuropathies, demyelinating neuropathies, mononeuritis multiplex, progressive polyradiculopathies, and diffuse infiltrative lymphocytosis syndrome. Peripheral neuropathy (PN) is one of the most frequently reported extrahepatic complications of HCV chronic infection, occurring in about 10% of HCV-infected patients. PN usually coexists with cryoglobulinemia and may manifest as chronic "length dependent” distal symmetrical sensorimotor or mainly sensory axonal polyneuropathy, "stocking-glove” asymmetric polyneuropathy, subacute mononeuropathy multiplex, or asymmetrical neuropathy involving large or small nerve fibers. Pure motor or demyelinating neuropathies and, rarely, cranial or autonomic neuropathies, have also been reported. Among the rarest causes of infectious neuropathies, leprosy and borreliosis are an important global health concern. The differential diagnosis is often difficult and sometimes, in particular in suspected neuritic form of leprosy, requires nerve biopsy and a detailed neuropathological analysis that can help for personalized therapy. With the COVID-19 pandemic, many cases of patients with peripheral nervous system involvement have been described, in the absence of a direct role of SARS-CoV-2. © Springer Nature Switzerland AG 2022.
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Introduction: Research related to Emotional Intelligence is gaining more and more space and importance in organizations, especially in the period of the Covid-19 pandemic.Purpose: the article sought to analyze how the Emotional Intelligence competencies perceived and used by leaders relate to Leadership Styles.Method: Research with a qualitative approach through a case study in a company in the southern region of Brazil. Data collection included 36 semi-structured interviews with leaders and followers, documents and observation. The collected data were analyzed through content analysis and triangulation.Main findings: It was identified that the vast majority of managers have Emotional Self-Awareness and are able to manage their own emotions. The Leadership Styles most present in the interviewed managers are: Coach, Affective and Democratic and 6 of the interviewed managers can be considered effective leaders. Theoretical and practical contributions: This research contributed to the development of studies on the topics of Emotional Intelligence and Leadership Styles.
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Background: Patients with autoimmune systemic diseases (ASDs) can be counted among frail populations as regards the predisposition to COVID-19 due to the frequent visceral organ involvement and comorbidities, as well as the ongoing immunomodulating treatments. Objectives: Our long-term multicenter telephone survey prospectively investigated the prevalence, prognostic factors, and outcomes of COVID-19 in Italian ASD patients during the frst 3 pandemic waves. Methods: A large series of 3,918 ASD patients (815 M, 3103 F;mean age 59±12SD years) was consecutively recruited at the 36 referral centers of COVID-19 & ASD Italian Study Group. In particular, ASD series encompassed the following conditions: rheumatoid arthritis (n: 981), psoriatic arthritis (n: 471), ankylosing spondylitis (n: 159), systemic sclerosis (n: 1,738), systemic lupus (172), systemic vasculitis (n: 219), and a miscellany of other ASDs (n: 178). The development of COVID-19 was recorded by means of telephone survey using standardized symptom-assessment questionnaire (1). Results: A signifcantly increased prevalence of COVID-19 (8.37% vs 6.49%;p<0.0001) was observed in our ASD patients, while the cumulative death rate revealed statistically comparable to the Italian general population (3.65% vs 2.95%;p: ns). In particular, among the 328 ASD patients complicated by COVID-19, 57 (17%) needed hospitalization, while mild-moderate manifestations were observed in the large majority of individuals (83%). In addition, 12/57 hospitalized patients died due to severe interstitial pneumonia and/or cardiovascular manifestations. Interestingly, a signifcantly higher COVID-19-related death rate was observed in systemic sclerosis patients compared to the Italian general population (6.29% vs 2.95%;p=0.018). Other adverse prognostic factors to develop COVID-19 were the patients' older age, male gender, pre-existing ASD-related interstitial lung involvement, and chronic steroid treatment. Conversely, patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) showed a signifcantly lower prevalence of COVID-19 compared to those without (3.58% vs 46.99%;p=0.000), as well as the chronic administration of low dose aspirin in a subgroup of SSc patients (with 5.57% vs without 27.84%;p=0.000). Conclusion: The cumulative impact of COVID-19 on ASD patients after the frst 3 pandemic waves revealed less severe than that observed during the frst phase of pandemic (1), especially with regards to the death rate that was comparable to the Italian general population in spite of the increased prevalence of complicating COVID-19 in the same ASD series. Ongoing long-term treatments, mainly csDMARDs, might usefully contribute to generally positive outcomes of in this frail patients' population. Of note, a signifcantly increased COVID-19-related mortality was recorded in only SSc patients' subgroup, possibly favored by pre-existing lung fbrosis. Among different ASD, SSc deserves special attention, since it shares the main pathological alterations with COVID-19, namely the interstitial lung involvement and the endothelial injury responsible for diffuse microangiopathy. Besides SSc, the patients' subgroups characterized by older age, chronic steroid treatment, pre-existing interstitial lung disease, and/or impaired COVID-19 vaccine response (1-3), may deserve well-designed prevention and management strategies.
