Clinical features of COVID-19 and SARS epidemics. A literature review

SARS-CoV-2, responsible for the current pandemic, is a novel strain of the Coronaviridae family, which has infected humans as a result of the leap to a new species. It causes an atypical pneumonia similar to that caused by SARS-CoV in 2003. SARS-CoV-2 has currently infected more than 9.200.000 people and caused almost 480.000 deaths worldwide. Although SARS-CoV-2 and SARS-CoV have similar phylogenetic and pathogenetic characteristics, they show important differences in clinical manifestations. We have reviewed the recent literature comparing the characteristics of the two epidemics and highlight their peculiar aspects. An analysis of all signs and symptoms of 3,365 SARS patients and 23,280 COVID-19 patients as well as of the comorbidities has been carried out. A total of 19 and 75 studies regarding patients with SARS and COVID-19, respectively, were included in the analysis. The analysis revealed an overlap of some symptoms between the two infections. Unlike SARS patients, COVID-19 patients have developed respiratory, neurological and gastrointestinal symptoms, and, in a limited number of subjects, symptoms involving organs such as skin and subcutaneous tissue, kidneys, cardiovascular system, liver and eyes. This analysis was conducted in order to direct towards an early identification of the infection, a suitable diagnostic procedure and the adoption of appropriate containment measures

Health Technology Assessment for In Silico Medicine: Social, Ethical and Legal Aspects

The application of in silico medicine is constantly growing in the prevention, diagnosis, and treatment of diseases. These technologies allow us to support medical decisions and self- management and reduce, refine, and partially replace real studies of medical technologies. In silico medicine may challenge some key principles: transparency and fairness of data usage; data privacy and protection across platforms and systems; data availability and quality; data integration and interoperability; intellectual property; data sharing; equal accessibility for persons and populations. Several social, ethical, and legal issues may consequently arise from its adoption. In this work, we provide an overview of these issues along with some practical suggestions for their assessment from a health technology assessment perspective. We performed a narrative review with a search on MEDLINE/Pubmed, ISI Web of Knowledge, Scopus, and Google Scholar. The following key aspects emerge as general reflections with an impact on the operational level: cultural resistance, level of expertise of users, degree of patient involvement, infrastructural requirements, risks for health, respect of several patients’ rights, potential discriminations for access and use of the technology, and intellectual property of innovations. Our analysis shows that several challenges still need to be debated to allow in silico medicine to express all its potential in healthcare processes

PROMUOVERE LA COMUNICAZIONE SANITARIA IN UN’OTTICA IAP- CENTRED

The steady promotion of participatory healthcare, from Empowerment policies for cancer patients to Patient-Reported Outcomes (PROs), is acknowledging the patient- citizen’s status as an Individual Active Participant (IAP), thus establishing a new patient-centred era based on the healing power of words. Given the impact of health communication notably in oncology units, this Participatory Action Research project detected and gave expression to both clinical and social needs in favour of female IAPs treated with radiotherapy. The project consisted of group discussions and support initiatives aimed at: (1) spurring self-awareness; (2) fostering health communication; (3) building a community of female IAPs regionwide.La progressiva promozione di prassi sanitarie partecipative, dal Patto per l’Empowerment del paziente oncologico alla diffusione dei Patient-Reported Outcomes, sta riconoscendo al/la paziente-cittadino/a il suo status di Individuo Attivo e Partecipe (IAP), e sancendo l’ingresso della comunità medica e scientifica in una nuova fase patient- centred: quella delle “parole che curano”. Dato l’impatto della comunicazione sanitaria nei reparti oncologici, il presente progetto di Ricerca-Azione Partecipata ha posto al servizio di donne-IAP trattate con radioterapia l’analisi dei loro bisogni clinici e sociali attraverso gruppi di supporto e discussione tesi a: (1) incentivare autoconsapevolezza; (2) promuovere la comunicazione sanitaria; (3) istituire una comunità di donne-IAP nel territorio pugliese

