Online medical, psychological and nutritional assistance for patients with eating disorders and their parents during the lockdown caused by COVID-19 from March 9th to May 4th, 2020

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)

"The resurrection of the damned by the elect": the newest place of the invisible in the face of the granting of temporary emergency aid

Our basic interest in this article is to analyze the integrated set of statements of socially undesirable subjects and the mishaps experienced by them in relation to the receipt of the Temporary Emergency Assistance (TEA);a route that is crossed under the intensity of a traffic congestion during the occurrence of the Covid-19 pandemic. When we resort through the method to the unconventional and the explanation constructed socially through the theories in relation to the thesis and the object of study placed here, namely, the discontinuities in receiving temporary emergency assistance between socially available and undesirable subjects as a mark of social protection with low rays of social well-being we are facing oscillating points and that put us beyond a frozen function of understanding what constitutes the main contradictory guidelines implementation of the income transfer in Brazil.

The difficult symbolic construction of physicians' and nurses' experiences working in COVID-19 intensive care units: A qualitative study on reports at a university public hospital in Southeastern Brazil

Introduction: Humanistic studies that explore symbolic aspects of the experience of working on the COVID-19 frontline are necessary. Do these professionals have psychic time to symbolize such acute experiences? We expect these preliminary findings of this research provide subsidies for discussing psychological management in groups with these professionals. Objective(s): To interpret emotional meanings reported by physicians and nurses on their experiences of working at COVID-19 intensive care units. Method(s): Clinical-qualitative design. Data collection with semidirected interviews with open-ended questions in-depth applied to a sample of six professionals, closed by theoretical information saturation, in a Brazilian university general hospital. Trigger question: "Talk about psychological meanings of your experience in face of management of patients with COVID-19 at ICU". Data treatment by the Seven Steps of the Clinical-Qualitative Content Analysis. Theoretical framework of Medical Psychology using Balintian concepts. Result(s): We raised 3 categories. (1) Psychic time and absence of symbolization in face of the pandemic;(2) Denial as a defense or psychosocial adaptation mechanisms;(3) Tensions and family support: triggers of ambivalent emotional experiences. Conclusion(s): Raw experience of COVID-19 pandemic did not allow for realization of symbolization. Psychological defenses are manifested, either to maintain balance or to deny the existence of dangers related to mental health. Presence of families and health team confirm that the feeling of loneliness is avoided. Anxieties related to the fear of contamination are recurrent. There is dual relationship regarding the emotional experiences of health professionals, but the data point to importance of looking at how these individuals perceive and experience the pandemic.

Antinuclear antibodies detected by Enzyme-Linked Immunosorbent Assay (ELISA) in severe COVID-19: clinical and laboratory associations.

OBJECTIVE: Antinuclear antibodies (ANA) are detected in approximately a quarter of COVID-19 patients when assessed by indirect immunofluorescence. Since there is no information, our study investigated the presence of ANA detected by Enzyme-Linked Immunosorbent Assay (ELISA) and its clinical and laboratory associations. PATIENTS AND METHODS: A longitudinal study was conducted on 92 patients with severe COVID-19, 20 patients with acute myocardial infarction, and 25 healthy subjects. Blood samples were obtained at hospital admission. Commercial ELISA was used to detect ANA, while flow cytometry was used to measure serum interferons. RESULTS: ANAs were positive in 8.6% of COVID-19 patients, 10% of myocardial infarction patients, and 4% in healthy individuals (p=0.676). COVID-19 patients with ANA+ had less ferritin, troponin, and neutrophils but more albumin and lymphocytes than ANA- patients. Serum levels of type I, II, and III interferons were similar between groups. At follow-up, all ANA+ patients survived, while mortality was significant in ANA- patients (0 vs. 36%; p=0.048). CONCLUSIONS: ANA detection is not increased in severe cases of COVID-19 when assessed by ELISA. However, its presence appears to be associated with a less aggressive disease phenotype, regardless of circulating levels of interferons.

ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN II RECEPTOR BLOCKERS AS A RISK FACTOR FOR PATIENTS HOSPITALIZED WITH COVID-19. IS THAT TRUE?

