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The Covid-19 pandemic that began in December 2019 and is still underway in 2022 has changed many habits and protocols in different economic industries including healthcare. In the specific case, the change in protocols and management of work activities also affected the health sector. Among the sectors in which the pandemic has influenced the flow of events is the cardiology sector. In the specific case, the present work will present how coronary bypass interventions have been influenced in their different aspects by the Covid-19 pandemic. The work will be based on a comparison between the 2019 data in the period prior to the pandemic and in 2020 in the post-pandemic period for two major public hospitals in the Campania region: The university hospital of Salerno (Italy) "San Giovanni di Dio and Ruggi D'Aragona"and AORN "A. Cardarelli "of Naples (Italy). Both the structures considered have an Emergency Department and First Aid Acceptance for surgical pathologies. © 2022 ACM.
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Passive immunization with mAbs has been employed in COVID-19. We performed a systematic review of the literature assessing the endogenous humoral immune response against SARS-CoV-2 in patients treated with mAbs. Administration of mAbs in seronegative patients led to a reduction in both antibody titres and neutralizing activity against the virus.Copyright © 2022
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Over the years, transportable instrumentation for cultural heritage (CH) in situ measurements has noticeably widespread, due to logistic, economical and safety reasons. Ion beam analysis, a powerful set of analytical techniques, of great importance for CH, is instead carried out by using fixed instrumentation. To overcome this limit, the Italian national Institute of Nuclear Physics (INFN), CERN (European Centre for Nuclear Research) and the Opificio delle Pietre Dure (OPD), started MACHINA, the "Movable Accelerator for CH In-situ Non-destructive Analysis: the new generation of accelerators for art” to build a transportable accelerator, compact, with strongly reduced weight, absorbed power and cost. MACHINA will be installed at the OPD and dedicated to CH. It will be moved to major conservation centres and museums, when needed. The INFN-CERN proposal, approved in December 2017, became operative in February 2018. 2018 was dedicated to the acquisition of material/instrumentations, to set up both a dummy accelerator (to test the vacuum system) and a vacuum chamber (to test the source). Due to COVID, in 2020 and 2021 the experimental work was slowed down, but we kept developing the control electronics/software and built the second-generation supporting structure. The HF-RFQ power supplies were integrated in October 2021. At the rise of 2022, after conditioning the cavities, we tested the system and in March 2022 we got the first extracted 2-MeV proton beam. In this paper, we present the structure of the MACHINA system, the approach followed and the main solutions adopted, with a special focus on the control system, and finally the first experimental results. © 2023, The Author(s).
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The purpose of the present work was to assess the impact of the Covid-19 epidemic on the activity of the Department of General Medicine in the University Hospital "San Giovanni di Dio and Ruggi d'Aragona” of Salerno and the hospital "A.O.R.N. A. Cardarelli” of Naples (Italy). COVID-19 is a specific disease affecting subject respiratory system is a respiratory infection that changed the health context. Because of the pandemic hospitals had to reorganize departments to better manage resources. In order to make a comparison with and without Covid-19, the data for the year 2019 (in the absence of Covid-19) and in the year of the pandemic 2020 have been collected. In the work was used the logistic regression technique to study the following variables: age, sex, LOS, weight of DRG, mode of discharge and type of hospitalization. In addition, the results of the two hospitals were used to make a comparison. For both hospitals in the year 2020 the number of patients admitted is lower than the previous year, and this shows that there has been appropriate management and control to establish patients who really needed hospitalization. