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Introduction: Pulmonary embolism (PE) is a major cause of intensive care unit (ICU) mortality and morbidity [1]. Optimal venous thromboembolism preventive strategy in COVID-19 patients remains a controversial issue. Therapeutic anticoagulation in the context of severe COVID-19 without a formal indication does not appear to offer a survival advantage and was associated with increased risk of major bleeding episodes. Locally, we adopted an enhanced anticoagulation (enoxaparin twice a day) pathway guided by anti-Xa levels. Method(s): This is a retrospective cross-sectional single-center study between March 2020 and March 2021. All patients admitted to the intensive care unit at University Hospital Southampton with diagnosis of COVID-19 confirmed via a reverse-transcriptase-polymerase-chain reaction (RT-PCR) test were included in this study. Result(s): There were 292 admissions included in the study with a mean age of 60 (+/- 15). 67.1% received enhanced anticoagulation titrated according to anti-Xa levels. The median day 7 trough and peak anti-Xa levels were 0.33 (IQR 0.18-0.41) and 0.54 (IQR 0.33-0.68) respectively. 62 patients had CTPA for clinical suspicion of pulmonary embolism and 11 were positive. The overall incidence of PE was 3.8%. The distribution of PE was mostly bilateral segmental or unilateral segmental. There were no lobar or main pulmonary artery pulmonary embolism. There were 9 major bleeding episodes in those received enhanced anticoagulation. Conclusion(s): For critically ill COVID-19 patients, anti-Xa guided enhanced anticoagulation protocol proved to be associated with lower than anticipated incidence of PE with minimal clot burden. Randomised controlled trials are required to explore this concept further.
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Background and Aims: Does automatised insulin administration in closed-loop (CL) with DBLG1 system improve TIR (time in range 70-180mg/dl) and TBR (time below range <70) in all adult patients affected by Type 1 diabetes (APT1D) ? Methods: 140 APT1D, HbA1c > 8%, 43,3 +/- 13,0 years, treated with Dana insulin pump were randomised to either receive after 2 weeks in open loop (OL), CL treatment with the DBLG1 algorithm, or continue in OL, with a 4 CL/1 OL ratio. COVID health crisis prematurely terminated the study. Nonetheless, 99 patients received at least 14 days of treatment with CGM data >=75% of the time (88CL, 11 OL). Result(s): After adjusting on baseline HbA1c and centers, patients in CL versus OL, spent 12min less per 24h in hypoglycemia <70 mg/dl (p < 0.01), 3h12 more in target 70-180 (p < 0.001), 3h less in hyperglycemia >180 mg/dl (p < 0.0007). These improvements were primarily nocturnal. Significative (p < 0.0001) linear correlations were observed between: 1 - TIR baseline/ Delta-TIR: patients with the lowest TIR at T0 are the ones who increase it the most. 2 - TBR baseline/Delta-TBR: patients with the highest TIR at T0 are the ones who lower it the most. The patients who were initially the most hyperglycemic, and therefore had the least hypoglycemias, are the ones who gained the most in TIR, without deteriorating their TBR. Conclusion(s): The DBLG1 system is likely to benefit the entire spectrum of metabolic disorders in Type 1 diabetes, either by improving TIR70-180 or decreasing TBR70, depending on the situation at initiation.
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Background: Histamine fish poisoning, known as scombroid syndrome, is a foodborne disease caused by histamine toxicity that results from eating specific types of spoiled fish. In some cases it can lead to the development of life-threatening anaphylactic reactions. In literature the possibility of correlated coronary involvements is widely recognized and accepted, cases described are rare, but even more rare if combined with the novel human coronavirus disease COVID-19 infection, the fifth documented pandemic since the 1918 flu pandemic. In this report, we describe a case of acute coronary syndrome in infected patient with COVID-19, for the first time. The occurrence of acute coronary events with allergic or hypersensitivity reactions has been described as the Kounis syndrome, but in few cases it has been associated with scombroid syndrome. Case report: A young woman came to our Emergency Department with erythematous lesions, mild itching, nausea, diaphoresis and weakness, after a meal with canned tuna. Her clinical situation worsened and she developed acute coronary syndrome due to vasospasm. After the first negative result for rapid oropharyngeal swab test of SARS-CoV-2RNA, waiting for molecular oropharyngeal swab during her hospitalization, a few days later she was tested positive for SARS-CoV-2 infection. Acute coronary syndrome in patients with scombroid syndrome is rare to find and more rare if associated with COVID-19 infection. This case demonstrated a linkage of histamine fish poisoning with Kounis syndrome and SARS-CoV-2 infection, allowing us to foster the treatment decision-making process. Why should an emergency physician be aware of this? This syndrome can represent a life-threatening, if not promptly and early known. An emergency physician must have this knowledge, to evaluate accurately the anamnesis of affected patients. Only a circumspect anamnesis can lead us to correct diagnosis and change our decision-making process for treatment.
