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Background: Little is known about the long-term re-hospitalization of patients with confirmed infection by SARS CoV 2 discharged from hospital. Aim: The aim of our retrospective cohort study was to identify death and re-hospitalization outcomes in a 16-month follow-up in a population of subjects already hospitalized for Covid-19. Materials and Methods: The study was conducted in the metropolitan area of Bari (population: 472,385 inhabitants) by examining the patients hospitalized from 17/03/2020 to 28/05/2021 at the Covid Unit of the F. Miulli hospital in Acquaviva delle Fonti. Results: 1238 patients (754 males, 60.9%, median 70 years) were hospitalized in Covid Unit: 1060 (85.6%) (M 60.1% median 71 years) were hospitalized in non-intensive wards, while 178 (14.4%) (M 65.7%, median 69 aa), passed through the IT. At follow-up, 922 subjects were still alive;66 deceased (7.2% of the total, 37.8% males, median 80 years). Analyzing only the data of patients residing in the metropolitan area, where the hospital is the reference, 780 patients discharged alive were examined. Of these, 11.2% were rehospitalized at least once, 30 died (4.3%). Mortality on re-admission to hospital was 17.2%. A third of the re-admissions were unrelated to Covid. Infections, pneumonia and cardiovascular disease were the most represented reason for hospitalization. Conclusions: Data show that at a follow-up of 16 months 92.8% of the subjects were still alive, while 7.2% had died, mainly elderly women. 11.2% of those discharged from the Covid ward have been re-admitted to the hospital at least once.
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Introduction and Purpose of the study: SARS-CoV2 infection is characterized by massive involvement of the respiratory system. During the various waves, the patients admitted to the Covid wards presented different degrees of pulmonary involvement and numerous comorbidities. Administration of oxygen therapy was the prevalent measure in almost all subjects. The aim of our study was to verify the level of severity and ventilation procedures in a group of subjects hospitalized for SARS-CoV2 infection. Materials and Methods: 388 subjects admitted to the semi-intensive Covid Unit of the F. Miulli Hospital in 2020 were retrospectively analyzed, by examining the SDOs. The main diagnoses and procedures performed were identified. A severity cluster was identified characterized by death, ventilation and hospitalization in the semi-intensive area (cut off at 14 days). Results: 82 were the deceased (21.1%). The main diagnoses most represented were: 84.2% respiratory failure, 3.3% heart failure, 2.5% pulmonary embolism and 1.5% septicemia. Regarding the procedures, 31.9% underwent C-PAP ventilation, while 0.7% underwent non-invasive mechanical ventilation. 64% of the subjects had a severe degree of disease evidenced by the composite cluster of deaths, ventilation and at least 14 nights in semi-intensive care. Conclusions: Our data shows that in the face of almost all patients with respiratory failure, about one third underwent ventilation procedures (C-PAP and NIV). More than half of the subjects had a severe degree of disease.
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Introduction: In our country, the percentage of subjects infected with HCV is about 2% of the general population, with a gradient that increases from the North to the South and the islands. The decline in hepatitis C treatments is sensationally evident. The WHO had set the goal of its elimination by 2030, a result made achievable thanks to the new direct-acting antiviral drugs (DAA), which allow the virus to be eradicated in definitively, quickly and without side effects. The pandemic has slowed both screening and treatment. Purpose of the study: Evaluate the prevalence of subjects positive for hepatitis C antigen (HCV +) in all hospitalized for Covid-19. Materials and Methods: 839 subjects admitted to the Covid Unit of the F. Miulli Hospital in Acquaviva delle Fonti were retrospectively assessed. Results: The prevalence of HCV+subjects was 4.7%. No statistically significant differences were found when comparing the main laboratory tests. No difference emerged regarding the outcomes (length of hospitalization and death) which are similar in the two groups. Conclusions: The prevalence of HCV+subjects in the Covid-19 population is double that of the general population. A project is underway in our hospital which provides for the screening of all over 50 year olds hospitalized in order to bring out HCV+subjects and direct them to an outpatient diagnostic confirmation path and any specific eradicating therapy.