CRISPR/Cas9-Mediated In Situ Correction of LAMB3 Gene in Keratinocytes Derived from a Junctional Epidermolysis Bullosa Patient

Deficiency of basement membrane heterotrimeric laminin 332 component, coded by LAMA3, LAMB3, and LAMC2 genes, causes junctional epidermolysis bullosa (JEB), a severe skin adhesion defect. Herein, we report the first application of CRISPR/Cas9-mediated homology direct repair (HDR) to in situ restore LAMB3 expression in JEB keratinocytes in vitro and in immunodeficient mice transplanted with genetically corrected skin equivalents. We packaged an adenovector carrying Cas9/guide RNA (gRNA) tailored to the intron 2 of LAMB3 gene and an integration defective lentiviral vector bearing a promoterless quasi-complete LAMB3 cDNA downstream a splice acceptor site and flanked by homology arms. Upon genuine HDR, we exploited the in vitro adhesion advantage of laminin 332 production to positively select LAMB3-expressing keratinocytes. HDR and restored laminin 332 expression were evaluated at single-cell level. Notably, monoallelic-targeted integration of LAMB3 cDNA was sufficient to in vitro recapitulate the adhesive property, the colony formation typical of normal keratinocytes, as well as their cell growth. Grafting of genetically corrected skin equivalents onto immunodeficient mice showed a completely restored dermal-epidermal junction. This study provides evidence for efficient CRISPR/Cas9-mediated in situ restoration of LAMB3 expression, paving the way for ex vivo clinical application of this strategy to laminin 332 deficiency

Antibody Response in Healthcare Workers before and after the Third Dose of Anti-SARS-CoV-2 Vaccine: A Pilot Study

The SARS-CoV-2 pandemic led to the development of various vaccines. The BNT162b2 mRNA vaccine was the first approved due to its efficacy in eliciting a humoral immunity response after the second dose. However, a decrease in the antibody concentration was observed over time. Therefore, the administration of a third dose was scheduled, primarily for frail people and workers of essential public activities. The aim of this study was to assess the level of antibodies against the spike (S) RBD of SARS-CoV-2 in healthcare workers before and after the third dose of BNT162b2 vaccine, according to sex, age, and the time interval between vaccine doses and tests. All 37 (12 males, 25 females, 19 < 50 years old, 18 ≥ 50 years old) healthcare workers recruited showed a consistent antibody titer increase after the third dose. Data analysis showed that the antibody concentration before the third dose significantly decreased as the time interval up to the test increased, and a significantly higher level was shown in young than older people. Cluster analysis revealed that young females had a higher antibody level than older females before the third dose (p < 0.05). This study indicated the benefit of the third dose of BNT162b2 vaccine and its effect on leveling up the humoral immune response

Mediazione in sanità. L’arbitrarietà dell’atto medico di imaging ionizzante, il consenso informato e l’opportunità stragiudiziale del D. Lgs. n. 28/2010

[Mediation in health care. Inappropriate use of ionizing tests, informed consent and opportunity of Legislative Decree n. 28/2010]Inappropriate use of ionizing tests in medicine represents an increasing trend, which causes noteworthy damages to health, as well as a huge increment of health expenditures, waiting lists, organizational conflicts, judicial disputes, and insurance compensations. This phenomenon is strictly related to the key bioethical and legal issue of patient’s autonomy, which is protectable by means of a correct implementation of informed consent. The current practice of the passive signature on incomplete and unreadable informed consent templates belongs to the so-called “event-based” approach. This practice mortifies the patient’s right to decide freely and deliberately, being him unaware of the biological consequences of diagnostic-therapeutic interventions on himself and on his progeny’s health. On the other hand, physicians themselves are not protected, since they can generate arbitrary clinical acts more frequently, with heavy deontological and legal consequences. Conversely, a “process-based” approach is necessary, which conveys informed consent in a series of other clinical and organisational processes towards a full therapeutic alliance among physician and patient. Actually, in both the presence and absence of the inauspicious event recurring also in the area of imaging as well as in other specialist areas, an arbitrary informed consent is the cause of deep conflicts, especially at relational level, between physician and patient. The authors suggest – in both juridical and communication perspectives – that these conflicts deserve to be properly analyzed and brought to the surface by the parties through the tool of mediation in healthcare, provided by Legislative Decree n. 28/2010. This tool is oriented not so much towards a technical solution at all costs, as towards a reconstruction of the care relationship, which unfortunately is lacking in the current way of conceiving and managing informed consent

