Pancreatic Stone Protein (PSP) as a predictive biomarker of multiple organ failure and clinical outcome

Background: COVID-19 syndrome is associated with high morbidity and mortality in haemodialyzed patients. Pancreatic Stone Protein (PSP) is an early biomarker of sepsis and a prognostic biomarker of disease severity in critically-ill patients and can be rapidly measured at the patient's bedside with a point-of-care-test from a small drop of whole blood. The aim of our pilot was to investigate PSP in patients requiring haemodialysis with SARS-CoV-2 infection, at different severities of COVID-19 disease. Method(s): Between February and July 2021, 23 patients (6 severe COVID-19 with Acute Kidney Injury, 6 moderate COVID-19 haemodialyzed, 2 haemodialyzed without COVID-19 and 3 healthy controls) were recruited at the University Hospital of Foggia for PSP evaluation. Biomarker's measurements were performed within 48 hours after admission or upon arrival for haemodialysis (pre-treatment). PSP was measured at the patient's bedside with "abioSCOPE", a point-of-care test capable of evaluating PSP levels in five minutes from a small drop (50mul) of whole blood or serum. Result(s): The preliminary results of this pilot study showed a trend for PSP to increase along with the severity of disease. In fact, serum PSP levels were significantly higher in Intensive Care Unit subjects than in COVID-19 negative haemodialysis subjects and controls (ANOVA p=0.032). Furthermore, PSP levels were significantly higher in subjects who died (p<0.017). Whether this increase is due to the kidney injury or COVID-19 disease remains unknown, and more research is needed to understand the relationship. Conclusion(s): Several clinical studies published in literature have shown the predictive value of PSP in the early identification of sepsis and severity of the clinical outcome. In our experience we have seen a trend for PSP to increase with disease severity also in COVID-19 patients. These results are preliminary, but PSP was significantly higher in patients who died, in accordance with the literature. This experience also has demonstrated the feasibility of a point of care system to be easily implemented in the unit and adopted by personnel and its design enables fast results and immediate decisions to be taken, especially in urgent situations.

Outcome of COVID-19 Infections After Vaccination in Kidney Transplant Patients

Background: Kidney transplant recipients (KT) are a vulnerable population with a risk of death after COVID-19 infection (COV-I) four times higher than in the general population. mRNA COVID-19 vaccines changed the prognosis. Although KT have an impaired immunological response to mRNA vaccines, in March 2021 we started a vaccination campaign. Method(s): Among 1611 KT, 72 (4.2%) had COV-I (positive molecular nasopharyngeal swab) between 31 October 2021 and 15 January 2022 (3rd outbreak). Fourty-one (57%) were male and 58 (80.5%) had a deceased donor transplant, median age was 52 (43-60) years, median transplant vintage 57 (27-159) months, median serum creatinine 1.37 (1.0-1.7) mg/dL. KT were on calcineurin inhibitors, prednisone, mycophenolate (MMF) and mTOR inhibitors in 93-87-79% and 5.6% respectively. At COV-I 43 KT had received 3 doses of Comirnaty (BNT162b2), 21 two and 4 one, 4 were not vaccinated. DELTA variant was present in 36. Treatment included: increase of the daily steroid dosage (69%), MMF withdrawal (70%) or halving (5%) and monoclonal antibodies: Ronapreve or Xevudy (32%). Nine delta positive KT were hospitalized for severe respiratory distress: 2 died (6.6%). Result(s): The variables associated with an increased risk for hospitalization were older age and dyspnea (p=0.023, p<0.0001 respectively). At multivariate analysis, dyspnea (p <0.0001) and MMF (p=0.003) were independently associated with the risk for hospitalization. Combination of the two variables increased the significance (p<0.0001). Comparing this series to the 82/1503 (5.4%) KT infected during the previous waves, hospitalization, mortality and cumulative mortality rates dropped from 45%, 29.3% and 13.4% to 30%, 6.6% and 2.7% respectively, main difference being the absence of vaccination in the first group. Conclusion(s): Vaccinations did not reduce the incidence of COV-I among KT but provided certain protection associated with a significantly better outcome.

