Comparison between suspected and confirmed COVID-19 respiratory patients: a pilot study

Introduction: The spread of COVID-19 imposed a re-organization of healthcare services. The increased circulation of the virus among the population and the need for a quick diagnosis suggest the identification of new decisionmaking actions. Aim(s): We aimed to determine whether clinical, laboratory and imaging characteristics can reliably differentiate suspected COVID from positives tested with nasal-pharyngeal(N-P)swab. Method(s): This is a retrospective, cross-sectional study on data collected(March-May 2020)at the Lung Unit, University of Pavia(confirmed cases=50)and at the Emergency Unit, University of Palermo(suspected cases=103). COVID-19 was confirmed by positive N-P swab. Suspected were tested negative. We recorded clinical, laboratory and radiological variables and compared them by Chi-squared or t-test. Logistic regression estimated which variables increased the risk of COVID-19 in both groups. A prediction model and derived ROC-AUCcurve, assessed the accuracy. P<0.05 was considered significant. Result(s): High ReactiveC-Protein, suggestive CTimages, dyspnea and respiratory failure increased the risk of COVID-19, whereas pleural effusion decreased the risk(table). ROC confirmed the discriminative role of these variables between suspected and confirmed COVID-19(AUC 0.91). Conclusion(s): Clinical, laboratory and imaging features predict the diagnosis of COVID-19, independently of the N-P swab result. We suggest the inclusion of these elements in the decision-making to facilitate the management of suspected COVID.

The effect of COVID-19 pandemics on the comprehensive laboratory diagnostic of alpha-1 antitrypsin deficiency in Europe - report from the AATD LABNet

Diagnosis of alpha1-antitrypsin deficiency, a rare genetic disorder, consists of biochemical serum analysis to evaluate protein deficiency and electrophoretic abnormalities, as well as genetic analysis to identify SERPINA1 gene variants responsible for the protein deficiency. In majority of European countries diagnostic is centralized, blood and/or DNA samples are referred to dedicated reference laboratories. We aimed at analyzing data reported by the 8 leading European centers (AATD LABnet part of the EARCO ERS CRC and ERN-LUNG activities) to assess the effect of COVID-19 pandemic and healthcare disruption on the AATD diagnostic provision. In total, the number of tests dropped in 2020 vs 2019 by -20,43% (+/-13,25) for AAT concentration analysis, -25,5% (+/-12,79) for AAT phenotyping and -23,57% (+/-10,28) for SERPINA1 genotyping, while in 2021 vs 2019 by respectively -16,86% (+/-21,34), -9,2% (+/-30,38), -13,57% (+/-40,82). Specifically, diagnostics in Poland and Italy were affected the most with -48% and -28% fewer samples analyzed (2021 vs 2019, phenotyping), while in France and Portugal referrals recovered by the end of 2021, with + 18% and +29% respectively (2021 vs 2019, genotyping). Disorganization of healthcare provision due to the COVID-19 pandemic severely disrupted AATD diagnostics in Europe. In some countries the detrimental effect was temporary, while in others it continued in 2021.

Respiratory function tests in the COVID-19 pandemic era. An update

Summary In June 2020, indications were developed for the resumption of pulmonary function testing in the course of a SARS-CoV-2 pandemic, in support of national, regional and company direc-tives, as well as for pulmonologists dedicated to pulmonary function laboratories. The present document represents an update of the previous one in the light of new knowledge and the current SARS-CoV-2 epidemiological situation.

Where are we with the use of N-acetylcysteine as a preventive and adjuvant treatment for COVID-19?

OBJECTIVE: As N-acetylcysteine (NAC) is promising as a re-purposed drug for the adjunctive or supportive treatment of serious COVID-19, this article aimed to describe current evidence. MATERIALS AND METHODS: A search was performed in PubMed/Medline for "NAC", "viral Infection", COVID-19", oxidative stress", "inflammation", retrieving preclinical and clinical studies. RESULTS: NAC is a pleiotropic molecule with a dual antioxidant mechanism; it may neutralize free radicals and acts as a donor of cysteine, restoring the physiological pool of GSH. Serious COVID-19 patients have increased levels of reactive oxygen species (ROS) and free radicals and often present with glutathione depletion, which prompts a cytokine storm. NAC, which acts as a precursor of GSH inside cells, has been currently used in many conditions to restore or protect against GSH depletion and has a wide safety margin. In addition, NAC has anti-inflammatory activity independently of its antioxidant activity. CONCLUSIONS: Clinical and experimental data suggest that NAC may act on the mechanisms leading to the prothrombotic state observed in severe COVID-19.

COVID-19 infection in severe Alpha 1-antitrypsin deficiency: Looking for a rationale.

The clinical manifestations of COVID-19 are heterogeneous: 46.4% of patients admitted into hospital reported to have at least one comorbidity. Comorbidities such as COPD, diabetes, hypertension and malignancy predispose patients with Covid-19 to adverse clinical outcomes. Alpha 1-antitrypsin deficiency (AATD) is a genetic disorder caused by pathological mutation(s) in the SERPINA1 gene resulting in an imbalance in proteinase activity which may lead to premature emphysema and COPD. Our aim was to investigate whether people with severe AAT deficiency (AATD) have an increased risk of (severe) COVID-19 infection. We collected data on COVID-19 symptoms, laboratory-confirmed infection, hospitalization and treatment by means of a telephone survey, directly administered to Italian severe AATD subjects in May 2020. We then compared our findings with data collected by the Istituto Superiore di Sanità on the total population in Italy during the same period. We found an higher frequency of SARS-CoV-2 infection in our cohort (3.8%) compared to national data regarding infection, thus giving severe AATD a relative risk of 8. 8 (95%CI 5.1-20,0; p<0.0001) for symptomatic SARS-CoV-2 infection. Moreover, the relative risk (RR) was higher in AATD patients with pre-existing lung diseases (RR 13.9; 95%CI 8.0-33.6; p<0.001), but with a similar death rate (1 in 8, 12.5%) compared to the general population (13.9%; RR 0.9). These preliminary findings highlight the importance of close surveillance in the spread of COVID-19 in patients with severe AATD and underlines the need for further studies into the role of the antiprotease shield in preventing SARS-Cov-2 infection.