Antibodies to SARS-CoV-2 in a Medical School Department of Pediatrics

Background. Healthcare workers are at high risk of Covid-19 (C19) infection and received priority for C19 vaccinations. Therefore, we conducted a serosurvey to determine anti-C19 antibodies and evidence of C19 infection in health care employees who did or did not have direct contact with patients. Methods. 49 participants provided finger stick blood samples collected onto filter papers and tested for antibodies to C19 using Bio-Plex Pro Human SARS-CoV-2 IgG reagents. Antibodies to C19 nucleocapsid (N), receptor-binding domain (RBD), spike 1 (S1), and spike 2 (S2) were measured. Samples were collected 8 to 11 months after C19 vaccines were made available. Results. All participants received two doses of Pfizer BioNTech or Moderna RNA-based C19 vaccines, and all showed serological evidence of antibodies to C19 RBD, S1, and S2. Antibodies to N, considered a marker of C19 infection, were detected in 16 individuals, of whom 10 reported having a PCR documented C19 infections. 6 individuals had evidence of C19 infection of which they were not aware. Antibody levels were notably higher following infection and for not infected participants following Pfizer-BioNTech vaccination. There was a 20% higher infection rate in participants with direct patient contact. Conclusion. This vaccinated population had significant rates of strong antibody responses to C19 infection and a notable rate of C19 infections, most notable in those providing direct patient care.

COVID-19 Syndrome After Liver Transplant: Immunosuppression Role and Risk Factors for Mortality

Purpose: Data on mortality and immunosuppression role regarding Liver transplant recipients affected by COVID-19 are still under debate. The present study identified risk factors for mortality and the role of immunosuppression in COVID-19 liver transplant recipients. Method(s): A systematic review about SARS-CoV-2 infection in liver transplant recipients was performed. The primary outcomes were risk factors of mortality and the role of immunosuppression. A meta-analysis was not performed as there was different metric of the same outcome (mortality). Result(s): An overall 1.110 LT recipients of 1.810 SOT were included and data on mortality were available for 1.110 liver transplant recipients with SARS-CoV-2 infection. The mortality rate ranged between 0-37%. Risk factors of mortality were age>60, Mofetil Mycophenolate use, extra-hepatic solid tumor, Charlson Comorbidity Index, male sex, dyspnoea at diagnosis, higher baseline serum creatinine, congestive heart failure, chronic lung disease, chronic kidney disease, diabetes, BMI>30. Tacrolimus was identified as a protective factor for mortality. Conclusion(s): Liver transplant patients present additional risk factors of mortality related to immunosuppression. Immunosuppression's role in the progression to severe infection and mortality may correlate with different drugs. The present research suggests a safe use of Tacrolimus during the COVID-19 pandemic and highlights the need for further studies about post-transplant immunosuppression in patients at high risk of mortality.

Sensorized Facemask with Temperature RFID Sensor for Cough Analysis

One of the most common symptoms of respiratory pandemics, like COVID-19, is cough. Its monitoring is useful to trace the progress of the disease and to evaluate its severity. Traditional measurement methods are bulky and wired. Instead, wearable and wireless technologies such as the Radio Frequency Identification (RFID) could allow the implementation of platforms able to monitor patients remotely. The monitoring of the respiratory function has already profited from the operation of temperature sensors put close to the airways as well as from the sensorization of facemasks, widely used in case of respiratory viruses. In this paper, a UHF RFID temperature sensor tag integrating auto-tuning capability is integrated inside a FFP2 facemask to retrieve temperature profiles used to count and detect three different types of coughing. All the cough shots are consistently detected by the system, and their periodicity and duration can be determined.

