Online medical, psychological and nutritional assistance for patients with eating disorders and their parents during the lockdown caused by COVID-19 from March 9th to May 4th, 2020

The COVID-19 pandemic severely hit Italy in early 2020, forcing the government to arrange a general lockdown across the country. The condition of forced quarantine, already experienced in China, has led to a worsening of symptoms in subjects already suffering from psychopathology, including Eating Disorders. To avoid this, after the closure of the Service, the Day Hospital of the Regional Center on Eating Disorders of the UO of Child Neuropsychiatry of the Azienda Policlinico S. Orsola-Malpighi of Bologna has activated an online treatment program aimed at five adolescent patients and their parents. The meetings were conducted by the Psychotherapist, the Child Neuropsychiatrist, the Dietitian and the Family Psychotherapist. During the lockdown, tests were administered to the patients, compared with test administered in the entry, to see if the symptoms related to the eating disorder and general psychopathology had changed. In addition, other tests were administered to both patients and parents with the aim of investigating the dynamics established during quarantine, which measured psychological well-being and general functioning. The observation made it possible to identify five psychological phases that the patients faced, related to eating symptoms, family dynamics and adaptation to the pandemic. The tests did not show significant changes in the psychopathology of the patients, while comparing the results of the tests also administered to the parents, an influence between mother and daughter can be seen, with often overlapping trends in relation to symptoms. The online treatment was effective and satisfactory for both patients and parents, and within the families greater moments of communication, listening and mutual involvement in the life of family members developed while maintaining personal spaces. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Italian) La pandemia COVID-19 ha gravemente colpito l'Italia nei primi mesi del 2020, costringendo il governo a predisporre un lockdown generale in tutto il paese. La condizione di quarantena forzata, gia sperimentata in Cina, ha portato un peggioramento dei sintomi in soggetti gia affetti da psicopatologia, compresi i Disturbi del Comportamento Alimentare. Per evitare questo, dopo la chiusura del Servizio, il Day Hospital del Centro Regionale sui Disturbi Alimentari dell'UO di Neuropsichiatria Infantile dell'Azienda Policlinico S. Orsola-Malpighi di Bologna ha attivato un programma di trattamento online rivolto a cinque pazienti adolescenti e ai loro genitori. Gli incontri sono stati condotti dalla Psicotera-peuta, dalla Neuropsichiatra Infantile, dalla Dietista e dalla Psicoterapeuta della famiglia. Durante il lockdown sono stati somministrati dei test alle pazienti, confrontati con quelli in entrata, per osservare se i sintomi relativi al disturbo alimentare e alla psicopatologia generale si fossero modificati. Inoltre sono stati somministrati altri test sia alle pazienti sia ai genitori con l'obiettivo di indagare le dinamiche instaurate durante la quarantena, che misuravano il benessere psicologico e il funzionamento generale. L'osservazione ha permesso di individuare cinque fasi psicologiche che hanno affrontato le pazienti, legate alla sintomatologia alimentare, alle dinamiche familiari e all'adattamento alla pandemia. I test non hanno riportato cambiamenti significativi nella psicopatologia delle pazienti, mentre confrontando i risultati dei test somministrati anche ai genitori si evince un'influenza fra madre e figlia, con andamenti spesso sovrapponibili relativamente ai quadri sintomatici. Il trattamento online e stato efficacie e soddisfacente sia per le pazienti sia per i genitori e all'interno delle famiglie si sonosviluppati maggiori momenti di comunicazione, ascolto, coinvolgimento reciproco nella vita dei familiari pur mantenendo gli spazi personali. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Strongyloidiasis - diagnostic and therapeutic dilemmas in hyperinfection patients: a case series.

The helminth infection caused by Strongyloides stercoralis is widespread in tropical regions, but rare in European countries. Unfamiliarity with the disease and diagnostic obstacles could contribute to its lethal outcome. Frequent use of corticosteroids during the COVID-19 pandemic could increase its significance. The aim of this retrospective descriptive study was to explore disease patterns and discuss clinical dilemmas in patients with S. stercoralis hyperinfection treated at the University Hospital for Infectious Diseases 'Dr. Fran Mihaljevic' in Zagreb, Croatia, between 2010 and 2021. Five out of 22 (22.7%) immunosuppressed patients treated due to strongyloidiasis developed hyperinfection. All patients were male, median 64 years; four were immunosuppressed by corticosteroids (although ileum resection could have been the trigger in one) and one by rituximab. The diagnosis was established after a median of 1.5 months of symptom duration, accidentally in all patients, by visualizing the parasite in the gastric/duodenal mucosa in four cases, and bronchial aspirate in one. All patients were cachectic, four out of five had severe hypoalbuminemia and all suffered secondary bacterial/fungal infection. Despite combined antibiotic, antifungal and antihelmintic therapy, three out of five of the patients died, after failing to clear living parasites from stool samples. We can conclude that significant delays in diagnosis and lack of clinical suspicion were observed among our patients with the most severe clinical presentations of strongyloidiasis. Although being beyond diagnostic recommendations for strongyloidiasis, an early upper gastrointestinal endoscopy with mucosal sample analysis could expedite diagnosis in severe, immunosuppressed patients. The persistence of viable parasites in the stool despite antihelmintic therapy should be further investigated.

