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1.
Rossijskij Psihiatriceskij Zurnal ; 2021(4):13-22, 2021.
Article in Russian | Scopus | ID: covidwho-1812196

ABSTRACT

In a comparative study the aim was to determine the age specificity of the symptomatic response to distress and the mechanisms of emotional regulation in physicians. The data of 203 psychiatric specialists aged 21 to 65 years was analyzed. Analysis of the age characteristics of stress response showed a special role in the formation of the symptomatic profile of stress response of a subjective assessment of the situation. For each of the identified age groups the factor structure of the mechanisms of emotional regulation is described and its universal characteristics are highlighted. © 2021, V. Serbsky National Medical Research Centre for Psychiatry and Narcology. All rights reserved.

2.
Eurasian Journal of Veterinary Sciences ; 38(1):050-058, 2022.
Article in English | CAB Abstracts | ID: covidwho-1780315

ABSTRACT

Aim: Declared as a pandemic by the World Health Organization on March 11, 2020, Covid-19 has raised significant psychological concerns and physical problems in humans. This study aimed to evaluate the relationship between the methods of coping with stress of the SUFVM students with socio-demographic characteristics, experiences during the Covid-19 pandemic process, and professional career concerns. Materials and Methods: The research sample consisted of 644 students from the 1st-5th grades who continued their education at SUFVM in the 2019-2020 academic year and agreed to participate in the research. The research was carried out by filling in the questionnaire form sent to the participants? mobile phones between 14-22 December 2020 voluntarily. The questionnaire consisted of four parts in total, which determined socio-demographic characteristics, professional career concerns, and experiences with Covid-19, and measuring the style of coping with stress.

3.
BMC Psychol ; 10(1): 87, 2022 Apr 04.
Article in English | MEDLINE | ID: covidwho-1775351

ABSTRACT

BACKGROUND: The sudden outbreak of COVID-19 had a great impact on the physical and mental health of people all over the world, especially for students whose physical and mental development was not yet mature. In order to understand the physical and mental conditions of students during the epidemic period and provide a theoretical basis for coping with psychological problems in public health emergencies, this study explored the mediating role of sleep disorders in the effect of the psychological stress response (PSR) on non-suicidal self-injury (NSSI), along with the moderating role of emotional management ability (EMA). METHODS: The SRQ-20, Pittsburgh Sleep Quality Index, NSSI Behavior Questionnaire, and Emotional Management Questionnaire were used to investigate the mental health of Chinese students in April 10-20 (Time point 1, T1) and May 20-30 (Time point 2, T2), 2020. A total of 1,955 students (Mage = 19.64 years, 51.4% male) were examined at T1 and 342 students (Mage = 20.06 years, 48.2% male) were reassessed at T2. RESULTS: Overall, the detection rate of PSR and NSSI were 17.60% (n = 344) and 24.90% (n = 486) respectively in the T1 sample, and were 16.37% (n = 56) and 25.44% (n = 87), in the T2 sample. We also found that sleep disorders played a mediating role in the effect of PSR on NSSI in the T1 and T2 samples. In addition, EMA was shown to regulate the effect of PSR on sleep disorders and the effect of sleep disorders on NSSI in the T1 samples. CONCLUSION: We found that PSR resulting from public health emergency might lead to NSSI behaviors in individuals. PSR may also cause sleep disorders, which can bring about NSSI. However, these effects were also moderated by the EMA. This research expands our understanding of PSR and NSSI in students during the pandemic.


Subject(s)
COVID-19 , Self-Injurious Behavior , Sleep Wake Disorders , COVID-19/epidemiology , China/epidemiology , Female , Humans , Male , Self-Injurious Behavior/epidemiology , Self-Injurious Behavior/etiology , Self-Injurious Behavior/psychology , Sleep Wake Disorders/epidemiology , Stress, Psychological/epidemiology , Students/psychology
4.
Microorganisms ; 10(3)2022 Mar 04.
Article in English | MEDLINE | ID: covidwho-1765793

ABSTRACT

Despite the widespread use of antiseptics such as chlorhexidine digluconate (CHX) in dental practice and oral care, the risks of potential resistance toward these antimicrobial compounds in oral bacteria have only been highlighted very recently. Since the molecular mechanisms behind antiseptic resistance or adaptation are not entirely clear and the bacterial stress response has not been investigated systematically so far, the aim of the present study was to investigate the transcriptomic stress response in Streptococcus mutans after treatment with CHX using RNA sequencing (RNA-seq). Planktonic cultures of stationary-phase S. mutans were treated with a sublethal dose of CHX (125 µg/mL) for 5 min. After treatment, RNA was extracted, and RNA-seq was performed on an Illumina NextSeq 500. Differentially expressed genes were analyzed and validated by qRT-PCR. Analysis of differential gene expression following pathway analysis revealed a considerable number of genes and pathways significantly up- or downregulated in S. mutans after sublethal treatment with CHX. In summary, the expression of 404 genes was upregulated, and that of 271 genes was downregulated after sublethal CHX treatment. Analysis of differentially expressed genes and significantly regulated pathways showed regulation of genes involved in purine nucleotide synthesis, biofilm formation, transport systems and stress responses. In conclusion, the results show a transcriptomic stress response in S. mutans upon exposure to CHX and offer insight into potential mechanisms that may result in development of resistances.

