Group vs Individual Trauma-Focused CBT for Parents of Premature Infants

Objectives: Trauma-focused CBT (TF-CBT) has been established as an effective treatment to reduce symptoms of psychological distress including PTSD, anxiety, and depression in parents of preterm infants. The current study compares results of a group-based intervention developed to reduce symptoms of posttraumatic stress with a prior study using an individual version of the treatment manual. Method(s): A total of 26 mothers of preterm infants (25-34 weeks' gestational age;>600 g) received 6 sessions of TF-CBT including psychoeducation, cognitive restructuring, progressive muscle relaxation, and the writing and sharing of their trauma narrative. Outcomes were compared with a group of 62 mothers who participated in a prior RCT with individual therapy based on the same model. Results were also compared for mothers receiving in-person treatment vs telehealth during the COVID-19 pandemic. Result(s): For the entire study period (baseline to follow-up), the individual intervention showed greater improvement in trauma symptoms assessed with Davidson Trauma Scale (d = 0.48;p =.016), although both conditions showed noticeable improvement. Similar patterns were found for maternal depression (Beck Depression Inventory-II [BDI-II]) and anxiety (Beck Anxiety Inventory [BAI]). In-person treatment was found to be superior to telehealth treatment administered during the COVID-19 pandemic, although the difference was not significant. Conclusion(s): Group-based TF-CBT is an effective treatment modality for parents of premature infants with symptoms of psychological distress. However, recruitment of parents was difficult, raising questions about feasibility. Future group-therapy approaches will require a more flexible, open-ended group format in which parents have the option of participating without making a commitment for the full 6-session protocol. Given the national shortage of neonatal intensive care unit (NICU)-based psychological services, group therapy is a potentially viable and cost-effective way to deliver care. PTSD, PAT, P Copyright © 2022

Vacina Sarscov-2 Pfizer/Biontech Precipitando Agudizacao De Trombocitopenia Imune

Introducao: Trombocitopenia Imune (PTI) e uma doenca mediada por auto anticorpos contra glicoproteinas na membrana das plaquetas causando sua destruicao, associada a inibicao da funcao dos megacariocitos. A PTI pode ser primaria ou secundaria a doencas autoimunes, doencas linfoproliferativas, infeccao, medicamentos e imunizacao. Existem descricoes de vacinas contra Hepatite B, Influenza e ate mesmo contra o coronavirus, desencadeando quadros de trombocitopenia imune. Entretanto, ha poucos casos descritos ate o momento de agudizacao da PTI apos esta vacinacao, bem como nao existe contraindicacao para seu uso nesta populacao de pacientes. Objetivo: Relatar caso raro de vacina contra SARS-CoV-2 precipitando reagudizacao da PTI. Relato de caso: Mulher de 50 anos com PTI ha 28 anos, esplenectomizada ha 17 anos por corticodependencia. Apesar da esplenectomia, a paciente apresenta quadros esporadicos de reagudizacao apos infeccoes, sempre controlados satisfatoriamente com uso de corticoide. Recebeu previamente duas doses da vacina da COVID (Coronavac), sendo liberada em consulta de rotina para tomar a 3 dose da vacina, na ocasiao com dosagem de plaquetas de 225 mil/mm3. Apos 4 dias deste exame recebeu a vacina Pfizer, evoluindo no 1degree dia com petequias em membros inferiores e cavidade oral. Tres dias apos a vacinacao procurou atendimento medico, apresentando ao hemograma plaquetas 4.000 mil/mm3. Paciente foi tratada com pulso de metilprednisolona 1g/dia por 3 dias atingindo plaquetas 216 mil/mm3 apos 4 dias, mantendo-se com plaquetometria normal ate o momento, 6 meses apos o presente relato. Discussao: Assim como outros casos de infeccoes virais associados a etiologia da trombocitopenia imune, acredita-se que o fenomeno possa ser atribuido tanto pelo mimetismo molecular quanto pela resposta imune gerada. Estudos mostraram que 13,7% dos pacientes com PTI recairam a doenca apos a vacina da COVID-19. Entretanto, nao existem referencias quanto ao tipo de vacina realizada. Todos os casos descritos foram transitorios e com boa resposta a terapia padrao, assim como a paciente deste relato. Devido a isso, a contagem de plaquetas deve ser monitorada antes e apos a vacinacao, independente do componente vacinal, e ate entao, nao e contra indicada para pacientes portadores de PTI. Conclusao: Assim, o presente relato sugere que a vacina propiciou recaida da PTI, visto que a doenca estava estavel, sem ser observado outro fator desencadeante. Apos revisao na literatura, pode ser observado casos semelhantes. Porem, ainda faltam dados para comprovacao desta associacao, alem de estabelecer o melhor esquema vacinal a ser realizado nos portadores de PTI. Copyright © 2022

Infiltracao Do Sistema Nervoso Central: Desafio Terapeutico Nas Doencas Linfoproliferativas B Cronicas