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This chapter discusses the dual nature of Brazilian federalism and the strengthening of subnational autonomy, as evidenced during the Covid-19 pandemic. On one hand, the crisis highlighted the importance of the federal government in the institutional arrangement of Brazilian federalism, which is highly centralised;on the other, it has provided greater scope for action by state governments, whose political power has gradually diminished over the 30 years since the 1988 Constitution came into being. Municipalities have also played a stronger role based on their local interest. To analyse those aspects, the chapter presents the constitutional design of the Brazilian federation and the public policies in health and disaster management to contain the pandemic, demonstrating that the intergovernmental relations generated by the very nature of federalism were indispensable in enabling Brazil to address the pandemic and so prevent worse outcomes in terms of public health. Additionally, the expanded autonomy of states and municipalities during the pandemic, due to a Supreme Court decision, was fundamental to the struggle against the denialism of the President Jair Bolsonaro, who neglected his federal responsibilities. © 2022 selection and editorial matter, Nico Steytler.
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The recent pandemic due to SARS-CoV-2 has brought to light the need for strategies to mitigate contagion between human beings. Apart from hygiene measures and social distancing, air ventilation highly prevents airborne transmission within enclosed spaces. Among others, educational environments become critical in strategic planning to control the spread of pathogens and viruses amongst the population, mainly in cold conditions. In the event of a virus outbreak - such as COVID or influenza - many school classrooms still lack the means to guarantee secure and healthy environments. The present review examines school contexts that implement air ventilation strategies to reduce the risk of contagion between students. The analysed articles present past experiences that use either natural or mechanical systems assessed through mathematical models, numerical models, or full-scale experiments. For naturally ventilated classrooms, the studies highlight the importance of the architectural design of educational spaces and propose strategies for aeration control such as CO2-based control and risk-infection control. When it comes to implementing mechanical ventilation in classrooms, different systems with different airflow patterns are assessed based on their ability to remove airborne pathogens considering parameters like the age of air and the generation of airflow streamlines. Moreover, studies report that programmed mechanical ventilation systems can reduce risk-infection during pandemic events. In addition to providing a systematic picture of scientific studies in the field, the findings of this review can be a valuable reference for school administrators and policymakers to implement the best strategies in their classroom settings towards reducing infection risks.
