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Background/Aims: Several studies showed that patients with liver cirrhosis have an immune dysregulation leading to poor immunological response to vaccination. However, in literature there are few data about the response to SARS-CoV-2 vaccination in patients with chronic liver disease (CLD). Aims of the study are (is) the evaluation of safety and immunogenicity of booster dose in patients with CLD. Methods: From September 2021 to April 2022, all consecutive outpatients with CLD who completed the primary vaccination course and the booster dose for anti-SARS-CoV-2 vaccination were enrolled. Blood samples were collected 12-16 weeks after second dose and after booster dose. Collected samples were analyzed for detecting anti-Spike protein IgG using LIAISON TrimericS IgG chemiluminescent assay (Diasorin, Italy). Results: We enrolled 340 patients (187 Males, mean age:64.32±17.34years). Stratified by the presence of cirrhosis, 249 had CLD and 91 were cirrhotic whose 57 (62.24%) had portal hypertension. At the end of the primary vaccination course, 60 patients (17.65%) did not develop a protective antibody titer, with no statistically significant differences between the two groups (19.7% in cirrhotic vs 16.8% in non-cirrhotic;p=0.076). The majority of them (53/60 patients;88.3%) developed a protective titer after booster dose, without differences between cirrhotics and non-cirrhotics (p=0.089). At multivariate analysis, factors associated with a higher humoral response after booster dose were young age (p=0.0098);porto-sinusoidal vascular disorder (p=0.005), none or a single comorbidity rather than two or more (p=0.05) and Spikevax booster dose compared with Comirnaty (p=0.001). Moreover, the antibody titer is inversely related to age (p=0.000). Conclusions: In a large cohort of patients with CLD booster dose of anti-Sars-CoV-2 vaccine has an excellent immunogenicity and leads to an adequate antibody response even in those who had not produced a protective titer after the primary vaccination course. Cirrhosis is not associated with a reduced humoral response.
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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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The CoViD-19 pandemic is an international public health emergency. The management of the hospitals found themselves facing an ever-increasing demand for beds, especially for intensive care, thus having to make critical decisions in a short time. A shared action was to block elective surgery deemed deferrable and to transfer resources to the management of the pandemic. The activity of the surgical departments has therefore undergone substantial alterations. In this study, logistic regression and statistical analysis was used to characterize this difference for the Urology Department in "San Giovanni di Dio and Ruggi d'Aragona"University Hospital of Salerno (Italy) by analyzing a set of variables and compared the data obtained in the year 2019, pre-pandemic, with that recorded the following year, in the height of the pandemic. The results show an increased number of emergency hospitalizations as well as scheduled hospitalizations with pre-admission. © 2021 ACM.
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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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Since the first case recorded in China in 2019, CoViD-19 has overwhelmed the health systems of all countries. The highly complex request for assistance combined with the fear of contagion have changed the normal activity of hospitals. Conversely, as the pandemic spreads, fewer people are going to the Emergency Department (ED) for non-CoViD diseases. In this study, logistic regression and statistical analysis were used to investigate how the pandemic changed the activity of the Emergency Medicine Department of "San Giovanni di Dio and Ruggi d'Aragona"University Hospital of Salerno (Italy). Patients admitted in 2020 have a higher Length of Stay (LOS) and the mode of discharge is mostly "at home". While the discharge modality 'transferred to another regime in the same hospital' had significantly decreased in order to counter the internal contagion. © 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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Hospital admissions and surgical activities have undergone substantial changes due to the spread of the coronavirus 19 (CoViD-19) pandemic. To date, however, there are in increasingly number studies that have quantified the effect of the pandemic and its protocols on hospital activity. Unlike other studies, which identify protocols for the containment of infections, in this study, logistic regression and statistical analysis were used to evaluate the type of patients admitted to the Complex Operative Unit (COU) of General Surgery and Day Surgery and Breast Unit in "San Giovanni di Dio and Ruggi d'Aragona"University Hospital of Salerno (Italy) in CoViD-19 era. Specifically, the aim is to study how hospitalized patients has changed by investigating the relative parameters extracts from hospital discharge forms, comparing year 2019 and year 2020. The result shows that in year 2020, the weight of Diagnostic Related Group (DRG) was significantly higher and it highlighted an increased use of the emergency hospitalization. © 2021 ACM.
