Efficacy of Breathox device inhalation on acute symptoms associated with COVID-19 (BREATH study)

Background: Breathox is a sodium chloride inhaler. Increase of the airway salinity has been proposed to reduce the symptomatic stage of a respiratory viral infection. Objective(s): to evaluate the effectiveness of nasal and inhaled sodium chloride therapy through Breathox on mild COVID-19 symptoms in patients >= 18 years-old compared to usual care. Method(s): a pilot, open, randomized clinical trial, including 100 patients with confirmed and symptomatic COVID-19 within 10 days of symptom onset. All patients received standard of care (SOC), i.e. antipyretic or analgesic. Breathox was administered as two oral inhalations and one nasal instillation in each nostril at each administration with 2mg per inhalation. Patients were randomized 1:1:1 into three groups: Group 1(G1): SOC + Breathox 10 times daily for 10 days;Group 2(G2): SOC + Breathox five times daily for 10 days;Group 3(G3): SOC. Recovery time for symptoms, such as cough was assessed. Result(s): In total 100 of 103 screened patients were included from December 1 2021 to March 03 2022. Of those, 33 from G1 and G3, and 32 from G2 completed the study. Mean age was 40.4/42.2/40.6 years old for G1, G2 and G3, (p=0.96). No patients were hospitalized or died during the study. Time to cough resolution was reduced in G1 (2.8+/-0.66 days) and G2 (2.4+/-0.66 days) compared to G3 (5.39+/-0.79 days) (p=0.001), with a hazard ratio (HR) for G2 of 2.17 (Confidence interval 1.17-4.04) and G3 of 2.01 (1.06-3.81) compared to SOC. Conclusion(s): ten days of Breathox use halved the time for resolution of COVID-19-induced cough.

Metabolomic spittle analysis of post COVID-19 patients

Post COVID-19 patients have been suffering from persistent symptoms even after long periods. The physiopathology of these clinical manifestations still has a lack of knowledge. The objective was to evaluate the total expression of metabolites and spittle biological pathways in patients with 60 days post COVID-19. We included 30 post-hospital discharge patients and we compared seven non COVID-19 patients control. All COVID-19 patients were assessed by demographic characteristics, pulmonary function, exercise capacity, quality of life and body composition. The metabolomic analysis was performed in the patient's splits. From the total of post COVID-19 patients, 66% were male, 60+/-14 years. The lean body mass was 30+/-7kg and fat mass 34+/-13kg. Spirometry mean severity showed FVC of 4+/-1L, FEV1 3+/-1L. Pimax and Pemax values were 90+/-31(cmH2O) and 97+/-31(cmH2O), respectively. The quality of life evaluated by the SGRQ questionnaire showed a mean percentage of magnitude of symptoms 32+/-15, activities 41+/-25, impact 13+/-11 and total of 24+/-15. Physical capacity was measured by the distance in the 6MWT, and presented an average of 413+/-131. The metabolomic analysis showed 19 metabolites statistically significant difference between groups. We observed 3 metabolites overexpressed and 16 with lower expression in post COVID19 patients. From those metabolites, we can have attention to Sphinganine(p=0.03), Piperenol A triacetate(p=0.02) and 1-Monopalmitin(p=0.03) were lower expressed in control group. The creatin was one of the non-expressed metabolites in post hospital discharge COVID-19 patients compared to the control group. Thus, metabolomic analysis can demonstrate different metabolites in post COVID-19 patients to answer persistent symptoms.

Parental attitude toward children's oral health during COVID-19 pandemic: a cross-sectional study in Italy.

AIM: During the COVID-19 pandemic, restrictive rules were imposed around the world to limit the spread of the virus. The present study aims to investigate how the pandemic and the consequent restrictions have affected the lives and oral health of Italian families with children aged 0-14 years. MATERIALS: Through a questionnaire distributed online from December 2020 to March 2021 the following aspects were investigated: family income during the pandemic, fear of the pandemic, dietary habits, perceived risk of infection in a dental practice and perceived children oral health status during the pandemic. CONCLUSION: The pandemic has not drastically changed the socio-economic conditions, the dietary habits and the oral health condition of most Italian children. Nevertheless, the pandemic seems to have highlighted significant macro-regional differences regarding the satisfaction with the response of the regional health services to the pandemic. The continuation of the pandemic and the possible socio-economic effects could favour new changes in lifestyles, oral health and discrepancies regarding health care access, which deserve to be the subject of further investigation.

