Showing papers by "Catholic University of the Sacred Heart published in 2020"
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico1, University of Milan2, Vita-Salute San Raffaele University3, Agostino Gemelli University Polyclinic4, Catholic University of the Sacred Heart5, Ospedale di Circolo e Fondazione Macchi6, University of Milano-Bicocca7, University of Pavia8, University of Brescia9, Kessler Foundation10, University of Bologna11, Humanitas University12
TL;DR: Patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy were characterized, including data on clinical management, respiratory failure, and patient mortality.
Abstract: Importance In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited. Objective To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy. Design, Setting, and Participants Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020. Exposures SARS-CoV-2 infection confirmed by real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs. Main Outcomes and Measures Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network. Results Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio2was greater than 50% in 89% of patients. The median Pao2/Fio2was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged ≤63 years) and older patients (n = 514 aged ≥64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0];P = .94). Median Fio2was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, −10% [95% CI, −14% to 6%];P = .006), and median Pao2/Fio2was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, −8 to 22];P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68];P Conclusions and Relevance In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.
4,331 citations
University of Sfax1, University of Münster2, German Center for Neurodegenerative Diseases3, Otto-von-Guericke University Magdeburg4, University of Gafsa5, Rio de Janeiro State University6, University of Twente7, Catholic University of the Sacred Heart8, Estácio S.A.9, American University in the Emirates10, Imam Khomeini International University11, University of Paris12, University of Genoa13, University of Arkansas14, Stanford University15, University of Toulouse16, Assiut University17, Karlsruhe Institute of Technology18, Georgia Southern University19, Government of Extremadura20, University Medical Center Groningen21, University of Ulm22, Yarmouk University23, University of Jordan24, University of Porto25, Loughborough University26, Paris West University Nanterre La Défense27
TL;DR: Results indicate that isolation is a necessary measure to protect public health, but results indicate that it alters physical activity and eating behaviours in a health compromising direction.
Abstract: Background: Public health recommendations and governmental measures during the COVID-19 pandemic have resulted in numerous restrictions on daily living including social distancing, isolation and home confinement. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on health behaviours and lifestyles at home is undefined. Therefore, an international online survey was launched in April 2020, in seven languages, to elucidate the behavioural and lifestyle consequences of COVID-19 restrictions. This report presents the results from the first thousand responders on physical activity (PA) and nutrition behaviours. Methods: Following a structured review of the literature, the “Effects of home Confinement on multiple Lifestyle Behaviours during the COVID-19 outbreak (ECLB-COVID19)” Electronic survey was designed by a steering group of multidisciplinary scientists and academics. The survey was uploaded and shared on the Google online survey platform. Thirty-five research organisations from Europe, North-Africa, Western Asia and the Americas promoted the survey in English, German, French, Arabic, Spanish, Portuguese and Slovenian languages. Questions were presented in a differential format, with questions related to responses “before” and “during” confinement conditions. Results: 1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%) were included in the analysis. The COVID-19 home confinement had a negative effect on all PA intensity levels (vigorous, moderate, walking and overall). Additionally, daily sitting time increased from 5 to 8 h per day. Food consumption and meal patterns (the type of food, eating out of control, snacks between meals, number of main meals) were more unhealthy during confinement, with only alcohol binge drinking decreasing significantly. Conclusion: While isolation is a necessary measure to protect public health, results indicate that it alters physical activity and eating behaviours in a health compromising direction. A more detailed analysis of survey data will allow for a segregation of these responses in different age groups, countries and other subgroups, which will help develop interventions to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.
1,275 citations
Duke University1, University of British Columbia2, Albert Einstein College of Medicine3, University of Parma4, University of Wisconsin-Madison5, Lenox Hill Hospital6, Columbia University7, New Generation University College8, Medical College of Wisconsin9, Stanford University10, University of Missouri11, National Institutes of Health12, University of California, Los Angeles13, Université Paris-Saclay14, University Hospital Heidelberg15, Sichuan University16, Cleveland Clinic17, Radboud University Nijmegen18, university of lille19, Catholic University of the Sacred Heart20, Osaka University21
TL;DR: A multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing COVID-19 patients across a spectrum of healthcare environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of CXR and CT in the management of COIDs.
1,232 citations
University of Sydney1, University of Michigan2, Duke University3, University of Alabama at Birmingham4, University of Pittsburgh5, University of Florida6, Centers for Disease Control and Prevention7, University of Münster8, University of Udine9, Ankara University10, University of Wisconsin-Madison11, Paris Diderot University12, University of Arkansas for Medical Sciences13, University of Paris14, University of Lausanne15, Brown University16, Istituto Giannina Gaslini17, Carlos III Health Institute18, Uniformed Services University of the Health Sciences19, National Institutes of Health20, University of Pennsylvania21, St George's, University of London22, Heidelberg University23, University of Copenhagen24, University College London25, University of Texas MD Anderson Cancer Center26, Katholieke Universiteit Leuven27, Goethe University Frankfurt28, University of Würzburg29, Johns Hopkins University30, Monash University31, Federal University of Rio de Janeiro32, Catholic University of the Sacred Heart33, University of Texas Health Science Center at San Antonio34, Masaryk University35, RMIT University36, Radboud University Nijmegen37, University of Melbourne38, Stanford University39, University of California, Davis40, Georgia Regents University41, Cornell University42, University of Aberdeen43, University Hospital of Wales44
TL;DR: These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.
