The evolution of educational events during the COVID-19 pandemic: the experience of G.Re.TA Foundation

Introduction The educational and professional life of everyone have been affected significantly by the COVID -19 pandemic. Many courses and meetings traditionally structured and organized as face-to-face events have been transformed in virtual events. Methods We report on the experience of G.Re.T.A. Fondazione in organizing international conferences, webinars and masterclasses on oncoplastic and aesthetic breast surgery before, during and after the pandemic. Results The organization of the meetings as online or hybrid events allowed to maintain a high number of participants with numbers being in line with those achieved in the traditional face-to-face events or even showing an increased number of participants, in particular from Countries not traditionally involved as Saudi Arabia, United Arab Emirates, India and Russian Federation. Discussion We think that the hybrid modality is likely to become a gold standard, even though purely online meetings will still survive in the post-pandemic era. Webinars are frugal and highly efficient events that can easily reach a worldwide audience with acceptable interaction.

Use of Psychotropics in COVID-19: Another Anti-inflammatory Pathway

The emergence of the novel coronavirus SARS-CoV-2 has significantly impacted the world's population, disrupting healthcare systems around the globe and leading to human and material losses. While different vaccines have been approved in record time, there continues to be a high number of daily new cases, and patients face a wide range of presentations of the disease, from asymptomatic to potentially fatal. Therefore, the search for therapeutic agents that can aid in the management and control of the disease has become one of the main goals for researchers and clinicians. As an inflammatory disease, targets for the treatment of COVID-19 have largely involved the immune system. Inflammation has also been associated with mental health disorders, and studies have shown the potential involvement of inflammatory pathways in the pathophysiology of depression. As a consequence, the hypothesis of using antidepressants and other psychotropics for the treatment of COVID-19 has emerged. In this review, we aim to summarize the molecular pathways that could be involved as well as the emergent evidence that has been reported by studies performed since the appearance of SARS-CoV-2 in 2019. While it has been observed that there are potential therapeutic pathways for the use of antidepressants in the treatment of COVID-19, additional studies are needed to evaluate the feasibility, safety, and efficacy of psychotropics in this disease.Copyright © 2023 Bentham Science Publishers.

Intradialityc hypotension in intermittent and prolonged Kidney Replacement Therapies in patients with acute respiratory distress syndrome due to COVID-19

Background: Intradialytic hypotension (IH) is a relatively common complication in patients with acute kidney injury (AKI) who undergoes Kidney Replacement Therapy (KRT) and it could be the potential factor for non-recovery due to ischemic events. It is known that high ultrafiltration rate (UFR) is associated with worse outcomes, a recent recommendation to limit UFR to less than 13 ml/hr/kg has been widely accepted among nephrologists. Continuous kidney replacement therapy (CKRT) is the modality of choice in critically ill patients with hemodynamic instability;however, during COVID 19 pandemic a shortage of resources was evident and other modalities such as sustained low-efficiency dialysis was used in this population. As of today, there is not a universally accepted definition of IH, accordingly a safe UFR goal in critically ill patients it is still unknown in the different KRT modalities. The aim of this study was to analyze the differences in demographical, clinical and KRT prescriptions among critically ill patients with AKI related COVID-19 who developed intradialytic hypotension. Method(s): A prospective, observational, single-center study was performed between April 2020 and December 2021. Critically ill patients with COVID-19 and AKI who required KRT were included. Blood and dialysate flow rates, dialysate temperature, dialysate sodium, bicarbonate and potassium prescriptions were recorded. Body weight and height were obtained from the medical records. Body mass index (BMI) were calculated and interpretated according to WHO recommendations. Ideal body weight (IBW) was calculated using Hamwi equations. Intradialytic hypotension was defined as KDOQI;drop in SBP >= 20mmHg drop in SBP or > 10mmHg in MAP. Result(s): Two hundred sixty-three patients were included in the study, the majority were male, the average age was 60 years and a third of the population was diabetic. A total of 1,942 sessions were prescribed (289 hemodiafiltration (HDF), 1,455 intermittent hemodialysis (IHD), 198 prolonged intermittent renal replacement therapy (PIRRT)). Development of hypotension were reported in 1,059 sessions (55%). No differences between all modalities of KRT were observed HDF 15% vs 15%, IHD 74% vs 76% and PIRRT 11% vs 9% respectively for hypotension or non-hypotension groups (p = 0.27). Differences were statistically significant for sex (p=<0.001), age (p=0.054), UFR prescription (p=<0.001), norepinephrine use (p=<0.001) and dialysate bicarbonate (p=0.001). Age, gender male, and norepinephrine doses were independently associated with the development of hypotension in multivariate logistic regression. Linear regression for norepinephrine and development of hypotension beta0.61 (95% CI 0.38-0.85, p<0.001). Conclusion(s): In our study, the prevalence of intradialytic hypotension was greater than reported in literature probably associated with an exaggerated inflammatory response and need for mechanical ventilation. KRT modality and UFR were not associated with development IDH, however the main risk factor associated was norepinephrine initial dose. Further prospective studies are needed for assessment of a safe ultrafiltration rate in critically-ill patients.

