Morphofunctional changes in the conducting and respiratory parts of the bronchopulmonary system in COVID-19 (analytical review)

The article reflects the analysis of the state of the problem concerning the pathogenesis of COVID-19 (CoronaVirus Disease 2019), the epidemic of which began from the end of 2019 to the beginning of 2020, from the position of the bronchopulmonary system, which is associated with the main route of penetration of the virus of this infectious disease (SARS-CoV-1) with the development of severe pneumonia, often fatal. And if the study and results of the study of this problem are to a certain extent highlighted in the literature, then they concerned mainly the respiratory regions of the respiratory tract (RT), given that mainly complications leading to death are associated with them. At the same time, studies on conducting RT are reflected in a few foreign works, although there are data suggesting their not small contribution to the pathogenesis of COVID-19. In the domestic literature, studies of this kind have not been reflected. The aim of the work is to analyze, reflect and assess the role of possible morphological and functional regional changes in the mucous membrane of the RT in the pathogenesis of COVID-19. Methodologically, the analysis was carried out using a systematic approach based on the material of various databases of biomedical and biomedical scientific information, including such as Index Medicus, PubMed, EMBASE, Cochrane, and others for the period, mainly 2020. Results. An analysis of the mechanisms of influence on the morphofunctional state of the mucous membrane of the RT of coronavirus infection is given, depending on their departments, including conductive and respiratory. Methods and approaches to the study of such influence are reflected. The possible role of disturbances in the morphofunctional state and defense mechanisms of the lungs is shown, hypotheses and paradigms regarding the pathogenesis of coronavirus infection are presented. The results of the analysis indicate that there is a whole complex of morphological and functional disorders that determine the development of this pathology, its virulence. The fundamental role of the epithelium of the respiratory tract has been established and multicellular receptor tropism in the pathogenesis of COVID-19 is reflected. In conclusion, it is pointed out that the essential role of epithelial cells not only of the respiratory, but also of the conductive parts of the LTP, mainly ciliates, which are involved in the pathogenesis of COVID-19 not only from the position of functional receptors, but also in terms of violations of the earliest leading protective mechanism - mucociliary clearance aggravating the "vicious circle of pathogenesis" of this pathology.Copyright © 2021 Infectious Diseases: News, Opinions, Training. All rights reserved.

The sense of loneliness in couples and the impact of the health crisis: A review of literature

Objective: The purpose of this review is to define the feeling of loneliness within a couple while taking into consideration the factors that lead a person to feel lonely in a couple or in a romantic relationship. Our goal is to understand the effects of the feeling of loneliness on these individuals during the global health crisis brought on by COVID-19 and to take these factors into account in designing effective therapeutic care. The different manifestations of loneliness in a couple should also be highlighted. Method(s): We used the PRISMA methodology to select the relevant studies. The keywords ("Solitude" or "Loneliness") and ("Couple" or "Married" or "Partnership") allowed us to select 19 references dealing with the theme. We conducted searches of the following databases: "Cairn", "PsychInfo and Psycarticle", "PubMed and Medline", "ScienceDirect" and finally, "Web of Science" in order to find articles covering a ten-year period. Result(s): There are different definitions for the subjective experience of loneliness. The review of the literature highlights the fact that loneliness can lead to positive or negative psychological consequences (it can lead to the development of creative capacity or, on the contrary, result in depression in some cases). Attachment patterns have been shown to be the basis for the tolerance of feelings of loneliness. Indeed, an anxious attachment would encourage the couple to avoid the feeling of loneliness. According to the literature, this defensive mechanism of seeking presence in the couple would make it possible to limit the impact of loneliness. This solitude depends on the level of relational quality within the couple. A poor relational quality would lead to greater loneliness and would impact intimate relationships. Loneliness is supposedly not experienced in the same way by men and women: Men seem to be more protected by marriage while women's level of loneliness may be higher because of the household chores they have to do. Men and women would nevertheless remain subject to the phenomena of contamination, i.e., when one of the partners feels lonely, the other will also be lonely. However, it seems that marriage protects against feelings of loneliness and its negative consequences. Loneliness does not have only negative effects. It can be beneficial for developing creativity and finding oneself. The periods of confinement during the COVID-19 crisis provided people with an increase in the amount of time they didn't normally have on a daily basis. This may have been beneficial for some people and can be associated with positive emotions. Individuals who spent the lockdowns with others felt less alone and experienced less psychological distress. However, confinements did produce some negative effects on couples. The increased stress of the pandemic and the constant proximity led to an increase in spousal abuse. The consequences of confinement for couples whose relationships were already troubled resulted in frequent separation and/or divorce. The potential for conflict was related to limited financial resources, not working, and the significant risk of contracting SARS COV-2. Conclusion(s): The articles dealing with the feeling of loneliness that we reviewed presented quantitative methods to the detriment of qualitative aspects and focused largely on the negative aspects of the feeling of loneliness. Other academic disciplines, such as sociology, demonstrate a lack of understanding concerning what is at stake with the feeling of loneliness. The articles intersect and tend to highlight the attachment relationships that are formed in childhood as a determining factor in the feeling of solitude later in life. The quality of the relationship, gender, and marital status are also factors to be considered. Loneliness has a clear influence on the well-being of the relationship but it is not an individual characteristic of the relationship itself. It finally appears as an individual characteristic with an impact on the assessment of the quality of the relationship and on the appreciatio of the spouse.Copyright © 2023 Elsevier Masson SAS

