Pharmacists' mental health during the SARS-CoV-2 pandemic in Italy.

OBJECTIVE: The year 2020 was characterized by the outbreak of a new pandemic caused by a novel coronavirus named SARS-CoV-2. To face the pandemic, many countries worldwide imposed general lockdowns, closing all non-essential businesses. As primary care services, pharmacies had to remain open, thus putting pharmacy staff at significant risk of viral infection and overwork. This study aimed to assess the mental health of Italian Pharmacists, considering demographic and occupational characteristics, lifestyle, and habits, during the SARS-CoV-2 outbreak and the subsequent lockdown period (March-May 2020). MATERIALS AND METHODS: A web-based survey was created using Google® Forms to collect data from March 30, 2020, to June 1, 2020. The questionnaire consisted of three sections investigating: (1) demographic and occupational variables, (2) lifestyle and habits variables, (3) psychological distress and perceived well-being. RESULTS: A total of 401 participants completed the questionnaire. Older workers and those with more work experience reported more psychological stress. Older and female workers, who felt lonely at home and reported psychological stress, perceived poor well-being. CONCLUSIONS: Our findings demonstrate that the Sars-CoV-2 outbreak and subsequent lockdown rules affected pharmacists' mental health and that it is important to put in place preventive measures against the occurrence of mental disorders among them.

Post-covid-19 hemostatic characteristics of convalescent patients: The bergamo experience

Introduction: Severe COVID-19 patients present with a hypercoagulable state, complement activation and endothelial perturbation, which result from an excessive inflammatory response. Thromboinflammation is one important mechanism underlying the COVID-19-associated coagulopathy and the increased risk of thrombosis. Bergamo city is one of the first and most affected area by SARS-CoV-2 infection in the world. For this reason, since the beginning we were actively involved in recruiting convalescent COVID-19 patients, in a program of selection of candidates for convalescent plasma donation. In a large cohort of convalescent COVID-19 patients, we aimed to characterize markers of coagulation activation and endothelial perturbation, in order to explore whether the COVID-19-related hemostasis activation might persist afterwards and evaluate its possible association with the degree of severity of the previous infection, and/or with demographic characteristics, or anti-SARS-CoV-2 antibody levels. Methods: In 392 convalescent COVID-19 patients (216M/176F, median age: 46 years) plasma levels of fibrinogen, protein C, protein S, factor V, factor VIII, factor XIII, D-dimer, von Willebrand factor (vWF), prothrombin fragment F1+2 were measured at the recruitment, i.e. 1-5 months from recovery. Samples were tested for the anti-SARS-CoV-2 antibodies, including anti-S IgG (Anti-S Ab) and anti-N IgG (Anti-N Ab) antibodies at enrollment and at each scheduled subsequent visits. Results: Levels of fibrinogen, D-dimer, von Willebrand factor, protein S and protein C were significantly higher (p<0.05) in patients who were hospitalized for severe COVID-19 as compared to patients who were treated at home. There was no correlation between levels of coagulation biomarkers and days from end of symptoms. Male gender, age > 40 years, and severe form of COVID-19 were identified as independent predictors of high levels of both anti-S and anti-N Ab (p<0.001). Among hemostatic biomarkers, fibrinogen (p<0.01) and vWF (p<0.05) independently predict high levels of anti-S Ab. In particular, vWF levels positively correlated with anti-S Ab levels (vWFantigen r=0.188;vWF-activity r=0.241 and vWF-RiC of r=0.223, p<0.01). Evaluation of anti-SARS-CoV2 antibody levels at different time points during follow up revealed that 30% of patients displayed high levels of anti-S Ab until more than 8 months from the end of symptoms. Conclusions: Convalescent patients, with a history of severe COVID-19 had a persistent endothelium activation, despite of disease clinical remission even after 9 months from end of symptoms. Furthermore, fibrinogen and vWF levels predicted high levels of Anti-S Ab. Among demographic characteristics, gender, age and severe disease can be predictors of increased antibody response. These findings suggest that inflammation, coagulation and endothelial dysfunction may persist after recovery and may explain the findings of persistent clinical symptoms reported in these patients after healing from COVID-19.

Hemostatic profile of COVID-19 convalescent plasma (CCP) donors from Bergamo Area

Background: Hypercoagulability, complement activation and endothelial perturbation characterize sever COVID-19. After disease remission, a proportion of convalescent subjects still experience post-COVID-19 symptoms. No information is available on persistence of hemostatic alterations in this setting. Bergamo city, represents one of the first and most affected area by SARS-CoV-2 infection in the world. For this reason, since the beginning we were actively involved in recruiting CCP donors. Aims: In a large cohort of CCP donors, we aimed to characterize biomarkers of hypercoagulability and of endothelial perturbation in order to find associations with disease severity, demographic characteristics, and anti-SARS-CoV-2 antibody levels. Methods : Candidate CCP donors were tested for the anti-SARSCoV-2 antibodies, including anti-S IgG antibodies (Anti-S Ab) and anti-N IgG antibodies (Anti-N Ab). In addition, the following plasma biomarkers were assessed: fibrinogen, protein C, protein S, factor V, factor VIII, factor XIII, D-dimer, and von Willebrand factor (vWF). Results: 425 CCP candidates (275M/150F, age range 19-67 years) were admitted to donation. Male gender, age > 40 years, and severe form of COVID-19 were identified as independent predictors of high levels of both anti-S and anti-N Ab ( p <0.001). Among hemostatic parameters, levels of vWF antigen, vWF activity and protein C were significantly higher in CCP donors who had severe COVID-19 compared to donors who had non-severe COVID-19 ( p <0.001). Furthermore, vWF levels positively correlated with anti-S Ab levels (vWF-antigen r=0.216 vWF-activity r=0.257 and vWFRiCof r=0.226, p <0.01). Conclusions: Our data show that gender, age and severe disease can be predictors of an increased immunological response. Furthermore, convalescent subjects show a persistently high vWF levels, suggesting a persistence of the endothelial activation, despite of clinical disease remission.

