ABSTRACT
The Italian system of the enforcement of the sentences has been shaped, since the enter into force of the Italian Constitution in 1948, on the rehabilitation principle but the path towards a real implementation of this pivotal goal is still ongoing. Moreover, conditions like the ones strictly linked to permanent prison overcrowding and reduced economical resources for the implementation of prison and probation staff stand as elements that slow down the achievement of the expected outcomes. In this complicated framework, people that committed a crime can count on a well structured system of alternative measures that have been improved and reinforced during the last twenty years. Despite the ongoing efforts for a better application of such measures, there are still specific issues linked, above all, to the most vulnerable people (foreigners and persons at the margins of the society) that are in the position to experiment substantial discrimination in regard to their lack of the fundamental elements asked by the law for the application of an alternative sanctions. To overcome the many problems still unresolved, the Italian prison and probation system is attaching great importance to the role of restorative justice, as a useful tool for achieving constitutional objectives. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.
ABSTRACT
Introduction: Cystic Fibrosis (CF) centers globally increased the number of telehealth clinics during the Covid-19 pandemic and developed processes utilizing telemedicine to replace a standard clinic visit. Whether these new approaches provide an opportunity to improve patients' clinical condition need further investigations. Aims and objectives: To assess the short-term clinical impact of using the NuvoAir Home platform to monitor children and adolescents with CF at home for six months as part of a virtual model of care. Method(s): The NuvoAir Home platform consists of a smartphone application, Bluetooth spirometer and clinician portal. Patients and/or parents were trained to use the platform and asked to do home spirometry monthly. Cystic Fibrosis Questionnaire-Revised (CFQ-R) was collected at the time of study entry and after six months. We calculated the percentage of change between "pre" and "post" conditions of the variables. Result(s): Sixteen children and adolescent CF patients from Federico II Hospital, Naples, Italy (9 females;mean age 16.3+/-0.9;5 homozygous for delta F508;FEV1 79.5+/-26.2 % predicted;FVC 91.6+/-23.6 % predicted;BMI 21.5+/-3.8) were recruited from June 2021. All patients had completed six months follow-up. CFQ-R revealed higher scores indicating a higher patient-reported quality of life with regard to "health perception" + 3%, "social limitations" + 11%, "digestive symptoms" + 6%. We observed a 2 % improvement from baseline in FEV1 % predicted. There was no difference in pulmonary exacerbation versus the previous year. No changes of medical treatment were reported during that time. Conclusion(s): Digital technology for home monitoring in children and adolescents with cystic fibrosis led to improved quality of life and lung function.
ABSTRACT
Background. The Symptoms of Infection with Coronavirus-19 (SIC) is a 30-item patient-reported outcome (PRO) measure developed to assess the presence and severity of COVID-19 signs and symptoms in adults. To further facilitate the evaluation of new vaccines and treatments in development, similar tools are needed for use within pediatric populations. The objectives of this study were to support adolescent selfcompletion and create an adaptation of the measure for caregiver assessment of signs and symptoms in children aged < 12 years (henceforth, the Pediatric SIC [PedSIC]). Methods. After developing draft versions of the PedSIC and reference materials with definitions to facilitate accurate completion of both measures, iterative rounds of cognitive debriefing interviews were conducted from November 2020 through January 2021 to evaluate understanding of the SIC (in adolescents aged 12-17), and inform refinement of the PedSIC for caregivers of children aged < 12. Recruitment quotas were employed to support sample diversity. Results. Nine adolescents (mean [SD, range] age, 14 [1.76, 12-17] years, 56% female, 78% white;round 1, n=6;round 2, n=3) and 17 caregivers (mean [SD, range] age, 34 [6.28, 26-41] years, 59% female, 65% white;round 1, n=9;round 2, n=8) completed interviews. All adolescents understood and completed the adult version of the SIC without instrument modification. Ease and accuracy of self-completion was improved through the use of reference materials. Caregiver feedback resulted in modification of the PedSIC to include two sections: observable signs (ages < 12), and symptoms assessed with input from children (ages >= 5-< 12). Reference materials provided standardization of item intent. Conclusion. Results support using the SIC, PedSIC, and their associated reference materials to assess the presence and severity of COVID-19 signs/symptoms in adolescents and children aged < 12 years, respectively, who participate in vaccine and treatment clinical trials.