Objective: The link with angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is because of the known association between angiotensin-converting enzyme 2 (ACE) and SARS-COV 2. ACE 2 has been shown to be a co-receptor for viral entry for SARS-COV-2 in the respiratory epithelium. It has been a global concern that the use of this drugs may be a risk for patients with COVID-19 infection. It has been published many studies about this subject. Even today there are still controversies regarding to the impact of these drugs. The aim of this study was to determine the association between the previous use of ACEI/ARB and the prognosis of patients with COVID-19 infection Design and method: Single-center, restrospective, cohort study included 608 patients with hypertension diagnosed with COVID-19, who where hospitalized in Macarena's hospital from Mars to December 2020. Analyses of main outcomes (mortality, need of intensive cares (ICU), and days of mean study) were adjusted by multivariate logistic regression. Results: Of a total population of 500,000, 608 patients (0.12%) required admission for COVID-19. A total of 83.7% were hypertensive, specifically 75.9% were under antihypertensive treatment (35.7% with only 1 drug, 29.9% were taking two drugs, 9% with three drugs, and 1.3% with 4 drugs). 26.2% were treated with an ACEI and 24.8% with ARBs. Treatment with ACEI / ARB-II (combined or individually) had no impact on mortality (OR = 1.29;95% CI, 0.829-2.014;p = 0.257), nor ICU admission (OR = 1, 7;95% CI, 0.68 - 4.95;p = 0.232), nor on the days of mean stay (OR = 0.98;95% CI, 0.95-1.04;p = 0.325). Conclusions: It is unlikely that previous treatment with ACEI/ARB was associated with an increased mortality risk, neither ICU admission or an increase in days of mean stay. This study supports current guidelines that discourage discontinuation of ACEIS or ARBs in COVID-19 patients.

THE IMPACT OF HYPERTENSION AND ANTIHIPERTENSIVE TREATMENTS ON PATIENTS WITH SARS-COV-2: A RETROSPECTIVE-COHORT STUDY

Objective: Hypertension is one of the most important factors for cardiovascular disease. It has been repeatedly proposed as a prognostic factor of severe COVID- 19 and has been included in clinical risk scores to predict the occurrence of critical illness in ospitalised with COVID-19. Also, it has been postulated the relation between antihypertensive drugs and the severity of COVID-19. The aims of our study were to analyze whether hypertension and antihypertensive treatment represent an independent risk factor for death or intensive care unit admission in patients with SARS-COV2. Design and method: Observational, retrospective, single-center cohort study of all patients admitted to Hospital Virgen Macarena diagnosed with COVID-19 between the months of March and December 2020. A bivariate analysis was performed using Pearson's chi-square Results: 608 patients required admission for COVID-19. A total of 83.7% were hypertensive, specifically 75.9% were under antihypertensive treatment (35.7% with only 1 drug, 29.9% were taking two drugs, 9% with three drugs, and 1.3% with 4 drugs). 26.2% were treated with an ACEI, 24.8% with ARA-II, 16.8% with calcium-antagonists, 30.9% with diuretics, 21.2% with beta-blockers, 0, 5% with alpha-blockers). Hypertension did not show a statistically significant relationship with mortality (p = 0.34), increase in mortality and ICU admissions. Neither treatment with ACEI (p = 0.4), ARB-II (p = 0.45), calcium antagonists (p = 0.53), diuretics (p = 0.68), alpha blockers (p = 0.07) demonstrated relation with those items. Surprisingly, beta-blockers increased the mortality in patients with SARS-COV2 (p = 0.048). Probably this results can be explained as these drugs were indicated for rate control in patients with atrial fibrillation (p = 0.006). The number of antihypertensive drugs used also did not show a statistically significant relationship with an increase in mortality (p = 0.978). Conclusions: Hypertension is a highly prevalent pathology in patients ospitalised with COVID-19 infection. However, high blood pressure was not associated with a higher risk for mortality in patients with SARS-COV-2, neither the type or the number of antihypertensive drug used. Only beta-blockers alter outcomes in hypertensive patients with COVID-19, as they were associated with more deaths.

