The Interplay between Autonomic Nervous System and Inflammation across Systemic Autoimmune Diseases.

The autonomic nervous system (ANS) and the immune system are deeply interrelated. The ANS regulates both innate and adaptive immunity through the sympathetic and parasympathetic branches, and an imbalance in this system can determine an altered inflammatory response as typically observed in chronic conditions such as systemic autoimmune diseases. Rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis all show a dysfunction of the ANS that is mutually related to the increase in inflammation and cardiovascular risk. Moreover, an interaction between ANS and the gut microbiota has direct effects on inflammation homeostasis. Recently vagal stimulation techniques have emerged as an unprecedented possibility to reduce ANS dysfunction, especially in chronic diseases characterized by pain and a decreased quality of life as well as in chronic inflammation.

Laryngotracheal aspiration test reduce the false negative rate in patients with suspected SARS-COV-2 pneumonia despite a negative nasopharyngeal swab.

BACKGROUND: In the emergency department (ED) definitive diagnosis of SARS-COV-2 pneumonia is challenging as nasopharyngeal swab (NPS) can give false negative results. Strategies to reduce false negative rate of NPS have limitations. Serial NPSs (24-48 h from one another) are time-consuming, sputum can not be collected in the majority of patients, and bronchoalveolar lavage (BAL), the most sensitive test, requires specific expertise. Laryngotracheal aspiration (LTA) is easy to perform and showed a similar accuracy to BAL for diagnosis of other pulmonary diseases, however it was not studied to diagnose SARS-COV-2 pneumonia. OBJECTIVE: An observational cross-sectional study was performed to evaluate the negative predictive value of LTA in patients with suspected SARS-COV-2 pneumonia despite a negative NPS. METHODS: In the EDs of two university hospitals, consecutive patients with suspected SARS-COV-2 pneumonia despite a negative NPS underwent LTA performed with a nasotracheal tube connected to a vacuum system. Final diagnosis based on all respiratory specimen tests (NPS, LTA and BAL) and hospital data was established by two reviewers and in case of discordance by a third reviewer. RESULTS: 117 patients were enrolled. LTA was feasible in all patients and no patients experienced adverse events. Fifteen (12.7%) patients were diagnosed with community-acquired SARS-COV-2 pneumonia: 13 LTA positive and only 2 (1.7%) LTA negative. The negative predictive value of NPS and LTA was 87.3% (79.9% - 92.7%) and 98.1% (93.3%99.8%) respectively. CONCLUSIONS: LTA resulted feasible, safe and reduced false negative rate in patients with suspected SARS-COV-2 pneumonia despite a negative NPS.

[Feasibility and efficacy of home monitoring for patients with suspected or confirmed COVID-19.] / Fattibilità ed efficacia di un modello di monitoraggio domiciliare avanzato dei pazienti affetti da CoViD-19 o sospetti.

INTRODUCTION: The MonCOVID study aimed to assess the feasibility of early home management and monitoring of patients with suspected or confirmed CoViD-19, and to evaluate if this would ensure a rapid and adequate transfer to hospital care. METHODS: This pilot, open-label, single-arm study included adult symptomatic patients with suspected or confirmed CoViD-19 for whom the general practitioner or other carer had decided not to proceed to hospitalization. Participants were monitored daily at home, by measuring the pulse oximetry (SpO2) at rest and after a rapid walking test. The study assessed feasibility outcomes (at least 80% of patients recommended to be sent to the competent emergency room actually transferred within 24 hours from reporting) and efficacy (SpO2 at emergency room admission). Patients with SpO2 values below 90% (86% if affected by chronic pulmonary diseases) at rest or with a decrease in SpO2 of five percentage points after a rapid walking test were recommended for hospital care. RESULTS: Thirty-seven participants reported by the local health unit of Alessandria and the Metropolitan City of Turin were included in the study. Enrollment, initially planned for two months to reach a target of 340, was interrupted early due to the drastic reduction in the number of cases. On average, each participant was monitored for 8.2 (median 6.0) days, for a total of 302 visits. The participants showed milder symptoms than those observed in the first phase of the epidemic, at least in terms of pulmonary impairment. No patient had a decrease in SpO2 of 5 percentage points or greater and only one patient required hospitalization due to a worsening of the disease. DISCUSSION: The cases collected were not sufficient to demonstrate or refute the hypothesis of the monitoring test effectiveness. However, the study showed the feasibility of such a program, and raised some elements of interest regarding hospital territory integration, the need to develop tools to support home care and the variability of the clinical manifestations of the CoViD-19 disease.