Incidence of ARF Due to COVID-19 interstitial pneumonia

Acute respiratory distress syndrome (ARDS) and hypoxemic respiratory failure represent the leading cause of death and a top priority complication in patients with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. ARDS, which tends to occur about 8-14 days from the onset of symptoms, may be found in 60-89.9% of patients who die during hospitalization. According to current literature, the reported incidence of ARDS among hospitalized patients with COVID-19 is quite wide and ranges from below 3% to 29%;the percentage increases to 32.8% among patients needing intensive care. Older age (especially ≥65 years), preexisting concurrent cardiovascular or cerebrovascular diseases, baseline hypertension, diabetes, and high temperature and injury to other organs (such as acute kidney disease) during COVID-19 course are associated with the occurrence of ARDS. Similarly, lymphopenia, decreased fibrinogen levels, and elevated d-dimer, C-reactive protein, ferritin serum levels, transaminases, and lactate dehydrogenase represent laboratory predictors of ARDS. Despite the increasing knowledge recently reached about COVID-19 course, further research efforts are needed to understand why some patients experience persistent inflammation, ARDS, and even death, while most of patients survive the inflammatory response and clear the virus more easily. © Springer Nature Switzerland AG 2020.

Analysis of SARS-CoV-2 Recombinant Lineages XBC and XBC.1 in the Philippines and Evidence for Delta-Omicron Co-infection as a Potential Origin (preprint)

We report the sequencing and analysis of 60 XBC and 114 XBC.1 SARS-CoV-2 lineages detected in the Philippines from August to September 2022, which are regarded as recombinant lineages of the BA.2 Omicron and B.1.617.2 Delta (21I Clade) variants. The sequences described here place the Philippines as the country with the earliest and highest number of XBC and XBC.1 cases within the included period. Majority of the detected cases were sampled from the adjacent Davao and Soccskargen regions in southern Philippines, but have also been observed at lower proportions in other regions of the country. Time-scaled phylogenetic analysis with global samples from GISAID reaffirms the supposed root of XBC-like cases from the Philippines. Furthermore, the apparent clustering of some foreign cases separate from those collected in the country suggests several occurrences of cross-border transmissions resulting in the spread of XBC-like lineages within and among those countries. The consensus mutation profile shows regions harboring mutations specific to either the Omicron BA.2 or Delta B.1.617.2 lineages, supporting the recombinant nature of XBC. Finally, alternative allele fraction pattern and intrahost mutation analysis revealed that a relatively early case of XBC collected in March 2022 is likely to be an active co-infection event. This suggests that co-infection of Omicron and Delta was already occurring in the Philippines early in 2022, facilitating the generation of recombinants that may have further evolved and gained additional mutations enabling its spread across certain local populations at a later time.

Telerehabilitation with Computer Vision-Assisted Markerless Measures: A Pilot Study with Rett Syndrome Patients

The use of telerehabilitation systems has shown a significant growth in the past years, demonstrating their crucial relevance in the time of the COVID-19 pandemic. Many devices and sensors have been proposed to analytically measure parameters for patient assessment, with limitations due to costs or feasibility. In this paper, we present a motor telerehabilitation system with computer vision-assisted markerless measures for patients with Rett syndrome. Twenty-one RTT (Rett syndrome) patients, with ages ranging from age 4 to 31 (Median: 12.50;IQR (interquartile range): 9.50–17.25) were recruited. The study follows a pre-test–post-test design, where the patients were submitted to a pre-test, treatment, post-test 1, treatment, post-test 2 procedure. Progress in patient outcomes was assessed by measuring joint passive range of movement (PRoM). Results show the reliability of our system, and the feasibility of a telerehabilitation treatment for RTT patients, with significant improvements in shoulder mobility and in elbow flexion and extension. Limited results in lower limbs suggest that home treatment should be fostered to reduce sedentary time. © 2023 by the authors.

COVID 19 and autoimmune blistering diseases: is there a link between epidermolysis bullosa acquisita and SARS-CoV-2?

