Depression and post-traumatic stress disorder symptoms during the COVID-19 pandemic in Italy

Introduction

Social restrictions imposed by the Italian Government during the COVID-19 emergency might have had a significant impact on mental health. The purpose of this study was to estimate the prevalence of depressive and post-traumatic stress disorder (PTDS) symptoms in a sample of Italian citizens during the first COVID-19 pandemic wave.

Materials and methods

A cross-sectional survey was carried out between April and June 2020 using a snowball sampling. Depressive symptoms were explored through the Patient Heath Questionnaire-2 (PHQ-2), while the post-traumatic stress disorder (PTDS) was investigated through the SPAN (Startle, Physical arousal, Anger, Numbness) questionnaire. Poisson regression models were used to explore the association between the outcomes under study and sociodemographic/housing characteristics.

Results

A total of 10.758 interviews were collected and 7.847 (73%), complete for a minimum set of indicators (age, sex, area of residence), were included in the final analysis. The majority of the respondents were females (71%). Sample mean age was 48.6 years. The prevalence of depressive symptoms was 21.2% and that of PTDS was 43.8%. Symptoms of depression and PTDS significantly diminished across age groups, in particular in people over 70 years compared with people aged 14-29 years (PR 0.65, 95% CI 0.49-0.86). A higher prevalence was found in students compared with retired people, both for depressive symptoms (PR 1.49, 95% CI: 1.05-2.10) and PTDS (PR 1.31, 95% CI: 1.02-1.69).

Conclusions

Prevalence of depressive and PTDS symptoms was high, in particular among younger people and students. That could potentially lead to adverse mental health outcomes in the future, with serious public health consequences. As the pandemic emergency is not solved yet, it is necessary to implement preventive strategies in order to protect the mental well-being of particularly vulnerable subgroups in the population.

Key messages

The prevalence of psychological symptoms was high in this sample during the first wave of COVID-19 pandemic.

The subgroups of the population at higher risk for adverse psychological outcomes were younger people and students.

High BRAF variant allele frequencies are associated with distinct pathological features and responsiveness to target therapy in melanoma patients

Background

BRAF mutant melanoma patients are commonly treated with anti-BRAF therapeutic strategies. However, many factors, including the percentage of BRAF-mutated cells, may contribute to the great variability in patient outcomes.

Patients and methods

The BRAF variant allele frequency (VAF; defined as the percentage of mutated alleles) of primary and secondary melanoma lesions, obtained from 327 patients with different disease stages, was assessed by pyrosequencing. The BRAF mutation rate and VAF were then correlated with melanoma pathological features and patients’ clinical characteristics. Kaplan–Meier curves were used to study the correlations between BRAF VAF, overall survival (OS), and progression-free survival (PFS) in a subset of 62 patients treated by anti-BRAF/anti-MEK therapy after metastatic progression.

Results

A highly heterogeneous BRAF VAF was identified (3%-90%). Besides being correlated with age, a higher BRAF VAF level was related to moderate lymphocytic infiltration (P = 0.017), to melanoma thickness according to Clark levels, (level V versus III, P = 0.004; level V versus IV, P = 0.04), to lymph node metastases rather than cutaneous (P = 0.04) or visceral (P = 0.03) secondary lesions. In particular, a BRAF VAF >25% was significantly associated with a favorable outcome in patients treated with the combination of anti-BRAF/anti-MEK drug (OS P = 0.04; PFS P = 0.019), retaining a significant value as an independent factor for the OS and the PFS in the multivariate analysis (P = 0.014 and P = 0.003, respectively).

Conclusion

These results definitively support the role of the BRAF VAF as a potential prognostic and predictive biomarker in melanoma patients in the context of BRAF inhibition.

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In melanoma the response to anti-BRAF targeted therapies is heterogeneous and influenced by several features.

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The role of the BRAF VAF as provider of sensitivity to target therapies is debated.

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We found that high BRAF VAFs are associated with patient age, melanoma thickness, non-brisk TILs and lymph node metastases.

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We proved the independent prognostic value of high BRAF VAFs in melanoma patients treated with targeted therapies.

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The quantitative evaluation of BRAF mutations allows stratifying melanoma patients to the BRAF/MEK targeted treatment.

Complications associated with bone marrow sampling in dogs and cats

OBJECTIVES

To evaluate the prevalence of complications during bone marrow sampling and associated patient and procedural factors in dogs and cats.

MATERIALS AND METHODS

Retrospective cohort study, records were evaluated to identify dogs and cats that had bone marrow sampling between 2012 and 2019. Data including signalment, the presence of specific clinicopathological findings, anatomical site of bone marrow sampling, number of attempts, diagnostic quality of sampling, analgesia protocol and complications postprocedure were recorded.

RESULTS

A total of 131 dogs and 29 cats were included in the study. Complications were recorded in 22 of 160 (14%) of cases. Pain was the most common complication of bone marrow sampling in 20 of 22 (91%) of cases with bruising reported in the remaining patients. A local anaesthetic block was used in 98 of 160 (61%) of patients.

CLINICAL SIGNIFICANCE

Excluding pain, complications associated with bone marrow sampling were rare and no clear association were detected between patient or procedural variables. Haemorrhage and infection are rare complications in dogs and cats when thrombocytopenia and neutropenia are present. Peri-procedure analgesia is strongly recommended to minimise complications.