COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Background and objectives: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Shear Bond Strength of Orthodontic Brackets Luted with RMGIC After Er:YAG Laser Etching with Two Pulse Modes Using a Digitally Controlled "X-Runner" Handpiece

Objective: To compare the shear bond strength (SBS) values of orthodontic brackets luted using a resin-modified glass ionomer cement (RMGIC) on enamel surfaces etched using either an Er:YAG laser in two different working modes, or a conventional etching protocol, including phosphoric acid. Materials and methods: Sixty healthy human premolars were randomly allocated to three experimental groups (n\u2009=\u200920) and etched with: Group 1: Er:YAG laser in super-short pulse (SSP) mode (100\u2009mJ, 20\u2009Hz, 2\u2009W); Group 2: Er:YAG laser in quantum square pulse mode (120\u2009mJ, 10\u2009Hz, 1.2\u2009W) using a digitally controlled handpiece (\u201cX-Runner\u201d); Group 3 (control): 5.25% sodium hypochlorite pretreatment, then 37% phosphoric acid for 15\u2009sec. Stainless steel brackets were bonded using light-curing RMGIC for orthodontic bonding. After term cycling (1800 cycles), SBS testing was performed using a universal testing machine. After debonding, both enamel and bracket surfaces were examined to determine the amount of RMGIC still present on the surfaces. Results: Group 3 surfaces gave the lowest mean SBS (10.6104\u2009\ub1\u20092.66196\u2009MPa), whereas Group 1 provided the highest 1 (13.1795\u2009\ub1\u20093.37904\u2009MPa), which was significantly different from the control (Group 3, p\u2009=\u20090.0226). Group 2 provided intermediate values (11.8486\u2009\ub1\u20090.59832\u2009MPa) nonsignificantly different from the control or from SSP (p\u2009=\u20090.4215 and p\u2009=\u20090.3082, respectively). Conclusions: Er:YAG laser treatment in SSP mode of enamel surfaces for orthodontic bonding provided higher SBS and a shear behavior of the luting material similar to the conventional acid-etching procedures, making it a viable alternative to acid etching

Push-out bond strength of three different calcium silicate-based root-end filling materials after ultrasonic retrograde cavity preparation

Objective: The aim of this study was to evaluate the bond strength of three calcium silicate-based root-end filling materials. Materials and methods: The root canals of 30 single-rooted teeth were endodontically treated; their root ends were resected and root-end cavities were prepared using ultrasonic tip. The teeth were randomly divided into three groups according to the material: (1) Micro-Mega mineral trioxide aggregate (MM-MTA), (2) Biodentine, and (3) TotalFill root repair material (RRM). Push-out test was performed using universal testing machine, and failure mode was analyzed by stereomicroscope. The data were statistically analyzed using Kruskal-Wallis and Man-Whitney post hoc tests. All p values < 0.05 were considered significant. Results: TotalFill RRM exhibited significantly higher bond strength (12.69\ua0MPa) than Biodentine (9.34\ua0MPa, p\ua0=\ua00.023) and MM-MTA (7.89\ua0MPa, p\ua0=\ua00.002). The difference between Biodentine and MM-MTA was not significant (p\ua0=\ua00.447). Mixed failures were the most noted in all three groups. MM-MTA had more adhesive failures than Biodentine and TotalFill, and no cohesive failures, but without statistical significance (p\ua0=\ua00.591). Conclusion: The bond strength was the highest for TotalFill RRM. Clinical relevance: In order to provide a persistent apical seal, root-end filling materials should resist dislodgement under static conditions, during function and operative procedures. TotalFill RRM exhibited higher bond strength to dentin than MM-MTA and Biodentine

Emerging Zoonoses: the “One Health Approach”

Zoonoses represent a public health risk recently pointed out by the spreading of previously unknown human infectious diseases emerging from animal reservoirs such as severe acute respiratory syndrome and avian influenza caused by H5N1-virus. These outbreaks have shown that animal breeding activities can pose a significant public health risk. Until now, the risk of zoonoses has probably been underestimated, particularly in occupational settings. The emergence or re-emergence of bacterial (Mycobacterium bovis and Brucella spp) or viral (hepatitis E virus) infections shows that zoonoses should be considered as emerging risks in agricultural and animal breeding and should be addressed by specific preventive interventions. Close cooperation and interaction between veterinarians, occupational health physicians and public health operators is necessary, for a worldwide strategy to expand interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment. This is what the One Health Approach was intended to be

Signs and symptoms of COVID-19 in patients with multiple sclerosis

Background and purpose Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID-19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID-19 in MS patients and identify all factors associated with their manifestation. Method Logistic and linear regression models were run to recognize factors associated with each pooled group of symptoms and their total number. Results From March 2020 to November 2021, data were collected from 1354 MS patients with confirmed infection of COVID-19. Ageusia and anosmia was less frequent in older people (odds ratio [OR] 0.98; p = 0.005) and more in smoker patients (OR 1.39; p = 0.049). Smoke was also associated with an incremental number of symptoms (OR 1.24; p = 0.031), substance abuse (drugs or alcohol), conjunctivitis and rash (OR 5.20; p = 0.042) and the presence of at least one comorbidity with shortness of breath, tachycardia or chest pain (OR 1.24; p = 0.008). Some disease-modifying therapies were associated with greater frequencies of certain COVID-19 symptoms (association between anti-CD20 therapies and increment in the number of concomitant symptoms: OR 1.29; p = 0.05). Differences in frequencies between the three waves were found for flu-like symptoms (G1, p = 0.024), joint or muscle pain (G2, p = 0.013) and ageusia and anosmia (G5, p &lt; 0.001). All cases should be referred to variants up to Delta. Conclusion Several factors along with the choice of specific therapeutic approaches might have a different impact on the occurrence of some COVID-19 symptoms

SARS-CoV-2 serology after COVID-19 in multiple sclerosis: An international cohort study

Background: The MuSC-19 project is an Italian cohort study open to international partners that collects data on multiple sclerosis (MS) patients with COVID-19. During the second wave of the pandemic, serological tests became routinely available. Objective: To evaluate the seroprevalence of anti-SARS-CoV-2 antibodies according to the use of disease-modifying therapy (DMT) in a subset of patients included in the MuSC-19 data set who had undergone a serological test. Methods: We evaluated the association between positive serological test results and time elapsed since infection onset, age, sex, Expanded Disability Status Scale score, comorbidities and DMT exposure using a multivariable logistic model. Results: Data were collected from 423 patients (345 from Italy, 61 from Turkey and 17 from Brazil) with a serological test performed during follow-up. Overall, 325 out of 423 tested patients (76.8%) had a positive serological test. At multivariate analysis, therapy with anti-CD20 was significantly associated with a reduced probability of developing antibodies after COVID-19 (odds ratio (OR) = 0.20, p = 0.002). Conclusion: Patients with MS maintain the capacity to develop humoral immune response against SARS-COV-2, although to a lesser extent when treated with anti-CD20 drugs. Overall, our results are reassuring with respect to the possibility to achieve sufficient immunization with vaccination

Signs and symptoms of COVID-19 in patients with multiple sclerosis

Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID-19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID-19 in MS patients and identify all factors associated with their manifestation