TWIDDLER SYNDROME AND HEART FAILURE: INTEGRATION OF REMOTE MONITORING AND CARDIOLOGY TELECONSULTATION FOR OPTIMAL MANAGEMENT

The prevalence of heart failure in the population and the COVID pandemic have rendered increasingly necessary the integration of remote monitoring with cardiology teleconsultation. A patient with dilated cardimiopathy was subjected to ICD implantation (Boston Scientific Perciva DR) with remote monitoring (LatitudeTM). One month after implant, remote monitoring recorded an increase in the HeartLogicTM heart failure index, a decrease of right ventricular and atrial sensing, contextually to fluctuations of the impedance values of the two leads (Fig. 1). The patient reported having performed shoulder's rehabilitation therapy with probable manipulation of the ICD pocket. Chest X-ray showed dislocation of both leads with distal end of right atrial catheter in superior vena cava and distal end of right ventricular catheter in right atrium (Fig. 2A) and kinking of proximal segments (Fig. 2B), a picture compatible with diagnosis of Twiddler's syndrome. Implant revision confirmed lead kinking in the subcutaneous pocket (Fig. 3A). The atrial catheter, given the amount of tissue deposited at its distal end (Fig.3B) which prevented its active fixation, was replaced. Following discharge, an increase in the HeartLogicTM Heart Failure Index was detected. The outpatient visit showed the presence of pleural effusion and medical therapy was therefore optimized. In order to avoid frequent ambulatory visits to the patient, a cardiology teleconsultation was planned, which enabled to verify the clinical benefit of therapy's variation. Remote device monitoring confirmed HeartLogicTM Heart Failure Index normalization. In conclusion, the integration of remote monitoring with cardiology teleconsultation, enables to timely detect device malfunctions and prevent episodes of heart failure, avoiding further hospitalizations. This integration is even more useful and necessary in geographically disadvantaged areas, strengthening the link between the territory and the hospital, improving patients compliance and therapeutic adherence and thus allowing a progressive improvement of the symptoms and quality of life of heart failure patients.

"A Wikivoyage to ..." Making the most of Emergency Remote Teaching for the development of transversal skills

In the context of a growing tendency towards teaching practices based on digital innovation, which the Covid-19 outbreak has further accelerated, experimenting with cooperative writing/translation projects based on Wiki technology has started to attract the attention of university scholars. A number of projects have thus emerged that exploit the Wikimedia ecosystem as a multilingual working environment for online authentic tasks, which are particularly appropriate for a new generation of "digital natives" who have been facing (forced) distant learning activities. Indeed, experience shows that the very myth of the digital natives' fluency in the use of ICT is to be questioned, and the need for the development of ICT literacy and related transversal competences is strongly advocated. Against this background, the article reports on a project completed with distance learning-based activities at the University of Bari: "Transl/Editathon@Uniba. A Wikivoyage To Puglia". The project had a twofold aim: it channelled resources with different expertise and knowledge backgrounds to offer a multi-disciplinary approach to tourism discourse, translation skills and IT competence;it aimed at raising awareness in students that a cooperation-based approach in a digital environment can enhance their transversal skills. The students' ability in narrating their territory via Wikivoyage, and their feeling part of a virtual community, was the project's added value in a time when distance(s) in geographical and interpersonal terms seem to have been loosening any sense of belonging.

Suicidality and COVID-19: Data from an Emergency Setting in Italy

BACKGROUND: Suicidality is a widespread phenomenon with a dramatic burden worldwide. The Coronavirus disease 2019 (Covid-19) pandemic determined a relevant impact on mental health, due to the infection itself and its socio-economic consequences. The present study is aimed at analyzing the prevalence of suicidality during the Covid-19 pandemic among subjects requiring a psychiatric consultation in an emergency setting. SUBJECTS AND METHODS: Socio-demographic and clinical information was collected at the emergency department of the General Hospital of Perugia from June 1st, 2020 to January 31st, 2021. Data was entered into an electronic datasheet and retrospectively analysed. Pearson's bivariate correlation was performed in order to assess significant associations between suicide-related variables and specific socio-demographic and clinical features (p<0.05). RESULTS: Among 447 subjects included in the analysis, 109 (24.4%) showed suicidality-related phenomena, particularly suicide attempts (SA) (n=44, 9.8%), suicidal ideation (SI) (n=41, 9.2%), non suicidal self-injury (NSSI) (n=31, 6.9%), that in some cases co-occurred. A statistically significant association was detected between NSSI and living with marital family (p=0.024) and between suicidality-related phenomena and adjustment disorders (p=0.018). None of the examined subjects reported a previous positivity for Covid-19 and neither did their relatives. CONCLUSIONS: The present study confirms the impact of the Covid-19 pandemic on suicide-related phenomena. Consultation psychiatry fulfills a key role in the early detection and clinical management of these conditions, that require targeted intervention strategies.

