Fear of death and the pandemic

Introduction

Looking at the vast majority of mental disorders in the last year, we noticed that most of them were closely related to this feeling of fear but also to the restrictive measures that appeared with the pandemic. Exposure for a period of more than a year to this mental stress has led to the appearance of a large number of psychiatric patients, especially those who have undergone SARS-CoV-2 infection or who have had close people infected, some of whom have even died.

Objectives

In this paper I will highlight the post traumatic consequences in patients who have gone through the disease.

Methods

To complete this work I used medical articles, studies, and specialized information on the subject.

Results

Patients who have gone through the disease developed sleeping problems, phobias, various anxiety and delusional disorders.

Conclusions

These conditions create the need for a multidisciplinary approach among this particular category of patients.

Disclosure

No significant relationships.

Vaccine hesitancy among hospital workers

Introduction

Vaccine hesitancy is a serious issue and it affects the scientific achievements of health. This phenomenon has begun to be studied more often in health care workers, to find its determining factors.

Objectives

The aim was to determine the percentage of hospital workers who got vaccinated against the infection with SARS-CoV-2.

Methods

Beginning with October 2021, we conducted an online questionnaire in which 57 hospital workers participated. Preliminary results allowed us to assess the rate of vaccine hesitancy among this group.

Results

Out of the 57 hospital workers, the majority were vaccinated (n=45, 78.94%) in comparison to less than a quarter (n=12, 21.05%) that refused vaccination. The group of hospital workers included mostly nurses ( n=21, 36.84%). Also, 12 psychologists (21.05%), 11 doctors (19.29%), and 10 students (17.54%) were included. Among the cases that did not accept getting vaccinated against COVID-19, the highest percentage was occupied by nurses (n=9, 15.78%). Moreover, there were only one doctor and one psychologist who did not get vaccinated.

Conclusions

In the current pandemic times, the hesitancy and refusal of vaccination prove to be very challenging. It is important to explore their reasons and to promote health education programs.

Disclosure

No significant relationships.

The consequences of the pandemic among patients with psychiatric history

Introduction

Throughout this period we were confronted with news and information about the Corona virus and its consequences. Which led to the development of a huge sense of fear among people. Although fear has helped to maintain restrictions, it has also had a significant impact on mental health, especially among patients with a psychiatric history.

Objectives

In this paper I will highlight the consequences of the nocebo effect of the pandemic among people with a psychiatric history.

Methods

To complete this work I used medical articles, studies, and specialized information on the subject.

Results

The pandemic’s restrictions have made it difficult for psychiatric patients to be compliant treatment by avoiding regular psychiatric exams.Isolation and fear of infection has led to new decompensations in existing psychiatric pathologies.

Conclusions

The exacerbations of psychiatric pathology increased both in number and in their intensity, ultimately determined by the increase in the number of hospitalizations in psychiatric emergencies.

Disclosure

No significant relationships.

Personal believes - Barriers to vaccination against Covid_19

Introduction

The ongoing global pandemic of Covid_19 had a huge pressure to accelerate the development process of Covid_19 vaccine. This acceleration of the vaccine appearance raised many concerns regarding the effectiveness and the adequate safety of the vaccine among general population.

Objectives

The aim of the study is to determine the reasons behind vaccine refusal among general population.

Methods

Online questionnaire with the subjects’ agreement; The study included 61 participants aged between 18 and 40 years old. The study was effectuated in October 2021.

Results

Most of the participants (n=60, 98.36%) declared that they knew some persons who have refused the Covid_19 vaccine. Moreover, a number of 29 participants (48.33%) declared that vaccine refusal among the people who refused the vaccine was due to personal believes.

Conclusions

The success of the vaccination programs mainly depends on the proportion of the population that receive the vaccine. It is crucial to implement new strategies to increase the acceptability of Covid_19 vaccine.

Disclosure

No significant relationships.