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Background: Idiopathic inflammatory myopathies are a heterogeneous group of pathological conditions characterized by muscle inflammation, and sometimes by inflammatory involvement of other organs, such as skin (in dermatomyositis) and lungs (pulmonary interstitial disease). Description of the case: 54-year-old woman, turns to the Emergency Room of Miulli Hospital in March 2021 for worsening dyspnea. In medical history: previous recent SARS-CoV-2 infection. She is admitted to Medicine Unit, where the characteristic signs and symptoms of myositis were objected: myasthenia affecting the proximal muscles, myalgias, plantar desquamation of the feet (climber's foot) and fingers (mechanic's hands), Gottron's papules. There are also: pericardial effusion, signs of pulmonary hypertension on echocardiogram, consolidating pulmonary parenchymal changes with fibrotic evolution on HR chest CT. She is transferred to the Rheumatology Unit of the Policlinico Di Bari to perform specific autoantibody panel (positivity of ANA, anti Jo- 1, anti Ro52), electromyography (signs of myogenic suffering), MRI of the thighs (hypotrophy and adipose replacement of the muscles of the posterior lodge) and muscle biopsy, indicative of muscle inflammation. Therapy with steroid boluses and cyclosporine 5mg/kg/day, shows quick effectiveness, and she is discharged with the diagnosis of antisynthetase syndrome. Conclusions: The diagnosis of antisynthetase syndrome is not always easy, due to the clinical heterogeneity of the disease and the need for specific instrumental and laboratory tests.
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Background and Aim: The CoViD-19 pandemic experienced two main waves: February-June 2020 and October 2020-February 2021 respectively. The F. Miulli Hospital has activated intensive and semi-intensive care, pulmonology and infectious disease departments, for a total of 240 beds. Aim of the study was to evaluate differences between the two waves, in relation to the length of hospitalization and mortality. Materials and Methods: We collected data from 1005 subjects (619 men). Age, gender, length of hospital stay, and deaths were analyzed. Results: In the second wave we found a higher percentage of deaths (25.8 vs 19.4%;p=0.043) and among these a higher prevalence of males (66 vs 44.7%;p=0.007);furthermore, in the subjects hospitalized during the second wave, we observed a lower average age of the deceased (78±13 vs 82±8 years;p=0.019) and a shorter duration of hospitalization (18±13 vs 21±14 days;p=0.004). No significant difference was observed in the prevalence of males, however most affected (62.4% second wave vs 59.1% first wave), and in mean age (69±15 seconds vs 68±18 first wave). Conclusions: The second wave showed greater lethality especially for males and younger subjects. Despite this, the duration of hospitalization was shorter, a condition probably linked to the experience acquired by the health professionals involved in the assistance and to a wider network of local structures capable of welcoming CoViD patients. The impact of the variants on the severity of the disease remains to be assessed.
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Background: SARS-CoV2 infection is frequently associated withcardiovascular and neurological manifestations, but pericardiumand Peripheral Nervous System (PNS) are rarely involved. Case Report: A 61 year-old man was admitted in March 2020 tothe Covid Unit of Miulli Hospital in Acquaviva delle Fonti (Bari) forfever, cough and oropharyngeal swab positive for SARS-CoV2. Hiscomorbidities were hypertension and obesity. Laboratory testsshowed high levels of inflammatory proteins and the presence ofIgM for Chlamydia. Computed Tomography (CT) documented pneumonia with bilateral peripheral and central ground glass opacitiesand little areas of consolidation. He was treated with hydroxychloroquine, ritonavir and quinolone. Despite an early clinical andradiological remission, the swab became negative after twomonths. In May the patient returned for chest pain and fever.SARS-CoV2 swab resulted positive again. Transthoracic Echocardiography (TTE) documented mild pericardial effusion that reducedafter ibuprofen. In June the patient presented to the EmergencyDepartment for weekness in both legs and arms, severe fatigueand evidence of simmetric iporeflexia. He tested negative forSARS-CoV2. Cerebrospinal Fluid (CSF) and Electromyography(EMG) were diagnostic for Guillain-Barrè Syndrome (GBS), AcuteInflammatory Demyelinating Polyradiculoneuropathy (AIDP) type,so we started infusion of human immunoglobulins. Conclusions: The persistence of SARS-CoV2 viral RNA induces anabnormal immunological activation that may damage pericardiumand Peripheral Nervous System (PNS).