SARS-CoV-2 management in emergency department: Risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital

COVID-19 patients require early treatment and admission to an appropriate care setting, considering possible rapid and unpredictable to Severe Acute Respiratory Syndrome. A flow-chart was developed by a multidisciplinary team of Emergency Department (ED) clinicians, intensivists and radiologists aiming to provide tools for disease severity stratification, appropriate ventilation strategy and hospitalization setting identification. We conducted a retrospective application of our model on 313 hospitalized patients at Pisa University Hospital including 222 patients admitted to ED for respiratory failure between March and April 2020. Risk stratification score was based on respiratory and chest imaging parameters, while management strategy on comorbidities and age. Age, comorbidities, clinical respiratory and arterial blood gas parameters, semi-quantitative chest computed tomography score were significant predictors of mortality (p<0.05). Mortality rate was higher in patients treated in intensive care units (26.5%) and undergoing endo-tracheal intubation (32.7%), compared to medical area (21.3%). We verified a good concordance (81.7%) between the proposed model and actual evaluation in ED. Outcomes analysis of subgroups of patients homogeneous for baseline features allowed to verify safety of our model: in non-elderly and/or non-comorbid patients (15% mortality) our scheme overestimates the risk in 30% of cases, but it suggests non-intensive management in patients with reduced functional reserve, elderly and with comorbidities (50% mortality). Correct management of respiratory failure COVID-19 patients is crucial in this unexpected pandemic. Our flow-chart, despite retrospectively application in small sample, could represents a valid and safe proposal for evaluation in ED.

Impact of COVID-19 pandemic and lockdown on emergency room access in Northern and Central Italy

In Northern Italy the coronavirus infection has spread since February 2020: the increase in admissions of COVID-19 patients corresponded to a drastic decrease in admissions of regular patients to the Emergency Room (ER). This retrospective study was conducted by Academy of Emergency Medicine and Care (AcEMC). During the lockdown period the accesses were reduced by more than 50%, and in the following months of May and June 2020, there was a recovery clearly below (70%) previous year's numbers. We have observed a drastic reduction in white and green codes, a fair reduction in yellow codes, while red codes remained stable. The decrease in access to the ER mainly concerned patients with low priority color codes, but also the reduction in the number of accesses of yellow and red codes, insignificant at a superficial glance, is notable. If we consider that yellow and red codes during the months of the lockdown included many patients with COVID-related respiratory insufficiency, it is evident that there was a clear reduction in the number of serious illnesses not COVID-related. This is certainly another serious consequence of the COVID-19 pandemic.

COVID-19 pandemic management at the Emergency Department: the changing scenario at the University Hospital of Pisa

Starting from 1st case in Italy, on February 20th, 2020, CO-rona VI-rus D-isease 2019 (COVID-19) pandemic spread to whole Italian territory, with different regional distribution. Tuscany has been classified as medium diffusion area (40-100 cases/100000 inhabitants). In this context, all healthcare structures reviewed their organization to meet new needs. Our study's objectives were description of organizational model outlined to safely manage Emergency Department (ED) and analysis of patients' flows within Hospital of Pisa during pandemic. The ED has been reorganized with dedicated areas for examination and waiting for tests results. A similar reduction (-62%) of ED accesses comparing to the same period of 2019 and the previous months of 2020 was observed. Hospital Task Force arranged for progressive activation of Units by modules, according to territorial needs. From the beginning of March to the end of April 2020, 315 COVID-19 patients were hospitalized. Overall, a 45% reduction in hospital admissions compared to the same period of 2019 was observed, with increased mortality (4% versus 2%). The University Hospital of Pisa efficiently managed COVID-19 emergency with a logistical reorganization of ED.