Incidence of [18F]FDG PET/CT lung findings suspected for COVID-19 in asymptomatic oncological patients after the first pandemic peak in Italy

Background-Aim: The SARS-CoV-2 infection was declared a global pandemic in March 2020 and initially had a wide diffusion in Northern Italy, especially in area of Bergamo. From December 2019 to May 2020 (peak of pandemic period), an increase of interstitial pneumonia cases was observed at [18F]FDG PET/CT in oncological patients in Bergamo area. Further, a significant increase of PETpositive interstitial lung alterations was found with higher incidence compared to the pre-pandemic period. These observations suggested the use of [18F]FDG PET/CT as a sentinel method to identify suspected cases of COVID-19 in asymptomatic oncological patients. This observational prospective multicentric study aimed at confirming the usefulness of [18F]FDG PET/CT in the occasional diagnosis of COVID-19. Methods: [18F]FDG PET/CT performed in oncological patients from May 2020 to January 2021 (post pandemic peak period) in 8 Nuclear Medicine Departments in Lombardy (Humanitas Gavazzeni Bergamo, IRCCS Humanitas Rozzano, IRCCS San Raffaele Milano, Ospedale San Gerardo Monza, IRCCS Ca'Granda Ospedale Maggiore Milano, IRCCS Istituto Nazionale Tumori, Milano) and Tuscany (Azienda USL Nord Ovest Livorno, Azienda Ospedaliera Universitaria Pisana, Pisa) were assessed. The PCR test was proposed to all patients with lung alterations suspected for COVID-19 to confirm the diagnosis of SARS-CoV-2 infection. Results: Overall 19814 patients were studied with [18F]FDG PET/CT for various oncological diseases in the Nuclear Medicine Departments of the Centers involved in the study. We identified 54 out of 19,814 (0.27%) [18F]FDG PET/CT with lung alterations suspected for COVID-19 interstitial pneumonia. 45/54 suspected patients underwent rhinopharyngeal swab for confirmation. 9 patients with lung imaging alterations did not undergo PCR confirmation. PCR test detected 11 positive cases (24% of patients who underwent PCR test). The incidence of PCR confirmed COVID-19 was 11 out of 19,814 (0.06%). Conclusions: Among oncological asymptomatic patients who underwent PET/CT, we identified by PCR test very few cases of COVID-19 pneumonia. This could result from two main reasons: firstly, the low incidence of COVID-19 in the examined period, as confirmed by the epidemiological curve, and, secondly, the effectiveness of environmental and personal hygiene, social distancing, the use of personal protective equipment. However, although PET/CT imaging is not a reference test for the diagnosis of COVID-19 pneumonia, this study demonstrated that [18F]FDG PET/CT can identify lung manifestations of COVID-19.

Hypermedia communication in COVID-19 times. Good practices in the Cuban press

Focused on the field of hypermedia journalism due to its possibilities of monitoring through teleworking, and because of the emphasis that the country is placing on the increasing use of ICTs, a team of researchers with diverse profiles, with representation in all regions of Cuba, identified 35 experiences of hypermedia journalism published in the Cuban public media until June 5th, 2020. From this sample, 20 proposals were selected using the nominal group technique in virtual variant, to which a more detailed analysis was carried out, based on 13 criteria identified among the international recommendations for dealing with the pandemic in the press. Both the analysis of the sample, as well as a discussion forum held with journalists from all over the archipelago from the publication of the report resulting from this research, yielded interesting guidelines about the positive communicative practices detected, potentially applicable in the productive dynamics of Cuban public media. © 2022, Centro Nacional de Informacion de Ciencias Medicas. All rights reserved.

DEVELOPMENT of COVID-19 MONOCLONAL ANTIBODIES and RECOMBINANT PROTEINS AS REAGENTS for BIOMEDICAL RESEARCH and DIAGNOSTIC TESTS