5.
MedEdPORTAL ; 18: 11224, 2022.
Article in English | MEDLINE | ID: covidwho-1761321

ABSTRACT

Introduction: Exposure to adverse childhood experiences (ACEs) can lead to a toxic stress response with impacts on health that affect health equity. As part of our Health Equity, Social Justice, and Anti-racism curriculum, our aim was to introduce second-year medical students to a case-based method using a template-based screening and application of toxic stress, buffering factors, and resiliency-fostering tools to address health disparities and inequities with a trauma-informed care approach. Methods: We developed an asynchronous e-learning module that demonstrated the impact of ACEs by introducing students to screening for toxic stress response and buffering factors on health, their role as health equity determinants, and the use of brief in-clinic resilience-fostering tools in patient care. This was followed by a synchronous, facilitated, small-group, virtual discussion of a clinical case. Pre- and postworkshop surveys assessed changes in knowledge, skills, and attitudes. A 3-month follow-up survey assessed students' behavioral changes. Results: Sixty-four students completed the learning module. Paired t-test analysis showed a statistically significant increase in students' knowledge, skills, and attitudes regarding the Educational Objectives, with a survey response rate of 98%. Three months after the workshop, a third of students were applying these concepts, with a survey response rate of 87%. Discussion: Implementing this case-based curriculum in trauma-informed patient care helped increase opportunities for equitable health in patient encounters by providing students with the skills to screen for toxic stress, buffering, and brief in-clinic resiliency-fostering tools. Such skills will become even more impactful as we emerge from the COVID-19 pandemic.


Subject(s)
COVID-19 , Health Equity , Students, Medical , COVID-19/diagnosis , COVID-19/epidemiology , Curriculum , Humans , Pandemics
6.
Psychiatr Q ; 93(1): 271-284, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1750792

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus that is causing the ongoing coronavirus disease 2019 (COVID-19) pandemic, was first reported in late 2019. Since then, an unprecedented amount of new knowledge has emerged about this virus and its treatment. Although the reported symptoms of COVID-19 are primarily respiratory with acute respiratory distress syndrome, SARS-CoV-2 has also been shown to affect other organs, including brain, and there are growing reports of neuropsychiatric symptoms due to COVID-19. There are two suggested pathways for how COVID-19 can affect the brain and mind: the direct impact on the brain and impact mediated via stress. Direct impact on the brain is manifested as encephalitis/encephalopathy with altered mental status (AMS) and delirium. In this paper, we summarize evidence from studies of previous outbreaks and current data from the COVID-19 pandemic that describe how COVID-19 is associated with an increased prevalence of anxiety, stress, poor sleep quality, obsessive-compulsive symptoms, and depression among the general population during the pandemic. In addition, we summarize the current evidence that supports how COVID-19 can also impact the CNS directly and result in delirium, cerebrovascular events, encephalitis, unspecified encephalopathy, AMS, or peripheral neurologic disorders.


Subject(s)
Brain Diseases , COVID-19 , Delirium , Encephalitis , Brain , Delirium/epidemiology , Humans , Pandemics , SARS-CoV-2
7.
Brain Behav Immun ; 87: 75-79, 2020 07.
Article in English | MEDLINE | ID: covidwho-1719340

ABSTRACT

The outbreak of COVID-19 is severely affecting mental health worldwide, although individual response may vary. This study aims to investigate the psychological distress perceived by the Italian general population during the early phase of the COVID-19 pandemic, and to analyze affective temperament and adult attachment styles as potential mediators. Through an online survey, we collected sociodemographic and lockdown-related information and evaluated distress, temperament, and attachment using the Kessler 10 Psychological Distress Scale (K10), the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire short version (TEMPS-A) and the Attachment Style Questionnaire (ASQ). In our sample (n = 500), 62% of the individuals reported no likelihood of psychological distress, whereas 19.4% and 18.6% displayed mild and moderate-to-severe likelihood. Cyclothymic (OR: 1.24; p < 0.001), depressive (OR: 1.52; p < 0.001) and anxious (OR: 1.58; p = 0.002) temperaments, and the ASQ "Need for approval" (OR: 1.08; p = 0.01) were risk factors for moderate-to-severe psychological distress compared to no distress, while the ASQ "Confidence" (OR: 0.89; p = 0.002) and "Discomfort with closeness" were protective (OR: 0.92; p = 0.001). Cyclothymic (OR: 1.17; p = 0.008) and depressive (OR: 1.32; p = 0.003) temperaments resulted as risk factors in subjects with moderate-to-severe psychological distress compared to mild distress, while the ASQ "Confidence" (OR: 0.92; p = 0.039) and "Discomfort with closeness" (OR: 0.94; p = 0.023) were protective. Our data indicated that a relevant rate of individuals may have experienced psychological distress following the COVID-19 outbreak. Specific affective temperament and attachment features predict the extent of mental health burden. To the best of our knowledge, these are the first data available on the psychological impact of the early phase of the COVID-19 pandemic on a sizeable sample of the Italian population. Moreover, our study is the first to investigate temperament and attachment characteristics in the psychological response to the ongoing pandemic. Our results provide further insight into developing targeted intervention strategies.


