COVID-19 emergency: Changes in quality of life perception in patients with chronic liver disease-An Italian single-centre study.

BACKGROUND: In December 2019, the coronavirus disease-2019 (COVID-19) emerged and rapidly spread worldwide, becoming a global health threat and having a tremendous impact on the quality of life (QOL) of individuals. AIM: To evaluate the awareness of patients with chronic liver disease (CLD) regarding the COVID-19 emergency and how it impacted on their QOL. METHODS: Patients with an established diagnosis of CLD (cirrhosis, autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis) who had been evaluated at our Outpatient Liver Disease Clinic during the 6-mo period preceding the start of Italian lockdown (March 8, 2020) were enrolled. Participants were asked to complete a two-part questionnaire, administered by telephone according to governmental restrictions: The first section assessed patients' basic knowledge regarding COVID-19, and the second evaluated the impact of the COVID-19 emergency on their QOL. We used the Italian version of the CLD questionnaire (CLDQ-I). With the aim of evaluating possible changes in the QOL items addressed, the questionnaire was administered to patients at the time of telephone contact with the specific request to recall their QOL perceptions during two different time points. In detail, patients were asked to recall these perceptions first during time 0 (t0), a period comprising the 2 wk preceding the date of ministerial lockdown decree (from February 23 to March 7, 2020); then, in the course of the same phone call, they were asked to recall the same items as experienced throughout time 1 (t1), the second predetermined time frame encompassing the 2 wk (from April 6 to April 19) preceding our telephone contact and questionnaire administration. All data are expressed as number (%), and continuous variables are reported as the median (interquartile range). The data were compared using the Wilcoxon paired non-parametric test. RESULTS: A total of 111 patients were enrolled, of whom 81 completed the questionnaire. Forty-nine had liver cirrhosis, and all of them had compensated disease; 32 patients had autoimmune liver disease. The majority (93.8%) of patients were aware of COVID-19 transmission modalities and on how to recognize the most common alarm symptoms (93.8%). Five of 32 (15.6%) patients with autoimmune liver disease reported having had the need to receive more information about the way to manage their liver disease therapy during lockdown and nine (28.2%) thought about modifying their therapy without consulting their liver disease specialist. About the impact on QOL, all CLDQ-I total scores were significantly worsened during time t1 as compared to time t0. CONCLUSION: The COVID-19 epidemic has had a significant impact on the QOL of our population of patients, despite a good knowledge of preventive measure and means of virus transmission.

Not all yawns tell the same story: The case of Tonkean macaques.

Here we show for the first time that the plasticity in morphology and duration of yawning in Macaca tonkeana can be associated with different functional contexts. Macaca tonkeana is classified as a tolerant macaque species characterized by social interactions minimally constrained by dominance rank or kinship. Tonkean macaques, as other egalitarian species, rely on a complex facial communicative system. We found that the degree of mouth opening (ranging from covered to uncovered tooth yawns) and the duration of yawning were not strictly dependent. The shortest uncovered tooth yawns were associated with an intense locomotor/physical activity and peaked immediately after stressful social events thus indicating an increase in arousal. In contrast, longer yawns, independently from teeth exposure, were primarily associated with a relaxed state of the subject. In conclusion, our study suggests that to explore the potential different functions of yawning, it is necessary to focus on the variability of its expression both in terms of morphology and duration, because not all yawns tell the same story.

Hematological Malignancies and HBV Reactivation Risk: Suggestions for Clinical Management.

It is well known that hepatitis B virus reactivation (HBVr) can occur among patients undergoing treatment for hematological malignancies (HM). The evaluation of HBVr risk in patients undergoing immunosuppressive treatments is a multidimensional process, which includes conducting an accurate clinical history and physical examination, consideration of the virological categories, of the medication chosen to treat these hematological malignancies and the degree of immunosuppression induced. Once the risk of reactivation has been defined, it is crucial to adopt adequate management strategies (should reactivation occur). The purpose of treatment is to prevent dire clinical consequences of HBVr such as acute/fulminant hepatitis, and liver failure. Treatment will be instituted according to the indications and evidence provided by current international recommendations and to prevent interruption of lifesaving anti-neoplastic treatments. In this paper, we will present the available data regarding the risk of HBVr in this special population of immunosuppressed patients and explore the relevance of effective prevention and management of this potentially life-threatening event. A computerized literature search was performed using appropriate terms to discover relevant articles. Current evidence supports the policy of universal HBV testing of patients scheduled to undergo treatment for hematological malignancies, and clinicians should be aware of the inherent risk of viral reactivation among the different virological categories and classes of immunosuppressive drugs.

Yawning and social styles: Different functions in tolerant and despotic macaques (Macaca tonkeana and Macaca fuscata).

Yawning is a multifunctional behavior with a role in social communication. In Old World monkeys, the "tension yawn" is often used as a threat, allowing individuals to completely expose their canines. To explore the role of this phenomenon, we selected 2 closely related species-Japanese macaques (Macaca fuscata) and Tonkean macaques (M. tonkeana)-which differ primarily in terms of their tolerance levels. Japanese macaques are classified as despotic; Tonkean macaques are classified as tolerant. Both species live in multimale-multifemale societies, show a high level of sexual dimorphism, and have comparable yawning repertoires that include displaying a covered teeth yawn and an uncovered gums yawn. We found comparable baseline frequencies of the 2 yawning types and a similar distribution of these behaviors according to sex (males yawned more frequently than females). This morphological homogeneity permitted us to evaluate potential differences in the meaning of yawning as a function of social tension, aggressive contexts, and dominance hierarchy. Divergent social styles determine a functional dichotomy in the use of the covered teeth yawn and the uncovered gums yawn. The covered teeth yawn is not susceptible to social and environmental stimuli and seems to be a form of yawning mostly linked to the physiology of the sleep-wake cycle. However, the uncovered gums yawn is modulated according to different social contexts, and its use could be favored by natural selection, especially in tolerant species, which apparently require more elaborate forms of social communication. (PsycINFO Database Record

Testing yawning hypotheses in wild populations of two strepsirrhine species: Propithecus verreauxi and Lemur catta.

Yawning, although easily recognized, is difficult to explain. Traditional explanations stressed physiological mechanisms, but more recently, behavioral processes have received increasing attention. This is the first study to test a range of hypotheses on yawning in wild primate populations. We studied two sympatric strepsirrhine species, Lemur catta, and Propithecus verreauxi, of the Ankoba forest (24.99°S, 46.29°E, Berenty reserve) in southern Madagascar. Sexual dimorphism is lacking in both species. However, their differences in ecological and behavioral characteristics facilitate comparative tests of hypotheses on yawning. Our results show that within each species males and females yawned with similar frequencies supporting the Dimorphism Hypothesis, which predicts that low sexual dimorphism leads to little inter-sexual differences in yawning. In support of the State Changing Hypothesis yawning frequencies was linked to the sleep-wake cycle and punctuated transitions from one behavior to another. Accordingly, yawning frequencies were significantly higher in L. catta than in P. verreauxi, because L. catta has a higher basal level of activity and consequently a higher number of behavioral transitions. In agreement with the Anxiety Hypothesis, yawning increased significantly in the 10 min following predatory attacks or aggression. Our findings provide the first empirical evidence of a direct connection between anxiety and yawning in lemurs. Our results show that yawning in these two strepsirrhines occurs in different contexts, but more research will be necessary to determine if yawns are a single, unitary behavior.