An IoT Based Smart Vault Security and Monitoring System with Zero UI

Recent advances have introduced IoT as one of the key technologies globally. As safety remains a critical issue for those who spend much time outside. Automated security systems are very useful where safety is an important issue. With a prospect of a Zero User Interface (UI) model this work represents a novel IoT based smart vault security system. The system is built and designed based on IoT combining with Arduino-Uno and Bluetooth module. This system involves LDR sensor, IR sensor and Sonar sensor for monitoring. The vault provides security on three levels. Password protected entry to connect with the smartphone using Bluetooth module, IR sensor array to use 'secret gesture pattern' to unlock the door, tracking number of transactions from the vault using Sonar sensor and LDR was used as a switch. To avoid the replication of physical unlocking of objects IR sensor array was used to introduce 'secret gesture pattern' unlocking system through touchless interfaces for the avoidance of transmissive diseases like COVID-19. This novel system has substantial possibility as a security vault system for industrial and residential use in a contactless manner. © 2023 IEEE.

When the Pandemic Changed the Rhythm of Sexual Life: The Role of Fear, Defense Mechanisms, and Perceived Stress in Sexual Activity after the Lockdown

Introduction: The pandemic has significantly altered people's life rhythms, affecting both their mental framework and their relational sphere. The perception of virus-related risks has generated strong feelings of fear and anxiety that have activated defense mechanisms aimed at managing the high levels of perceived stress. This greatly affected people's levels of well-being and life satisfaction. One of the areas involved in relation to well-being was sexuality. Much research has been concerned with monitoring well-being with respect to sexual distress, coping strategies, and mood states;however, little research has been concerned with providing an explanatory model of the psychological and contextual dynamics that influenced both sexual satisfaction and sexual conduct during this period. Our aim is to provide a model that sheds light on the dynamics related to sexual satisfaction and sexual behavior during the pandemic, considering the role of risk perception, fear of covid.19, levels of coping mechanisms, and perceived stress. Method(s): From the end of May to the end of September 2020, we administered a battery of questionnaires and self-reports (Semantic differential, MAC-RF, DSQ-40, PPS, SSS-W/M, BISF-item7) through various social networks to a sample of 636 subjects (461 F;171M) with a mean age of 26.7 years (SD 8.1). Data analysis was carried out using the macro Process 3.0 (Mod. 6) of SPSS V.24., It was intended to test a multiple sequential mediation model in which different perceptions of risk influence both people's sexual activity and sexual satisfaction through the mediation of fear, defense mechanisms, and perceived stress. Result(s): The results of sequential multiple mediation show the absence of a direct influence between the different risk perceptions related to covid.19 (exposure, knowledge, and death) on sexual satisfaction, however, this influence is affected by the mediation of fear of covid.19 (M1), defense mechanisms (mature, neurotic, and immature) (M2), and perceived stress (M3). Regarding sexual activity, similar to previous results, only perceptions related to exposure to risk and death have an indirect influence on the frequency of different sexual practices. Conclusion(s): The data show that perceptions related to feeling exposed to risk, knowledge of risk, and the risk of deadly consequences of Sars-Covid 19 infection fuel various fears interconnected with the virus, such as fear for one's own body and for others;such negative emotion overload activated defense mechanisms that increased perceptions of stress in relation to the current living situation, affecting both the degree of sexual satisfaction and the frequency of sexual activity of cohabiting and noncohabiting couples. The implications of these findings are both clinical and research. First, we know how sexuality is an important dimension of a couple's affective life that, when compromised by excessive stress load, can negatively affect couple homeostasis, generating, where elements of resilience are lacking, the exacerbation of conflict, dissatisfaction, online infidelity, and negative feelings toward self and partner. This situation, embodied in the post-pandemic in couple crises and an increase in requests for couple therapy and relationship separations and breakups, poses the challenge to reflect and concretize interventions aimed at supporting the couple's needs to increase relationship security, to model and test specific helping actions in eventual, hopefully distant, critical events such as the pandemic.

