Hemoperfusion with CytoSorb as Adjuvant Therapy in Critically Ill Patients with SARS-CoV2 Pneumonia

Background: Several pro- and anti-inflammatory cytokines involved in COVID-19 and it is reasonable to speculate that their removal from blood might limit organ damage. Hemoperfusion with CytoSorb is a technique developed to adsorb molecules in the middle molecular weight range (up to 55 kDa). Studies in vitro and in vivo have shown that HP is highly effective in clearing blood from a number of cytokines. Method(s): We report a case series of 9 consecutive COVID-patients admitted to our COVID Intensive Care Unit (ICU). Five of them were treated with HP using CytoSorb (T), due to the heavy emergency overload it was impossible to deliver blood purification in the other 4 patients (C), who were also considered as potential candidates by the attending medical team. All patients had pneumonia and respiratory failure requiring continuous positive airway pressure. Different antibacterial prophylaxes, antiviral, and anti-inflammatory therapies including steroids were delivered. Result(s): Our results show a better clinical course of T compared to control patients (C), in fact all T except 1 survived, and only 2 of them were intubated, while all C required intubation and died. CRP decreased in both groups, but to a greater extent after HP. Lymphocytopenia worsened in control patient but not in treated patient after HP. Procalcitonin increased in 2 of the not treated patients. In all survived patients (n = 4) HP reduced pro-inflammatory cytokines, as IL-6, TNF-alpha, and IL-8. Notably, a striking effect was observed on IL-6 levels that at the end of the second session were decreased by a 40% than before the first treatment. Serum levels of IL-8 and TNF-alpha were lowered within normal range. In all patients the treatment was safe and there were no complications. Conclusion(s): Our study suggests a potential efficacy of HP in an early phase of viral infection not only for improving survival in the treated patients but also by the remodeling treatment-associated cytokine levels.

Acute ischemic stroke due to floating thrombus of ascending aorta: An acute and subacute complication of SARS-CoV-2 infection

Objective: To describe ischemic stroke due to floating thrombus of ascending aorta occurring as acute and subacute complication of SARS-CoV-2 infection. Material(s) and Method(s): consecutive identification in clinical practice of ischemic strokes secondary to aortic arch thrombosis and history of acute or recent Covid-19 infection. Result(s): two patients had ischemic stroke with evidence of aortic arch thrombosis. The first case had concomitant acute Covid-19 infection, the second had recent Covid-19 infection. Both patients underwent intravenous thrombolysis, and subsequent anticoagulation. One patient died due to cerebral hemorrhage. Discussion and Conclusion(s): aortic arch thrombosis can be an incidental finding in acute ischemic stroke in patients with concomitant and recent COVID-19 disease. However, the infection may lead to thrombosis in non-atherosclerotic vessels and to cerebral embolism. Our findings support active radiological search for aortic thrombosis during acute stroke in patients with acute or recent COVID-19 disease.Copyright © 2022

Professional development of in-training museum educators: an experience of curriculum improvement in time of a pandemic

The present paper aims to illustrate the reorganization of two post-graduate courses, "Museum Education. Theoretical aspects" and "Advanced Studies in Museum Education" promoted by CDM (Center for Museum Studies) - Dept. of Education at Roma Tre University, carried out during the Covid-19 pandemic, and to analyze the education strategies adopted in terms of museum professionals development to face the Covid-19 museum and universities 2020 Italian lockdown. The results emerging from the quantitative evaluation of the module "Museum and Social Networks", taking into consideration the activities and digital tools proposed, show the efficacy of the courses reorganization, in terms of transverse and professional skills development in university students, critical thinking and collaboration in particular. Moreover, the data analysis give useful indications in term of university online lectures, laboratory activities and practices in e-learning mode, evaluation tools and methodologies aimed at solliciting professional development of in-training museum educators in university learning context.