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Background and Aim of the study: Tocilizumab (TCZ), an IL-6 receptor (IL-6R) blocker, emerged as an effective drug for patientswith severe COVID-19 associated Pneumonia. The aim of this observational retrospective study was to evaluate the laboratory characteristics of patients who received i.v. TCZ treatment. Materials and Methods: We collected serum levels of IL-6, procalcitonin (PCT), C-reactive protein(CRP), D-Dimers and CD4/CD8ratio, to evaluate the systemic inflammatory state, of 16 patientsaffected by nasopharyngeal swab confirmed SARS COV-2 Pneumonia who received TCZ (8 mg/kg once or twice in 12 hours).Blood samples for analysis were collected before and after theadministration.Results: Baseline serum levels of laboratory parameters were:CRP 14±10 mg/dl,IL-6 249±264 pg/dl, D-dimers 1872±1833pg/ml, CD4/CD8 ratio 2,4±1,2, PCT 0,61±0,91 pg/ml. After TCZadministrations we observed a rapid increase of IL-6 serum levelsto 941±1317 pg/dl (p=0,05), CD4/CD8 ratio to 3,1±2,3 (trendp=0,07) while D-Dimers didn't decrease significantly. CRP levels,after the administration, decreased to 6±6 mg/dL(p=0,0002)while PCT levels showed no significant variations.Conclusions: The anti-inflammatory effect of TCZ administrationis suggested by the variations in laboratory characteristic, most ofall represented by a decrease of CRP levels and an increase of IL-6 levels, as a result of the displacement of the interleukin from itsreceptor.
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Introduction and Aim of the study: Hydroxychloroquine has beenauthorized in the therapy of patients with COVID-19. Many publications have not clarified the real efficacy of the drug. Really, thedrug was widely used during the pandemic. A single-center observational cohort study was conducted to evaluate the effectiveness of hydroxychloroquine therapy in a group of subjects admittedin the sub-intensive therapy of the COVID Unit Hospital F. Miulli(Acquaviva delle Fonti, Bari, Italy) from 17 march to 17 may 2020.Materials and Methods: The data contained in the medicalrecords were studied. The sample was divided into two groups withrespect to therapy with or without hydroxychloroquine'. Clinicaland laboratory data were analyzed.Results: A total of 174 patients hospitalized (60.4% males),mean age 68 yrs, with diagnosis of SARS-CoV2, were analyzed.118 patients were treated with hydroxychloroquine. The treatment group consisted of 66.1% males, mean age 63 years. Thetwo groups were homogeneous in comorbidity and in the severityof clinical presentation of SARS-CoV2 infection. The death ratewas significantly higher in the group of untreated than in thosereceiving hydroxychloroquine, 40% vs 2.6% respectively. Therewere no significant differences on QTc prolongation between thetwo groups (467+47 ms control group, 446 + 35 ms, treatmentgroup).Discussion and Conclusions: The data of our study, although referring to a reduced sample, show the effectiveness of hydroxychloroquine in reducing mortality in subjects suffering fromSARS-CoV2 infection.
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Background and Aim of the study: As of 17 June 2020, Italy had237.828 cases of SARS-CoV-2 infections, with about 35.000deaths;median age of cases 61 years, median age of deceased81 years. A single-center observational cohort study was conducted to evaluate clinical features, laboratory characteristicscomparing two groups of subjects by age (>75 and <75 years)admitted in the sub-intensive therapy of the COVID Unit HospitalF. Miulli (Acquaviva delle Fonti, Bari, Italy) from 17 march to 17may 2020.Materials and Methods: The data contained in the medicalrecords were studied.Results: A total of 174 patients hospitalized (60.4% males),mean age 68 yrs, with diagnosis of SARS-CoV2, were analyzed;they were divided into two groups >75 years and <75 years (110pts and 64 pts respectively). The group of older subjects had ahigher prevalence of comorbility (heart, kidney failure, COPD);mortality was more significant in subjects >75 years (37.3% vs 0.9%)compared to young people. No difference was observed in thelength of stay (21 days on average), while the younger subjectswere treated with hydroxychloroquine more than the elderly(83.6% vs 40.6% respectively) as well as with lopinavir / ritonavir(39.4% vs 14.5%).Conclusions: Our data, although referring to a small sample ofsubjects, show that patients over 75 years of age are more fragile(die more), have better comorbidities and have been under treatedcompared to younger subjects.