ABSTRACT
Background: Cardiovascular abnormalities have been largely reported in patients with COVID-19. Among these, myocardial injury and rhythm disorders represent one of the most important complications in patients affected by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Moreover, a poorer prognosis has been documented in COVID-19 patients when complicated by arrhythmias, independently by age and sex. Objective(s): The aims of the present study were to identify some of non-cardiac and cardiac comorbidities and some myocardial electrical features (including QT dispersion) associated with arrhythmia in hospitalized COVID-19 patients. Moreover, another objective was to contribute in analyzing the impact of arrhythmias on outcome in this setting of patients. Method(s): At admission, each patient underwent cardiac telemetry monitoring through entire hospitalization period. In all the subjects, laboratory analyses, standard 12-lead electrocardiogram (both at admission and on discharge), and lung imaging examination (by means of both ultrasound scans and computed tomography) were performed. Patients exhibiting arrhythmia during in-hospital period were divided into three groups: i, with brady-arrhythmias;ii, with tachy-arrhythmias;and, iii, with tachy- and brady-arrhythmias. Result(s): Two-hundred patients completed the study (males, 123;mean age, 70.1 years);of these, 80 patients (40%) exhibited rhythm disorders on cardiac telemetry. Patients with arrhythmia resulted to be older (p<0.0001) than patients without arrhythmia. Moreover, patients with arrhythmia showed: i, greater number of comorbidities (p<0.0001);ii, higher values of creatinine (p=0.007), B-type natriuretic peptide (p<0.0001), troponin (p<0.0001), c-reactive protein (p=0.01), ferritin (p=0.001), d-dimer (p<0.0001), and procalcitonin (p=0.0008);iii, QT interval (p=0.002), QTc interval (p=0.04), and QTc dispersion (p=0.01);and, iiii, lower values of sodium (p=0.03), magnesium (p=0.04), glomerular filtration rate (p<0.0001), and hemoglobin (p=0.008) as compared to patients without arrhythmia. By comparing the three subgroups of patients, no significant differences were found. Multivariate analysis showed that age (OR=1.14 [95% CI: 1.07-1.22];p=0.0004), coronary artery disease (OR=12.7 [95% CI: 2.38-68.01];p=0.005), and circulating troponin (OR=1.05 [95% CI: 1.003-1.10];p=0.04) represented risk factors independently associated with arrhythmia. By analyzing allcause in-hospital mortality, it resulted a ~forty-fold higher among patients with arrhythmia (OR=39.66 [95% CI: 5.20-302.51];p=0.0004) when compared to patients without rhythm disorders. Conclusion(s): In the present study, arrhythmias have been to be associated with ageing, coronary artery disease, subtle myocardial injury, hyperinflammatory status, coagulative unbalance, and abnormalities in myocardial electrical impulse propagation in patients affected by SARS-CoV-2 infection. In alignment with previous reports, the presence of arrhythmia seems to be associated with a worse in-hospital prognosis. Given its usefulness, routinary use of cardiac telemetric monitoring should be encouraged in COVID wards.
