The impact of the covid-19 pandemic on the risk of social stigma

Introduction: Social stigma indicates a process of negative connotation of a person which results in discrimination. The victim of stigma experiences a condition of social exclusion that negatively affects his relationships. The COVID-19 pandemic has spread the fear of being contaminated, which has led to the discrimination of a part of population. Objective(s): The purpose of this work is to analyze which people have suffered from stigma due to the COVID-19 pandemic by examining the negative effects on their health during this period. Method(s): A literature review of peer-reviewed articles was performed on Pubmed NCBI database by inserting the keywords: stigma and COVID-19 in the period 2020-2021. Result(s): The data showed that the categories most at risk were positive patients and their families;healthcare workers in COVID- 19 wards;Asian people. Discrimination has included avoidance attitudes, physical or verbal abuse, hypersurveillance in public places. Negative effects on victims included anxiety, depression, feelings of rejection and shame, self-harm and suicide. COVID-19 patients attempted to hide the disease by avoiding access to hospital;health personnel developed risk of burnout;Asian restaurants experienced a drop in reservations, even after quarantine period. Conclusion(s): Social stigma is a public health problem and greater efforts are mandatory to reduce it including correct information, with the help of social and mass media;social interventions aimed at generating empathy;avoiding the use of negative language focused on stereotypes that could generate fear or discrimination. Such interventions are crucial to reduce discrimination in such a fragile period as COVID-19 pandemic.

Suicide presentation and the risk at the time of the mandatory quarantine for the SARS-Cov-2 pandemic: medico-legal and forensic aspects

Introduction: COVID-19 pandemic is the most important health emergency of the 21st century. Since the high number of infected people and as there is still no specific therapy worldwide, the pandemic has been countered through the application of prevention measures based on social distancing and home isolation. These elements are known risk factors for the development of various psychiatric conditions. From a forensic point of view, these pathologies are related to a high suicide rate. Objective(s): It is no coincidence that during the previous pandemics that have occurred in history there has been a significant increase in suicides. By this work, we therefore want to highlight the psychological consequencesofapandemicandthe importanceofpreventivestrategies. Method(s): It is important to focus not only on physical well-being but also on the psychological aspects that the pandemic produces in the daily life of each individual Results: If the infecting agent causes the death of millions of people around the world, the socio-economic context that is created indirectly determines as many deaths. Conclusion(s): Therefore it is necessary to underline how it is advisable to implement preventive measures in order to significantly reduce deaths from suicide, a problem with an important impact in the social and forensic fields.

"Second victims" in Covid-19 pandemic: A crosssectional study among medical doctors of the Catanzaro Hospital

Introduction: Medical errors are a serious public health problem. The COVID-19 pandemic has caused further stress to doctors with the increase in patient mortality, the lack of definite guideline and growing work demands. In this scenario, the patient is not the only victim of the medical error. The "second victim" (SV) is defined as a health worker who was involved in an unforeseen and negative event for the patient, who suffers physically and psychologically, because he was traumatized by his own mistake and/or by the injuries caused to the patient. The SV phenomenon prevalence varies from 10.4% up to 43.3%. Objective(s): The aim of this study is to evaluate the second victim phenomenon during the COVID-19 pandemic among medical doctors of the Catanzaro University Hospital (Italy). Method(s): A cross-sectional study will be conducted by administering an anonymous questionnaire to the Catanzaro University Hospital medical doctors using SurveyMonkey software. Descriptive analysis will be performed. Result(s): The data collection is ongoing. Currently, 300 subjects are included in the sample. Conclusion(s): The second victim phenomenon has a negative impact on doctors, colleagues and patients. It is important to aid health workers involved in an adverse event by activating support networks and adopting appropriate strategies in order that the event is a source of learning and not of demotivation.

