Circulation of SARS-CoV-2 Among Asylum Seekers: A Real-Life Experience to Address Health Equity in Piacenza, Italy

Aim of the Study: We aimed to evaluate the virus spreading among a migrant population previously excluded by community surveillance programs. Method(s): We conducted a retrospective study, collecting data about people without SARS-CoV-2-related symptoms who attended the outpatient clinic for undocumented migrants from November 1, 2020, to April 30, 2021. Patients who performed a nasopharyngeal swab and serologic test to evaluate the presence of antibody anti-SARS-CoV-2 were enrolled. Result(s): Overall, 240 people were included in our study. Of them, 15 (6.3%) were female, with a median age of 27.0 years (interquartile range [IQR], 24.3-32.1 years). Thirty-seven patients (15.4%) tested positive for SARS-CoV-2 at the nasopharyngeal swab during the study period. Of these, 16 had positive or low positive results for immunoglobulin G (IgG) and 3 tested positive for both IgG and IgM. Besides, 22 participants (9.2%) resulted positive to serological testing, but negative to polymerase chain reaction testing. The median age of SARS-CoV-2 positive patients (n = 59) was significantly higher than negative (29.6 [IQR, 25.0-35.0] vs 26.8 [IQR, 24.2-31.5], P = 0.022). Among positive patients, the most frequent nationality was Bangladeshi, with 24 people (40.7%, P < 0.001). The highest percentage of positive was found among the same nationality (51.1% of Bangladeshi tested positive). Conclusion(s): Our data underline the significantly higher prevalence of SARS-CoV-2 infection in the undocumented migrant population in respect of the general population of Piacenza province in the same period (15.4% vs 5.9%, P < 0.001). The extension of surveillance programs to the whole population, thus including undocumented people, is crucial to curb the spreading of the virus.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Ensuring the implementation of healthcare policies able to eliminate hepatitis C at both central and regional levels during the COVID-19 pandemic

Viral hepatitis C is an important public health problem and its elimination by 2030, defined by the World Health Organization, is an ambitious goal. The chance of free screening for HCV infection represents an important achievement that requires a successful State-Regions coordination and an effective regional organisation, that guarantees an interdisciplinary course between local and specialized healthcare. A structured communication program to increase the sensitivity of target populations as well as health professionals is the key for success. The implementation of the proactive screening, defined by the Milleproroghe Law, is crucial because it will define the tracks for the whole HCV costeffective screening strategies (1948-1988 birth cohorts) required to achieve the HCV elimination targets in Italy by 2030.

The Systemic Inflammation Index on admission is independently associated with length of stay in hospitalized COVID-19 patients

BACKGROUND: The early detection of factors predicting hospital length of stay (LOS) in patients affected by severe acute respiratory syndrome in Coronavirus 2 (SARS-CoV-2) disease (COVID-19) might facilitate therapeutic decisions and patient flow management. METHODS: We collected routine clinical and laboratory parameters and derived inflammatory indexes on admission in 65 consecutive COVID-19 patients transferred to the Unit of Respiratory and Infectious Disease of the University Hospital of Sassari (North-Sardinia, Italy) who were alive on discharge. RESULTS: Patients with prolonged length of stay (LOS) (PLOS >= 26 days, N.=22) had significantly higher chest CT severity scores, neutrophils, neutrophil lymphocyte ratio (NLR), aggregate index of systemic inflammation, Systemic Inflammation Response Index, Systemic Inflammation Index (SII), aspartate aminotransferase, lactate dehydrogenase (LDH), and rates of obesity and respiratory support, than non-PLOS patients (N.=43). In univariate analysis, LOS was significantly and negatively correlated with lymphocytes and monocytes, and positively correlated with Body Mass Index (BMI), intensity of care, chest CT severity score, NLR, platelet lymphocyte ratio, SII and LDH. In multivariate regression analysis, only the SII was significantly associated with LOS (beta=0.506, P=0.002) after adjusting for BMI, intensity of care, chest CT severity score and LDH. CONCLUSIONS: SII values on admission were independently associated with LOS in COVID-19 patients. Prospective studies in larger cohorts are required to confirm our findings and to determine the role of the SII in clinical decision making.

Systemic inflammatory markers and psychophysical olfactory scores in coronavirus disease 2019 patients: is there any correlation?

