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Objective: This retrospective and prospective cohort study was designed to describe the characteristics, treatments, and outcomes of patients with SARS-CoV-2 infection (COVID-19) admitted to subintensive care units (SICU) and to identify the variables associated with outcomes. SICUs have been extremely stressed during the pandemic, but most data regarding critically ill COVID-19 patients come from intensive care units (ICUs). Studies about COVID-19 patients in SICUs are lacking. Setting and participants: The study included 88 COVID-19 patients admitted to our SICU in Cuneo, Italy, between March and May 2020. Measurements: Clinical and ventilatory data were collected, and patients were divided by outcome. Multivariable logistic regression analysis examined the variables associated with negative outcomes (transfer to the ICU, palliation, or death in a SICU). Results: A total of 60 patients (68%) had a positive outcome, and 28 patients (32%) had a negative outcome;69 patients (78%) underwent continuous positive airway pressure (CPAP). Pronation (n=37 [42%]) had been more frequently adopted in patients who had a positive outcome vs a negative outcome (n=30 [50%] vs n=7 [25%];P=.048), and the median (interquartile range) Pao2/Fio2 ratio after 6 hours of prone positioning was lower in patients who had a negative outcome vs a positive outcome (144 [140-168] vs 249 [195-268], P=.006). Independent predictors of a negative outcome were diabetes (odds ratio [OR], 8.22;95% CI, 1.50-44.70;P=.015), higher D-dimer (OR, 1.28;95% CI, 1.04-1.57;P=.019), higher lactate dehydrogenase level (OR, 1.003;95% CI, 1.000-1.006;P=.039), and lower lymphocytes count (OR, 0.996;95% CI, 0.993-0.999;P=.004). Conclusion: SICUs have a fundamental role in the treatment of critically ill patients with COVID-19, who require long-term CPAP and pronation cycles. Diabetes, lymphopenia, and high D-dimer and LDH levels are associated with negative outcomes.
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Micro-pulse transscleral laser therapy (MP-TLT) is a non-invasive laser procedure for the treatment of glaucoma, and was introduced in 2015. The aim of the procedure is to achieve a reduction in intraocular pressure while minimizing collateral tissue damage. The favourable risk profile of this non-cyclodestructive procedure makes it applicable to a broad spectrum of glaucoma cases, including patients with good central vision, and does not limit its usability to late-stage refractive cases. In 2019, a revised delivery device simplified the procedure, and more recently, a ‘topical-plus’ anaesthesia protocol has been introduced. The revised delivery system and topical-plus protocol reinforce the utility of MP-TLT as a practical treatment option in an office setting or procedure room, with minimal patient discomfort during and after treatment. Additionally, with minimal follow-up requirements, MP-TLT is ideal for glaucoma management during COVID-19 social restrictions. The following article provides an overview of the use of MP-TLT under topical anaesthesia (topicalplus), the potential role of MP-TLT in the glaucoma treatment algorithm during the COVID-19 pandemic, and the advantages of the revised MicroPulse P3® probe (IRIDEX Corporation, Mountain View, CA, USA).
ABSTRACT
After the outbreak of the Covid-19 pandemic, cases of SARS-CoV-2 infections may gradually decrease in the next months. Given the reduced prevalence of the disease, Emergency Departments (ED) are starting to receive more and more non-Covid-19 patients. Thus, a way to quickly discriminate ED patients with potential Covid-19 infection from non-Covid-19 patients is needed in order to keep potentially contagious patients isolated while awaiting second-level testing. In this paper, we present the derivation and validation of a simple, practical, and cheap score that could be helpful to rule out Covid-19 among ED patients with suspicious symptoms (fever and/or dyspnoea). The LCL score was derived from a cohort of 335 patients coming to the ED of our hospital from March 16th to April 1st, 2020. It was then retrospectively validated in a similar cohort of 173 patients admitted to our ED during April. The score is based on blood values of lactate dehydrogenase, C-reactive protein, and lymphocyte count. The LCL score performed well both in the derivation and in the validation cohort, with an AUC respectively of 0.81 (95% CI: 0.77 - 0.86) and of 0.71 (95% CI: 0.63 - 0.78), given the difference in Covid-19 prevalence between the two cohorts (57% vs 41% respectively). An LCL score equal to 0 had a negative predictive value of 0.92 in the derivation cohort and of 0.81 in the validation cohort, with a negative likelihood ratio respectively of 0.08 and 0.36 for Covid-19 exclusion. This score could, therefore, constitute a useful tool to help physicians manage patients in the ED.