Subject(s)
Affect , Anxiety/psychology , Coronavirus Infections/epidemiology , Cyclothymic Disorder/psychology , Depression/psychology , Object Attachment , Pneumonia, Viral/epidemiology , Psychological Distress , Temperament , Adolescent , Adult , Betacoronavirus , COVID-19 , Disease Outbreaks , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , SARS-CoV-2 , Severity of Illness Index , Stress, Psychological/psychology , Young Adult
8.
J Proteome Res ; 21(3): 623-634, 2022 03 04.
Article in English | MEDLINE | ID: covidwho-1671479

ABSTRACT

Despite the scientific and human efforts to understand COVID-19, there are questions still unanswered. Variations in the metabolic reaction to SARS-CoV-2 infection could explain the striking differences in the susceptibility to infection and the risk of severe disease. Here, we used untargeted metabolomics to examine novel metabolic pathways related to SARS-CoV-2 susceptibility and COVID-19 clinical severity using capillary electrophoresis coupled to a time-of-flight mass spectrometer (CE-TOF-MS) in plasma samples. We included 27 patients with confirmed COVID-19 and 29 healthcare workers heavily exposed to SARS-CoV-2 but with low susceptibility to infection ("nonsusceptible"). We found a total of 42 metabolites of SARS-CoV-2 susceptibility or COVID-19 clinical severity. We report the discovery of new plasma biomarkers for COVID-19 that provide mechanistic explanations for the clinical consequences of SARS-CoV-2, including mitochondrial and liver dysfunction as a consequence of hypoxemia (citrulline, citric acid, and 3-aminoisobutyric acid (BAIBA)), energy production and amino acid catabolism (phenylalanine and histidine), and endothelial dysfunction and thrombosis (citrulline, asymmetric dimethylarginine (ADMA), and 2-aminobutyric acid (2-AB)), and we found interconnections between these pathways. In summary, in this first report several metabolic pathways implicated in SARS-CoV-2 susceptibility and COVID-19 clinical progression were found by CE-MS based metabolomics that could be developed as biomarkers of COVID-19.


Subject(s)
COVID-19 , SARS-CoV-2 , Biomarkers , Humans , Metabolome , Metabolomics/methods
9.
Shinrigaku Kenkyu ; 92(5):408-416, 2021.
Article in Japanese | Scopus | ID: covidwho-1662761

ABSTRACT

This study was conducted to investigate the relationship between stress responses and the lifestyle habit changes of elementary school students during a temporary leave of absence from school during measures to prevent the spread of COVID-19 infections. We surveyed 637 parents of elementary school students about their lifestyle habit changes and stress responses during their temporary leave and finally analyzed 510 subjects. Variance analysis, showed that there were significant differences in “irregular sleep,” “disordered eating habits,” and “increased use of games and smartphones,” but the effect size was small. When the correlation was calculated, “disordered eating habits” was associated with all stress responses, and six lifestyle-related changes were associated with lethargy. © 2021 Japanese Psychological Association. All rights reserved.

10.
"Lucrari Stiintifice Medicina Veterinara, Universitatea de Stiinte Agricole si Medicina Veterinara ""Ion Ionescu de la Brad"" Iasi" ; 64(2):41-43, 2021.
Article in English | CAB Abstracts | ID: covidwho-1652085

ABSTRACT

The study was conducted over a period of 2 months, between March and May 2020, in collaboration with 3 private clinics in Moldova region on 23 dogs of different breeds, sex and ages, paraclinically examined by hematological and biochemical tests. The inclusion criterion in the study was the ownership of all subjects by elderly persons affected.by COVID 19 limitations during the emergency state in Romania. The study aimed to establish the correlation between the limited walking time in dogs and the level of stress induced by it. Each subject underwent 2 paraclinical check-ups in term of hematological testing and cortisol dosage at the end of March and beginning of May. Also, a control group of 13 dogs owned by active people was examined in a similar manner, both at the beginning of the experiment and also at the end of it. Compared with the initial values which were highly elevated (10,89..1,66 g/dl) in all dogs owned by elderly people, the second testing revealed values comparable to normal, but still increased (4,85..1,22 g/dl). The study demonstrates the impact of COVID 19 limitations in terms of outdoor time for dogs which produced transitional changes in cortisol levels, but also the adaptive compensatory mechanisms used to cope with modified environmental conditions.