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Background: From January 2022 the Omicron SARS-CoV-2 variant became the dominant circulating variant worldwide, showing increased transmissibility and the ability to evade immunity. Booster vaccinations improved the protective effects of neutralizing antibodies and might have lowered the risk of hospitalization and mortality, as recently observed. Aim: to evaluate the prevalence and outcome of Omicron-related infection in a cohort of liver transplant (LT) recipients. Material and Methods: From January to September 2022, we enrolled in a longitudinal study all LT recipients who became SARS-CoV-2 infected (95% vaccinated;88% receiving a 1st booster dose and 25% a 2nd booster). All patients were included in a protocol of testing anti-spike (a-S) and anti-nucleocapsid (a-N) antibodies titres before/after each dose (Elecsys Anti-SARS-CoV-2, Roche Diagnostic). Diagnostic criteria for SARS-CoV-2 infection were 1) presence of a positive nasopharyngeal swab (NFS) by PCR or antigenic assays or 2) presence of a-N seroconversion (if previously a-N negative). Reinfection was defined by a new NFS positivity or an increased value of a-N titre. Results: Overall, 201 LT-recipients have been infected by SARS-CoV-2 (62% males, median age=61yr, 50% viral-etiology, 35% with HCC, all received a CNI-based regimen, plus MMF=63%). Most of infections were diagnosed by NFS (72%);mild flu-like symptoms were observed in 59% of our LT recipients;72% of them remained untreated, while 28% received antivirals (11%) or monoclonal antibodies (17%). Fifteen LT recipients were hospitalized, 6 of them for interstitial pneumonia and 2 (both with previous lung diseases) died for COVID-19. Conclusions: A mild or asymptomatic infection occurred frequently in our LT recipients with a less severe outcome than the past waves. A possible explanation could be the high prevalence of vaccinated patients in our cohort. Interestingly, the overall prevalence of SARS Cov2 infection might be underestimated without a careful monitoring of SARS-CoV-2 serology against nucleocapsid.
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Background. The CoViD-19 pandemic has hit the public health system in many nations hard. The long incubation period, the high infectious rate, the varied manifestation and the lack of effective treatment make managing the transmission of the disease difficult. For this reason, the health focus has been shifted to its management, thus limiting the activity carried out by surgical specialties. In neurosurgery, the complexity and importance of treatments in some cases requires timely intervention that cannot be delayed. Methods. In this study, the demographic and activity data of patients discharged from the Complex Operative Units (COU) of Neurosurgery and Neurosurgical Clinic of the "San Giovanni di Dio e Ruggi d'Aragona"University Hospital of Salerno (Italy) in the years 2019 (pre-pandemic) and 2020 (during the pandemic) were analyzed using statistical test and logistic regression. Results. Both statistical tests and logistic regression showed a significant increase in the weight of the Diagnosis Related Group (DRG) obtained from the COUs, demonstrating an improvement in the appropriateness of the services provided. Conclusion. This work demonstrates how a more consistent use of the hospital due to fear and containment measures has improved the performance of the COU. © 2022 ACM.
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Background. The Covid-19 pandemic has deeply impacted the oncology community. The European Society for Medical Oncology (ESMO) suggests strengthening telemedicine services, reducing clinic visits and switching to subcutaneous or oral, rather than intravenous, therapies whenever possible. Methods. This study was conducted at the Oncology Complex Operating Unit by collecting data on all patients who accessed in 2019-2020. The aim was to understand how Covid-19 affected hospital admissions. Statistical tests and Logistic Regression were implemented. Results. The statistical analysis carried out showed that between 2019 and 2020 there was less use of emergency admission and voluntary discharge, while highlighting the increase in the "Protected with integrated home care"discharge mode. Conclusion. The results show how the European guidelines have improved the health process, from admission with the reduction of emergencies to discharge. © 2022 ACM.