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Recent experiences of socio-environmental disasters in Latin America have demonstrated the ineffectiveness of the state as a social actor in the organisation, coordination and implementation of adequate public policies to face these emergencies. This affects the most vulnerable urban areas, leading to unequal levels of impact from crises and disasters within cities. As a response, local collective actions, led by citizens, have emerged to manage risks. In Medellin, Colombia, in the context of the current COVID-19 crisis, our research identified a diverse repertoire of collective actions within informal, vulnerable communities, including collaboration towards improving food security, sanitation, pedagogy for self-care and prevention, and financial aid. Although these actions have had limited scope within the context of the ongoing COVID-19 pandemic, they demonstrate the need to promote a more proactive interaction between society and the state, based on a series of agreed interventions, promoting the exchange of knowledge and articulation of actions in the production and improvement of informal urban areas. This research explores how these collective actions have developed through a set of semi-structured interviews with community leaders and key actors in Medellin, with a view to identifying lessons for state-community dynamics in relation to disaster risk management and achieving a more integrated approach to improving habitat conditions within vulnerable urban areas. This work demonstrates that vulnerable communities in informal urban settlements can actively address their exposure to risk through locally-oriented, bottom-up collective actions. However, key linkages with institutional frameworks are needed to strengthen state-community dynamics and facilitate sustainable, inclusive and equitable development in cities.
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Background: Blinatumomab, a bispecific T-cell engager (BiTE ®) molecule that directs cytotoxic T-cells to lyse CD19-expressing B lineage cells, has been investigated in NHL (Goebeler JCO 2016, Viardot Blood 2016, Katz ASH 2019). Here, we evaluated subcutaneous (SC) blinatumomab, which may simplify administration, improve convenience, and potentially reduce adverse events (AEs). Methods: Patients (pts;≥18 y) had indolent NHL (follicular, marginal zone, lymphoplasmacytic, mantle cell, or small lymphocytic) that was primary refractory (1+ prior line), relapsed (within 1 y of first response), or that had responded to initial therapy for ≥1 y and relapsed after 2+ lines, including an anti-CD20 monoclonal antibody. Disease must not have been irradiated and was measurable (≥1.5 cm) on PET-CT or CT. Pts had a 3-wk continuous intravenous (cIV) run-in period followed by SC dosing in 5 cohorts, a further 2 wks of cIV dosing, and the option for a second cycle of cIV dosing (Figure). The primary objective was safety and tolerability of SC blinatumomab;secondary objectives included pharmacokinetics (PK), estimating the maximum tolerated dose (MTD), ie, the highest dose at which ≤1/6 pts had a dose-limiting toxicity (DLT), and efficacy (NCT 02961881). Results: Pts (n=29) had a median (range) age of 64 (42-75) y, 55% were male, 90% Caucasian, with follicular I-IIIA (76%), marginal zone (10%), mantle cell (10%) and lymphoplasmacytic lymphoma (3%) subtypes;no pts had prior allo-hematopoietic stem cell transplant (HSCT), 38% had prior auto-HSCT. Of the 29 pts, 5 discontinued (D/C) blinatumomab due to AEs (n=3;2 cIV, 1 SC), pt request (1), and disease progression (1);no pts D/C due to COVID-19 control measures;26 pts completed the study;pts received a median (range) of 5 (3-10) doses. AEs leading to D/C in SC treatment included neurologic events of aphasia and seizure. During SC dosing, 2 DLTs occurred (aphasia, n=1;seizure, n=1 ). MTD was not reached. Five pts had grade 3 (G3) AEs (thrombocytopenia, erosive esophagitis, asthenia, device-related infection, hyperglycemia, aphasia, seizure;pts may have had >1 G3 AE);there were no G4 AEs or fatal AEs. AEs of interest included neurologic events (all, n=15;G3, n=2), infection (2;1), and cytokine release syndrome (4;0). One pt had