Vitamin D Status and SARS-CoV-2 Infection in a Cohort of Renal Transplanted Patients

Purpose: Immunomodulatory and anti-inflammatory properties have been hypothesized for native vitamin D (nVD). Very little is reported about nVD and risk of Sars- CoV-2 infection (COV) in renal transplant (RTx). In a cohort of renal transplanted patients (RTxp) we retrospectively evaluated: a) nVD status in patients with (COV+) and without (COV-) COV infection;b) the impact of nVD status on severity of COV. Method(s): The study includes 61 COV+ in whom nVD status was available in the year before the infection, and 122 COV- matched 1:2 for age (53[45-64]years), gender (M=60.7%), RTx vintage (7[2-15]years), presence of diabetes (18%), arterial hypertension (85%) and cardiac symptomatic disease (3%). Renal function, 24-h proteinuria, mineral metabolism (MM) parameters were evaluated at 1, 6 and 12 months before COV whereas nVD status was considered as the mean 25-OH-VD levels at the same timepoints. Severity of COV was based on the need for hospitalization (HOSP+: 27/61, 44.3%) and death (D+: 6/61, 9.8%). Result(s): a) nVD levels were significantly lower in COV+ than in COV- (19[12-26] ng/mL and 23[16-30] ng/mL, respectively, p=0.01). No differences in the other biochemical parameters were found. The COV discriminative power of nVD status was evaluated by ROC curve (AUC 0.61, 95% CI 0.54-0.68, p=0.01), with a value of 25-OHVD 23.9 ng/mL showing the best discriminative power (sensibility 72%, specificity 47%).b) nVD levels showed a trend towards lower values in HOSP+COV+ than HOSP-COV+ (17[8-25] ng/mL vs 20[14-26] ng/mL) and in D+COV+ than D-COV+ (13[6-23] ng/mL vs 20[13-26] ng/mL), although these differences did not reach the statistical significance (p=0.1 and p=0.2, respectively). Conclusion(s): With the limitations of the retrospective nature of the study and the small sample size, our data report that:COV+ showed lower nVD levels in the year preceding the infection compared to controls with similar main demographic features and comorbid conditionsNo differences were found in renal function, proteinuria, and other MM parameters between the two groupsNo association was found between nVD levels in the year preceding the infection and COV severity.

VITAMIN D STATUS AND SARS-COV-2 INFECTION IN A COHORT OF RENAL TRANSPLANTED PATIENTS

BACKGROUND AND AIMS: Immunomodulatory and anti-inflammatory properties have been hypothesized for native vitamin D (nVD). Very little is reported about nVD and risk of Sars-CoV-2 infection (COV) in renal transplant (RTx). In a cohort of renal transplanted patients (RTxp) we retrospectively evaluated: (i) nVD status in patients with (COV+) and without (COV-) COV infection;(ii) the impact of nVD status on severity of COV. METHOD: The study includes 61 COV + in whom nVD status was available in the year before the infection, and 122 COV- matched 1:2 for age (53[45-64]years), gender (M = 60.7%), RTx vintage (7[2-15] years), presence of diabetes (18%), arterial hypertension (85%) and cardiac symptomatic disease (3%). Renal function, 24-h proteinuria and mineral metabolism (MM) parameters were evaluated at 1, 6 and 12 months before COV whereas nVD status was considered as the mean 25- OH-VD levels at the same timepoints. Severity of COV was based on the need for hospitalization (HOSP+: 27/61, 44.3%) and death (D+: 6/61, 9.8%). RESULTS: (i) nVD levels were significantly lower in COV + than in COV- (19[12- 26] ng/mL and 23[16-30] ng/mL, respectively, P = 0.01). No differences in the other biochemical parameters were found. The COV discriminative power of nVD status was evaluated by ROC curve (AUC 0.61, 95% CI: 0.54-0.68, P = 0.01), with a value of 25-OHVD 23.9 ng/mL showing the best discriminative power (sensibility 72%, specificity 47%). (ii) nVD levels showed a trend towards lower values in HOSP + COV + than HOSP-COV+ (17[8-25] ng/mL versus 20[14-26] ng/mL) and in D + COV + than D-COV+ (13[6-23] ng/mL versus 20[13-26] ng/mL), although these differences did not reach the statistical significance (P = 0.1 and P = 0.2, respectively). CONCLUSION: With the limitations of the retrospective nature of the study and the small sample size, our data report that: (i) COV + showed lower nVD levels in the year preceding the infection compared with controls with similar main demographic features and comorbid conditions (ii) No differences were found in renal function, proteinuria and other MM parameters between the two groups. No association was found between nVD levels in the year preceding the infection and COV severity.

