A magnetic approach for understanding the impact of Covid-19 lockdown on PM10 in Rome, Italy

The magnetic properties of PM10 daily filters collected in Rome and Latium region during and after the Covid-19 lockdown (9 March-18 May 2020) were compared for outlining the impact of the mobility restrictions on airborne particulate matter. In urban traffic sites, the average PM10 concentration levels did not significantly change after the end of the lockdown, when vehicular traffic returned to its usual levels. Conversely, the average magnetic susceptibility of PM10 daily filters approximately doubled after the lockdown, pinpointing the increase of metallic emissions related to vehicular traffic. The magnetic fraction of PM10 nearurban traffic sites was dominated by magnetite-like minerals mainly arising from brakes emissions.

Predictors of in-hospital mortality of COVID-19 patients and the role of telemetry in an internal medicine ward during the third phase of the pandemic.

OBJECTIVE: The first pandemic phase of COVID-19 in Italy was characterized by high in-hospital mortality ranging from 23% to 38%. During the third pandemic phase there has been an improvement in the management and treatment of COVID-19, so mortality and predictors may have changed. A prospective study was planned to identify predictors of mortality during the third pandemic phase. PATIENTS AND METHODS: From 15 December 2020 to 15 May 2021, 208 patients were hospitalized (median age: 64 years; males: 58.6%); 83% had a median of 2 (IQR,1-4) comorbidities; pneumonia was present in 89.8%. Patients were monitored remotely for respiratory function and ECG trace for 24 hours/day. Management and treatment were done following the timing and dosage recommended by international guidelines. RESULTS: 79.2% of patients necessitated O2-therapy. ARDS was present in 46.1% of patients and 45.4% received non-invasive ventilation and 11.1% required ICU treatment. 38% developed arrhythmias which were identified early by telemetry and promptly treated. The in-hospital mortality rate was 10%. At multivariate analysis independent predictors of mortality were: older age (R-R for≥70 years: 5.44), number of comorbidities ≥3 (R-R 2.72), eGFR ≤60 ml/min (RR 2.91), high d-Dimer (R-R for≥1,000 ng/ml:7.53), and low PaO2/FiO2 (R-R for <200: 3.21). CONCLUSIONS: Management and treatment adherence to recommendations, use of telemetry, and no overcrowding appear to reduce mortality. Advanced age, number of comorbidities, severe renal failure, high d-Dimer and low P/F remain predictors of poor outcome. The data help to identify current high-risk COVID-19 patients in whom management has yet to be optimized, who require the greatest therapeutic effort, and subjects in whom vaccination is mandatory.

Work ability in Post-acute COVID-19 syndrome: one-month follow-up after Hospital discharge

Introduction: Preliminary data suggest that about 10% of patients who have been tested positive for SARS-CoV2, remain unwell beyond three weeks. Little is known about work ability of COVID-19 survivors (C19W) after their discharge from the hospital. Material and Methods: Sixty C19W (41M;age 53±9 yrs) admitted to Humanitas Research Hospital during the 2nd and 3rd outbreaks in Italy were consecutively enrolled at the time of hospital discharge (T0). Work Ability (WA) was assessed by the Work Ability Index (WAI) questionnaire after one month (T1) from hospital discharge. At T0, C19W were asked to retrospectively complete an additional questionnaire to assess their WA before COVID19 (PRE). The WAI score accounting for seven domains, ranges from 0 to 49 and provides a stratification in four WA categories. In the present study, we assessed the total WAI score at PRE and T1, in 33 C19W. Data are expressed as mean±DS. The present study was approved by the Internal Review Board (#2742/2020). Results and conclusion: At PRE the WAI total score was 41.9±5.7 corresponding to “good category work ability” while at T1 was significantly lower (35.6±5.6;p<0.0001) corresponding to “medium category work ability”. Similar changes were observed in the WA domains except in the one exploring the “Prognosis of WA 2 years from now”. These results indicated that after one month from hospital discharge, the WAI of C19Ws survivors was still significantly reduced, thus suggesting the need for a whole-patient perspective clinical management including interventions to promote an appropriate return to work.