grade 1 injection site erythema. Anti-blinatumomab antibodies have not been detected to date. Preliminary PK results were consistent across the 5 SC cohorts and 3 different dosing regimens. Following the first dose, maximum concentrations (C max) were reached after ~5-12 hours and exposures (C max and area under concentration-time curve [AUC] from 0-12 hours) increased in a dose-related manner. At steady state, exposures (AUC over the dosing interval) increased in a dose-related manner for dosing intervals of once every 12, 24, and 48 hours across cohorts. Blinatumomab bioavailability and apparent terminal elimination half-life were favorable for extending the dosing interval to once every other day and potentially longer intervals. The steady-state concentrations during both cIV infusion periods were consistent with those previously reported in NHL pts. In all pts, the overall response rate (ORR, representative of cIV, 5 wks and SC, 1wk) per Cheson criteria was 69% (evaluable, n=23: complete response [CR], 21%;partial response [PR], 48%;cycle 1 [C1], n=22: ORR, 62%;CR, 14%;PR,48%;cycle 2 [C2], n=17: 45%;17%;28%;respectively);per Lugano criteria, the ORR was 52% (n=21: CR, 24%;PR, 28%;C1, n=18: 45%;17%;28%;C2, n=12: 31%;21%;10%);for follicular lymphoma, ORR was 77% per Cheson (n=19: CR, 23%;PR, 55%) and 55% per Lugano (n=15: CR, 23%;PR, 32%). Conclusions: In pts with R/R indolent NHL, SC blinatumomab had a favorable safety profile, with the caveat that pts who could not tolerate cIV blinatumomab did not advance to SC dosing. Efficacy was comparable with that seen for cIV dosing in prior blinatumomab NHL studies. In contrast to prior blinatumomab trials, no dose dependency in efficacy or toxicity was observed because SC dosi g was administered for only 1 wk, after 3 wks of cIV;pts not tolerating cIV did not receive SC dosing. Safety/tolerability of blinatumomab SC administration over the whole cycle is currently being evaluated in a phase 1 trial of pts with R/R acute lymphoblastic leukemia (NCT 04521231). SC blinatumomab PK, including bioavailability and half-life, showed promising features, warranting further investigation. [Formula presented] Disclosures: Rossi: Astellas: Membership on an entity's Board of Directors or advisory committees;Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees;Abbvie: Membership on an entity's Board of Directors or advisory committees;Alexion: Membership on an entity's Board of Directors or advisory committees;Sanofi: Honoraria;Takeda: Membership on an entity's Board of Directors or advisory committees;Celgene: Membership on an entity's Board of Directors or advisory committees;Daiichi Sankyo: Consultancy, Honoraria;Janssen: Membership on an entity's Board of Directors or advisory committees;Jazz: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees;Pfizer: Membership on an entity's Board of Directors or advisory committees. Prince: Takeda: Consultancy, Honoraria;Amgen: Honoraria, Research Funding;Novartis: Honoraria. Tam: Janssen: Consultancy, Honoraria, Research Funding;BeiGene: Consultancy, Honoraria;AbbVie: Consultancy, Honoraria, Research Funding;Loxo: Consultancy;Roche: Consultancy, Honoraria;Novartis: Honoraria;Pharmacyclics: Honoraria. Ku: Roche: Consultancy;Genor Biopharma: Consultancy;Antegene: Consultancy. Thieblemont: Gilead Sciences: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses;Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses, Research Funding;Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees;Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees;Kyte: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses;Bristol Myers Squibb/Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses;Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses;Incyte: Honoraria, Membership on an entity's Board of Directors or advisory committees;Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses;Cellectis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses;Hospira: Research Funding;Bayer: Honoraria;Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses. Popplewell: Pfizer: Other: Travel;Hoffman La Roche: Other: Food;Novartis: Other: Travel. Wermke: Novartis, Roche, Pfizer, BMS: Consultancy, Honoraria, Research