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Background: Little is known about the long-term re-hospitalization of patients with confirmed infection by SARS CoV 2 discharged from hospital. Aim: The aim of our retrospective cohort study was to identify death and re-hospitalization outcomes in a 16-month follow-up in a population of subjects already hospitalized for Covid-19. Materials and Methods: The study was conducted in the metropolitan area of Bari (population: 472,385 inhabitants) by examining the patients hospitalized from 17/03/2020 to 28/05/2021 at the Covid Unit of the F. Miulli hospital in Acquaviva delle Fonti. Results: 1238 patients (754 males, 60.9%, median 70 years) were hospitalized in Covid Unit: 1060 (85.6%) (M 60.1% median 71 years) were hospitalized in non-intensive wards, while 178 (14.4%) (M 65.7%, median 69 aa), passed through the IT. At follow-up, 922 subjects were still alive;66 deceased (7.2% of the total, 37.8% males, median 80 years). Analyzing only the data of patients residing in the metropolitan area, where the hospital is the reference, 780 patients discharged alive were examined. Of these, 11.2% were rehospitalized at least once, 30 died (4.3%). Mortality on re-admission to hospital was 17.2%. A third of the re-admissions were unrelated to Covid. Infections, pneumonia and cardiovascular disease were the most represented reason for hospitalization. Conclusions: Data show that at a follow-up of 16 months 92.8% of the subjects were still alive, while 7.2% had died, mainly elderly women. 11.2% of those discharged from the Covid ward have been re-admitted to the hospital at least once.
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Introduction and Purpose of the study: SARS-CoV2 infection is characterized by massive involvement of the respiratory system. During the various waves, the patients admitted to the Covid wards presented different degrees of pulmonary involvement and numerous comorbidities. Administration of oxygen therapy was the prevalent measure in almost all subjects. The aim of our study was to verify the level of severity and ventilation procedures in a group of subjects hospitalized for SARS-CoV2 infection. Materials and Methods: 388 subjects admitted to the semi-intensive Covid Unit of the F. Miulli Hospital in 2020 were retrospectively analyzed, by examining the SDOs. The main diagnoses and procedures performed were identified. A severity cluster was identified characterized by death, ventilation and hospitalization in the semi-intensive area (cut off at 14 days). Results: 82 were the deceased (21.1%). The main diagnoses most represented were: 84.2% respiratory failure, 3.3% heart failure, 2.5% pulmonary embolism and 1.5% septicemia. Regarding the procedures, 31.9% underwent C-PAP ventilation, while 0.7% underwent non-invasive mechanical ventilation. 64% of the subjects had a severe degree of disease evidenced by the composite cluster of deaths, ventilation and at least 14 nights in semi-intensive care. Conclusions: Our data shows that in the face of almost all patients with respiratory failure, about one third underwent ventilation procedures (C-PAP and NIV). More than half of the subjects had a severe degree of disease.
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Introduction: In our country, the percentage of subjects infected with HCV is about 2% of the general population, with a gradient that increases from the North to the South and the islands. The decline in hepatitis C treatments is sensationally evident. The WHO had set the goal of its elimination by 2030, a result made achievable thanks to the new direct-acting antiviral drugs (DAA), which allow the virus to be eradicated in definitively, quickly and without side effects. The pandemic has slowed both screening and treatment. Purpose of the study: Evaluate the prevalence of subjects positive for hepatitis C antigen (HCV +) in all hospitalized for Covid-19. Materials and Methods: 839 subjects admitted to the Covid Unit of the F. Miulli Hospital in Acquaviva delle Fonti were retrospectively assessed. Results: The prevalence of HCV+subjects was 4.7%. No statistically significant differences were found when comparing the main laboratory tests. No difference emerged regarding the outcomes (length of hospitalization and death) which are similar in the two groups. Conclusions: The prevalence of HCV+subjects in the Covid-19 population is double that of the general population. A project is underway in our hospital which provides for the screening of all over 50 year olds hospitalized in order to bring out HCV+subjects and direct them to an outpatient diagnostic confirmation path and any specific eradicating therapy.