Acute myocarditis: Atypical presentation and CMR diagnosis

Background. The clinical presentation of myocarditis is very variable, it can start as asymptomatic or it can manifest itself with acute and severe symptoms such as dyspnoea or chest pain. In rare cases, focal myocarditis can mimic acute myocardial infarction. Case report. We present the case of a 21-year-old man with no relevant medical history admitted at the emergency department (ED) of our hospital with severe chest pain spontaneously regressed after 20 minutes. There was no history of cocaine or other substance abuse, neither of chest wall trauma. The patient reported a gastrointestinal illness with diarrhea and fever two days before the initiation of the chest discomfort. At presentation, the patient was afebrile. His vital signs and ECG were normal. Blood analysis showed mildly increased levels of monocytes, Creactive protein, lactate dehydrogenase and high levels of troponin I (5274 pg/ml, cut off value 34,2 pg/ml). Transthoracic echocardiography revealed inferior wall motion abnormalities with preserved (57%) ejection fraction and without pericardial effusion. During evaluation in the ED the patient had another episode of acute chest pain, the ECG is shown in Figure 1. The patient underwent urgent coronary angiography, which showed normal epicardial coronary arteries. During the first hours of hospitalization in coronary intensive care unit, the patient had some episodes of intermittent chest pain with transient ST elevation and also some episodes of non sustained ventricular tachycardia;troponin I increased up to 15000 pg/ml. Nonsteroidal anti-inflammatory drugs and non-dihydropyridine calcium channel-blockers were initiated with gradual symptom improvement and laboratory findings. Cardiac magnetic resonance (CMR) showed inferolateral intramyocardial late gadolinium enhancement and oedema as for acute focal myocarditis (Figure 2). The serology for most common cardiotropic viruses was performed and COVID-19 nasopharyngeal swab was negative. During the rest of the hospitalization, the patient remained asymptomatic and troponin I decreased progressively. The patient was discharged after one week and enrolled in our follow-up program. After two weeks the patient was free of symptoms and ECG an TTE echo were improved. Conclusion. The correct diagnosis of myocardial diseases often requires integrated imaging. In this reported case, CMR led to the correct diagnosis of focal acute myocarditis.

Resilient Aspirants: Women's Candidacies and Election in Times of COVID-19

The COVID-19 pandemic has gendered implications for women's time and resources. The use of informal institutions that pose obstacles to women's electoral viability may also be particularly consequential at a time of rapid change, when election dates and procedures are being amended because of health concerns. Together, these dynamics suggest that the COVID-19 pandemic may impact women's electoral participation, support, and viability in meaningful ways. The November 2020 Brazilian municipal elections provide an opportunity to explore this. Employing data from an original survey of eligible individuals and aspirant candidates, we find that the main obstacle to women's representation is not personal political ambition or efforts but women's perceptions of their access to support for their candidacies. In the face of greater challenges, resilient aspirants are choosing to work harder to compensate for potential losses in campaign support and funds.

SARS-CoV-2 infection in patients with autoimmune rheumatic diseases in northeast Italy: A cross-sectional study on 916 patients.

BACKGROUND: Whether patients with autoimmune rheumatic diseases (ARD) have a higher risk for SARS-CoV-2 infection (COVID-19) and how SARS-CoV-2 pandemic impacts on adherence to therapy has not been fully elucidated. We assessed the rate and clinical presentation of COVID-19, and adherence to therapy in a large cohort of patients with ARD followed-up in a tertiary University-Hospital in Northeast Italy. METHODS: Between April 9th and April 25th, 2020, after SARS-CoV-2 infection peak, a telephone survey investigating the impact of COVID-19 on patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), ANCA-associated vasculitis (AAV), and idiopathic inflammatory myopathies (IIM) was administered. Demographics, disease activity status, therapy, occupational exposure, and adherence to social distancing advise were also collected. RESULTS: 916 patients (397 SLE, 182 AAV, 176 SSc, 111 RA, 50 IIM) completed the survey. 148 patients developed at least one symptom compatible with COVID-19 (cough 96, sore throat 64, fever 64, arthromyalgias 59, diarrhea 26, conjunctivitis 18, ageusia/hyposmia, 18). Among the 916 patients, 65 (7.1%) underwent SARS-CoV-2 nasopharyngeal swab (18 symptomatic and 47 asymptomatic), 2 (0.21%) tested positive, a proportion similar to that observed in the general population of the Veneto region. No deaths occurred. 31 patients (3.4%) withdrew ≥1 medication, mainly immunosuppressants or biologics. Adoption of social distancing was observed by 860 patients (93.9%), including 335 (36.6%) who adopted it before official lockdown. CONCLUSIONS: COVID-19 incidence seems to be similar in our cohort compared to the general population. Adherence to therapy and to social distancing advise was high.