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A new highly efficient GPU-equipped computing platform for studying the molecular inhibition mechanisms of the Sars-Cov-2 virus by natural compounds and aptamers has been installed and configured. Studies will be carried out by means of molecular dynamics methods and programs. For this reason, we have assembled specific hardware components into a 4U rack, together with a NVIDIA RTX 3060 GPU for speeding up molecular dynamics calculations and visualizing their outcomes. In fact, not only computational resources, in terms of computing power and execution times, are needed by molecular dynamics programs adopted by us, but also a system allowing the rendering and visualization of large biomolecules and their trajectories, such as viruses and proteins, represents a key factor for our work. Details about platform implementation and preliminary tests carried out are discussed. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Premise and Study aim: In Italy at the end of 2020 more than 30.000 deaths were observed not attributable to COVID;we wanted to test this hypothesis in our non-COVID internal medicine, benchmark for an area of about 150.000 inhabitants. Materials and Methods: We compared the number of discharges and deaths hospitalized in our UOC in the year of the pandemic, 2020 and 2021, respect to 2019, and we assessed any differences in mortality between the years and gender, and if these had statistical significance. Results: Total mortality showed an increasing trend from 2019 to 2021 (statistically not significant);hospital mortality in males is reduced in 2020 and unchanged in 2021, mortality in females showed a clear increasing trend (OR:1.58, IC:0.96-2.06) in 2019, statistically significant (OR:1.9, IC:1.2-3.1) in 2021. Conclusions: Delayed hospitalization for “fear of infection” of more serious patients and with lower chances of survival, together with the drastic reduction/absence of territorial outpatient diagnosis and treatment activities starting from March 2020, with further impact on chronicity in 2021, can be considered responsible for the increase in in-hospital mortality compared to 2019, detected in our patients. Data become statistically significant in female population, and it is attributable both to a greater fragility (living alone, less economic resources, less education) and the role of main care givers in the pandemic, continuing to guarantee assistance to all family members, in particular to the partner, even if detrimental of self health.
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CoViD-19 has placed the health systems of many countries in further crisis. The elective surgeries were canceled and the staff of several departments, including general medicine, underwent a reallocation to deal with the health emergency. In a context of economic fragility, in recent years the use of indicators for measuring health quality and performance has acquired more and more importance. Access limited only to emergency-urgency cases within hospitals has however produced a benefit in improving the appropriateness of admissions. In this study the value of parameter sets obtained in year 2019 (pre-pandemic) and year 2020 (during the pandemic), including Length of Stay and Diagnostic Related Group (DRG) Weight, of the Department of General Medicine of the University Hospital of Salerno 'San Giovanni di Dio e Ruggi D'Aragona' in Salerno (Italy) were compared using statistical analysis and logistic regression. The statistical analysis shows an increase in the DRG Weight in 2020, so an increase of the complexity of the cases treated and a greater appropriateness of hospitalizations. © 2021 ACM.
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The CoViD-19 pandemic has unfortunately not spared the children. In most cases, the infection is asymptomatic and the serious outcomes are much lower than in adults. Despite this, as the hospital is committed to treating infected patients and limiting the spread of infections, pediatric surgery has also undergone the blocking of procedures deemed deferrable like other surgeries. In light of this, in this study it was decided to analyze how the activity of the Complex Operative Units (COUs) of Pediatrics and Pediatric Surgery in "San Giovanni di Dio and Ruggi d'Aragona"University Hospital of Salerno (Italy) was affected by the pandemic. Both statistical analysis and logistic regression show an increase of patients' average age and of weight of Diagnostic Related Group (DRG). © 2021 ACM.