Personality, Defenses, Mentalization, and Epistemic Trust Related to Covid-19 Containment Strategies: A Psychodynamic Perspective

Introduction: The COVID-19 pandemic has considerably influenced all the domains of people's lives worldwide, determining a high increase in overall psychological distress and several clinical conditions. The study attempted to shed light on the relationship between strategies adopted to manage the pandemic, vaccine hesitancy, and distinct features of personality and mental functioning. Method(s): The sample consisted of 367 Italian individuals (68.1% women, 31.9% men;M age=37, SD=12.79) who completed an online survey including an instrument assessing four response styles to the pandemic and lockdown(s) (RSPL;Tanzilli et al., 2021), the Personality Inventory for DSM-5-Brief Form (PID-BF;Krueger et al., 2013), the Defense Mechanisms Rating Scales-Self-Report-30 (DMRS-SR-30;Di Giuseppe et al., 2020, 2014), the Reflective Functioning Questionnaire (RFQ;Fonagy et al., 2016), and the Epistemic Trust, Mistrust, Credulity Questionnaire (ETMCQ;Campbell et al., 2021). Result(s): Maladaptive response patterns to pandemic restrictions were related to dysfunctional personality traits, immature defense mechanisms, poor mentalization, and epistemic mistrust or credulity. Moreover, more severe levels of personality pathology was predictive of an extraverted-maladaptive response style to health emergency through the full mediation of low overall defensive functioning, poor certainty of others' mental states, and high epistemic credulity. Conclusion(s): Recognizing and understanding dysfunctional psychological pathways associated with individuals' difficulties in dealing with the pandemic are crucial for developing tailored mental health interventions and promoting best practices in healthcare services.

Targeting viral ORF3a protein: A new approach to mitigate COVID- 19 induced Immune cell apoptosis and associated respiratory complications

Infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a growing concern to the global well-being of the public at present. Different amino acid mutations alter the biological and epidemiological characteristics, as well as immune resistance of SARS-CoV-2. The virus-induced pulmonary impairment and inflammatory cytokine storm are directly related to its clinical manifestations. But, the fundamental mechanisms of inflammatory responses are found to be the reason for the death of immune cells which render the host immune system failure. Apoptosis of immune cells is one of the most common forms of programmed cell death induced by the virus for its survival and virulence property. ORF3a, a SARS-CoV-2 accessory viral protein, induces apoptosis in host cells and suppress the defense mechanism. This suggests, inhibiting SARS-CoV-2 ORF3a protein is a good therapeutic strategy for the treatment in COVID-19 infection by promoting the host immune defense mechanism.Copyright © 2023 Tabriz University of Medical Sciences. All rights reserved.

Developing a Brief Tele-Psychotherapy Model for Covid-19 Patients and Their Family Members

Introduction: While many studies are available on the psychological impact that the pandemic has had on the general population, few studies have considered survivors of COVID-19 and their first-degree relatives. The incidence and prevalence of psychological distress in COVID-19 patients greatly vary by country and by study methodology, and go beyond the current possibilities of any mental health system to offer in-person services, with the result that most users fail to receive the necessary support. There exists an urgent need to intervene on the psychological suffering of COVID-19 patients and their family members with treatments that can be offered safely and on a large scale, without burdening an already strained health system. We leveraged the ongoing clinical experiences with COVID-19 survivors and family members to design a clinical intervention model that could be remotely administered and could easily integrate with the workflow of the regional health system. The result of this process was the development of a brief remote psychotherapy program to be delivered via telemedicine. Method(s): We first reviewed the scientific literature on psychotherapeutic interventions that were designed to treat psychopathology among COVID-19 patients and family-members. Based on this evidence, we harmonized techniques and strategies deriving from several psychotherapeutic orientations into a brief psychotherapy program that was developed along three main theoretical trajectories: psychodynamic therapy, constructivist therapy and hermeneutic-phenomenological therapy. Result(s): The program consists of 8 remote, 50-minute, individual psychological sessions offered weekly using secure video conferencing software. The severity of the clinical conditions of COVID-19 patients has largely influenced the sequencing of the intervention both for patients themselves and for their family members dealing with the COVID-19 hospitalization/discharge/loss of a loved one. We considered it appropriate to circumscribe the exploration of the different psychological targets within each session, given the unpredictable nature of the course of illness, and the possible onset of events that could radically change the psychological state of patients and family members. During the initial phase of treatment, the therapist highlights the patient's ways of suffering and coping, in hopes to identify together with the patient which ones are already familiar and which ones are novel. In the context of the patient's textual refiguration, the therapist makes room for interpretative cooperation by sharing clinical objectives: a commonality of intents that brings therapist and patient to accept the challenge of the clinical work. During all phases of the clinical work, suffering is contextualized both in the light of the recent traumatic experience (bereavement, hospitalization in intensive care, fear for one's life or that of a relative), and in the light of historical ways of suffering, so that the patient is able to recognize the meaning of the currently experienced symptom. Session 1 includes introductions and exploration of the patient's current experience space as well as identification of the areas of suffering and brief recapitulation of the patient's psychological functioning pre- COVID. Session 2 attempts to define shared goals for the therapeutic process and creates an initial diagnostic framework to identify unprocessed or unregulated emotions. Session 3 aims to validate the intrapsychic and interpersonal resources associated with a greater degree of adaptation to the stressful situation, including: a flexible personality;positive beliefs about the self;identity roles and acceptance and commitment skills;work functioning;s solid network of friends;family/loved ones. In Sessions 4 through 6, areas of clinical concern are addressed and defense mechanisms are examined. Session 7 aims to integrate the lived experience in the cohesive narrative of the self. In Session 8, internal working models or relational patterns that have emerged during ther py closure are discussed and psychoeducation on relapse prevention is offered. Conclusion(s): We described a newly designed remote psychotherapeutic approach to tackle the COVID-19 pandemic psychological aftermath. We believe that the intervention model described here has great innovation potential in that: (1) it offers immediate psychotherapeutic support to all those who experience psychological suffering associated with COVID-19;(2) helps therapists to operate in acute and subacute settings, overcoming the barriers imposed by public health and prevention measures;and (3) contributes to study and determine the procedures by which tele-psychotherapy can be best implemented. In doing so, this treatment model could provide a blueprint for future tele-psychology wide-scale interventions.