DETERMINANTS OF OUTCOME OF MODERATE TO SEVERE COVID-19 IN A HOSPITAL SETTING: A COMPARISON BETWEEN FIRST AND SECOND/THIRD WAVE IN LOMBARDY

Objective: Coronavirus disease 2019 (COVID-19) represents a major clinical problem in terms of death and long-term sequelae. We conducted a retrospective cohort study at Montichiari Hospital (Brescia, Italy) to better understand different determinants of outcome in different COVID-19 outbreaks. Design and method: A total of 635 patients admitted from local emergency room with a confirmed diagnosis of SARS-CoV-2 infection and a moderate to severe COVID-19 were included in the present study. A group of 260 consecutive patients during SARS-CoV-2 first wave (from February to May 2020) and 375 consecutive patients during SARS-CoV-2 second/third wave (from October 2020 to May 2021) were considered. Demographic data, comorbidities, ongoing treatment and bio-humoral, respiratory and haemodynamic data were recorded and compared. Results: Main demographic data (Table 1) were not significantly different in the two considered time-lapses, except a lower prevalence of female sex during first wave. Mortality rate was significantly lower during the latter period (25% vs 11%;p < 0.001). Time from symptoms onset to hospital admission was longer during first wave (7.8 ± 5.6 vs 5.6 ± 4.3 days;p < 0.001) while hospital staying was significantly shorter (11 ± 10 vs 15 ± 12 days;p < 0.001). Other significant differences were a wider use of corticosteroids and low-molecular weight heparin (LMWH) as well less antibiotic prescription during the second wave (Table 2). Respiratory, bio-humoral and x-Ray score were significantly poorer at the time of admission in first-wave patients (Table 3). After a multivariate regression analysis, C-reactive protein and procalcitonin values, % fraction of inspired oxygen at admission, days after symptoms onset and duration of hospital staying were the strongest predictors of outcome in both periods. Concomitant anti-hypertensive treatment (including ACE-inhibitors and ARBs) did not affect outcome. Conclusions: Our preliminary data suggest that an earlier diagnosis, a timely hospital admission and a rational use of the therapeutic options allowed to reduce the rate of systemic inflammation response (of which CRP is a hallmark) and granted a better outcome during the second of the two time-lapses considered.

COMPARISON BETWEEN FIRST AND SECOND/THIRD WAVE OF SARS-COV-2 MODERATE TO SEVERE INFECTION IN ELDERLY PATIENTS IN AN NORTH ITALIAN HOSPITAL SETTING

Objective: Worldwide spread of SARS-CoV-2 caused a pandemic as never were seen in the last fifty years and represented a major clinical problem in Lombardy, one of the most affected Italian Regions, in terms of death toll and long-term sequelae. This is particularly true when elder people are considered;therefore, we conducted a retrospective cohort study in the General Medicine of our Hospital. Design and method: In the present study we recorded data of patients older than 65 years, admitted to a COVID-19 unit during 2020 and 2021;we compared the characteristics of in-patients admitted in the first (March-May 2020) and the second/ third pandemic waves (October 2020-May 2021) Results: A total of 407 patients 65 year-old and older were included, 185 during the first wave and 222 during second/third waves;63 (34%) of them died during the first and 36 (16%) during the second/third wave. No significant differences were found according to main comorbidities and chronic prescriptions between the two groups of patients, whereas those admitted during the second/third wave were slightly older. Number of in-hospital adverse events were similar in the two samples. Main differences between the two groups were: a lower mean number of days with symptoms before hospitalization, and a less severe laboratory, respiratory ed radiologic profile. Further, steroid treatment was highly implemented during the second/third wave. Conclusions: Older patients admitted to hospital since the beginning of the pandemic showed diverse clinical severity profile according to different waves;patient admitted during the first wave had worse respiratory, radiological and laboratory parameters than those admitted in the second/third wave;further difference was found in COVID-19 treatment during hospital stay as steroids were largely administered during the latter waves.

RFID Research Against COVID-19-Sensorized Face Masks

The last two years were strongly shaped by the COVID-19 pandemic and the social distancing countermeasures. The worldwide research changed as well, focusing on the problems created or exacerbated by the novel coronavirus. The Pervasive Electromagnetics Lab of the Tor Vergata University of Rome with a great engagement of several medical engineering students focused on applying sensor-oriented RFID to improve personal safety. In particular, the sensorization of the filtering facepiece respirators (FFRs) was one of the COVID-inspired research topics. FFRs integrating RFID-based sensors were designed and tested. In this contribution, the most significant results achieved are summarized regarding humidity-sensing and cough-monitoring FFRs.