Abstract: BACKGROUND: Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. METHODS: To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups' findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. RESULTS: There is no change in the classifications of "proven," "probable," and "possible" IFD, although the definition of "probable" has been expanded and the scope of the category "possible" has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. CONCLUSIONS: These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.
1,211 citations
Jagiellonian University1, University of Glasgow2, Queen Mary University of London3, Vanderbilt University Medical Center4, University of Manchester5, University of Naples Federico II6, University of Roehampton7, University of Texas at Austin8, Jagiellonian University Medical College9, Humboldt University of Berlin10, Huazhong University of Science and Technology11, Catholic University of the Sacred Heart12
TL;DR: While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis, Hence, patients should not discontinue their use.
Abstract: The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer. The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically, SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane angiotensin-converting enzyme 2 (ACE2) -a homologue of ACE-to enter type 2 pneumocytes, macrophages, perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis. Hence, patients should not discontinue their use. Moreover, renin-angiotensin-aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm [interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures (social distancing and social isolation) also increase cardiovascular risk. Cardiovascular considerations of therapies currently used, including remdesivir, chloroquine, hydroxychloroquine, tocilizumab, ribavirin, interferons, and lopinavir/ritonavir, as well as experimental therapies, such as human recombinant ACE2 (rhACE2), are discussed.
1,060 citations
Hospital General Universitario Gregorio Marañón1, Hospital Sant Joan de Déu Barcelona2, Boston Children's Hospital3, Sofia Medical University4, Ljubljana University Medical Centre5, University of Naples Federico II6, Great Ormond Street Hospital7, UCL Institute of Child Health8, Geneva College9, Royal Children's Hospital10, Ruhr University Bochum11, Guy's and St Thomas' NHS Foundation Trust12, Catholic University of the Sacred Heart13, Agostino Gemelli University Polyclinic14, University of Oslo15, University of Fribourg16
TL;DR: Key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic are captured to reflect the current uncertainties regarding specific treatment options.
918 citations
25 Mar 2020
TL;DR: Pregnancy and perinatal outcomes of Coronavirus (CoV) spectrum infections, and particularly COVID-19 disease due to SARS-COV-2 infection during pregnancy were reported, including miscarriage, preterm birth, pre-eclampsia, pre term prelabor rupture of membranes, fetal growth restriction, and mode of delivery.
Abstract: Objective The aim of this systematic review was to report pregnancy and perinatal outcomes of coronavirus spectrum infections, and particularly coronavirus 2019 (COVID-19) disease because of severe acute respiratory syndrome–coronavirus-2 infection during pregnancy. Data Sources Medline, Embase, Cinahl, and Clinicaltrials.gov databases were searched electronically utilizing combinations of word variants for coronavirus or severe acute respiratory syndrome or SARS or Middle East respiratory syndrome or MERS or COVID-19 and pregnancy. The search and selection criteria were restricted to English language. Study Eligibility Criteria Inclusion criteria were hospitalized pregnant women with a confirmed coronavirus related–illness, defined as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), or COVID-19. Study Appraisal and Synthesis Methods We used meta-analyses of proportions to combine data and reported pooled proportions, so that a pooled proportion may not coincide with the actual raw proportion in the results. The pregnancy outcomes observed included miscarriage, preterm birth, preeclampsia, preterm prelabor rupture of membranes, fetal growth restriction, and mode of delivery. The perinatal outcomes observed were fetal distress, Apgar score Results Nineteen studies including 79 hospitalized women were eligible for this systematic review: 41 pregnancies (51.9%) affected by COVID-19, 12 (15.2%) by MERS, and 26 (32.9%) by SARS. An overt diagnosis of pneumonia was made in 91.8%, and the most common symptoms were fever (82.6%), cough (57.1%), and dyspnea (27.0%). For all coronavirus infections, the pooled proportion of miscarriage was 64.7% (8/12; 95% confidence interval, 37.9-87.3), although reported only for women affected by SARS in two studies with no control group; the pooled proportion of preterm birth Conclusion In hospitalized mothers infected with coronavirus infections, including COVID-19, >90% of whom also had pneumonia, preterm birth is the most common adverse pregnancy outcome. COVID-19 infection was associated with higher rate (and pooled proportions) of preterm birth, preeclampsia, cesarean, and perinatal death. There have been no published cases of clinical evidence of vertical transmission. Evidence is accumulating rapidly, so these data may need to be updated soon. The findings from this study can guide and enhance prenatal counseling of women with COVID-19 infection occurring during pregnancy, although they should be interpreted with caution in view of the very small number of included cases.
813 citations
King's College London1, University of Cambridge2, University of Leicester3, Catholic University of the Sacred Heart4, HealthPartners5, Nanyang Technological University6, Tan Tock Seng Hospital7, University of Southampton8, University of Miami9, University of Amsterdam10, Centre national de la recherche scientifique11, Anschutz Medical Campus12, Monash University13, Imperial College London14, State University of Campinas15, The Chinese University of Hong Kong16, Peking University17
TL;DR: An international panel of experts in the field of diabetes and endocrinology is formed to provide some guidance and practical recommendations for the management of diabetes during the COVID-19 pandemic.