Haematological Indices Predictive Role In Post Contrast Induced Acute Kidney Injury

Contrast-induced acute kidney injury (CI-AKI) is a frequent complication in cardiac patients after percutaneous coronary intervention (PCI). Thus, the early prediction of such cases is essential to improve outcomes and prevent complications. Hemogram-derived indices provide a cheap, easy, and non-invasive test. Systemic immune inflammation index (SII) is a novel marker that can be calculated easily from a complete blood count test. It can be an important indicator in determining the balance between systemic inflammation and immune status and can predict CI-AKI better than neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR).Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

On epidemiology as racial-capitalist (re)colonization and epistemic violence

This commentary reflects upon power-knowledge dynamics and matters of epistemic, procedural, and distributive justice that undergird epidemiological knowledge production related to racial health inequities in the U.S. Grounded in Foucault's power-knowledge concepts-"objects", "ritual", and "the privileged"-and guided by Black feminist philosopher Kristie Dotson's conceptualization of epistemic violence, it critiques the dominant positivist, reductionist, and extractivist paradigm of epidemiology, interrogating the settler-colonial and racial-capitalist nature of the knowledge production/curation enterprise. The commentary challenges epidemiology's affinity for epistemological, procedural, and methodological norms that effectively silence/erase community knowledge(s) and nuance in favor of reductionist empirical representations/re-presentations produced by researchers who, often, have never stepped foot inside the communities they aver to model. It also expressly names the structurally racist reality of a "colorblind" knowledge production/curation system controlled by White scholars working from/for an invisibilized White scientific gaze. In this spirit, this commentary engages the public health critical race praxis principle of "disciplinary self-critique", illuminating the inherent contradictions of a racial health equity discourse that fails to interrogate the racialized power dynamics underlying its knowledge production enterprise. In doing so, this commentary seeks to (re)frame and invite discourse regarding matters of epistemic violence and (re)colonization as manifest/legible within epidemiology research, suggesting that the structural racism embedded within-and perpetuated through-our collective work must be addressed to advance antiracist and decolonial public health futures. In this regard, I suggest the value of engaging poetry as praxis-as mode of knowledge production/expression to "center the margins" and offer counternarratives to epidemiology's epistemic violence. Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Epidemiological analysis of hospitalized patients at the Clinic for Psychiatry KCV in Novi Sad during 2020

Introduction: The 2020 year was the first year of Covid19 pandemy in Serbia. Epidemiological measures introduced to prevent the spread of the infection have shaped both the everyday life of citizens and the way the health system of our country functions. A large number of those infected required the redistribution of health personnel to work in covid zones and therefore the work with non covid patients suffered. Objective(s): The aim of the study is to process and present the epidemiological characteristics of hospitalized patients at the Clinic for Psychiatry of the Clinical Center of Vojvodina in Novi Sad in 2020. Method(s): A retrospective analytical study of the epidemiological type was conducted. Result(s): During 2020, a total of 1345 patients were hospitalized at our Clinic, which is over 30%less than during the previous year. Several males, aged 19 to 45, with a predominant diagnosis of psychosis, were hospitalized. Hospitalizations lasted significantly shorter than during the previous year. The number of relapses was significantly lower. Patients with other diagnoses of mental disorders are significantly less often hospitalized, except for those with addiction diseases who are hospitalized in a reduced percentage. Conclusion(s): Restrictive epidemiological measures led to a significant reduction in the number of hospitalizations at our Clinic, primarily because patients were prevented from exercising their right to health care, but also because of the mobilization of all healthy defense mechanisms in a collective crisis situation and consequently reduced psychopathological manifestations.