The blistering disease Epidermolysis bullosa acquisita is a genetic/autoimmune disorder deriving from alterations of the human protein Collagen alpha-1(VII) chain (CO7A1). Exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) promotes a wide variety of autoimmune diseases and might be a risk factor for Epidermolysis bullosa acquisita;in order to further our understanding of the link between this blistering disease and SARS-CoV-2, this study analyzes the peptide-sharing between CO7A1 and SARS-CoV-2 proteome. Results indicate a high level of molecular mimicry between CO7A1 and SARS-CoV-2 and hCoV-229E, and hCoV-NL63, thus suggesting a potential role of COVID-19 as a risk factor for Epidermolysis bullosa acquisita. Copyright © by BIOLIFE, s.a.s. This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder.

Healthcare-associated infections in a neonatal ICU before and during COVID-19: preliminary results : Mariateresa Ceparano

Background Healthcare-associated infections (HAIs) are a frequent complication in neonatal intensive care units (NICUs). Hospital policies caused by COVID-19 pandemic may have played a role in HAIs development. The aim of this study was to describe and characterize over time the occurrence of HAIs in a NICU at the Policlinico Umberto I in Rome both before and during the COVID-19 pandemic. Methods All infants of all birth weight (BW) classes with >2 days in the NICU, admitted from January 2018 to December 2021, were included. To assess the effect of the pandemic, we compared surveillance data from 2018-2019 with those from 2020-2021. Infections were defined using standard Centers for Disease Control and Prevention definitions. Results We included 513 infants, 274 admitted in 2018-2019 and 239 between 2020-2021. NICU stay in days was similar in the two periods (14.4 and 15.3 respectively) but the number of patients who died in 2018-2019 (N = 13) was almost double that of 2020-2021 (N = 7). A total of 27 infections were recorded in the post-pandemic period compared to 9 recorded in the previous period, mainly central line-associated bloodstream infections (CLABSI) (7% vs 3.0%, p = 0.043), followed by ventilator-associated pneumonias (VAP) (3.0% vs 0.4%, p = 0.019). The incidence density of device-associated infections was higher in patients with lower BW class in both periods analyzed. Different microorganisms were isolated: in 2018-2019 K. pneumoniae (33.3%) and Serratia marcescens (33.3%) were the most found, while S. aureus (29.0%) and Staphylococci coagulase negative (51.6%) were predominant in the following years. Conclusions Results indicate that patient management may have influenced the occurrence of HAIs during the pandemic. This reinforces the importance of the HAI surveillance protocol in the NICU, which monitors microbiologic isolates and medical device use for all classes of infants with BW. Key messages • The Covid-19 pandemic has resulted in an increase in healthcare-associated infections occurrence in our neonatal intensive care unit. • Monitoring device-associated infections in all BW classes of infants is critical to prevent nosocomial infections.

Conspiracy theories, radicalization and quest for significance

The Covid-19 pandemic has represented and continues to represent a moment of crisis for many societies worldwide. During times of emergency like this, conspiracy theories spread very quickly as they provide simple explanations to complex events giving the illusion of being in control of an unknown and often frightening reality. Recently there has been an increase in the spread, especially online, of conspiracy theories connected both to the Covid-19 pandemic and to other social events. However, the spread of conspiracy theories can have very serious social consequences such as favoring the flourishing of forms of radicalization. In the present cross-sectional research conducted in Italy (N = 197) we used the Significance Quest Theory (SQT;Kruglanski et al., 2017) to describe how radicalization is connected to the quest for significance that can lead people to embrace a conspiracy mentality which in turn can support radicalized cognitions and behaviors. The results of this study reveal that the relationships between quest for significance and the tendency to radicalization and forms of prejudice towards immigrants, are partly explained by conspiracy thinking. The theoretical-practical implications of this research take into consideration the developments of SQT applied to the understanding of conspiracy thinking and the prefiguration of educational actions to be designed in a transformative perspective.