Health Emergency and Disaster Risk Management During the COVID-19 Pandemic: A Case Study from Italy : Emanuela Parotto

Background The COVID-19 pandemic has profoundly impacted societies, influencing countries’ Health Emergency and Disaster Risk Management (H-EDRM) systems. By taking Italy as a case study, this research aimed to investigate the response to the pandemic focusing on challenges, response strategies, lessons learned and implications for H-EDRM, with an emphasis on health workforce, health services delivery and logistics. Methods This was a retrospective observational study using qualitative methodology. Data was collected via semi-structured interviews and analyzed according to the H-EDRM framework. Multiple interviewees were selected to obtain a holistic perspective on the Italian pandemic response. Stakeholders from five sectors (policymaking, hospital, primary care, third sector, lay community) from three of the most impacted Italian regions (Piemonte, Lombardia, Veneto) were interviewed, reaching 15 interviewees in total. Results With regard to human resources, the main themes concerned the shortage of personnel, inadequate training, poor occupational health, and lack of multidisciplinarity. Regarding health services delivery, interviewees reported weakness of public health, hospital, and primary care systems. With regard to logistics, the following themes emerged: inadequate infrastructures, shortage of supplies, issues with transportation systems, and weak communication channels. Lessons learned stressed the importance of considering pragmatic disaster preparedness and the need for cultural and structural reforms. Conclusions Implications that emerged from this study can inform advancements in disaster management in Italy. Acknowledgments: This study was conducted in collaboration with the Department of Public Health and Health Policy, Hiroshima University, Japan and funded by the World Health Organization Kobe Centre for Health Development (WKC-HEDRM-K21001). *ALC and EP are both first authors Key messages • Findings show that great interconnection of sectors is key in overcoming challenges and for future disaster preparedness. • Lessons learned contribute to translating the H-EDRM precepts into practice.

Primary health care disaster preparedness: A review of the literature and the proposal of a new framework

With the publication of the Health Emergency and Disaster Risk Management (H-EDRM) Frame-work in 2019, the World Health Organization (WHO) emphasized the need for disaster prepared-ness in all sectors of the health system, including primary health care (PHC). PHC disaster pre-paredness plays a crucial role in guaranteeing continuity of care and responding to the health needs of vulnerable populations during disasters. While this is universally acknowledged as an important component of disaster management (DM), there is still a severe paucity of scholarship addressing how to practically ensure that a PHC system is prepared for disasters. The objective of this study is to propose a new framework that describes key characteristics for PHC disaster pre-paredness and lays the groundwork to deliver operational recommendations to assess and im-prove PHC disaster preparedness. A systematic literature review was performed and a total of 145 records were analyzed. Twenty-five characteristics that contribute to a well-prepared PHC system were identified and categorized according to the WHO Health System Building Blocks to form a new PHC disaster preparedness framework. The findings will contribute to the elaboration of a set of guidelines for PHC systems to follow in order to assess and then boost their disaster pre-paredness. This manuscript will hopefully help to raise awareness among international policy -makers and health practitioners on the importance to design interventions that integrate the PHC system into overall DM strategies, as well as to assess the preparedness of PHC systems in differ-ent political, developmental, and cultural contexts.