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Background and Aims: SARS-CoV-2 mRNA vaccines have been approved to prevent COVID-19. We assessed immunogenicity, effectiveness and safety of vaccines in patients with compensated and decompesated cirrhosis. Method: This is a prospective single center study assessing humoral and cellular responses in cirrhotics compared to healthy controls, incidence post-vaccination SARS-CoV-2 infections and adverse events (AEs). Antibodies against the spike- and nucleocapside-protein (anti-S and anti-N) were tested at baseline, 21 days after the first and second doses and during follow-up. Spike-specific T-cells quantity assessment was longitudinally conducted by the stimulation of whole blood with peptides covering the SARS-CoV-2 spike protein, followed by IFN-γ and IL-2 measurement. Results: 182 cirrhotics (61 years, 75% males, 45% viral-related, 74% Child-Pugh A, 31% HCC, 85% COVID-19 naïve) and 38 healthy subjects were enrolled. Previous SARS-CoV-2 infection predicted higher anti-S titres at all time points after vaccination, in both groups. COVID-19 naïve cirrhotics showed significantly lower anti-S titres compared to controls [998.5 (0.4-12,500) vs 1,520 (259-12,500) U/mL, p=0.048], anti-S titres significantly decreased after a median of 133 (70-182) days [536 (0.4-8,777) U/mL, p<0.0001] and were lower in decompensated vs compensated cirrhosis [632 (0.4-12,500) vs 1,377 (0.4-12,500) U/mL, p=0.028]. By multivariable analysis in COVID-19 naïve cirrhotics, independent predictors of lower anti-S were active HCC, immunocompromised conditions, BNT162b2 and lower anti-S after first dose. The spike-specific T-cell response was evaluated in 14 cirrhotics, showing a heterogeneous magnitude of response, but on average the quantity and kinetics of decline of the spike-specific cellular responses diverged in cirrhotics compared to controls, with lower concentrations of both IFN-γ and IL-2. During follow-up, 4/133 (3%) COVID-19 naïve cirrhotics tested positive for anti-N, all asymptomatic. Neither unexpected nor severe AEs emerged. Conclusion: Humoral and cellular responses to SARS-CoV-2 mRNA vaccines appeared suboptimal in patients with cirrhosis, however the rate of post-vaccination infection seems low.
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Introduction: Registration studies have shown high efficacy of BNT162b2 mRNA COVID-19 vaccine. We evaluated vaccine effectiveness (VE) of BNT162b2 mRNA COVID-19 vaccine in a cohort of healthcare workers (HCWs) of a large hospital in Milan, Lombardy, Italy. Material and Methods: Follow-up started on 27 December 2020 (beginning of the vaccination campaign). HCWs without history of SARS-CoV-2 infection before the start date and with at least a nasopharyngeal test afterwards were included. Vaccination was treated as a time-dependent variable. For selected periods after vaccination we calculated incidence rate ratios (IRR) and 95% confidence intervals (CI) of infection with a Poisson regression model adjusted for gender, age, occupation, and 30-day periods, and then VE as (1 – IRR)x100 using unvaccinated person-time as reference. Databases were closed on 27 September 2021. The study was approved by the hospital’s ethics committee (Milano Area 2, Prot. No. 828_2021bis). Results and Conclusions: We included 3,809 HCWs, 131 still unvaccinated and 3,678 vaccinated (3,576 with two doses). We identified 134 infections (62% symptomatic). Adjusted VE was 77% (CI: 43-91) from day 14 after the first vaccine dose and 87% (CI: 79-92) at least 7 days after the second dose. After full vaccination schedule VE was 89% (CI: 82-94) for symptomatic and 77% (CI: 45-90) for asymptomatic infections. In conclusion, we found high effectiveness of BNT162b2 vaccine in reducing incidence of both symptomatic and asymptomatic infections. The follow-up is continuing to assess long-term effectiveness, also considering emerging SARS-CoV-2 variants.