Since SARS-COV-2 virus spread worldwide and COVID-19 turned rapidly into a pandemic illness, the necessity for vaccines and diagnostic tests became crucial. The viral surface is decorated with Spike, the major antigenic determinant and main target for vaccine development. Within Spike, the receptor binding domain (RBD), constitutes the main target of highly neutralizing antibodies found in COVID-19 convalescent plasma. Besides vaccination, another important aspect of Spike (and RBD) is their use as immunogen for the development of poli- and monoclonal antibodies (mAbs) for therapeutic and diagnostic purposes. Here we report the development and preliminary biochemical characterization of a set of monoclonal antibodies against the Spike RBD domain along with the recombinant expression of two mayor COVID-19 protein reagents: the viral Spike RBD domain and the extracellular domain of the human receptor ACE2. RBD and the extracellular domain of ACE2 (aa 1-740) were obtained through transient gene transfection (TGE) in two different mammalian cell culture systems: HEK293T adherent monolayers and Expi293F™ suspension cultures. Due to its low cost and ease scale-up, all transfections were carried with polyethyleneimine (PEI). Expressed proteins were purified from culture supernatants by immobilized metal affinity chromatography. Anti-RBD mAbs were developed from two different immunization schemes: one aimed to elicit antibodies with viral neutralizing potential, and the other with the ability to recognize denatured RBD for routine lab immunoassays. To achieve this, the first group of mice was immunized with RBD in aluminum salts (RBD/Al) and the other with RBD emulsified in Freunds adjuvant (RBD/FA). Polyclonal and monoclonal antibody reactivities against native or denatured RBD forms were then assessed by ELISA. Complete RBD denaturation was followed by intrinsic fluorescence spectral changes upon different physicochemical stress treatments. As expected, RBD/Al immunized mice developed an antibody response shifted to native RBD while those immunized with RBD/FA showed a high response against both forms of the protein. In accordance with the observed polyclonal response, RBD/FA derived mAbs recognize both, native and denatured RBD. On the contrary, hybridomas generated from the RBD/Al protocol mostly recognize RBD in its native state. Further ELISA binding assays revealed that all RBD/FA derived mAbs can form a trimeric complex with ACE2 and RBD, denoting they would not have viral neutralizing activity. ELISA competition assays with the RBD/ACE2 complex aimed to determine the neutralization potential of the RBD/Al derived mAbs are under way. Overall, the anti-Spike RBD mAbs and the recombinant RBD and ACE2 proteins presented here constitute valuable tools for diverse COVID-19 academic research projects and local immunity surveillance testing.

An Online Educational Hackathon to Foster Professional Skills and Intense Collaboration on Software Engineering Students

The global pandemic of COVID19 demanded that professors rethink teaching strategies considering the use of online environments due to the social isolation stipulated to reduce the rate of contagion of the disease. A challenge for software engineering professors is to develop fundamental professional skills in students who are in the process of learning using these virtual environments. The purpose of this study is to identify how an online educational hackathon can support students of a Software Engineering program to develop professional skills. We also seek to understand how intense collaboration takes place between student teams, considering the digital context for the production of a technological solution. We conducted a Case Study on an educational hackathon that took place in the online context, collecting data through questionnaires, interviews, and observations. As some results, the skills that students most considered that this hackathon helped them to develop were communication, initiative, and creativity/innovation, among others. Also, the strategies of collaboration adopted by the students during this competition, considering the remote context. Therefore, the main contribution is the identification of how the realization of this event supported students to develop professional skills and to practice collaboration skills with each other. © 2021 ACM.

Intraoperative radiation therapy (IORT)for1200 early breast tumors

Introduction: Two prospective randomized trials, TARGIT-A and ELIOT, have shown intraoperative radiationtherapy (IORT) to be a safe alternative with a low-risk of local recurrence compared to whole breast radiationtherapy following breast conserving surgery for selected low-risk patients. We report the first 1200 tumors treatedwith this modality at our facility. Methods: 1200 distinct breast cancers in 1169 patients (31 bilateral) were treatedwith breast conserving surgery and X-ray IORT, using the Xoft Accent System from June 2010 to November 2018.Patients were enrolled in an IORT registry trial and data were collected at 1 week, 1 month, 6 months, 1 year, andyearly thereafter. The primary endpoint was local recurrence. Results: To date, there have been 61 events in 54patients: 50 ipsilateral local recurrences (14 DCIS and 36 invasive), 7 regional nodal recurrences and 4 distantrecurrences. Of local recurrences, 9 were within the IORT field, 21 outside of the IORT field but within the samequadrant as the index cancer, and 20 were new cancers in different quadrants. There has been no breast cancerrelated deaths and 27 non-breast cancer deaths. Currently, with a median follow-up of 52 months, Kaplan Meieranalysis projects 5.2 % local recurrence rate at 5 years. In the table below, the five-year probability of localrecurrence is analyzed by quadrant and/or type of recurrence (all recurrences or just invasive). Using the 2017,ASTRO Categories, 520 patients (43%) were suitable for IORT, 415 (35%) were cautionary, and 265 (22%) wereunsuitable for IORT after final histopathology was evaluated. Conclusion: IORT is profoundly convenient. Whenused as the only adjuvant breast irradiation, it eliminates approximately 15-35 outpatient visits. This has become increasingly important during the current COVID-19 pandemic. In the group of patients described here, more that100,000 patient-hours were saved. The local, regional, and distant recurrence rates observed in this trial wereslightly higher than those of the prospective randomized TARGIT-A and ELIOT Trials. This may be explained by22% of our patients being considered unsuitable for IORT by ASTRO Criteria. The low complication rates previouslyreported by our group as well as the low recurrence rates reported in this study support the cautious use andcontinued study of X-ray IORT in women with low-risk breast cancer.

