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Abstract: In Italy, at the beginning of the SARS-CoV-2 pandemic, the main organizational model of hospital care was represented by the physical or functional division of hospitals and wards into COVID and non-COVID areas, in order to separate SARS-CoV-2-infected patients from the others. Now that the emergency phase has reached its long-awaited end, it is necessary to develop a new hospital care paradigm that may deal with SARS-CoV-2-positive patients discriminating between those who are hospitalized because of COVID-19 and those who are diagnosed with SARS-CoV-2 infection immediately before or after the first access to healthcare facilities.
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Introduction: Some disease modifying treatments (DMTs) impair response to SARS-CoV-2 vaccines in multiple sclerosis (MS), potentially increasing the risk of breakthrough infections. Objective(s): To investigate longitudinal post-vaccine antibody dynamics and memory B cell responses after 2 and 3 SARSCoV- 2 mRNA vaccine doses, and their association with risk of COVID-19 in MS patients treated with different DMTs. Method(s): Prospective observational monocenter cohort study in MS patients undergoing SARS-CoV-2 mRNA vaccinations. Anti- SARS-CoV-2 spike IgG serum titers were measured by chemiluminescence microparticle immunoassay. Frequency of spike-specific memory B cells were measured upon polyclonal stimulation of total PBMCs and screening of secreted antibodies by ELISA. Result(s): We recruited 120 MS patients (58 on anti-CD20, 9 on S1P-modulators, 15 on cladribine, 24 on teriflunomide and 14 untreated) and collected 392 samples before and up to 10.8 months after a 2nd vaccine dose. Compared to no treatment, anti-CD20 antibodies (beta=-2.07, p<0.001) and S1P-modulators (beta=-2.02, p<0.001) were associated with lower anti-spike IgG titers, while teriflunomide and cladribine were not. Anti-spike IgG titers progressively decreased with months since last vaccine dose (beta=-0.14, p<0.001), independently of DMTs. Within anti-CD20 treated patients, anti-spike IgG remained constantly higher in those with greater baseline CD19+ B cell counts and were not influenced by post-vaccine anti-CD20 infusions. Antispike IgG titers increased after a 3rd vaccine dose on cladribine and teriflunomide and marginally on anti-CD20 and S1Pmodulators. Spike-specific memory B cell responses were weaker on S1P-modulators and anti-CD20 than on teriflunomide and influenced by post-vaccine anti-CD20 infusions. Risk of SARS-CoV-2 infection was predicted by SARS-CoV-2 IgG at last sample before infection (OR=0.56, 95%CI=0.37-0.86, p=0.008). Conclusion(s): Post-vaccine SARS-CoV-2 IgG antibody titers progressively decrease over time in MS regardless of DMTs, and are associated with risk of breakthrough COVID-19. Both immediate humoral and specific memory B cell responses are diminished in patients on S1P-modulator and anti-CD20 antibody treatments. Within the latter group, B cell count at first vaccine dose determines anti-spike IgG production shortly after vaccination, whereas post-vaccine anti-CD20 infusions negatively impact memory B cell responses.
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Introduction: SARS-CoV-2, responsible for severe human infection with high mortality rate, has been classified as HG3 pathogen. Despite the need to perform autopsy to clarify the pathogenesis of COVID, such procedures are at high risk of contagion due to the direct contact with aerosols and body fluids. To ensure the safety of the personnel against contagion, it is mandatory to follow the SOP for the management of autopsy environment and infected body. Several studies have shown that SARS-CoV-2 persists on inanimate surfaces for a long time and is also ubiquitously detected in many human tissues, even after long time after death. Material and Methods: Many international scientific societies have drowned up various guidelines on biosafety and exposure precautions, but none of these is uniquely adopted. So, in the daily practice our greatest difficulty was to identify SOP adherent to the guidelines but applicable to our reality. In our experience, COVID autopsies were performed accordingly to the following SOP: - COVID mortuary refrigerators - BSL3 autopsy facility - Autopsy saw with aspiration system - PPE: surgical scrub, rubber medical shoes, coverall, shoe leggings, FFP3 mask, waterproof gown or apron, eyes protection, two pairs of medical gloves and one of cut-resistant gloves - Sanitization of surgical tools in autoclave - Sanitization of the environments with VHP - Periodic nasopharyngeal swabs from personnel Results and Conclusions: Our work aims to share our experience and to demonstrate that adopting these measures is effective in reducing risk of infection. In fact, the periodic COVID swabs were negative in 100% of cases.
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SARS-CoV-2 infection (COVID-19) results predominantly in pulmonary involvement but a direct, virus-induced liver damage may also occur, whose mechanisms are being actively investigated. Accordingly, it appears of utmost importance to monitor liver function and carefully evaluate hepatic safety of the various drugs administered during COVID-19. In this respect, many drugs, biological agents and novel molecules, whose efficacy in COVID-19 is under scrutiny, have also been shown to potentially cause or worsen liver damage. In this article, we review safety data of established as well as promising agents for COVID-19.
Subject(s)
COVID-19 Drug Treatment , Antiviral Agents/adverse effects , Humans , Hydroxychloroquine , Liver , SARS-CoV-2ABSTRACT
The continuity of monitoring operations at national earthquake centers during crisis is an important challenge. In 2020, because of the COronaVIrus Disease 2019 (COVID-19) health emergency, monitoring centers all over the world faced new, unexpected problems. In Italy, the Istituto Nazionale di Geofisica e Vulcanologia (INGV) has the duty to perform earthquake and volcano monitoring, seismic surveillance and tsunami alerting, and maintaining effective communication with the National Civil Protection agency and the public. During the lockdown, that started on 9 March 2020, INGV set up a series of sanitary and organizational measures and improved the technological infrastructures in the control room in Rome for remote use of software for seismic network monitoring, seismic surveillance, and tsunami alerting. Our main goal was to protect the researchers and technicians on duty as much as possible and develop the remote use of software tools necessary to perform service activities when needed to limit the presence in the control room to the essential. In the first month of lockdown, we implemented the organizational controls, the health aids, and the tools for remote surveillance and alerting, and gave online training courses for about 100 shift workers. At the end of March 2020, most of the technicians, researchers, and tsunami experts on duty were able to access the new monitoring tools from home. During these months, the shifts in the control room were done in person and we performed remote seismic surveillance and tsunami alerting only during the weekly disinfections of the control room and at the beginning of each week. The tools developed during the COVID health emergency are going to be useful in the future especially in the case of other emergencies including the occurrence of a strong earthquake. © Seismological Society of America