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1.
European psychiatry : the journal of the Association of European Psychiatrists ; 64(Suppl 1):S263-S263, 2021.
Article in English | EuropePMC | ID: covidwho-2072930

ABSTRACT

Introduction During the COVID-19 pandemic, health workers represented a group particularly vulnerable to work-related stress, but prevention and management of psychiatric symptoms are still under evaluation. Neurofeedback is a safe and non-invasive neuromodulation technique with the target of training participants in the self-regulation of neural substrates underlying specific psychiatric disorders. Protocols based on the increase of alpha frequencies, associated with the process of relaxation, are used for the treatment of stress, anxiety and sleep disturbances. Objectives The aim of the present study was to assess the effectiveness of an alpha-increase NF protocol for the treatment of stress in healthcare workers exposed to the COVID-19 pandemic. Methods Eighteen medical doctors belonging to the Sacco Hospital were recruited during the COVID-19 health emergency and underwent a 10 sessions NF alpha-increase protocol during two consecutive weeks. The level of stress was assessed at the beginning (T0) and at the end (T1) of the protocol through the following questionnaires: Severity of Acute Symptoms Stress (SASS), Copenhagen Burnout Inventory (CBI), Pittsburgh Sleep Quality Index (PSQI), Brief-COPE. Statistical analyses were performed with Paired Samples t-Test for continuous variables, setting significance at p < 0.05. Results A significant increase in alpha waves mean values between T0 and T1 was observed. In addition, a significant reduction in the PSQI test score between T0 and T1 was observed. Conclusions Alpha-increase protocol showed promising results in terms of stress modulation, sleep quality improvement and safety profile in a pilot sample of health-care workers. Larger controlled studies are warranted to confirm present results.

2.
European Journal of Neurology ; 29:72, 2022.
Article in English | EMBASE | ID: covidwho-1978446

ABSTRACT

Background and aims: The impact of the COVID-19 pandemic during the first wave in Italy caused a decrease of hospital admissions, delays in reperfusion treatments and an overall worse outcome in COVID+ patients with stroke. However, few data are available on outcome of stroke stratified by gender. Methods: A multi-center observational study on neurological complications in COVID-19 patients was conducted in 19 Neurology Units by the Italian society of Hospital Neuroscience (SNO). Adult patients admitted to Neurological units between March-April 2020 with ischaemic stroke were recruited. Demographic, clinical, treatment and outcome data were compared in patients with (COVID19+) and without COVID-19 (COVID19-), as well as in male and female patients. Results: 812 patients with ischemic stroke were enrolled (682 COVID-, 129 COVID+);males were 54.1% and 52.7%. Intra-hospital mortality was 31.9% in COVID+ patients (38.6% in male and 27.8% in female) and 7.2% in COVID- (8.4% in males and 6% in females). Male patients with COVID+ were more likely to have cPAP (30.9% vs 14.8%;p=0.03) or being intubated (14.9% vs 3.3%;p=0.02) than females. Reperfusion treatment was administered more frequently in women if COVID- (34.5% vs 29.8%), while less frequently if COVID+ (11.5% vs 29.4%;p=0.01). COVID+ patients had a higher frequency of ESUS than COVID- (31.8% vs 22.3%;p=0.02), with a higher frequency in COVID+ females compared to males (36.1% vs 27.9%). Conclusion: Our study detected some differences due to gender in ischaemic stroke with and without COVID-19. Multivariate analyses is ongoing to define predictors of mortality across gender categories.

4.
Italian Journal of Medicine ; 16(SUPPL 1):42-43, 2022.
Article in English | EMBASE | ID: covidwho-1912901

ABSTRACT

Background and Aim of the study: Evidence suggests that most patients who recovered from COVID-19 carry residual respiratory symptoms. Aim of the study was to evaluate blood gas changes in post-COVID-19 patients. Materials and Methods: Hospitalized COVID-19 patients attending the outpatient clinic for post-COVID-19 patients in Magenta (Italy) were included in this retrospective study. They underwent blood draw (for inflammatory biomarkers and arterial blood gas analysis [ABG]) and chest high-resolution computed tomography (HRCT) scan. The primary endpoint was the assessment of blood gas exchanges after 3 months. Other endpoints included assessment of symptoms and chest HRCT scan abnormalities and changes in inflammatory biomarkers after 3 months from hospital discharge. Results: Eighty-eight patients (n=65 men) were included. Admission ABG showed hypoxia and hypocapnia and a PaO2/FiO2 of 271.4 (IQR 238-304.7) mmHg, that greatly improved after 3 months (426.19 [IQR 395.2-461.9] mmHg, p<0.001). Forty percent of patients were hypocapnic after 3 months, while inflammatory biomarkers improved. Fever, resting dyspnea, and cough were common at hospital admission and improved after 3 months, when dyspnea on exertion and arthralgias arose. On chest HRCT scan, more than half of individuals still presented interstitial involvement after 3 months. Conclusions: While inflammatory biomarkers normalized after 3 months, signs of lung damage persisted for a longer period, suggesting the need for an adequate follow-up of post-COVID- 19 patients.

