ABSTRACT
Public Transport (PT) extremely suffered from the Covid-19 pandemic. While trying to guarantee the service supply as regularly as possible, great efforts have been made by Transport Companies to deal with constantly changing emergency prescriptions. Moreover, overall uncertainty led to a sharp shift in travel behaviors and habits, resulting in a general increase in private (especially motorized) modes. Over the past months, a lot of research has tried to investigate the several perspectives for the PT sector, during and beyond the Covid-19, by accounting for e.g., new technologies, innovative service supply or transport modes, etc. which have been implemented overtime. However, after two-years from the Covid-19 outbreak, the transport demand is still not back to the pre-pandemic situation. Considering the trends of the past two-years, this paper aims at exploring how the transport demand has varied, with respect to the Covid-19 impact, the safety prescriptions, and the PT service supply, to shed light over still unobserved factors that may be useful to move forward. By considering the area of Brescia as a case study, the analysis compares the transport demand from the different urban PT systems (i.e., buses, metro light rail and bike sharing) of Brescia with the related service supply (i.e., kms-travelled, service availability, etc.), the Covid-19 infections, the service limitations (i.e., lockdowns, vehicle capacity reductions, etc.), to understand whether relationships exist among the several variables included. It emerged that the progressive easing of restrictions, the enhancements of intermodal transport system and the improvement of service's quality could have contributed to recovery transport demand. Future developments of the research could be addressed to extend the available database to confirm or improve the research findings. © 2023 The Authors. Published by ELSEVIER B.V.
ABSTRACT
Introduction: It is still debated whether Multiple Sclerosis (MS) patients are at high-risk of COVID-19 because of their life style, disease- or treatments-associated immune alterations. We compared features of MS patients with COVID-19 infection (MS-COVID) to those of residency-, age-, sex- and treatmentmatched MS controls (MS-NCOVID). Moreover, the severity of COVID-19 infection was assessed in MS-COVID patients and their cohabitants. Aims: Evaluate epidemiologic factors of MS patients who developed COVID-19 infection. Evaluate wether COVID-19 infection severity was different between patients and their cohabitants Methods: So far, we have enrolled 25 MS-COVID and 104 MS-NCOVID patients. Neurological examination, premorbid laboratory tests, anthropometric variables (height, weight and BMI), life-style habits (smoke, alcohol intake, diet), workingactivity and living conditions (number of cohabitants, schoolaged children) were assessed. COVID-19 severity was evaluated in terms of fever (magnitude, duration), radiological pneumonia and typical symptoms. Results: Clinical and anthropometric features, life-style habits and living conditions were similar between MS-COVID and MS-NCOVID patients. However, they differed in terms of working activity, with lower rate of unemployment (7.1% vs 23.4%) and higher rate of team-working (61.5% vs 26.5%) in the MS-COVID group (p<0.01). Furthermore, MS-COVID patients had lower premorbid vitamin D levels (31 vs 40 ng/ml p=0.048) and higher neutrophils count (3803 vs 3182 cells/ul, p=0.046). Disease course was similar between MS-COVID patients and their cohabitants with fever, ageusia and anosmia being the most common symptoms. Fever and radiologic signs of pneumonia were also comparable. Conclusion: Working-activity, lower vitamin D levels and higher neutrophil count seem to be associated with the risk of COVID-19 infection in MS patients. The burden of COVID-19 disease was comparable between MS patients and their cohabitants.