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Hospital services absorb almost half of the costs of the health sector;therefore, it is necessary to promote the effectiveness, efficiency and appropriateness of the services provided. These concepts become even more important in the era of the CoViD-19 pandemic, where the efforts made to manage it have absorbed all hospital resources. Inappropriate hospitalization and length of stay (LOS) are the factors that impose higher costs on hospitals. This study analyzed how CoViD-19 changed the activity of the Department of Neurology and Stroke Unit of the "San Giovanni di Dio e Ruggi d'Aragona"University Hospital of Salerno (Italy). Logistic regression showed a significant increase in relative Diagnosis Related Group (DRG) weight which translates into greater appropriateness of admission diagnoses. © 2021 ACM.
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Due to the Sars-Cov-2 pandemic, the entire health sector in all countries around the world had to reorganize. It was not only a question of increasing the number of intensive care places, but all other medical specialties also had to rewrite their protocols. In this context, it is interesting to investigate whether these new measures have changed the volume of activity and the way hospital departments work. The aim of this study is precisely to verify what has happened to the Transplantation and Related Surgery Centre of the "San Giovanni di Dio e Ruggi d'Aragona"University Hospital of Salerno. For this reason, data were collected on patients who were admitted in 2019 (pre-pendemic) and 2020. The statistical analysis carried out showed that nothing had changed in this department in 2020. © 2021 ACM.
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Introduction: In the context of the Italian SARS-CoV-2 vaccination program, liver transplant (LT) recipients were prioritized for vaccine administration, although the lower response to vaccines is a well known problem in this population. Aim: We aimed to evaluate immunogenicity of BNT162b2 mRNA vaccine in LT recipients and healthy controls and to identify factors associated with negative response to vaccine. Materials and Methods: We prospectively evaluated a cohort of adult LT patients the humoral response (with anti-Spike protein IgG-LIAISON SARS-CoV-2 S1/S2-IgG chemiluminescent assay) at 1 and 3 months after 2-dose vaccination. A group of 307 vaccinated healthcare workers, matched by age and sex, served as controls. Results: Overall, 492 LT patients were enrolled (75.41% male, median age 64.85 years). Detectable antibodies were observed in the 75% of patients with a median value of 73.9 AU/mL after 3 months from 2-dose vaccination. At multivariable analysis, older age (>40years, p=0.016), shorter time from liver transplantation (<5years, p=0.004), and immunosuppression with antimetabolites (p=0.029) were significantly associated with non-response to vaccination. Moreover, the LT recipients showed antibody titers statistically lower than the control group (103 vs 261 AU/ml, p<0.0001) (fig. 1). Finally, both in controls and LT patients we found a trend of inverse correlation between age and antibody titers (correlation coefficient: -0.2023 and -0.2345, respectively). Conclusions: Three months after vaccination, LT recipients showed humoral response in 75% of cases. Older age, shorter time from transplantation and use of antimetabolites were factors associated with non-response to vaccination and needed to be kept under close monitoring.
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The CoViD-19 pandemic imposed severe social containment measures in all sectors on countries around the world. This led to a general reorganization of the health sector involving all medical specialties. In addition, the growing influx of CoViD-19 patients in serious or critical conditions has led to a reallocation of healthcare personnel and a block of elective procedures deemed deferrable. Therefore, the surgical departments are those that have most undergone a modification of the activity normally provided. In fact, various protocols have been adopted to help doctors identify those cases in which a delay in surgery could cause serious damage to patients and on which it is necessary to intervene, thus also improving the appropriateness of admission. This study was conducted in the Complex Operative Unit (C.O.U.) of Otorhinolaryngology of the University Hospital of Salerno (Italy) "San Giovanni di Dio e Ruggi d'Aragona". Data were collected on patients who entered hospital in 2019 and 2020. Statistical analysis and logistic regression were used to quantify the effect of CoViD-19 on C.O.U.. To do this, the year 2019 was used as a reference of the normal activity of the department and compared with what was achieved in 2020, in the midst of the pandemic. Logistic regression performed on these data showed an increase in length of hospital stay (LOS) and diagnostic related group (DRG) weight in 2020 thus showing increased appropriateness of care offered. © 2021 ACM.