Rehabilitation of Post-COVID Patients: A Virtual Reality Home-Based Intervention Including Cardio-Respiratory Fitness Training

The post-COVID syndrome is emerging as a new chronic condition, characterized by symptoms of breathlessness, fatigue, and decline of neurocognitive functions. Rehabilitation programs that include physical training seem to be beneficial to reduce such symptoms and improve patients’ quality of life. Given this, and considering the limitations imposed by the pandemic on rehabilitation services, it emerged the need to integrate telerehabilitation programs into clinical practice. Some telerehabilitation solutions, also based on virtual reality (VR), are available in the market. Still, they mainly focus on rehabilitation of upper limbs, balance, and cognitive training, while exercises like cycling or walking are usually not considered. The presented work aims to fill this gap by integrating a VR application to provide cardio-respiratory fitness training to post-COVID patients in an existing telerehabilitation platform. The ARTEDIA application allows patients to perform a cycling exercise and a concurrent cognitive task. Patients can cycle in a virtual park while performing a “go/no-go” task by selecting only specific targets appearing along the way. The difficulty of the practice can be adjusted by the therapists, while the physiological response is continuously monitored through wearable sensors to ensure safety. The application has been integrated into the VRRS system by Khymeia. In the next months, a study to assess the feasibility of a complete telerehabilitation program based on physical and cognitive training will take place. Such a program will combine the existing VRRS exercises and the cardio-respiratory fitness exercise provided by the ARTEDIA application. Feasibility, acceptance, and usability will be assessed from both the patients’ and the therapists’ sides. © 2022, Springer Nature Switzerland AG.

COVID-19 and SARS-CoV-2. We learn that there's still so much more to learn

Background: Current COVID-19 pandemic exposes health staff to a new and potentially fatal disease Case history: Male, 37 yo, entered ER referring worsening asthenia, feeling non-specifically unwell for 7 days, recent history of SARSCoV- 2 infection with interstitial pneumonia requiring hospitalization two weeks prior admission. Blood tests showed severe anemia (Hb 4gr/dl), mild hyperbilirubinemia, markedly raised LDH, positive direct/ indirect Coombs' reaction. Autoimmune haemolytic anemia was suspected because of symptomatic anaemia, evidence of ongoing haemolysis on blood tests, history of a viral infection. Chest XRay and CT pulmonary angiogram were negative for features suggestive of Covid-19 but highlighted lower right lobar pneumonia. Nasopharyngeal molecular swab was negative, while antibody test showed high titer G Immunoglobulin, confirming recent infection. He was initially treated with high doses steroids (1 gr/Kg bw) as well as antibiotics for pneumonia;but, due to lack of efficacy, on the fourth day we started ev immunoglobulins, obtaining gradual improvement in Hb towards baseline and tests normalization. Discussion: SARS-CoV2 infection frequently meets complications;although the pathophysiology underlying COVID-19 remains poorly understood, evidence argues for hyperinflammatory syndrome and/or various autoimmune disorders, which may appear after pneumonia recovery, highlighting need of medium and longterm follow up, to identify possible presentations of COVID-19 complications.

A rare complication after anti-SARS-CoV-2 vaccination: septic arthritis of the sternoclavicular joint, mediastinitis and pulmonary embolism

Introduction: The systemic side-effects of anti-SARS CoV-2 vaccination are described for all types of vaccines. We describe a case of a likely adverse reaction to the Spikevax Moderna vaccine, manifested by septic arthritis of the left sternoclavicular joint, mediastinitis and pulmonary embolism. Case Report: 22-year- old female soldier developed symptoms of fever, chest and limb discomfort in her left upper arm around 10 days after receiving her first dose of Spikevax Moderna vaccine, necessitating hospitalization 14 days after. Septic arthritis of the left sternoclavicular joint, mediastinitis, deep vein thrombosis of the left upper limb, and pulmonary embolism were diagnosed. The blood culture result showed the development of Staphylococcus aureus. The patient was treated with antibiotic therapy and with anticoagulant therapy. There was a rapid improvement in clinical conditions, allowing the patient to be discharged 10 days after admission. Conclusions: The vaccination's causative role in the formation of the clinical picture is extremely likely in this case, but with a plausible not-specific pathogenetic mechanisms. There have been reports of septic arthritis following SARS CoV2 vaccination, especially of the shoulder joint, but the novelty of our finding stems from the fact that it would be the first case of septic arthritis after vaccination involving a sternoclavicular localization. This case emphasizes the importance of maintaining a high degree of attention when administering vaccines and keeping a close eye on the patient in the days after the vaccine.