11.
Intensive Care Med Exp ; 9(1): 63, 2021 Dec 29.
Article in English | MEDLINE | ID: covidwho-1591604

ABSTRACT

In critically ill patients with sepsis, there is a grave lack of effective treatment options to address the illness-defining inappropriate host response. Currently, treatment is limited to source control and supportive care, albeit with imminent approval of immune modulating drugs for COVID-19-associated lung failure the potential of host-directed strategies appears on the horizon. We suggest expanding the concept of sepsis by incorporating infectious stress within the general stress response of the cell to define sepsis as an illness state characterized by allostatic overload and failing adaptive responses along with biotic (pathogen) and abiotic (e.g., malnutrition) environmental stress factors. This would allow conceptualizing the failing organismic responses to pathogens in sepsis with an ancient response pattern depending on the energy state of cells and organs towards other environmental stressors in general. Hence, the present review aims to decipher the heuristic value of a biological definition of sepsis as a failing stress response. These considerations may motivate a better understanding of the processes underlying "host defense failure" on the organismic, organ, cell and molecular levels.

12.
Blood ; 138:3733, 2021.
Article in English | EMBASE | ID: covidwho-1582385

ABSTRACT

Introduction Coronavirus disease 2019 (COVID-19) is a life-threatening condition of high relevance for co-morbid patients, such as those with baseline hematological malignancies (HM). One year after the diagnosis of the first COVID-19 case, at the end of 2020, the first vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were administered to the population, starting with individuals at highest risk of infection. EPICOVIDEHA aims to describe the epidemiology, vaccination strategies and mortality rates from HM patients at risk. Methods We collected clinical and epidemiological data from patients with laboratory-based diagnosis of SARS-CoV-2 infection after partial or complete vaccination. The study was sponsored by the European Hematology Association - Infectious Diseases Working Party. Patients were registered in the EPICOVIDEHA online survey between January 1, 2021 and July 31, 2021 from Europe and United States. Data captured included underlying conditions prior to SARS-CoV-2, HM status and management prior to SARS-CoV-2, SARS-CoV-2 vaccination and infection details and mortality. The survey will continue until December 31, 2021. Results Overall, 40 patients have been so far registered, 24 male and 16 females, the vast majority of them aged over 50 years (N=38, 95%). Three quarters of patients were affected by lymphoproliferative malignancies (chronic lymphoid leukemia [CLL] N=14 and non-Hodgkin lymphoma [NHL] and multiple myeloma [MM] N=8, each), followed by myelodysplastic syndrome (MDS) (N=4), acute myeloid leukemia (AML) (N=2) and others (chronic myeloid leukemia [CML], acute lymphoid leukemia [ALL], polycythemia vera [PV] and aggressive mastocytosis one of each). Thirty-one patients (77.5%) were receiving active treatment for underlying HM at the time of SARS-CoV-2 infection, with 16 of them being on chemotherapy in the month prior to infection. All patients were vaccinated with a median time from vaccine to SARS-CoV-2 infection of 45.5 days (IRQ 19-67.5). Twenty-nine patients received a mRNA vaccine (BioNTech/Pfizer N=28, Moderna COVE N=1), whereas the remaining 11 an inactivated vaccine (Sinovac CoronaVac N=6) and vector-based vaccine (AstraZeneca Oxford N=5). Twenty-three patients were completely vaccinated, of which 22 (97.5%) patients were immunized (a minimum of 15 days following second dose). On the contrary, among 17 patients partially vaccinated, none was immunized. In 9 cases, viral genomes were analyzed (English variant N=7, South Africa variant N=1, Indian variant N=1). Overall, 25/40 patients presented with a severe/critical infection (62.5%), 13 of which (52%) were fully vaccinated and immunized, whereas only 15 (37.5%) were asymptomatic or mildly symptomatic. Twenty-seven (92.5%) patients were admitted to hospital, 5/27 (18.5%) to ICU, all requiring mechanical ventilation. After a follow-up of 30 day from SARS-CoV-2 infection, 8 patients died (20%), with 7/8 deaths (87.5%) attributable to SARS-CoV-2. There was no difference in overall survival between those patients that received 