Social representations of coronavirus/COVID-19 in Italy: Psychosocial anchoring to conspiracy beliefs, vaccine hesitancy, and the psychological dimension

From the societal approach of the Theory of Social Representations, this study aimed to investigate the social representations of coronavirus/COVID-19 among the Italian population. By means of an online questionnaire, 599 individuals participated in the research, with a mean age of 38.09 years (SD = 14.44), 62.1% being women. The instrument was composed of sociodemographic questions, free association technique for the inductive term “coronavirus/COVID-19” and scales on conspiracy beliefs, vaccine hesitancy, and psychological dimension. The results allowed us to identify four social representations: “Citizens driven by Social Representations anchored to factual Covid-19 pandemic data,” with lower vaccine hesitancy and conspiracy beliefs, and greater faith in science; “Citizens with low confidence in anti-pandemic preventive measures by government,” with lower agreement with restriction measures; “Emotional people,” with higher agreement with restriction measures and expression of psychological distress; and “Minority group of Citizens driven by denial of Covid-19,” with higher vaccine hesitancy and conspiracy beliefs. We discuss the different social representations identified from the psychological and psychosocial anchoring processes in the context of the COVID-19 pandemic

CReAMA: Uma Arquitetura de Referência para o Desenvolvimento de Sistemas Colaborativos Móveis Baseados em Componentes.

Sistemas colaborativos são sistemas que suportam dois ou mais usuários engajados em uma tarefa comum, fornecendo uma interface para um ambiente compartilhado para esses usuários e as aplicações móveis se tornaram uma parte importante das ferramentas de suporte à colaboração. Quando usados no contexto de mobilidade, sistemas colaborativos podem ser chamados de sistemas colaborativos móveis. Esses sistemas possibilitam, por exemplo, que equipes cooperem enquanto estão em movimento, aumentando o potencial da colaboração. Ferramentas para apoiar desenvolvedores de software são muito importantes de uma forma geral, mas no que diz respeito à colaboração móvel, ferramentas se tornam fundamentais principalmente por se tratar de uma área multidisciplinar que lida com muitas questões técnicas. Porém, sem uma base de requisitos ou modelos que mapeiam esses requisitos para se apoiar, muitas vezes o ferramental pode se tornar inutilizado ou pouco útil. Torna-se com isso de grande importância prover suporte ao desenvolvimento de sistemas colaborativos móveis por meio de um conjunto de ferramentas e métodos que apoiem o desenvolvedor na criação desses sistemas. Devido a isto, neste trabalho foi desenvolvida CReAMA, uma arquitetura de referência para orientar o desenvolvimento de sistemas colaborativos móveis orientados a componentes. Além da definição da arquitetura de referência também foi realizada uma avaliação de CReAMA com o intuito de observar com uma visão abrangente a validade da proposta

The challenge of perioperative pain management in opioid-tolerant patients

The increasing number of opioid users among chronic pain patients, and opioid abusers among the general population, makes perioperative pain management challenging for health care professionals. Anesthesiologists, surgeons, and nurses should be familiar with some pharmacological phenomena which are typical of opioid users and abusers, such as tolerance, physical dependence, hyperalgesia, and addiction. Inadequate pain management is very common in these patients, due to common prejudices and fears. The target of preoperative evaluation is to identify comorbidities and risk factors and recognize signs and symptoms of opioid abuse and opioid withdrawal. Clinicians are encouraged to plan perioperative pain medications and to refer these patients to psychiatrists and addiction specialists for their evaluation. The aim of this review was to give practical suggestions for perioperative management of surgical opioid-tolerant patients, together with schemes of opioid conversion for chronic pain patients assuming oral or transdermal opioids, and patients under maintenance programs with methadone, buprenorphine, or naltrexone

The Occipital Nerves Applied Strain Test to Support Occipital Neuralgia Diagnosis

