Comparison of emotional approaches of medical doctors against COVID-19 pandemic: Eastern and Western Mediterranean countries

Background: Pandemics are states of disease that occur worldwide and sharply increase in populations. It causes life events which trigger anxiety, depression, anger, sleep deprivation, emotional distress and stress. World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic on March 11, pointing to the over 118,000 cases in over 110 countries. Many healthcare workers became ill during the pandemic and some among them died. In this study, we aimed to evaluate and compare level of stress against COVID-19 pandemic among doctors from Turkey and Italy. Methods: This research is a cross-sectional study in which Perceived Stress Scale (PSS-10) and Secondary Traumatic Stress Scale (STSS) are administered online via social networks. All data collection tools were delivered to individuals between 1 and 15 June 2020 and filled in online with Google Forms application. In total, 618 individuals were included in this study and all of them were medical doctors. Results: Higher PS and STS levels were found related to female gender, being married, working in pandemic hospital and older ages. Stress levels were found statistically higher in Turkish doctors when compared to Italian doctors for both stress scales (Turkish/Italian PSS:20.18 ± 7.90/ 19.35 ± 6.71, STSS: 44.19 ± 13.29/ 38.83 ± 13.74). Conclusion: The number of doctors per 1000 of population is lower and per capita visits to a physician are higher in Turkey when compared to Italy. Besides pandemic, these heavier working conditions, increased weekly working hours can cause stress for Turkish doctors. Reporting information such this study is important and international collaborations are essential to plan future prevention strategies. We need to strengthen international ties and build more international collaborations rather than staying within our national silos. Additionally, interventions to promote mental well-being in health care professionals exposed to COVID-19 need to be immediately implemented

Impact of intrauterine growth restriction on cerebral and renal oxygenation and perfusion during the first 3 days after birth

Intrauterine growth restriction (IUGR) is associated with a higher incidence of perinatal complications as well as cardiovascular and renal diseases later on. A better insight into the disease mechanisms underlying these sequalae is important in order to identify which IUGR infants are at a higher risk and find strategies to improve their outcome. In this prospective case–control study we examined whether IUGR had any effect on renal and cerebral perfusion and oxygen saturation in term neonates. We integrated near-infrared spectroscopy (NIRS), echocardiographic, Doppler and renal function data of 105 IUGR infants and 105 age/gender-matched controls. Cerebral and renal regional oxygen saturation values were measured by NIRS during the first 12 h after birth. Echocardiography alongside Doppler assessment of renal and anterior cerebral arteries were performed at 6, 24, 48 and 72 h of age. Glomerular and tubular functions were also assessed. We found a left ventricular dysfunction together with a higher cerebral oxygen saturation and perfusion values in the IUGR group. IUGR term infants showed a higher renal oxygen saturation and a reduced oxygen extraction together with a subclinical renal damage, as indicated by higher values of urinary neutrophil gelatinase-associated lipocalin and microalbumin. These data suggest that some of the haemodynamic changes present in growth-restricted foetuses may persist postnatally. The increased cerebral oxygenation may suggest an impaired transition to normal autoregulation as a consequence of intra-uterine chronic hypoxia. The higher renal oxygenation may reflect a reduced renal oxygen consumption due to a subclinical kidney damage

Proceedings of the 24th Paediatric Rheumatology European Society Congress: Part three

From Springer Nature via Jisc Publications Router.Publication status: PublishedHistory: collection 2017-09, epub 2017-09-0

The frequency and clinical course of SARS-COV2 infection in children with juvenile idiopathic arthritis

Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), first reported from the Wuhan city of China in December 2019, swept the world in a few months and became a global health emergency of primary international concern continues to be a priority health problem. Recent studies suggest that subjects with autoimmune disorders (JIA, RA, SLE) do not have an increased risk to get Sars-Cov2. Juvenile Idiopathic Arthritis (JIA) is an inflammatory chronic disease concerning joints and others structures. According to International League of Association for Rheumatology (ILAR) seven subtypes of arthritis can be defined in relation with the number of joints and the extra-articular involvement occurring in the first six months of disease. NSAIDs and intra-articular steroids represent the first line treatment for JIA. Systemic steroids, disease modifying anti-rheumatic drugs (DMARDs) and biologic drugs are used in children with severe disease. Objectives: To evaluate the incidence and the impact on the disease course of Sars-cov2 infection in a group of children affected from juvenile idiopathic arthritis in treatment with Methotrexate and/or biological drugs. Methods: This study includes 77 children affected from JIA (55 females, 22 males). JIA diagnosis was made according to ILAR criteria and treatment was assigned with recommendations of the American College of Rheumatology. For each patient we recorded the type and the duration of pharmacological treatment, JIA subtype and relapses (defined according to Wallace criteria). During follow up visit from Nov 1st, 2020 to April 30th, 2021 we investigated in each patient history of Sars-Cov2 infection and related symptoms, diagnostic tests for Sars-Cov2. Results: The mean age at the last follow-up visit was 13.3±5.61 years. Thirteen out of 77 patients was affected Sars-Cov2 infection, none of them needed to be hospitalized. The most common symptom was headache (8 of 13 patients), followed by myalgia (6 of 13), fever (4 of 13), anosmia or dysgeusia (3 of 13), upper respiratory tract symptoms (3 of 13) and nausea (3 of 13). Five out of 13 patients were asymptomatic (38,5%). The mean duration of Sars-Cov2 infection was 12,5 days (confirmed with nose pharyngeal swab). In the group of patients with Sars-Cov2 infection 4 of 13 (30%) were in treatment with MTX, 2 of 13 (15%) with both MTX and biological drugs, 5 of 13(38%) with biological drugs, 2 of 13 (15%) with NSAIDs. In the group of patients without Sars-Cov2 infection 37 of 64 (48%) patients were in treatment with MTX, 32 of 64 (41,5%) with biological drugs, 18 of 64 (28%) with both MTX and biological drugs, 10 of 64 (15,6%) with NSAIDs. We didn’t find a higher risk to contract Sars-Cov2 infection in patients under MTX treatment (48% vs 46.15 %; p value 0.6416), in ones under MTX and biological drugs (28.1% vs 15.4%p value 0.543) or in ones under only biological therapy (50% vs 53.8% ; p value 0.231). We found that in patient with JIA the risk to get Sars-Cov2 infection is not related to the treatment. The percentage of JIA relapses was higher in patients with Sars-Cov2 infection than in the ones without infection (53,8% vs 9%; p value 0.0004). Conclusion: Treatment with MTX or biological drugs did not increase the risk to get Sars-Cov2 infection. The frequency of JIA relapses was higher in patients who got Sars-Cov2 infection than in ones who didn’t get i