Introducao: O acometimento do sistema nervoso central (SNC) e raro nas doencas linfoproliferativas B cronicas, sendo mais frequente a recaida nos linfomas nao-Hodgkin agressivos, porem a era pos Rituximab promoveu um ganho para esse perfil de pacientes. Objetivo: Relatar o envolvimento de SNC em 04 pacientes com doencas linfoproliferativas B cronicas e indolentes e revisar a literatura. Relato de caso: Caso 1: Homem, 53 anos, com leucemia linfoide cronica (LLC) Binet A desde 2012 e delecao 17p, apresentou crise convulsiva e rebaixamento neurologico em 12/2021. O liquor mostrou 18,3% de celulas B CD5+, CD19+, CD200+, recebeu imunoquimio intratecal e ibrutinibe sem resposta, LCR ainda infiltrado. Caso 2: Homem, 56 anos, com LLC Binet A desde 07/2021 evoluiu com abrupta piora cognitiva, RNM encefalica previa normal, novo exame em 02/2022 mostrou lesoes expansivas infiltrativas e nodulares intra-axiais bilaterais, compativeis com LNHDGCB (BCL-2+, CD20+, c-Myc+, Ki-67+, MUM1+), LCR normal, tratado com metotrexate (MTX) em altas doses, sem resposta. Caso 3: Mulher, 56 anos, com LNH folicular EC IVA em 2019, recebeu 06 ciclos de R-CHOP e manutencao por 02 anos, em remissao clinica. Em 04/2022 cursou com rapido agravo neurologico. A RNM mostrou lesoes na substancia branca nos hemisferios cerebrais, LCR infiltrado por celulas CD19, CD23, CD20, CD10 positivas, tratada com Ara C em altas doses, regressao das lesoes encefalicas, LCR ainda infiltrado. Caso 4 - Homem, 64 anos, com linfocitose, assintomatico desde 2011, IF de SP CD5- CD20+, CD22+, CD79b+, CD200+, evoluiu em 01/2022 subitamente com rebaixamento neurologico, entubado, LCR com 52,8% de linfocitos B CD19+, CD 20+, CD200+. Intercorreu com infeccao pelo SARS-Cov 19, complicacoes clinicas e obito. Discussao: O envolvimento do SNC nas doencas linfoproliferativas, tanto na apresentacao inicial ou na recidiva, e raro, podendo ser leptomeningeo disseminado e/ou parenquimatoso. Raramente descrito, o acometimento meningeo na LLC e objeto de discussao quanto ao impacto prognostico e ao tratamento. A infiltracao do SNC e mais descrita nos linfomas agressivos em cerca de 5% dos casos. Descrevemos 04 casos com envolvimento SNC em patologias de comportamento tipicamente indolente. Lemma et al. exploraram o papel dos marcadores biologicos que podem conferir as celulas do linfoma tropismo pelo SNC, altos niveis de Integrina alpha 10 e PTEN em amostras de tecido foram associadas a este tropismo, enquanto a expressao de CD44 e caderina-11 parecem ser protetivas, estes dados sao preliminares e precisam de validacao. A apresentacao clinica e heterogenea, desde alteracao comportamental, cefaleia, meningismo, hidrocefalia, e hipertensao intracraniana. No tratamento do linfoma primario de SNC o MTX e fundamental, mas ainda nao ha consenso em relacao a profilaxia e ao protocolo padrao nas recaidas. Fica claro que a dose de MTX IT parece insuficiente para tratar as formas parenquimatosas. Quando ha envolvimento meningeo, a via IT pode ser usada, mas os dados sobre os resultados nao sao conclusivos. Conclusao: O tratamento dos pacientes que apresentam infiltracao SNC permanece um desafio principalmente nos linfomas indolentes, considerando a dificuldade de padronizar tratamento eficaz, de menor toxicidade e a gravidade das sequelas por vezes irreversiveis. O mecanismo associado a invasao e a predilecao de alguns casos pelo SNC permanece incerto. Copyright © 2022

Chess at school, executive functions and pandemic: an exploratory study

The Covid-19 outbreak has significantly altered learning and development in school-age children. The study intends to explore executive functions before and after quarantine, investigating the possible effect of a chess laboratory intervention. 83 children were involved: 39 (control group-GC) carried out school activities in distance learning;44 (experimental group-GS) carried out distance learning and an online chess workshop. Parents completed the BRIEF questionnaire for the evaluation of executive functions before the activation of the laboratory (March 2020) and at the end of the school year (June 2020). The results show in the GC an increase in the frequency of risk in the acquisition of executive functions (task monitoring, inhibition and behavioral regulation);on the contrary, these areas are improved in the GS. The results support the chess laboratory as a useful tool to support learning and the development of some executive functions. © 2022, Institution of Russian Academy of Sciences. All rights reserved.

Structured reporting of chest CT in COVID-19 pneumonia: a consensus proposal.

OBJECTIVES: The need of a standardized reporting scheme and language, in imaging of COVID-19 pneumonia, has been welcomed by major scientific societies. The aim of the study was to build the reporting scheme of chest CT in COVID-19 pneumonia. METHODS: A team of experts, of the Italian Society of Medical and Interventional Radiology (SIRM), has been recruited to compose a consensus panel. They used a modified Delphi process to build a reporting scheme and expressed a level of agreement for each section of the report. To measure the internal consistency of the panelist ratings for each section of the report, a quality analysis based on the average inter-item correlation was performed with Cronbach's alpha (Cα) correlation coefficient. RESULTS: The overall mean score of the experts and the sum of score were 3.1 (std.dev. ± 0.11) and 122 in the second round, and improved to 3.75 (std.dev. ± 0.40) and 154 in the third round. The Cronbach's alpha (Cα) correlation coefficient was 0.741 (acceptable) in the second round and improved to 0.789 in the third round. The final report was built in the management of radiology report template (MRRT) and includes n = 4 items in the procedure information, n = 5 items in the clinical information, n = 16 in the findings, and n = 3 in the impression, with overall 28 items. CONCLUSIONS: The proposed structured report could be of help both for expert radiologists and for the less experienced who are faced with the management of these patients. The structured report is conceived as a guideline, to recommend the key items/findings of chest CT in COVID-19 pneumonia.