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Introduction and Background: During COVID-19 outbreak approximately 5% of patients were admitted in ICU with ARDS. Some of them developed persistent atelectasis. Rehabilitation plays a role in promoting pulmonary recruitment after weaning from mechanical ventilation. EzPAP is a simple device used to apply a positive airway pressure during spontaneous breath. Bedside ultrasonography of diaphragmatic amplitude during contraction could be used to evaluate the efficacy of respiratory rehabilitation. Aim of the study: Evaluation of the efficacy of EzPAP recruitment maneuver with the use of diaphragmatic ultrasound. Methods: 16 patients discharged from ICU after weaning from mechanical ventilation have been subjected to EzPAP recruitment maneuvers (PEEP: 10 cmH2O, air or Oxygen flow: 8L/min for 10 minutes twice a day). We detected SpO2/FiO2 and we measured the maximal amplitude of diaphragmatic inspiratory excursion with transthoracic ultrasonography at the beginning and at the end of the rehabilitation cycle Results: The maximal amplitude of diaphragmatic inspiratory excursion and SpO2/FiO2 were significantly higher at the end of the rehabilitation cycle with EzPAP. Conclusions: EzPAP is a valide thecnique and ultrasonography is a simple diagnostic method to evaluate the efficacy of rehabilitation treatment.
ABSTRACT
COVID-19 is a highly infectious respiratory disease which leads to a respiratory and physical dysfunction. For patients discharged at home, post acute care, pulmonary rehabilitation is an important intervention to relive dyspnea and anxiety, to improve exercise capacity and the quality of life (QoL). Due to mandatory social distancing telemedicine could be a useful method. The aims of this study are to assess the efficacy and feasibility of a 4-week exercise training program with telemonitoring and to evaluate the impact of the program on the quality of life. Methods: A COPD assessment test (CAT) was used before and after the training program to measure QoL, performance in activities of daily living were measure through the Barthel scale. Weekly phone calls were made by a medical doctor, using the Fenix televista program to collect data on dyspnea, cough and asthenia or other symptoms. This remote care service was complemented by a respiratory rehabilitation program (sent as educational video) which consists of breathing exercises, aerobic training at mild-to-moderate intensity and muscle reinforcement. Oxygen saturation was checked. Workloads were adjusted based on the improvement/worsening of symptoms. Patients with suggestive symptoms of exacerbation detected during the phone interview were directed towards a specialist. The project is still ongoing, starting on April 2020 at Rimini Hospital (Italy). Currently 50 symptomatic patients were enrolled (post-acute severe infection). The program is well accepted, only 2 patients dropped out due to poor compliance. Method: A preliminary analysis of the data highlights good efficacy and feasibility of this approach to optimize a rapid recovery in COVID-19 patients.
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Introduction or background: During COVID-19 outbreak, helmet noninvasive ventilation (hNIV) and helmet continuous positive airway pressure (hCPAP) have been used with the purpose of early supporting patients with acute respiratory distress syndrome (ARDS) considering the frequent lack of Intensive Care Units (ICU) beds. Rimini province is one of the Italian areas more severely affected. In order to face the increasing number of patients needing respiratory support, in our hospital, 11 monitored beds in Infectious Disease Department's negative pressure rooms have been set up. The management of respiratory failure has been entrusted to the pulmonologists. Aims and objectives: The aim of the study is to evaluate the effectiveness of early hNIV/hCPAP used to avoid or to safely postpone intubation while waiting for a bed in ICU. Methods: We evaluated data collected in 59 patients (14 female and 45 male) with COVID-19 related ARDS admitted in Rimini Hospital Infectious Disease Department to be subjected to hCPAP/hNIV. (Table 1). Results: 36/59 patients (61%) treated with hCPAP survived without intubation. 10 patients were declared do not intubate for comorbidities and received hCPAP as a ceiling treatment, 3/10 survived. 16 patients were intubated (13 in election and 3 for complications), 5/16 died in ICU. To date 47/59 patients (79%) are still alive. Conclusions: During COVID-19 outbreak hCPAP avoided intubation for 36/59 (61%) patients, for others 8 the intubation was elective and postponed. Thanks to the early use of hCPAP, 36 ICU beds could be used to treat other patients with ARDS.
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Although Information and Communication Technology-ICT solutions have been used for a long time in various sectors of the economy, recent developments in Communications, IoT, Data Science and Artificial Intelligence have brought very attractive possibilities for their wider adoption, especially with regard to cities and its citizens.In this article, some aspects of the international and the Brazilian technical regulations are addressed, with special attention to issues of interest to cities. The General Data Protection Law of Brazil is highlighted.Some specific projects and initiatives related to smart cities are also presented and commented on, such as the National IoT Plan and its consequences, besides other initiatives to address smart cities.Additionally, some aspects of present days combat actions in the Covid-19 pandemic and its relationships with public policies applied to cities are highlighted.Finally, considerations about the need for effective and efficient public policies to reinforce the resilience of cities, including tackling biological hazards, are addressed. © 2020 IEEE.