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BACKGROUND: Digital devices have represented a fundamental resource for maintaining communication relationships during the period of restrictive measures imposed by the COVID-19 pandemic. However it is evident that this period has contributed to increase the risks connected to the inappropriate use of digital devices. The aim of our study is to demonstrate how the COVID-19 pandemic and the consequent lockdown had an impact on children's use of digital devices. METHOD(S): One hundred and thirty children aged between six and 18 from Montalto di Castro were recruited in the study carried out in November 2020. All participants were asked to fill in two identical questionnaires: questions of the first questionnaire were related to the pre-lockdown period, while questions of the second questionnaire were related to the period between March and November 2020. RESULT(S): The average age of the 130 participants was 11.8+/-2 years. The amount of time spent by using digital devices is significantly lower in the pre-lockdown period than in the lockdown period (P<0.02). The smartphone addiction index is significantly lower in the pre-lockdown period (P<0.001). The analysis of headaches in the early morning hours - considered as one of the effects deriving from the use of the smartphone before sleeping - showed a statistically significant difference between the two groups (P<0.05). There are also significant differences related to physical activity and its frequency, with data showing the increase of children who did not perform physical activity (P<0.0001). CONCLUSION(S): This study does not only show a constant increase over time of the smartphone/tablet use, but also how the pandemic and social restrictions have worsened the phenomenon itself. This is particularly evident for the duration of exposure to screens, the addiction to smartphones, the quality of sleep and the practice of physical activity.Copyright © 2021 EDIZIONI MINERVA MEDICA.
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Introduction: Some disease modifying treatments (DMTs) impair response to SARS-CoV-2 vaccines in multiple sclerosis (MS), potentially increasing the risk of breakthrough infections. Objective(s): To investigate longitudinal post-vaccine antibody dynamics and memory B cell responses after 2 and 3 SARSCoV- 2 mRNA vaccine doses, and their association with risk of COVID-19 in MS patients treated with different DMTs. Method(s): Prospective observational monocenter cohort study in MS patients undergoing SARS-CoV-2 mRNA vaccinations. Anti- SARS-CoV-2 spike IgG serum titers were measured by chemiluminescence microparticle immunoassay. Frequency of spike-specific memory B cells were measured upon polyclonal stimulation of total PBMCs and screening of secreted antibodies by ELISA. Result(s): We recruited 120 MS patients (58 on anti-CD20, 9 on S1P-modulators, 15 on cladribine, 24 on teriflunomide and 14 untreated) and collected 392 samples before and up to 10.8 months after a 2nd vaccine dose. Compared to no treatment, anti-CD20 antibodies (beta=-2.07, p<0.001) and S1P-modulators (beta=-2.02, p<0.001) were associated with lower anti-spike IgG titers, while teriflunomide and cladribine were not. Anti-spike IgG titers progressively decreased with months since last vaccine dose (beta=-0.14, p<0.001), independently of DMTs. Within anti-CD20 treated patients, anti-spike IgG remained constantly higher in those with greater baseline CD19+ B cell counts and were not influenced by post-vaccine anti-CD20 infusions. Antispike IgG titers increased after a 3rd vaccine dose on cladribine and teriflunomide and marginally on anti-CD20 and S1Pmodulators. Spike-specific memory B cell responses were weaker on S1P-modulators and anti-CD20 than on teriflunomide and influenced by post-vaccine anti-CD20 infusions. Risk of SARS-CoV-2 infection was predicted by SARS-CoV-2 IgG at last sample before infection (OR=0.56, 95%CI=0.37-0.86, p=0.008). Conclusion(s): Post-vaccine SARS-CoV-2 IgG antibody titers progressively decrease over time in MS regardless of DMTs, and are associated with risk of breakthrough COVID-19. Both immediate humoral and specific memory B cell responses are diminished in patients on S1P-modulator and anti-CD20 antibody treatments. Within the latter group, B cell count at first vaccine dose determines anti-spike IgG production shortly after vaccination, whereas post-vaccine anti-CD20 infusions negatively impact memory B cell responses.