COVID-19 VACCINE IN KIDNEY TRANSPLANTED PATIENTS. IS THERE A CLINICAL RELEVANCE? AN ITALIAN SINGLE CENTER EXPERIENCE

BACKGROUND AND AIMS: COVID-19 is a life-threatening infection among elderly, comorbid patients or transplanted patients. In our recently published paper (Campise, M.;Alfieri, C.M.;et al. Pathogens 2021, 10, 964), we described our single Centre experience with 82 adult kidney-transplant patients (KTxp) with COVID-19 infection during the previous two pandemic outbreaks: 27 KTxp (first outbreak) and 65 (second). We observed a relatively low and possibly underestimated incidence of infection (5.1%) with a incidence of death almost four times higher than in general population (13%). The availability of COVID-19 vaccines has undoubtedly changed the outcome of the infection in both immunocompetent and immunosuppressed patients. Aim of this second ongoing observational and descriptive study, is to evaluate if the vaccination performed extensively among our KTxp, has modified the incidence and gravity of COVID-19 infection. METHOD: Data on KTxp with COVID-19 infection (COV+) from the 29 October 2021 to 31 December 2021 were collected. Particularly, we focused our anthropometric, clinical and therapeutic aspects. In the statistical analyses, continuous variables were expressed as median and interquartile range (25%-75%), and nominal variables were reported as percentage of cases. RESULTS: From the 29 October 2021 to the 31 December 2021, 33 KTxp developed COVID-19 infection, 60% were male. Median age was 50[29-58] years. Transplant vintage was 57[27-163] months. Median serum creatinine was 1.30[1.0-1.9] mg/dL and body mass index was 23[21-28] kg/m2. Immunosuppressive schedule included: CNI inhibitors, steroids and mycophenolate (MMF) in 97-90 and 70% of COV + respectively. In 50% of cases native vitamin D supplementation was present, whereas only 30% of cases were treated with renin-angiotensin inhibitors. Only one had insulin dependent diabetes. At the moment of nasopharyngeal swab positivity 64% of COV + had already received three doses of vaccine (Comirnaty (BNT162b2)®) and 30% 2 doses. Only 3% of pts had received a single dose. One patient had refused vaccination for personal reasons. Antigenic nasopharyngeal swab was performed in 70% of COV + and molecular swab in 60%. Thirty-five % of COV + were tested with both methods. The most frequent symptoms were: fever (70%), cough (75%) and headache (40%). In the previous outbreaks dyspnea was present in 33% of cases dropping to 13% in this cohort. Smell and taste alteration were present in 25% and 28% respectively. We did not perform the COVID-19 sequence. But, on the base of the symptoms referred, we are confident that 17 patients had delta variant and remaining had omicron. The first therapeutic approaches were the increase of the daily steroid dosage up to 25 mg (60% of cases) together with MMF temporarily withdrawing in 70% of cases and halving in 10%. Forty % of pts were also treated with monoclonal antibodies (Ronapreve®) upon infectious disease specialist evaluation. During the first two outbreaks, hospitalization was necessary in 45% of cases, and 13% of pts died. In the present cohort only 10% of patients required oxygen support and hospitalization. Nobody died. CONCLUSION: Although very preliminary, our results indicate that the vaccination campaign has noticeably ameliorated the incidence, the clinical presentation and the outcome of COVID-19 in KTxp. This comforting data should further sensitize the medical community on vaccination counseling in KTxp as soon as possible. Study with higher number of patients are needed to further clarify the individual response on antibody production and sensitivity to this still life-threatening infection.