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Background: Peripheral nervous (PNS) system involvement in SARS-CoV-2 infection has been described as a consequence of direct neurotropic invasion or parainfectious autoimmune spinal nerve demyelination in the clinical form of acute inflammatory demyelinating polyraduculoneuropathy (AIDP). Few cases have been described with cranial nerves involvement too. Description of the case: A 62 year-old male patient was admitted in March 2020 to our CoViD Unit in Miulli Hospital in Acquaviva delle Fonti (Bari) for recent onset of cough, fever, with interstitial pneumonia with peripheral and central ground glass opacities and consolidation at lungs CT. Oropharyngeal swab tested positive for SARS-CoV-2. Despite an early clinical and radiological remission, the swab became negative after two months. In May, he came back to our attention for chest pain and fever with echocardiography documenting pericardial effusion;SARS-CoV-2 swab was positive again. Some weeks later, he presented weakness in both legs ascending to arms, with severe fatigue and iporeflexia followed in a few days by bilateral facial palsy. Cerebrospinal fluid (CSF) analysis and electromyography (EMG) were suggestive for AIDP, so we started infusion of human immunoglobulins, with immediate partial recovery followed by complete recovery in a few weeks after rehabilitation. Conclusions: The persistence of SARS-CoV-2 induces an abnormal immunological activation that may result in neurologic issues such as involvement of peripheral nervous system (PNS) with spinal - and in some cases - cranial nerves inflammatory demyelination.
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Background and Aim:We currently do not have a specific therapy for SARS-CoV-2 infection;experimental therapies have been improved with various drugs such as lopinavir/ritonavir, hydroxychloroquine, tocilizumab with controversial data about efficacy. The aim of the study is to highlight any gender differences in the response to the aforementioned therapies. Materials and Methods: Retrospective analysis of 234 patients, 96 F and 138 M, referring to our CoViD UNIT from March 2020 to April 2021, divided into groups based on the administered drug. Results: Lopinavir/ritonavir: in the overall cohort (M+F) the drug reduces the risk of death/ICU admission (p=0.01);this impact on the outcome is not significant in the individual groups M and F when analyzed separately. On the other hand, considering mortality alone, in the collective group this was lower in treated patients, an efficacy figure that does not differ in the two sexes after stratification by gender. Hydroxychloroquine: considering the whole cohort there is a reduced mortality in the treated (p <0.001). The impact of the drug on the risk of death/intensive care admission is comparable in the two sexes. Tocilizumab: the drug does not change the risk of death/ICU admission in the overall group;the subgroup analysis is lacking due to the small number of samples. Conclusions: The gender difference does not show a significant impact on the efficacy of the drugs considered. New studies, on larger cohorts, are needed to confirm or refute these preliminary data.
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Background: Idiopathic inflammatory myopathies are a heterogeneous group of pathological conditions characterized by muscle inflammation, and sometimes by inflammatory involvement of other organs, such as skin (in dermatomyositis) and lungs (pulmonary interstitial disease). Description of the case: 54-year-old woman, turns to the Emergency Room of Miulli Hospital in March 2021 for worsening dyspnea. In medical history: previous recent SARS-CoV-2 infection. She is admitted to Medicine Unit, where the characteristic signs and symptoms of myositis were objected: myasthenia affecting the proximal muscles, myalgias, plantar desquamation of the feet (climber's foot) and fingers (mechanic's hands), Gottron's papules. There are also: pericardial effusion, signs of pulmonary hypertension on echocardiogram, consolidating pulmonary parenchymal changes with fibrotic evolution on HR chest CT. She is transferred to the Rheumatology Unit of the Policlinico Di Bari to perform specific autoantibody panel (positivity of ANA, anti Jo- 1, anti Ro52), electromyography (signs of myogenic suffering), MRI of the thighs (hypotrophy and adipose replacement of the muscles of the posterior lodge) and muscle biopsy, indicative of muscle inflammation. Therapy with steroid boluses and cyclosporine 5mg/kg/day, shows quick effectiveness, and she is discharged with the diagnosis of antisynthetase syndrome. Conclusions: The diagnosis of antisynthetase syndrome is not always easy, due to the clinical heterogeneity of the disease and the need for specific instrumental and laboratory tests.