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Background: Italy was one of the first European Countries to deal with the Coronavirus Disease 2019 (COVID-19) outbreak, since its appearance in China. The virus spread from northern regions to central and southern ones with different intensity. Drastic emergency restrictions were introduced including quarantine and self-isolation measures. Initially, these were limited to Northern Italy then extended nationwide. The Italian Health System is organized on a regional basis with different funding, resources, institutional pathways. Health Care Professionals (HCPs) working in clinically demanding areas such as Emergency Departments and Intensive Care Units are at high risk of developing physical/mental health outcomes related to Coronavirus pandemic, such as stress, anxiety, depression, sleep disorders and burn-out symptoms (Luo et al., 2020). Nurses in Hematopoietic Stem Cell Transplant (HSCT) Units are caring for "complex" immune-compromised patients, being hospitalized for long period without seeing relatives. However, it is not known if nurses working in HSCT settings experience similar problems during the pandemic. The aim of the study was to investigate physical and psychological issues among nurses working in Italian HSCT Units during COVID-19 spread. Methods: A cross-sectional study was conducted between June and August 2020 through an online questionnaire sent to nurses working in Italian HSCT centers registered with GITMO (Gruppo Italiano per il Trapianto Midollo Osseo). Data were collected immediately after the lockdown period (during phase 2, consisting of a progressive reduction of lockdown measures) in order to:-investigate the prevalence of sleep disorders and burnout symptoms with validated tools: Pittsburgh Sleep Quality Index (PSQI) and Maslach Burnout Inventory (MBI), respectively.-explore significant correlations with other variables such as geographical areas (Northern Italy-NIT vs Central Sothern Italy-CSIT) according with COVID-19 incidence, its spread. Statistical analysis was performed using the Matrix Laboratory (MATLAB) Statistical toolbox version 2008 (MathWorks, Natick, MA, USA). Results: Three hundred and eight nurses working in 61 Italian HSCT Units responded to the survey: 214 nurses from NIT and 94 nurses from CSIT. Nurses responding from CSIT were older (mean 47, p = 0.0001) and male (74.5%, p < 0.0001). More nurses from NIT did not have children compared to those from CIST (49.5% vs 30.9%, p = 0.0023). Symptoms like stress, anxiety and depression were more frequently reported by CSIT than NIT nurses (NIT 27.7% vs 12.6%, p = 0.0013). MBI results: NIT and CSIT nurses reported low level of emotional exhaustion (median score: 14.0 vs 12.0 respectively) and depersonalization (3.0 vs 4.0);medium level of personal accomplishment (36.0 vs 34.5) were reported without significant differences between groups. Worst sleep quality was detected on nurse working in CSIT centers than NIT (global PSQI score 7.6 vs 6.5;p = 0.008) with the main differences in sleep duration (p = 0.006), sleep disturbance (p = 0.03), need of medication (p < 0.001). Conclusions: Despite cited differences on disease incidence and spread of infection, COVID-19 pandemic did not appear to have an impact on nurses' sleep quality or symptoms of burnout. Greater sleep disorders of nurses working in CSIT centers suggests that other factors influencing this issue.
