Covid-19 and impulsivity: an evaluation of self-harm admissions in emergency care

Introduction: Several studies highlighted how COVID-19-related isolation and quarantine deeply weighed on the mental health of both the general and psychiatric population. There has been limited investigation about self-harm and impulsivity during the COVID-19 pandemic. Objective(s): The aim of this study is to evaluate how COVID-19- related lockdown affected self-harm rates in an Italian hospital. Method(s): Data on 59 patients were retrospectively collected from the Emercency deparment of the Policlinico Tor Vergata, Rome, from March 11 to May 4, 2020 (Italian mass quarantine) and the same periods of 2019 and 2021. Demographics, psychiatric history, substance use/abuse, types of self-harm and admission in psychiatric acute unit (PAU) rates were recorded. Result(s): No statistical difference was reported in self-harm rates [9.8%(26/266) in 2019 vs 13.2%(10/76) in 2020 vs 10.7%(23/215) in 2021;p>0.05]. In 2020 subjects were younger (31.9+/-12.1 vs 39.2+/-14.4,p=0.22;vs 38.1+/-14.4;p=0.15) and had higher incidence of psychiatric history [90%(9/10) vs 73.1%(19/26), p= 0.42;vs 65.2% (15/23),p=0.29],than 2019 and 2021 respectively. Substance use/abuse rates were significantly lower in 2020 compared to 2019 and 2021 [10%(1/10) vs 53.8%(14/26),p= 0.04;vs 60.9% (14/23), p=0.02]. In 2020, subjects committing self-harms were more frequently admitted to PAU compared to 2019 and 2021 [60%(6/10)vs19.2%(5/26),p=0.04;vs 17.4% (4/23), p=0.04). Conclusion(s): Consistent with the literature, lockdown-related measures negatively impacted on younger people, with higher rates of self-harm between March and May 2020. This, together with a higher rate of admissions to PAU, should warn the mental health system to target with specific programs to support adolescents and youngers.

How Covid-19 changed emergency department access: observational study comparison of patient stage of the day access in the psychiatric emergency department over three years

Introduction: A few studies have analyzed the impact of COVID-19 pandemic on psychiatric Emergency Department (ED) accesses. The pandemic may indeed have influenced the phase of day accesses for patients with psychiatric disorders. Objective(s): Aim of this cross-sectional study is to analyze how COVID-19 weighed on psychiatric patients daily accesses over the course of three years. Method(s): Data on 219 patients were retrospectively collected from the ED in the Policlinico Tor Vergata, Rome. According to the stage of the day, accesses were divided into 4 groups: between 00:00 and 6:00;between 6:00 a.m. and 12:00 a.m.;between 12:00 a.m. and 18:00 p.m.;between 18:00 p.m. and 00:00 p.m. Result(s): Performing a regression analysis, a relation was found between psychiatric symptoms, stage of the day admission and year. In 2019 the admissions seem to be homogeneously distributed, however during 2021 and 2020 the admissions rates have a delayed evening trend. Conclusion(s): Despite the low number of accesses considered, the Covid-19 pandemic appears to exert an effect that still lasts in terms of both accesses and worsening or new onset of psychiatric symptoms. Measures taken to prevent the spread of infections may have affected access in the ED of patients in various ways. However, the trend of increasing evening accesses could be related to a saturation of territorial psychiatric services that work mainly until the afternoon. Thus, an enhancement of territorial psychiatric services seems highly necessary to cope with what could be an increase in psychopathology in patients without previous diagnosis.

RNA Viruses, Pandemics and Anticipatory Preparedness.

RNA viruses are likely to cause future pandemics and therefore we must create and organize a deep knowledge of these viruses to prevent and manage this risk. Assuming prevention will fail, at least once, we must be prepared to manage a future pandemic using all resources available. We emphasize the importance of having safe vaccine candidates and safe broad-spectrum antivirals ready for rapid clinical translation. Additionally, we must have similar tools to be ready for outbreaks of RNA viruses among animals and plants. Finally, similar coordination should be accomplished for other pathogens with pandemic potential.