Prevalence and predictors of burnout syndrome among schoolteachers during the COVID-19 pandemic in Italy: A cross-sectional survey

Introduction: During the COVID-19 pandemic, teleworking affected the mental well-being of nearly all strata of the population. Teachers, who were employed to teach online courses during lockdown have been psychologically distressed. The primary aim of the current study was to estimate the prevalence and differences in the Burnout Syndrome (BOS) symptomatology in the light of gender, work position, teaching role, and subject taught. As a secondary aim, differences in perceived wellbeing were estimated through the contribution of individual factors. Methods: An online cross-sectional survey was conducted from February-May 2021 to recruit a total of 361 teachers from all Italian regions. The Work-Life Balance scale, the Maslach Burnout Inventory, and an ad-hoc questionnaire with items on perceived physical well-being and perceived impact and difficulty in remote work were utilized. Predictors associated with burnout and its subscales were examined using linear regression analyses. Results: Burnout, measured as the co-existence of high emotional exhaustion (EE), high depersonalization (DP), and low personal accomplishment (PA) was revealed in 16.9% of teachers, while high EE, high DP, and low PA were respectively measured in 35.2%, 13.2% and 35.2% of the sample. Variables, such as gender, work position, teaching role, and subject taught were all significant for group differences in perceived well-being or BOS dimensions among teachers. Discussion: Our findings suggest that the implementation of occupational health programs and workplace health promotion programs for improving the mental well-being of teachers. In particular, a higher caution must be needed for implementing critical institutional changes, such as the wide and rapid adoption of telecommuting. Take-home message: Italian schoolteachers engaged in teleworking are exposed to a high risk of stress and burnout during the COVID-19 emergency. Implementing occupational health surveillance programs and workplace health promotions programs are needed to protect and improve teachers’ mental well-being. © 2022 by the authors.

COVID 19 and Pemphigus vulgaris: a potential correlation

Autoimmune blistering diseases have been associated with exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In addition, oropharyngeal Pemphigus vulgaris appears to be associated with the coronavirus. In order to understand the molecular basis linking SARS-CoV-2 and Pemphigus vulgaris, this study explores the molecular mimicry hypothesis and analyzes the peptide sharing between the Pemphigus vulgaris autoantigen, i.e., Desmoglein 3 (Dsg-3), and the SARS-CoV-2 proteome. Results indicate a low molecular mimicry level, still immunologically significant, between SARS-CoV-2 and Dsg-3.

HUMORAL RESPONSE RATE POST MRNA COVID19 VACCINATION (BNT162B2) IS HIGLY DEPENDENT TO BONE MARROW PLASMACYTOSIS: LONG FOLLOW-UP OF SYMPTOMATIC MULTIPLE MYELOMA PATIENTS

Background: SARS-COV-2 anti-Spike IgG response following mRNA vaccination (BNT162b2) is suboptimal and highly variable in MM patients. Patients and Methods: We report here a single-institution retrospective analysis of 127 consecutive patients with symptomatic MM (71 males, 56 females), [median age 69.5 years (range 45-85)], 63 patients with untreated MM and 64 patients with MM refractory to one or more previous treatment lines. Myeloma therapies included PI+IMiD combos, IMiD-based regimens, PI-based regimens, anti-CD38 mAb-based therapies, antibody-drug conjugates (Belantamab Mafodotin monotherapy), dexamethasone and high dose melphalan. Anti-spike IgG antibody were detected also in 50 healthy volunteers. Patients with symptomatic MM and healthy controls received two dose of COVID-19 mRNA vaccine (Pfizer BioNTech) on days 1 and 21 between 29 April and 15 May 2021. Patients with prior history of SARS-CoV-2 were excluded from analysis. Quantitative determination of anti-spike S1/S2 IgG antibody was performed at 4 weeks from vaccination completion (LIAISONR SARS-COV-2 S1/S2 IgG, LIAISONR). It was previously established a threshold >15 AU/ml of anti-Spike IgG which was related to neutralizing activity of anti-SARS-COV-2 antibodies. Results: Sixty-five out of 127 patients were evaluable for response. Antispike IgG antibody were detected in 50/65 (76.9%) MM patients, defined as responders [177 AU/mL (range 26.4 - 1430)]. 23.1% of MM patients, defined as non-responders, failed to respond at two doses of COVID-19 mRNA vaccine [3.8 AU/mL (range 0.65 - 9.33)]. Seroprotection rate at cutoff of 15 AU/mL was 100% in controls [249 AU/mL (range 104 - 2430)]. No statistically significant differences were found between the two subgroups of patients for myeloma disease phase (relapse/refractory MM vs. untreated symptomatic MM), LDH, residual gammaglobulin levels, WBC, ANC, lymphocytic response, age and sex (Tab. 2). Conversely, plasmacytosis, B2M and haemoglobin concentration were associated with a different response to vaccine. Patients with extreme plasmacytosis (60.0 20.3 vs. 28.218.8 meanSD;p <0.001) (Tab. 2) had a mean titer less than 15 AU/ml of anti-Spike IgG compared with patients with a low plasmacytosis, who, conversely, showed significantly higher mean titers of anti-Spike IgG. B2M was significantly higher in non-responders compared to responders (4.6 4.1 vs. 3.23.6 mean SD;p = 0.006) (Tab. 2). Haemoglobin value was significantly lower in non-responders compared to responders (10.8 1.8 vs. 12.11.8 mean SD;p = 0.008) (Tab. 2). Multivariate analysis confirmed the bone marrow infiltration pattern and haemoglobin value as statistically significant variables. In addition, in the present cohort, the myeloma treatment, including high-dose melphalan and autologous stem cell transplantation, have not been associated with SARS-CoV-2 infection. Conclusions: In our experience, significant fraction of MM patients (23.1%) does not developed any detectable anti-Spike IgG after two dose of COVID-19 mRNA vaccine. Lack of IgG response associated with three statistically significant variables: extreme plasmacytosis, B2M, and haemoglobin concentration. In the subgroup of patients with good response to vaccine, after a median follow-up of 7 months from second dose of COVID-19 mRNA vaccine, no cases of COVID-19 occurred. .