659 citations
Humanitas University1, University College Dublin2, Autonomous University of Madrid3, Cambridge University Hospitals NHS Foundation Trust4, University of Basel5, Winterthur Museum, Garden and Library6, Catholic University of the Sacred Heart7, Aarhus University Hospital8, University of Copenhagen9, Royal Liverpool University Hospital10, Aalborg University11, Mater Dei Hospital12, University of Bologna13, Barts Health NHS Trust14, Comenius University in Bratislava15, Sheba Medical Center16, University of Porto17, McMaster University18, Linköping University19, Seconda Università degli Studi di Napoli20, Katholieke Universiteit Leuven21, University of Padua22, Maastricht University Medical Centre23, Beaujon Hospital24, University of Zurich25, Imperial College London26
TL;DR: The present article addresses surgical management, including preoperative aspects and drug management before surgery, and provides technical advice for a variety of common clinical situations.
Abstract: This article is the second in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the management of Crohn's disease. The first article covers medical management; the present article addresses surgical management, including preoperative aspects and drug management before surgery. It also provides technical advice for a variety of common clinical situations. Both articles together represent the evidence-based recommendations of the ECCO for Crohn's disease and an update of previous guidelines.
563 citations
University of Milan1, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico2, University of Bologna3, Humanitas University4, University of Milano-Bicocca5, National University of Ireland, Galway6, University of Turin7, Boston Children's Hospital8, Université libre de Bruxelles9, Catholic University of the Sacred Heart10, St. Michael's Hospital11
TL;DR: Patients with COVID-19-associated ARDS have a form of injury that, in many aspects, is similar to that of those with ARDS unrelated to CO VID-19, who have a reduction in respiratory system compliance together with increased D-dimer concentrations have high mortality rates.
496 citations
TL;DR: The data indicated that a relevant rate of individuals may have experienced psychological distress following the COVID-19 outbreak, and the results provide further insight into developing targeted intervention strategies.
Abstract: The outbreak of COVID-19 is severely affecting mental health worldwide, although individual response may vary. This study aims to investigate the psychological distress perceived by the Italian general population during the early phase of the COVID-19 pandemic, and to analyze affective temperament and adult attachment styles as potential mediators. Through an online survey, we collected sociodemographic and lockdown-related information and evaluated distress, temperament, and attachment using the Kessler 10 Psychological Distress Scale (K10), the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire short version (TEMPS-A) and the Attachment Style Questionnaire (ASQ). In our sample (n = 500), 62% of the individuals reported no likelihood of psychological distress, whereas 19.4% and 18.6% displayed mild and moderate-to-severe likelihood. Cyclothymic (OR: 1.24; p < 0.001), depressive (OR: 1.52; p < 0.001) and anxious (OR: 1.58; p = 0.002) temperaments, and the ASQ "Need for approval" (OR: 1.08; p = 0.01) were risk factors for moderate-to-severe psychological distress compared to no distress, while the ASQ "Confidence" (OR: 0.89; p = 0.002) and "Discomfort with closeness" were protective (OR: 0.92; p = 0.001). Cyclothymic (OR: 1.17; p = 0.008) and depressive (OR: 1.32; p = 0.003) temperaments resulted as risk factors in subjects with moderate-to-severe psychological distress compared to mild distress, while the ASQ "Confidence" (OR: 0.92; p = 0.039) and "Discomfort with closeness" (OR: 0.94; p = 0.023) were protective. Our data indicated that a relevant rate of individuals may have experienced psychological distress following the COVID-19 outbreak. Specific affective temperament and attachment features predict the extent of mental health burden. To the best of our knowledge, these are the first data available on the psychological impact of the early phase of the COVID-19 pandemic on a sizeable sample of the Italian population. Moreover, our study is the first to investigate temperament and attachment characteristics in the psychological response to the ongoing pandemic. Our results provide further insight into developing targeted intervention strategies.
TL;DR: This study provides a first account of the huge psycho-physical impact of COVID-19 outbreak for healthcare workers in Italy and reports relevant work-related psychological pressure, emotional burnout and somatic symptoms.
Abstract: Italy is among the most severely hit nations in terms of hospital patients' overload, and its healthcare workforce is struggling to cope with challenges that could threaten their own wellbeing. In this scenario, understanding the health-related consequences of COVID-19 outbreak on Italian frontline healthcare professionals is urgent. Our study provides a first account of the huge psycho-physical impact of COVID-19 outbreak for healthcare workers in Italy. Italian healthcare professionals reported relevant work-related psychological pressure, emotional burnout and somatic symptoms. This result requires attention as previous studies showed that emotional distress is associated with long-lasting effect on professionals' health, including risk of post-traumatic stress disorder.
University of Insubria1, University of Pavia2, University of Eastern Piedmont3, University of Bologna4, University of Verona5, Humanitas University6, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico7, University of Milan8, University of Genoa9, University of Catania10, University of Parma11, University of Pisa12, University of Turin13, University of Perugia14, Sapienza University of Rome15, University of Padua16, University of Brescia17, University of Modena and Reggio Emilia18, University of Siena19, University of Udine20, Università Campus Bio-Medico21, Catholic University of the Sacred Heart22
TL;DR: This study adds to the evidence that patients with haematological malignancies have worse outcomes and the general Italian population with COVID-19 has high mortality, by calculating standardised mortality ratios between observed death in the study cohort and expected death by applying stratum-specific mortality rates.