OBJECTIVE: To analyse the correlations between olfactory psychophysical scores and the serum levels of D-dimer, C-reactive protein, ferritin, lactate dehydrogenase, procalcitonin and neutrophil-to-lymphocyte ratio in coronavirus disease 2019 patients. METHODS: Patients underwent psychophysical olfactory assessment with the Connecticut Chemosensory Clinical Research Center test, and determination of blood serum levels of the inflammatory markers D-dimer, C-reactive protein, ferritin, lactate dehydrogenase, procalcitonin and neutrophil-to-lymphocyte ratio within 10 days of the clinical onset of coronavirus disease 2019 and 60 days after. RESULTS: Seventy-seven patients were included in this study. D-dimer, procalcitonin, ferritin and neutrophil-to-lymphocyte ratio correlated significantly with severe coronavirus disease 2019. No significant correlations were found between baseline and 60-day Connecticut Chemosensory Clinical Research Center test scores and the inflammatory markers assessed. CONCLUSION: Olfactory disturbances appear to have little prognostic value in predicting the severity of coronavirus disease 2019 compared to D-dimer, ferritin, procalcitonin and neutrophil-to-lymphocyte ratio. The lack of correlation between the severity and duration of olfactory disturbances and serum levels of inflammatory markers seems to further suggest that the pathogenetic mechanisms underlying the loss of smell in coronavirus disease 2019 patients are related to local rather than systemic inflammatory factors.

Milestones to reach Hepatitis C Virus (HCV) elimination in Italy: From free-of-charge screening to regional roadmaps for an HCV-free nation

Although Italy has been on track for Hepatitis C Virus (HCV) elimination since 2019, it fell off track due to the decrease in the number of treated patients. HCV elimination in Italy will be possible if immediate action is taken. A health policy was implemented beginning in 2021, consisting of screening among key populations and birth cohorts (1969-1989), estimated to have a high prevalence of undiagnosed individuals. The active screening requires regional governance that manages the processes' complexity integrating a well-organized network between territory assistance and hospital to achieve an effective HCV care cascade. This document aims to support the regional decision-making process by defining paths for screening and linkage-to-care. Implementing active screening strategies beyond a risk-based approach is required as a General Practitioners' task. Simplified paths must be drawn for the key populations screening. The infrastructure built for COVID-19 vaccination could be used also for HCV screening. According to a multidisciplinary care delivery, screening should be supplemented with rapid linkage-to-care and treatment of newly diagnosed patients. The realization of the proactive screening during the first two years is vital because it will define the tracks for the whole HCV cost-effective screening of 1948-1988 birth cohorts in Italy.

Does Angiotensin II receptor blockers increase the risk of SARS-CoV-2 infection? A real-life experience.

OBJECTIVE: Since the start of the COVID-19 pandemic, millions of people have been infected with thousands of deaths. Few data regarding factors that increase the risk of infection are available. Our study aimed to evaluate all people living in retirement homes (PLRNH) and identify factors that could increase infection risk in a close community. MATERIALS AND METHODS: We conducted a retrospective study enrolling all PLRNH, where at least one SARS-CoV-2 infected person was present. Variables were compared with Student's t-test or Pearson chi-square test as appropriate. Uni- and multivariate analyses were conducted to evaluate variables' influence on the infection. RESULTS: We included 452 PLRNH; 144 (31.7%) were male, with a mean age of 82.2±8.6 years. People with a positive swab for SARS-CoV-2 were 306 (67.4%). A significant difference between SARS-CoV-2 infected and not infected was observed in the percentage of those receiving chronic treatment with Angiotensin II receptor blockers (ARBs) (18.6% vs. 9.5%, p=0.012). On the contrary, there was no difference in the proportion of those receiving ACE inhibitors (ACE-I) (21.2% vs. 23.6%, p=0.562). At multivariate analysis, people with mental illness and cancer had an increased risk of being infected. Furthermore, receiving ARBs as a chronic treatment was an independent predictor of infection risk [OR 1.95 (95% CI 1.03-3.72) p=0.041]. CONCLUSIONS: Our data suggest that, in close communities, such as retirement nursing homes, the receipt of ARBs increased the risk of acquiring SARS-CoV-2 infection. However, before changing an important chronic treatment in a fragile population, such as the elderly living in retirement nursing homes, clinicians should carefully evaluate the risk-benefit ratio.