Positive Development Through Sport: Effects of the COVID-19 Pandemic and Future Challenges

Over the last few decades research has shown the potentiality of sports practice and of relationships experienced in this context to social and emotional skills development in different age groups. Theoretical models were proposed to support sports programs that aim to promote positive outcomes and adaptive behaviors that act as protective factors for mental health, contributing to a healthy development. However, physical distancing measures imposed by the COVID-19 pandemic prevented sport practices in the conventional way, as predicted in these models. The aim of this chapter was to discuss the impact of the COVID- 19 pandemic on the potentiality of sport to foster positive development in practitioners of different age groups, as well as to reflect on the challenges to be faced after the pandemic is controlled, specially those related to the resumption of in-person sports practices. In this sense, positive youth, adults and older adults development models in sports are presented, their main limitations in face of the pandemic, as well as possible theoretical and practical adaptations in sports programs to confront current and future challenges to the maintenance of sports practices. © 2021 by Nova Science Publishers, Inc.

CONTINUOUS THERAPY WITH CARFILZOMIB-LENALIDOMIDE-DEXAMETHASONE (KRD): A MULTICENTRIC EXPERIENCE IN REAL-LIFE

The irreversible proteasome inhibitor Carfilzomib has a proven efficacy in doublet and triplet combinations for the treatment of patients with relapsed or refractory multiple myeloma (RRMM) as shown in the ENDEAVOR and ASPIRE trials. Here we retrospectively analyzed a series of RRMM patients treated with KRd regimen over 18 cycles to evaluate efficacy and tolerability of continuous treatment (Table 1). Data were elaborated using SPSS Statistics Version 26. Overall survival (OS) was calculated from the time of the beginning of treatment until the date of death for any cause or last follow-up visit. Progression free survival (PFS) was defined as the time from the beginning of treatment to documented progression. OS and PFS were analysed by the Kaplan-Meier test. The statistical significance level was set at the 95th percentile. 36 patients were enrolled at one Calabrian and three Sicilian centres on behalf of the Sicilian Myeloma Network from June 2016 to November 2021. 24 of them were on first relapse (66,6%). Median number of cycles was 31.5 (range 18-61). Overall response rate (ORR) at first response to KRd was 92%: 3 patients (8%) achieved a complete response (CR), 14 patients (39%) achieved a very good partial response (VGPR), 16 (45%) achieved PR, 2 (5%) a minimal response (MR) and 1 (3%) had a stable disease (SD). ORR at best response was 97% (56% CR, 30% VGPR, 4% PR), 1 patient (3%) had SD. At last follow up ORR was 53%: (36% CR, 8% VGPR, 8% PR), one (3%) had a SD. Progression disease (PD) occurred in 16 patients (44%), 15 of them were exposed to another treatment, among them 9 patients were exposed to at least two more treatments including novel agents (Daratumumab, Pomalidomide, Belantamab- Mafodotin). Median PFS was not reached and so was median OS calculated from the beginning of KRd. 9 patients (25%) reported grade 3-4 hematological AEs, 13 patients experienced (36%) grade 3-4 nonhematological AEs, only 3 (8%) cardiovascular AEs. Lenalidomide was reduced in 21 (58%), interrupted in 9 (25%) patients due to serious adverse events (SAEs). During Sars-Cov-2 pandemic waves, to reduce hospital admission, 8 patients who achieved at least VGPR continue halved Carfilzomib administration schedule (total dose 27 mg/m2 once every 2 weeks instead of twice) maintaining previous response except for 1 patient who experienced PD (at cycle 32, after one more year of KRD treatment). Real-world experiences often significantly diverge from randomized clinical trials for patients selection resulting into differences in terms of efficacy and tolerability. In our study KRd combination deepened response over time without relevant toxicity as showed also in a subgroup analysis of ASPIRE and ENDEAVOR. In addition, schedule modification during Sars-Cov-2 pandemic reduced the number of hospital admissions without losing quality of response, thus opening the question of which is the best administration regimen of Carfilzomib as maintenance. (Table Presented).