ABSTRACT
Background: The exceptional circumstances caused by the Covid-19 pandemic have had a strong logistical and psychological impact on the population. A specific attention has been devoted to the organization of activity of Oncology units and to oncological patients' mental health conditions. In fact, together with the anxiety caused by the disease, oncological pts are now experiencing also apprehension because of the pandemic. The aim of this research is to evaluate how the Covid-19 emergency has affected access to treatments, management of disease and the psychological impact on pts in 2 Oncology Units in Brindisi (Apulia) and Turin (Piedmont). Methods: In a 2 week period between April and May 2020, a structured questionnaire was administered to pts in active treatment at the Day hospital (DH)/ Day Service (DS) of Oncology Dpts at Brindisi and Mauriziano Hospital. The questionnaire was anonymous, self-administered, with 5 closed-ended questions with a 'yes/no' answers and 10 questions involving a modified Likert scale of 4 answers (not at all, a little, quite a bit, very much). Percentage data are analyzed for the whole series and the 2 centers separately. Results: 404 questionnaires were collected (Brindisi 202, Turin 202). The main difference involves the number of pts with relatives tested positive to SARS-CoV2 (Apulia 2% vs Piedmont 11.4%, p=0.002). Overall, 343 pts (84,9%) referred no relevant changes in the treatment of their illness. They indicated no relevant alterations in the access to medical care (n= 362, 90%), in outpatient visits (n= 341, 84.8%), in running diagnostic exams (n= 340, 84.6%) and in drug supply (n= 365, 90.8%). 291 pts (72,4%) did not perceive a significant risk of contagion in accessing their DH/DS. Overall, pts did not believe they have received a significant reduction in assistance (n=372, 92.1%). The communication with the medical staff has been judged effective and clear (n= 374, 93%) and pts claimed it had been easy to reach the staff via phone and/ or e-mail (n=364, 90.1%). There were no relevant differences between the 2 centers. Conclusions: Despite the changes in the clinical management of cancer pts due to the Covid-19 emergency, our data show that most pts did not perceive any relevant difference in the management, both from an operational and relational point of view. In perspective, we aim to promote a comparative analysis between the 2 regions, to take into account the different morbidity of the Covid-19 infection.
ABSTRACT
Background: The COVID-19 pandemic have had a strong logistical and psychological impact on the population. A specific attention has been devoted to the organization of activity of Oncology units and to oncological patients’ mental health conditions. In fact, oncological pts are now experiencing apprehension not only for their cancer but also for the pandemic. The aim of this research is to evaluate how the COVID-19 emergency has affected access to treatments, management of disease and the psychological impact on pts in 2 Oncology Units in Brindisi (Apulia) and Turin (Piedmont). Methods: In a 2 week period between April and May 2020, a structured questionnaire was administered to pts in active treatment at the Day hospital (DH)/ Day Service (DS) of Oncology Dpts at Brindisi and Mauriziano Hospital. The questionnaire was anonymous, self-administered, with 5 closed-ended questions with a “yes/no” answers and 10 questions involving a modified Likert scale of 4 answers. Percentage data are analyzed for the whole series and the 2 centers separately. Results: 404 questionnaires were collected (Brindisi 202, Turin 202). The main difference involves the number of pts with relatives tested positive to SARS-CoV2 (Apulia 2% vs. Piedmont 11.4%, p=0.002). Overall, 343 pts (84,9%) referred no relevant changes in the treatment of their illness. They indicated no relevant alterations in the access to medical care (n= 362, 90%), in outpatient visits (n= 341, 84.8%), in running diagnostic exams (n= 340, 84.6%) and in drug supply (n= 365, 90.8%). 291 pts (72,4%) did not perceive a significant risk of contagion in accessing their DH/DS. Overall, pts did not believe they have received a significant reduction in assistance (n=372, 92.1%). The communication with the medical staff has been judged effective and clear (n= 374, 93%) and pts claimed it had been easy to reach the staff via phone or e-mail (n=364, 90.1%). There were no relevant differences between the 2 centers. Conclusions: Despite the changes in the clinical management of cancer pts due to the COVID-19 emergency, our data show that most pts did not perceive any relevant difference in the management, both from an operational and relational point of view. Legal entity responsible for the study: Saverio Cinieri. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.