Impact of Covid-19 pandemic on injection-based practice: report from an Italian multicenter and multidisciplinary survey.

Background: There are no papers exploring the impact of COVID-19 pandemic on the injection-based practice in patients affected by different rheumatic diseases, including osteoarthritis. The aim was to investigate the impact of COVID-19 pandemic on injection-based practice trough the Italian country. Study design: A survey-based retrospective cross-sectional study. Methods: An Italian-language questionnaire was developed by a group of senior researchers and distributed by e-mail to some Rheumatology, Orthopedic and Rehabilitation Units from different geographic areas of Italy. The survey included information about the number of injections performed during COVID-19 pandemic (stratified by injected agents and injected joint), in comparison to the pre-pandemic period, and the possible reasons behind an eventual reduction. Responses were collected and descriptive analysis calculated. Results: Eleven centers of the National Health Service completed the survey. The activities of the injections services significantly decreased across the country with a percentage of reduction of 60% compared to the pre-pandemic period. A significant reduction of both intra-articular and peri-articular injections was registered. Among intra-articular. treatments, the most affected ones were the hyaluronic acid injections, when compared to corticosteroids. A significant decrease of the total amount of peri-articular injections was observed. The strict government restrictions and the fear of patients to become infected represented the most limiting factors. Conclusions: The reported decrease of the injection-based practice in our country during the COVID-19 pandemic highlights the detrimental effects of the COVID-19 pandemic on the management of chronic musculoskeletal diseases with possible negative consequences in terms of disability and quality of life.

Ultrasound in CoViD-19 not only for the lung: work-up of a case of acute kidney injury

Background: Acute kidney failure (AKI) is not an infrequent complication of CoViD 19 infection, especially in severe forms. Several pathogenic mechanisms could provoke AKI in CoViD 19: some aspecific (dehydratation, post-renal, rhabdomyolisis), other directly related to virus toxicity (tubulopathy, endothelial damage, coagulopathy), other to immune response. Ultrasound findings in AKI in CoViD 19 are poorly reported in literature at this moment and could help in diagnostic workup. Description of clinical case: A 72-year old hypertensive man born in Senegal was admitted for respiratory failure from CoViD-19, requiring NIV support. Starting creatinine levels slightly elevated (1,25 mg/dl) rapidly grew in the next days (2,74 mg/dl), although adequate crystalloid support;micro-hematuria and glycosuria were present with absence of relevant proteinuria;glycemic levels were high and HBA1c (7%) revealed previous diabetes. Ultrasound reveals normal dimension kidneys with preserved parenchymal thickness, but diffused hyper-echogenicity;Doppler study showed parenchymal IR in the upper range of normality (0,67-0,70). Renal function gradually improved with respiratory condition and patient was discharged 28 days after admission. Conclusions: AKI in CoViD-19 has relevant prognostic implications and ultrasound evaluation could inform about previous nephropathy, current renal damage and prognostic prevision through measurement of parenchymal IR, known to be related in several AKI conditions with prognosis and reversal of AKI condition.

Urban sprawl and mobility

In the last century the territory and the layout of the cities have undergone important changes with an enlargement in the space of human settlements. It deserves attention in terms of the principles of sustainability, limitation of soil consumption, environmental impacts and social needs. Then, a holistic vision for the definition of city and its mobility is needed. This paper introduces a systemic conceptual framework for the urban planning by combining different definitions and illustrating a review of the main themes of modern urban planning. This study analyzes the relationship between urban sprawl and upward mobility. Territorial dynamics, transport issues, and effects of the urban decentralization are examined. Moreover, the TOD (transit oriented development), based principally on the presence of central transport stops in a medium-high density area, and the smart growth models, focusing on a compact city improving sustainable transports like pedestrian mobility and bicycles, are also illustrated. The analyzed criteria for city management and organization could be applied to the present emergency due to COVID-19 and its new challenges. The recent pandemic has highlighted the need to reorganize and adapt public services to obtain self-sufficient neighborhoods, where short distances are preferred and mobility is limited: f smart cities, defined as compact and green, could answer COVID-19 related necessities. © 2021 WITPress. All rights reserved.

Airport landside sustainable capacity and level of service of terminal functional subsystems

The airport terminal is a complex building composed of many functional subsystems dimensioned to host passenger traffic, considering an appropriate level of service (LoS). The most widely known method to assess the LoS and design the terminal areas is the Airport Development Reference Manual by the International Air Transport Association (IATA). Based on this, a calculation tool in Microsoft Excel® was implemented to assess the capacity and dimension of the facilities for each functional subsystem of the terminal. The tool, composed of nine correlated spreadsheets, is a useful model to design new structures, evaluate the LoS currently offered, plan interventions, and face the new rules of passenger distancing due to the COVID-19 emergency. An international airport terminal with 20 million/year including Schengen and extra-Schengen passengers was studied. The LoS of the terminal subsystems was assessed and the areas needed for each subsystem were calculated. In the analyzed case study, most subsystems (departure hall, check-in, boarding gates, baggage claim, and arrival halls) were over-designed, according to the definition of the IATA LoS. This means that available spaces for queues and holding are sufficiently large to easily face the new rules of social distancing for passengers due to the recent COVID-19 emergency. © 2020 by the authors.