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The COVID-19 pandemic has put a strain on all health systems as there has been a growing rapidity in the demand for health care from COVID 19 positive patients in hospitals around the world. With the intensification of the pandemic, determining in real time the consequent needs for health resources (beds, personnel, equipment) has in fact become the fundamental priority for many countries to ensure health services consistent with the health needs expressed by the population. In Italy, the demand has often been satisfied with the conversion of existing beds and the remodeling of the healthcare offer or where the available resources allow it also with the opening of new beds dedicated to pandemic assistance. This work analyzes the falls detected at the time of COVID in patients and hospitalized in direct hospital beds (600 beds) of a Local Health Authority of Lazio (ASL ROMA 2). Although the data on the incidence of falls recorded in the three centers were equal to 2.21 every 1000 days of beds occupied and that the data recorded are lower than those reported in the literature, it is also true that the increase in average hospital stay and the reduction in the rotation rate of beds had an impact on the still low occupancy rates compared to the literature data. The COVID-19 pandemic has put a strain on all health systems as there has been a growing rapidity in the demand for health care from COVID 19 positive patients in hospitals around the world. With the intensification of the pandemic, determining in real time the consequent needs for health resources (beds, personnel, equipment) has in fact become the fundamental priority for many countries to ensure health services consistent with the health needs expressed by the population. In Italy, the demand has often been satisfied with the conversion of existing beds and the remodeling of the healthcare offer or where the available resources allow it also with the opening of new beds dedicated to pandemic assistance. This work analyzes the falls detected at the time of COVID in patients and hospitalized in direct hospital beds (600 beds) of a Local Health Authority of Lazio (ASL ROMA 2). Although the data on the incidence of falls recorded in the three centers were equal to 2.21 every 1000 days of beds occupied and that the data recorded are lower than those reported in the literature, it is also true that the increase in average hospital stay and the reduction in the rotation rate of beds had an impact on the still low occupancy rates compared to the literature data. In fact, the scientific literature shows that in England and Wales, whose national health service is very similar to the Italian one, the falls of patients in hospitals with optimal bed occupancy rates and optimal average hospitalization rates (equal to 4.5 days in general medicine, 3.5 days in general surgery, 3 days in orthopedics) represent the first sentinel event in terms of incidence and frequency, albeit with a very variable damage detection. The average falls is 6.63 falls per 1,000 bed-occupied days, which equates to approximately 1,700 falls per year in an 800-bed hospital with an optimal occupancy rate. Regarding damage, the literature documents that physical injuries and fractures occur in 30-50% of events and fractures occur in 1-3% of cases. The data collected in ASL ROMA 2 have documented that despite the increase in staff dedicated to assistance by 15 - 30%, an increase due to the application of COVID pathways and to the activities of compression of the risk of circulation of the virus among hospitalized patients , the rate of falls has nevertheless increased by 13.5% despite the persistence of standards of quality and safety of patients in care activities, debunking the paradigm that falls can be caused by an undersizing of the care staff and by the possible overcrowding of the emergency departments - urgency.
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Introduction Randomized controlled trials showed efficacy of vaccines against coronavirus disease 19 (COVID-19). There is the need to quantify vaccine effectiveness in real-word contexts, including people at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), such as health care workers (HCWs). Objectives To evaluate vaccine effectiveness among hospital HCWs. Methods We performed a cohort study among HCWs of a large University hospital in Milan, Lombardy, Italy by merging routinely collected data on demographics, COVID-19 vaccination, and polymerase chain-reaction (PCR) tests performed on nasopharyngeal swabs. Follow-up started on December 27, 2020 (start of vaccination campaign). We included HCWs never PCR-positive before the start date and with at least a PCR test afterwards. Vaccination was treated as a time-dependent variable by calculating person-years (PY) at risk before and after vaccine doses. Subjects contributed PY until first positive PCR test (cases) or last test for never positive HCWs (to avoid immortal time bias). We calculated infection rates (cases per 1000 PY), rate ratios (RR, with a Poisson regression model adjusted for gender, age, occupation and 30-day periods), vaccine effectiveness (VE = (1-RR)x100) and 95% confidence intervals (CI) taking never vaccinated HCWs as reference. Results As of May 10, there were 3,152 vaccinated (97% with BNT162b2, 140 with one dose, 2,679 with two doses) and 333 non-vaccinated. We counted 29 infected cases (rate 385) among non-vaccinated, 6 (rate 65) from day 14 after the first dose (VE 79%, CI 49-92%), and 24 (rate 65) from day 7 after the second dose (VE 89%, CI 80-94%). Most cases after vaccination were asymptomatic or mildly symptomatic. Conclusion In these preliminary analysis we found high effectiveness of COVID-19 vaccine in HCWs in our hospital. Further work is needed to assess long-term effectiveness and to better plan future preventive strategies among this high-risk occupational group.
