Telehealth modulation and new proposals during the Covid-19 pandemic: a literature review.

Abstract: The Covid-19 pandemic has completely modified the Healthcare organization. This review aims to analyze the evolution of the different Telemedicine areas during pandemic. Electronic Health Records allows accelerating the study of patients suffering from Covid-19 disease, supporting their clinical assistance. The decreasing rehabilitation programs have determined a deterioration of the patient quality of life. Teleradiology was necessary to discard the increased requests and dab the shortage of staff, and to guarantee the interaction between specialist and patient. Telecardiology was fundamental determining a reduced of secondary mortality for cardiological complications of the infection. Teledermatology has permitted an early identification of the patients affected through diagnoses of cutaneous signs, reducing clinical visits. Telelegal-medicine changed through a law, that was introduced allowing a remarkable use of videoconferencing in the different stages of judicial and extrajudicial process. The digital consultations and home drug delivery were implemented in telepharmacy area. Artificial Intelligence allows an early diagnosis of the infection, monitoring the treatment through an intelligent platform. Robotic assisted telemedicine minimizes the risk of exposure allowing the disinfection of the places, drugs and meals delivery, the measurement of vital signs. Mobile Health facilitated the collection and the automatic transfer of the patient's parameters. Telemedicine would constitute still today as complementary but not substitutive to the traditional medicine. During the pandemic telemedicine has resulted important to guarantee continuity cures. Radiology and Dermatology showed a major telemedicine application.

Placental localization of SARS-CoV-2 in low-risk paucisymptomatic woman affected by COVID-19

INTRODUCTION We report a case of stillbirth in a 33-years-old Caucasian woman at 36+1 weeks of gestation (WG), with a positive nasopharyngeal swab (NFS) for COVID-19 and preterm labor in the absence of vertical transmission. METHODS Histologic examination of the placenta was performed after fixation in 10% buffered formalin. The fetal and placental samples underwent routine processing with paraffin embedding, and staining with hematoxylin and eosin for microscopic morphological evaluation. Additional maternal surface samples were later additionally fixed in 2.5% glutaraldehyde in 1X PBS pH 7.4, and processed for examination by transmission electron microscopy Paraffin embedded placental tissue sections were used for immunohistochemical staining with anti-platelets CD61 antibody and anti SARS-CoV Spike Antibody Viral infection of the placenta was assessed by the presence of SARS-CoV-2 RNA by real time RT-PCR assay. Swabs were obtained from fetal right and left main bronchus, small intestine and rectum to detect SARS-CoV-2 RNA by RT-PCR assay. RESULTS Sectioning and examination of the cut placental surface showed a diffuse marbled appearance and a focal hemorrhagic area. At light microscope, the placental tissue showed multiple areas of hemorrhagic/ischemic necrosis and thrombosis of several maternal and fetal vessels with mural/ luminal fibrin and platelet deposition defining a clear picture of fetal vascular malperfusion.SARS-CoV-2 RNA in placental tissue was revealed by real time rRT-PCR assay. Virus particles were uniquely identified by Electron Microscopy mainly within the cytoplasm of endothelial cells, in the cytosol and in cytoplasmic vacuoles, or adjacent to damaged endothelial cells. CONCLUSIONS In our case, fetal vascular malperfusion was likely casually associated with the infection;indeed, our unique Electron Microscopy images clearly showed that the marked SARS-CoV-2 endotheliotropism involved the intravillous fetal capillaries likely leading to cell dysfunction and procoagulant activity. Since placental infection does not always correlate with infection of the fetus, it is possible that a time interval may ensue between these two processes;a stillbirth that occurs in this time frame can be mechanistically explained by an overriding process of severe endothelial dysfunction occurring within intravillous capillaries or massive hypoperfusion of the intervillous space. The consequences of placentotropic COVID-19 include the possible occurrences of vertical transmission or fetal death resulting from maternal and/or fetal placental hypoperfusion the prevailing mechanism being dependent by unknown determinants. The diffuse thrombosis and subsequent ischemia of fetal capillaries induced by COVID-19 cannot be predicted by standard clinical surveillance nor prevented by anticoagulants and represent a severe burden of Sars-Cov-2 infection.

Emergency surgery in a tertiary hospital: The covid-19 experience

Objective: Evaluate the impact of Covid-19 in a critical area and analyze the changes in the daily activities in an Emergency Department of a tertiary COVID-Hospital. Methods: We reported and compared the surgical procedures performed for acute appendicitis and acute cholecystitis between two periods (March and April 2019 and March and April 2020) at Emergency Surgery Department of Parma University Hospital, a tertiary COVID-Hospital. Results: A total of 72 patients underwent surgery between March and April 2019 and 36 between March and April 2020 for acute appendicitis and cholecystitis. The average length of stay was comparable in the two considered years for LA (4.23±1.69 days in 2019 versus 4.5±2.33 days in 2020). The average length of stay in patients with acute cholecystitis was 5.9±3.8 days in 2019 and 8.23±5.5 days in 2020(P=0.038). The average hospitalization was comparable with 2019 data (5.62±3.77 days)n March 2020;whereas, April 2020 was statistically significantly longer 10.5±6 days (P= 0.023). Conclusions: Half of the emergency centers reported a drop in the overall number of urgent cases as confirmed in our department, where the number of total appendicectomy and cholecystectomy was halved comparing the two months in 2019 and 2020, 72 operations in 2019 versus 36 operations in 2020.During the pandemic, the confidence of the population to the healthcare systems was poor, and this can explain the delayed access to the emergency department of patients who suffered from an acute illness.