ABSTRACT
Background: SARS-COV-2 anti-Spike IgG response following mRNA vaccination (BNT162b2) is suboptimal and highly variable in MM patients. Patients and Methods: We report here a single-institution retrospective analysis of 127 consecutive patients with symptomatic MM (71 males, 56 females), [median age 69.5 years (range 45-85)], 63 patients with untreated MM and 64 patients with MM refractory to one or more previous treatment lines. Myeloma therapies included PI+IMiD combos, IMiD-based regimens, PI-based regimens, anti-CD38 mAb-based therapies, antibody-drug conjugates (Belantamab Mafodotin monotherapy), dexamethasone and high dose melphalan. Anti-spike IgG antibody were detected also in 50 healthy volunteers. Patients with symptomatic MM and healthy controls received two dose of COVID-19 mRNA vaccine (Pfizer BioNTech) on days 1 and 21 between 29 April and 15 May 2021. Patients with prior history of SARS-CoV-2 were excluded from analysis. Quantitative determination of anti-spike S1/S2 IgG antibody was performed at 4 weeks from vaccination completion (LIAISONR SARS-COV-2 S1/S2 IgG, LIAISONR). It was previously established a threshold >15 AU/ml of anti-Spike IgG which was related to neutralizing activity of anti-SARS-COV-2 antibodies. Results: Sixty-five out of 127 patients were evaluable for response. Antispike IgG antibody were detected in 50/65 (76.9%) MM patients, defined as responders [177 AU/mL (range 26.4 - 1430)]. 23.1% of MM patients, defined as non-responders, failed to respond at two doses of COVID-19 mRNA vaccine [3.8 AU/mL (range 0.65 - 9.33)]. Seroprotection rate at cutoff of 15 AU/mL was 100% in controls [249 AU/mL (range 104 - 2430)]. No statistically significant differences were found between the two subgroups of patients for myeloma disease phase (relapse/refractory MM vs. untreated symptomatic MM), LDH, residual gammaglobulin levels, WBC, ANC, lymphocytic response, age and sex (Tab. 2). Conversely, plasmacytosis, B2M and haemoglobin concentration were associated with a different response to vaccine. Patients with extreme plasmacytosis (60.0 20.3 vs. 28.218.8 meanSD;p <0.001) (Tab. 2) had a mean titer less than 15 AU/ml of anti-Spike IgG compared with patients with a low plasmacytosis, who, conversely, showed significantly higher mean titers of anti-Spike IgG. B2M was significantly higher in non-responders compared to responders (4.6 4.1 vs. 3.23.6 mean SD;p = 0.006) (Tab. 2). Haemoglobin value was significantly lower in non-responders compared to responders (10.8 1.8 vs. 12.11.8 mean SD;p = 0.008) (Tab. 2). Multivariate analysis confirmed the bone marrow infiltration pattern and haemoglobin value as statistically significant variables. In addition, in the present cohort, the myeloma treatment, including high-dose melphalan and autologous stem cell transplantation, have not been associated with SARS-CoV-2 infection. Conclusions: In our experience, significant fraction of MM patients (23.1%) does not developed any detectable anti-Spike IgG after two dose of COVID-19 mRNA vaccine. Lack of IgG response associated with three statistically significant variables: extreme plasmacytosis, B2M, and haemoglobin concentration. In the subgroup of patients with good response to vaccine, after a median follow-up of 7 months from second dose of COVID-19 mRNA vaccine, no cases of COVID-19 occurred. .
ABSTRACT
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.