Funding. Haioun: Roche: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company);Janssen-Cilag: Consultancy;Celgene: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company);Novartis: Honoraria;Amgen: Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company);Servier/Pfizer: Honoraria;Gilead Sciences: Consultancy, Honoraria;Takeda: Consultancy;Miltenyi Biotec: Consultancy. Viardot: Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees;Amgen: Membership on an entity's Board of Directors or advisory committees;Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees;Kite/Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees;F. Hoffmann-La Roche Ltd: Honoraria, Membership on an entity's Board of Directors or advisory committees;University Hospital of Ulm: Current Employment. Ferreri: Pfizer: Research Funding;x Incyte: Membership on an entity's Board of Directors or advisory committees;Amgen: Research Funding;Genmab: Research Funding;BMS: Research Funding;Hutchison Medipharma: Research Funding;PletixaPharm: Membership on an entity's Board of Directors or advisory committees;Adienne: Membership on an entity's Board of Directors or advisory committees;ADC Therapeutics: Research Funding;Gilead: Membership on an entity's Board of Directors or advisory committees, Research Funding;Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding;Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding;Ospedale San Raffaele srl: Patents & Royalties;Beigene: Research Funding. Wong: Amgen: Current Employment;Amgen: Current equity holder in publicly-traded company. Kadu: IQVIA: Current Employment. Zugmaier: Amgen: Current Employment;Micromet/Amgen: Patents & Royalties: Patents 20190300609 and 20130323247 licensed;receives royalties of family members of international applications published as WO2010/052014;WO2010/052013;WO2011/051307;WO2012/055961;WO 2012/062596;WO2014/122251;and WO2015/181683;Amgen: Current equity holder in publicly-traded company. Zeng: Amgen: Current Employment, Current equity holder in publicly-traded company. Rambaldi: Celgene: Other: Travel, Accommodations, Expenses;Jazz Pharmaceuticals: Consultancy;Astellas Pharma: Consultancy;Novartis: Consultancy;Omeros: Consultancy, Honoraria;Amgen: Consultancy, Honoraria. OffLabelDisclosure: Blinatumomab is approved in the United States for administration as a continuous intravenous infusion. It has not been approved for subcutaneous administration.
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Background and aims: Objective: Several preclinical and clinical investigations have argued for nervous system involvement in SARS-CoV-2 infection. No data about clinical, imaging and biomarkers presentations as well as long-term outcomes are available for SARS-CoV-2 encephalitis in comparison with infectious and autoimmune encephalitis. Methods: The ENCOVID European registry included patients with probable or definite diagnosis of encephalitis with and without SARS-CoV-2 infection admitted for hospitalization in the European recruiting centers between February 1st 2020 and March 30th, 2021. Each patient underwent a standardized assessment including full infectious screening, CSF, EEG, MRI data. Clinical presentation and laboratory markers, severity of COVID-19 disease, response to treatment and outcomes were recorded. Results: Results – Out of 155 cases screened, forty-five cases of encephalitis positive for SARS-CoV-2 infection and 63 without COVID-19 with full available data were included. SARS-CoV-2 encephalitis exhibited common presentation with aphasia and dysarthria compared to non-COVID- encephalitis and exhibited higher prevalence of patients with normal MRI but mild hyperproteinorracchia/pleocytosis. Most SARS-CoV-2 cases appeared during the onset of COVID-19 and exhibited different response to treatment and long-term outcomes compared to non COVID encephalitis. Conclusions: Conclusions –The registry identified a wide spectrum of encephalitis associated with COVID19 infection, with clinical characteristics and course different from classical infectious and autoimmune encephalitis. Biomarkers studies are warranted in order to evaluate the specific inflammatory pathways associated with SARS-Cov-2 encephalitis.