University of Illinois at Urbana–Champaign1, University of Florida2, University of Minnesota3, University of Valencia4, National University of Public Service5, University of Texas Medical Branch6, Catholic University of the Sacred Heart7, Agostino Gemelli University Polyclinic8, Xi'an Jiaotong University9, University of South Carolina10, Chengdu Kinesiology University11
TL;DR: The cellular mechanisms and danger of this “second wave” effect of COVID-19 to the human body, along with the effects of aging, proper nutrition, and regular physical activity, are reviewed in this editorial article.
Abstract: The SARS-CoV-2-caused COVID-19 pandemic has resulted in a devastating threat to human society in terms of health, economy, and lifestyle. Although the virus usually first invades and infects the lung and respiratory track tissue, in extreme cases, almost all major organs in the body are now known to be negatively impacted often leading to severe systemic failure in some people. Unfortunately, there is currently no effective treatment for this disease. Pre-existing pathological conditions or comorbidities such as age are a major reason for premature death and increased morbidity and mortality. The immobilization due to hospitalization and bed rest and the physical inactivity due to sustained quarantine and social distancing can downregulate the ability of organs systems to resist to viral infection and increase the risk of damage to the immune, respiratory, cardiovascular, musculoskeletal systems and the brain. The cellular mechanisms and danger of this “second wave” effect of COVID-19 to the human body, along with the effects of aging, proper nutrition, and regular physical activity, are reviewed in this article.
TL;DR: The study shows that willingness to COVID-19 vaccine is correlated to trust in research and in vaccines, which decreased between phase 1 and phase 2 of the Italian pandemic.
Abstract: Researchers have been working quickly and collaboratively for the development of vaccines against the COVID-19 virus. The effort of the scientific community in searching a vaccine for COVID-19 may be hampered by a diffused vaccine hesitancy. Two waves of data collection on representative samples of the Italian population (during the "first" and "second" phase of the Italian Covid-19 mitigation strategy) were conducted to understand citizens' perceptions and behaviors about preventive behaviors willingness to vaccine for COVID-19. Our study shows that willingness to COVID-19 vaccine is correlated to trust in research and in vaccines, which decreased between phase 1 and phase 2 of the Italian pandemic. According to the results of our study, the proportion of citizens that seem to be intentioned to get the Covid-19 vaccine is probably too small to effectively stop the spreading of the disease. This requires to foster a climate of respectful mutual trust between science and society, where scientific knowledge is not only preached but also cultivated and sustained thanks to the emphatic understanding of citizens worries, needs of reassurance and health expectations.
TL;DR: There is a need of programs aimed to prevent acts of domestic violence and to achieve accurate assessment of multiple domains of abuse provided by trained multidisciplinary staffs (including psychiatrists, psychologists, social and legal services).
Abstract: Background Intimate partner violence (IPV) is defined as physical or sexual violence, emotional abuse and stalking. It is typically experienced by women but can also be experienced by men. During quarantine due to the COVID-19, home risks to become a very dangerous place for victims of domestic violence. Method Very recent studies focusing on abusive situations during COVID emergence were identified in PubMed/Medline, Scopus, Embase. Results During the COVID-19 outbreak people have encountered an invisible and dark enemy and an experience of impotence. Due to the feelings of frustration and agitation, aggression arises with possible transgenerational transmission of trauma and violence. Conclusions Especially during quarantine and COVID emergence around the world there is a need of programs aimed to prevent acts of domestic violence and to achieve accurate assessment of multiple domains of abuse (psychological, physical, sexual) provided by trained multidisciplinary staffs (including psychiatrists, psychologists, social and legal services).
TL;DR: Routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration is recommended.
Abstract: Prophylaxis 1 ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration. Strong recommendation, moderate quality evidence. 2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation). Strong recommendation, moderate quality evidence. 3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction. Weak recommendation, moderate quality evidence. 4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP. Strong recommendation, moderate quality evidence. 5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy. Weak recommendation, moderate quality evidence. 6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced. Weak recommendation, low quality evidence. Treatment
7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis. Weak recommendation, low quality evidence. 8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities. Weak recommendation, low quality evidence. 9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP. Weak recommendation, low quality evidence.
University of Padua1, Catholic University of the Sacred Heart2, University of Chieti-Pescara3, Academy for Urban School Leadership4, University of Turin5, Vita-Salute San Raffaele University6, University of Milano-Bicocca7, University of Parma8, University of Bari9, Seconda Università degli Studi di Napoli10
TL;DR: Quarantine induces a rapid increase of BPSD in approximately 60% of patients and stress-related symptoms in two-thirds of caregivers and were associated with increased patients’ neuropsychiatric burden (p<0.0001); health services need to plan a post-pandemic strategy.