ABSTRACT
Background and aims: SARS-CoV-2 infection is now known to be associated with a wide spectrum of neurological autoimmune syndromes, in some cases responding to immunotherapies, arising during or after the infection. Whether molecular mimicry or other immune stimulation may induce an aberrant delayed autoimmune response is still to be established. Methods: Case report. Results: A 71 year-old man with no previous medical history apart from mild COVID-19 pneumonia three month earlier, sought medical attention for a subacute onset of diplopia in left gaze, general malaise and fatigue. MRI was characterized by bilateral FLAIR hyperintensities with punctate, perivascular and confluent post-gadolinium enhancement in the pons, mesencephalon, hypothalamus, internal capsules and right hippocampus. Repeated cerebrospinal fluid analysis were normal (2 cells/μL), with no evidence of oligoclonal bands or atypical cells. Screening panel for autoimmune and infectious aetiologies was negative. Whole-body contrast-enhanced CT was unremarkable. Stereotactic temporal lobe brain biopsy showed aspecific chronic lymphocytic perivascular inflammation. Partial spontaneous remission of symptoms occurred within few weeks. He was then treated with intravenous high-dose methylprednisolone with almost complete enhancement regression on MRI. Collected data were suggestive of CLIPPERS with diffuse bilateral sovratentorial involvement. The patient started daily oral steroid tapering and monthly cycles of intravenous cyclophosphamide with persistent clinical and neuroradiological stability. Conclusion: CLIPPERS is a rare diagnosis and to the best of our knowledge, this is the first time it was reported after COVID-19 disease. Even though a case report is not enough to suggest a causal link, future reports could support this possibility. (Figure Presented).
ABSTRACT
Background and aims: Anton-Babinski syndrome is a rare condition due to occipital injury by different mechanisms, such as vasogenic edema in posterior reversible encephalopathy syndrome (PRES) resulting from bood-brain barrier (BBB) disruption. PRES has been rarely associated with Guillain-Barré syndrome (GBS). It has hypothesized that autonomic dysfunction in GBS might lead to BBB damage with consequent PRES before motor symptom onset. Another possibility is that BBB injury in PRES might trigger immune-mediated reaction leading to GBS. Methods: An 80-year-old woman was admitted to our emergency room (ER) after she developed two partial seizures, successfully treated with 5mg of intravenous midazolam. Her medical history was unremarkable except for previous SARS-CoV-2 disease. Results: After one hour from midazolam administration, the patient was still markedly confused. Examination revealed binocular blindness, without signs of optic neuropathy;despite being obviously blind, she denied any vision disturbance, a phenomenon known as visual anosognosia. Her blood pressure was 180/90mmHg. Brain MRI showed posterior alterations compatible with PRES. She was treated with antihypertensive and vision recovered after 24 hours. On day 3, she developed areflexia and proximal symmetrical weakness to both upper and lower limbs. Electromyography suggested recent motor poliradiculoneuropathy. Clinical picture was compatible with GBS and intravenous immunoglobulins were started, with gradual recovery. A 8-day follow-up MRI showed nearly complete normalization of posterior lesions. Figure 1 Conclusion: Anton syndrome is a possible rare presentation of PRES. Occurrence of unexplained weakness after PRES should raise suspicion of GBS in consideration of their pathophysiologic connection.
ABSTRACT
Background and aims: It is still debated whether Multiple Sclerosis (MS) patients are at high-risk of COVID-19 because of their life style, disease-or treatments-associated immune alterations. We compared features of MS patients with COVID-19 infection (MS-COVID) to those of residency-, age-, sex-and treatment-matched MS controls (MS-NCOVID). Moreover, the severity of COVID-19 infection was assessed in MS-COVID patients and their cohabitants. Methods: So far, we have enrolled 25 MS-COVID and 104 MS-NCOVID patients. Neurological examination, premorbid laboratory tests, anthropometric variables (height, weight and BMI), life-style habits (smoke, alcohol intake, diet), working-activity and living conditions (number of cohabitants, school-aged children) were assessed. COVID-19 severity was evaluated in terms of fever (magnitude, duration), radiological pneumonia and typical symptoms. Results: Clinical and anthropometric features, life-style habits and living conditions were similar between MS-COVID and MS-NCOVID patients. However, they differed in terms of working activity, with lower rate of unemployment (7.1% vs 23.4%) and higher rate of teamworking (61.5% vs 26.5%) in the MS-COVID group (p<0.01). Furthermore, MS-COVID patients had lower premorbid vitamin D levels (31 vs 40ng/ml p=0.048) and higher neutrophils count (3,803 vs 3,182 cells/ul, p=0.046). Disease course was similar between MS-COVID patients and their cohabitants with fever, ageusia and anosmia being the most common symptoms. Fever and radiologic signs of pneumonia were also comparable. Conclusion: Working-activity, lower vitamin D levels and higher neutrophil count seem to be associated with the risk of COVID-19 infection in MS patients. The burden of COVID-19 disease was comparable between MS patients and their cohabitants.