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Embracing resilience in multiple sclerosis: a new perspective from COVID-19 pandemic

Coronavirus disease 2019 (COVID-19) resulted in several psychological consequences. Past epidemiological experiences already showed the deep albeit heterogeneous psychological repercussions of pandemics. Nevertheless, little is known about COVID-19 outbreak and the possible strategies for boosting resilience in patients with chronic diseases such as Multiple Sclerosis (MS). Therefore, we designed a study aiming to assess the changes in mental distress during COVID-19 outbreak in patients with MS and to identifyfactors contributing to resilience's development.We enrolled 106 patients (69 relapsing-remitting, 20 secondary-progressive, and 17 primary-progressive) whose neuropsychological assessment before the COVID-19 pandemic (1 January 2019-1 March 2020) was available. It consisted of Brief International Cognitive Assessment for MS (BICAMS), Hospital Anxiety and Depression Scale (HADS) and patient-reported MS Neuropsychological Screening Questionnaire (MSNQ-P). All patients were re-tested during Italian lockdown through an online survey, comprehensive of sociodemographic information, HADS self-rating Scale, MSNQ-P Questionnaire and finally Connor-Davidson Resilience self-rating Scale (CD-RISC 25), in order to evaluate resilience.No significant changes in HADS and MSNQ-P scores were detected during COVID-19 pandemic in our population. Though, pre-existing lower HADS and MSNQ-P scores but not demographic, disease- and treatment-related elements were found significantly (p < 0.0001) and independently associated with a better resilience attitude.

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The Effect of Covid-19 Pandemic on Business Systems’ Innovation and Entrepreneurship and How to Cope with It: A Theatrical View

This study investigates the issue of coronavirus effects on business intelligence systems regarding business innovation and entrepreneurship Even though the Covid-19 pandemic has become the most significant crisis in the modern world and has negatively influenced numerous life spheres and business activities, it is possible to mention a few positive effects that might be used by different business organizations Thus, the paper analyzes the relevant literature and shows that many positive ones follow short-term negative effects The used the literature review approach to review many studies to answer the study questions and support its claims mentioned previously The findings reveal that the coronavirus stimulates individuals and businesses to mobilize their efforts to overcome the existing Covid-19 pandemic challenge in the spheres of business innovation and entrepreneurship The present paper also mentioned a set of advices related to how to cope with dealing with such a pandemic and mentioned a set of practical and theoretical implications for businesses in the near future © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG

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Childhood B-Cell Acute Lymphoblastic Leukemia Following SARS CoV-2 Infection: A Potential Second "Hit" in Leukemogenesis

The Coronavirus Disease 2019 (COVID-19) pandemic has become the worst pandemic in modern history. The lack of prior immunity to the virus has resulted in a high mortality rate, though children have fared better than adults, overall. We present a case of a child who developed B-cell acute lymphoblastic leukemia 1 week following a symptomatic COVID-19 infection. It is possible that this viral infection provided the "second hit" posited to occur in pediatric leukemogenesis as proposed by Dr Greaves, with his initial viral exposure occurring several weeks earlier.

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Nursing professionals' mental well‐being and workplace impairment during the COVID‐19 crisis: A Network analysis

AIM: To investigate the effects of years of nursing experience and mental health on work impairment among nurses during the COVID‐19 crisis. BACKGROUND: During the COVID‐19 crisis, nurses experience a greater psychological burden than other health care workers. Studies have not yet investigated the effects of years in nursing and mental health on potential work impairment during the COVID‐19 crisis in nurses. METHODS: A survey was administered to 83 nurses on active duty during the COVID‐19 crisis. The graphical LASSO and the DAG helped estimate the associations between years of nursing experience, mental health and work impairment. RESULTS: A moderate negative correlation emerged between years of nursing experience, avoidance and work impairment. A direct effect was observed between anxiety and work impairment. A moderate positive correlation emerged between anxiety, depression and work impairment. An indirect effect was observed between depression, burnout, insomnia, years of nursing experience and work impairment. CONCLUSIONS: In the present sample, nurses' work impairment decreased with greater years of nursing experience and increased with higher anxiety, depression, burnout and avoidance levels. IMPLICATIONS FOR NURSING MANAGEMENT: These findings can help design effective infectious disease management programmes for students and professionals in nursing to prevent breakdowns and avoid work impairment.