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Objective: To assess Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) specific IgA/G seropositivity in patients with suspected autoimmune central nervous system (CNS) disorders. Background: Inflammatory/autoimmune disorders can be triggered by viral infections, as described in patients with antibodies to neuronal surface proteins or myelin oligodendrocyte glycoprotein (MOG). Whether SARS-CoV-2 infection induces such conditions is unknown, although widely hypothesised. Design/Methods: We retrospectively analysed consecutive samples referred for antibody screening to the Neuropathology Laboratory, Verona, for SARS-COV-2 IgA and IgG testing, from March 1 2020 to August 31 2020. Clinical information of seropositive cases was extracted from clinical records or provided by referring physicians. Results: Among 332 patients referred for antibody testing, 26 showed either SARS-CoV-2 IgA and/or IgG (IgA n=12, IgG n=1, IgA and IgG n=13). Among 22/26 available CSF, 4 were positive (IgG n=3, IgG and IgA n=1). Median age of seropositive cases was 61 years (range 27- 82) and 16 were female. Clinical features, available in 23 cases, revealed encephalopathy (n=15) and seizures (n=8) as common manifestations and, in four cases, myelitis, predominantly with lower limbs weakness. 19/23 patients were systemically asymptomatic. Brain MRI showed FLAIR-T2 hyperintensities in 13/18 patients. EEG showed alterations including epileptic discharges (n=5) and/or generalized slowing (n=12). CSF pleocytosis (>5 cells/μL) was reported in 9/19 investigated cases. Autoimmune neurology screening revealed one patient with serum titin autoantibodies, one with limbic encephalitis and seizures had serum and CSF amphiphys in antibodies, and one presenting with acute disseminated encephalomyelitis had serum and CSF MOG antibodies. Conclusions: The incidence of SARS-CoV-2 IgG/IgA positivity in our referred cohort, which was higher (7.8%, 18% when considering only patients with suspected encephalitis) than that reported in the Italian population (2.5%) and the observed clinical spectrum of disorders suggest that SARS-CoV2 could trigger inflammatory CNS processes, usually not associated with wellknown autoantibodies. Case-control studies are now required.
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Purpose : The COVID-19 pandemic further increased the lack of human donor corneas for research purposes. In this study we established a porcine cornea model for testing corneal storage media formulations. Methods : 14 corneas were extracted from porcine eye globes obtained from local slaughterhouse after povidone-iodide 5% disinfection. The tissues were stored in standard corneal culture medium Eusol-C (AL.CHI.MI.A. SRL) at 4°C. After 0, 3, 7, and 14 days the tissues were analyzed in quintuplicate at T0 and in triplicate for the other timepoints with Optical coherence tomography (OCT) for central corneal thickness (CCT). The corneal transparency was evaluated by measurement of optical density using a homemade instrument. At each timepoint corneal endothelium was stained with trypan blue and alizarin red and evaluated with an inverted microscope with 100 X magnification (Nikon) for endothelial cell density (ECD) and morphology in both whole cornea and in dissected corneal lamellas consisting of Descemet's membrane (DM) and endothelial cells (EC). Results : The corneal transparency diminished along storage time of approximately 10%. Corneal thickness increased of approximately 100 μm at day 14. ECD decreased of approximately 10% from T0 to the final T14 timepoint leading to an average of 2800 cells/mm2 at T14. The dissected DM corneal lamellas allowed good EC morphology evaluation which was well preserved after 14 days at 4°C. The flaccidity of porcine corneas made OCT measurements difficult and CCT showed slight variability. Conclusions : We established a porcine cornea model that allowed reproducible corneal evaluation of ECD, endothelial morphology CCT and transparency in whole porcine corneas and dissected DM corneal lamellas. In conclusion, the evaluation of porcine corneal tissues allowed to compensate to the lack of human donor tissues for research use, providing a reliable tool for testing corneal storage media formulations.