Perceived stress among physician parents during COVID-19 pandemic

Introduction: Stress among physician parents is still poorly studied, especially during the SARS-COV-2 pandemic. Objective(s): To describe the stress of being both a doctor and a parent during COVID-19 epidemic. Method(s): It was a cross-sectional, descriptive and analytical study, carried out on google drive in March 2021, and relating to 93 Tunisian medical parents. We used a questionnaire containing the parents' personal and professional data as well as the perceived stress scale (PSS10). Result(s): The majority of parents (94.7%) were women. The average age was 34.43 years old. The average age of marriage was 29.6 years for men and 25.4 years for women. The majority of parents (89.4%) had one or two children and 70.2% were satisfied with their relationship with their children. On another side, 71.3% of doctors had to provide on duty services in the hospital, with 44.1% providing 3-4 on-calls per month, while 69% were providing on duty services in the COVID units. The average PSS score was 22.6. The distribution of scores indicated medium and high stress level in respectively 84.9% and 14% of parents. Furthermore, the PSS score was negatively correlated with the marriage age (p=0.046, r=-0.2). On the other hand, no association was observed with the children number nor with the satisfaction of the relationship with his child. Conclusion(s): It follows from our study that stress among physician parents is at a fairlyhighlevel. Managing this stress during a pandemic is not easy and requires the activation of several defense mechanisms.

Vaccination for SARS-CoV-2: a review

The present overview describes the various vaccines in use to prevent SARS-CoV-2 infection and COVID-19 disease. Their action is based on the natural defense mechanisms of the human body against viral infections. The effectiveness of the vaccines is described and details of the cellular and humoral immune response as measured following infection and following vaccination are reported. The immune response is waning in time. Side effects of vaccination exist, but are minor when compared to COVID-19 disease itself. Due to waning of the antiviral immunity and the continuing emergence of virus variants, regular repeat vaccinations and the development of stronger vaccines, ideally with coverage of an extended antigen spectrum, seem necessary. Copyright © 2022 Tijdschrift voor Geneeskunde en Gezondheidszorg. All rights reserved.

Our evolving prescribing practice: inhaled medication prescription changes over 5 years at the West Midlands Adult Cystic Fibrosis Centre

Background: Highly effective modulator therapy (HEMT) is now available for ∼90% of adults with CF with Kaftrio® licenced for use in the UK from August 2020. Despite continuation of routine CF treatments in randomised controlled trials, real-world evidence suggests a reduction in prescribed inhaled medication for people with CF on HEMT.1 Alongside the introduction of Kaftrio®, additional factors have impacted upon our inhaled medication prescribing practice including the COVID-19 pandemic and the introduction of CFHealthHub, which allows us to monitor nebulised treatment adherence. Objective: To examine how and to what extent our inhaled medication prescribing practice has changed over the past 5 years. Method: A retrospective audit of our prescribed inhaled medication databases from 2016, 2019 and 2021. Results: See table 1. Table 1. Number of CF patients prescribed inhaled mucolytics and long term inhaled therapy for Pa. (Table Presented) Conclusion: Despite an increasing rate of Pa infection,we have observed an overall reduction in prescribing of inhaled antibiotics and mucolytics. HEMTs, particularly Kaftrio®, have improved the health of our patients and, despite our caution, many have requested a reduction of inhaled therapy in line with their improved well-being. Assessment of adherence via CFHealthHub has often led to rationalisation of inhaled treatments in order to support improved adherence. During the COVID-19 pandemic, drug response assessments, the gateway to accessing a change in inhaled medication, have frequently been delayed as we have had to redesign our service in response to changing circumstances.

Is it Time to Revisit Neuroinflammatory Depression? A Case of COVID-19 Associated Depression and the Role of ECT