2 doses of vaccine or 1 dose (figure 1a), as well as no difference being observed between patients with and without lymphoproliferative malignancies (figure 1b), patients that receiving/not receiving active treatment in the last month (figure 1c), or the type of vaccine injected (figure 1d). Conclusions Our survey, involving over 150 Hematology Departments around the world, provides some preliminary insights. The majority of patients who do not respond to vaccination are patients with lymphoproliferative diseases, as can also be observed for other types of vaccination (e.g., flu-vaccination). Dramatically the mortality observed in all patients, although lower than that observed in the pre-vaccination period which in our experience was around 31%, still remains high (20%). Recruitment to this survey continues, and we hope that with larger numbers of cases, more definitive conclusions can be drawn to develop strategies to keep these complex patients safe. [Formula presented] Disclosures: Lop z-Garcia: Celgene: Other: Speaker Honoraria;Abbvie: Other: Speaker Honoraria, Advisor, Travel and accommodation grants;Janssen: Other: Speaker Honoraria, Advisor, Travel and accommodation grants, Research Funding;Roche: Other: Speaker Honoraria, Travel and accommodation grants;Novonordisk: Other: Speaker Honoraria;Fresenius: Other: Speaker Honoraria. Glenthoej: Novo Nordisk: Honoraria;Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees;Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees;bluebird bio: Consultancy, Membership on an entity's Board of Directors or advisory committees;Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees;Alexion: Research Funding. Mikulska: Biotest: Speakers Bureau;Janssen: Speakers Bureau;MSD: Speakers Bureau;Gilead: Speakers Bureau;Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Busca: Gilead Sciences: Other: Lecture Honoraria;Merck: Other: Lecture Honoraria;Pfizer Pharmaceuticals: Other: Lecture Honoraria;Basilea: Other: Lecture Honoraria;Biotest: Other: Lecture Honoraria;Jazz Pharmaceuticals: Other: Lecture Honoraria;Takeda: Membership on an entity's Board of Directors or advisory committees. Corradini: KiowaKirin;Incyte;Daiichi Sankyo;Janssen;F. Hoffman-La Roche;Kite;Servier: Consultancy;AbbVie, ADC Theraputics, Amgen, Celgene, Daiichi Sankyo, Gilead/Kite, GSK, Incyte, Janssen, KyowaKirin, Nerviano Medical Science, Novartis, Roche, Sanofi, Takeda: Honoraria;AbbVie, ADC Theraputics, Amgen, Celgene, Daiichi Sankyo, Gilead/Kite, GSK, Incyte, Janssen, KyowaKirin, Nerviano Medical Science, Novartis, Roche, Sanofi, Takeda: Consultancy;Amgen;Takeda;AbbVie: Consultancy, Honoraria, Other: Travel and accommodations;Novartis;Gilead;Celgene: Consultancy, Other: Travel and accommodations;BMS: Other: Travel and accommodation;Sanofi: Consultancy, Honoraria;Incyte: Consultancy;Novartis, Janssen, Celgene, BMS, Takeda, Gilead/Kite, Amgen, AbbVie: Other: travel and accomodations. Hoenigl: Gilead, Pfizer, Astellas, Scynexis, and NIH: Research Funding. Klimko: Gilead Science, MSD, Pfizer: Membership on an entity's Board of Directors or advisory committees;Gilead Sciences, MSD, Pfizer Pharmaceuticals, and Astellas Pharma: Speakers Bureau. Pagliuca: Gentium/Jazz Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Gilead, Pfizer, and MSD: Research Funding. Passamonti: Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;AbbVie: Speakers Bureau;BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau;Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Köhler: German Federal Ministry of Research and Education and the State of North Rhine-Westphalia, Germany: Other: Support;Miltenyi Biotec GmbH, Bergisch Gladbach, Germany, and the Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany: Other: Non-financial grants;Akademie für Infektionsmedizin e.V., Ambu GmbH, Astellas Pharma, European Confederation of Medical Mycology, Gilead Sciences, GPR Academy Ruesselsheim, MSD Sharp & Dohme GmbH, Noxxon N.V., and University Hospital, LMU Munich: Consultancy, Honoraria. Cornely: Amplyx, Basilea, BMBF, Cidara, DZIF, EU-DG RTD (101037867), F2G, Gilead, Matinas, MedPace, MSD, Mundipharma, Octapharma, Pfizer, Scynexis: Other: Grants or Contracts. Pagano: Gilead Science, MSD, Pfizer, Basilea, Janssen, Novartis, Jazz Pharmaceutical, Cidara: Membership on an entity's Board of Directors or advisory committees;Gilead Sciences, MSD, Pfizer Pharmaceuticals, Astellas Pharma: Speakers Bureau;Menarini: Consultancy.

