A MODEL OF RELOCATION OF GASTROENTEROLOGICAL PROCEDURES SUSPENDED DURING FIRST COVID 19 LOCKDOWN: THE EXPERIENCE OF BOLOGNA EMERGENCY GASTROPACK PROJECT

Background and aim: Due to COVID-19 spread, in March 2020 Emilia Romagna government ordered the first lockdown blocking non-urgent health services. After 4 months, regional health service reopened but thousands of people had pending requests. In order to avoid the excess of requests to create jams in the system, we established a controlled reopening according to criteria of prescriptive appropriateness and clinical priority, called Emergency-Gastropack (E-GPack). Aim of present study is to evaluate the outcomes of this project. Materials and methods: Non-urgent sanitary activity was suspended between March 6, 2020 and July 10. From May 7 to June 12, the E-GPack was carried out. The system is based on the collaboration between hospital Gastroenterolgists and GPs. The Department of Primary Care informed the GPs that had made requests suspended during the lockdown, agreeing a telephone appointment with the Gastroenterologist. For each request a digitalised record was created in the RIS-PACS software (Polaris). On the scheduled date and time, the Gastroenterologist contacted the GP to discuss the clinical case that led to the suspended request. Based on the original indication and on the possible clinical evolution occurred meanwhile, different outcomes were possible: confirmation of the request with different priority (to be performed by 10,30,60 or 180 days), cancellation of the request, cancellation of the original request with programming of different performance. At the end of the consultation, the Gastroenterologist filled the Polaris record with the final decision, this determined the appropriate action: the cancellation of the request or the issuance of a new request for the same or for another service according to the agreed priority. The requests issued were sent to a reservation centre, who contacted the patient to arrange an appointment. At the same time, the GP and the patient, received a summary letter about the interview. Results: A total of 1097 requests were handled. The E-GPack has affected the remodulation of performance with a reduction of 20% for consultations, 22% Colonoscopies and 24% EGDS. Thus, after reevaluation, 853 requests (31% consultations, 38% EGDS, 59% colonoscopies) were programmed (20% with priority of 10 days, 36% of 30 days, 30% of 60 days, 14% of 180 days). Conclusions: E-Gpack has allowed to spread the peak of requests in a period up to 180 days, lowering the peak supply requirement for recovery and creating the conditions for the crossover activation of room available to new accesses.

Sensitivity of serology assay in Covid-19 diagnosis: does the antigen matter?

Since the spreading of Sar-CoV-2 in March 2020, many serologic tests have been developed to identify antibody responses. Indeed, different commercial kits are directed against different antigens and could utilise different methods thereby triggering confusion and criticism. Here, we compared two Food and Drug Administration (FDA)-approved automatized assays that detect IgG responses against spike or nucleocapsid protein of Sars-Cov-2 virus in 127 subjects among healthcare workers of IRCCS Policlinico San Donato (MI), Italy. We observed different kinetics of IgG responses, demonstrating the importance of timing of sampling to correctly interpret the results both for infection diagnosis and for epidemiologic studies. We observed that Anti-N response starts earlier than Anti-S1/S2 response but also decreases earlier, affecting the sensitivity of the tests at different time points. Combining two different assays, designed against different antigens, could reduce false negative results. Finally, we observed a patient who produced anti-nucleocapsid IgG, but not anti-spike IgG. In conclusion, we investigated antibody responses in Covid-19 disease, aiming to direct clinicians and laboratory scientists to correctly interpret serologic results by always paying attention to clinical history correlation, timing of sampling, methods and antigens used, to avoid false negative results and obtain relevant epidemiologic data.

MUSEUMS IN TIMES OF THE COVID-19 PANDEMIC. FOCUS ON ROMANIA AND ITALY

Museums depend on two factors to achieve their educational and cultural missions: heritage/collections and audience. In the past decades the role of museums in society, as well as the way they relate with their audiences changed significantly. As in many other domains, the internet and technological development influenced museums' public offers and how they interact with their audiences, either visitors or the online public. Nevertheless, museums' strategies have concentrated on effective visitors to the museums' premises. One of the effects of COVID-19 pandemic was the complete closure of museums around the world. Therefore, museums had to adapt to remain significant to their audience and to continue to achieve their missions. The present investigation tries to map innovative approaches of museums, especially the ones in Romania and Italy. A special focus is put on the strategies adopted by museums aiming to help their communities better cope with the pandemic.

Abdominal obesity phenotype predicts covid-19 chest x-ray severity score better than general obesity

Introduction: Chest x-ray (CXR) severity score and obesity are predictive risk factors for COVID-19 hospital admission. However, the relationship between abdominal obesity and CXR severity score is not fully explored. Methods: This retrospective cohort study analyzed the association of different adiposity indexes, including waist circumference and body mass index (BMI), with CXR severity score in 215 hospitalized patients with COVID-19. Results: Patients with abdominal obesity had significantly higher CXR severity scores (Figure 1A) and higher rates of these scores than those without abdominal obesity (P<0.001;P=0.001, respectively) while there were no significant differences between BMI classes (P=0.104;P=0.271, respectively) (Figure 1B). Waist circumference and waist-to-height ratio correlated more closely with CXR severity score than BMI (r=0.43, P<0.001;r=0.41, P<0.001;r=0.17, P=0.012, respectively). The AUCs for waist circumference and WHtR were significantly higher than those for BMI for distinguishing a high CXR severity score (≥8) (0.68 [0.60-0.75] and 0.67 [0.60-0.74] vs 0.58 [0.51-0.66], P=0.001) (Figure 2). Multivariable analysis indicated abdominal obesity (risk ratio: 1.75, 95% CI: 1.25-2.45, P<0.001), bronchial asthma (risk ratio: 1.73, 95% CI: 1.07-2.81, P=0.026) and oxygen saturation at admission (risk ratio: 0.96, 95% CI: 0.94-0.97, P<0.001) as the only independent predictors of a high CXR severity score. Conclusion: Abdominal obesity might predict a high CXR severity score better than general obesity in hospitalized patients with COVID-19. Therefore, in hospital clinical practice waist circumference should be assessed and patients with abdominal obesity should be monitored closely.