Health workforce shortage – doing the right things or doing things right?

Healthcare workforce shortage is a worldwide problem (1). Workforce shortage may be defined as not having the right number of people with the right skills in the right place at the right time, to provide the right services to the right people (2). In this regard, the trends are worrisome, and the situation is getting worse. The consequences are also very consistent – limited care health services and limited quality of health care (1). In short, there is an imbalance between need and supply. The solution: as health care needs increase worldwide, the “production” of personnel must be increased! But is it really that simple? Are the problem and the solution so reciprocal and directly linked

Cerebral hypoperfusion in post-COVID-19 cognitively impaired subjects revealed by arterial spin labeling MRI

Cognitive impairment is one of the most prevalent symptoms of post Severe Acute Respiratory Syndrome COronaVirus 2 (SARS-CoV-2) state, which is known as Long COVID. Advanced neuroimaging techniques may contribute to a better understanding of the pathophysiological brain changes and the underlying mechanisms in post-COVID-19 subjects. We aimed at investigating regional cerebral perfusion alterations in post-COVID-19 subjects who reported a subjective cognitive impairment after a mild SARS-CoV-2 infection, using a non-invasive Arterial Spin Labeling (ASL) MRI technique and analysis. Using MRI-ASL image processing, we investigated the brain perfusion alterations in 24 patients (53.0 ± 14.5 years, 15F/9M) with persistent cognitive complaints in the post COVID-19 period. Voxelwise and region-of-interest analyses were performed to identify statistically significant differences in cerebral blood flow (CBF) maps between post-COVID-19 patients, and age and sex matched healthy controls (54.8 ± 9.1 years, 13F/9M). The results showed a significant hypoperfusion in a widespread cerebral network in the post-COVID-19 group, predominantly affecting the frontal cortex, as well as the parietal and temporal cortex, as identified by a non-parametric permutation testing (p < 0.05, FWE-corrected with TFCE). The hypoperfusion areas identified in the right hemisphere regions were more extensive. These findings support the hypothesis of a large network dysfunction in post-COVID subjects with cognitive complaints. The non-invasive nature of the ASL-MRI method may play an important role in the monitoring and prognosis of post-COVID-19 subjects

Deficient GABABergic and glutamatergic excitability in the motor cortex of patients with long-COVID and cognitive impairment

Objective: Attention, working memory and executive processing have been reported to be consistently impaired in Neuro-Long coronavirus disease (COVID). On the hypothesis of abnormal cortical excitability, we investigated the functional state of inhibitory and excitatory cortical regulatory circuits by single "paired-pulse" transcranial magnetic stimulation (ppTMS) and Short-latency Afferent Inhibition (SAI). Methods: We compared clinical and neurophysiological data of 18 Long COVID patients complaining of persistent cognitive impairment with 16 Healthy control (HC) subjects. Cognitive status was evaluated by means of the Montreal Cognitive Assessment (MoCA) and a neuropsychological evaluation of the executive function domain; fatigue was scored by the Fatigue Severity Scale (FSS). Resting motor threshold (RMT), the amplitude of the motor evoked potential (MEP), Short Intra-cortical Inhibition (SICI), Intra-cortical Facilitation (ICF), Long-interval Intracortical Inhibition (LICI) and Short-afferent inhibition (SAI) were investigated over the motor (M1) cortex. Results: MoCA corrected scores were significantly different between the two groups (p = 0.023). The majority of the patients' performed sub-optimally in the neuropsychological assessment of the executive functions. The majority (77.80%) of the patients reported high levels of perceived fatigue in the FSS. RMT, MEPs, SICI and SAI were not significantly different between the two groups. On the other hand, Long COVID patients showed a reduced amount of inhibition in LICI (p = 0.003) and a significant reduction in ICF (p < 0.001). Conclusions: Neuro-Long COVID patients performing sub-optimally in the executive functions showed a reduction of LICI related to GABAb inhibition and a reduction of ICF related to glutamatergic regulation. No alteration in cholinergic circuits was found. Significance: These findings can help to better understand the neurophysiological characteristics of Neuro-Long COVID, and in particular, motor cortex regulation in people with "brain fog"

A 25-Year-Old Woman With Long-Lasting Abdominal Pain and Spleen Abscess

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Development of microsatellite markers for the invasive mosquito Aedes koreicus