13.
Crit Care ; 25(1): 424, 2021 12 14.
Article in English | MEDLINE | ID: covidwho-1577182

ABSTRACT

The preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose enteral nutrition can be safely started within 48 h after admission, even during treatment with small or moderate doses of vasopressor agents. A percutaneous access should be used when enteral nutrition is anticipated for ≥ 4 weeks. Energy delivery should not be calculated to match energy expenditure before day 4-7, and the use of energy-dense formulas can be restricted to cases of inability to tolerate full-volume isocaloric enteral nutrition or to patients who require fluid restriction. Low-dose protein (max 0.8 g/kg/day) can be provided during the early phase of critical illness, while a protein target of > 1.2 g/kg/day could be considered during the rehabilitation phase. The occurrence of refeeding syndrome should be assessed by daily measurement of plasma phosphate, and a phosphate drop of 30% should be managed by reduction of enteral feeding rate and high-dose thiamine. Vomiting and increased gastric residual volume may indicate gastric intolerance, while sudden abdominal pain, distension, gastrointestinal paralysis, or rising abdominal pressure may indicate lower gastrointestinal intolerance.


Subject(s)
Enteral Nutrition , Intensive Care Units , Critical Illness , Food, Formulated , Humans , Residual Volume
14.
Eur J Psychotraumatol ; 12(1): 1968141, 2021.
Article in English | MEDLINE | ID: covidwho-1475710

ABSTRACT

The no-visitor policies endorsed by healthcare organizations to limit COVID-19 virus risk exposure have unfortunately contributed to the isolation of patients further exacerbating distress in relatives and frontline healthcare workers. To contrast such effects, many healthcare institutions have adopted technology-based solutions helping patients and families communicate online through the aid of virtual devices. To date, no study has investigated whether facilitating patient-family videocalls would mitigate distress levels in frontline healthcare professionals. Caring for emotional needs of patients by re-establishing affiliative connections interrupted by the pandemic through patient-family videocalls is expected to mitigate distress in engaged healthcare workers as an example of a tend-and-befriend response to stress caused by the pandemic. We tested this hypothesis in a cross-sectional study conducted during 1-30 June 2020, involving 209 healthcare workers (nurses = 146; physicians = 63) engaged in the COVID-19 frontline in Italy. Half of participants in our sample (n = 107) had assisted efforts aimed at connecting patients remotely with families through videocalls. Psychological distress measures included symptoms of burnout, post-traumatic stress, anxiety, depression, and difficulty in sleep and wakefulness. Partially in line with our expectations we found a modulation effect specific for professional category: nurses assisting patient-family videocalls reported significantly lower levels of distress and a better quality of wakefulness compared to those who did not, whereas physicians reported higher levels of distress during such virtual communications. We interpret these findings from the perspective of patient-family communication and differences in skills and training between nurses and physicians. These findings highlight that technology-based solutions aimed at reducing barriers and alleviating distress in healthcare settings should be promoted in concert with skill enhancement training for healthcare professionals especially in terms of communicating online and communicating difficult topics with patients and families.


La política de no recibir visitas que ha sido legitimada por organizaciones de atención de salud para limitar el riesgo de la exposición al virus COVID-19 ha contribuido en forma desafortunada al aislamiento de los pacientes, lo que aumenta el malestar/angustia en familiares y en trabajadores de salud de la primera línea. Para contrastar tales efectos, muchas instituciones de salud han adoptado soluciones basadas en la tecnología para ayudar a pacientes y familiares a comunicarse en línea a través de la ayuda de dispositivos virtuales. Hasta la fecha, ningún estudio ha investigado si es que la facilitación de video llamadas paciente-familiares pudiese mitigar el nivel de angustia en profesionales de salud de primera línea. Se espera que el cuidado de las necesidades emocionales de los pacientes mediante el restablecimiento de conexiones afilativas interrumpidas por la pandemia a través de video llamadas entre el paciente y la familia ayude a mitigar la angustia en los trabajadores de la salud como un ejemplo de una respuesta de "cuidar y hacer amigos" a la angustia causada por la pandemia. Probamos esta hipótesis en un estudio transversal realizado entre el 01 y el 30 de junio del 2020, en la que participaron 209 trabajadores de la salud (enfermeras=146; médicos=63) involucrados en la atención de la primera línea del COVID-19 en Italia. La mitad de los participantes en nuestra muestra (n=107) habían asistido a esfuerzos destinados a conectar a los pacientes en forma remota con sus familias a través de video-llamadas. Las medidas de angustia psicológica incluyeron síntomas de burnout, estrés postraumático, ansiedad, depresión, dificultad para dormir y estar despiertos. Parcialmente en línea con nuestras expectativas, encontramos un efecto modulador específico para la categoría profesional: Las enfermeras que asistían las video llamadas de los pacientes con sus familias reportaron significativamente menor nivel de angustia y una mejor calidad de vigilia en comparación con las que no lo hicieron, mientras los médicos reportaron mayores niveles de angustia durante tales comunicaciones virtuales. Interpretamos estos hallazgos desde la perspectiva de la comunicación paciente-familia y las diferencias en las habilidades y formación entre las enfermeras y los médicos. Estos hallazgos destacan que las soluciones basadas en la tecnología destinadas a reducir las barreras y aliviar la angustia en los entornos de atención de salud deben promoverse junto con la capacitación para la mejora de habilidades para profesionales de la salud especialmente en términos de comunicarse en línea y comunicar temáticas difíciles a pacientes y familiares.


Subject(s)
COVID-19/therapy , Family/psychology , Health Personnel/psychology , Inpatients/psychology , Psychological Distress , Videoconferencing/instrumentation , Adult , Cross-Sectional Studies , Female , Hospitals , Humans , Italy , Male , Middle Aged , Quarantine , Technology
15.
IUBMB Life ; 74(1): 93-100, 2022 01.
Article in English | MEDLINE | ID: covidwho-1353459

ABSTRACT

Unfolded protein response (UPR) and endoplasmic reticulum (ER) stress are aspects of SARS-CoV-2-host cell interaction with proposed role in the cytopathic and inflammatory pathogenesis of this viral infection. The role of the NF-kB pathway in these cellular processes remains poorly characterized. When investigated in VERO-E6 cells, SARS-CoV-2 infection was found to markedly stimulate NF-kB protein expression and activity. NF-kB activation occurs early in the infection process (6 hpi) and it is associated with increased MAPK signaling and expression of the UPR inducer IRE-1α. These signal transduction processes characterize the cellular stress response to the virus promoting a pro-inflammatory environment and caspase activation in the host cell. Inhibition of viral replication by the viral protease inhibitor Nelfinavir reverts all these molecular changes also stimulating c-Jun expression, a key component of the JNK/AP-1 pathway with important role in the IRE-1α-mediated transcriptional regulation of stress response genes with anti-inflammatory and cytoprotection function. The present study demonstrates that UPR signaling and its interaction with cellular MAPKs and the NF-kB activity are important aspects of SARS-CoV-2-host cell interaction that deserve further investigation to identify more efficient therapies for this viral infection.


