COVID-19 and pregnancy: clinical outcomes and scientific evidence about vaccination.

Pregnant women and their infants are at high risk to develop a severe COVID-19, with increased rates of hospitalisation to intensive care units, need for mechanical ventilation and mortality. Preterm birth, fetal vascular malperfusion, and premature rupture of membrane have been the most reported adverse pregnancy outcomes and these effects have been especially associated with the onset of the disease at early gestational age. The early expression of ACE2 and TMPRSS2 in human embryos has been proven, determining an increased susceptibility to SARS-CoV-2. Preterm infants born to women infected by SARS-CoV-2 have a higher risk of need for specialist neonatal care with prolonged hospitalization. Moreover, inflammation of developing embryos could cause long-term defects, regardless of vertical transmission of SARS-CoV-2. Due to Maternal Immune Activation (MIA), in utero inflammation is associated with neurodevelopmental, cognitive and psychiatric disorders in affected offspring. Despite risks that COVID-19 could induce in pregnancy, there are not many published data describing the safety and/or efficacy of COVID-19 vaccines in pregnant women, commonly not included in vaccine research. The evidence from the few pregnant women unintentionally enrolled in clinical trials and vaccinated suggests that COVID-19 vaccines, both based on mRNA and viral vectors, do not pose significant risks to the fetus or breastfeeding infants. Moreover, human studies using mRNA-based vaccines against Zika virus, influenza, and rabies have reported good safety and immunogenicity during pregnancy. In this review, we evaluate the role of COVID-19 in adverse pregnancy and neonatal outcomes and the need to vaccinate pregnant women.

Telemedicine and management of the patient affected by giant cell arteritis during the COVID-19 pandemic-telemacov

Background: Giant cell arteritis (GCA) is the most common primary systemic vasculitis in western countries with the highest incidence among persons 70-79 years of age. Treatment has been with glucocorticoids (GCs) alone for many decades but recently Tocilizumab (TCZ) has demonstrated efficacy in reducing GC dose and flare rates in patients with GCA. Therefore, both early diagnosis and regular monitoring are necessary for the correct management of GCA. The COVID-19 pandemic has led to decisions by the governments of the countries involved, aimed above all at reducing the contagion. This has also led to reductions in health activities, limiting them to those of urgency by reducing or canceling checkups involving the risk of a time gap which for the GCA meant the interruption of clinical monitoring and therapeutic adjustment. At the same time, the pandemic situation has stimulated remote monitoring activities, through telephone contacts or video calls carried out by the rheumatologist. EULAR identified a minimal data set aimed at research and for clinical use, which includes the main clinical and instrumental data to be taken into consideration in monitoring the patient. For many data a clinical examination is not necessary but an interview is sufficient. We activated the TELEMACOV protocol (TELEmedicine and Management of the patient affected by giant cell arteritis during the COVid-19 pandemic) monitoring the follow-up of patients affected by GCA through telemedicine tools in order to maintain an effective and risk-free follow-up in a pathology with a high risk of relapse. Objectives: The purpose of the study is to evaluate the effectiveness of telemedicine in the follow-up of the patient with GCA. Methods: We evaluated patients (pts) with a clinical diagnosis of GCA (received in previous periods) who were admitted to the our Rheumatology Unit. They were monitored monthly by telephone from 9 March to 9 June 2020 (during lockdown). All patients were asked questions divided according to the sub-groups listed below: -Onset of new symptoms or their recurrence -Exams carried out -Current therapy -Satisfaction of telephone call Results: We performed 148 remote monitoring visits in 37 pts. The cohort was mainly composed by female (77,8%) and had a mean age of 71,85 ± 9,25 years. They were affected by GCA, with a mean duration of 5,3±2,3 months. The characteristics of these pts and the course of the disease are reported in Table 1. Pts treated with TCZ reduced their GC dose more than patients treated with GC alone (p: 0.032). Only one patient (treated with GC alone) had an ocular flare with the need to increase the dosage of the GC with good response and rapid improvement. Furthermore, all patients considered this type of monitoring very satisfactory according to the Likert scale (1-5) with mean 4,4±0,2. Conclusion: Our study has shown how telemedicine can be well used in pts with GCA as a possible alternative, for a limited period, to traditional visits, especially in a fragile population such as the elderly and more exposed to the risk of SARSCOV2 infection.