Abstract: BACKGROUND: In March 2020, the World Health Organization declared a global pandemic due to the novel coronavirus SARS-CoV-2 and several governments planned a national quarantine in order to control the virus spread. Acute psychological effects of quarantine in frail elderly subjects with special needs, such as patients with dementia, have been poorly investigated. The aim of this study was to assess modifications of neuropsychiatric symptoms during quarantine in patients with dementia and their caregivers. METHODS: This is a sub-study of a multicenter nation-wide survey. A structured telephone interview was delivered to family caregivers of patients with diagnosis of Alzheimer disease (AD), dementia with Lewy bodies (DLB), frontotemporal dementia (FTD) and vascular dementia (VD), followed regularly at 87 Italian memory clinics. Variations in behavioral and psychological symptoms (BPSD) were collected after one month since quarantine declaration and associations with disease type, severity, gender and caregiver’s stress burden were analyzed. RESULTS: A total of 4913 caregivers participated in the survey. Increased BPSD was reported in 59.6% of patients as worsening of preexisting symptoms (51.9%) or as new onset (26%), and requested drug modifications in 27.6% of these cases. Irritability, apathy, agitation and anxiety were the most frequently reported worsening symptoms and sleep disorder and irritability the most frequent new symptoms. Profile of BPSD varied according to dementia type, disease severity and patients’ gender. Anxiety and depression were associated with a diagnosis of AD (OR 1.35, CI: 1.12-1.62), mild to moderate disease severity and female gender. DLB was significantly associated with a higher risk of worsening hallucinations (OR 5.29, CI 3.66-7.64) and sleep disorder (OR 1.69, CI 1.25-2.29), FTD with wandering (OR 1.62, CI 1.12-2.35) and change of appetite (OR 1.52, CI 1.03-2.25). Stress-related symptoms were experienced by two-thirds of caregivers and were associated with increased patients’ neuropsychiatric burden (p<0.0001). CONCLUSION: Quarantine induces a rapid increase of BPSD in approximately 60% of patients and stress-related symptoms in two-thirds of caregivers. Health services need to plan a post-pandemic strategy in order to address these emerging needs.
TL;DR: Understanding the student’s perspective about the future COVID-19 vaccine and supporting their health engagement and consciousness may be useful in planning adequate response and multidisciplinary educational strategies—including the psychological perspective on vaccine hesitancy underlying factors - in the post-pandemic period.
Abstract: The debate around vaccines has been in the spotlight over the last few years in Europe, both within the scientific community and the general public debate. In this regard, the case of the Italian vaccination debate is particularly worrying given that Italy has been one of the European countries with the highest number of measles cases in the recent past. According to this scenario, we conducted a cross-sectional study on a convenience sample of Italian university students aimed at: (1) exploring their attitudes towards a future vaccine to prevent COVID-19 and; (2) evaluating the impact of the university curricula (healthcare vs. non-healthcare curricula) on the intention to vaccinate. Descriptive analysis on the 735 students that answered to the question on the intention to vaccinate showed that 633 (86.1%) students reported that they would choose to have a vaccination for the COVID-19 coronavirus; on the other side, 102 (13.9%) students reported that they would not or be not sure to vaccine (low intention to vaccinate). This means that in our sample more than one student out of 10 shows low intention to vaccinate (vaccine hesitancy). Furthermore, when running analysis comparing healthcare students versus non-healthcare students we found no significant differences in responses' percentage distribution (p = .097). Understanding the student's perspective about the future COVID-19 vaccine and supporting their health engagement and consciousness may be useful in planning adequate response and multidisciplinary educational strategies-including the psychological perspective on vaccine hesitancy underlying factors - in the post-pandemic period.
University of Sfax1, Otto-von-Guericke University Magdeburg2, University of Münster3, German Center for Neurodegenerative Diseases4, University of Gafsa5, Rio de Janeiro State University6, University of Twente7, Estácio S.A.8, Canadian University of Dubai9, Imam Khomeini International University10, University of Paris11, University of Genoa12, York University13, Paris West University Nanterre La Défense14, University of Thessaly15, Loughborough University16, Stanford University17, University of Toulouse18, Assiut University19, Karlsruhe Institute of Technology20, Georgia Southern University21, Government of Extremadura22, University Medical Center Groningen23, University of Ulm24, Yarmouk University25, University of Jordan26, University of Porto27, ISCTE – University Institute of Lisbon28, Catholic University of the Sacred Heart29, Józef Piłsudski University of Physical Education in Warsaw30, University of Sousse31, University of Arkansas32, Manouba University33
TL;DR: The preliminary findings elucidate the risk of psychosocial strain during the early COVID-19 home confinement period in 2020 and suggest implementation of national strategies focused on promoting social inclusion through a technology-based solution is strongly suggested.
Abstract: Public health recommendations and governmental measures during the new coronavirus disease (COVID-19) pandemic have enforced numerous restrictions on daily living including social distancing, isolation, and home confinement. While these measures are imperative to mitigate spreading of COVID-19, the impact of these restrictions on psychosocial health is undefined. Therefore, an international online survey was launched in April 2020 to elucidate the behavioral and lifestyle consequences of COVID-19 restrictions. This report presents the preliminary results from more than one thousand responders on social participation and life satisfaction. Methods: Thirty-five research organizations from Europe, North-Africa, Western Asia, and the Americas promoted the survey through their networks to the general society, in 7 languages (English, German, French, Arabic, Spanish, Portuguese, and Slovenian). Questions were presented in a differential format with questions related to responses “before” and “during” confinement conditions. Results: 1047 participations (54% women) from Asia (36%), Africa (40%), Europe (21%), and others (3%) were included in the analysis. Findings revealed psychosocial strain during the enforced COVID-19 home confinement. Large decreases (p < 0.001) in the amount of social activity through family (−58%), friends/neighbors (−44.9%), or entertainment (−46.7%) were triggered by the enforced confinement. These negative effects on social participation were also associated with lower life satisfaction (−30.5%) during the confinement period. Conversely, the social contact score through digital technologies significantly increased (p < 0.001) during the confinement period with more individuals (+24.8%) being socially connected through digital technology. Conclusion: These preliminary findings elucidate the risk of psychosocial strain during the early COVID-19 home confinement period in 2020. Therefore, in order to mitigate the negative psychosocial effects of home confinement, implementation of national strategies focused on promoting social inclusion through a technology-based solution is strongly suggested.