Hemostatic characterization of post-covid-19 convalescent plasma donors: The bergamo experience

Background: Severe COVID-19 is associated with a profound derangement of the hemostatic system characterized by hypercoagulability, complement activation and endothelial cell perturbation. After disease resolution, some convalescent subjects still experience post-COVID-19 symptoms. No information is available on persistence of hemostatic alterations in this setting. Bergamo city, represents one of the first and most affected area by SARS-CoV-2 infection in the world. For this reason, since the beginning we were actively involved in hyperimmune plasma collection from COVID-19 convalescent subjects. Aims: In this study, in a large cohort of convalescent donors of hyperimmune plasma, we aimed to characterize select hemostatic parameters of hypercoagulability and endothelial cell perturbation and their association with disease severity, demographic characteristics, and antibody levels. Methods: Recovered COVID-19 patients eligible to plasma donation were tested for the SARS-CoV-2 antibodies by the anti-N IgG SARSCoV- 2 antibodies (Abbott Laboratories, IL, USA, Anti-N Abs), and/or the anti-S IgG SARS-CoV-2 antibodies (Liaison-Diasorin, Sallugia-VC, Italy, Anti-S Abs), according to the manufacturer's instructions. Fibrinogen, protein C, protein S, factor V, factor VIII, factor XIII, D-dimer, and von Willebrand factor (vWF) were assessed. Results: 425 subjects have been included (275M/150F) with a median age of 48 years (range: 19-67 years). Among convalescent subjects admitted to the donation, male gender, age > 40 years, and previous hospitalization for COVID-19, were identified as independent predictive factors for significantly (p<0.001) higher levels of SARS-CoV-2 IgG (both anti-S and anti-N). Hemostatic parameters including fibrinogen, protein S, factor V, factor VIII, factor XIII, and D-dimer were not different between severe and non-severe COVID-19. Differently, convalescent subjects with previous severe COVID-19 showed significantly higher levels of vWF (124±40 vs 121±41 %, p<0.001) and PC (119±19 vs 109±19 %, p<0.001) compared with non-severe COVID-19 subjects. In addition, significant positive correlations were found between vWF levels and anti-S Abs (vWF antigen r=0.216;vWF activity r=0.257 and vWF RiCof r=0.226, p<0.01). Summary/Conclusion: Our data show that gender, age and severe disease can be potential predictors of an increased immunological response. Furthermore, convalescent subjects show a persistently high vWF levels, suggesting a persistence of the endothelial activation, despite of clinical disease remission.

May SARS-CoV-2 diffusion be favored by alkaline aerosols and ammonia emissions?

Ammonia is a common factor linking air in bat caves and air pollution in the proximity of agricultural fields treated with livestock farming sewage and slaughterhouses, where important clusters of COVID-19 have recently been reported all over the world. Such a commonality has a further connection with the known behavior of some viruses of the coronavirus family, such as the murine hepatitis virus, whose spike glycoprotein (S) can be triggered to a membrane-binding conformation at pH 8.0. Within the airborne route of virus transmission, with particular relevance for crowded and enclosed environments, these observations have prompted a hypothesis that may represent a contributing cause to interpret the geographical variability of the virus diffusion and the surging rise of COVID-19 cases in slaughterhouses all over the world. The hypothesis is that, in these environments, the SARS-CoV-2 S protein may find on a fraction of the airborne particles an alkaline pH, favorable to trigger the conformational changes, needed to induce the fusion of the viral envelope with the plasma membrane of the target cells.

Challenges for Midwives' Healthcare Practice in the Next Decade: COVID-19 - Global Climate Changes - Aging and Pregnancy - Gestational Alcohol Abuse.

Midwives are multifaceted healthcare professionals whose competence spectrum includes a large variety of knowledge and skills going from antenatal care to education and research. The aim of this review is to suggest the future challenges midwives are going to face in the upcoming decade of this Century. COVID-19 and other infections will reasonably impact healthcare workers all over the world. Midwives are frontline healthcare professionals who are constantly at risk of contagion as their job implies close contact with women, physical support and hand touch. Also, menstruation waste plays a large role in the pollution of waters, severely impacting hygiene in the developing countries and fueling climate change. Appropriate disposal of used menstrual material is still insufficient in many countries of the world especially because of lack of sanitary education on girls. As educators, midwives will be more involved into preventing inappropriate disposal of menstrual hygiene devices by educating girls around the world about the green alternatives to the commercial ones. Despite the evidences about the fertility decrement that occurs with aging, women keep postponing reproduction and increasing their chance being childless or suffering complications related to the advanced maternal age. Teen pregnancies are as well an important issue for midwives who will be called to face more age-related issues and use a tailored case to case approach, enhancing their family planning skills. Another crucial role of midwifery regards the information about the risk of drinking alcohol during gestation. Alcohol assumption during pregnancy is responsible for serious damage to the fetus causing a wide range of pathological conditions related to Fetal Alcoholic Spectrum Disorder, leading cause of mental retardation in children of western countries. On the whole, midwives have demonstrated their willingness to expand their practice through continuing professional development, and through specialist and advanced roles especially in preventive and educational positions.