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Background and Aim: Vaccination against SARS-CoV-2 started in Italy in January 2021. First, healthcare personnel were vaccinated. Immunization of subjects should lead to a reduction in the clinical manifestations of the disease. Aim of the study was to evaluate the antibody response after the administration of two doses of the BNT162b2 SARS-CoV-2 mRNA vaccine. Materials and Methods: We determined antibody levels at baseline (before second dose of vaccine) and 3 weeks after the second dose of the BNT162b2 SARS-CoV-2 mRNA vaccine in 92 (middle age 44±12 ) health care workers (35 male 38%, and 57 female). Written informed consent was obtained for all study participants. Results: Antibody responses was of 452 U/mL±2744 (median 36, interquartile range 9-99) vs 3154±4389 (median 1957, interquartile range 1242-3238) p<0.001 (average increase of 2702±2554). Excluding 3 cases with baseline value>1000 the response was 63±92 (median 35, interquartile range 8-78) vs 2693±2410 (median 1912, interquartile range 1241-3136) p<0.001 (average increase of 2630±2369). According to multivariate regression analysis: baseline is inversely associated with age (p <0.001) but not with sex (p=0.393);post sampling is inversely associated with age (p=0.003) but not with sex (p=0.653). Conclusions: Our data demonstrate that the antibody response after the administration of two doses of the BNT162b2 SARS-CoV-2 mRNA vaccine was obtained in 100% of the subjects studied. In particular, there is a relationship with age: younger subjects show a more robust response. Gender does not influence extent of response.
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Background and Aim of the study: CoViD-19 pandemic required to the physicians the necessity to gain effective treatments against this infectious disease;one of the tried drugs is remdesivir. The aim of our study is to analyze clinical and laboratory features of a cohort of CoViD-19 patients treated with remdesivir. Materials and Methods:We evaluated retrospectively data of 22 patients (18 men and 4 women), considering two main items: the trend of inflammation markers (erythrocyte sedimentation rate, Creactive protein, interleukin-6, D-dimers, lymphocyte count, ferritin) and the severity of respiratory failure, comparing data between admission and discharge. Results: At admission, 85,7% of patients showed signs of acute respiratory failure (P/F ratio <300) and needed oxygen therapy but only 9,1% of them had this condition at discharge. Moreover, ESR, CRP and IL-6 levels were high at admission but showed a significant reduction at discharge;lymphocyte count was instead reduced at the beginning of the disease and increased after treatment;no significative variations were observed for D-dimer and ferritin levels. Finally average hospital stay was 4 days lower than the one of the cohort of patients non treated with remdesivir. Conclusions: Our results indicate that patients treated with remdesivir showed a good outcome in terms of respiratory function and reduction of inflammation state. However, a larger cohort of patients and the comparison with control patients are necessary to better investigate potential benefits of remdesivir.
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Background and Aim: The CoViD-19 pandemic experienced two main waves: February-June 2020 and October 2020-February 2021 respectively. The F. Miulli Hospital has activated intensive and semi-intensive care, pulmonology and infectious disease departments, for a total of 240 beds. Aim of the study was to evaluate differences between the two waves, in relation to the length of hospitalization and mortality. Materials and Methods: We collected data from 1005 subjects (619 men). Age, gender, length of hospital stay, and deaths were analyzed. Results: In the second wave we found a higher percentage of deaths (25.8 vs 19.4%;p=0.043) and among these a higher prevalence of males (66 vs 44.7%;p=0.007);furthermore, in the subjects hospitalized during the second wave, we observed a lower average age of the deceased (78±13 vs 82±8 years;p=0.019) and a shorter duration of hospitalization (18±13 vs 21±14 days;p=0.004). No significant difference was observed in the prevalence of males, however most affected (62.4% second wave vs 59.1% first wave), and in mean age (69±15 seconds vs 68±18 first wave). Conclusions: The second wave showed greater lethality especially for males and younger subjects. Despite this, the duration of hospitalization was shorter, a condition probably linked to the experience acquired by the health professionals involved in the assistance and to a wider network of local structures capable of welcoming CoViD patients. The impact of the variants on the severity of the disease remains to be assessed.