Differences in Perceived Stress between Genders among People with Diabetes during COVID Lockdown in Argentina

Many studies suggest that there is a difference in perceived stress (PS) among genders in general population. Gender differences in patients with diabetes are uncertain. Descriptions of gender differences in PS during Covid lockdown in people with diabetes are lacking. Objectives: To assess the differences regarding perceived stress and anxiety between genders among persons with diabetes during COVID-pandemic lockdown. Secondary: To describe the association between PS with metabolic control and other co-variables. Methods: Multicenter, cross-sectional observational study of data collection through an online survey. Adults with T1D and T2D in 37 Argentine Diabetes Centers were included, from April to May, 2020. Degree of stress was evaluated by the Perceived Stress Scale (PSS) , and anxiety by the Beck Anxiety Inventory (BAI) . Results: 2273 patients were included. 1194 (52.5%) were female. Age in woman 48.6 years and 52.1 in men. The proportion of patients with T2D was higher in male (58.6% vs. 48.9%) . Diabetes duration was around 14 years, similar in both genders. A1c levels were higher in female patients (7.7% vs. 7.5%, p < 0.05) . BAI and PPS scales resulted significantly correlated (r=0.58;p <0.001) . In the univariate analysis BAI and PPS scores were significantly higher in women with both T1D and T2D vs. men (BAI 8.9 vs. 6.6, p<0.001, PSS 14.3 vs. 11.8, p<0.001) . Using a logistic model as a discriminant function, female gender was significantly associated with BAI and PPS scores after adjustment for type of diabetes, age, A1c, educational level, living alone condition and the presence of comorbidities or complications (p<0.001) . Using multiple linear regression, BAI and PSS scores were significantly associated with female gender, after adjustment by the same covariates (BAI p<0.00 and PSS p<0.0013) . Conclusion: In the study sample, female gender was associated with higher scores of anxiety and PS, in a context of isolation due to COVID pandemic in Argentina.

Profile of the entrepreneur by opportunity in times of pandemic: An exploratory study

The objective of this scientific article was to determine the profile of the entrepreneur by opportunity in Latin America in the context of the Covid pandemic19, for this purpose a referential framework of the entrepreneur proposed by Veciana (1999) was considered and secondary sources were analyzed accordingly. As global and individual GEM reports, to achieve this objective exploratory research with a qualitative and quantitative approach was carried out. After applying the methodology and obtaining results, the most outstanding characteristics for an entrepreneur by opportunity in times of pandemic are proposed and described, which are: emotional leadership, creativity and innovation and the ambition for growth and help to others. © 2021, Associacao Iberica de Sistemas e Tecnologias de Informacao. All rights reserved.

Natural Barrier Feeding Technique in Megaptera novaeangliae in Central Coastal Area of Golfo San Jorge, Patagonia, Argentina

Humpback whales (Megaptera novaeangliae) are cosmopolitan and highly migratory animals. They are found in all ocean basins and annually migrate between low-latitude waters, where they breed and calve during the winter and spring, and high-latitude waters, where they feed during the summer and autumn. Commercial whaling resulted in a considerable reduction in all humpback whale populations. In the Southern Hemisphere alone, more than 200,000 whales were caught. Most populations, including the Western South Atlantic Ocean Breeding Stock "A" (BSA), have shown signs of recovery after the International Whaling Commission (IWC) enacted a moratorium in the late 1960s.

Chemical Engineering Teaching in COVID-19 Times: Successfully Adapting a Capstone Design Course to a Remote Format

The coronavirus COVID-19 pandemic required educational institutions to adapt face-to-face to remote teaching. This study reports the experience in the first semester of 2020 for a Chemical Engineering Capstone Design Course at the University of Campinas in Brazil. In this course, senior year students develop a group project, in which they simulate a chemical plant and evaluate its technoeconomic feasibility. In 2020, the groups were proposed to design a process to replace diesel fuel from the bus fleet in Campinas city with renewable fuel DME. Because of the pandemic, several adaptations were needed: the theoretical classes became asynchronous, group meetings were online, a commercial simulator was replaced by an open access one, and the schedule was extended by 2 weeks. Despite that, the students had a great performance, comparable to face-to-face. To assess student satisfaction, a questionnaire was used. The course met the expectations of most of the students who also recommended keeping it in the remote format or merging it with face-to-face teaching. Therefore, these changes made it possible to apply new teaching dynamics and tools that could be used in the future to improve the course quality. ©

Success Factors in e-Learning Systems for Students during the COVID-19 pandemic: Case Study in A Brazilian Higher Education Institution

The COVID-19 pandemic has brought changes to people's daily life around the world, safety measures were taken so to reduce the speed with which the virus would spread itself, one of the most notorious of these is social isolation. In Brazil, higher education institutions were ordered by the State to cease in-person classes. This work aims to evaluate the factors that contribute to the success of e-learning platforms during the pandemic, when the migration from in-person classes to online classes was compulsory. This is an exploratory research, with quantitative and qualitative approach, making use of structural equation modeling. The sample used was 115 participants who answered a validated questionnaire (α = 0.88), with questions about the e-learning system adopted by the institution. Thus, the variables that most influenced the Individual Impact and the Use of e-learning systems were User Perceived Satisfaction, which had the most impact variables on Computer Anxiety and Interaction with Others. This result indicates that the establishment of routines with interactive classes and the attention to students who may feel uncomfortable with new technologies are crucial for the success of e-learning systems. © 2021 AISTI.