A Multi-center Study to Describe Obese Pediatric Patients with COVID-19 Across the United States

Background. Obesity is linked to increased risk of complications and is reported to be the most common underlying condition for severely ill SARS-CoV-2 infected individuals. Therefore, we aim further to explore the clinical outcomes of obese children with COVID-19. Methods. Data were from the Pediatric COVID-19 Case Registry, which includes any patient < 21 years of age diagnosed with COVID-19 at 170 instructions across the United States. A total of 778 COVID-19 positive non-immunocompromised hospitalized patients aged 24 months or older were included. Patients were assigned as obese or non-obese based on BMI as reported from medical records referenced to CDC BMI by gender and age classification (https://www.cdc.gov/growthcharts/ clinical-charts.htm). Results. Patients meeting inclusion criteria included 56% not obese and 44% obese. Compared to matched US population, obese children and adolescents appeared in this database at a rate of 2.3 times their frequency in the population. Obese patients were more likely to be Hispanic and older, symptomatic, have abnormal radiological findings, and require oxygen and ICU admission. Mortality, in this analysis, was similar across the groups. Demographic and clinical characteristics. NS: Not significant ∗within seven days of COVID diagnosis ∗∗∗mild: no need for supplemental oxygen;moderate: need for supplemental oxygen and severe: need for mechanical ventilation. Conclusion. The incidence of obesity in hospitalized COVID children is higher than that of the general population (34% vs. 19%), highlighting obesity as an important risk factor for hospitalization associated with SARS-CoV-2 infected. Therefore, obese children and adolescents with COVID should be prioritized for COVID immunization and managed aggressively, given their significant COVID morbidity.

Impact of the COVID-19 Pandemic on Routine HIV Screening in an Emergency Department

Background. The Emergency Department (ED) at Memorial Hermann Hospital (MHH) - Texas Medical Center (TMC), Houston, Texas has a long established screening program targeted at detection of HIV infections. The impact of the COVID-19 pandemic on this screening program is unknown. Methods. The Routine HIV screening program includes opt-out testing of all adults 18 years and older with Glasgow score > 9. HIV 4th generation Ag/Ab screening, with reflex to Gennius confirmatory tests are used. Pre-pandemic (March 2019 to February 2020) to Pandemic period (March 2020 to February 2021) intervals were compared. Results. 72,929 patients visited MHH-ED during the pre-pandemic period and 57,128 in the pandemic period, a 22% decline. The number of patients tested for HIV pre-pandemic was 9433 and 6718 pandemic, a 29% decline. When the pandemic year was parsed into first and last 6 months interval and compared to similar intervals in the year pre pandemic, 39% followed by 16% declines in HIV testing were found. In total, 354 patients were HIV positives, 209, (59%) in the pre-pandemic and 145 (41%) in the pandemic period.The reduction in new HIV infections found was directly proportional to the decline in patients visiting the MHH-ED where the percent of patients HIV positive was constant across intervals (2.21% vs 2.26%). Demographic and outcome characteristics were constant across the compared intervals. Conclusion. The COVID -19 pandemic reduced detection of new HIV infections by screening in direct proportion to the reduction in MHH-ED patient visits. The impact of COVID-19 pandemic decreased with duration of the pandemic.

Positive, Mildly Positive, and Uncertain Nasopharyngeal Swab and Outcome in COVID-19 Patients