A RECOMBINANT BIO-HDL (CER-001) CAN PREVENT SARS-COV2-INDUCED RENAL DYSFUNCTION BY RESTORING SR-BI SIGNALLING

BACKGROUND AND AIMS: Replication of the enveloped SARS-COV2 virus can alter lipidomic composition and metabolism of infected cells [1]. These alterations commonly result in a decline in HDL, total cholesterol and LDL, and an increase in triglyceride levels in COVID-19 patients. Furthermore, the 'cytokine storm' subsequent to release of inflammatory cytokines can severely impair lipid homeostasis. Importantly, decreased HDL-cholesterol correlates with severity of COVID-19 infection and represents a significant prognostic factor in predicting poor clinical outcomes [2]. Similarly, it has been observed that COVID-19 patients' recovery is accompanied by a rise in serum HDL levels. Pharmacological intervention that aims to restore ApoA-1 or functional HDL particles may have beneficial roles for clinical outcome of COVID-19 patients and has recently been approved for compassionate use [3]. SARS-CoV 2 spike proteins S1 and S2 can bind free cholesterol and HDL-bound cholesterol, facilitating virus entry by binding the ACE2 co-receptor Scavenger Receptor-BI (SR-BI) [4]. When activated at the trans-membrane level, SR-BI signalling culminates in Ser1173-eNOS phosphorylation with both anti-inflammatory and anti-apoptotic effect. We hypothesized that SARS-COV2 binding promoted SR-BI internalization, so that it could not exert its essential protective function. Therefore, the aim of this study is to evaluate the effects of CER-001, a mimetic HDL, in antagonizing this process. METHOD: Endothelial and tubular (RPTEC) cells were exposed to S1, S2 and S1 + S2 (50-250 nM) with or without CER-001 (CER-001 50-500 ug/mL) and cholesterol (10-50 uM). Apoptosis tests (MTT and AnnV/PI) were performed. Internalization of SR-BI, ACE2 with S1 and activation of eNOS was evaluated by FACS analysis. SR-BI and ACE2 expression were evaluated on kidney biopsies from COVID-19 patients. RESULTS: At concentrations used, the exposition of S1, S2 and S1 + S2 in the presence of CER-001 and cholesterol did not induce apoptosis of endothelial cells and RPTEC. Endothelial and tubular cells stimulated by S1, in presence of cholesterol, showed an increased intracellular level of SR-BI and ACE-2, with significantly reduced eNOS phosphorylation compared to baseline (P < 0.05). The treatment with CER-001 reversed trans-membrane SR-BI levels and eNOS phosphorylation to baseline values. The detection of S1 spike protein by endothelial cells immunohistochemistry revealed an increased level in S1-exposed cells with cholesterol and reduced S1 intracellular positive staining in CER-001-exposed cells (P < 0.05). Interestingly, S1-exposed cells without cholesterol appeared not to be capable of mediating S1 spike protein internalization. Consistent with in vitro results, analysis of renal biopsies from COVID-19 patients with proteinuria showed increased SR-BI and ACE-2 cytoplasmic signals and reduced expression at the apical domain of injured tubules. CONCLUSION: Our data confirmed the key role of lipid profile in SARS-COV2 infection, evaluating the molecular signalling involved in HDL metabolism and inflammatory processes, and could offer new therapeutic strategies for COVID-19 patients. (Figure Presented).

Understanding Art with AI: Our Research Experience

Artificial Intelligence solutions are empowering many fields of knowledge, including art. Indeed, the growing availability of large collections of digitized artworks, coupled with recent advances in Pattern Recognition and Computer Vision, offer new opportunities for researchers in these fields to help the art community with automatic and intelligent support tools. In this discussion paper, we outline some research directions that we are exploring to contribute to the challenge of understanding art with AI. Specifically, our current research is primarily concerned with visual link retrieval, artwork clustering, integrating new features based on contextual information encoded in a knowledge graph, and implementing these methods on social robots to provide new engaging user interfaces. The application of Information Technology to fine arts has countless applications, the most important of which concerns the preservation and fruition of our cultural heritage, which has been severely penalized, along with other sectors, by the ongoing COVID pandemic. On the other hand, the artistic domain poses entirely new challenges to the traditional ones, which, if addressed, can push the limits of current methods to achieve better semantic scene understanding. © 2021 Copyright for this paper by its authors. Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0). CEUR Workshop Proceedings (CEUR-WS.org)