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Retrospective Evaluation of Various Serological Assays and Multiple Parameters for Optimal Diagnosis of Lyme Neuroborreliosis in a Routine Clinical Setting.

Laboratory diagnosis of Lyme neuroborreliosis (LNB) is challenging, and validated diagnostic algorithms are lacking. Therefore, this retrospective cross-sectional study aimed to compare the diagnostic performance of seven commercial antibody assays for LNB diagnosis. Random forest (RF) modeling was conducted to investigate whether the diagnostic performance using the antibody assays could be improved by including several routine cerebrospinal fluid (CSF) parameters (i.e., leukocyte count, total protein, blood-CSF barrier functionality, and intrathecal total antibody synthesis), two-tier serology on serum, the CSF level of the B-cell chemokine (C-X-C motif) ligand 13 (CXCL13), and a Borrelia species PCR on CSF. In total, 156 patients were included who were classified as definite LNB (n = 10), possible LNB (n = 7), or non-LNB patient (n = 139) according to the criteria of the European Federation of Neurological Societies using a consensus strategy for intrathecal Borrelia-specific antibody synthesis. The seven antibody assays showed sensitivities ranging from 47.1% to 100% and specificities ranging from 95.7% to 100%. RF modeling demonstrated that the sensitivities of most antibody assays could be improved by including other parameters to the diagnostic repertoire for diagnosing LNB (range: 94.1% to 100%), although with slightly lower specificities (range: 92.8% to 96.4%). The most important parameters for LNB diagnosis are the detection of intrathecally produced Borrelia-specific antibodies, two-tier serology on serum, CSF-CXCL13, Reibergram classification, and pleocytosis. In conclusion, this study shows that LNB diagnosis is best supported using multiparameter analysis. Furthermore, a collaborative prospective study is proposed to investigate if a standardized diagnostic algorithm can be developed for improved LNB diagnosis. IMPORTANCE The diagnosis of LNB is established by clinical symptoms, pleocytosis, and proof of intrathecal synthesis of Borrelia-specific antibodies. Laboratory diagnosis of LNB is challenging, and validated diagnostic algorithms are lacking. Therefore, this retrospective cross-sectional study aimed to compare the diagnostic performance of seven commercial antibody assays for LNB diagnosis. Multiparameter analysis was conducted to investigate whether the diagnostic performance using the antibody assays could be improved by including several routine (CSF) parameters. The results of this study show that LNB diagnosis is best supported using the detection of intrathecally produced Borrelia-specific antibodies, two-tier serology on serum, CSF-CXCL13, Reibergram classification, and pleocytosis. Furthermore, we propose a collaborative prospective study to investigate the potential role of constructing a diagnostic algorithm using multiparameter analysis for improved LNB diagnosis.

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Aortic thrombosis with persistently positiveantiphospholipid antibodies in a patient with COVID-19 pneumonitis