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Background: The coronavirus 2019 (COVID-19) pandemic has affected all aspects of stroke care delivery and resource allocation. We sought to study this effect utilizing the Florida Stroke Registry (FSR), which collects data from hospitals in large metropolitan cities and small communities, each facing pandemic peaks at different timepoints and within various healthcare system organizations. Methods: From March 2019 to March 2021, the FSR identified 82,899 patients with the final diagnosis of ischemic stroke and TIA. Stroke care metrics were compared in patients enrolled during the COVID-19 pandemic (March 2020 to February 2021) to those enrolled in the immediate pre-pandemic year. These metrics included utilization of intravenous thrombolytic (IVT), Endovascular therapy (EVT), Door-To-Needle time (DTN), Door-To-Puncture time (DTP), Door-To-Computed Tomography time (DTCT) and overall Defect-Free Care (DFC). Results: Pre-pandemic patients (n= 41,929, 49.0% female, mean age 70.1 ± 14.6 years, 64.3% white, 20.4% black, 15.3% Hispanic) had similar demographics to pandemic patients (48.8% female, mean age 69.9 ± 14.4 years, 65.4% white, 19.9% black, 14.7% Hispanic). Pandemic stroke patients had more severe presentations (median NIHSS 3 [IQR 8] vs 3 [7], p < .0001), longer onset-to-arrival time (242 [677] vs 229 [654] minutes, p = 0.002), and were more likely to arrive via emergency medical services (62.3% vs. 60.8%, p < .0001) than pre-pandemic stroke patients. Although both groups received IVT equally (13.4% vs. 13.5%, p = 0.67), pandemic stroke patients were more likely to receive EVT (7.0% vs. 6.5%, p = 0.005) and had longer DTP (84 [60] vs. 81 [64] minutes, p = 0.01), shorter DTCT (22 [52] vs 23 [56] minutes, p = 0.01) and similar DTN (36 [22] vs. 37 [22] minutes, p = 0.05) times, with an increased DFC rate of 2.2% (86.6% vs. 84.4%, p < .0001). Conclusions: In this large registry based study, we found that compared to pre-pandemic care, ischemic stroke patients treated during the COVID19 pandemic presented sicker and later to the hospital and were more likely to receive EVT, but had longer door-to-puncture times. Despite many healthcare delivery challenges imposed by COVID19, Florida hospitals within the FSR maintained high quality of stroke care overall.
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Introduction: Recently developed vaccines can prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, but vaccine-induced immune responses can be impaired by disease modifying treatments (DMTs) commonly used in multiple sclerosis (MS). Objectives: To investigate the humoral response to SARS-CoV-2 mRNA vaccines in MS patients under different DMTs, and provide indications on potential strategies to optimize SARS-CoV-2 vaccination. Methods: this was a prospective single center observational cohort study performed at the Neurocenter of Southern Switzerland (Lugano Switzerland). MS patients were consecutively recruited between 25/02/2021 and 16/04/2021 during routine clinical visits. Inclusion criteria were: A diagnosis of MS according to the 2017 McDonald criteria;age >18 years;scheduled mRNA COVID-19 vaccination. IgG antibodies against the spike receptor-binding domain of SARS-CoV-2 were measured by chemiluminescence microparticle immunoassay (CMIA) at 21-35 days after the second vaccine dose. Results: A total of 107 patients were included (56 under anti-CD20 therapy, 14 under cladribine, 20 under teriflunomide, 7 under sphingosine- 1-phosphate receptor [S1P] modulators, and 10 untreated). Post-vaccine SARS-CoV-2 IgG titers were high among untreated patients (median=8,003 [QR=1,792-21,137] mAU/ml), patients under treatment with cladribine (6,175 [IQR=3,982-10,194] mAU/ ml), and teriflunomide (5,630 [2,596-14,087] mAU/ml). Titers were significantly lower under anti-CD20 therapy (68 [0-808] mAU/ml;β=-2.009, p<0.001) and S1P modulators (123 [57-641)] mAU/ml;β=-1.512, p=0.026). Within patients under anti-CD20 therapy, postvaccine SARS-CoV-2 IgG titers were increased in those who had their last anti-CD20 infusion >6 months before vaccination, and with higher CD19+ B cell counts at vaccination. Conclusions: The humoral response to SARS-CoV-2 mRNA vaccines is preserved in untreated MS patients and those treated with cladribine and teriflunomide, but reduced under anti-CD20 therapies and S1P-modulators. Within patients under treatment with anti-CD20 therapies, delaying vaccinations to more than 6 months after last infusion and waiting for B cell repopulation are potential strategies to optimize humoral response to vaccines.
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The current study examined the impact of the lockdown due to the Covid-19 disease on mood state and behaviours of children and adolescents with ADHD. Nine hundred ninety-two parents of children and adolescents with ADHD filled out an anonymous online survey through the ADHD family association website. The survey investigated the degree of severity of six emotional and mood states (sadness, boredom, little enjoyment/interest, irritability, temper tantrums, anxiety) and five disrupted behaviours (verbal and physical aggression, argument, opposition, restlessness) based on their frequency/week (absent; low: 1-2 days/week; moderate: 3-4 days/week; severe: 5-7 days/week) before and during the lockdown. Important fluctuations were found in all dimensions during the lockdown independently by the severity degree. Subjects with previous low severity degree of these behaviors significantly worsened in almost all dimensions during the lockdown. On the contrary, ADHD patients with moderate and severe degree showed important improvement during the lockdown. Little enjoyment/interests and boredom resulted the dimensions more strongly affected by the condition of restriction, overall in children. Children vs. adolescents showed substantially similar trend but the former resulted significantly more vulnerable to emotive changes. The results provided both the individuation of domains affected, and the indirect benefits produced by restriction condition.