[Trauma emergency room cases before and during the COVID-19 pandemic : Data from an alpine trauma center]. / Schockraumpatienten vor und während der COVID-19-Pandemie : Daten eines alpinen Traumazentrums.

INTRODUCTION: The COVID-19 pandemic had a strong impact on the work of trauma medical teams. The aim of the study was to compare the trauma emergency room (TER) incidence and trauma mechanisms before and during the pandemic at a level I trauma center. OBJECTIVE: The TER incidence before and during the pandemic should be assessed to be prepared for future pandemics or new COVID-19 outbreaks. MATERIAL AND METHODS: Medical charts from all TER patients from March 2019 to February 2021 were analyzed. The incidence and trauma mechanisms of the 12 months before and the 12 months during the pandemic were compared. The trauma distribution and severity were described by the AIS and ISS, and the patients' country of residency was noted. RESULTS: The TER cases decreased from 694 before the COVID-19 pandemic to 477 cases during the pandemic (Incidence rate 0.69). The strongest decrease in trauma cases was noted in sports injuries (0.55), followed by suicide attempts (0.63), traffic accidents (0.71) and leisure accidents (0.76). The rate of patients with severe injuries (ISS ≥ 16) was comparable with 40% before the pandemic and 44% during the pandemic. Foreign residency of TER patients shifted from 37% before the pandemic to 16% during the pandemic. The number of foreign patients was significantly reduced during the pandemic (257 vs. 77). DISCUSSION: The TER incidence significantly decreased during the pandemic due to the imposed lockdowns during the peak winter tourism season. The rate of foreign TER patients changed during the pandemic, while the rate of severely injured patients remained stable.

Interferon-γ-induced protein 10 in Lyme disease.

Lyme disease is an infectious disease caused by bacteria of the Borrelia type, that affects about 300,000 people a year in the USA and 65,000 people a year in Europe. Borrelia infection, and Lyme disease, following occupational exposure has been frequently reported in USA, Europe and Asia. The manifestations of Lyme disease include erythema migrans (EM), arthritis, neuroborrelliosis (NB), and others. Cytokines and chemokines primarily orchestrate leukocyte recruitment to the areas of Borrelia infection, and they are critical mediators of immune and inflammatory responses, in particular of the induction of interferon (IFN)-γ and IFN-γ dependent chemokines. In EM high levels of T helper (Th) 1 cells chemoattranctants [monokine induced by IFN-γ (MIG), IFN-γ-induced protein 10 (IP- 10), and IFN-inducible T cell alpha chemoattractant (I-TAC)] have been shown. Synovial tissues and fluids of patients with Lyme Arthritis (LA) (overall with antibiotic-refractory LA) contained exceptionally high levels of Th1 chemoattractants and cytokines, particularly MIG and IFN-γ. In NB concentrations of IP-10 and I-TAC in the cerebrospinal fluid (CSF) were significantly higher, suggesting that IP-10 and I-TAC create a chemokine gradient between the CSF and serum and recruite C-X-C chemokine receptor 3-expressing memory CD4+ T-cells into the CSF of these patients. A positive association between the disseminating capacity of B. burgdorferi and early type I IFN induction has also been shown. These results suggest that IFN-γ dependent chemokines are important biomarkers to monitor the progression and diffusion of the disease in patients with Borrelia infection; further larger studies are needed.

Leishmaniasis and IFN-γ dependent chemokines.

Leishmaniasis is a disease caused by Leishmania and spread by the bite of certain types of sandflies. Leishmaniasis affects as many as 12 million people worldwide, with 2 million new cases each year. Leishmania infection, and Leishmaniasis, following occupational exposure has been also reported. Three forms of Leishmaniasis are known: a- Cutaneous Leishmaniasis (CL); b-Mucocutaneous Leishmaniasis; c- Visceral Leishmaniasis (VL). The visceral form of Leishmaniasis has an estimated incidence of 500,000 new cases. Cytokines and chemokines primarily orchestrate leukocyte recruitment to the areas of leishmania infection, and they are critical mediators of immune and inflammatory responses, in particular of the induction of Interferon (IFN)-γ and IFN-γ dependent chemokines. Skin biopsies from patients with CL showed higher expression of interferon-γ-induced protein (IP)-10, in recent lesions than in late lesions. Following L. braziliensis infection, enhanced expression of IP-10 and its receptor, chemokine C-X-C receptor (CXCR) 3, was predominantly detected in CD14(+) monocyte; this may contribute to disease severity by increasing cellular recruitment. It has been shown that IP-10 renders protection against VL, and it is associated with a strong host-protective T helper cell (Th)1 immune response. High clinical scores were positively correlated with IP-10 expression. Furthermore IP-10 is critical for rendering a protective cellular immunity during soluble leishmanial antigen (SLA) pulsed-CpG-ODN stimulated dendritic cells (SLA-CpG-DCs) vaccination that confers protection against L. donovani infection. Further studies are needed to evaluate IP-10 in Leishmaniosis, and to evaluate it as a potential therapeutic target.

Hypersensitivity of vaccination and of infection due to Mycobacterium leprae

The authors have made a comparative study of the reactions provoked by intradermal injection of lepromin in healthy persons and dogs which are sensitized with M. leprae (designated vaccination hypersensitivity), and those provoked under the same conditions in patients with tuberculoid leprosy (infection hypersensitivity). It is concluded that the mechanism of development of hypersensitivity appears to be similar in all instances, and that the striking thing connected with intradermal injection of lepromin in them is the early, 48-hour, tuberculin type reaction and the accelerated formation of the tubercle or nodule by the end of the first week. The opinion is held that the early reaction in tuberculosis. The Mitsuda reaction is interpreted as the final or terminal stage of the inflammation of the tuberculin-type hypersensitivity, occurring weeks before. It is held that the early and late reactions are different stages of the same process, and that it is not permissible to give them different significances. It is emphasized that in the immunology of leprosy one should study the phenomena of hypersensitivity independently of the phenomena of resistance or immunity, and that there are many reason for believing that they are different states and that they obey different pathogenic mechanisms.