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Background and Aim of the study: Intravenous administration ofTocilizumab (TCZ), a monoclonal antibody against interleukin-6(IL-6) receptor, has been proven to be an effective treatment forSars-COV2-associated pneumonia. In our observationalretrospective study we compared different outcomes measures inpatients with different settings and timing of treatment.Materials and Methods: We included patients affected bynasopharyngeal swab-confirmed SARS COV-2 pneumonia whoreceived TCZ treatment admitted to the COVID Unit of F. MiulliHospital (BA), from 16th March to 7th April 2020. Outcomemeasures were pO2/FiO2 ratio (P/F) and CRP serum levels atbaseline and at 6,24 and 48 hours after intravenous administrationof TCZ. We compared patients treated in intensive care unit (ICP)and non-intensive unit (NICP) even with respect to the duration ofthe disease, shorter (SD) or longer (LD) than 16 days.Results: We analyzed 16 patients;mean disease duration 15±5days. At baseline, mean CRP was 14±10 mg/dl and P/F 144±44mmHg. 6 hours after TCZ P/F improved significantly in NICP(p=0.03) but not in ICP, confirmed at 48h (NICP p=0.002, ICPp=0.23). Comparison between SD and LD showed that P/F earlyimproved(24h) only in SD (p=0.03). At 48 h, P/F improved in bothgroups (SD p=0.05, LD p=0.03). CRP decreased both in ICP(p=0.01) and NICP (p=0.04);in regard of timing, only in SDpatients (p=0.002) it decreased significantly.Conclusions: Our real-life experience suggests that TCZadministration is effective when early performed in subjectsadmitted to non-intensive therapy.
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Background and Aim of the study: Tocilizumab (TCZ), an IL-6 receptor (IL-6R) blocker, emerged as an effective drug for patientswith severe COVID-19 associated Pneumonia. The aim of this observational retrospective study was to evaluate the laboratory characteristics of patients who received i.v. TCZ treatment. Materials and Methods: We collected serum levels of IL-6, procalcitonin (PCT), C-reactive protein(CRP), D-Dimers and CD4/CD8ratio, to evaluate the systemic inflammatory state, of 16 patientsaffected by nasopharyngeal swab confirmed SARS COV-2 Pneumonia who received TCZ (8 mg/kg once or twice in 12 hours).Blood samples for analysis were collected before and after theadministration.Results: Baseline serum levels of laboratory parameters were:CRP 14±10 mg/dl,IL-6 249±264 pg/dl, D-dimers 1872±1833pg/ml, CD4/CD8 ratio 2,4±1,2, PCT 0,61±0,91 pg/ml. After TCZadministrations we observed a rapid increase of IL-6 serum levelsto 941±1317 pg/dl (p=0,05), CD4/CD8 ratio to 3,1±2,3 (trendp=0,07) while D-Dimers didn't decrease significantly. CRP levels,after the administration, decreased to 6±6 mg/dL(p=0,0002)while PCT levels showed no significant variations.Conclusions: The anti-inflammatory effect of TCZ administrationis suggested by the variations in laboratory characteristic, most ofall represented by a decrease of CRP levels and an increase of IL-6 levels, as a result of the displacement of the interleukin from itsreceptor.