5.
Brazilian Journal of Infectious Diseases ; 26, 2022.
Article in Portuguese | EMBASE | ID: covidwho-1693850

ABSTRACT

Papiliotrema laurentii (Cryptococcus laurentii), é raramente associado a infecções humanas. Entretanto, nas últimas décadas, o número de infecções por não-C.neoformans aumentou,incluindo P. laurentii e C. albidus. Fungemia por espécies não-neoformans tem sido descritas em pacientes imunocomprometidos (AIDS,doenças linfoproliferativas,corticoesteróides,sarcoidose e TOS). Feminina 54 anos, obesa, diabetes mellitus tipo 2, cardiopata e hipertensa. Admitida com tosse e dispneia, evoluindo com insuficiência respiratória e Sars-Cov-2 por RT-PCR. Transferida para UTI e tratada com o protocolo para COVID-19. Em 4 dias,evoluiu com piora da função renal e hipotensão com indicação de hemodiálise. Apresentou instabilidade hemodinâmica refratária e vasopressores, sendo coletadas amostras de hemocultura, recebendo pipetazobactam 4,5 g 6/6h.Após 10 dias foi identificado P. laurentii, (sequenciamento D1/D2, ITS1 e ITS4). Teste de suscetibilidade in vitro (CLSI M27ED4) para AMB), FLUCO) e VORICO = 0,25, 8 e 0,125 µg, respectivamente.Iniciado AMB 50 mg/dia + FLUCO-800 mg/dia. Amostras deLCR coletadas LCR revelaram redução progressiva de proteína e leucócitos. Hemoculturas foram negativas após 2 semanas e um mês do início da terapia. AMB foi suspenso após 12 dias,com manutenção do FLUCO por 84 dias. Após 78 dias de ventilação mecânica e 107 dias em UTI,paciente foi transferida para enfermaria de reabilitação, recebendo alta em 09/11/2020 com oxigênio via traqueostomia. P. laurentii é raramente associado a infecção humana. A imunossupressão induzida pela COVID-19, associada ao uso de corticoesteróides e dispositivos invasivos pode ser relacionada a infecção por patógenos incomuns, como P. laurentii. Considerando a vulnerabilidade a co-infecções em pacientes com COVID-19, a suspeita precoce e identificação do agente etiológico é fundamental pararedução de mortalidade. Tratamento recomendado para infecções por não-C.neoformans é limitada devido a pouca quantidade de casos e falta de estudos clínicos. Para fungemia por P. laurentii, AMB é usado para diversos casos, com tempo médio de 25 dias. FLUCO também têm sido utilizado em alguns pacientes com fungemia, por 17 dias em média. Poucos dados estão disponíveis para o tratamento de meningite, com alguns casos tratados com sucesso com indução com AMB seguido de manutenção com FLUCO por longo período.

7.
New Microbiol ; 44(4), 2021.
Article in English | PubMed | ID: covidwho-1589425

ABSTRACT

The SARS-CoV-2 pandemic is ongoing worldwide, causing prolonged pressure on molecular diagnostics. Viral antigen (Ag) assays have several advantages, ranging from lower cost to shorter turnaround time to detection. Given the rare occurrence of low-load viremia, antigen assays for SARS-CoV-2 have focused on nasopharyngeal swab and saliva as biological matrices, but their effectiveness must be validated. We assayed here the performances of the novel quantitative Liaison® SARS-CoV-2 Ag assay on 119 nasopharyngeal swabs and obtained results were compared with Hologic Panther and Abbott m2000 RT-qPCR. The Ag assay demonstrated a good correlation with viral load, shorter turnaround time, and favorable economics. The best performance was obtained in the acute phase of disease.