Automatic Clustering of CT Scans of COVID-19 Patients Based on Deep Learning

Although several vaccination campaigns have been launched to combat the ongoing COVID-19 pandemic, the primary treatment of suspected infected people is still symptomatic. In particular, the analysis of images derived from computed tomography (CT) appears to be useful for retrospectively analyzing the novel coronavirus and the chest injuries it causes. The growing body of literature on this topic shows the predominance of supervised learning methods that are typically adopted to automatically discriminate pathological patients from normal controls. However, very little work has been done from an unsupervised perspective. In this paper, we propose a new pipeline for automatic clustering of CT scans of COVID-19 patients based on deep learning. A pre-trained convolutional neural network is used for feature extraction;then, the extracted features are used as input to a deep embedding clustering model to perform the final clustering. The method was tested on the publicly available SARS-CoV-2 CT-Scan dataset that not only provides scans of COVID patients but also of patients with other lung conditions. The results obtained indicate that the radiological features of COVID patients largely overlap with those of other lung diseases. Unsupervised approaches to COVID analysis are promising, as they reduce the need for hard-to-collect human annotations and allow for deeper analysis not tied to a binary or multiclass classification task. © 2021, Springer Nature Switzerland AG.

Increased prevalence of acute kidney injury and mortality in COVID-19 hospitalized patients

BACKGROUND AND AIMS: In 2020, SARS-CoV-2 pandemic had a devastating impact on individuals and on national health systems worldwide. Although being primarily a lung disease, COVID-19-associated systemic inflammation and activation of coagulation/complement cascades lead to multiple organ dysfunction including Acute Kidney Injury (AKI). Our aim is to evaluate AKI prevalence and mortality in hospitalized patients during COVID-19 pandemic in a 500-bed University Hospital. METHOD: Observational study on 945 COVID-19 patients (March-May 2020). Data collection from Board Hospital Discharge and serum creatinine (Lab database). AKI stratification in accordance to KDIGO criteria and evaluation of outcome in the different subgroups. The same methodology was adopted to assess AKI prevalence and outcome in 2018-2019. RESULTS: 351/945 (37.14%) of all hospital admissions for COVID-19 showed AKI further sub-classified as follows: 173 (18.3%) stage 1, 112 (11.9%) stage 2 and 66 (6.9%) stage 3: the control NO AKI group was 594/945 (62.86%). COVID-associated AKI prevalence was higher than that observed in 2018 (total AKI 17.9%, stage 1 10.7%, stage 2 4.5%, stage 3 2.7%) and 2019 (total AKI 17.2%, stage 1 10.1%, stage 2 4.5%, stage 3 2.6%). During COVID-19 pandemic, in-hospital mortality was 27% for NO AKI group, 28% for total AKI group, further subdivided 24% for stage 1, 45% for stage 2 and 42% for stage 3 group, respectively. Mortality was different from that observed during 2018 (NO AKI 3.77%, total AKI 15.2%, stage 1 9.69%, stage 2 17.24%, stage 3 18.9%) and 2019 (NO AKI 3.56%, total AKI 18.35%, stage 1 10.6%, stage 2 20.1%, stage 3 24.3%). In COVID-19 patients, mean age of NO AKI group was 64.6 ys vs. 71.7 ys of total AKI group divided in 71.6 ys for stage 1, 74.3 ys for stage 2 and 67.9 ys for stage 3, respectively. Mean eGFR at admission was 74.2 ml/min for NO AKI group, 61.3 ml/ min for total AKI group divided in 64.3 ml/min for stage 1, 57.8 ml/min for stage 2 and 52.5 ml/min for stage 3. Mean serum creatinine at admission was 1.17 mg/dl in NO AKI group, 1.43 mg/dl for total AKI group divided in1.22 mg/dl for stage 1, 1.4 mg/dl for stage 2 and 2.25 mg/dl for stage 3. Among evaluated comorbidities, only diabetes (p=0,048) and cognitive impairment (p=0,001) were associated with a significant increased risk for AKI development. ICU admission rate was 5% for NO AKI group and 18% for total AKI group divided in 14% for stage 1, 22% for stage 2 and 44% for stage 3. Mean length of hospital stay for NO AKI group was 7.22 days vs 15.08 days for total AKI group divided in 13.67 for stage 1, 15.83 for stage 2 and 21.82 for stage 3. Of note, all different therapies administered to COVID-19 patients did not correlate with AKI incidence. Mean eGFR at discharge was 76 ml/min for NO AKI group vs 66 ml/min for total AKI group divided in 68.7 ml/min for stage 1, 59.3 ml/min for stage 2 and 59.3 ml/min for stage 3. Mean serum creatinine at discharge was 1.14 mg/dl for NO AKI group vs 1.45 mg/dl for total AKI group divided in 1.28 mg/dl for stage 1, 1.58 mg/dl for stage 2 and 2.05 mg/dl for stage 3. CONCLUSION: COVID-19 pandemic is associated with an increased AKI prevalence in hospitalized patients (2-fold increase in all KDIGO stages). AKI associated with an increased risk of mortality: of note, AKI stage2-3 had a strong impact on mortality in comparison to NO AKI group (OR 2.59 and 2.11, respectively). The presence of eGFR >60 ml/min and serum creatinine < 1.2 mg/dl at admission were associated with a lower risk of AKI development: reduced eGFR levels were observed at discharge particularly in AKI stage 2-3. The length of hospital stay and risk of ICU admission depended on AKI incidence and severity. COVID-19 lead to an increased burden for Nephrologists due to increased AKI prevalence: a nephrological follow-up is needed to avoid progression from AKI to chronic kidney disease (CKD).