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Background and Aim of the study: In the course of the epidemic,COVID 19 disease first appeared severely and then with a gradualreduction in symptoms. Aim of the study was to compare the clinical characteristics of patients hospitalized in two different periodsfrom March to May.Materials and Methods: 174 patients, 161 subjects admitted inthe period March 17 / April 17 and 13 subjects admitted in theperiod April 17 / May 17, at the Covid Unit of F. Miulli Hospital inAcquaviva delle Fonti (Ba), were studied.Results: From the comparison of the two periods, there is a clearreduction in hospitalizations (161 vs 13). The number of asymptomatic or mildly complicated patients is significantly greater inthe second group. The rate of patients hospitalized with severepneumonia (19.9%) or ARDS (6.8%) in the first period is higherthan the patients of the second period (7.7% and 0%). In March/ April, 3.1% of patients needed ICU admission while no patientwas admitted to ICU in the past thirty days. The length of stay wasalso significantly higher in the first period (21 ± 8 days vs 8 ± 2days) as well as mortality (14% vs 11%). IL 6, d-dimers and fibrinogen values were lower (but not statistically significant) in theApril / May period.Discussion and Conclusions: Our sample, although of limitedsize, shows a significant difference in the clinical evolution of theCOVID 19 infection in the two study periods. The reduction inlength of stay, severe respiratory failure and mortality indicate alikely attenuation in coronavirus virulence in the last month of thepandemic spread.
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Background and Aim of the study: Tocilizumab (TCZ), a monoclonal antibody against IL-6 receptor, has been recently employedas a treatment for SARS-Cov2-associated pneumonia (COVID),due to the central role of IL-6 on the citokyne-storm associatedhyperinflammatory syndrome. Aim of this observational retrospective study was to evaluate effectiveness and safety of TCZ for thetreatment of COVID.Materials and Methods: We retrospectively evaluated, from 16thMarch 2020 to 7th April 2020, outcomes of 16 patients affected bynasopharyngeal swab-confirmed SARS-COV-2 Pneumonia who received TCZ i.v. treatment (8 mg/kg once or twice in 12 hours). Weevaluated clinical features, Arterial Blood Gas Test (ABG), laboratoryfindings collected at baseline and after consecutive two days. Results: We analyzed 16 patients (M/F: 12/4) with mean age (±SD) 69±9 years and mean disease duration 15±5 days. At baseline, mean CRP level was 14±10 mg/dl and IL-6 249±264 pg/ml.To evaluate respiratory improvement after treatment, we collectedABG data at 6,24 and 48 hours;we observed a rapid improvement of P/F ratio to 165,6±55,4 mmHg (p=0,01). We also observed a significant reduction of CRP levels to 6±6 mg/dl(p=0,0002) and a rapid increase of IL-6 serum levels to941±1317 pg/ml (p=0,05). Clinically we observed a global improvement in ten patients, while six died for infective complications. No adverse event was detected following TCZ administration.Conclusions: In our real-life experience TCZ treatment was effective and safe in a group of patients affected by SARS COV2-associated pneumonia.
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Background and Aim of the study: A novel coronavirus (SARSCoV2) in 2019 has been recognized as the responsible of an interstitial pneumonia characterized by a severe acute respiratorysyndrome initially reported in China with a subsequent pandemicoutbreak. Aim of this observational retrospective cohort study wasto describe the CT findings of this new disease in a cohort of patients treated in our COVID Unit.Materials and Methods: TC scan of 49 patients with naso-pharyngeal swab confirmed SARS CoV2 pneumonia admitted toCOVID Unit of F. Miulli General Hospital from 19th March 2020 to03rd May 2020 were retrospectively analyzed.Results: The cohort included 49 patients (42 males, 86%;7 female, 14%);mean age 63,2 years (SD 14,8). Radiological findings distribution was bilateral in the whole cohort;peripheralinvolvement was constant (n=46 [93%]), in some cases exclusively subpleural (n=10;20%), with pleuric sparing in few cases(n=7, 14%). 2 patients had central distribution of alterations (4%).The great part of the cohort showed mixed (central/periferic) distribution (n=29 [60%]). Radiological phenotypes were: predominant ground-glass (GG) (n=20 [41%]), consolidative (C) (n=3,6%) and mixed pattern (n=23, 47%).Conclusions: SARS-CoV2 is characterized by a wide range of CTfeatures with a frequently mixed presence of ground glass and consolidative with a periferic and central - usually bilateral - distribution. Combining assessment of imaging with clinical and laboratory findings could facilitate early diagnosis of COVID-19.