RARE CASE OF ILEOCOLIC MESENTERY PRIMARY MELANOMA WITH LIVER METASTASIS

Purpose/Background: Although GI melanoma is commonly a metastatic disease, it is very unusual to see the mesenteric mass of the cecum and terminal ileum as the primary origin of melanoma. Hypothesis/Aim: This is a case report and presentation showing a rare occasion of primary melanoma in the cecum and the terminal ileum mesentery along the ileocolic pedicle causing cecal complete bowel obstruction. Methods/Interventions: The reported case is a rare occasion of large bowel obstruction near the cecum resulted from primary mesenteric melanoma invading into the wall of the descending colon. Primary melanoma of the GI tract is still controversial and only a limited of cases have been reported in the literature. We added a review of the other published case reports to this case report using Endnote. Results/Outcome(s): This is a 68-year-old female who was seen in the outpatient setting with increasing abdominal girth in addition to nausea and vomiting and obstipation. The patient had alternating bowel habits for over 2 months which she felt this was related to Covid as she was tested Covid positive and diagnosed with Covid pneumonia at the same time. She was directly admitted from the office to the inpatient and she had a CAT scan of the abdomen pelvis that demonstrated cecal obstruction related to possibly cecal mass/mesenteric mass with multiple liver metastatic diseases. She underwent exploratory laparotomy which resulted in Right extended hemicolectomy en bloc with a loop of jejunum and part of the terminal ileum. We tested later serum S100 the protein and it was elevated to 18,000, she had serum negative alpha-fetoprotein and negative CEA. This is a 68-year-old female who was seen in the outpatient setting with increasing abdominal girth in addition to nausea and vomiting and obstipation. The patient had alternating bowel habits for over 2 months which she felt was related to Covid as she was tested Covid positive and diagnosed with Covid pneumonia at the same time. She was directly admitted from the office to the inpatient service and she had a CAT scan of the abdomen pelvis that demonstrated cecal obstruction related to possibly cecal mass/ mesenteric mass with multiple liver metastatic diseases. She underwent exploratory laparotomy which resulted in Right extended hemicolectomy en bloc with a loop of jejunum and part of the terminal ileum. She had also intraoperative liver biopsy that demonstrated metastasis of the melanoma to the liver. We tested later serum S100 the protein and it was elevated to 18,000, she had serum negative alpha-fetoprotein and negative CEA. Limitations: Case report study with reported cases reviewed. Conclusions/Discussion: Large bowel obstruction could be related to unusual diagnoses like melanoma of the bowel mesentery. Although, primary GI melanoma is rare this showed the possibility of such diagnosis. (Figure Presented).

RELATO DE CASO: TROMBOCITOPENIA IMUNE PÓS VACINAÇÃO COVID

Introdução: A Trombocitopenia Imune (TI) pós vacina é um fenômeno já relatado com outros imunizantes já introduzidos no calendário vacinal. Com a atual pandemia da infecção pelo coronavírus (COVID-19) houve também uma corrida para desenvolvimento de agentes capazes de imunizar e dessa forma proteger a população da infecção. O mecanismo pelo qual ocorre a TI pós vacina é imunológico, com desenvolvimento de anticorpos contra plaquetas. O tempo médio para desenvolvimento da TI na infecção por COVID foi de 13 dias, na reação pós vacinal variou em uma série de casos de 1-23 dias. Nosso estudo vem relatar um quadro de TI após 9 dias da vacinação com AstraZeneca. Relato: Trata-se de paciente adulto, sexo masculino,53 anos, previamente hígido, intercorrendo 9 dias após vacinação, imunizante AstraZeneca, com petéquias em MMII, tronco e purpura úmida, o que o levou a procurar atendimento médico. Sendo internado no dia 04 de julho com plaquetopenia isolada. Exames: Hb:14,30 Htc:41,50 VCM:92 HCM:31,80 GB:14210 (Seg:11652—Linf:1421) Plaquetas: 3000. Investigadas infecções latentes que poderiam ser a etiologia do processo, contudo negativas. Iniciado corticoterapia em dose 1 mg/Kg/dia, sem resposta adequada. Prescrito Imunoglobulina venosa (IGV), no 4°dia de internação, na dose 1 g/kg/dia por 2 dias, sem resposta. Mantido prednisona 1 mg/kg/dia e repetido no 25°dia, a IGV, com resposta clínica. Durante o período o paciente foi investigado para fenômenos trombogênicos, associado a Trombocitopenia Trombótica induzida por Vacina (TTIV) não pontuando para síndrome (Fibrinogênio não consumido, VHS e PCR dentro do valor normal de referência, LDH normal, D-dímero: normal, anticorpo anti fator 4 plaquetário ainda pendente). Discussão: No caso da COVID-19 foi descrita TI com diversos mecanismos: destruição imunológica;destruição direta pela infecção, redução da produção da trombopoetina. O mecanismo pós vacina é imunomediada. A TTIV ocorre de 4 a 28 dias após a vacinação contudo haveria fenômeno trombótico associado, o que não ocorreu com nosso paciente. A demora a resposta terapêutica é similar a TI pós Covid-19.