TL;DR: Promotion of lung ultrasound in this setting is strongly suggested to reduce health-care workers’ risk of exposure and also patient movement from the consultation room to the radiology room.
TL;DR: Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not, and Preventing acute IBD flares may avoid fatal CO VID-19 in patients with IBD.
Abstract: Objectives COVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The characteristics and outcomes of COVID-19 in patients with IBD remain unclear. Design This Italian prospective observational cohort study enrolled consecutive patients with an established IBD diagnosis and confirmed COVID-19. Data regarding age, sex, IBD (type, treatments and clinical activity), other comorbidities (Charlson Comorbidity Index (CCI)), signs and symptoms of COVID-19 and therapies were compared with COVID-19 outcomes (pneumonia, hospitalisation, respiratory therapy and death). Results Between 11 and 29 March 2020, 79 patients with IBD with COVID-19 were enrolled at 24 IBD referral units. Thirty-six patients had COVID-19-related pneumonia (46%), 22 (28%) were hospitalised, 7 (9%) required non-mechanical ventilation, 9 (11%) required continuous positive airway pressure therapy, 2 (3%) had endotracheal intubation and 6 (8%) died. Four patients (6%) were diagnosed with COVID-19 while they were being hospitalised for a severe flare of IBD. Age over 65 years (p=0.03), UC diagnosis (p=0.03), IBD activity (p=0.003) and a CCI score >1 (p=0.04) were significantly associated with COVID-19 pneumonia, whereas concomitant IBD treatments were not. Age over 65 years (p=0.002), active IBD (p=0.02) and higher CCI score were significantly associated with COVID-19-related death. Conclusions Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. Preventing acute IBD flares may avoid fatal COVID-19 in patients with IBD. Further research is needed.
TL;DR: Clinicians need to ensure early and thorough metabolic control for all patients affected by COVID-19 to ensure safe and effective treatment of type 2 diabetes mellitus and hypertension.
Abstract: Type 2 diabetes mellitus and hypertension are the most common comorbidities in patients with coronavirus infections. Emerging evidence demonstrates an important direct metabolic and endocrine mechanistic link to the viral disease process. Clinicians need to ensure early and thorough metabolic control for all patients affected by COVID-19.
TL;DR: Increased D-dimer levels have gained particular attention as a predictor of the development of acute respiratory distress syndrome (ARDS), the need for admission to an intensive care unit (ICU) or death1-5, and many issues remain to be addressed.
Abstract: Arrived: 05/04/2020 Accepted: 07/04/2020 Correspondence: Marco Marietta e-mail: marco.marietta@unimore.it 1Department of Oncology and Haematology, University Hospital, Modena; 2Department of Medicine and Surgery, “Insubria” University, Varese; 3IRCCS “Ca’ Granda Maggiore” Hospital Foundation, “Angelo Bianchi Bonomi” Haemophilia and Thrombosis Center and “Fondazione Luigi Villa”, Milan; 4Department of Medicine and Translational Surgery, “Università Cattolica del Sacro Cuore”, Faculty of Medicine and Surgery, Rome; 5Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Foundation \"A. Gemelli\" IRCCS University Hospital, Rome; 6Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia; 7Immunohematology and Transfusion Medicine Department, “ASST Papa Giovanni XXIII”, Bergamo; 8Department of Experimental and Clinical Medicine, “Careggi” University Hospital, University of Florence, Italy The ongoing pandemic of Coronavirus disease 2019 (COVID-19) is severely challenging healthcare systems all around the world, with the need to provide intensive care to a previously inconceivable number of patients. The clinical spectrum of the disease is very wide, ranging from minor, unspecific symptoms, such as fever, dry cough and diarrhoea, sometimes combined with mild pneumonia and mild dyspnoea, to severe pneumonia with dyspnoea, tachypnoea and disturbed gas exchange, leading in approximately 5% of infected patients to severe lung dysfunction, a need for ventilation, shock or multiple (extra pulmonary) organ failure1. Among the several clinical and biochemical parameters associated with poor prognosis, increased D-dimer levels have gained particular attention as a predictor of the development of acute respiratory distress syndrome (ARDS), the need for admission to an intensive care unit (ICU) or death1-5. On the other hand, disease severity also correlates with pro-inf lammatory cytokines (i.e., IL-2, IL6, IL-7, IL-10, G-CSF, IP-10, MCP-1, MIP-1A and TNF-α), although it is not yet clear what is the cause of such a cytokine storm6. These findings are consistent with the already demonstrated close connection between thrombosis and inf lammation7,8, two processes that mutually reinforce each other. Indeed, both coagulation factors (proand anti-coagulants)9-11 and platelets12-14 are directly implicated in the modulation of the host immune response, displaying proinf lammatory functions that are independent from their haemostatic effects. All the above issues have been instrumental in spreading the feeling that COVID-19 is associated with the classical syndrome named disseminated intravascular coagulation (DIC) and the subsequent consumption coagulopathy. Moreover, it has been shown that heparin, beside its anticoagulant effects, also displays an anti-inf lammatory action, various immunomodulatory properties, and protects glycocalyx from shedding15. It has also been suggested that dipyridamole, an antiplatelet drug with antiviral and antioxidant properties, has beneficial effects in patients with COVID-1916. Despite such a tight interconnection between inf lammation and haemostasis abnormalities, no good evidence is available of the efficacy/safety of heparin and/or antiplatelet agents on sepsis patients, and many issues remain to be addressed, such as the proper timing, dosages and administration scheme of antithrombotic drugs17-19. Nevertheless, very recent data showed that low molecular weight heparin (LMWH) or unfractionated heparin (UFH) at prophylactic doses are associated with a reduced 28-day mortality in more severe COVID-19 patients displaying a sepsis-induced coagulopathy (SIC) score ≥4 (40.0% vs 64.2%, p=0.029) or D-dimer levels >6-fold the upper limit of © SI MT IP RO Sr l
TL;DR: In the coronavirus disease 2019 (COVID-19) pandemic, Italy has been hit very hard, with 110 574 documented cases and 13 155 documented deaths related to severe acute respiratory syndrome coronav virus 2 (SARS-CoV-2) infection as of April 1, 2020.