[Selective IgA deficiency]

Selective IgA deficiency (SIgAD) is defined by the European Society for Immunodeficiencies (ESID) as a serum IgA of less than 0.07g/L in patients greater than 4 years old with normal levels of IgG and IgM, normal vaccine responses, and with the exclusion of secondary causes of hypogammaglobulinemia. When serum IgA level is higher than 0.07g/L but two standard deviations below normal for age, the condition may be referred to as partial IgA deficiency, which is quite common. SIgAD is the most common primary immunodeficiency in Europe (1/600 in France) and most patients with SIgAD are asymptomatic (75-90%). The clinical complications associated with SIgAD include recurrent respiratory infections (in particular involving Haemophilus influenza and Streptococcus pneumoniae) and gastrointestinal (mainly due to Giardialamblia), autoimmune and allergic manifestations (anaphylaxis if blood products with IgA are administrated), inflammatory gastrointestinal disease. There is no specific treatment for SIgAD and each patient must be managed individually. While asymptomatic subjects do not need any treatment, it is still necessary for them to be up-to-date with vaccinations. If the patient experiences recurrent infections, prophylactic antibiotics may be beneficial. Immunoglobulin replacement therapy should be considered in patients with SIgAD and concomitant IgG subclass deficiency. Treatment for autoimmune and allergic manifestations is based on current standards of care for specific disease entities. To improve quality of life and reduce morbidity, an interdisciplinary team approach is essential.

The traps of the internet in the covid era

Introduction

The paper presents the results of one international study due by our team in the period of restrictions imposed by Covid-19, between March and June 2020.

Objectives

To inform the population about the risks concerning the excessiv use of internet To prevent the effects of those behaviors which affects the global functioning of individuals

Methods

Questionnaire applied to a number of 549 subjects, 18 to 60 years old, 217 from Romania and 332 from other European and Asian countries

Results

The results allowed us to verify the assumption that there is a change in communications needs of individuals, as well gender and age differences in terms of time spent on the internet during the covid period.

Conclusions

The issue of psycho-education regarding the awareness of dangers and the traps of the virtual era remain relevant.

AB0283 REDUCED HOSPITAL ADMISSION IN RA PATIENTS TAPERING BIOLOGIC DMARDS: PRELIMINARY ANALYSIS OF A RETROSPECTIVE STUDY

Background:

bDMARDs are among the most effective therapies in the management of inflammatory arthritides, but they are associated with potentially severe adverse events (AEs), particularly infection. Tapering strategies of bDMARDs for patients in remission/low disease activity (R/LDA) have demonstrated comparable efficacy to standard-dose treatments, but their safety profile has not been studied yet.

Objectives:

To compare the number and the causes of hospital admissions in RA patients in R/LDA continuing or tapering bDMARDs.

Methods:

Consecutive patients with rheumatoid arthritis (RA) evaluated between 2011 and 2017, were assigned, based on treating physician’s discretion, to continue the standard dose (STD) of bDMARDs or to undergo a predetermined tapering strategy (TAP), after being in R/LDA for two consecutive visits at least 3 months apart. Down-titration of bDMARDs was obtained by a stepwise increase of the dosing interval to achieve a reduction of about 30% (e.g. administration of etanercept every 10 days instead of weekly). Demographic, clinical data and concomitant treatments were retrospectively retrieved from the electronic charts of the outpatient clinics. Information about hospital admissions, including main diagnosis, period and duration of hospitalization, and death were retrieved from the Regional Healthcare System Database.

For the STD group, the observation period started with the occurrence of remission and finished with one of these events: loss of remission, switch to another bDMARD, withdrawal of the bDMARD, severe AE, death, end of the study period in (December 2017). For the TAP group, the observation period started with tapering onset and finished with one of these events: reduction of the dosing interval due to either a relapse (according to a DAS28 increase) or to a subjective, symptomatic relapse (according to the patient’s definition), switch to another bDMARD, withdrawal of the bDMARD, severe AE, death, end of the study period in (December 2017).

Results:

81 patients were included, of whom 40 underwent TAP. Demographic, clinical and treatment data are shown in table 1. Baseline characteristics were comparable between the two groups, except for the number of previous bDMARDs before observational period entry that was slightly higher in the STD group (STD 1.0±0.9 versus TAP 0.5±0.8, P=0.11).

Table 1.

Baseline demographic and clinical characteristics of the patients in remission or low disease activity.