9.
Journal of the Neurological Sciences ; 429, 2021.
Article in English | EMBASE | ID: covidwho-1466657

ABSTRACT

Background and aims: The number of cases of encephalitis in COVID-19 pandemic is increasing. We describe characteristics and outcome of encephalitis in COVID-19 (COV-ENC) patients in one of the most affected regions by COVID-19 of the world, Lombardia, during the first pandemic wave. Methods: A multi-center observational study on neurological complications in COVID-19 patients was conducted by the Italian society of Hospital Neuroscience (SNO). Adult patients admitted to 20 Neurological Departments in Lombardia between February-April 2020 with COV-ENC have been included. Results: 30 COV-ENC patients had a mean age of 66.5 years and male frequency of 56.6%. Altered consciousness was characterized by confusion in 86%, coma in 30%, delirium in 37.9% and alteration of personality traits in 27.6%. Epileptic seizures occurred in 74% of cases. One third of cases had hyperproteinorrachia, one third pleocytosis/hyperproteinorrachia, and remaining third had a normal CSF. PCR for SARS-CoV-2 was negative in all tested patients. EEG was altered in 82.7% of patients. Brain CT and MRI were normal in 9 patients, and among abnormal findings 9 patients had mesial temporal lesions, one of which confirmed with PET imaging. The course was favorable in 39.2% of patients, sequelae were few in 26.6% and moderate in 19.2%, while 20% of patients died. Conclusions: The outcome tends to be worse in male patients. PCR negativity seems to confirm an autoimmune etiology more than a direct invasion of the virus. However, a temporal lobe involvement, detected in 30% of patients with COV-ENC, suggests usual sites of encephalitis due to herpes virus.

11.
European Journal of Neurology ; 28(SUPPL 1):159, 2021.
Article in English | EMBASE | ID: covidwho-1307714

ABSTRACT

Background and aims: Mounting data has been published as to the impact of SARS-CoV-2 on cerebrovascular events, particularly on ischemic strokes. Our study addresses the clinical course of patients with cerebral haemorrhage and simultaneous SARS-CoV-2 infection, paying particular attention to both SARS-CoV-2 positive and negative patients hospitalized during the pandemic. Methods: The Italian Society of Hospital Neurosciences (SNO) promoted a multicentre, retrospective, observational study (SNO-COVID-19), involving 20 Neurology Units in Northern Italy. Data were collected on patients consecutively admitted to neurological departments, from March 1st to April 30th with cerebrovascular diseases, occurring either at home or during hospitalization for other causes. Results: 949 patients were enrolled (average age 73.4 years;52.7% males);135 patients had haemorrhagic stroke and 127 (13.4%) had a primary ICH. Only 16 patients with ICH (12.6%) had laboratory confirmed SARS-CoV-2 infection, clinically expressed or not. SARS-CoV-2 related pneumonia or respiratory distress, lobar location and previous antiplatelet or anticoagulant treatment were the only factors significantly associated with increased mortality in ICH. SARS-CoV-2 infection, regardless of respiratory involvement, led to a nonsignificantly increased risk of in-hospital death. Conclusion: Our study confirms that age, ICH location and previous antiplatelet or anticoagulant treatment are predictors of in-hospital death. Unlike ischemic stroke, ICH in SARS-CoV-2 patients led only to a slight increase in mortality, mainly due to respiratory involvement.

12.
European Journal of Neurology ; 28(SUPPL 1):103, 2021.
Article in English | EMBASE | ID: covidwho-1307709

ABSTRACT

Background and aims: Several studies reported increased incidence of Guillain-Barre' Syndrome (GBS) after Zika epidemic, SARS-CoV and MERS, and more recently SARS-CoV-2 infection. We estimate incidence and describe clinical characteristics and outcome of GBS in COVID-19 patients in one of the most affected regions by COVID-19 of the world, Lombardia. Methods: A multi-center observational study on neurological complications in COVID-19 patients was conducted in 20 Neurology Units by the Italian society of Hospital Neuroscience (SNO). Adult patients admitted to Neurological units between February-April 2020 with COVID19-GBS were included. Results: 38 COVID19-GBS patients had mean age of 60.7 years and male frequency of 86.8%. Mean interval between COVID-19 onset and GBS onset was 15.1 days. CSF albuminocytologic dissociation was detected in 71.4% of cases, PCR for SARS-CoV-2 negative in all 15 tested patients, and anti-ganglioside antibodies positive in 43.7%. Based on neurophysiology, 81.8% of patients had a diagnosis of AIDP diagnosis, 12.1% AMSAN and 6% AMAN. 29 patients have been treated with intravenous Immunoglobulin (IVIg), two with plasma exchange (PE), two with PE followed by IVIg and five untreated. The course was favorable in 76.3% of patients, stable in 10.5%, while 13.1% worsened, of which three died. The estimated occurrence rate in Lombardia is 0.5 GBS cases per 1000 COVID-19 infections. Conclusion: We detected an increased incidence of GBS in COVID-19 patients which can reflect higher risk of GBS in COVID-19 patients or be secondary to an increase of prevalence of prior infection in that period.