Background/AimsArterial thrombosis and positive antiphospholipid antibodies havebeen reported following COVID-19 infection. We report a case of aorticthrombosis occurring after COVID-19 pneumonitis, with persistentlypositive anticardiolipin antibodies.MethodsA 63-year-old lady presented with sudden onset of abdominal painradiating to the back, associated with vomiting. She reported feelingslightly breathless, and ten days prior to admission a throat swab forSARS-CoV-2 tested positive. Oxygen saturation was 96% (94-100%)on room air. Respiratory examination revealed minimal basal cracklesbilaterally. Her heart sounds were normal, and there was no carotid orsubclavian bruit. Radial, ulnar, brachial, subclavian and temporalpulses were intact and symmetrical. The abdomen was soft, but tenderover the right upper quadrant and epigastrium. Nailfolds were normal, and there was no livedo reticularis and no vasculitic rash. Initialinvestigations showed a CRP of 235 mg/L (&lt;5), White blood cell count15.2 x109/L (4.0-11.0), neutrophil count 12.6 x109/L (1.7-7.5). She wasreviewed by the surgical team and CT Thorax, Abdomen and Pelvisrequested due to the high CRP.ResultsCT showed a mild COVID pattern pneumonitis, inflammatory changesaround the infrarenal aorta containing irregular circumferential clot, raising the suspicion of aortitis. An autoimmune screen was requestedwith followingResultspositive IgM Anti-Cardiolipin Antibodies (ACL) at 34.6 U/mL (0.0-20.0), IgG ACL 8.5 U/mL (0.0-20.0), Anti-B2-GP1 (B2GP1) Antibodiesnegative, Lupus anticoagulant (LAC) was not tested as patient wasalready on Low Molecular Weight Heparin (LMWH). ANA screen, AntiENA screen, ANCA screen, Crithidia Lucillae (dsDNA), RF, Anti-CCPAntibodies, Complement C3 and C4 were all negative. No steroidtreatment was commenced. The patient then self-discharged againstmedical advice and was reviewed as an out-patient. CT scan wasreviewed by a vascular radiologist who confirmed the suspicion ofaortitis. Subsequently, a 5-Fluorodeoxyglucose-Positron EmissionTomography (FDG PET) CT scan showed no evidence of active, ongoing large vessel vasculitis. A short, linear focus of mild increasedFDG uptake associated with some calcification within the left lateralabdominal aortic wall was more typical of atheromatous disease thanvasculitis. LMWH was switched to long-term warfarin. She has nowfully recovered from COVID and has remained well. Repeat Antiphospholipid screen taken more than 12 weeks later showed apositive IgM ACL (40.2 U/mL), and negative IgG ACL and B2GP1.Once again LAC was not tested as the patient has continued warfarin.IgM ACL positivity following COVID-19 infection has been reported byseveral other centres.ConclusionOur understanding of the significance of positive antiphospholipidantibodies and COVID-19 infection is evolving. Further research isneeded to establish if there is a relationship between COVID-19infection, thrombosis and positive ACL or if this is an epiphenomenon.

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Analysis of the Effects of COVID-19 Mask Mandates on Hospital Resource Consumption and Mortality at the County Level

Coronavirus disease 2019 (COVID-19) threatens vulnerable patient populations, resulting in immense pressures at the local, regional, national, and international levels to contain the virus. Laboratory-based studies demonstrate that masks may offer benefit in reducing the spread of droplet-based illnesses, but few data are available to assess mask effects via executive order on a population basis. We assess the effects of a county-wide mask order on per-population mortality, intensive care unit (ICU) utilization, and ventilator utilization in Bexar County, Texas. METHODS: We used publicly reported county-level data to perform a mixed-methods before-and-after analysis along with other sources of public data for analyses of covariance. We used a least-squares regression analysis to adjust for confounders. A Texas state-level mask order was issued on July 3, 2020, followed by a Bexar County–level order on July 15, 2020. We defined the control period as June 2 to July 2 and the postmask order period as July 8, 2020–August 12, 2020, with a 5-day gap to account for the median incubation period for cases; longer periods of 7 and 10 days were used for hospitalization and ICU admission/death, respectively. Data are reported on a per-100,000 population basis using respective US Census Bureau–reported populations. RESULTS: From June 2, 2020 through August 12, 2020, there were 40,771 reported cases of COVID-19 within Bexar County, with 470 total deaths. The average number of new cases per day within the county was 565.4 (95% confidence interval [CI] 394.6–736.2). The average number of positive hospitalized patients was 754.1 (95% CI 657.2–851.0), in the ICU was 273.1 (95% CI 238.2–308.0), and on a ventilator was 170.5 (95% CI 146.4–194.6). The average deaths per day was 6.5 (95% CI 4.4–8.6). All of the measured outcomes were higher on average in the postmask period as were covariables included in the adjusted model. When adjusting for traffic activity, total statewide caseload, public health complaints, and mean temperature, the daily caseload, hospital bed occupancy, ICU bed occupancy, ventilator occupancy, and daily mortality remained higher in the postmask period. CONCLUSIONS: There was no reduction in per-population daily mortality, hospital bed, ICU bed, or ventilator occupancy of COVID-19-positive patients attributable to the implementation of a mask-wearing mandate.

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