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As the SARS-CoV-2 pandemic continues to rage worldwide, the emergence of numerous variants of concern (VOC) represents a challenge for the vaccinal protective efficacy and the reliability of commercially available high-throughput immunoassays. Our study demonstrates the administration of two doses of the BNT162b2 vaccine that elicited a robust SARS-CoV-2-specific immune response which was assessed up to 3 months after full vaccination in a cohort of 37 health care workers (HCWs). SARS-CoV-2-specific antibody response, evaluated by four commercially available chemiluminescence immunoassays (CLIA), was qualitatively consistent with the results provided by the gold-standard in vitro neutralization assay (NTA). However, we could not observe a correlation between the quantity of the antibody detected by CLIA assays and their neutralizing activity tested by NTA. Almost all subjects developed a SARS-CoV-2-specific T-cell response. Moreover, vaccinated HCWs developed a similar protective neutralizing antibodies response against the EU (B.1), Alpha (B.1.1.7), Gamma (P.1), and Eta (B.1.525) SARS-CoV-2 variants, while Beta (B.1.351) and Delta (B.1.617.2) strains displayed a consistent partial immune evasion. These results underline the importance of a solid vaccine-elicited immune response and a robust antibody titre. We believe that these relevant results should be taken into consideration in the definition of future vaccinal strategies.
Subject(s)
BNT162 Vaccine/immunology , COVID-19 Vaccines/immunology , COVID-19/immunology , COVID-19/prevention & control , SARS-CoV-2/immunology , Adult , Aged , Antibodies, Neutralizing/blood , Antibodies, Neutralizing/immunology , Antibodies, Viral/blood , Antibodies, Viral/immunology , BNT162 Vaccine/administration & dosage , BNT162 Vaccine/genetics , COVID-19/blood , COVID-19/virology , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/genetics , Female , Humans , Immunity, Cellular , Immunity, Humoral , Immunoassay , Longitudinal Studies , Male , Middle Aged , Prospective Studies , SARS-CoV-2/genetics , T-Lymphocytes/immunology , Vaccination , Young AdultABSTRACT
OBJECTIVES: The management of healthcare workers (HCWs) exposed to confirmed cases of coronavirus disease 2019 (COVID-19) is still a matter of debate. We aimed to assess in this group the attack rate of asymptomatic carriers and the symptoms most frequently associated with infection. METHODS: Occupational and clinical characteristics of HCWs who underwent nasopharyngeal swab testing for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a university hospital from 24 February 2020 to 31 March 2020 were collected. For those who tested positive and for those who tested positive but who were asymptomatic, we checked the laboratory and clinical data as of 22 May to calculate the time necessary for HCWs to then test negative and to verify whether symptoms developed thereafter. Frequencies of positive tests were compared according to selected variables using multivariable logistic regression models. RESULTS: There were 139 positive tests (8.8%) among 1573 HCWs (95% confidence interval, 7.5-10.3), with a marked difference between symptomatic (122/503, 24.2%) and asymptomatic (17/1070, 1.6%) workers (p < 0.001). Physicians were the group with the highest frequency of positive tests (61/582, 10.5%), whereas clerical workers and technicians had the lowest frequency (5/137, 3.6%). The likelihood of testing positive for COVID-19 increased with the number of reported symptoms; the strongest predictors of test positivity were taste and smell alterations (odds ratio = 76.9) and fever (odds ratio = 9.12). The median time from first positive test to a negative test was 27 days (95% confidence interval, 24-30). CONCLUSIONS: HCWs can be infected with SARS-CoV-2 without displaying any symptoms. Among symptomatic HCWs, the key symptoms to guide diagnosis are taste and smell alterations and fever. A median of almost 4 weeks is necessary before nasopharyngeal swab test results are negative.