Post-COVID-19 arthritis: a case report and literature review

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is the novel pathogen responsible for the coronavirus disease 19 (COVID-19) outbreak. Researchers and clinicians are exploring the pathogenetic mechanisms of the viral-induced damage and growing interest is focusing on the short-term and long-term immune-mediated consequences triggered by the infection. We will focus on post-SARS-CoV2 infection arthritis which may arise as a new pathological condition associated with COVID-19. In this article, we describe a case of acute oligoarthritis occurring 13 days after a SARS-CoV2 severe pneumonia in a middle-aged Caucasian man and we go over a brief review of the current available literature. We hypothesize that molecular mimicry might be the basic immunological mechanism responsible for the onset of COVID-19-related arthritis based on the current knowledge of SARS-CoV2 and on the known pathogenetic mechanism of viral-induced arthritis

Acute noradrenergic activation induces insulin resistance in human skeletal muscle

We assessed in normal subjects the effects of an acute increase in forearm norepinephrine (NE) release, evoked by -20 mmHg lower body negative pressure (LBNP), on insulin-mediated muscle glucose uptake. Seven normal subjects underwent the following two insulin euglycemic clamps in random sequence: one during application of LBNP and the other without LBNP (control study). In the control study, hyperinsulinemia (approximately 60 microU/ml) produced a significant increment in forearm NE release, measured by using the forearm perfusion technique combined with infusion of tritiated NE (from 4.91 +/- 1 to 7.94 +/- 1.33 ng.l-1.min-1; P < 0.05). Forearm glucose uptake rose from 0.97 +/- 0.13 to 5.2 +/- 0.2 mg.l-1.min-1 in response to insulin infusion. When the insulin clamp was performed during LBNP, forearm NE release rose to significantly higher values than those of the control study (from 4.33 +/- 0.52 to 12.7 +/- 1.46 ng.l-1.min-1; P < 0.01 vs. control). Under these conditions, the stimulatory effect of insulin on forearm glucose uptake was markedly reduced (from 0.78 +/- 0.10 to 3.2 +/- 0.7 mg.l-1.min-1; P < 0.02 vs. control). Forearm blood flow and plasma epinephrine and free fatty acid concentrations were comparable in the two study sessions. These data demonstrate that an acute activation of endogenous NE release antagonizes insulin-mediated glucose uptake in forearm skeletal muscle, probably accounted for by a direct metabolic effect of NE.We assessed in normal subjects the effects of an acute increase in forearm norepinephrine (NE) release, evoked by -20 mmHg lower body negative pressure (LBNP), on insulin-mediated muscle glucose uptake. Seven normal subjects underwent the following two insulin euglycemic clamps in random sequence: one during application of LBNP and the other without LBNP (control study). In the control study, hyperinsulinemia (≃60 μU/ml) produced a significant increment in forearm NE release, measured by using the forearm perfusion technique combined with infusion of tritiated NE (from 4.91 ± 1 to 7.94 ± 1.33 ng · l -1 · min -1 ; P < 0.05). Forearm glucose uptake rose from 0.97 ± 0.13 to 5.2 ± 0.2 mg · l -1 · min -1 in response to insulin infusion. When the insulin clamp was performed during LBNP, forearm NE release rose to significantly higher values than those of the control study (from 4.33 ± 0.52 to 12.7 ± 1.46 ng · l -1 · min -1 ; P < 0.01 vs. control). Under these conditions, the stimulatory effect of insulin on forearm glucose uptake was markedly reduced (from 0.78 ± 0.10 to 3.2 ± 0.7 mg · l -1 · min -1 ; P < 0.02 vs. control). Forearm blood flow and plasma epinephrine and free fatty acid concentrations were comparable in the two study sessions. These data demonstrate that an acute activation of endogenous NE release antagonizes insulin-mediated glucose uptake in forearm skeletal muscle, probably accounted for by a direct metabolic effect of NE

Elevated myocardial and lymphocyte GRK2 expression and activity in human heart failure.

The G protein-coupled receptor kinase-2 (GRK2 or beta-ARK1) regulates beta-adrenergic receptors (beta-ARs) in the heart, and its cardiac expression is elevated in human heart failure (HF). We sought to determine whether myocardial levels and activity of GRK2 could be monitored using white blood cells, which have been used to study cardiac beta-ARs. Moreover, we were interested in determining whether GRK2 levels in myocardium and lymphocytes may be associated with beta-AR dysfunction and HF severity.In myocardial biopsies from explanted failing human hearts, GRK activity was inversely correlated with beta-AR-mediated cAMP production (R(2)=-0.215, P<0.05, n=24). Multiple regression analysis confirmed that GRK activity participates with beta-AR density to regulate catecholamine-sensitive cAMP responses. Importantly, there was a direct correlation between myocardial and lymphocytes GRK2 activity (R(2)=0.5686, P<0.05, n=10). Lymphocyte GRK activity was assessed in HF patients with various ejection fractions (EFs) (n=33), and kinase activity was significantly higher in patients with lower EFs and was higher with increasing NYHA class (P<0.001).Myocardial GRK2 expression and activity are mirrored by lymphocyte levels of this kinase, and its elevation in HF is associated with the loss of beta-AR responsiveness and appears to increase with disease severity. Therefore, lymphocytes may provide a surrogate for monitoring cardiac GRK2 in human HF

Emergency Department as an epidemiological observatory of Human Mobility: the experience of the Moroccan population