NO TAPERING(n=41)TAPERING(n=40)p valueMean age (yrs)57±1158±130.563Mean disease duration (yrs)12±912±70.897Starting bDMARD to tapering/monitoring (months)52±4567±410.128Mean monitoring period (months)22±2419±230.632Taking sDMARD at any time ((n (%))40 (98%)37 (92%)0.359Taking glucocorticoids29 (71%)28 (70%)0.999Mean prednisone dose (mg/day)2.5±2.92.1±2.70.527DAS28 at the time of tapering or first LDA/REM2.3±0.82.3±0.90.863Previous bDMARDs >1 (n (%))10 (24.4%)4 (10%)0.140

In the STD group, 14 hospital admissions occurred, while in the TAP group there were 7 admissions (p=0.128). The corresponding figures for hospital admission due to infectious diseases were 6 in the STD group and 0 in the TAP group (p=0.026).

Conclusion:

Tapering bDMARDs in RA patients in R/LDA is associated with fewer hospital admissions, with a possible protective effect especially toward infections.

Acknowledgments:

The authors are indebted with Mrs Rosella Gramuglia and Mrs Cristina Olivieri for the management and analysis of the data on the flow of the drugs, and with Mrs Anna Consigliere, Mrs Anna Cosso, Mrs Romina Petralito and Mrs Laura Ravaschio for helping in retrieving clinical data.

Disclosure of Interests:

Dario Camellino Consultant of: I have received consultancy fees from Celgene, Sanofi, Novartis, Janssen-Cilag, Accord, Paid instructor for: I have served as a paid instructor for Mylan, Andrea Giusti Consultant of: UCB, Amgen, Janssen, Eli Lilly, Abiogen, EffRx, Speakers bureau: UCB, Amgen, Janssen, Eli Lilly, Abiogen, EffRx, Alfa-Sigma, Chiesi, Giuseppe Girasole: None declared, Chiara Craviotto: None declared, Paola Diana: None declared, Antonia Locaputo: None declared, Tiziana Caviglia: None declared, Lacramioara Luca: None declared, Gerolamo Bianchi Consultant of: Amgen, Janssen, Merck Sharp & Dohme, Novartis, UCB, Speakers bureau: Abbvie, Abiogen, Alfa-Sigma, Amgen, BMS, Celgene, Chiesi, Eli Lilly, GSK, Janssen, Medac, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Sanofi Genzyme, Servier, UCB

[Breast lesions as the presenting feature of giant cell arteritis]

INTRODUCTION

Giant cell arteritis most commonly involves the external carotid branches. Although they are less typical, extra-cephalic forms have also been reported.

CASE REPORT

We report the case of a 59-year-old female patient who developed bilateral, painful breast nodules with fever and altered general status since two months. Two weeks later, she presented frontal headache and scalp tenderness. A colour duplex ultrasound of the temporal artery showed a halo sign. The results of a breast needle biopsy were inconclusive but the temporal artery biopsy confirmed the diagnosis of giant cell arteritis. The disease course was rapidly favourable after institution of corticosteroids.

INTRODUCTION

Breast involvement is rare but could be the first sign of giant cell arteritis. The internal mammary artery, which is a branch of the subclavian artery, can be affected and responsible for breast nodules.

Nasal lavage CCL24 levels correlate with eosinophils trafficking and symptoms in chronic sino-nasal eosinophilic inflammation

OBJECTIVES

The aim of our study was to measure CCL24 (eotaxin-2) levels in nasal lavage fluid of patients with different forms of sinonasal chronic eosinophilic inflammation to verify the relationship with nasal hypereosinophilia and symptoms.

METHODS

Patients with nasal hypereosinophilia were randomly recruited and grouped in persistent allergic rhinitis, non-allergic rhinitis with eosinophilia syndrome (NARES) and chronic rhinosinusitis with polyps. Non rhinitic volunteers were recruited as controls. CCL24 concentration was measured by `Quantikine Human CCL24 Immunoassay`. Differential cell counts were performed by microscopic cytological examination of nasal tissue scraped by inferior turbinate.

RESULTS

CCL24 levels measured in patient groups were significantly higher compared to control group with the highest levels in NARES patients. Eotaxin- 2 levels were significantly correlated to severity of symptoms and to the percentage of eosinophils in nasal tissue.

CONCLUSIONS

We revealed high levels of CCL24 in all patient groups showing a significant correlation with the degree of eosinophilia and clinical symptoms. A prolonged accumulation of CCL24 inside the nasal mucosa may sustain the process of unspecific self-perpetuating eosinophil recruitment pathognomonic of these patients.

Gallbladder adenoma with focal adenocarcinoma

The majority of polypoid lesions of the gallbladder are cholesterolosis pseudopolyps. True neoplastic GB polyps are represented mainly by adenomas. The case of a 52-year old male patient with an adenomatous polyp of the GB with focal adenocarcinoma is presented.

