ABSTRACT
The COVID-19 pandemic severely hit Italy in early 2020, forcing the government to arrange a general lockdown across the country. The condition of forced quarantine, already experienced in China, has led to a worsening of symptoms in subjects already suffering from psychopathology, including Eating Disorders. To avoid this, after the closure of the Service, the Day Hospital of the Regional Center on Eating Disorders of the UO of Child Neuropsychiatry of the Azienda Policlinico S. Orsola-Malpighi of Bologna has activated an online treatment program aimed at five adolescent patients and their parents. The meetings were conducted by the Psychotherapist, the Child Neuropsychiatrist, the Dietitian and the Family Psychotherapist. During the lockdown, tests were administered to the patients, compared with test administered in the entry, to see if the symptoms related to the eating disorder and general psychopathology had changed. In addition, other tests were administered to both patients and parents with the aim of investigating the dynamics established during quarantine, which measured psychological well-being and general functioning. The observation made it possible to identify five psychological phases that the patients faced, related to eating symptoms, family dynamics and adaptation to the pandemic. The tests did not show significant changes in the psychopathology of the patients, while comparing the results of the tests also administered to the parents, an influence between mother and daughter can be seen, with often overlapping trends in relation to symptoms. The online treatment was effective and satisfactory for both patients and parents, and within the families greater moments of communication, listening and mutual involvement in the life of family members developed while maintaining personal spaces. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Italian) La pandemia COVID-19 ha gravemente colpito l'Italia nei primi mesi del 2020, costringendo il governo a predisporre un lockdown generale in tutto il paese. La condizione di quarantena forzata, gia sperimentata in Cina, ha portato un peggioramento dei sintomi in soggetti gia affetti da psicopatologia, compresi i Disturbi del Comportamento Alimentare. Per evitare questo, dopo la chiusura del Servizio, il Day Hospital del Centro Regionale sui Disturbi Alimentari dell'UO di Neuropsichiatria Infantile dell'Azienda Policlinico S. Orsola-Malpighi di Bologna ha attivato un programma di trattamento online rivolto a cinque pazienti adolescenti e ai loro genitori. Gli incontri sono stati condotti dalla Psicotera-peuta, dalla Neuropsichiatra Infantile, dalla Dietista e dalla Psicoterapeuta della famiglia. Durante il lockdown sono stati somministrati dei test alle pazienti, confrontati con quelli in entrata, per osservare se i sintomi relativi al disturbo alimentare e alla psicopatologia generale si fossero modificati. Inoltre sono stati somministrati altri test sia alle pazienti sia ai genitori con l'obiettivo di indagare le dinamiche instaurate durante la quarantena, che misuravano il benessere psicologico e il funzionamento generale. L'osservazione ha permesso di individuare cinque fasi psicologiche che hanno affrontato le pazienti, legate alla sintomatologia alimentare, alle dinamiche familiari e all'adattamento alla pandemia. I test non hanno riportato cambiamenti significativi nella psicopatologia delle pazienti, mentre confrontando i risultati dei test somministrati anche ai genitori si evince un'influenza fra madre e figlia, con andamenti spesso sovrapponibili relativamente ai quadri sintomatici. Il trattamento online e stato efficacie e soddisfacente sia per le pazienti sia per i genitori e all'interno delle famiglie si sonosviluppati maggiori momenti di comunicazione, ascolto, coinvolgimento reciproco nella vita dei familiari pur mantenendo gli spazi personali. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Background: COVID-19-associated nephropathy (COVAN) is a type of collapsing glomerulopathy that leads to acute kidney injury (AKI) and overt proteinuria in individuals with apolipoprotein L1 (APOL1) polymorphism infected with SARS-CoV-2. Although the severity of the acute presentation of COVAN is well described, the long-term renal prognosis has not been clearly established. Method(s): We retrospectively identified native kidney biopsies from patients with diagnosis of COVAN discharged alive between January 2020 and March 2021. Time of biopsy pathological and clinical data were collected. We performed APOL1 genotyping for G1/G2 risk alleles. We examined the rate of end-stage kidney disease (ESKD), de novo or progressive chronic kidney disease (CKD) and death. Factors associated with those outcomes were assessed by logistic regression. Result(s): A total of 43 patients with COVAN with median follow-up at 244 days were included. Mean age was 53 +/- 12 years (range 30-78), 49% women, and 85% were of African descent. High-risk APOL1 genotypes were found in 86%. Most presented with AKI (91%) and nephrotic-range proteinuria (81%). Sixteen patients required dialysis at presentation (AKI-RRT), 8 of which reached ESKD and dialysis dependence at followup. Additionally, 6 patients without AKI-RRT developed ESKD and required dialysis at follow-up. Forty patients (93%) either developed de novo CKD or progressed to advanced stage of CKD [mean serum creatinine (sCr) 3.1 +/- 1.9 mg/dL]. Overall, 35% reached the combined endpoint of ESKD, progressive CKD or death. Predictive factors of ESKD included older age (59.1 +/- 13.9 vs. 50.4 +/- 10.7 years, p=0.03), increased sCr at time of biopsy (9.4 +/- 3.2 vs. 6.0 +/- 4.9, p=0.03), increased glomerular obsolescence (52.8 +/- 21.3 vs. 25.0 +/- 23.2%, p=0.0005), and IFTA [moderate-severe vs. mild, OR 9.8 (CI: 1.1-85.2), p=0.03]. AKI-RRT, sex, proteinuria at the time of biopsy, and absence vs. presence of an APOL1 high-risk genotype were not predictive of ESKD. Conclusion(s): COVAN is associated with ominous long-term renal sequelae. Serum creatinine at time of biopsy, patient age, glomerular obsolescence, and IFTA are associated with greater risk of ESKD.
ABSTRACT
Background and aims: The COVID-19 pandemic may have hampered the management of patients with Parkinson's disease (PD) and Parkinsonian syndromes (PS). Since during the 1st epidemic bout (March-May 2020) the Local Healthcare Trust of Bologna (population=800,000) reduced scheduled healthcare activities, we designed a cohort study to assess the potential worsening of health status in PD/PS. Methods: Design/population: clinically confirmed PD/PS recruited through a record linkage system (ParkLink cohort);matched population control cohort (ratio=1:10). Outcomes: healthcare supply measures (outpatient visits, medical tests, pre-scheduled hospital admissions);clinical outcomes (urgent hospital admissions, disease-specific hospital admissions), March-August time frames in 2019/2020. Statistical analysis: ratios of monthly rates (RR). Results: Compared to 2019, in the ParkLink cohort (n=880, PD=696/PS=184) the overall 2020 scheduled healthcare provision was reduced (p<0.01), namely: any outpatient visit RR 0.67, neurologic visits 0.72, physical therapy 0.47, any medical test 0.69, pre-scheduled hospital admission 0.80. The control cohort (n=8,817) showed a similar reduction. Undesirable clinical outcomes (Figure) increased in the ParkLink cohort (p<0.05): urgent hospital admissions RR 1.35, major injuries 1.83, infections 3.5, acute vascular events 2.2. Conversely, the control cohort did not show any increase. Conclusion: During the first six months of the COVID-19 epidemic healthcare provision was substantially reduced. PD/PS patients showed a significantly higher risk of major clinical events, that was not observed in a control population. The abrupt rearrangement of healthcare supplies, as well as the general reduction of physical activity during the lockdown period, may have favoured complications in PD/ PS patients.