We conducted a retrospective study of the accesses to the Emergency Department registered from January 2000 to December 2014 in 5 major hospitals in the Metropolitan Area of Rome. We extrapolated data relating to patients of Moroccan origin from about 5 million total accesses, so we compared with Italians data which, in the same period, came to ED. The Moroccan population is distinguished by a larger number of diagnoses belonging to the ICD-9 code of Infectious Diseases and, more precisely, to Respiratory Infectious Diseases. There are also no differences in the assignment of such diagnoses to Moroccans with Italian citizenship, and this led to think that this could play an important role in the use of the ED and moreover that enrollment to the National Health Service may reduce its inappropriate use. Regarding to Degenerative Disorders, the result of our analysis is quite emblematic, showing that the accesses to the ED is due to Cardiovascular Diseases: 6.33% of Italians' accesses against 1.81% of Moroccans and 2.36% of Moroccans with Italian citizenship. The main explanation for this difference is, obviously, due to the age of the population: about 60% of Moroccans who accessed to ED was less than 40 years old. It is interesting how, in the field of ​​Cardiovascular Diseases, Moroccans have a lower percentage of diagnosis compared to Italians for acute diseases and a greater percentage of diagnoses for chronic diseases, suggesting once again that accesses to ED for migrants often is due to the inability to use the general services of the National Health Service. In conclusion, from the point of view of the Emergency Department, Migration Medicine still has Infectious Diseases as the main reason for access. Degenerative Disorders remain a prerogative of the Italians, but we could certainly assume that the Moroccan population would develop at some point with the aging

Clastic vs. primary precipitated evaporites in the Messinian sicilian Basins

The Messinian stratigraphy of Sicily has a particular importance for the comprehension ofthe Messinian salinity crisis as its successions bear the greatest similarity with those of thedeep Mediterranean basins. Despite the large number of studies carried out in the last 30years, we believe that the true time and genetic relationships between the different evaporiticand non evaporitic rock bodies are still not well established. This is probably due to thelimited, partial view offered by the central Sicilian basin, despite its complete Messinianstratigraphic record.Clastic and chaotic evaporitic deposits emplaced by tectonically-driven small to largescaleresedimentation processes form an important part of the MSC record of Sicily in theBelice and Caltanissetta basins. Facies characteristics of clastic evaporites, the stratigraphicrelationships with the other Messinian deposits, their possible significance in the regionalgeological evolution and the implications at a Mediterranean scale will be discussed in thefield. Attention also will be paid to primary precipitated facies of Lower and UpperEvaporites.The main aim of this field trip is to visit and discuss, beside some of the classic localitiesof the Caltanissetta basin, other less known outcrops of western Sicily (Belice basin), inorder to have a more complete regional geological framework of the MSC events in Sicily.This will give the participants the opportunity to discuss many of the still open problemsconcerning the MSC. In this section we suggest some topics for discussion during the fieldtrip

CPO and quantitative textural analyses within sheath folds

Acknowledgments This has been a multi-national collaboration from authors based in Europe, North America, Australia and India. Erasmus funding to GIA in 2018 enabled a visit to Catania leading to discussion and initiation of this project. The authors are grateful to Amarnath Dandapat for preparation of superpolished rock thin sections at the Department of Geology and Geophysics (IIT Kharagpur, India). Niloy Bhowmik is thanked for assistance with SEM-EBSD data generation in the Central Research Facility (IIT Kharagpur, India). E.F. thanks Sibio Carmelo for thin sections preparation at the University of Turin (Italy). Authors are grateful to ANSTO laboratory personnel for the preparation of specimens (funded proposals: P9835 with the title “Sheath fold texture characterisation”, principal scientist: E.F.; co-proposers: G.I.A. and V.L.; DB6749 with the title “Texture analysis of rocks”, principal scientist: V.L.; co-proposer: E.F.; DB9606 with the title “A pilot experiment for texture characterisation in a sheath fold”, principal scientist: E.F..; co-proposers: G.I.A. and V.L.). L.N. and R.G. report that this publication has been assigned the NRCan contribution number 20230109. Many thanks to Richard D. Law and an anonymous reviewer for their careful revision that substantially improved the original version of the manuscript. We also thanks Dr. T.K. Cawood from the Geological Survey of Canada for her useful comments on the drafted manuscript. The editorial handling by Fabrizio Agosta is greatly appreciated.Peer reviewedPublisher PD

Digitally enabled health service for the integrated management of hypertension: A participatory user-centred design process

This article describes a user-centred approach taken by a group of five procurers to set specifications for the procurement of value-based research and development services for IT-sup-ported integrated hypertension management. The approach considered the unmet needs of patients and health systems of the involved regions. The procurers established a framework for requirements and a solution design consisting of nine building blocks, divided into three domains: service delivery, devices and integration, and health care organisation. The approach included the development of questionnaires, capturing patients’ and professionals’ views on possible system functionalities, and a template collecting information about the organisation of healthcare, professionals involved and existing IT systems at the procurers’ premises. A total of 28 patients diagnosed with hypertension and 26 professionals were interviewed. The interviewees identified 98 functional requirements, grouped in the nine building blocks. A total of nine use cases and their corresponding process models were defined by the procurers’ working group. As result, a digitally enabled integrated approach to hypertension has been designed to allow citizens to learn how to prevent the development of hypertension and lead a healthy lifestyle, and to receive comprehensive, individualised treatment in close collaboration with healthcare professionals