Pandemic and (Im)mobility: the spatial effects of the lockdown through digital platform's Big Data

In the absence of vaccines and due to an emergency generated by the rapid spread of the pandemic, the strategy adopted to counter the diffusion of COVID-19 was social distancing and lockdown measures which strongly influenced the mobility of individuals. In this context, the study aims to measure the spatial effects of these measures on mobility in two moments - during and after the italian lockdown - and for different functions (residence, workplaces, leisure, public transport). To this end, the contribution analyzes the spatial data made available by the digital platforms Google and Facebook through the Google Mobility Report and Facebook Data for Good programs. On the one hand, results show in (near) real-time the attractive and repulsive areas for insistent population, on the other hand, offer a critical reflection on the role of 'platform data' in a context of the growing diffusion of digital platforms in our society. © 2021 Pacini Editore. All rights reserved.

Addressing COVID-19 Communication and Management by a Systems Thinking Approach

A systemic stock-flow diagram is proposed for the communication and management of health services and strategies concerning the COVID-19 epidemic. The possible role of government interventions in activating systemic leverage points is also addressed. The presented approach, based on Systems Thinking, can create the basis for creating an analytical simulator of the disease spread, and at the same time the diagram can constitute a powerful tool for improving the quality of information for both policy-makers and the general public in situations of epidemics. © Gonella, Casazza, Cristiano and Romano.

How to Cultivate Personal Learning and Professional Growth in Times of Disruption, Resistance and Collective Transformation?

The article presents the results of a national study about reactions, feelings and resistance to the changes imposed by the lockdown due to the pandemic of a sample of primary and secondary school teachers. Our hypothesis is that the pandemic unexpected widespread and the consequential lockdown imposed in many countries may be assimilated to:—a traumatic experience (Kendler et al. 2003;Felitti in Journal of Child & Adolescent Trauma 10:205–206 2017), with high emotional impact on people mindsets and behaviors,—a collective disorienting dilemma (Journal of Transformative Education 4(2):123–139 2006. https://doi.org/10.1177/1541344606287503 ), capable to elicit emotional reactions and increase people’s disposability to learn and adaptability to change if adequately supported. Research questions were: What kind of feelings, reactions and behaviors did school teachers assume during and after the lockdown? How did teachers, faculty, and educational instructors react to the shift from in presence classes to distance learning and which factors were mostly influencing their reactions? What factors are effective in helping them to cultivate their professional development while engaging with these epochal challenges? An on-line survey was designed and administered to more than 400 in-service teachers of primary, secondary and high schools across Italy. 348 teachers completed the survey. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.