Introduction: Occipital neuralgia (ON) is a disabling cephalalgia form with demanding diagnostic workflow. We report the description and reliability analyses of the occipital nerves applied strain (ONAS) test for occipital neuralgia (ON) early-stage diagnosis in cephalalgia patients. Methods: In a retrospective and observational study, we evaluated, among n = 163 consecutive cephalalgia patients, the sensitivity, specificity, and prior probability [positive (PPV) and negative (NPV) predictive values] of the ONAS test against two reference tests (occipital nerve anesthetic block and the painDETECT questionnaire). Multinomial logistic regression (MLR) and v2 analyses verified the ONAS test outcome’s dependence upon independent variables (gender, age, pain site, block test, and painDETECT outcomes). We assessed inter-rater agreement with Cohen’s kappa statistic. Results: ONAS test showed sensitivity and specificity of 81 and 18%, respectively, against the painDETECT and of 94 and 46%, respectively, against the block test. PPV was >70% against both tests, while NPV was 81% against the block test and 26% against the painDETECT. Interrater agreement Cohen’s kappa was excellent. Significant association (X2 analyses) and relationship (MLR) were found only between ONAS test and pain site but not with the other independent predictors. Conclusions: The ONAS test showed satisfactory reliability among cephalalgia patients; thus, it might be considered a valuable early stage tool for ON diagnosis in these patients.PLAIN LANGUAGE SUMMARY We report the description and reliability features of an occipital neuralgia diagnostic tool. The latter is based on the assertion that applying a strain on putatively compromised occipital nerves prompts abnormal nerve discharges and subjective pain reactions and thus may reveal occipital neuralgia. Among 163 cephalalgia patients, the test showed sensitivity and specificity of 81 and 18%, respectively, against the painDETECT questionnaire and 94 and 46%, respectively, against the occipital nerves’ block test. Interrater agreement was excellent, and significant associations and relationships were found only between the tool and congruent pain site but not with the other independent predictors. This tool may help clinicians’ early detection of occipital neuralgia in cephalalgia patients

Genomic characterization of Achromobacter species isolates from chronic and occasional lung infection in cystic fibrosis patients

Achromobacter species are increasingly being detected in cystic fibrosis (CF) patients, where they can establish chronic infections by adapting to the lower airway environment. To better understand the mechanisms contributing to a successful colonization by Achromobacter species, we sequenced the whole genome of 54 isolates from 26 patients with occasional and early/late chronic lung infection. We performed a phylogenetic analysis and compared virulence and resistance genes, genetic variants and mutations, and hypermutability mechanisms between chronic and occasional isolates. We identified five Achromobacter species as well as two non-affiliated genogroups (NGs). Among them were the frequently isolated Achromobacter xylosoxidans and four other species whose clinical importance is not yet clear: Achromobacter insuavis, Achromobacter dolens, Achromobacter insolitus and Achromobacter aegrifaciens. While A. insuavis and A. dolens were isolated only from chronically infected patients and A. aegrifaciens only from occasionally infected patients, the other species were found in both groups. Most of the occasional isolates lacked functional genes involved in invasiveness, chemotaxis, type 3 secretion system and anaerobic growth, whereas the great majority (>60%) of chronic isolates had these genomic features. Interestingly, almost all (n=22/23) late chronic isolates lacked functional genes involved in lipopolysaccharide production. Regarding antibiotic resistance, we observed a species-specific distribution of blaOXA genes, confirming what has been reported in the literature and additionally identifying blaOXA-2 in some A. insolitus isolates and observing no blaOXA genes in A. aegrifaciens or NGs. No significant difference in resistance genes was found between chronic and occasional isolates. The results of the mutator genes analysis showed that no occasional isolate had hypermutator characteristics, while 60% of early chronic (<1 year from first colonization) and 78% of late chronic (>1 year from first colonization) isolates were classified as hypermutators. Although all A. dolens, A. insuavis and NG isolates presented two different mutS genes, these seem to have a complementary rather than compensatory function. In conclusion, our results show that Achromobacter species can exhibit different adaptive mechanisms and some of these mechanisms might be more useful than others in establishing a chronic infection in CF patients, highlighting their importance for the clinical setting and the need for further studies on the less clinically characterized Achromobacter species

Cutaneous sarcoid-like reaction in a patient treated with target therapy for metastatic melanoma: the hue is the clue

Cutaneous sarcoid-like reaction in a patient treated with target therapy for metastatic melanoma: the hue is the clu

Mobilome analysis of Achromobacter spp. isolates from chronic and occasional lung infection in cystic fibrosis patients