Abstract Background Aedes koreicus is a mosquito species native to East Asia which has recently invaded several countries in Europe. In Italy, this mosquito was first detected in the North-East in 2011 and is now widely distributed in the entire northern part of the country. The development of specific genetic markers, such as microsatellites, is necessary to uncover the dispersal routes of this mosquito from its native areas and, eventually, to plan future control interventions. Methods Available raw sequences of genomic DNA of Ae. koreicus were screened in silico using BLASTn to identify possible microsatellite-containing sequences. Specific primer pairs were then designed, and their efficiency was determined through polymerase chain reaction (PCR) on 32 individuals of Ae. koreicus collected in Italy. PCR conditions were optimised in three multiplex reactions. Genotyping of individual mosquitoes was performed on both single and multiplex PCR reactions. Finally, analysis of intra-population variation was performed to assess the level of polymorphism of the markers. Results Mosquito genotyping provided consistent results in both single and multiplex reactions. Out of the 31 microsatellite markers identified in the Ae. koreicus genome raw sequences, 11 were polymorphic in the examined mosquito samples. Conclusions The results show that the 11 microsatellite markers developed here hold potential for investigating the genetic structure of Ae. koreicus populations. These markers could thus represent a novel and useful tool to infer the routes of invasion of this mosquito species into Europe and other non-native areas. Graphical Abstrac

Efficacy and toxicity of FLAI vs ICE for induction treatment of newly diagnosed AML patients, younger than 60 years

Acute myeloid leukaemias (AMLs) are a heterogeneous family of hemopoietic malignancies that share a high frequency and a high degree of Pgp-mediated multidrug resistance (MDR), one of the major causes of treatment failure. Induction treatment (FLAI), including 5 days administration of Idarubicin (IDA- 10mg/sqm/day), in combination with high-dose Arabinosyl Cytosine (HDAC-2g/sqm/day) and Fludarabine (FLUDA-25mg/sqm/day) was adopted as induction treatment of newly diagnosed patients with AML, except acute promyelocytic leukemia (APL). In our previous experience (Russo et al. Leuk. Lymphoma, 2001), FLAI regimen showed to be highly effective (CR rate 72%), also in AML MDR-pos patients, with a low extra-hematological toxicity. In this prospective randomized trial, FLAI was compared with ICE (IDA 10mg/sqm/day x 3 days + AC p.c 100mg/sqm/day x 10 days + VP16 100mg/sqm/day x 5 days) for induction of remission. Post-induction treatment program included: HDAC (3g/sqm/12h x 6 days), MEC (Mitoxantrone 12 mg/sqm/day x 4 days, Etoposide 100 mg/sqm/day x 4 days, Cytarabine 1 gr/sqm/day x 4 days) and allogeneic or autologous BMT. Over a period of 2 years, 118 patients were randomly assigned to FLAI (67) or ICE (51). The clinical and hematological characteristics of the two patient population were not different. In the FLAI group, the complete remission (CR) rate was 72% after the first course and 76% after HDAC; in the ICE group, the CR rate was 53% and 69%, respectively (P 1.0 x 109/L and platelets > 50 x 109/L was significantly better in FLAI arm than in ICE arm. In both groups, it was seen an approximately equal rate of FUO, Gram negative/Gram positive bacteremias and systemic fungal infections. Infections and haemorrhages caused death during induction (DDI) in 3% of patients treated with FLAI and in 10% of patients treated with ICE. Non-hematological toxicity of FLAI was mild and significantly lower than ICE. In particular, in the FLAI arm, only 3/67 pts developed a grade 3 or 4 gastro-intestinal toxicity, whereas in ICE arm 16/51 patients experienced this toxicity (p=0.0001). Other grade 3 or 4 toxicity (ipertransaminasemia, cutaneus toxicity, renal or cardiac failure) were seen in 1/67 pts in FLAI arm versus 7/51 pts in ICE arm (p=0.02). In conclusion, these preliminary results strongly suggest that FLAI, as single induction course, is an highly effective regimen with a limited non-haematologic toxicity. Furthermore, FLAI seems to be more effective than ICE to overcome Pgp-mediated multidrug resistance. 2005, The American Society of Hematolog