Online group psychotherapy for patients with binge eating disorder during COVID-19 emergency

IntroductionOn March 13th 2020, in execution of the Law Decree 14/2020 regarding the reorganization of National Health Care related to COVID-19 emergency, all non-urgent outpatient healthcare services were suspended in Italy. The present work describes remote support and online group psychotherapy set in motion during COVID-19 emergency for outpatients with Binge Eating Disorder.ObjectivesAim of the present work is to describe and evaluate online support and group psychotherapy for outpatients with Binge Eating Disorder during lockdown due to COVID-19 emergency. Outcomes were evaluated by remote administration of questionnaires.Methods20 outpatients with Binge Eating Disorder, treated by psychotherapists of Hospital Psychology Unit in Psychiatry Day Hospital of an Italian General Hospital, received remote support by phone calls and online group psychotherapy from march to may 2020. During the first two weeks, patients were supported via phone calls. From the third week on, they took part to online group psychotherapy sessions, held every week at the same day and time. Pre-post remote administration of Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and the Questionnaire of Eating Behaviours (Scheda dei Comportamenti Alimentari, SCA) was used to evaluate outcomes. Data were analyzed by Student’s t-test.ResultsNo significant difference was found, thus indicating stability of symptomatology.ConclusionsLockdown was a highly stressful period, in which many people lost control on eating behaviours and those with Binge Eating Disorder were expected to have an exacerbation of symptoms. Remote support and online group psychotherapy proved effective in protecting patients from a possible aggravation of their condition.

Making data big for a deep-learning analysis: Aggregation of public COVID-19 datasets of lung computed tomography scans

Lung Computed Tomography (CT) is an imaging technique useful to assess the severity of COVID-19 infection in symptomatic patients and to monitor its evolution over time. Lung CT can be analysed with the support of deep learning methods for both aforementioned tasks. We have developed a U-net based algorithm to segment the COVID-19 lesions. Unfortunately, public datasets populated with a huge amount of labelled CT scans of patients affected by COVID-19 are not available. In this work, we first review all the currently available public datasets of COVID-19 CT scans, presenting an extensive description of their characteristics. Then, we describe the design of the U-net we developed for the automated identification of COVID-19 lung lesions. Finally, we discuss the results obtained by using the different publicly available datasets. In particular, we trained the U-net on the dataset made available within the COVID-19 Lung CT Lesion Segmentation Challenge 2020, and we tested it on data from the MosMed and the COVID-19-CT-Seg datasets to explore the transferability of the model and to assess whether the image annotation process affects the detection performances. We evaluated the performance of the system in lesion segmentation in terms of the Dice index, which measures the overlap between the ground truth and the predicted masks. The proposed U-net segmentation model reaches a Dice index equal to 0.67, 0.42 and 0.58 on the independent validation sets of the COVID-19 Lung CT Lesion Segmentation Challenge 2020, on the MosMed and on the COVID-19-CT-Seg datasets, respectively. This work focusing on lesion segmentation constitutes a preliminary work for a more accurate analysis of COVID-19 lesions, based for example on the extraction and analysis of radiomic features. Copyright © 2021 by SCITEPRESS - Science and Technology Publications, Lda. All rights reserved

Effects of cytokine blocking agents on hospital mortality in patients admitted to ICU with acute respiratory distress syndrome by SARS-CoV-2 infection: Retrospective cohort study

Background: The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID-19. Tocilizumab and anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV-2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID-19 patients requiring mechanical ventilation and admitted to intensive care unit. Methods: The association between therapy with tocilizumab or anakinra and in-hospital mortality was assessed in consecutive adult COVID-19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who received to those who did not receive tocilizumab or anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with tocilizumab or anakinra and after patient matching. Results: Sixty-six patients who received immunotherapy (49 tocilizumab, 17 anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in non-treated (OR 0.77, 95% CI 0.56-1.05, p=0.069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0.40, 95% CI 0.19-0.83, p=0.015). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission. Conclusions: Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need for mechanical ventilation.

Clinical application of lung ultrasound score on COVID-19 setting: a regional experience in Southern Italy.

