Absence of Major Cardiovascular Event in a Group of Patients Followed for More Than One Year after Severe Covid-19 Pneumoniae

Introduction: The Coronavirus disease 2019 (COVID-19), doesn't affect only respiratory system, but it also involves other organs including cardiovascular system, possibly causing acute or chronic cardiovascular events. Preexisting cardiovascular diseases enhance COVID-19 morbidity, as well. Aim(s): In this retrospective analysis we investigated the onset of cardiovascular events during a time-span of more than one year since hospitalization (384 days). Method(s): The analysis included 43 patients, who were hospitalized in Internal Medicine Department of Montichiari Hospital (ASST Spedali Civili of Brescia) for moderate to severe SARS-CoV2 related pneumonia treated with high-flow oxygen support (ranging from 40% fraction of inspired oxygen to non-invasive ventilation) Mean age was 63 years, 28% (12/43) were female and 72% (31/43) were male. Thirty-five percent of the patients suffered from heart diseases, 56% of them were hypertensives and 23% had type 2 diabetes;12% had chronic kidney disease (CKD) and 5% an active neoplasm. 49% of the sample was obese. Nineteen percent took ACE inhibitors and 19% was on ARBs. Statins were taken by 37% of the patients;an antiaggregant by 21%, and an anticoagulant by 2% (see table) Results: The follow-up visit included the evaluation of post-covid infection quality-of-life, standard laboratory tests, chest computed tomography, spirometry with evaluation of DLCO. The onset of cardiovascular events during the average period of 384 days was evaluated. None of the 43 patients had major cardiovascular events: coronary heart disease, cerebrovascular disease, peripheral arterial disease, deep vein thrombosis and pulmonary embolism. Conclusion(s): Even if this study failed to demonstrate new-onset CV events, longer follow-up studies performed to evaluate cardiovascular risk following SARS-CoV1 infection showed persistent hyperlipidemia, cardiovascular system abnormalities, and glucose metabolism disorders in a very high number of patients. Further analyses are needed to further investigate longer term cardiovascular consequences of SARS-CoV2 infection. (Figure Presented).

Ongoing Ace-Inhibitor or Atii-Antagonist Treatment Doesn't Impact on Outcome nor on Sequelae of Patients with Moderate to Severe Covid-19 Pneumonia

Introduction: COVID-19 pandemic still represents a major clinical problem worldwide. Many studies are actively being carried out to better understand prognostic factors of outcome as well as optimal treatment. Aim(s): ACE-2 receptor is highly expressed on the surface of cardiac and pulmonary cells, and it is used by coronaviruses to enter host cells;this makes the role of ACE-inhibitors and Angiotensin Receptor Blockers (ARBs) drugs controversial. Moreover, it is still unclear whether these drugs may have any impact on sequelae. Method(s): In this retrospective study, we analysed a group of 244 hypertensive unvaccinated patients (134 on ACE-inhibitors, 110 on ARBs) admitted for moderate to severe COVID-19 pneumonia. As shown in Table 1, the two groups were homogeneous. Of these patients, 46 (20 treated with ACE-I and 26 treated with ARBs) came to a follow-up visit after a mean of 260 days;they underwent a quality-of-life assessment, laboratory and radiologic tests and spirometry (with DLCO). Result(s): A total of 20 of 110 (18%) patients under treatment with ARBs and 23 of 134 (17%) died during hospitalization (p = 0.8, NS). At discharge, biochemical, radiological and respiratory data were not significantly different. We did not find any significant difference in terms of radiological alterations, lung fibrosis, spirometry data, DLCO, persisting effort dyspnea. Biochemical data were substantially super-imposable in the two groups. Conclusion(s): In conclusion, we could not detect any difference in outcome nor in complications type or number in the two groups of hypertensive patients undergoing treatment with ACE-inhibitor or ARBs. This result seems to support and to strengthen the idea that ACE-inhibitors and ARBs do not play a significant role in onset, evolution and outcome of moderate to severe COVID-19 pneumoniae. Although the number of follow-up patients is small, we did not find any difference in follow-up sequelae in both groups.

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.

Scoliosis: online exercises versus telerehabilitation A feasibility trial

BACKGROUND: During the interruption of the non-urgent healthcare services in Italy due to the SARS-Cov-2 pandemic, telemedicine proved to be an effective alternative, in that it supported exercise delivery in individuals with adolescent idiopathic scoliosis (AIS). Recent scientific evidence demonstrates its feasibility and patient satisfaction. During the lockdown period, the Department of Pediatric Orthopedics at the Istituto di Cura Citta di Pavia supported subjects affected by AIS in two manners: online with the physical therapist (TR) and by using pre-recorded videos (VE). The aim of the present exploratory trial was to evaluate the practice of telerehabilitation in order to employ it in case of new lockdown measures. METHODS: Adherence, perceived enjoyment during the exercise performance and degree of satisfaction with technology were assessed on 18 subjects with AIS, divided into two groups according to the type of exercise administration (seven patients in TR;11 patients in VE). RESULTS: The VE group shows a more noticeable adherence than the TR group. Nonetheless, the perceived enjoyment is more significant in the TR subjects than in the VE ones. The level of satisfaction with technology is positive in both groups under study, without remarkable differences. CONCLUSIONS: The exercise administered at a distance has been positively perceived by all the subjects, though on different levels according to the type of technology employed. Results speak in favor of the use of technology as a means to therapeutic exercise delivery in individuals with AIS. Nevertheless, it is not clear which of the two types it is better to suggest. Biopsychologically speaking, the individual choice is likely to be the most workable solution.