Background: The neurobiology of depression can be heterogeneous with multiple hypotheses proposed, including serotonin and neuroinflammatory pathways, each falling short of explaining the complete picture. Several reports describe the increased frequency of depression in the community following the COVID-19 pandemic and reports about neuropsychiatric sequela of the virus are emerging and the possible role of neuroinflammation. We present a patient who developed severe depression with psychotic features subsequent to his COVID-19 infection and was treated successfully with ECT following several failed medication trials. Case: A 49-year-old male with a past medical history of type II diabetes, hyperlipidemia, hypertension, chronic kidney disease, and gastroesophageal reflux disease was diagnosed with COVID-19 in January 2021. Upon initial diagnosis, neither admission nor treatment with steroids was required. He presented to the emergency department four days later with sepsis, pneumonia, and AKI secondary to COVID-19 along with the new onset of suicidal ideations with plans to cut himself and significant psychomotor features despite no previous history of mental illness or treatment. His EEG showed diffuse slow waves, consistent with encephalopathy, but no delirium was noted. He exhibited irritability, anger, anhedonia, negativism, and isolated himself in his room. He demonstrated delusional fear about his apartment exploding due to electricity disconnected for not paying his bills. He misinterpreted the blood draws as someone suspecting he has HIV. Treatment started on the medical floor and he was later transferred to the psychiatric floor. Several psychotropic medications were tried separately including citalopram 20mg, escitalopram 20mg, and bupropion (titrated to 300mg) with the addition of aripiprazole 5 mg without improvement. ECT was considered and his depression and psychosis improved following 6 treatments of bilateral ECT. He was discharged following completion of 10 ECT treatments on 300 mg of bupropion daily and 5mg olanzapine at night. Discussion: Viral infections such as HIV, Hepatitis C, and Influenza are associated with neuropsychiatric sequelae, including depression. COVID-19 infection is occasionally associated with ‘cytokine storm’ which may exacerbate neuroinflammation via increases in cytokines and possible activation of mast cells and microglia.[1] The role of elevated pro-inflammatory cytokines and glucocorticoid receptor resistance is widely studied. Interleukin-6 and CRP are the most strongly linked to depression with a high correlation for anhedonia and psychomotor retardation, prominent features of depression in our case, hinting at a possible role of neuroinflammation. [2] Psychotic features and psychomotor retardation are predictors of ECT response which matched the response to ECT in this case. References: 1. Kempuraj, Duraisamy, et al. COVID-19, mast cells, cytokine storm, psychological stress, and neuroinflammation. The Neuroscientist 2020: 402-414. 2. Tiemeier, Henning, et al. Inflammatory proteins and depression in the elderly. Epidemiology 2003: 103-107.

Conversion of Stuporous Catatonia to Excited Catatonia from Lorazepam Challenge

Background: Catatonia, a motor dysregulation syndrome with behavioral components, has undergone many conceptual changes since its inception as a syndrome by Kahlbaum in 1874. Prevalence of catatonia in consultation-liaison services is approximately 5.5 percent in patients aged 65 and older.1 Stuporous catatonia is most common, but catatonia may present in excited or malignant subtypes. Together, the subtypes have over 40 documented signs and symptoms, making catatonia difficult to diagnose and appropriately treat.2 Catatonia involves hyperactivation of the orbitofrontal cortex (OFC) and ventromedial prefrontal cortex. GABA, NMDA, and dopamine have been implicated. GABA-A agonism by benzodiazepines improve catatonia by normalizing OFC activity.3 Case: A 66-year-old male with schizophrenia was admitted to a medical unit for failure to thrive after not eating for three days. He had not taken his medications for 2 weeks including chlorpromazine, quetiapine, oxcarbazepine, and clonazepam. Upon psychiatric consult, the patient exhibited staring, grimacing, echopraxia, and negativism. He was diagnosed with stuporous catatonia. 30 minutes after lorazepam challenge (2 milligram intravenous lorazepam), the patient was moving, conversing, and eating. After second dose of lorazepam, the patient became difficult to redirect, displaying stereotypy, verbigeration, and hitting. Additional doses of lorazepam were unsuccessful in breaking excited catatonia. History revealed previous catatonic episodes, including nine months prior when the patient was admitted to a gero-psychiatric unit. He initially presented in stuporous state, normalized with lorazepam, then transitioned to excited state. He received 16 milligrams of lorazepam in 24 hours without successful termination of excited catatonia. Lorazepam in combination with carbamazepine, clozapine, or valproic acid was unsuccessful. Catatonia was successfully treated with 10 sessions of electroconvulsive therapy (ECT) with lorazepam, clozapine, and valproic acid. Maintenance ECT was not continued because of the COVID pandemic, and the patient was admitted to a state facility after regression. Discussion: Catatonia is often encountered on consultation-liaison services in general hospital settings. We observed conversion of stuporous catatonia to excited catatonia after administration of lorazepam. This treatment-resistant catatonia ultimately required ECT. No reported cases of stuporous catatonia transitioning to excited catatonia were found on thorough literature review. Recognition of this conversion may be difficult and may require development of a catatonia scale that clearly identifies the presenting subtype. This is a challenge;clinical signs are not mutually exclusive among subtypes. This patient’s clinical course may provide insight into the identification of treatment-resistant catatonia, and accurate identification is necessary to allow for timely escalation of treatment. References: 1. Solmi M, et al. Prevalence of catatonia and its moderators in clinical samples: Results from a meta-analysis and meta-regression analysis. Schizophrenia Bulletin. 2017;44(5):1133–50. 2. Fink M, Taylor MA. The catatonia syndrome. Archives of General Psychiatry. 009;66(11):1173. 3. Ellul P, Choucha W. Neurobiological approach of Catatonia and Treatment Perspectives. Frontiers in Psychiatry. 2015;6.