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Background: SARS-CoV-2 infection poses a serious challenge for patients with rheumatic autoimmune systemic diseases (ASD), characterized by marked immune-system dysregulation and frequent visceral organ involvement. Objectives: To evaluate the impact of COVID-19 pandemic in a large series of Italian patients with ASD. Methods: Our multicenter telephone survey (8-week period, March-April 2020) included a large series of 2,994 patients (584 M, 2,410 F, mean age 58.9±13.4SD years) with ASD followed at 34 tertiary referral centers of 14 regions of northern, central, and southern Italian macro areas, characterized by different prevalence of SARS-CoV-2 infection. According to currently used criteria, COVID-19 was classified as definite COVID-19 (signs or symptoms of COVID-19 confirmed by positive oral/nasopharyngeal swabs at PCR testing) or highly suspected COVID-19 (signs or symptoms highly suggestive of Covid-19, but not confirmed by PCR testing due to limited availability of virological tests in that period). The results were analyzed performing the Odds Ratio by Java-Stat 2-way Contingency Table Analysis. Results: The main findings of the survey study revealed a significantly increased prevalence of COVID-19 in: a.the whole series of ASD patients (definite Covid-19: 22/2994, 0.73%;p=0.0007;definite COVID-19 plus highly suspected Covid-19: 74/2,994, 2.47%;p<0.0001) when compared to Italian general population of COVID-19 infected individuals (349/100000 = 0.34%;data from Italian Superior Institute of Health;h t t p s : / / w w w . e p i c e n t r o . i s s . i t / e n / c o r o n a v i r u s / sars-cov-2-national-surveillance-system). b.the subgroup of patients with connective tissue diseases or systemic vasculitis (n = 1,901) compared to the subgroup of inflammatory arthritis (n = 1,093), namely rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (definite Covid-19: 19/1,901, 0.99%, vs 3/1,093, 0.27%;p=0.036;definite COVID-19 plus highly suspected Covid-19: 69/1,901, 3.6%, vs 5/1,093, 0.45%;p<0.0001) c.the subgroup of patients with pre-existing interstitial lung involvement (n = 526) compared to those without (n = 2,468) (definite Covid-19: 10/526, 1.90%, vs 12/2,468, 0.48%;p=0.0015;definite COVID-19 plus highly suspected Covid-19: 33/526, 6.27%, vs 41/2,468, 1.66%;p<0.0001). Of interest, the prevalence of COVID-19 did not correlate with presence/absence of different comorbidities, mainly diabetes, cardio-vascular and/or renal disorders, as well as of ongoing treatments with biological DMARDs;while patients treated with conventional DMARDs showed a significantly lower prevalence of COVID-19 compared to those without. COVID-19 was more frequently observed in the patients' populations from northern and central compared to southern Italian macro area with lower diffusion of pandemic. Clinical manifestations of Covid-19, observed in 74 patients, were generally mild or moderate;4/9 individuals requiring hospital admission died for severe pneumonia. Conclusion: The prevalence of COVID-19 observed in ASD patients during the first wave of pandemic was significantly higher than that observed in Italian general population;moreover, the actual prevalence of COVID-19 might be underestimated due to the high number of mild variants as well as the possible clinical overlapping between these two conditions. Patients with ASD should be invariably regarded as 'frail patients' during the pandemic course, considering the risk of worse outcome in the acute phase of Covid-19, as well as the potential long-term effects of viral infection. The statistically significant association of COVID-19 with connective tissue diseases/ systemic vasculitis, as well as with pre-existing interstitial lung involvement, suggests the presence of distinct clinico-pathological ASD subsets, characterized by markedly different patients' vulnerability to SARS-CoV-2 infection.
ABSTRACT
COVID-19 pandemic had a serious occupational impact on people with preexisting mental disorders. To deliver care in this context, telehealth groups were a therapeutic option for occupational therapists for mental health care. This paper presents an occupational therapy experience with telehealth groups in Brazil, sustained by the Dynamic Occupational Therapy Method, seeking to discuss the use of technology during the COVID-19 outbreak, the limits and potential of occupational therapy in the face of the necessary change in work with groups. The paper is a critical analysis of practice sustained by a practice-based evidence perspective through a collaborative partnership between practitioners and academics from Brazil and the UK. Practitioners reflected on their professional skills in an online context, highlighting their initial concerns and their discoveries within this new practice scenario. The delivery of telehealth groupwork in occupational therapy in mental health practice requires multiple digital tools, and the occupational therapist needs to understand digital inequity issues (digital access or skills), be digitally upskilled to meet client needs, and also be guided by clear occupational therapy theoretical and methodological frameworks that underpin telehealth practices.