Comparison of psychiatric emergency service admission rates in an italian COVID-19 hospital during lockdown and last year

IntroductionItaly has been one of the most affected countries by Covid-19 pandemic. Our University General Hospital, Policlinico of “Tor Vergata” (PTV) in Rome, has become a Covid Hub in order to manage the spread of the epidemic. Thus, our Psychiatric Emergency Service (PES)’s access has been partially limited. Direct indicators of PES activity, as admission rates, can be useful for evaluating the psychological impact of Covid epidemic.ObjectivesTo assess psychiatric admittance rates to PES of PTV before and during Covid-19 global pandemic.MethodsData from our PES register have been obtained and analyzed. We compared all the psychiatric access during the trimester March – May 2019 and 2020. All patients have been characterized according to clinical features.ResultsA marked reduction of the number of patients presenting to PES has been observed (76 patients) in the 57-day period (March 11–May 04, 2020) of lockdown compared to the same period in 2019 (266 patients). The cutback was visible for all diagnostic groups, except for “Borderline Personality Disorder” diagnosis which have slightly increased. On the other hand, hospitalization rates in our psychiatric inpatients unit remained steady.ConclusionsAlthough larger study are needed to understand the mental consequences of the lockdown experience, people’s fear of potential infection might explain our results. Interestingly, personality disorder patients represent an exception to it, suggesting the importance of the clinical characteristics of fearless, engagement in dangerous behavior and detachment from reality. These findings might be helpful to improve psychosocial crisis interventions during the pandemic.

Lung ultrasound predicts non-invasive ventilation outcome in COVID-19 acute respiratory failure: a pilot study.

BACKGROUND: The aim of this study is to determine relationships between lung aeration assessed by lung ultrasound (LUS) with non-invasive ventilation (NIMV) outcome, intensive care unit (ICU) admission and mechanical ventilation (MV) needs in COVID-19 respiratory failure. METHODS: A cohort of adult patients with COVID-19 respiratory failure underwent LUS during initial assessment. A simplified LUS protocol consisting in scanning six areas, three for each side, was adopted. A score from 0 to 3 was assigned to each area. Comprehensive LUS score (LUSsc) was calculated as the sum of the score in all areas. LUSsc, the amount of involved sonographic lung areas (LUSq), the number of lung quadrants radiographically infiltrated and the degree of oxygenation impairment at admission (SpO2/FiO2 ratio) were compared to NIMV Outcome, MV needs and ICU admission. RESULTS: Among 85 patients prospectively included in the analysis, 49 of 61 needed MV. LUSsc and LUSq were higher in patients who required MV (median 12 [IQR 8-14] and median 6 [IQR 4-6], respectively) than in those who did not (6 [IQR 2-9] and 3 [IQR 1-5], respectively), both P<0.001. NIMV trial failed in 26 patients out 36. LUSsc and LUSq were significantly higher in patients who failed NIMV than in those who did not. From ROC analysis, LUSsc ≥12 and LUSq ≥5 gave the best cut-off values for NIMV failure prediction (AUC=0.95, 95%CI 0.83-0.99 and AUC=0.81, 95% CI 0.65-0.91, respectively). CONCLUSIONS: Our data suggest LUS as a possible tool for identifying patients who are likely to require MV and ICU admission or to fail a NIMV trial.

Intramuscular Hematomas and Compartment Syndrome - An Inevitable Consequence in the COVID-19 Saga