Communication and Education Processes involved in COPD Patient Engagement within the Italian Health System

The World Health Organization has estimated that chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death worldwide. Due to the economic and social extent of the problem, patient engagement must be comprised as a new resource for the achievement of higher health outcomes and lower costs. As many key processes involved in the COPD patient engagement consist of communication and education processes, modelling those processes in a whole framework, including actors and content needs, is a requirement. The main scope of this chapter is contributing to design such a framework within the Italian Health System. Final recommendations suggest to create a synergy among patient engagement and a set of legal tools, namely informed consent, integrated care and advance care planning. The synergy is based on the fact that both patient engagement and those legal tools have a common deep root in the universal principle of patient autonomy

Promuovere la comunicazione sanitaria in un’ottica IAP-centered. Un progetto di Ricerca-Azione Partecipata

Come sancito dalla World Health Organization, la salute è un “diritto umano fondamentale” ed un “valore” che i cittadini e l’intera collettività sono chiamati a tutelare e difendere (WHO, 1948). La pubblicazione del Patto per l’Empowerment del paziente oncologico (CPE, 2017) e la promozione di politiche di cittadinanza attiva e di servizi come i Patient-Reported Outcomes (PROs) in ambito ospedaliero ed ambulatoriale testimoniano l’attenzione istituzionale verso una sanità equa, plurale ed inclusiva, basata sulla persona. Diversi contesti di cura stanno riconoscendo al paziente lo status di “Individuo Attivo e Partecipe” (Individual Active Participant [IAP]) (Topol, 2015) a cui spettano le principali decisioni sanitarie. L’accresciuto controllo di tutti gli attori sociali può essere predittivo di una migliore aderenza al trattamento da parte dei pazienti (Náfrádi, Nakamoto &amp; Schulz, 2017), e la comunicazione sanitaria svolge un ruolo cruciale in questo processo di consapevole partecipazione (Immacolato et al., 2010). Recenti studi (Chou et al., 2017) ipotizzano inoltre un’associazione fra qualità della comunicazione medico-paziente ed andamento pronostico in pazienti con diagnosi di tumore. In accordo con i principi della Ricerca-Azione Partecipata (RAP), il presente lavoro intende facilitare l’accesso e la partecipazione dei pazienti/IAP dell’Ospedale di Brindisi Di Summa-Perrino alle decisioni di cura radioterapica. Lo studio si articola nelle seguenti fasi: 1) conduzione di 6 sessioni di Focus Group Discussion (FGD) al fine di identificare i bisogni reali di ciascun paziente; 2) svolgimento di analisi linguistiche quantitative (Corpus Linguistics) e qualitative (analisi del discorso) sui dati raccolti dalle FGD con l’obiettivo di ottenere una mappatura dei pattern comunicativi dei pazienti; 3) restituzione ed implementazione dei dati nella pratica clinica, attraverso la co-costruzione di spazi di confronto e comunicazione fra pazienti, caregiver e personale sanitario. Scopo principale del progetto è offrire ai pazienti la duplice opportunità di “dar voce” e “dare un nome” ai propri bisogni, acquisendo un maggior controllo in tutte le fasi della terapia. Attraverso l’adozione di un approccio bottom-up multidisciplinare e multimetodo, lo studio rende possibile una collaborazione fra le diverse figure coinvolte nella realtà ospedaliera locale, volta a promuovere la comunicazione come un’essenziale prestazione sanitaria