Introduction and Aim Diagnosis of SARS-CoV-2 infection is mainly based on gene detection through polymerase chain reaction analysis on nasopharyngeal swab. The Allplex TM 2019-nCoV assay targets 3 different viral genes: RNA-dependent RNA polymerase, envelope, and nucleocapside. A coding system was developed based on different number of genes expressed: a nasopharyngeal swab was considered "positive" if all 3 genes tested underwent amplification, "mildly positive" if only 2 out of 3 genes were detected, "uncertain" if only 1 gene and "negative" if none resulted amplified from the test. Our aim was to assess whether this classification correlates with clinical outcome in a cohort of COVID-19 patients. Methods This is a retrospective study including patients admitted with diagnosis of SARS-CoV-2 infection to a medical ward at the Montichiari Hospital, Brescia, Italy, from February 28 to April 30, 2020. All patients underwent the nasopharyngeal swab upon admission. Results A total of 204 patients were included in this study. Patients with full positive nasopharyngeal swab showed higher values of C-reactive protein and neutrophiles/lymphocytes ratio compared with patients with mildly positive or uncertain nasopharyngeal swab. Mortality did not differ between the 2 groups. A Cox multivariate analysis showed that age, male sex, and CRP values are independent predictors of in-hospital mortality. Conclusions Our study demonstrated that patients with a complete SARS-CoV-2 gene detection nasopharyngeal swab show a higher inflammatory profile, and this can be an indirect measurement of viral load in COVID-19 patients.

A Survey on Radio Frequency Identification as a Scalable Technology to Face Pandemics

The COVID-19 pandemic drastically changed our way of living. To minimize life losses, multi-level strategies requiring collective efforts were adopted while waiting for the vaccines’rollout. The management of such complex processes has taken benefit from the rising framework of the Internet of Things (IoT), and particularly the Radiofrequency Identification (RFID) since it is probably the most suitable approach to both the micro (user) and the macro (processes) scale. Hence, a single infrastructure can support both the logistic and monitoring issues related to the war against a pandemic. Based on the COVID-19 experience, this paper is a survey on how state-of-the-art RFID systems can be employed in facing future pandemic outbreaks. The three pillars of the contrast of the pandemic are addressed: 1) use of Personal Protective Equipment (PPE), 2) access control and social distancing, and 3) early detection of symptoms. For each class, the envisaged RFID devices and procedures are discussed based on the available technology and the current worldwide research. This survey that RFID could generate an extraordinary amount of data so that complementary paradigms of Edge Computing and Artificial intelligence can be tightly integrated to extract profiles and identify anomalous events in compliance with privacy and security. IEEE

RFID sensors for the monitoring of body temperature and respiratory function: A pandemic prospect

Since the onset of the COVID-19 pandemic, in the last year many researchers have focused their efforts on limiting the spread of the virus. Along with the rush in the developing of vaccines, wearable technologies appeared to be excellent candidates for the early detection of infected individuals and the remote monitoring in hospitals and homes, by fostering the reduction of the contacts between caregivers and patients, while ensuring their safety. The wearable and epidermal Radio Frequency IDentification (RFID) sensors offer nowadays a wide selection of comfortable devices, able to wirelessly monitor a significant set of physiological parameters. In particular, this short review will focus on the monitoring of body temperature and respiratory function, highly affected by the SARS-CoV-2 virus, providing an overview of the current state of the art of RFID sensors, thus envisaging the benefits they can offer for the current and future pandemics. © 2021 University of Split, FESB.

Effect of ongoing treatment and different therapies on prognosis in COVID-19 patients in An hospital setting

Objective: Patients affected by novel pandemic SARS-CoV-2 may develop COVID-19 related pneumonia, which is potentially fatal. To date, the role of ongoing treatments for different conditions (such as hypertension) has been clarified in terms of their impact on survival and there is no established specific therapy for the disease, although many molecules are under investigation. Aim of the present study was testing those two issues in a population of 258 consecutive patients admitted from 29 February to 30 April 2020 to General Medicine ward of the Hospital of Montichiari (Brixia). Design and method: A group of 258 patients (173 males and 85 females, aged 71 ± 14) was enrolled. Their medical record and ongoing treatment were assessed. Patients were treated according to emerging information with oxygen, anti-malarian agents, anti-viral drugs, different antibiotics (azithromycin and others), tocilizumab and low molecular weight heparin (LMWH) at different doses. As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test Results: Ongoing therapy with ACE-inhibitors at the time of admission was associated with a worse prognosis (p=0.004), while no difference in survival was observed in patients under treatment with ARBs (p=0.68). Ongoing treatment with statins (p<0.001), low-dose aspirin (p<0.001) and steroids (p<0.001) was associated with a poorer outcome as well Administration during hospitalization of LMWH (p<0.001), steroids (p<0.001), anti-viral drugs (p=0.002), anti-malarian drugs (p<0.001) and tocilizumab (p<0.001), improved prognosis, while antibiotics (azithromycin and other) didn't have any impact. Conclusions: our experience confirms most findings in ongoing trials. Surprisingly, treatment with ACE-inhibitors seems to impact negatively on survival in patients affected by SARS-CoV-2 pneumonia. A possible explanation may be that patients treated with certain drugs are more comorbid and due to this, more fragile.