Abstract: In the coronavirus disease 2019 (COVID-19) pandemic, Italy has been hit very hard,1 with 110 574 documented cases and 13 155 documented deaths related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as of April 1, 2020. The number of cases and deaths cannot be explained simply because of the epidemic starting in Italy earlier compared with other countries besides China. It is important to understand why death rates were so high in Italy to learn how to best prepare and how to plan for optimal actions in other countries. Some contributing factors may be immutable (eg, age structure of the population), but even these need to be laid out carefully in preparedness assessments. Some other contributing factors are potentially modifiable. Some factors pertain to demographics and background disease in the population. Italy has the most elderly population in Europe and the second most elderly population in the world after Japan. COVID-19 has a strong age dependence for the severity of the infection and the risk of death. The median age of people infected with SARS-CoV-2 who are dying in Italy has been 80 years, and the average age of patients requiring critical care support has been 67 years. Moreover, COVID-19 morbidity and mortality is strongly dependent on the presence of concomitant serious diseases, and Italy has a high proportion of patients with history of smoking and high rates of chronic obstructive pulmonary disease and ischemic heart disease.2 The corollary is that preparedness for needs of intensive care unit (ICU) beds and estimates of expected deaths should consider the age structure and chronic diseases of the population served by each health care system. Taking this adjustment into account, burden of disease may be expected to be much less in most areas in the United States, with variability across states and hospital catchment areas. For example, the proportion of the population older than 65 years is 9.5% in Alaska as compared with 19.1% in Florida and 23.1% in Italy. A second set of factors in Italy is the increased burden of cases that presented themselves to the health care system. The proportion of people infected must have been very high in specific areas that were highly affected. In the town of Vò, all 3300 residents were tested the day the first case was detected in the third week of February, and 3% were found to be infected.3 Following aggressive testing, the epidemic was extinguished. However, elsewhere in Italy, it is likely that the prevalence of infection was several times higher in the absence of effective public health intervention. For example, it is likely that the health care system was overwhelmed in Bergamo owing to massive viral transmission during the Champions League match on February 19, 2020 (Atalanta vs Valencia), where a third of the population of Bergamo attended and continued celebrations overnight. Italian life is famous for its socialization and frequent congregations and clustering. It is possible also that in early stages, there was not much adoption of standard hygienic measures, and instructions to stay at home proved difficult to accept, with many complaints registered with the police.4 Accordingly, a higher level of preparedness should be considered for areas where mass gatherings have occurred or where there is extensive social intermingling. A third set of factors pertains to the standard capacity of the health care system and decisions made during hospital management of the presenting cases. Italy has a highly competent state-run health care system, but it has only a modest number of ICU beds and very few subintensive care beds. Overall, 5090 ICU beds (8.4 per 100 000 population) are available in Italy, and 2601 beds in coronary care units (4.3 per 100 000 population),5 as opposed to much higher numbers (36 ICU beds per 100 000 population) in the United States. Given the little experience in dealing with the new virus, it is unavoidable that some strategic mistakes were made about which patients should be hospitalized. In the winter, hospitals tend to run close to full capacity, with 87% average occupancy in Italy during the flu season. Apparently, many patients with relatively modest symptoms were admitted; by the time more patients with severe cases started to arrive, there were limited reserves. Hospital overcrowding may also explain the high infection rate of medical personnel. As of March 30, 2020, 8920 medical personnel had been found to be infected in Italy,6 leading to further loss of capacity for hospitals to respond. Moreover, early infection of medical personnel led to the spread of the infection to other patients within hospitals. In Lombardy, SARS-CoV-2 became largely a nosocomial infection. Nine percent of infections in Italy occurred among health care personnel.6 Characteristically, the first patient with COVID-19 visited the emergency department twice, thus exposing all of the personnel and patients in that area before the infection was recognized. Italy is a decentralized country; thus, preparedness and containment may have been hampered. There was a delay from the first case detection (February 21, 2020) to the first containment decree from the government that closed the relevant villages 3 days later. The lessons relevant to other countries are the need to (1) avoid bringing patients with suspected SARS-CoV-2 infection to the hospital, except when they clearly require hospital care; (2) maintain strict hygienic procedures in the hospital environment; and (3) act swiftly in VIEWPOINT
TL;DR: How the COVID-19 outbreak and related infection control measures could hit the most frail individuals, worsening the condition of NCD patients, while further jeopardizing the sustainability of the healthcare systems is discussed.