Training Hospital Transplantation Coordinators in Brazil

In Brazil from 1993 to 1997, the rate of deceased organ donors did not increase, remaining fixed around 3 donors per million population (pmp/y). In 1997, seeking to improve this situation, we introduced a policy seeking to improve the transplantation rates. Among the organizational measures, we created hospital transplantation coordinators based on the Spanish model. Because there was not enough qualified personnel in this area, 18 basic courses (12 to 24 hours) were performed in 9 states, with the purpose to train 1020 coordinators. Furthermore 20 advanced courses (40 hours) were introduced to train these coordinators in 16 of the 21 Brazilian states that perform transplantations in addition to the Federal District, resulting in 920 new coordinators. As a consequence, there was a mean annual increase of 20% in donations, namely 600 deceased donors in 1999 (3.8 pmp), 840 in 2001 (5.2 pmp), and 1232 in 2004 (7.3 pmp). The potential rate of donors notification attained 4981 (29 pmp) in 2004, about 50% of the estimate figures. However, this rate is far lower than that necessary. It is important to continue coordination of new training (4 yearly) and retraining courses for qualified coordinators using 2-day intensive courses (16 hours).

Non invasive estimation of mean right atrial pressure utilizing the 2D-Echo transverse diameter of the left hepatic vein

Aim of our study was to assess if the 2D-Echo transverse diameter of the left hepatic vein (LHV) obtained from the subcostal approach is correlated with invasive mean right atrial pressure (RAP). Thirty-two consecutive patients with acute myocardial infarction were studied by simultaneous 2D-Echo and right heart catheterization. LHV could be adequately imaged in 90% of patients. Mean RAP values at catheterization ranged from 0 to 15 mmHg (mean 6 +/- 3.5 mmHg). A correlation was found between mean RAP and LHV diameter calculated after inspiration (r = 0.81, SEE = 1.54 mm, slope = 0.71, p less than 0.001) as well as after expiration (r = 0.82, SEE = 1.32 mm, slope = 0.62, p less than 0.001) or during post-expiratory apnoea (r = 0.85, SEE = 1.3 mm, slope = 0.71, p less than 0.001). Moreover, percent increments of LHV diameter correlated well with percent changes of mean RAP during rapid infusion of 250-500 cc of saline in 4 patients (r = 0.98, p less than 0.001). Thus, the 2D-Echo LHV diameter is a feasible measurement that seems to correlate well with invasive mean RAP over a wide range of mean RAP values in patients with myocardial infarction; the changes in LHV diameter correlate well with the percent increase in central venous pressure obtained with saline infusion. Underestimation of invasive RAP occurs when mean RAP value exceeds 12 mmHg and can be explained by limited venous compliance. However these preliminary results suggest that this method may represent a valid alternative to obtain a non invasive estimate of mean RAP with 2D-Echocardiography.

[Acute alcoholic hepatitis]

In a group of 1,025 cases of alcoholic liver the authors detected 28 cases (2.73%) of acute alcoholic hepatitis on the basis of the morphologic examination, 75% were males, mean age 45 +/- 18 years. The mean amount of alcohol consumed daily was 106.7 g for a mean duration of 19.78 years. The hepatic lesional substrate was hepatic steatosis and cirrhosis in 7 cases (25%) and steatofibrosis in the other 14 cases (50%). The triggering factors were the abuse of alcohol in 27 cases and a pneumonia in the last case. The disease was characterized by fever, encephalopathy, hepatomegaly, hepatocytolytic-cholestatic syndrome. The evolution was dictated by the gravity of the background hepatic lesional substrate.

[The dumping syndrome: its risk factors and evolution]

The paper reports on a comparative study of 24 cases of operated gastroduodenal ulcer, in which the dumping syndrome appeared at a short interval after the operation, and of a control lot of patients operated for ulcerous disease without complications. This study shows that the incidence of the dumping syndrome in the ulcerous patients operated is of 12.83%, predominant in gastric ulcer (15%). Among the factors favouring the development of the dumping syndrome, mention is made of subtotal gastric resection with Billroth II anastomoses, early surgical indication, and pre-existing neuroendocrine disturbances. Although the dumping syndrome causes weight loss, its evolution in time is benign and improving after 3 years, surveillance.