Introduction: Anticoagulation in COVID-19 induced hypercoagulable state remains to be balanced with bleeding complications. Spontaneous muscle hematomas (SMH) often occur in the rectus sheath or gluteal muscles. Risk factors include trauma, increased abdominal pressure, anticoagulation, and hypertension. We describe two cases of non-iatrogenic SMH in therapeutically anticoagulated COVID-19 patients. Case Report: 1. 64 year old Caucasian male with ARDS due to COVID-19 was treated with mechanical ventilation, proning, methylprednisolone, tocilizumab (TOZ), and azithromycin/hydroxychloroquine. Right popliteal-posterior tibial vein DVT led to full anticoagulation (FA) with enoxaparin. Later the hemoglobin dropped (12.2 to 6.1 g/dl). Imaging showed SMH in the left posterolateral chest wall and gluteus minimus requiring blood transfusions and cessation of FA. D-dimer was 1.2 μ g/ml. A week later, imaging showed increased hematoma size in the left chest wall and right gluteal area. After hemoglobin stabilized, he was started on DVT prophylaxis. He required tracheostomy/PEG tube and placement in a long term acute care (LTAC) facility where he had decannulation and PEG tube removal. Patient recovered fully and is home with normal function. 2. 27 year old Caucasian female with sepsis due to COVID-19 was treated with mechanical ventilation, dexamethasone, TOZ, convalescent plasma, colchicine, and remdesivir. D-dimer was 1.6 μ g/ml and FA was started with enoxaparin. After intubation, hemoglobin dropped (11-6.9 g/dl). Imaging showed SMH in left biceps and pectoralis. Decreased radial pulse and increased capillary refill time with enlarging forearm hematoma prompted arterial US and CT angiogram. No flow was seen in the distal left upper extremity. Fasciotomy of the left forearm and carpal tunnel was performed with adequate perfusion of radial and ulnar arteries. Debridement was required for the non-viable flexor carpi radialis, flexor digitorum superficialis and flexor digitorum profundus. Patient was extubated and did well thereafter. Discussion: Thrombosis contributes much to the morbidity and mortality in COVID-19 patients. In a recent Veterans Health Administration study, deep vein thrombosis, pulmonary embolism, and cerebral ischemia/infarction comprised 9.3% of these patients. Despite the study's limitations, HESACOVID has shown that therapeutic enoxaparin is associated with fewer days on the ventilator and large reductions in D-dimer levels. Monitoring for SMH should be routinely performed on these patients. Research on optimal anticoagulation is necessary to assess the risk/benefit in this population. The bleeding risks are however less likely to cause mortality or disability as compared to the coagulation problems.

Topoisomerase III-ß is required for efficient replication of positive-sense RNA viruses.

Based on genome-scale loss-of-function screens we discovered that Topoisomerase III-ß (TOP3B), a human topoisomerase that acts on DNA and RNA, is required for yellow fever virus and dengue virus-2 replication. Remarkably, we found that TOP3B is required for efficient replication of all positive-sense-single stranded RNA viruses tested, including SARS-CoV-2. While there are no drugs that specifically inhibit this topoisomerase, we posit that TOP3B is an attractive anti-viral target.

A high-throughput neutralizing antibody assay for COVID-19 diagnosis and vaccine evaluation.

Virus neutralization remains the gold standard for determining antibody efficacy. Therefore, a high-throughput assay to measure SARS-CoV-2 neutralizing antibodies is urgently needed for COVID-19 serodiagnosis, convalescent plasma therapy, and vaccine development. Here, we report on a fluorescence-based SARS-CoV-2 neutralization assay that detects SARS-CoV-2 neutralizing antibodies in COVID-19 patient specimens and yields comparable results to plaque reduction neutralizing assay, the gold standard of serological testing. The fluorescence-based neutralization assay is specific to measure COVID-19 neutralizing antibodies without cross reacting with patient specimens with other viral, bacterial, or parasitic infections. Collectively, our approach offers a rapid platform that can be scaled to screen people for antibody protection from COVID-19, a key parameter necessary to safely reopen local communities.

A high-throughput neutralizing antibody assay for COVID-19 diagnosis and vaccine evaluation (preprint)

Virus neutralization remains the gold standard for determining antibody efficacy. Therefore, a high-throughput assay to measure SARS-CoV-2 neutralizing antibodies is urgently needed for COVID-19 serodiagnosis, convalescent plasma therapy, and vaccine development. Here we report on a fluorescence-based SARS-CoV-2 neutralization assay that detects SARS-CoV-2 neutralizing antibodies in COVID-19 patient specimens and yields comparable results to plaque reduction neutralizing assay, the gold standard of serological testing. Our approach offers a rapid platform that can be scaled to screen people for antibody protection from COVID-19, a key parameter necessary to safely reopen local communities.

Topoisomerase III-beta is required for efficient replication of positive-sense RNA viruses (preprint)

Based on genome-scale loss-of-function screens we discovered that Topoisomerase III-{beta} (TOP3B), a human topoisomerase that acts on DNA and RNA, is required for yellow fever virus and dengue virus-2 replication. Remarkably, we found that TOP3B is required for efficient replication of all positive-sense-single stranded RNA viruses tested, including SARS-CoV-2. While there are no drugs that specifically inhibit this topoisomerase, we posit that TOP3B is an attractive anti-viral target.