On the use of FIS inside a Telehealth system for cardiovascular risk monitoring

Cardiovascular diseases are the first cause of death in Italy. This has been worsened by the COVID-19 pandemic we are living in. Indeed, worldwide citizens are invited to stay at home to reduce the spreading of the virus, in the hospitals the priority is given to patients affected by COVID-19, and often patients affected by other diseases prefer to postpone routine check-ups, thus aggravating their health condition. There is a need for continuous monitoring of patients at risk, while contacts should be avoided. Telehealth systems, together with smart objects, are able to create assisted environments where patients are remotely and continuously monitored by the medical staff. In this paper, we present the overall architecture of a telehealth system, where vital parameters related to cardiovascular diseases such as heart rate, respiration rate, blood oxygen saturation, and color of lips are collected through a contact-less smart object. Based on these parameters, the level of cardiovascular risk is predicted through a Fuzzy Inference System (FIS) which provides a highly interpretable model against a lower accuracy [1]. To investigate the extent to which the loss of accuracy can be balanced by the acquired interpretability, in this work, we compare the FIS model with black-box models derived by standard machine learning algorithms. Experiments show that the performance of the FIS model is comparable with those of black-box models. Moreover, the FIS is easy to implement and it is easily explainable, thus it is worth in the medical domain where either patients and medical staff need to understand and trust the prediction made by machines. © 2021 IEEE.

The Effects of Motivational Strategies and Goal Attainment on Children's Trust in a Virtual Social Robot: A Pilot Study

Understanding the way different robot's strategies affect children's perceptions of social robots is crucial for a trustworthy child-robot relationship. This paper presents a preliminary study on whether motivational strategies based on Regulatory Focus Theory and goal attainment affect children's perception of a virtual social robot when solving a task. The ongoing pandemic (COVID-19) is altering the way we perform research. Hence, we designed a fully autonomous game with a virtual social robot. In an online user study, 25 children (8 to 17 years old) played a regulatory focus goal-oriented game with a virtual child-like version of the Furhat robot. We evaluated children's perceptions of the robot's social trust, competency trust, and likability. Also, we assessed the children's affective state (valence and arousal) before and after playing the game. Our preliminary results show that in the prevention condition, fulfilling the goal elicited less happiness in children. Surprisingly, we observed a trend increase in the social and competency trust elicited by the virtual robot when children were prevented from fulfilling the goal of the task. We discuss the results and the effects of online setups on conducting user studies with children. © 2021 Owner/Author.

Anesthesiologic management of pregnant women with SARS-COV-2 infection undergoing cesarean delivery