Yoga and Mantram for Veterans with Chronic Pain and PTSD

Methods: In this RCT, 32 veterans were randomized to either Yoga+MR or a manualized relaxation control intervention. Due to the COVID-19 pandemic, in-person recruitment, assessments, and intervention attendance were re-evaluated. Although remote delivery of aspects of the study were utilized, interventions were delivered in-person. Feasibility benchmarks met included full recruitment in 12 months or less, 75%+ retention at initial follow-up assessment, 50%+ attendance rate, and 75%+ of participants satisfied with the interventions. Results: Participant recruitment took approximately 11 months instead of the 6-8 months that was targeted. Out of 32 participants initially randomized, 2 participants (6%) asked to be dropped from the study. For the remaining 30 participants, retention rates were 87% for the 12-week postintervention follow-up, and 80% for the 18-week follow-up. Participants attended 68% of in-person yoga and 54% of inperson relaxation sessions (p = 0.23). Yoga participants were significantly older than relaxation participants (55 vs 39 years respectively;p = 0.003). Satisfaction was high, with 83% of yoga participants and 85% of relaxation participants agreeing or strongly agreeing they were satisfied with the intervention/ instructors. Many participants greatly appreciated the ability to attend in-person sessions during the pandemic. Younger participants in the relaxation arm may have contributed to lower attendance. Health outcomes data are being analyzed. Background: Veterans with PTSD are more likely to report chronic pain than veterans without PTSD. Yoga has been shown to reduce both chronic pain and PTSD symptoms in various studies. The goal of our study was to assess the feasibility of conducting an RCT that combined yoga and mantram repetition (Yoga+MR) into one program for military veterans with both chronic pain and PTSD. Conclusion: Amidst numerous research challenges during the pandemic, study results indicate that it is feasible for the investigators to conduct a larger RCT at VA San Diego.

Connecting cancer research and communities: Assessing barriers and facilitators to the implementation of a community scientist program

Introduction: Community Scientist (CS) programs - often referred to as Citizen Scientist programs - that facilitate direct engagement between scientific researchers and community members have emerged as effective strategies for building community trust in scientists and better informing research design and dissemination to address true community needs. While population health research has increasingly incorporated community stakeholders into the research continuum, basic and translational sciences struggle to do the same and may contribute to cancer disparities. We designed and implemented a virtual CS program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University (LCC). We report barriers, facilitators, and lessons learned. Methods: Translational scientists (TSs) were recruited from among LCC investigators, and CSs were identified for participation from among LCC community networks. We sought to recruit a CS cohort representing LCC's catchment area and a TS cohort whose research focuses on cancers most impacting LCC catchment. CS program interactions included monthly meetings between two CSs and one TS wherein the CS-TS triad discuss TS research in lay terms and work together to co-create educational infographics suitable for dissemination to the catchment and LCC scientists. Virtual attendance was tracked and meeting recordings retroactively reviewed to identify and create product development. Results: Six CSs and three TSs agreed to participate in the CS program. The CS cohort includes cancer survivors, patient advocates, community organization leaders, a nurse, and an educator, while the TS cohort includes breast, prostate, and lung cancer researchers. Currently, 11 of 18 triad meetings have been completed, with attendance averaging 97%. Barriers to program implementation have included technological difficulties, restrictions on in-person meeting, scheduling conflicts, time limitation, and language barriers, while facilitators have included small group meetings to promote comfortable group-member contribution, presence of a trained facilitator, articulation of achievable meeting goals and mission for product creation, and clear assignment of team roles. Conclusion: The COVID-19 pandemic has illuminated pre-existing needs for improved connectivity between communities impacted by cancer disparities and cancer researchers. By identifying current barriers and facilitators to successful virtual CS program implementation, our findings can be used to guide development and implementation of similar programs at LCC and other cancer centers that are aimed at mitigating cancer health disparities.

[Pathogenic mechanisms of SARS-CoV-2 infection and kidney disease: a clinical and molecular perspective].

The SARS-CoV-2 infection has become as a worldwide public health emergency. It exhibits a variety of clinical presentations, ranging from benign to acute respiratory distress syndrome, systemic involvement, and multiorganic failure. The severity of the clinical picture depends on host and virus biological features and the presence of comorbidities such as chronic kidney disease. In addition, the interaction between the virus, angiotensin-converting enzyme 2, and the exacerbated immune response could lead to the development of acute kidney injury. However, the implications of SARS-CoV-2 infection on renal cells, the prognosis of patients with chronic kidney disease, and the long-term behavior of renal function are not entirely understood. This review aims to explore the role of SARS-CoV-2 in acute and chronic kidney disease and the possible pathogenic mechanisms of renal involvement.

Clinical and Nutritional Implications of Kidney Disease and COVID-19

By the end of 2019 emerged a cluster of pneumonia that was caused by a novel SARS-CoV-2 virus. The disease, subsequently named COVID-19, has a wide range of signs and symptoms, including fever, respiratory and gastrointestinal manifestations, and kidney disease that can evolve to a nutritional imbalance through direct and indirect mechanisms. Moreover, the prognosis of COVID-19 could worsen in high-risk populations like kidney disease patients, given their depressed immunity and impaired nutritional state. Therefore, previous reports suggest prioritizing a nutritional approach in these patients, adjusting for individual dietary needs. Thus, we aim to explore the current knowledge about the clinical and nutritional implications of patients with COVID-19 who develop acute or chronic kidney disease, highlighting proposed dietary recommendations in this group of patients.