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Cianci F, Olga A, Magnani M, Pignataro F, Massimo F, Reta M. AB1407 TELERHEUMATOLOGY AND WORKING VISIT: INITIAL MONOCENTRIC EXPERIENCE ON USE OF TELEVISIT IN THE REGULAR FOLLOW-UP. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe COVID-19 pandemic shifted most healthcare to remote delivery methods (telehealth technologies including clinical video televisit) to protect patients, clinicians, and hospital staff. Telerheumatology visits were found to be noninferior to in-person visits and are often more time and cost effective for patients.1ObjectivesDescription of an initial integration of video televisit in regular follow-up.MethodsIn cooperation with the ALTEMS Operational Telemedicine Observatory, we built a procedural manual for televisit, whose phases were as much as possible similar to the usual visit scenario. Patients in remission or in mild disease activity at the time of enrolling visit were involved. Clinical characteristics, treatments and televisits’ features were considered for all patients (Table 1). Patient overall satisfaction was evaluated (rating 1 to 5).Table 1.Patients (n.)74M/F27/47Age (y) median46.2±13.5RA n. (%)19 (25.6)PsA n. (%)21 (28.3)SpA (%)13 (17.5)CTD n. (%)8 (10,4)Vasculitis n. (%)7 (9.4)Other n. (%)6 (8.1)b or tsDMARDs n. (%)20 (62.5)Televisits n.86Mean duration (min.)17±3.5Satisfaction (1-5)4.68Device (PC/smartphone) %62.5/37.5Distance saved, mean (km)77,5Time travel saved, mean (min.)66CO2 saved (kg)866.71€ saved (per patient)44,37Working visit n. (%)5 (15.6)Results86 televisits were performed in 74 consecutive patients, with a mean age of 46.2 ± 13.5 years, diagnosed with the most common rheumatic diseases and on chronic immunosuppressive therapy (c-b-ts DMARDs mono or combination therapy). In 5 cases, in-person visit after televisit was required. the average duration of the televisit was 17 ± 3.5 minutes and the average overall satisfaction was 4.68 / 5. The average distance saved (round trip) was 77,5 km, equal to an avoided travel time of 66 minutes and with a total reduction in CO2 production of approximately 866 kg. 5 patients performed video visit from workplace, de facto inventing the “working visit”.ConclusionTelemedicine is going to become an essential element of clinical practice in rheumatology,2 especially for active, young, and working patients, helping to minimize the overall impact of the disease on QoL, as far as they are properly selected for clinical characteristics and informatic skills. The possibility to attend to televisit from the workplace will reduce the lost working-hours and the need of travel, thus acquiring undoubted social utility. In the near future, the use of televisit should be also extended to vulnerable patients lacking basic informatic resources, with the help of care-givers or dedicated territorial services.References[1]Matsumoto R, Barton JL. Curr Opin Rheum 2021 May; 1;33(3):262-269. doi:0.1097/BOR.0000000000000790.[2]https://www.salute.gov.it/imgs/C_17_pubblicazioni_2129_allegato.pdfALTEMS = Alta Scuola di Economia e Management dei Sistemi SanitariDisclosure of InterestsNone declared
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Moti BS, Oz E, Olga A, Bella G, Shifra S, Eilam P. New Cortical Neurodegenerative Pathways in the Hypertensive Rat Brain. Cereb Cortex 2021; 31:5487-5496. [PMID: 34179944 DOI: 10.1093/cercor/bhab173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/20/2021] [Accepted: 05/25/2021] [Indexed: 11/12/2022] Open
Abstract
Hypertension is a risk factor for neurodegenerative diseases. We hypothesized that chronic hypertension underlies neurodegeneration. In this study, we examined the expression of brain cortical proteins involved in homeostasis, apoptosis, and brain functions in Spontaneously Hypertensive Rats (SHR) compared with normotensive Wistar-Kyoto (WKY) rats. We used paraffin-embedded brain sections of 8-month-old SHR and WKY rats, immunohistochemically stained and analyzed by image processing. In SHR, cytochrome c oxidase subunit 7A increased, indicative of hypoxia; heat shock protein 40, the chaperon for refolding proteins, decreased, leading to accumulation of misfolded proteins; the levels of both voltage-gated sodium channels, Na1.2, 1.6, decreased, reflecting attenuation of the action potential, causing axonal injury; autophagy-related protein 4A (Atg4a), an essential protein of autophagy, decreased, reducing the removal of misfolded proteins; demyelination, the hallmark of neurodegeneration, was shown; modulation of both histone deacetylases 2 and histone acetyltransferase 1 was shown, indicative of altered regulation of gene transcription; increased activated (cleaved) caspase-3, indicative of apoptosis. These new findings suggest that chronic hypertension induces hypoxia and oxidative stress, axonal injury, accelerates the accumulation of misfolded proteins and apoptosis, pathways preceding neurodegeneration.
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Affiliation(s)
- Ben Shabat Moti
- Galilee Medical Center, Research Institute, PO Box 21, Nahariya 22100, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eliya Oz
- Galilee Medical Center, Research Institute, PO Box 21, Nahariya 22100, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Azrilin Olga
- Galilee Medical Center, Research Institute, PO Box 21, Nahariya 22100, Israel.,Neurology Department, Galilee Medical Center, Nahariya, Israel
| | - Gross Bella
- Galilee Medical Center, Research Institute, PO Box 21, Nahariya 22100, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Neurology Department, Galilee Medical Center, Nahariya, Israel
| | - Sela Shifra
- Galilee Medical Center, Research Institute, PO Box 21, Nahariya 22100, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Palzur Eilam
- Galilee Medical Center, Research Institute, PO Box 21, Nahariya 22100, Israel
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