Routine laboratory tests alterations in relation with the severity of coronavirus disease 2019 (COVID-19)

Introduction. Coronavirus disease 19 (COVID-19) is the greatest pandemic in modern history. The aim of this study was to investigate the alteration and prognostic potential of routine blood tests in a series of consecutive Italian patients with COVID-19. Methods. Clinical data and routine laboratory tests of a consecutive series of 62 COVID-19 patients treated in the Units of Infectious and Respiratory Diseases of the University of Sassari from 15 March through 30 April 2020, have been retrospectively collected. Differences in laboratory tests performed at hospital admission between COVID-19 survivors and non survivors were statistically searched and analyzed. Results. Patients in non-survivors group had higher number of WBCs (median: 9.16 x109L;IQR: 6.29-13.07 x109L vs 6.37 x109L;IQR: 4.95-9.04 x109L, p=0.037), neutrophils (mean: 9.2±6.0 x109L vs 5.4±2.7 x109L, p=0.001), and lower lymphocytes number (median: 0.6 x109L;IQR: 0.6-0.85 x109L vs 1.0 x109L;IQR: 0.7-1.2 x109L, p=0.013). In addition, non-survivors showed lower albumin (median: 3.2 g/dL;IQR: 2.9-3.4 g/dL vs 3.5 g/dL;IQR: 3.0-3.9 g/dL, p=0.035), and increased PCR/albumin ratio (median: 3.65;IQR: 2.17-6.86 vs 1.56;IQR: 0.64-4.36, p=0.035) and De Ritis ratio (median: 1.14;IQR: 0.89-1.48 vs 1.73;IQR: 1.29-2.27, p=0.002). Increased levels of LDH (median: 359 IU/L;IQR: 259-504 vs 273 IU/L;IQR: 197-356 IU/L, p=0.017), procalcitonin (median: 0.28 ng/mL;IQR: 0.19-0.52 ng/mL vs 0.07 ng/mL;IQR: 0.03-0.17 ng/mL, p=0.0006) and troponin (median: 0.181 ng/mL;IQR: 0.068-0.193 ng/mL vs 0.004 ng/mL;IQR: 0.000-0.017 ng/mL, p=0.002) has been found in nonsurvivors. In ROC curve analysis the better performing indexes were troponin, with a threshold of 0.037 ng/mL, 86% sensitivity and 100% specificity (AUC=0.908, 95% CI 0.701 to 0.989, p<0.001) and procalcitonin with a threshold of 0.18 ng/mL, 79% sensitivity and 79% specificity (AUC=0.807, 95% CI 0.681 to 0.900, p<0.001). Conclusions. Differences in routine laboratory test alterations between COVID-19 survivors and nonsurvivors have been detected;troponin and procalcitonin were the biomarkers which showed the highest prognostic abilities in our study.

A case of vasculitis-like skin eruption associated with COVID-19

Since the start of the SARS-CoV-2 outbreak, more than 4 million cases have been reported with almost 300,000 deaths. Commonly, the virus involves the respiratory system causing fever, cough, and dyspnea. On the contrary, cutaneous involvement has been infrequently reported. We described the case of a 72-year-old woman without a history of dermatologic diseases with COVID-19 who developed vasculitis-like skin eruptions. Because she has not received any treatment for COVID-19, we suggest that the dermatologic clinical picture was related to SARS-CoV-2. © Wolters Kluwer Health, Inc. All rights reserved.

Clinical features, laboratory findings and predictors of death in hospitalized patients with COVID-19 in Sardinia, Italy.

OBJECTIVE: Since December 2019, when the first SARS-CoV2 infections have been reported, the number of cases has increased exponentially. In our University Hospital Unit, the first patient with COVID-19 was admitted on the 8th of March 2020. We aimed to investigate the predictors of death among inpatients with COVID-19. MATERIALS AND METHODS: We performed a retrospective, monocentric study, consecutively enrolling patients with SARS-CoV2 infection. Clinical, laboratory, and radiological data were collected from the 8th of March to the 8th of April 2020. We aimed to describe the most frequent clinical and laboratory features and predictors of death among patients admitted to our Unit. RESULTS: 87 patients were enrolled, 56 (64.4%) were male, with a median age of 72 (IQR 62.5-83.5) years. The majority of our population had at least one comorbidity in their medical anamnesis. Hypertension and cardiovascular disease were the most frequent, followed by obesity. Eighty (92%) patients had at least one symptom, whereas 7 (8%) were asymptomatic. The most common symptoms were fever and dyspnoea. Overall, 53 patients had lung disease confirmed at CT scan (60.9%). Twenty-five (28.7%) deaths occurred. Statistically significant predictors of death at multivariate analysis were lymphocytes count <900 cells/mm3, moderate ARDS, and lack of compliance at baseline. CONCLUSIONS: This is the first Italian experience available. Our results seem to be in line with international literature. As highlighted by our data, more studies are needed to investigate the role of lymphocytes subsets, CT scan values. Furthermore, therapy choice and timing in this challenging setting should be urgently investigated in randomized clinical trials.