OBJECTIVE: We aimed to assess the correlation between LUS Soldati proposed score and clinical presentation, course of disease and the possible need of ventilation support/intensive care. PATIENTS AND METHODS: All consecutive patients with laboratory confirmed SARS-CoV-2 infection and hospitalized in two COVID Centers were enrolled. All patients performed blood gas analysis and lung ultrasound (LUS) at admission. The LUS acquisition was based on standard sequence of 14 peculiar anatomic landmarks with a score between 0-3 based on impairment of LUS picture. Total score was computed with their sum with a total score ranging 0 to 42, according to Soldati LUS score. We evaluated the course of hospitalization until either discharge or death, the ventilatory support and the transition in intensive care if needed. RESULTS: One hundred and fifty-six patients were included in the final analysis. Most of patients presented moderate-to-severe respiratory failure (FiO2 <20%, PaO2 <60 mmHg) and consequent recommendation to invasive mechanic ventilation (CPAP/NIV/OTI). The median ultrasound thoracic score was 28 (IQR 18-36) and most of patients could be ascertained either in a score 2 (40%) or score 3 pictures (24.4%). The bivariate correlation analysis displayed statistically significant and high positive correlations between the LUS score and the following parameters: ventilation (rho=0.481, p<0.001), lactates (rho=0.464, p<0.001), dyspnea (rho=0.398, p=0.001) mortality (rho=0.410, p=0.001). Conversely, P/F (rho= -0.663, p<0.001), pH (rho = -0.363, p=0.003) and pO2 (rho = -0.400 p=0.001) displayed significant negative correlations. CONCLUSIONS: LUS score improve the workflow and provide an optimal management both in early diagnosis and prognosis of COVID-19 related lung pathology.

SARS-CoV-2 vaccine development: where are we?

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has proved to be one of the most challenging infectious diseases in the modern era, and despite several countermeasures to lessen its impact, the spread of the virus is still affecting most countries. This renders the goal of active immunization of the population through vaccination a worldwide public health priority. In fact, only when efficient vaccination programs will be successfully implemented, a return to pre-pandemic normality can be considered. The scientific community has made a tremendous effort to blow the lid off the pathogenesis of the disease, and unprecedented efforts are ongoing with governments, private organizations, and academics working together to expeditiously develop safe and efficacious vaccines. Previous research efforts in the development of vaccines for other coronaviruses (Severe Acute Respiratory Syndrome Coronavirus 1 and Middle East Respiratory Syndrome Coronavirus) as well other emerging viruses have opened the door for exploiting several strategies to design a new vaccine against the pandemic virus. Indeed, in a few months, a stunning number of vaccines have been proposed, and almost 50 putative vaccine candidates have entered clinical trials. The different vaccine candidates use different vaccine development platforms, from inactivated whole virus vaccine to subunit vaccine, nucleic acid, and vectored vaccines. In this review, we describe strengths, flaws, and potential pitfalls of each approach to understand their chances of success.

Association between the spread of COVID-19 and weather-climatic parameters.

OBJECTIVE: To explore whether the climate has played a role in the COVID-19 outbreak, we compared virus lethality in countries closer to the Equator with others. Lethality in European territories and in territories of some nations with a non-temperate climate was also compared. MATERIALS AND METHODS: Lethality was calculated as the rate of deaths in a determinate moment from the outbreak of the pandemic out of the total of identified positives for COVID-19 in a given area/nation, based on the COVID-John Hopkins University website. Lethality of countries located within the 5th parallels North/South on 6 April and 6 May 2020, was compared with that of all the other countries. Lethality in the European areas of The Netherlands, France and the United Kingdom was also compared to the territories of the same nations in areas with a non-temperate climate. RESULTS: A lower lethality rate of COVID-19 was found in Equatorial countries both on April 6 (OR=0.72 CI 95% 0.66-0.80) and on May 6 (OR=0.48, CI 95% 0.47-0.51), with a strengthening over time of the protective effect. A trend of higher risk in European vs. non-temperate areas was found on April 6, but a clear difference was evident one month later: France (OR=0.13, CI 95% 0.10-0.18), The Netherlands (OR=0.5, CI 95% 0.3-0.9) and the UK (OR=0.2, CI 95% 0.01-0.51). This result does not seem to be totally related to the differences in age distribution of different sites. CONCLUSIONS: The study does not seem to exclude that the lethality of COVID-19 may be climate sensitive. Future studies will have to confirm these clues, due to potential confounding factors, such as pollution, population age, and exposure to malaria.