OVERALL DIABETES MORBIDITY AND MORTALITY WITH COVID-19

Overall Diabetes Morbidity and Mortality with COVID-19 Viral N. Shah, MD Associate Professor, Barbara Davis Center for Diabetes, University of Colorado Denver On December 12, 2019, a pneumonia cluster of unknown causes was identified in Wuhan in the Hubei province of China. Later on, it was confirmed to be caused by novel coronavirus (COVID-19) probably linked to seafood wholesale market in Wuhan. Within three months of the first case in Wuhan, many countries reported cases of COVID-19. There has been a large amount of publications since the first case of COVID-19 in December 2019. Per a PubMed search (using the search strategy COVID-19 [tiab]), in the year 2020 alone there were 79,593 publications related to COVID-19. Earlier publications from China and other countries reported a higher frequency of diabetes patients in the hospital setting. Earlier studies reported a two- to three-fold increased risk for severe disease and mortality in patients with diabetes compared to non-diabetic patients. This higher mortality among patients with diabetes was confirmed across different geographic locations, cross-sectional studies, as well as cohort or nationwide studies. Moreover, diabetes was associated with a higher risk for hospitalization, longer hospital stays, and ICU admissions. The majority of earlier studies reported an association between diabetes and COVID-19 morbidity and mortality without specifying diabetes type. A large population-based study from the United Kingdom, mortality in patients with type 1 diabetes was threefold higher (OR 3.51;95% CI 3.16-3.90) and in patients with type 2 diabetes was two-fold higher (OR 2.03;95% CI 1.97-2.09) compared to the general population. This suggested a higher mortality among patients with type 1 diabetes compared to type 2 diabetes. However, another population-based study from Sweden reported a two-fold increased but similar mortality between patients with type 1 diabetes and type 2 diabetes. Similarly, studies from the United States reported similar outcomes in patients with type 1 and type 2 diabetes. The published studies suggest mortality and morbidity is higher among patients with diabetes compared to patients without diabetes. However, there are many limitations and confounders of which we should be cognizant. Timing and virus strain may have confounded the results of many studies. For example, during the first wave of COVID-19 in many countries, health care systems were unprepared to deal with the huge surge of this new viral infection leading to rationalization of health care. In addition, there were no drugs or vaccines available during the first wave leading to higher mortality in older adults with multiple comorbidities such as diabetes. Moreover, different strains of the virus overtime had varied infection severity. For example, the alpha and delta strains of the virus led to more severe infections and increased mortality compared to a wild virus and the newer omicron variant. Higher mortality in people with diabetes was attributed to old age (>70 years) and the presence of other comorbidities such as hypertension and cardiovascular diseases. In summary, the present evidence indicates higher mortality and morbidities in patients with type 1 diabetes and type 2 diabetes. There is no data on morbidity and mortality of COVID-19 in patients with other types of diabetes such as monogenic diabetes. Higher mortality may be attributed to advanced age and presence of comorbidities. The COVID-19 disease is evolving and future studies will provide a greater understanding on the pathophysiology of COVID-19 in patients with diabetes and drugs to prevent disease severity in this patient population.

Diet and Lifestyle Guidelines for Immunomodulation with Reference to Corona Virus Pandemic: A Scientific Statement of the International College of Nutrition

The immune system is comprised of lymph glands, lymph nodes, thymus gland, spleen, bone marrow, lymphocytes, and molecules such as antibodies and cytokines. It has a vast array of functionally different cells such as T and B lymphocytes, macrophages, neutrophils and mast cells. The ontogenesis of the immune system is comprised of the innate immune cells and the adaptive immune cells, where innate immune cells are the first defense mechanisms to respond to pathogenic environmental factors. There are multiple components of the adaptive immune cells, including immunoglobulins (Igs), T-cell receptors (TCR), and major histocompatibility complex (MHC) responsible for adaptive immunity. However, many elements of both the innate and adaptive immune systems are conserved in our bodies. The adaptive immunity is a type of immunity that develops when a person’s immune cells respond to a pathogen such as microorganism or vaccination. Environmental factors such as pathogenic bacteria or viruses, solar exposure, age, exercise, stress, diet, sleep quality and air pollutants can influence the immune system. There may be marked decline in the immune function due to attack of COVID-19. Most patients with mild COVID-19 develop an appropriate immune response that culminates with viral clearance. However, severe disease manifestations have been linked to lymphopenia and immune hyper-responsiveness leading to cytokine storm. It has been observed that in COVID-19, alveolar macrophages are epigenetically altered after inflammation, leading to long-term lung immune-paralysis. Western diets are known to have adverse effects on the immune function. However, Mediterranean-type diets rich in short-and long-chain polyunsaturated fatty acids (PUFA), vegetables, nuts and fruits, dairy products and fish and red wine, due to high content of vitamins, minerals and flavonoids may be useful in boosting immunity. Moderate physical activity may also cause an extensive increase in numerous and varied lipid super-pathway metabolites, including oxidized derivatives called oxylipins. Emerging evidence suggests that dietary supplements containing flavonoids, carotenoids, coenzyme Q10 (CoQ10), vitamins, minerals and antioxidants modulate gene and protein expression and thereby modify endogenous metabolic pathways, and consequently enhance the immunity. Mediterranean-type diet and multiple bioactive nutrients, fatty acids, amino acids, vitamins and minerals as well as moderate physical activity may be crucial for enhancing immunomodulation.