Subject(s)
Antiviral Agents/pharmacology , COVID-19/drug therapy , COVID-19/metabolism , Endoplasmic Reticulum Stress/drug effects , NF-kappa B/metabolism , SARS-CoV-2 , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/pharmacology , Alanine/analogs & derivatives , Alanine/pharmacology , Animals , COVID-19/virology , Caspase 9/metabolism , Chlorocebus aethiops , Cytopathogenic Effect, Viral/drug effects , Humans , MAP Kinase Signaling System/drug effects , Models, Biological , Nelfinavir/pharmacology , SARS-CoV-2/drug effects , SARS-CoV-2/pathogenicity , Unfolded Protein Response/drug effects , Vero Cells
16.
Int J Mol Sci ; 22(11)2021 May 26.
Article in English | MEDLINE | ID: covidwho-1244042

ABSTRACT

Infection induces the production of proinflammatory cytokines and chemokines such as interleukin-8 (IL-8) and IL-6. Although they facilitate local antiviral immunity, their excessive release leads to life-threatening cytokine release syndrome, exemplified by the severe cases of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this study, we investigated the roles of the integrated stress response (ISR) and activator protein-1 (AP-1) family proteins in regulating coronavirus-induced IL-8 and IL-6 upregulation. The mRNA expression of IL-8 and IL-6 was significantly induced in cells infected with infectious bronchitis virus (IBV), a gammacoronavirus, and porcine epidemic diarrhea virus, an alphacoronavirus. Overexpression of a constitutively active phosphomimetic mutant of eukaryotic translation initiation factor 2α (eIF2α), chemical inhibition of its dephosphorylation, or overexpression of its upstream double-stranded RNA-dependent protein kinase (PKR) significantly enhanced IL-8 mRNA expression in IBV-infected cells. Overexpression of the AP-1 protein cJUN or its upstream kinase also increased the IBV-induced IL-8 mRNA expression, which was synergistically enhanced by overexpression of cFOS. Taken together, this study demonstrated the important regulatory roles of ISR and AP-1 proteins in IL-8 production during coronavirus infection, highlighting the complex interactions between cellular stress pathways and the innate immune response.


Subject(s)
Coronavirus Infections/metabolism , Endoplasmic Reticulum Stress/genetics , Eukaryotic Initiation Factor-2/metabolism , Interleukin-8/metabolism , Unfolded Protein Response/genetics , Alphacoronavirus/metabolism , Alphacoronavirus/pathogenicity , Animals , Cell Line , Chlorocebus aethiops , Coronavirus Infections/genetics , Gammacoronavirus/metabolism , Gammacoronavirus/pathogenicity , Gene Expression Regulation , Humans , Immunity, Innate , Infectious bronchitis virus/metabolism , Infectious bronchitis virus/pathogenicity , Interleukin-8/genetics , Phosphorylation , Porcine epidemic diarrhea virus/metabolism , Porcine epidemic diarrhea virus/pathogenicity , Proto-Oncogene Proteins c-fos/genetics , Proto-Oncogene Proteins c-fos/metabolism , Proto-Oncogene Proteins c-jun/genetics , Proto-Oncogene Proteins c-jun/metabolism , Signal Transduction/genetics , Transcription Factor AP-1/genetics , Transcription Factor AP-1/metabolism , Up-Regulation , Vero Cells , eIF-2 Kinase/genetics , eIF-2 Kinase/metabolism
17.
Front Cell Infect Microbiol ; 11: 668034, 2021.
Article in English | MEDLINE | ID: covidwho-1231324

ABSTRACT

The ability to sense and adequately respond to variable environmental conditions is central for cellular and organismal homeostasis. Eukaryotic cells are equipped with highly conserved stress-response mechanisms that support cellular function when homeostasis is compromised, promoting survival. Two such mechanisms - the unfolded protein response (UPR) and autophagy - are involved in the cellular response to perturbations in the endoplasmic reticulum, in calcium homeostasis, in cellular energy or redox status. Each of them operates through conserved signaling pathways to promote cellular adaptations that include re-programming transcription of genes and translation of new proteins and degradation of cellular components. In addition to their specific functions, it is becoming increasingly clear that these pathways intersect in many ways in different contexts of cellular stress. Viral infections are a major cause of cellular stress as many cellular functions are coopted to support viral replication. Both UPR and autophagy are induced upon infection with many different viruses with varying outcomes - in some instances controlling infection while in others supporting viral replication and infection. The role of UPR and autophagy in response to coronavirus infection has been a matter of debate in the last decade. It has been suggested that CoV exploit components of autophagy machinery and UPR to generate double-membrane vesicles where it establishes its replicative niche and to control the balance between cell death and survival during infection. Even though the molecular mechanisms are not fully elucidated, it is clear that UPR and autophagy are intimately associated during CoV infections. The current SARS-CoV-2 pandemic has brought renewed interest to this topic as several drugs known to modulate autophagy - including chloroquine, niclosamide, valinomycin, and spermine - were proposed as therapeutic options. Their efficacy is still debatable, highlighting the need to better understand the molecular interactions between CoV, UPR and autophagy.