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Background and Aim of the study: Partial or complete ageusiaand anosmia have been observed as initial and sometimes uniquesymptoms of COVID-19 infection, especially in paucisymptomaticpatients. A single-center observational cohort study was conductedto evaluate taste and smell in a group of subjects admitted in thesub-intensive therapy of the COVID UNIT Hospital F. Miulli (Acquaviva delle Fonti, Bari, Italy) from 8 april to 11 may 2020.Materials e Methods: A questionnaire was administered to agroup of patients, with normal cognitive system. The laboratoryand clinical data contained in the medical records were studied.Results: 53 patients, 35 male and 18 female aged between 23and 82 replied to the questionnaire. 19 patients reported no loss,3 reported only loss of smell and 31 loss of taste;of these, 23also reported an associated loss of smell (9 partial loss and 14total loss). Patients with olfactory deficits complained of nasalcongestion and the need to breathe through the mouth in 23% ofcases and rhinorrhea in 15%. The loss of taste was rarely associated with a decrease in appetite (3%) and in 65% this deficit wastotal. The division of patients into 4 phenotype groups (based onthe severity of the clinical presentation) did not reveal significantdifferences between the groups.Conclusions: The data of our study, although referring to a reducedsample, show that olfactory and gustatory deficits are associatedwith SARS-CoV2 infection in a high percentage of patients. The phenotype did not show a role in the development of these symptoms.
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Background and Aim of the study: From March 2020 to May2020 we treated 133 SARS-CoV-2 patients in our COVID Unit at'F. Miulli' Hospital, 15 of these were also affected by severe acuterespiratory syndrome that needed CPAP support. The aim of thestudy was to evaluate the clinical features of patients with severerespiratory failure treated with CPAP compared to those with milderone that didn't require it.Materials and Methods: A retrospective observational study on133 patients was performed. Patients have been divided into twogroups: those who needed CPAP (15) and those who didn't (118)to compare comorbidities and the supportive medical therapy.Results: 80% of the patients treated with CPAP were males (age71 ± 12). Only 13% were smokers;the most frequent comorbidities were heart failure (20%) and renal failure (40%);pre-existentrespiratory diseases, high blood pressure and diabetes mellitusdidn't show a significant impact on the respiratory outcome. Comparing the 2 groups we found a significant difference about theprobability to be transferred in Intensive Care Unit, higher in CPAPtreated patients (p 0,034). We also found differences between thetwo groups about the medical therapy support, in particular theuse of diuretics, resulted significantly higher (p 0,002) in CPAPtreated patients.Conclusions: A severe respiratory failure related to COVID 19 ap pears to be more frequently associated with kidney and heart disease rather than pre-existing worst respiratory situation and so requires in association with C-PAP support also a more substantialmedical therapy.
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Background and Aim of the study: After the outbreak in China,Italy was the first country facing COVID-19 pandemic. The earliestidentified cases in Lombardy at mid-February, 2020 have promptlygiven the idea of a dramatic infection. During the first decade ofMarch the Italian Government introduced drastic measures of social isolation to contain the spread of contagion, to prevent thecollapse of healthcare system, and to reduce deaths. We evaluatedthe geographic differences in COVID-19 cases, hospitalizations,and deaths as well as compared to the initial stage of diffusionacross Italian regions.Materials and Methods: We assessed data daily released by Italian Civil Protection Department since February to May, 2020. Wecompared six geographic repartitions of similar population sizeafter the first 1000 cases in each macro-area. Results: Out 227364 patients infected by COVID-19, 32330(14.2%) dead. Time to double infections was initially very short.The northern regions nearest to the epicenter showed the majorpercentage of cases, hospitalizations and fatal events. Conclusions: The COVID 19 infection represents an unexpectedhealth-care challenge. Although the spatial heterogeneity ofCOVID-19 diffusion through Italy, prompt containment measureshave produced positive results, in particular for southern regions.This aspect is due to holographic isolation, delay in spreading thevirus and social restrictions. The adopted strategies by the ItalianGovernment have been relevant to control the unpredictable andpotential fatal evolution of infection in our regions.