Subject(s)
COVID-19/mortality , Hospital Departments/organization & administration , Hospital Mortality , Internal Medicine/methods , Pandemics , Telemetry/methods , Age Factors , Aged , Critical Care , Electrocardiography , Female , Fibrin Fibrinogen Degradation Products , Humans , Italy/epidemiology , Male , Middle Aged , Oxygen/blood , Pneumonia/drug therapy , Pneumonia/etiology , Pneumonia/mortality , Predictive Value of Tests , Prospective Studies , Respiratory Distress Syndrome/drug therapy , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/mortalityABSTRACT
The current COVID-19 pandemic, caused by SARSCoV-2 virus, has made it necessary to identify positive, symptomatic and asymptomatic patients, in a timely manner to activate appropriate containment measures, in order to limiting the spread of infection. The standard test for the diagnosis of COVID-19 is based on the detection of the viral RNA in respiratory specimens using the Real Time reverse-transcription PCR (rtRT-qPCR). In our Molecular Medicine Laboratory, from November 2020 to May 2021, we tested 98.540 respiratory samples collected in UTM swabs (Copan Diagnostics). Viral RNA were extracted with Nextractor magnetic automated system NX48S (Genolution) and they were tested for the detection of SARS-CoV-2 with two different rtRTqPCR kits: i) NeoPlex kit COVID-19 Detection Kit (GeneMatrix, Eurospital), whose gene targets are RdRp and N (N=68.951), and ii) KHB Diagnostic kit for Sars-CoV-2 (KHB), whose gene targets are ORF1ab region, N and E (N=29.589). About 30% of the total analyzed samples, in the mentioned period, were found to be positive to SARS-CoV-2 RNA. However, 1.538 samples found to be positive to only ORF1ab region with KHB Diagnostic kit for Sars-CoV-2, resulting then negative to both N and RdRP genes after being re-tested, within the same working day, with NeoPlex kit COVID-19 Detection Kit, as confirmed by further clinical/diagnostic and followup insights. This indicated a false positive rate of about 5% by using ORF1ab region as target gene in SARS-CoV-2 detection. In conclusion, our preliminary data strongly suggest to use a kit for RdRp gene, whose detection has a greater clinical specificity, particularly, in the late phase of infection. From May 2021, we introduced in the diagnosis of SARS-CoV-2 routine a new kit, 1copy COVID-19 qPCR 4plex (1drop, Eurospital), which not only amplifies three genes in a single tube (i.e., RdRp, N and E), but allows to obtain results after 50 minutes from the extraction, thereby improving the TAT. These results suggest the need of use more than one diagnostic kit, with different targets, in order to obtain more reliable diagnostic data.
ABSTRACT
INTRODUCTION: Influenza (the flu) and CoViD-19 are contagious respiratory illnesses, both affecting lungs and breathing that can be easily spread between people. Although Flu and CoViD-19 share similar symptoms (including fever, cough, body aches, and sometimes vomiting and diarrhoea), these diseases are caused by different viruses. The aim of this study is to compared the spread of Flu and CoViD-19 by means of Real time PCR test. METHODS: From January 2020 to March 2021 a total of 200 respiratory samples from both male and female symptomatic patients in the age group of 15-70 years were tested for the detection of the Flu A (Matrix Protein gene), Flu B (Non Structural Protein gene) and SARS-CoV-2 (RdRp and N genes) viruses with Neoplex FluCovid kit (GeneMatrix, distributed by Eurospital). Samples were divided into three groups: i) collected from patients hospitalized in the E.R. (N=30);ii) collected from patients with respiratory distress 7 days after the first respiratory swab, which resulted negative at the molecular testing for SARS-CoV-2 (N=40);iii) collected from patients with typical symptoms of both Flu and CoViD diseases. RESULTS AND CONCLUSIONS: Real time PCR test on samples of the first group revealed that 30% of patients were positive to Flu A, 67% were positive to SARSCoV-2 and the remaining 23% negative for both Flu and CoViD-19 etiological agents. In the second group, only the 5% of patients were positive to Flu A, 25% positive to SARS-CoV-2 and 70% negative to both Flu and CoViD-19. In the third group, only <1% of patients revealed to be co-infected with both Flu A and SARSCoV-2 viruses, whereas the 67% were found positive to only SARS-CoV-2 and the remaining 32% negative to both Flu and SARS-COV-2 target genes. Overall, our data suggest the importance of using an appropriate diagnostic testing to get an accurate diagnosis in order to define the most right and effective therapy. Moreover, our analysis revealed a low incidence of Flu, which can be related to the extensive use of masks.
