Purpose
Hyponatremia occurs in about 30% of patients with pneumonia, including those with SARS-CoV-2 (COVID-19) infection. Hyponatremia predicts a worse outcome in several pathologic conditions and ...in COVID-19 has been associated with a higher risk of non-invasive ventilation, ICU transfer and death. The main objective of this study was to determine whether early hyponatremia is also a predictor of long-term sequelae at follow-up.
Methods
In this observational study, we collected 6-month follow-up data from 189 laboratory-confirmed COVID-19 patients previously admitted to a University Hospital. About 25% of the patients (
n
= 47) had hyponatremia at the time of hospital admission.
Results
Serum Na
+
was significantly increased in the whole group of 189 patients at 6 months, compared to the value at hospital admission (141.4 ± 2.2 vs 137 ± 3.5 mEq/L,
p
< 0.001). In addition, IL-6 levels decreased and the PaO
2
/FiO
2
increased. Accordingly, pulmonary involvement, evaluated at the chest X-ray by the RALE score, decreased. However, in patients with hyponatremia at hospital admission, higher levels of LDH, fibrinogen, troponin T and NT-ProBNP were detected at follow-up, compared to patients with normonatremia at admission. In addition, hyponatremia at admission was associated with worse echocardiography parameters related to right ventricular function, together with a higher RALE score.
Conclusion
These results suggest that early hyponatremia in COVID-19 patients is associated with the presence of laboratory and imaging parameters indicating a greater pulmonary and right-sided heart involvement at follow-up.
Background: First objective was to evaluate changes in health trajectories at 6 months follow-up in older people with post-acute COVID syndrome (PACS), prospectively evaluated with a multidimensional ...assessment of clusters of PACS symptoms, frailty and HRQoL. Secondary objective was to assess patients' satisfaction and engagement in this participatory research and action study, in which a voice assistant (VA) tool was used to empower people with PACS. Methods: This study included 50 consecutive patients, aged >50 years, previously hospitalized in March–April 2020 for severe COVID pneumonia attending Modena PACS clinic in February 2021. PACS was defined as the persistence of ≥1 cluster of symptoms, including respiratory, neurocognitive, musculoskeletal, psychological, sensory and dermatological. Enrolled patients used for 6 months a Google Nest Mini VA tool. This tool was engineered (1) to collect patient reported outcomes, (2) to promote healthy lifestyles, (3) to provide brief records about PACS and how to treat it, and (4) to collect narrative medicine records. The following patients reported outcomes (PROs) were evaluated with questionnaires at baseline and at 6-month follow-up: Depression Anxiety Stress Scale (DASS-21), Connor-Davidson Resilience Scale (CD-RISC-25), SUNFRAIL, Quality of Life (EQ-5D-5L), Insomnia Severity Index (ISI), General Health Survey (SF-36). Clinical data included frailty phenotype and assessment for sarcopenia with hand grip measured with dynamometer. At follow-up participants were asked to evaluate their satisfaction with the VA tool. Patients' empowerment was assessed with the proportion of people acquiring a normal caloric and normal protein diet, and reduction of sedentary life and engagement with moderate and vigorous physical activity. Results: Enrolled patients were 39 (78%) males, median age was 63 years old. 2 patients (aged >75 years) withdrew the study (4%). Table 1 shows improvements in anthropometric, symptoms, and PROs data. Patients' satisfaction was evaluated as following: 96% of participants considered VA useful, among them: 56% appraised all the 4 utilities, 27% PROs collection in particular, 11% lifestyle promotion in particular. Moreover 44% used VA for entertainment and to cope with loneliness. Patients' empowerment was evaluated as following: 6.4% of participants modified diet from hypercaloric to adequate caloric intake and 8.3% from hypo-protein to normal protein intake. 48% participants modified sedentary life, in detail 46% increased moderate physical activity and 22% increased vigorous physical activity, respectively. Conclusions: In this pilot study, PACS cluster symptoms, frailty and HRQoL improved at 6 months follow up. VA tool was appraised and contributed to empower people with PACS improving lifestyle, in particular physical activity. Funding: The study was funded by Azione Finalizzata 2020, Ministero della salute di Italia (project code: WFR: COVID-2020-12371808).
Une belle créature, mi humaine mi fée, qui renonce par amour à son statut d'immortelle ; un prince amoureux fou de cette créature, qui laisse le royaume de son père aux mains d'un despote sanguinaire ...; un mage démoniaque qui a lancé contre eux une terrible malédiction. Ce trio est au centre de La Femme serpent, fable théâtrale tragicomique que Carlo Gozzi offre avec succès au public de Venise en octobre 1762, peu après Turandot. Transformations, apparitions, disparitions, déchaînement de tonnerre et d'éclairs, palais merveilleux succédant à un désert rocailleux, grottes peuplées de monstres hideux. À partir de sources diverses, françaises et italiennes, Gozzi déploie toute sa science de la scène et de l'écriture, et mêle avec brio le merveilleux, le tragique, le pathétique et le comique hérités de la commedia dell'arte. Les amants réussiront-ils à surmonter les épreuves imposées par le mage ? Le prince sauvera-t-il son royaume ? La fée deviendra-t-elle humaine ?
Autism Spectrum Disorder (ASD) is characterized by substantial, yet highly heterogeneous abnormalities in functional brain connectivity. However, the origin and significance of this phenomenon remain ...unclear. To unravel ASD connectopathy and relate it to underlying etiological heterogeneity, we carried out a bi-center cross-etiological investigation of fMRI-based connectivity in the mouse, in which specific ASD-relevant mutations can be isolated and modeled minimizing environmental contributions. By performing brain-wide connectivity mapping across 16 mouse mutants, we show that different ASD-associated etiologies cause a broad spectrum of connectional abnormalities in which diverse, often diverging, connectivity signatures are recognizable. Despite this heterogeneity, the identified connectivity alterations could be classified into four subtypes characterized by discrete signatures of network dysfunction. Our findings show that etiological variability is a key determinant of connectivity heterogeneity in ASD, hence reconciling conflicting findings in clinical populations. The identification of etiologically-relevant connectivity subtypes could improve diagnostic label accuracy in the non-syndromic ASD population and paves the way for personalized treatment approaches.
The pathophysiology of autism has been suggested to involve a combination of both macroscale connectome miswiring and microcircuit anomalies. Here, we combine connectome-wide manifold learning with ...biophysical simulation models to understand associations between global network perturbations and microcircuit dysfunctions in autism. We studied neuroimaging and phenotypic data in 47 individuals with autism and 37 typically developing controls obtained from the Autism Brain Imaging Data Exchange initiative. Our analysis establishes significant differences in structural connectome organization in individuals with autism relative to controls, with strong between-group effects in low-level somatosensory regions and moderate effects in high-level association cortices. Computational models reveal that the degree of macroscale anomalies is related to atypical increases of recurrent excitation/inhibition, as well as subcortical inputs into cortical microcircuits, especially in sensory and motor areas. Transcriptomic association analysis based on postmortem datasets identifies genes expressed in cortical and thalamic areas from childhood to young adulthood. Finally, supervised machine learning finds that the macroscale perturbations are associated with symptom severity scores on the Autism Diagnostic Observation Schedule. Together, our analyses suggest that atypical subcortico-cortical interactions are associated with both microcircuit and macroscale connectome differences in autism.
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