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Background and Aim: As of 22 June 2020, Italy had 238.499cases of Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2) infections, with about 35.000 deaths. A single-center observational cohort study was conducted to evaluate epidemiological, demographic, clinical and laboratory data of SARS-CoV-2patients who were admitted to the sub-intensive therapy unit ofthe COVID Unit Hospital F. Miulli (Acquaviva delle Fonti, Bari, Italy),from Mar 17, 2020 to May 17, 2020.Materials and Methods: Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes wereall collected and analysed. Results: A total of 143 SARS-CoV-2 patients, 60.4% males, meanage 68 yrs , were included. Twenty-seven patients (19%) had clinical signs of severe pneumonia and 6.3% had an ARDS, ICU admissions were 2.9%. The most represented comorbidities were:chronic heart failure (10.3%), diabetes (15.5%), chronic obstructive pulmonary disease (17.8%), cancer (13.2%), kidney chronicfailure (28.2%). The used drugs have been distributed as follows:lopinavir/ritonavir (30.4%), hydroxychloroquine (67.8%), steroid(21.2%), tocilizumab (4%). Length of stay was 21 days and theaverage negative time of the second nasopharyngeal swab was18 days. In our study, a total of 20 patients (13.9%) died, withmean age 86 yrs .Conclusions: Our findings show that SARS-CoV-2 infection maybe severe, requiring intensive care admission, expecially in olderpatients and in those with comorbidities.
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Background and Aim of the study: Partial or complete ageusiaand anosmia have been observed as initial and sometimes uniquesymptoms of COVID-19 infection, especially in paucisymptomaticpatients. A single-center observational cohort study was conductedto evaluate taste and smell in a group of subjects admitted in thesub-intensive therapy of the COVID UNIT Hospital F. Miulli (Acquaviva delle Fonti, Bari, Italy) from 8 april to 11 may 2020.Materials e Methods: A questionnaire was administered to agroup of patients, with normal cognitive system. The laboratoryand clinical data contained in the medical records were studied.Results: 53 patients, 35 male and 18 female aged between 23and 82 replied to the questionnaire. 19 patients reported no loss,3 reported only loss of smell and 31 loss of taste;of these, 23also reported an associated loss of smell (9 partial loss and 14total loss). Patients with olfactory deficits complained of nasalcongestion and the need to breathe through the mouth in 23% ofcases and rhinorrhea in 15%. The loss of taste was rarely associated with a decrease in appetite (3%) and in 65% this deficit wastotal. The division of patients into 4 phenotype groups (based onthe severity of the clinical presentation) did not reveal significantdifferences between the groups.Conclusions: The data of our study, although referring to a reducedsample, show that olfactory and gustatory deficits are associatedwith SARS-CoV2 infection in a high percentage of patients. The phenotype did not show a role in the development of these symptoms.
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Description of the case: A 83-year-old man has been hospitalized for fever, cough and dyspnea in our UOC pneumology Covid fornasopharyngeal swab positive for SARS COV2. In anamnesis itpresented hypertension, COPD and atherosclerotic vasculopathy.At the entrance it has dyspnoea, BP 130/80 mmHg, CF 72 bpm,no heart failure symptoms, Ps 02 89% in ambient air. Pulmonaryauscultation demonstrated the presence of ronchi spreads tochest with hypomobile bases. At ECG sinus rhythm was 65 bpmwith repolarization anomalies QTc470 ms. Echocardiography wascompatible for hypertensive heart disease. Bilateral thickeningswith an emery glass appearance in the bilateral basal middle fieldat the chest CT scan. Laboratory showed the signs of inflammation.He begins antibiotic and antiviral therapy with lopinavir, LMWH,dexametazone and O2 therapy with integral mask with fi02 50%peep 10 mmHg. The respiratory symptoms have improved but itshowed up steep edema, asthenia, bradycardia with difficultyspeaking. Ecg presents complete atrioventricular block with junctional escapement at 35 bpm. Bilateral thickenings with an emeryglass appearance in the bilateral basal middle field at the chestCT scan. Laboratory showed the signs of inflammation. He beginsantibiotic and antiviral therapy with lopinavir, LMWH, dexametasone and O2 therapy with integral mask with fi02 50% peep 10mmHg. The respiratory symptoms have improved but it showed upsteep edema, asthenia, bradycardia with difficulty speaking. ECGpresents complete atrioventricular block with junctional escapement at 35 bpm. Ps O2 94% in O2 at 4 l / m. The patient waspromptly taken to the electrophysiology room for the definitive single-chamber pacemaker implant. Clinical and hemodynamic conditions have improved as well as lung and ventilator conditions.Conclusions: In our experience we have observed the presenceof numerous cases of heart rhythm disturbances both in the bradycardic and tachycardic sense not only iatrogenic but also suggestive of a direct action of the SARS-CoV2 virus on the cardiacconduction system.