RELATO DE CASO: APLASIA MEDULAR SECUNDÁRIA A COVID-19

Introdução: Desde de dezembro de 2019, temos enfrentado a infecção pelo novo coronavírus (SARS-COV-2), causando repercussões diversas, que vão de síndrome respiratória aguda grave até formas assintomáticas. Uma hiperativação inflamatória parece estar associada a fenômenos autoimunes associada ao SARS-COV2. Se tratando de uma afecção emergente pouco se sabe dos fenômenos autoimunes induzidos pela infecção, sobretudo, patologias autoimunes hematológicas. Com esse intuito, o presente estudo vem relatar uma aplasia medular transitória em paciente internado pela infecção. Relato: Trata-se de paciente adulto, sexo masculino,52 anos, apresentando sintomas gripais e teste positivo para COVID-19, vinha em seguimento ambulatorial em uso de moxifloxacino, quando no 12°dia de sintomas foi internado em leito de terapia intensiva, após evolução com síndrome respiratória aguda grave (SRAG) e intubação orotraqueal. Iniciada terapia com dexametasona 10mg/dia, enoxaparina 40 mg de 12/12h SC, Ceftriaxona 1 g 12/12h. Intercorrendo após 10 dias de internação com disfunção renal, necessitando suporte dialítico. No 18°dia evoluindo com pancitopenia, sem sangramentos e sendo suspenso a profilaxia para tromboembolismo venoso (nesse momento era feita com heparina não fracionada devido a disfunção renal) e acionado o serviço de hematologia. Realizando seguimento diário com exames de sangue, e evoluindo para pancitopenia grave, com agranulocitose (neutrófilos: < 200). Exames Hb:7,90 Htc:22% VCM: 84,3 HCM: 30,30 GB:487 (Seg:194 — Lin:243 — Mon:49) Plaquetas: 50000. Havendo troca de esquema de antimicrobianos para Meropenem, Vancomicina e após 3 dias sem melhora clínica, introduzido Anfotericina B, e ampliado esquema antimicrobiano com associação de Polimixina B. Realizada biopsia de medula óssea com achados corroborando para hipótese de Aplasia de medula óssea. Afastados critérios para linfohistiocitose hemofagocítica e com sorologias negativas para outras infecções virais que sabidamente poderiam apresentar esse quadro. Após o 26°dia paciente iniciou melhora clínica e resolução espontânea da neutropenia, persistindo até o 30°dia com anemia e necessidade transfusional em raras ocasiões. Evolui com desmame ventilatório e recuperação da função renal, tendo alta após 45 dias de internação. Discussão: Acreditamos que a aplasia medular nesse caso foi associada a infecção pelo SARS-COV2, paciente que intercorreu com doença grave, necessidade de suporte ventilatório e acometimento sistêmico pela infecção. Dados da literatura trazem descrição de fenômenos imunes associados a infecção, como trombocitopenia imune, sem associação com linfohistiocitose ou coagulação intravascular disseminada. O mecanismo pelo qual os fenômenos imunes hematológicos ocorrem não estão claros.

