ABSTRACT
SARS-CoV-2 has had a profound impact on the human population in the last 24 months. This includes dramatic changes in lifestyle, hygiene, and altered food sources/consumption patterns, which could directly impact the small bowel microbiome on an individual and perhaps even at a population level. To date, this has not been examined. Here, we compare small bowel microbial profiles in subjects before SARS-CoV-2 and intra-pandemic. Methods: The REIMAGINE study is a large-scale study using validated methods for duodenal aspirate collection and microbiome sequencing in subjects undergoing upper endoscopy. Subjects were divided into 2 groups: pre-pandemic, from February 2019 to March 2020;and intrapandemic, from April 2021 to September 2021. Groups were matched for gender, age, and BMI. Duodenal aspirates were collected, and microbial DNA was isolated using the MagAttract PowerSoilDNA Kit. V3 and V4 libraries were sequenced on a MiSeq. Reference-based Operational Taxonomic Unit clustering was performed using SILVA v132 database. Taxonomic analysis was performed with CLC Microbial Genomics Module v.2.5 and MicrobiomeAnalyst, and duodenal microbial alpha- and beta-diversity indices were calculated. Significance was determined by Wilcox test. Results: In total 94 subjects were included in the analysis. The overall duodenal microbiome profile (beta-diversity) of intra-pandemic subjects (n=38, mean age= 51 ± 18, mean BMI =23.9 ± 4.7) was significantly different from pre-pandemic subjects (n=56, mean age= 51 ± 15, mean BMI = 25.24 ± 4.9)(p<0.002, Fig1A), with no significant changes in duodenal microbial alpha diversity between groups (Fig1B). Significant duodenal microbial taxonomic differences were identified between groups, including changes in the relative abundance (RA) of 2 phyla, 3 classes, 6 orders, 4 families and 23 genera (Fig2A). At the phylum level, Actinobacteria RA was significantly decreased in the intra vs. the pre group (FC=-1.99, P=9.83E-8, Fig2B). Additionally, at the genus level, RA of Rothia (P= 6.85E-7), Pseudomonas (P=0.0376), and Escherichia (P=0.0092) were significantly decreased in the intra group (Fig2A). Of note, the phylum Deinococcus (P=0.0016) was increased in the intra vs. the pre group (Fig2B). Conclusion: In this first study examining the effect of the COVID-19 pandemic on the small bowel microbiome, we show substantial changes in microbial profiles intra-pandemic as compared to pre-pandemic. The duodenal microbiome of intra-pandemic subjects was associated with less disrupter bacteria (Escherichia and Pseudomonas), commonly associated with GI disorders. In contrast, Deinococcus phylum was increased intra-pandemic. This phylum includes organisms resistant to sanitation and increased in the nasal passage of people during the pandemic. The short and long term impact of these changes on human health require further study.(Figure Presented)
ABSTRACT
Background and aim: Liver transplant (LT) recipients are clinically vulnerable to SARS-CoV-2 infection, due to immunosuppression and comorbidities. Aim of this study was to evaluate the impact of COVID-19 on LT recipients compared to general population in Southern Italy (Campania region). Materials and methods: In this case-control double-center study, we enrolled all consecutive adult liver recipients with confirmed SARS-CoV-2 infection. Data were collected at diagnosis of COVID-19 and during follow-up and compared with the Campania regional population (extracted by National Health System COVID-19 database – https://covid-19.iss.it). Results: A total of 30 LT patients developed Sars-CoV-2 infection (76.6% male, median age 62.6yrs). Sixteen (53.3%) were symptomatic;no differences in LT indications, immunosuppression and comorbidities were found between asymptomatic and symptomatic patients. Common COVID-19 symptoms were fever (46.6%), cough (36.6%), fatigue (36.6%) and anosmia (36.6%). Twenty-five (83.4%) patients were managed at home, while 5 (16.6%) required hospitalization (2 were admitted to ICU, 2 developed ARDS and 2 died). Immunosuppressors were modified only in hospitalized patients incidence rate of Sars-CoV-2 infection was similar between LT patients and general population (3.28% vs 4.37%, p=0.1) while symptomaticity rate was higher in LT patients (46.67% vs 15.87%, p<0.00). Hospitalization rate was higher in LT patients than in general population (16.67% vs 4.54%, p=0.001), with similar median length of stay (11 vs 20 days, p=0.32). Lethality rate was higher in LT patients than in general population (6.67% vs 1.76%, p=0.041). According to the multivariable logistic regression analysis, age (fully adjusted-OR 1.02 [95% CI 1.00-1.04], p=0.005) and female sex (fully adjusted-OR 0.31 [95% CI 0.13-0.73], p=0.007) showed positive and negative association, Sars-CoV-2 infection in LT patients. In fully adjusted model, LT patients are more frequently symptomatic (OR 5.44 [95% CI 2.44-12.17], p<0.00), while hospitalization and death for COVID-19 are not significatively associated with liver transplant and p=0.46, respectively). Conclusions: Our study showed that the vulnerability of the LT patients is not a risk factor for acquiring SARS-CoV-2 infection. Nonetheless, LT patients are more frequently symptomatic, although they are comparable to the general population in terms of hospitalization and lethality.
ABSTRACT
Purpose or Objective: To evaluate the emotional state of oncological patients undergoing radiotherapy (RT) during the COVID-19 Lockdown. Materials and Methods: To evaluate patients’anxiety, depression and distress, the Hospital Anxiety Depression Scale (HADS) and Distress Thermometer (DT) were used. Patients were divided into 3 groups: those who underwent radiotherapy before COVID-19 emergency (July–December 2019) (Group 1), in early stage of COVID-19 emergency (January– February 2020) (Group 2) and one week (wk) before the Lockdown (Group 3). For Group 3 the evaluations of anxiety, depression and distress were conducted at 3 different time points: at the RT beginning(1-wk before Lockdown,T0), during RT (1-wk after the start of Lockdown, T1) and at the RT ending (during Lockdown, T2). Results: From July 2019 to 8th March 2020, on 452 treated patients, 223 (49.3%) accepted to participate in psychooncological support program: 80 (35.9%) were in Group 1, 121 (54.2%) in Group 2 and 22 (9.9%) in Group 3. Anxiety was higher in Groups 1 and 2 and distress was higher in Group 3 (p 0.01;p 0.0001) while no differences were noted for depression (p 0.1). Regarding Group 3, respect to baseline (T0), all considered emotional states increased at T1 and decreased at T2: anxiety and depression increased considerably from T0 to T1 and decreased from T1 to T2 (p 0.00001, p 0.001 respectively);distress also showed the same trend, but the differences was not statistically significative (p 0.1). All patients completed their planned RT without delays. Conclusion: The study revealed optimal compliance to RT despite the increase of anxiety and distress COVID19-related. The appropriate supportive care in term of psychologic support must be prioritized for all oncological patients, even more during pandemic.