The associations between loneliness, anxiety, and problematic gaming behavior during the COVID-19 pandemic: The mediating role of mentalization

Background: The COVID-19 pandemic has negatively impacted mental health, contributing to increase the feeling of loneliness, the psychological distress, and the gaming involvement. Despite accumulating data in the field of gaming, the research examining the psychological determinants of gaming severity, especially in the unique circumstances of COVID-19 pandemic, is still in its infancy. The aim of the present study was to examine, for the first time, the role of mentalization in gaming and to clarify the pattern of associations between loneliness, psychological distress, and problematic gaming behavior, as well as the mediating role of mentalizing in this relationship during COVID-19 pandemic in Italy. Methods: A total of 466 adults aged 18-29 years completed an online survey including the Internet Gaming Disorder Scale-Short Form, the Reflective Functioning Questionnaire, the UCLA Loneliness Scale, and the Depression Anxiety Stress Scales. Results: Regression analysis showed that male gender, anxiety, hypermentalizing, and loneliness were good predictors of problematic gaming behavior. The path analysis indicated that gender predicted gaming directly, whereas anxiety and loneliness contributed to gaming both directly and indirectly via hypermentalizing. Conclusions: The present study is the first to examine the role of mentalizing in gaming during COVID-19 pandemic and provide insight into the interrelationships between mentalization, psychological distress, perceived loneliness, and problematic gaming behavior, demonstrating that an inaccurate mentalization has a key role in contributing to problematic gaming. The study provides a useful contribution for prevention of gaming severity and indicates that specific intervention on mentalizing could be effective in reducing problematic gaming by reducing levels of both anxiety and perceived loneliness. © 2022. by the Author(s);licensee Mediterranean Journal of Clinical Psychology, Messina, Italy. This article is an open access article, licensed under a Creative Commons Attribution 4.0 Unported License. Mediterranean Journal of Clinical Psychology, Vol. 10, No. 1 (2022).

Increased von willebrand factor (VWF) and factor VIII (FVIII) levels in severe acute respiratory syndrome SARS-CoV2-positive pneumonia compared with severe acute respiratory syndrome SARS-CoV2-negative: A case-control study

Background : The SARS-COV-2 direct interaction with Angiotensin-Converting-Enzyme-2 (ACE2) membrane receptor on pulmonary epithelial and endothelial cells, impairs angiotensin 1-7 production and its vasculoprotective role, promoting an upregulation of the ACE/angiotensinII/angiotensinII receptor type-1 pathway. The consequent endothelial activation and increasing secretion of VWF and FVIII levels contributes to complement activation and leukocyte extravasation, leading to local microcirculation damage. Aims : Our case-control study is aimed to investigate the characteristics of thrombotic microangiopathies (TMA)-like syndromes in COVID-19 evaluating VWF, FVIII and ADAMTS-13 levels, because the complement-mediated TMA and multiorgan microvascular lesions, observed in COVID-19 patients, seem not attributable to typical TMA. Methods : Ten COVID-19 cases presenting fever, cough and sore throat, admitted to the Fondazione Policlinico Gemelli IRCCS, Rome, and diagnosed by RT-PCR, were compared to ten control patients with non-SARS-CoV-2 interstitial pneumonia, diagnosed by chest Xray/computerized tomography;notably no patient needed mechanical ventilation. ADAMTS-13 activity was measured by a FRET-based assay;FVIII levels by a two-stage clotting assay, while VWF:antigen and VWF:activity were evaluated by chemiluminescence assays. Platelet count, schistocytes, D-dimer, C-reactive protein were centrally measured. Results : COVID-19 pneumonia patients compared with controls showed a marked elevation of both VWF:Ag (median values: 324.1 Vs 139.5%, P < 0.0001) and VWF:act levels (median values: 341.5 Vs 133%, P < 0.001), as well as FVIII levels (median values: 202.5 Vs 123%, P < 0.0001), consistent with the presence of a thrombophilic condition;without significant differences in ADAMTS-13 activity (median values: 69 Vs 76%, P = 0.473). In both groups, D-dimer and C-reactive protein levels were elevated, but not statistically different, platelet counts were normal, and schistocytes, a typical TMAs hallmark, were not observed Conclusions : The increased VWF/FVIII levels in COVID-19 pneumonia cases compared with non-COVID-19 controls cannot be fully explained by the inflammatory state alone and was likely caused by SARS-CoV-2-mediated downregulation of the ACE2 axis, resulting in damage to the local microcirculation and increased leukocyte extravasation.