ABSTRACT
We examined the impact of the molecular diagnosis of CoViD-19 based on only one target gene detected at high Ct. About 1600 nasopharyngeal swabs, collected from both male and female patients, were analyzed everyday for the detection of N and RdRp genes of SARS-CoV-2 by Real-Time PCR with NeoPlex CoViD -19 (GeneMatrix, Eurospital). About 11% of samples were found positive to N gene at high Ct (Ct > 37) and negative to RdRp gene.However, patients were retested after 24 hours, 48 hours or 1 week and about 2% of samples were found negative for both N and RdRp genes.These data suggest that probably samples were initially found positive to only N gene because of very low viral RNA loads.In coronaviridae, including SARS-CoV-2, subgenomic RNAs (sgRNA) are replicative intermediates, whose presence could correlate with viral replication activity and with the type or stage of the infection.Moreover, lower levels of RNA were detected in asymptomatic patients with post-CoViD-19 conditions.Therefore, to get an accurate diagnosis, samples resulted positive for only N gene at high Ct has to be carefully interpreted and clinical correlation is highly recommended to define the most right and effective therapy.
ABSTRACT
Background: During the CoViD-19 pandemic, cancer screening has been suspended, routine diagnostic work deferred, and only urgent symptomatic cases had priority for diagnostic intervention. This disruption to cancer screening services may have a significant impact on patients, health care practitioners, and health systems. In this study, we estimated the increase of diagnosis of cancer in our department of Clinical Medicine. Methods: In this retrospective cohort study, we collected data on patients with active or previous malignancy, aged 18 years and older, admitted to our Unit of Clinical Medicine from 1 January 2021 to 31 March 2021 (Group A) compared with pre-pandemic figures from 1 January 2020 to 31 March 2020 (Group B). Results: We collected data of 239 patient from Group A, 121 (50.6%) were female. Median (interquartile range) age was 65.0 (56.0-70.0) years, median (interquartile range) hospitalization was 16 day (12-20), 43/239 (18%) were hospitalized due to cancer or its complications. Compared with pre-pandemic figures (Group B), we estimate an increase in hospitalizations of patients with newly diagnosed advanced cancer and/or complications of previous cancer. Conclusions: Substantial increases in the number of new cases of cancer in our wards of Internal Medicine are to be expected as a result of diagnostic delays due to the CoViD-19 pandemic. Urgent interventions are necessary, particularly the need to manage the backlog within routine diagnostic services to mitigate the expected impact of the CoViD-19 pandemic on patients with cancer.
ABSTRACT
Background: Endothelial dysfunction represents a key pathophysiological factor in CoViD-19. A significant proportion of patients (pts) who have been infected with SARS-CoV-2 continue to have symptoms for a long time (long-term CoViD-19). Nailfold videocapillaroscopy (NVC) is nowadays considered one of the best diagnostic techniques of non-invasive imaging, able to study the microcirculation in vivo. The aim of our study was to assess microvasculature by means of NVC in long-term CoViD-19 pts. Methods: We examined 18 pts (12 F and 6 M), aged 53.9 years (range 29-84) with recent diagnosis of CoViD-19 and two successive oropharyngeal swabs resulted negative for the SARS-CoV-2 genome, hospitalized in our ward for other acute pathologies or related to our NVC clinic. The control group consisted of 20 healthy subjects without previous or current SARS-CoV-2 infection with overlapping demographic characteristics. We used a VideoCap 3.0 (DS Medica), equipped with 200x optics to evaluate microcirculation and its elementary alterations. Results: Long-term CoViD-19 pts, compared to control subjects, showed a higher prevalence of meandering capillaries, enlarged capillaries, loss of capillaries, hemosiderin deposits expression of micro-hemorrhages and micro-thrombosis, sludge flow and pericapillary edema. Conclusions: Long-term CoViD-19 pts present greater microvascular abnormalities at NVC compared to healthy subjects. However, further studies with larger case series are needed to assess the clinical relevance of NVC in long-term CoViD-19.