P.602 Burnout and post-traumatic stress spectrum in 110 emergency operators in Italy: a preliminary report

Background: Post-Traumatic Stress Disorder (PTSD) is a severe psychiatric disorder, developed in response to the exposure to one or more traumatic events, and characterized by typical disabling symptoms, chronic course, significant deterioration in the quality of life and a high suicidal risk [1]. Healthcare emergency personnel are a high-risk category for the development of PTSD, due to the repeated exposure to stressful and traumatic experiences during their work activities [2]. In such healthcare professionals can frequently occur also a Burnout Syndrome, that is a condition resulting from a work-related stress-causing process, determining a combination of emotional exhaustion, depersonalization and a reduction of personal abilities [3]. PTSD and Burnout present a complex, and not fully explored, relationship, because of the shared risk factors and overlapping symptomatic manifestations [4]. Objective: The aim of this study is to investigate PTSD, post-traumatic stress spectrum symptoms, Burnout Syndrome, and their relationship, in a sample of emergency operators of a major University Hospital of Italy. Methods: The study sample included 110 emergency operators (Emergency Room, Emergency Medicine, Intensive Care Unit) of the “Azienda Ospedaliero-Universitaria Pisana” (A.O.U.P., Pisa, Italy). Participants were administered the Trauma and Loss Spectrum - Self Report (TALS-SR), to investigate full or partial DSM-5 PTSD and posttraumatic stress spectrum symptoms related to the work activity, and the Professional Quality of Life Scale - Revision IV (ProQOL R-IV), to examine Compassion satisfaction, Burnout and Compassion fatigue related to work. We used the Kruskal-Wallis test for independent samples to evaluate the differences in ProQOL scales between subjects with full PTSD, partial PTSD and without PTSD. Spearman's correlation coefficients were used to verify the possible associations between the TALS-SR symptomatological domains and the three dimensions of ProQOL. Results: Fifteen subjects reported a full (15.05%) and 25 a partial (26.88%) symptomatological DSM-5 PTSD. The ProQOL Compassion Satisfaction subscale mean score did not show statistically significant differences between the three groups. Healthcare operators with PTSD reported higher scores with respect to individuals without PTSD in the ProQOL Burnout and the Compassion Fatigue subscales (18.6±4.9 versus 13.9±4.4, p=0.014;and 14.38±4.073 versus 9.9±3.9, p=0.001 respectively). Pearson's linear correlation between the TALS-SR symptomatological domains, and the ProQOL subscales highlighted significant relationships between Burnout and Reactions to losses or upsetting events (r=0.236, p=0.035), Re-experiencing (r=0.248, p=0.027) or Avoidance and numbing (r=0.319, p=0.004);and between Compassion fatigue and Reactions to losses or upsetting events (r=0.293, p=0.008), Re-experiencing (r=0.359, p=0.001) or Avoidance and numbing (r=0.406, p<0.001). Conclusions: This work underlines a positive correlation between Burnout Syndrome and Post-traumatic stress spectrum symptoms in emergency operators, highlighting the clinical importance of a deeper assessment of work-related trauma and post-traumatic stress manifestations in these subjects to improvethe well-being and to prevent Burnout Syndrome. In this regard, increasing attention is required particularly in healthcare emergency operators due to COVID-19 pandemic, in order to strengthen the training of psychological skills aimed at mitigating the impact of a such stressful and traumatic event [5]. No conflict of interest

Critically ill patients with covid-19 treated in the intensive care unit at the university hospital for infectious diseases „dr. Fran mihaljević” in zagreb

Objective: To describe the characteristics, clinical course, treatment, outcomes and complications in critically ill patients with COVID-19 treated in the intensive care unit (ICU) at the University Hospital for Infectious Diseases „Dr. Fran Mihaljević” (UHID) in Zagreb. Materials and methods: A retrospective observational study of 38 adult patients with COVID-19 treated in the ICU at UHID between March 11 and June 6, 2020. Results: Among the 167 patients with COVID-19 treated at the UHID, 38 (22,8%) were admitted to the ICU. The mean age of these patients was 69.5 (33-85) years, 70 (43-85) years in deceased patients and 66 (33-80) in survivors. The majority of patients were male (26 patients-68%). The mMost common comorbidities were arterial hypertension (20-53%), diabetes mellitus (9-24%) and ischaemic heart disease (8-21%). All patients were admitted for hypoxaemic respiratory failure. In addition to acute respiratory failure with the need for mechanical ventilation (30-79%), shock (25-66%) and acute renal insufficiency (21-55%) were common. Continuous renal replacement therapy was used in 13 (34%) patients. The median duration of ICU stay was 18 (3-68) days and of mechanical ventilation 19 (5-43) days. Overall mortality was 50%, 63% in patients who received mechanical ventilation and it was the highest in patients over 65 years of age. Conclusions: Patients with COVID-19, treated in the ICU, often require prolonged mechanical ventilation, have numerous complications of critical illness and ICU treatment, and high mortality rates. Mortality rate is highest in men over 65 years with comorbiditeies – arterial hypertension, diabetes mellitus and ischaemic heart disease.