DEVELOPMENT OF A HYPERIMMUNE EQUINE SERUM THERAPY FOR COVID-19 IN ARGENTINA

The disease named COVID-19, caused by the SARS-CoV-2 coronavirus, is currently generating a global pandemic. Vaccine development is no doubt the best long-term immunological approach, but in the current epidemiologic and health emergency there is a need for rapid and effective solutions. Convalescent plasma is the only antibody-based therapy available for COVID-19 patients to date. Equine polyclonal antibodies (EpAbs) put forward a sound alternative. The new generation of processed and purified EpAbs containing highly purified F(ab')(2 )fragments demonstrated to be safe and well tolerated. EpAbs are easy to manufacture allowing a fast development and scaling up for a treatment. Based on these ideas, we present a new therapeutic product obtained after immunization of horses with the receptor-binding domain of the viral Spike glycoprotein. Our product shows around 50 times more potency in in vitro seroneutralization assays than the average of convalescent plasma. This result may allow us to test the safety and efficacy of this product in a phase 2/3 clinical trial to be conducted in July 2020 in the metropolitan area of Buenos Aires, Argentina.

Potential usefulness of pentoxifylline, a non-specific phosphodiesterase inhibitor with anti-inflammatory, anti-thrombotic, antioxidant, and anti-fibrogenic properties, in the treatment of SARS-CoV-2.

Although most patients with coronavirus disease 2019 (COVID-19) have a good prognosis, in some cases, the disease progresses rapidly, and the mortality rate is high. Some evidence suggests that infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) produces a 'cytokine storm', which is related to acute respiratory distress syndrome or multi-organ dysfunction leading to physiological deterioration and death. It is important to highlight the state of hypercoagulability that can be triggered, involving microvascular thrombosis and vascular occlusive events, which are relevant to such poor outcomes. At present, no specific antiviral drug or vaccine is available for SARS-CoV-2 infection, and current research is aimed at preventing and mitigating damage to the target organs, mainly the lungs. In seeking therapies for patients with COVID-19, immunomodulators, cytokine antagonists and early anti-coagulation therapies have been tested in attempts to reduce the mortality rate. Pentoxifylline, a non-specific phosphodiesterase inhibitor widely used to improve the rheological properties of blood, has beneficial anti-inflammatory properties and can significantly reduce the serum levels of pro-inflammatory cytokines such as interleukin (IL)-6, IL-1, tumour necrosis factor-alpha, C-reactive protein and other immunoregulators. It has also been found to exert anti-thrombotic, antioxidant and anti-fibrogenic actions. These properties could help to prevent or mitigate the inflammatory response and hypercoagulability that develop with SARS-CoV-2 infection, decreasing multi-organ dysfunction manifesting primarily as acute lung injury.

Early neurological manifestations of hospitalized COVID-19 patients.

INTRODUCTION: Neurological manifestations can occur during coronavirus disease 19 (COVID-19). Several pathogenic mechanisms have been hypothesized, without conclusive results. In this study, we evaluated the most frequent neurological symptoms in a cohort of hospitalized COVID-19 patients, and also investigated the possible relationship between plasmatic inflammatory indices and olfactory disorders (ODs) and between muscle pain and creatine kinase (CK). METHODS: We consecutively enrolled hospitalized COVID-19 patients. A structured questionnaire concerning typical and neurological symptoms, focusing on headache, dizziness, ODs, taste disorders (TDs), and muscle pain, was administrated by telephone interviews. RESULTS: Common neurological symptoms were reported in the early phase of the disease, with a median onset ranging from 1 to 3 days. Headache showed tension-type features and was more frequently associated with a history of headache. Patients with ODs less frequently needed oxygen therapy. Inflammatory indices did not significantly differ between patients with and without ODs. Muscle pain did not show any association with CK level but was more frequently associated with arthralgia and headache. CONCLUSION: In our cohort, ODs were an early symptom of COVID-19, more frequently reported by patients with milder forms of disease. Headache in association with arthralgia and muscle pain seems to reflect the common symptoms of the flu-like syndrome, and not COVID-19 infection-specific.