ABSTRACT
BACKGROUND AND AIMS: After the official coronavirus (SARS-CoV-2) pandemic declaration by the WHO, Italy had the second-largest number of confirmed cases, after China. The Italian government introduced progressive infection-mitigation measurements, thus dramatically reducing social interactions and preventing virus spread. During the summer, infection containment measures progressively loosened until, due to an unjustified interpretation of some permissions and the excessive utilization of public transportation at school reopening, the contagion rate progressively increased until causing a severe challenge for our NHS again. Aim of the study: to assess the efficiency of our previously described protocol in 18 Campania region-located Nefrocenter Consortium DCs as further adapted to new knowledge under the new ubiquitous contagion conditions and to identify SARS-CoV-2-infection mortality rate and risk factors. METHOD: Dialysis patients did so too during that period according to the expected shifting prevalence over time (mean±SD: 853±30 per month;range 825 to 873)± (11.8% in April, and 14.8% in November vs. a pre-COVID-19 12.0% rate in January). RESULTS: More patients got infected in November (10.19%) than in April (0,24%), and 22 patients of the 89 from the SARS-CoV-2 November positive subjects required hospitalization for moderate-severe symptoms (24.72%), with death unavoidably coming in 19 (86.36% of hospitalized and 21.35% of infected patients) compared to the only one recorded in April (0.12%). The pandemic's two periods showed a strong association between mortality rate and often co-existing comorbidities, primarily represented by arterial hypertension, type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD). CONCLUSION: The prevously efficient contagion containment measures adopted by our DCs were not enough in November to fight the global infection risk pending on the whole Italian social community around. The Authors discuss possible reasons and put forward further suggestions for the best handling of any future infection waves.
ABSTRACT
Background: Efficacious vaccines are urgently needed to contain the ongoing coronavirus disease 2019 (Covid-19) pandemic of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On December 11, 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for Pfizer-BioNTech COVID-19 vaccine to prevent COVID-19, administered as 2 doses separated by 21 days (1) On December 27, 2020, Italy started use of Pfizer-BioNTech COVID-19 vaccine and initial doses were reserved for health care personnel Objectives: The primary end points were the safety of each administered dose in patients with Rheumatic diseases (RD's) Methods: In this multicenter, observational study, we interviewed by phone 27 patients with rheumatic diseases (RDs) and 30 healthy subjects receiving the Pfizer-BioNTech vaccine (0.3 ml i.m. in two doses 21 days apart, time 0 and 3 weeks). Results: As of 30 January 2021, 57 subjects (27 patients and 30 healthy subjects) were interviewed. The epidemiological and clinical features of the 27 patients are reported in Table 1. Among the whole population, 35 subjects (16 patients and 19 healthy subjects) complained of an adverse event after the first vaccine dose, with symptom onset occurring within 1 day of vaccination. All adverse events (100%) were classified as nonserious and included: injection site pain (17), fatigue (5), headache (16), fever (3), tachycardia (2), and paresthesia (2). After 21 days, 6 patients and 11 healthy subjects received the second vaccine dose. Fifteen (5 patients and 10 healthy subjects) of them (88%) reported adverse events, again categorized as nonserious. Specifically, injection site pain (7), fatigue (10), headache (10), fever (10), paresthesia (1), cutaneous vasculitis (1), itchy and scratchy throat (1), diarrhea (4), lymph node enlargement (1) were recorded. No differences were noted between patients with RDs and healthy subjects in terms of adverse events. Conclusion: This preliminary study shows that the Pfizer-BioNTech COVID-19 vaccine is as safe in patients with RDs as in healthy subjects. Whether patients with RDs will develop protective titers of anti-SARS-CoV-2 antibodies as compared to healthy subjects will be evaluated in further, ongoing studies.