TETRAPARESIA FLÁCIDA APÓS TRANSPLANTE AUTÓLOGO DE MEDULA ÓSSEA: RELATO DE CASO

Objetivo: Relatar um caso de tetraparesia flácida após início do esquema vacinal em paciente submetida a transplante de medula óssea (TMO) autólogo para tratamento de linfoma não Hodgkin. Relato do caso: Trata-se de uma mulher parda, de 32 anos, com histórico de linfoma não Hodgkin, hipertensão arterial e diabetes mellitus tipo 2, submetida a TMO em abril/2020 que, após iniciar regime vacinal de rotina pós-TMO, em outubro/2020, evoluiu com sintomas sistêmicos inespecíficos, caracterizados por febre não aferida, náuseas e vômitos. Nenhum quadro infeccioso foi detectado naquele momento. Cerca de 12 dias mais tarde, a paciente passou a apresentar quadro sensitivo-motor caracterizado por parestesia e paresia ascendentes, inicialmente em pés, com progressão para o abdome e mãos em 24 horas, além de disfagia para líquidos e diplopia. Familiares relatavam ainda alguns episódios de síncope nos últimos dois dias anteriores à consulta médica e sudorese extrema e intermitente na região da face. A paciente foi admitida em unidade de terapia intensiva onde foram verificadas hipotonia generalizada, arreflexia global, disautonomia e dissociação proteíno-citológica na análise do líquido cefalorraquidiano, estabelecendo-se o diagnóstico de Síndrome de Guillain-Barré (SGB). Foram descartados quadros infecciosos, inclusive COVID-19, assim como a recidiva do linfoma. Três dias depois houve deterioração da função respiratória com necessidade de intubação orotraqueal e ventilação mecânica. Optou-se por tratamento com plasmaférese (cinco sessões em dias alternados com troca de uma volemia plasmática por sessão). Os efeitos colaterais ao procedimento foram um pequeno hematoma em local de inserção do acesso venoso e distúrbios eletrolíticos moderados, corrigidos sem dificuldade. A recuperação motora foi rápida e a paciente recebeu alta hospitalar após 20 dias de internação, deambulando sem apoio e mantendo-se livre de quaisquer sequelas sensitivo-motoras durante o seguimento. Discussão: paralisias flácidas progressivas são condições frequentes em departamentos de urgência, mas que ainda constituem relevante desafio diagnóstico. Na maioria das vezes a SGB está associada a uma resposta imunológica a um estado infeccioso prévio, porém, em alguns raros casos, pode se desenvolver após imunizações ou transplante de medula óssea. A plasmaférese é tão efetiva quanto a infusão de imunoglobulinas no tratamento da SGB, embora com mais efeitos colaterais em potencial como hipotensão, sepse, reações transfusionais e problemas relacionados ao acesso vascular. Os resultados tendem a ser superiores quando a plasmaférese é iniciada nos primeiros sete dias do surgimento dos sintomas, melhorando a força muscular, diminuindo a necessidade de ventilação mecânica e acelerando a recuperação dos pacientes com SGB grave. Conclusão: a rápida progressão sintomática apresentada pela paciente e a excelente resposta clínica após a instituição da plasmaférese reforçam a importância de um diagnóstico precoce pois, com a terapia adequada é possível atingir uma reversão completa das manifestações e evitar danos neurológicos permanentes.

ITALIAN JOURNALISM AND THE CHALLENGE OF PLATFORMS. THE COVERAGE OF THE REGULARISATION OF IMMIGRANT WORKERS BETWEEN POLARISATION AND INCIVILITY

The article analyses the Facebook news coverage of a critical moment in the management ofthe Covid-19 emergency in Italy, such as the regularisation of immigrant workers. Throughmixed methods and a double-level approach based on the journalistic discourse (top-down)and the grassroots responses (bottom-up), the study has empirically investigated in whichway the main national news organisations contributed to feed a polarised and uncivil debate.The news frame analysis on the articles shared on Facebook has shown a pluralityof interpretations about the issue (regularisation as emergency, regularisation as problem,political conflict, and solidarity). In comparison to the other outlets, partisan media not onlyhave privileged a problematic and conflictual representation, but also adopted different devicesof outrage discourse, thus developing a highly polarised news coverage. The analysis ofthe users’ comments reinforced the impression that right-wing newspapers have contributedto amplifying negative emotions and harsh attacks towards sensitive targets. Overall, thecombination of the three levels of investigation (on news frames, uncivil language devicesand users’ comments) gives a clear picture about the relationship between the partisanshipof news media and the polarisation of the audience as well as their mutual influence inaccordance with the platform mechanisms. © Società editrice il Mulino

Open learning for museum educators professional development: An online experience in time of a pandemic

During the COVID-19 pandemic, many open and distance learning experiences were carried out by different museum and cultural institutions in order to promote the development of digital skills in museum professionals. This contribution aims to illustrate the results of an ERE (Emergency Remote Education) experience carried out in 2020 by the Center for Museum Studies (CDM) of Roma TRE University and aimed at soliciting digital, professional and transverse skills, such as critical thinking, in museum operators and educators attending the post-graduate courses in "Museum Education. Theoretical aspects"and "Advanced Studies in Museum Education". The results show a good level of self-assessment of the skills solicited in the participants and provide useful directions for the realization of online and open learning experiences for museum professionals. © 2021 IEEE.