Abstract: The early stages of the COVID-19 pandemic have focused on containing SARS-CoV-2 infection and identifying treatment strategies. While controlling this communicable disease is of utmost importance, the long-term effect on individuals with non-communicable diseases (NCD) is significant. Although certain NCDs appear to increase the severity of COVID-19 and mortality risk, SARS-CoV-2 infection in survivors with NCDs may also affect the progression of their pre-existing clinical conditions. Infection containment measures will have substantial short- and long-term consequences; social distancing and quarantine restrictions will reduce physical activity and increase other unhealthy lifestyles, thus increasing NCD risk factors and worsening clinical symptoms. Vitamin D levels might decrease and there might be a rise in mental health disorders. Many countries have made changes to routine management of NCD patients, e.g., cancelling non-urgent outpatient visits, which will have important implications for NCD management, diagnosis of new-onset NCDs, medication adherence, and NCD progression. We may have opportunities to learn from this unprecedented crisis on how to leverage healthcare technologies and improve procedures to optimize healthcare service provision. This article discusses how the COVID-19 outbreak and related infection control measures could hit the most frail individuals, worsening the condition of NCD patients, while further jeopardizing the sustainability of the healthcare systems. We suggest ways to define an integrated strategy that could involve both public institutional entities and the private sector to safeguard frail individuals and mitigate the impact of the outbreak.
Charité1, University of Helsinki2, Catholic University of the Sacred Heart3, Erasmus University Rotterdam4, University Hospitals Birmingham NHS Foundation Trust5, University of Graz6, University of Regensburg7, Boston Children's Hospital8, French Institute of Health and Medical Research9, Ankara University10, Sheba Medical Center11, University Hospital of Basel12, Katholieke Universiteit Leuven13, University of Valencia14, University Hospital Centre Zagreb15, University Medical Center Freiburg16, Medical University of Warsaw17
TL;DR: Key updates to these recommendations include a broader use of rabbit anti-T-cell globulin; lower steroid doses for the management of grade 2 acute GVHD with isolated skin or upper gastrointestinal tract manifestations; fluticasone, azithromycin, and montelukast should be used for bronchiolitis obliterans syndrome; and the addition of newer treatment options for resteroid-refractory acute and chronic GV HD.
Brigham and Women's Hospital1, Catholic University of the Sacred Heart2, National Institutes of Health3, university of lille4, Katholieke Universiteit Leuven5, Icahn School of Medicine at Mount Sinai6, Harvard University7, University of Ulsan8, University of Parma9, University of British Columbia10, Columbia University Medical Center11, New Generation University College12, Samsung Medical Center13
TL;DR: This multidisciplinary Position Paper by the Fleischner Society addresses important issues regarding interstitial lung abnormalities, including standardisation of the definition and terminology; predisposing risk factors; clinical outcomes; options for initial evaluation, monitoring, and management; the role of quantitative evaluation; and future research needs.
Uppsala University1, Gloucestershire Hospitals NHS Foundation Trust2, Nova Southeastern University3, University of Hamburg4, University of Amsterdam5, University of Pécs6, Catholic University of the Sacred Heart7, University of Bern8, Utrecht University9, Houston Methodist Hospital10, University of Patras11, University of Southern Denmark12, Ghent University13, Cambridge University Hospitals NHS Foundation Trust14, Asahikawa Medical University15, Medical University of Graz16, University of Adelaide17, University Health Network18, Imperial College London19, National University of Colombia20
TL;DR: Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia.
TL;DR: Multiple subpopulations of synovial tissue macrophages with varied transcriptional, phenotypic and functional features may contribute to disease flare and tissue repair in patients with active rheumatoid arthritis and patients in clinical remission.
Abstract: Immune-regulatory mechanisms of drug-free remission in rheumatoid arthritis (RA) are unknown We hypothesized that synovial tissue macrophages (STM), which persist in remission, contribute to joint homeostasis We used single-cell transcriptomics to profile 32,000 STMs and identified phenotypic changes in patients with early/active RA, treatment-refractory/active RA and RA in sustained remission Each clinical state was characterized by different frequencies of nine discrete phenotypic clusters within four distinct STM subpopulations with diverse homeostatic, regulatory and inflammatory functions This cellular atlas, combined with deep-phenotypic, spatial and functional analyses of synovial biopsy fluorescent activated cell sorted STMs, revealed two STM subpopulations (MerTKposTREM2high and MerTKposLYVE1pos) with unique remission transcriptomic signatures enriched in negative regulators of inflammation These STMs were potent producers of inflammation-resolving lipid mediators and induced the repair response of synovial fibroblasts in vitro A low proportion of MerTKpos STMs in remission was associated with increased risk of disease flare after treatment cessation Therapeutic modulation of MerTKpos STM subpopulations could therefore be a potential treatment strategy for RA