IPSICO survey on the psychological impact of COVID-19 on healthcare providers in obstetrics: A study design

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is giving rise to a relevant impact on the wellbeing and mental health of several Health Care Providers (HCPs). Among HCPs, those who work in the field of obstetrics repre-sent a particular group of HCPs who are susceptible to stressful events, given the stress derived from a physically, emotionally, and intellectually demanding work, the difficulty in reschedul-ing and postponing daily activities during a health emergency, and the special ability to develop personal resilience. Based on this background, the aim of the present study is to assess the acute psychological and professional impact of the SARS-CoV-2 outbreak on this group of HCPs at four University Hospitals in Italy (Verona, Roma Policlinico Gemelli, Varese, Brescia). For this purpose, a 104-items survey named Impatto PSicologico Covid in Ostetricia (IPSICO) has been developed and administered with a web-based platform. This survey, divided into four sections, will collect demographic data and information about past personal and mental health history, the impact of the epidemic on the personal and professional life, and the outcomes of this health care emergency. The results of this survey will help to plan effective strategies in order to face the psychological consequences of possible future new health care emergencies of this type.

Management of obstetrics and gynaecological patients with COVID-19

The widespread SARS-CoV-2 implies the application of procedures aimed to detect, isolate, and appropriately manage affected patients in the setting of obstetrics and gynaecologic emergency room and in inpatient setting, such as during labour, delivery, and postpartum. Here we report specific recommendations for the management of suspected and confirmed gynaecologic and obstetrics patients with COVID-19. The checklist developed by the Società Italiana di Malattie Infettive e Tropicali (SIMIT-2, available in English, Italian, Chinese) represents the first step to clas-sify patients who need to be managed following the SIMIT-1 flowchart, applying all the appropriate infection control procedures. In this scenario, the management of pregnant women needs to follow the same procedures as the general population. Nevertheless, as for other potentially severe respiratory infections, pregnant women could be more vulnerable. In this regard, the maternal and foetal interests can be conflicting, such as the choice of the time and mode of delivery or the use of steroids for foetal maturation. More-over, available evidence suggests a maternal-foetal transmission via contact with respiratory secretions and seems to exclude in utero transmission. Therefore, the appropriate management of breastfeeding is unclear, and the temporary separation of the infant from the mother could be an option. Finally, in general, delivery represents a moment of a high risk of infection for healthcare providers, and specific behaviours are mandatory.

Inositol and pulmonary function. Could myo-inositol treatment downregulate inflammation and cytokine release syndrome in SARS-CoV-2?

The outbreak of Sars-CoV-2 (COVID-19) poses serious challenges to people's health worldwide. The management of the disease is mostly supportive, and respiratory failure from acute respiratory distress syndrome is the leading cause of death in a significant proportion of affected patients. Preliminary data point out that dramatic increase in IL-6 and subsequent cytokine release syndrome may account for the development of fatal interstitial pneumonia. Inhibition of IL-6 by blocking its specific receptor with monoclonal antibodies has been advocated as a promising attempt. Here we assess the potential utility of myo-Inositol, a polyol already in use for treating the newborn Respiratory Distress Syndrome, in downregulating the inflammatory response upon Sars-CoV-2 infection. Myo-Inositol proved to reduce IL-6 levels in a number of conditions and to mitigate the inflammatory cascade, while being devoid of any significant side effects. It is tempting to speculate that inositol could be beneficial in managing the most dreadful effects of Sars-CoV-2 infection.