P09.02 Impact of COVID-19 in Portuguese Lung Cancer Patients’ Treatment: Portuguese Lung Cancer Study Group Survey

Introduction: The first patient with COVID-19 in Portugal was diagnosed on March 2. There was a lack of knowledge concerning the risks of COVID-19 infection in lung cancer patients, prognostic factors, the influence of cancer treatments and cure criteria. Treatments and consultations were readjusted in order to maintain the ones that increase patients’ survival, while reducing the risks of SARS-CoV-2 infection. International and national “guidelines” were followed, but each hospital had its own strategies to reduce COVID-19 risk. Purpose: The Portuguese Lung Cancer Study Group launched a survey in order to study the early impact of COVID-19 in lung cancer patients, changes in treatments and the way of implementation of COVID-free circuits. Methods: A survey was sent to lung cancer doctors of all the Portuguese hospitals. Results: At the data cut-off, information from twenty one hospitals was collected, corresponding to about 66% (n=3.446) of each year new diagnoses of lung cancer in Portugal. In March and April there was a reduction in newly lung cancer diagnosed patients while comparing with 2019: in March, 86% had a reduction;in April, 90% of the hospitals reported a reduction and it was greater than 40% in eight hospitals (38%). About 62% of the doctors considered less referral from primary care as a cause, and 33% delayed biopsies or other imaging exams. The most difficult exams to obtain were CT guided biopsies and EBUS for 48%. The majority of the hospitals (57%) were also referral for COVID-19 patients’ treatment. In 48% of the lung cancer treating departments’ there were doctors reallocated to COVID-19 treatment areas. In 48% the assistance teams were divided into teams that weren’t previously working together. The majority of doctors (90%) reported having individual protection equipment available. Hospitals performed teleconsultation (100%), and, in seven hospitals (33%), more than half of the consultations were done using communication technology. All the hospitals were able to perform SARS-CoV-2 testing. It was done before every cycle of chemotherapy in 90% of the hospitals. In the majority (67%) it was only performed before day D1, in D1 and D8 chemotherapy protocols. About 19% reported changes in prescription of adjuvant chemotherapy and in maintenance chemotherapy, 33% increased the prescription of oral chemotherapy, 33% changed the periodicity, 29% reported reduction in inclusion in clinical trials. In 33% there was an earlier end of chemotherapy in ECOG2 and vulnerable patients. In 38% the prescription of G-CSF (Granulocity-colony stimulating factor) increased, being used for prophylaxis if the risk of febrile neutropenia was more than 10-15%. The periodicity of consultations was changed for patients under TKI treatment in 86%, and 67% hospitals reported changes in immune checkpoint inhibitor treatment schedule. In 29% oral drugs could be delivered at patients’ home. All the patients admitted for surgery were tested for SARS-CoV-2, and 86% performed SARS-COV-2 testing before radiotherapy. Conclusion: Portuguese hospitals responded to the sudden need of creation of COVID-free circuits, change protocols and even teleconsultation. With a larger follow up we will study the late consequences of COVID-19 pandemic in lung cancer diagnosis and treatment. Keywords: COVID-19, survey, Portuguese Lung Cancer Study Group

Surveying the impacts of COVID-19 on the perceived productivity of Brazilian software developers

The new coronavirus pandemic has forced companies around the world to adopt measures to stop the spread of this virus and the associated COVID-19 disease. In Brazil, this was no different with software development professionals having to work from home (WFH) due to the need of social isolation. WFH was an imposition and was a new experience for many professionals, generating unpredictable impacts. In this article, we present the results of a survey to understand the impacts of social isolation on the perceived productivity of Brazilian software developers. Data were collected during March and April/2020 with a sample of 413 respondents. The results indicate developers' perceived productivity has increased, mainly because there are fewer interruptions throughout the day. In addition, most respondents informed that they wish to continue working most of the time remotely. We contrast our results with another study published on this topic. © 2020 ACM.