Subject(s)
COVID-19 , Autophagy , Endoplasmic Reticulum/metabolism , Endoplasmic Reticulum Stress , Humans , SARS-CoV-2 , Unfolded Protein Response
18.
Int J Mol Sci ; 22(8)2021 Apr 15.
Article in English | MEDLINE | ID: covidwho-1196033

ABSTRACT

Amyloidoses are a group of diseases associated with the formation of pathological protein fibrils with cross-ß structures. Approximately 5-10% of the cases of these diseases are determined by amyloidogenic mutations, as well as by transmission of infectious amyloids (prions) between organisms. The most common group of so-called sporadic amyloidoses is associated with abnormal aggregation of wild-type proteins. Some sporadic amyloidoses are known to be induced only against the background of certain pathologies, but in some cases the cause of amyloidosis is unclear. It is assumed that these diseases often occur by accident. Here we present facts and hypotheses about the association of sporadic amyloidoses with vascular pathologies, trauma, oxidative stress, cancer, metabolic diseases, chronic infections and COVID-19. Generalization of current data shows that all sporadic amyloidoses can be regarded as a secondary event occurring against the background of diseases provoking a cellular stress response. Various factors causing the stress response provoke protein overproduction, a local increase in the concentration or modifications, which contributes to amyloidogenesis. Progress in the treatment of vascular, metabolic and infectious diseases, as well as cancers, should lead to a significant reduction in the risk of sporadic amyloidoses.


Subject(s)
Amyloidosis/etiology , Stress, Physiological , Brain Injuries/complications , Communicable Diseases/complications , Humans , Metabolic Diseases/complications , Neoplasms/complications , Oxidative Stress , Vascular Diseases/complications
19.
Cell ; 184(8): 1990-2019, 2021 04 15.
Article in English | MEDLINE | ID: covidwho-1163481

ABSTRACT

The population is aging at a rate never seen before in human history. As the number of elderly adults grows, it is imperative we expand our understanding of the underpinnings of aging biology. Human lungs are composed of a unique panoply of cell types that face ongoing chemical, mechanical, biological, immunological, and xenobiotic stress over a lifetime. Yet, we do not fully appreciate the mechanistic drivers of lung aging and why age increases the risk of parenchymal lung disease, fatal respiratory infection, and primary lung cancer. Here, we review the molecular and cellular aspects of lung aging, local stress response pathways, and how the aging process predisposes to the pathogenesis of pulmonary disease. We place these insights into context of the COVID-19 pandemic and discuss how innate and adaptive immunity within the lung is altered with age.


Subject(s)
Aging , Cellular Senescence , Lung Diseases , Lung , Adaptive Immunity , Aged , Aging/immunology , Aging/pathology , COVID-19/immunology , COVID-19/pathology , Humans , Lung/immunology , Lung/pathology , Lung Diseases/immunology , Lung Diseases/pathology , Oxidative Stress
20.
Cell Mol Immunol ; 18(3): 539-555, 2021 03.
Article in English | MEDLINE | ID: covidwho-1065857

ABSTRACT

Retinoic acid-inducible gene I (RIG-I)-like receptors (RLRs) are RNA sensor molecules that play essential roles in innate antiviral immunity. Among the three RLRs encoded by the human genome, RIG-I and melanoma differentiation-associated gene 5, which contain N-terminal caspase recruitment domains, are activated upon the detection of viral RNAs in the cytoplasm of virus-infected cells. Activated RLRs induce downstream signaling via their interactions with mitochondrial antiviral signaling proteins and activate the production of type I and III interferons and inflammatory cytokines. Recent studies have shown that RLR-mediated signaling is regulated by interactions with endogenous RNAs and host proteins, such as those involved in stress responses and posttranslational modifications. Since RLR-mediated cytokine production is also involved in the regulation of acquired immunity, the deregulation of RLR-mediated signaling is associated with autoimmune and autoinflammatory disorders. Moreover, RLR-mediated signaling might be involved in the aberrant cytokine production observed in coronavirus disease 2019. Since the discovery of RLRs in 2004, significant progress has been made in understanding the mechanisms underlying the activation and regulation of RLR-mediated signaling pathways. Here, we review the recent advances in the understanding of regulated RNA recognition and signal activation by RLRs, focusing on the interactions between various host and viral factors.


Subject(s)
DEAD Box Protein 58/immunology , Mitochondria/immunology , Receptors, Immunologic/immunology , Signal Transduction , Virus Diseases/immunology , Viruses/immunology , Animals , Humans , Immunologic Factors , Interferon Type I/immunology , Interferons/immunology
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