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Background and Aim of the study: The SARS-CoV2 associatedinterstitial pneumonia characterized by acute respiratory failureand other symptoms affecting different organs and systems.Among these also the cardiovascular system.Materials e Methods: More than 250 patients were hospitalizedin our Covid Unit to 15 March from 15 May 2020, divided betweenCovid pulmonology, Covid infectious diseases and Covid intensivecare unit.Results: Of the patients discharged, more than 200 from the various units, between the end of May and June 15, 10 patients werereadmitted to the covid unit for the re-positivity of the nasopharyngeal swab. Among them, 4 patients (40%) 3 males (54, 24and 42 years) and 1 female (50 years) had clinical, instrumentaland laboratory signs indicative of acute pericarditis, absent previously and at discharge. They were treated with anti- inflammatoryand colchicine therapy with clinical and instrumental improvementand re-discharged to subsequent negativity with clinical follow-upprogramming.Conclusions: It is suggestive that the long-term persistence ofpositivity to SARS-CoV2, perhaps because it is linked to a greaterpersistence over time of the inflammatory state linked to the viralinfection, triggers a local inflammatory reaction to the pericardialsheets, especially in subjects of a younger age.
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Background and Aim of the study: From March 2020 to May2020 we treated 133 SARS-CoV-2 patients in our COVID Unit at'F. Miulli' Hospital, 15 of these were also affected by severe acuterespiratory syndrome that needed CPAP support. The aim of thestudy was to evaluate the clinical features of patients with severerespiratory failure treated with CPAP compared to those with milderone that didn't require it.Materials and Methods: A retrospective observational study on133 patients was performed. Patients have been divided into twogroups: those who needed CPAP (15) and those who didn't (118)to compare comorbidities and the supportive medical therapy.Results: 80% of the patients treated with CPAP were males (age71 ± 12). Only 13% were smokers;the most frequent comorbidities were heart failure (20%) and renal failure (40%);pre-existentrespiratory diseases, high blood pressure and diabetes mellitusdidn't show a significant impact on the respiratory outcome. Comparing the 2 groups we found a significant difference about theprobability to be transferred in Intensive Care Unit, higher in CPAPtreated patients (p 0,034). We also found differences between thetwo groups about the medical therapy support, in particular theuse of diuretics, resulted significantly higher (p 0,002) in CPAPtreated patients.Conclusions: A severe respiratory failure related to COVID 19 ap pears to be more frequently associated with kidney and heart disease rather than pre-existing worst respiratory situation and so requires in association with C-PAP support also a more substantialmedical therapy.
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Background and Aim of the study: The SARS-CoV 2 pandemicinvolved about 230.00 people in Italy with about 35.000 deaths.In China the lethality rate of confirmed cases is 4.7% in men compared to 2.8% in women. In Italy women represent 34.0% of thetotal and are older than men (respectively 83 years vs 79). A single-center observational cohort study was conducted to evaluategender differences in clinical features, laboratory, length of stayand mortality in patients admitted in sub-intensive COVID Unit ofF. Miulli Hospital (Acquaviva delle Fonti, Bari, Italy) from 17 marchto 17 may 2020.Materials and Methods: The data contained in the medicalrecords were studied.Results: A total of 174 patients were analyzed. Females accountfor 39.6%. The average age was 66 yrs and 70 yrs respectively inmales and females. No difference was observed with respect to themain inflammation markers (IL6, d-Dimer, CRP);the length of hospital stay was similar, 20 days in females and 21 days in males.Chronic heart failure, COPD, diabetes, chronic renal failure, wereequally represented in the two groups. Disease severity and mortalitywere similar. The only significant difference (p <0.02) was in the useof hydroxychloroquine, prevalent in the group of male subjects.Discussion and Conclusions: The data of our study, although witha limited sample of subjects, do not show significant differencesbetween males and females. Length of stay and mortality are notinfluenced by gender. We could conclude that when women getsick they feel the disease in the same way as men.