13.
IEEE Control Syst Lett ; 6: 199-204, 2022.
Article in English | MEDLINE | ID: covidwho-1096623

ABSTRACT

The COVID-19 pandemic and the disordered reactions of most governments made the importance of mathematical modelling and model-based predictions evident, even outside the scientific community. The basic reproduction number [Formula: see text] quickly entered the common jargon, as a concise but effective tool to communicate the spreading power of a disease and estimate, at least roughly, the possible outcomes of the epidemic. However, while [Formula: see text] is easily defined for simple models, its proper definition is more subtle for larger, state-of-the-art models. Here we show that it is nothing else than the spectral radius of the gain matrix of a linear system, and that this matrix generalizes [Formula: see text] in the computation of the vector-valued final epidemic size and epidemic threshold, in a large class of finite-dimensional SIR-like models.

14.
Italian Journal of Medicine ; 14(SUPPL 2):109, 2020.
Article in English | EMBASE | ID: covidwho-984231

ABSTRACT

Background: COVID-19, the disease caused by SARS-CoV-2, ischaracterized by multiple lung infiltrates and extensive venous andarterial thromboembolism. Little is known about the natural historyof the disease, so we plan an outpatient clinic to follow COVID-19patients.Materials and Methods: All patients discharged alive who hasdeveloped respiratory insufficiency (i.e., arterial pO2 less than 60mmHg), or have needed mechanical ventilation for at least 72hours, or had lung infiltrates >40% of pulmonary parenchyma waseligible for the study. All those patients were re-evaluated at 1 and3 months after discharge with high-resolution CT (HRCT) of thechest, blood gases, blood chemistry, and Doppler color flow of theinvolved vessels.Results: Between February and May 2020, seventy-one COVID-19 patients were re-evaluated. Of these, with HRCT study, 12(17.14%) had pulmonary fibrosis, 19 (27,14%) had ground-glassopacities and 25 (35%) had multiple lesions;15 (21,43%) wasnormal;52 (73%) had persistent hypocapnia (mean pCO2 35.9;SD 3.26);14 had to start steroid therapy again;all patients hadcomplete vein recanalization at CUS. Conclusions: Our preliminary report showed that an outpatientclinic for patients convalescent from COVID-19 is highly advisableand may result in better knowledge of the natural history of thedisease and may help to clarify which patients will need in prolonged treatment and interventions. Furthermore, we speculatedthat a high incidence of persistent hypocapnia may result frompulmonary venous vessel microthrombosis.

15.
Italian Journal of Medicine ; 14(SUPPL 2):109, 2020.
Article in English | EMBASE | ID: covidwho-984194

ABSTRACT

Background: Most studies on SARS-CoV-2 infection show thatpeople who have recovered from COVID-19 have antibodies to thevirus. No study has evaluated whether the presence of antibodiesto SARS-CoV-2 confers immunity to the infection relapse but however, to date, no human reinfections with SARS-CoV-2 have beenconfirmed.Materials and Methods: In our prospective, multicenter, cohortstudy we investigated within three months all patients, with confirmed COVID-19, discharged from two Hospitals (Legnano andMagenta Hospitals), in an area of Italy severely affected by the infection. Telephone follow-up at 1 and 2 months and clinical contact within 3 months was initiated;demographic, clinical,radiologic and laboratory data were recorded in electronic medicalrecords and updated.Results: Of 1081 patients involved, 804 (74.3%) were discharged alive. For all these patients we obtained follow-up data.In particular we reviewed the signs and symptoms of acute SARSCoV-2 infection, extending our attention also to the skin, the cardio-circulatory system, the gastro-enteric, psychic and nervousapparatus. At 1 and 2 months none has died and none has hadany signs of recurrence of infection at both telephone interviewand clinical visit.Conclusions: We are aware that our follow-up is still short, incomplete and lacking of the immunological data that will be investigated in the next months, but with our clinical observation we thinkwe have confirmed two basic points: the reinfection is very unlikelyand any antibody immunity protects against recurrence, at leastin the short term.

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