When amputation is not the end of the challenge: A successful therapy for osteomyelitis and soft tissue infection in a patient with type 1 diabetes

Infection is a common complication in patients with diabetic foot ulcer, leading to lower extremities amputation and healing failure. In this article, we report the case of a 39-year-old man with diabetes who developed a severe soft tissue infection and osteomyelitis after experiencing a major amputation for wet gangrene of both the foot and the ankle

Leg pain in a 4 year-old child with selective diet, think about scurvy!

Introduction: Scurvy is the disease generated by the lack of vitamin C, although it is considered a rare and past disease, scurvy continues to be detected in children with neurodevelopmental disorders and with restricted and selective diet habits. Clinical features are hypertrophy, swelling and bleeding of the gums, follicular hyperkeratosis, lower limbs swelling and tenderness. Identifying scurvy could be demanding due to the perceived rarity of the condition, and it could become a tricky diagnostic question given to the variety of nonspecific symptoms, including gingival manifestations. Objectives: Here we present a case report of Scurvy in a 4 year-old child. Methods: A 4 year-old child presented to our Department with lower limbs pain and refusal to walk for about 4 months. The symptoms were partially managed with Non Steroidal antinfiammatory Drugs. Patient’s mother did not refer ferver, skin rash or weight loss. Patient psychomotor development was referred in the norm up to 7-8 months of age, then patient presented a delay of psychomotor and language development. Dietary history reveals highly selective eating since the second year, based exclusively on ham and white meat homogenized, with refusal of fruits and vegetables. Since about 1 year the mother reports difficulty in eating, and several episodes of gengivitis with antivirals and topical antifungals with partial benefit. When patient came to our department he was in fair general conditions, his weight was 17 kg (25-50 th), his height was 105 cm.(25-50 th). Physical examination althought difficult because of the patient’s developmental delay revealed :pale and dry skin, corkscrew hair, signs of follicular hyperkeratosis in the lower and upper limbs. Child refused to walk, with legs fixed in flexion at hips and knees (“Frog leg-position”). Both legs were diffusely tender to palpation. The child was uncooperative for oral examination but erythematous, hemorrhagic, and swollen gums in maxillary anterior region were noted. Blood examinations revealed low iron and vitamin D level, inflammatory parameters (C-reactive ptotein and erythrocyte sedimentation rate) were normal. Hips, knees and ankle ultrasound did not revealed joints effusion. X-ray of the lower limbs did not revealed fractures, but generalized osteopenia and typical features of malnutrition, including a ground glass appearance, Pelkan spur, which represents a healing metaphyseal pathologic fracture, and a Wimberger ring sign, which denotes a thin sclerotic cortex surrounding a lucent epiphysis. Periosteal new bone formation secondary to subperiosteal, hemorrhage, a dense provisional calcification immediately adjacent to the physis (Frankel line), and an adjacent lucent band more, diaphyseal in location (Trummerfeld line). Results: In consideration of personal history, result of blood examinations and of lower limbs X-ray, we hypothesized a state of vitamin C deficiency. This clinical suspicion was confirmed by the finding of low levels serum vitamin C <2.4 micromol / L (normal value 26.1-84.6). Supplementary treatment with oral vitamin C (300 mg daily) and D (800 UI daily) was started . Patient clinical condition improved with recovery of walking. One month after discharge, the boy had normal vitamins’ levels: 35,6 micromol/L (normal value 26.1-84.6). Conclusion: Scurvy is rare, but it still occurs among children with autism and developmental disorders, so this condition should be keep in mind in a clinical constellation of lower extremity pain, limp, recurrent gengivitis, fatigue, anemia, in particular in children with an history of selective diet. The adoption of a detailed dietary anamnesis is fundamental to the early recognition of nutritional deficiency diseases in order to avoid invasive procedures and/or their severe complications