Background: Pregnant women are usually more susceptible to infection due to typical physiological and mechanical changes, such as increased heart rate, stroke volume and pulmonary residual capacity. The aim of this study was to evaluate an innovative anesthesiologic opioid-free management protocol in symptomatic pregnant women, with COVID-19 and with oxygen therapy, undergoing cesarean delivery with spinal anesthesia. Methods: With the patient in the sitting position, spinal anesthesia was performed at the L1-L2 level. Vertebral level has been identified starting from the sacrum, we counted the laminae in the caudal-to-cephalad direction, which was then marked with a surgical pen. The technique was performed in asepsis, in the subarachnoid space after vision of clear Cephalo-Spinal Fluid (CSF) in the spinal needle 27 Gauge, without letting out the CSF, bupivacaine 0.5% 10 mg, dexmedetomidine 10 μg and dexamethasone 4 mg was injected. Results: During the study period, 40 pregnant women with one or more symptoms and supplemental oxygen (FiO2 35-40%) who underwent cesarean delivery were included in the study. All pregnant women had pain visual analog scale (VAS) <3, and no pregnant women required rescue dose. Adverse effects, such as nausea, vomiting, shivering, or pruritus were not recorded in any case. After a mean of 2.5 hours from the spinal anesthesia, all the included women had a complete motility of the lower limbs and were able to mobilize independently within 12 hours after delivery. Mean time to first latus was about 8 hours after delivery. Conclusions: Pregnant women in COVID-19 can safely receive intrathecal dexamethasone and dexmedetomidine during planned cesarean delivery. © 2021 The Author(s). Published by IMR Press.

A mHealth solution for contact-less self-monitoring of blood oxygen saturation

Mobile health (mHealth) technologies play a fundamental role in epidemiological situations such as the ongoing outbreak of COVID-19 because they allow citizen to self-monitor their health status while staying at home and being constantly in remote connection with the physicians despite the quarantine. Special care should be given to self-monitoring vital parameters such as blood oxygen saturation (SpO2), whose abnormal values are a warning sign for potential infection by COVID-19. Measurement of SpO2 is commonly made through the pulse oximeter that requires skin contact and hence could be a potential way of spreading contagious infections. For this reason, contact-less solutions for self-monitoring of SpO2 would be beneficial. In this paper we present a mHealth approach to self-monitor SpO2 that does not require any contact device since it is based on video processing. Video frames of the patient's face acquired by a camera are processed in real-time in order to extract the remote photoplethysmography signal useful to derive an estimation of SpO2. Preliminary experimental results show that the SpO2 values obtained by our contact-less solution are consistent with the measurements of a commercial pulse oximeter used as reference device.

Severe acute respiratory syndrome coronavirus 2 may exploit human transcription factors involved in retinoic acid and interferon-mediated response: a hypothesis supported by an in silico analysis.

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19), resulting in acute respiratory disease, is a worldwide emergency. Because recently it has been found that SARS-CoV is dependent on host transcription factors (TF) to express the viral genes, efforts are required to understand the molecular interplay between virus and host response. By bioinformatic analysis, we investigated human TF that can bind the SARS-CoV-2 sequence and can be involved in viral transcription. In particular, we analysed the key role of TF involved in interferon (IFN) response. We found that several TF could be induced by the IFN antiviral response, specifically some induced by IFN-stimulated gene factor 3 (ISGF3) and by unphosphorylated ISGF3, which were found to promote the transcription of several viral open reading frame. Moreover, we found 22 TF binding sites present only in the sequence of virus infecting humans but not bat coronavirus RaTG13. The 22 TF are involved in IFN, retinoic acid signalling and regulation of transcription by RNA polymerase II, thus facilitating its own replication cycle. This mechanism, by competition, may steal the human TF involved in these processes, explaining SARS-CoV-2's disruption of IFN-I signalling in host cells and the mechanism of the SARS retinoic acid depletion syndrome leading to the cytokine storm. We identified three TF binding sites present exclusively in the Brazilian SARS-CoV-2 P.1 variant that may explain the higher severity of the respiratory syndrome. These data shed light on SARS-CoV-2 dependence from the host transcription machinery associated with IFN response and strengthen our knowledge of the virus's transcription and replicative activity, thus paving the way for new targets for drug design and therapeutic approaches.

Social assistive robots in elderly care: Exploring the role of empathy

The COVID-19 emergency has shown that elderly people living in Assisted Living Houses (ALHs) have been highly exposed to the virus. Besides health problems, during the social distancing restrictions, the elderly were also strongly affected by loneliness due to a lack of contact with their loved ones. Innovative solutions for ALH based on Social Assistive Robotics can reduce the risk of infection and, at the same time, improve the quality of life of elderly people. In this work, after a brief overview on the Pepper4Elderly project, we focus on the role of empathy and affective behaviors in human-robot interaction when the robot is used as a caring agent to assist and entertain the elderly guests of ALHs. © 2020 CEUR-WS. All rights reserved.