ABSTRACT
Background: The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has imposed considerable restrictions on people's mobility in order to limit infection transmission. Before the COVID -19 pandemic tele-rheumatology was proposed to patients living in remote areas. Currently, the use of telemedicine has increased significantly. We report on the implementation of a telemedicine program for the evaluation and treatment of patients with rheumatic diseases (1). Objectives: The aim of the study is to evaluate telemedicine as a viable approach for routine follow-up and management of rheumatic disease. Methods: Sixty-six patients were evaluated online by the remote rheumatologist in four weeks. The population of rheumatology patients was evaluated using a IARPLUS platform Information collected included demographic information consisting of age, gender, and primary rheumatologic diagnosis. Results: The average age of patients who were seen was 54 years and 85% of patients were women. The most common disorders included rheumatoid arthritis (22, 33%), axial spondyloarthropathies (7, 11%), and psoriatic arthritis (15,23%), systemic sclerosis (13, 20%), lupus (6, 9%), UCTD (2,3%), Sjogren and fibromyalgia (1, 1.5%). Results: All patients were given recommendations on COVID-19 vaccine administration. Therapy was remodeled in 13 patients (in particular in 5 patients with anemia intravenous iron infusion was scheduled;1 started immunosuppressant therapy for proteinuria, 4 increased methotrexate for disease activity, 2 discontinued Methotrexate for adverse events (hypertransaminasemia), 1 suspended OH-chloroquine due to retinal accumulation;2 biologic-naive patients, after a three-month of waiting due to inability to come to the hospital, started the biologic drug;22 patients received a renewal of the therapeutic plan;25 patients had a regular six-month follow up;2 ticket exemption for illness;13 consultations and/ or laboratory tests (1 pneumological consultation, 1 ophthalmological consultation, 1 request for sacro-iliac MRI, 3 nailfold videocapillaroscopies, 3 FKT, 1 musculotendinous ultrasound, 1 antibodies for celiac disease, 2 antibodies anti Sars-CoV-2). Conclusion: Telemedicine is becoming more prevalent. We report the successful use of this service in evaluation and management of rheumatic diseases in a period with limited access to rheumatologic care. We have shown that patients can be seen, evaluated, and successfully treated with a variety of medications, including biologic agents, and evaluated for both chronic inflammatory arthropaties and connective tissue diseases.
ABSTRACT
The spreading of the new coronavirus pandemic (Covid-19) in Italy caused inevitable consequences also on our penitentiary system and on all the people that live and work there. Thoughts, experiences and strategies for coping with the emergency are reported through three testimonies of three Directors of Italian Penitentiary Institutes. In some cases, the crisis was managed using creativity, imagination and motivation. This attitude lead to valid treatments profiles and to functional communication systems between the prison and the outside world. The mediation of conflicts and the inevitable tensions caused by the pandemic emergency were well handled and the results are visible and concrete. © Pensa MultiMedia Editore – Rassegna Italiana di Criminologia.
ABSTRACT
The article n°34 of the Italian Constitution establishes that the school is open to all, without any reference to the personal conditions of the student that can be deprived of his freedom. This right to education is inviolable. The education is an es-sential element to reach the re-educational function of the sentence. The article n°17 of the Norms for the Penitentiary System establishes the important role of the in the external community and of private and public subjects to help in re-educating and re-socializing prisoners. In normal conditions there are often contradictions between the principle and the reality of prison condition so in a condition of crisis such as the covid-19 pandemic there is a high risk to break important achievements in this part. Our article starts from thoughts on the right to study in prison and on the history of Criminology’s attention to the treatment of the offender and from studies on the sector of sentence execution. Then our article presents the results of surveys carried out by the National Conference of Delegates of Rectors for the Prison University Centers at the prison facilities where they are established, during the Coronavirus Pandemic. © Pensa MultiMedia Editore – Rassegna Italiana di Criminologia.
ABSTRACT
The coronavirus emergency led to a particularly serious situation, increasing the precarious conditions in which the external company found itself. The responses of the penitentiary world have produced heterogeneous consequences, in some cases resulting in violent acts, in others based on internal mediation strategies that allowed collaboration between prisoners and staff. The implementation of new measures such as calls on a daily basis and video calls, certainly contributed to alleviating internal tensions and marked an innovative turning point for the national penitentiary system. The main problem, however, remains as always the overcrowding: in Italy but also in Europe has understandably increased the management problems of the pandemic. © Pensa MultiMedia Editore – Rassegna Italiana di Criminologia-.
ABSTRACT
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.