Achromobacter spp. is an opportunistic pathogen that can cause lung infections in patients with cystic fibrosis (CF). Although a variety of mobile genetic elements (MGEs) carrying antimicrobial resistance genes have been identified in clinical isolates, little is known about the contribution of Achromobacter spp. mobilome to its pathogenicity. To provide new insights, we performed bioinformatic analyses of 54 whole genome sequences and investigated the presence of phages, insertion sequences (ISs), and integrative and conjugative elements (ICEs). Most of the detected phages were previously described in other pathogens and carried type II toxin-antitoxin systems as well as other pathogenic genes. Interestingly, the partial sequence of phage Bcep176 was found in all the analyzed Achromobacter xylosoxidans genome sequences, suggesting the integration of this phage in an ancestor strain. A wide variety of IS was also identified either inside of or in proximity to pathogenicity islands. Finally, ICEs carrying pathogenic genes were found to be widespread among our isolates and seemed to be involved in transfer events within the CF lung. These results highlight the contribution of MGEs to the pathogenicity of Achromobacter species, their potential to become antimicrobial targets, and the need for further studies to better elucidate their clinical impact

A modified vimentin histological score helps recognize pulmonary sarcomatoid carcinoma in small biopsy samples

Background: As pulmonary sarcomatoid carcinomas (PSCs) are life-threatening tumors, an improvement in their recognition in small-sized tumor samples is clinically warranted. Materials and Methods: Preoperative biopsy samples and paired surgical specimens from 20 pleomorphic carcinomas, two pulmonary blastomas and one carcinosarcoma (training set) were studied for vimentin immunohistochemistry. A modified vimentin histologic score (M-VHS) was devised by multiplying three independently assessed parameters, i.e. the percentage of positive cells (from 0 to 5+, by quintiles), the intensity of immunostaining (low=1 vs. strong=2) and the distribution pattern within the cytoplasm (partial=1 vs. diffuse=2), so ranging from 0 to 20. Forty-eight consecutive and independent cases of non-small cell lung carcinoma (NSCLC), including two additional cases of PSC, were used as control groups (validation set). Results: No differences in M-VHS were found between biopsies and surgical specimens of PSC, thus confirming the occurrence of stable epithelial mesenchymal transition (EMT) and hence the specific diagnosis of PSC. All types of PSC shared the same M-VHS. The M-VHS of 46 conventional NSCLC was by far lower (p<0.0001), whereas two additional cases of PSC showed the same results as the training set. Poorly differentiated NSCLC with marked pleomorphism but not stable EMT did not exhibit significantly increased M-VHS values. Conclusion: M-VHS helped in morphological analysis to render more definite diagnoses on small biopsies of PSC

CEA and CYFRA 21-1 as prognostic biomarker and as a tool for treatment monitoring in advanced NSCLC treated with immune checkpoint inhibitors

Aims: To assess prognostic value of pre-therapy carcinoembryonic antigen (CEA) and cytokeratin-19 fragments (CYFRA 21-1) blood levels in non-small cell lung cancer (NSCLC) patients treated with immune-checkpoint inhibitors (ICIs) and their early change as predictor of benefit. Materials and methods: This is a retrospective cohort study including patients with stage IIIB–IV NSCLC who received anti PD-1/PD-L1 in first or advanced lines of therapy in two institutions. A control cohort of patients treated only with chemotherapy has been enrolled as well. Results: A total of 133 patients treated with nivolumab or atezolizumab were included in the test set, 74 treated with pembrolizumab first line in the validation set and 89 in the chemotherapy only cohort. CYFRA 21-1 >8 ng/mL was correlated with overall survival (OS) in the test set, validation set and in univariate and multivariate analysis (pooled cohort hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.24–2.93, p 0.003). Early 20% reduction after the third cycle was correlated with OS for CEA (HR 0.12; 95% CI 0.04–0.33; p < 0.001), and for CYFRA 21-1 (HR 0.19; 95% CI 0.07–0.55; p 0.002) Conclusions: CYFRA 21-1 pre-therapy assessment provides clinicians with relevant prognostic information about patients treated with ICI. CEA and CYFRA 21-1 repeated measures could be useful as an early marker of benefit