Assessment of CXCL10 and vitamin D in patients with persistent pityriasisrosea during COVID-19 pandemic

Background Pityriasisrosea (PR) is an exanthematous disorder accompanied by systemic recurrence of HHV 6 and/ or 7. Objective To explain the link between levels of vitamin D and CXCL10 in persistent PR during COVID-19. Methods The study encompassed 25 patients (10 males and 15 females, age range: 10-40 years) with persistent PR more than 12 weeks and 25 control subjects (12 males and 13 females, age range: 11- 38 years) examined in the medical Excellence center, Dermatology Outpatient Clinic, National Research Center, Egypt between November 2020 and March 2021. Blood samples were collected from controls and persistent PR patients for more than 12 weeks, 15 days later after topmost clinical symptoms. Assessment of serum CXCL10 was done by ELISA kit. Vitamin D was determined using the chemi-luminescence technique. Results A student unpaired T- test was done at P<0.05 illustrating a significant increase in levels of CXCL10 while a significant decrease in levels of vitamin D in the sera of both male and female patients in comparison to control ones. Conclusion Our study provided evidence that circulating CXCL10 is elevated in persistent PR patients as well as in COVID-19 where PR is one of clinical symptoms of coronavirus. This highlights the immunological response in PR and contributes to a clear explanation of cutaneous defense mechanism. Vitamin D showed a significant reduction in persistent PR patients and has been shown to be safe and guard against acute respiratory infections as in COVID-19

Implementation and decentralization of the analytical process in molecular biology: The experience of Modena for COVID-19 diagnosis

Background: Real time reverse transcriptase polymerase chain reaction (RT-PCR) on clinical specimens is considered the first line test for the diagnosis of SARS-CoV-2 infection. This test involves different steps: RNA extraction, reverse trancription, PCR setting-up, amplification and analysis of results. To date, several analyzers for extraction and amplification phases are availabe, while few are able to guarantee the automation of the entire workflow. To optimise the allocation of swabs, with the aim of maximising the number of swabs tested and reducing the wait time for results, we applied a decentralysed system.Methods: In Provincia of Modena a network of 5 suburban laboratories referring to central laboratory was developed.The work was focused not only on the implementation of new analyzers, but also on the organization and consolidation of the whole workflow integrating the pre-analytical, analytical and postanalytical phases and including the molecular biology tests report on LIS (Laboratory Information System). Furthermore, all laboratory professionals attended a specific training.Results: Between march 2020 and June 2021 450,000 RT-PCR for RNA of Sars-Cov-2 research were performed. The central laboratory analyzes the majority of swabs (n= 259832, 58%), including those enrolled at drive through (44%). 76% were analyzed with a automated system, and 24% with a manual procedure. The laboratory is open every day including Sunday, from 8:00 a.m. to 8:00 p.m. engaging two biologists and five laboratory technicians per day. Our project allowed to increase significantly the number of swabs tested in a day (from 100 in march 2020 to 4600 in march 2021), guaranteeing their reporting within 3 hours in emergency or 24 hours for routine and drive setting.Conclusions: The employ of automated, user friendly and with a guided interface instrument facilited the entire workflow, reducing the operator work and the reporting time. RT-PCR executed with a manual procedure need of a specific expertise to read the reaction products, but the shorter reporting time makes it useful for swabs made in emergency. However, the presence of the barcode reader and the connectivity with the management LIS facilitated the traceability of the samples for the entire diagnostic pathway and the minimization of human error. The implementation of our workflow has involved an important rationalization and optimization of the staff, while integration of new knowledge about SARSCOV-2 and optimal analytical performance of analyzers has allowed a modern management of the samples maximising the laboratory's test capacity for RT-PCR tests.