Low molecular weight heparin at high dose impacts on outcome of COVID-19 hospitalized patients, while standard dose doesn't

Objective: COVID-19 is a new disease caused by pandemic SARS-CoV-2, that involves multiple organs and can cause a potentially fatal respiratory distress syndrome. Accumulating evidence point out that an “endothelitis” due to a cytokines storm causes intravascular thrombosis, especially in the lungs, and is related to the poor outcome. We tested possible relationships between anticoagulant treatment and/or administration of low molecular weight heparin (LMWH) at different doses and outcome in a population of 258 COVID-19 patients admitted from February 28th to April 30th, 2020 to General Medicine ward of the Hospital of Montichiari (Brixia, Italy). Design and method: A group of 258 consecutive patients (174 males and 84 females, mean age 71 years +/-14) was included in the present study. In 168 patients, high-flow oxygen was required (Venturi mask), 6 patients needed orotracheal intubation and 20 were given continuous positive pressure oxygen therapy (CPAP). Patient were treated (unless a pulmonary embolism was detected) with different doses of prophylactic LMWH, according to emerging evidence during pandemic period. As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test. Results: LMWH at standard dose (4000 IU once daily) didn't reduce mortality compared to no treatment (p=ns), while LMWH at a higher dose than usual prophylactic dose (enoxaparin 6000 IU once daily or 4000 IU bid) was associated with better outcome (p<0.001 vs untreated and treated with standard dose). Significance was confirmed adding patients treated with oral anti-coagulant (OAC)for any reason. None of the patients treated with LMWH at higher doses or OAC died. Conclusions: The administration of subcutaneous LMWH at a higher dose than indicated for deep vein thrombosis prophylaxis is associated with a better outcome in patients with SARS-CoV-2 pneumonia, confirming some emerging evidence.

Role of hypertension, cardiovascular disease and cardiovascular risk factors on outcome in hospitalized COVID-19 patients

Objective: Emerging data show that hypertension as well as other cardiovascular risk factors may have a major role on outcome in terms of death on patients with COVID-19. We analysed a population of 258 consecutive patients admitted to General Medicine ward of the Hospital of Montichiari (Brixia, Italy) from 29 February to 30 April 2020. Design and method: A group of 258 consecutive patients (173 males and 85 females, aged 71 ± 14) was enrolled. In 168 patients, high-flow oxygen was required (Venturi mask), 20 patients needed orotracheal intubation and 11 were given continuous positive pressure oxygen therapy (CPAP). Patients were treated with the best approach according to available evidence during pandemic period: anti-malaria agents, anti-viral drugs, antibiotics (azithromycin and others), tocilizumab and low molecular weight heparin (LMWH). As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test. Results: As shown in the table, a significant raise in mortality was observed in patients older than 65 years (p<0.001), of male sex (p<0.001), hypertensives (p<0.001) as well as in patients with heart disease (picture 1;p<0.001), COPD (picture 2;p=0.004), diabetes (p<0.001) and neoplasms (p=0.03) compared with patients with no comorbidities or different diseases, both at discharge and at standard follow-up. The number of comorbidities impacted on survival as well. Conclusions: Hypertension, heart disease and cardiovascular risk factors play a significant role as a negative prognostic factor in patients affected by SARSCoV-2 pneumonia. This confirms previous observations (Pol Arch Intern Med 2020;130(4):304-309) and outlines the importance of prevention of contagion in population with cardiovascular risk factors or established cardiovascular disease.