The diagnosis of COVID ARF in elderly: The radiological findings in elderly

The world aging population is continuously rising, and older age even in Italy is an important risk for COVID-19 infection and mortality. Lung aging is accompanied by physiological functional and morphologic-structural changes that lead to increased respiratory impairment in the elderly. Increased vulnerability of elderly patients with chronic comorbidities and weaker immune function makes them an easier target of viral infection and acute respiratory failure. The COVID-19 pandemic poses a high risk to older people. Thoracic imaging plays a pivotal role for the diagnosis, temporal evolution, complications, monitoring of therapeutic efficacy, and elderly COVID-19 patients discharge assessment. The aim of this chapter is to provide a rapid overview of the COVID-19 disease imaging, with a specific focus on older adults. © Springer Nature Switzerland AG 2020.

Comparison between ELISA and automated ECLIA for Interleukin-6 determination during COVID-19 pandemic

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is a highly contagious illness associated with a hyperactivated and dysregulated host immune humoral response. In detail, there is a cytokine storm which may take to the release of interleukin IL-6 as a critical mediator for respiratory failure, shock and multiorgan dysfunction. Such dysregulation may act as a target for therapeutics and, in this view, a blockade of IL-6 function by an anti-IL-6 receptor antibody (tocilizumab) has been described to be effective for the treatment of the inflammatory process COVID-19-related. Timing of administration of therapy was reported in literature to have a critical role in benefit for patients;thus, the aim of the present study is to compare two different methods for the IL-6 assessment: the Human IL-6 ELISA Kit (Invitrogen) and the Elecsys IL-6 (Roche). Method(s): IL-6 levels of 128 COVID-19 patients, who were consequently admitted to the Emergency and Medicine Department of AOU Careggi (Hospital in Florence -Italy ) between April and May 2020, were assessed by using the two above mentioned methods and were analysed through Passing-Bablok regression fit and Bland-Altman plot. Result(s): The analyses showed that the two methods correlate, but do not agree in terms of numeric results. In particular, further investigation were performed on the Bland-Altman results, showing that the maximum number of samples for which the differences between the two methods is close to "0" (p > 0.05) (which means a good overlap between the two methods) is 49 (p=0.07), and among them, 40 samples showed a complete agreement of results (p=0.95). These results can be attributed to the different methods' linearities: 3.1-200 pg/mL for ELISA and 1.5#5000 pg/mL for ECLIA, which could be extended to 50 000 pg/mL. Conclusion(s): Although a small percentage of data overlapping in a certain range, still a high correlation among the two methods can be found;given the overall analytical performance of the ECLIA, it can be considered more adequate for different reasons: i) it is available on a fully automated platform h24, ii) it uses of a small sample volume, iii) it is low cost and no-time consuming and iiii) the different timing for measuring IL-6 is much attractive.

Effects of Different Oncological Treatments on the Antibody Response to Covid19 Mrna Vaccine

Background: A satisfying development of antibody title after vaccine finds out his protagonist in immune system. In oncological patient immune system can be influenced by type of active treatment as Immunotherapy, Target therapy, Chemo therapy and its premedication with anti inflammatory steroids. This study aim to determine whether cancer medical treatment influenced antibody title response to Covid 19 mRNA vaccine. Material(s) and Method(s): We retrospectively analyzed 256 vaccinated patients with two doses of Covid19 mRNA vaccine, undergoing treatment with immuno chekpoint inhibitors, target therapy, chemo therapy, in our institution between february and july 2021. Total IgG and antiSpike protein anti SARS Covid 19 antibody title, a complete blood cell count and blood dosage of vitamine D have been determined at four weeks from the end of vaccination cycle. Differences in antiCovid19 antibody title has been evaluated and compared with t-student, test Wilcoxon Mann Whitney, Kilmogorov Smirnov among each subgroup of patients according to different types of treatment. Bivariate analysis has been performed in order to asses correlation between continous variables: blood dosage of vitamine D, Neutrophils-lymphocyte-ratio (NLR) and antiSpike protein antibody title. Result(s): No statistically significant difference has been observed in total and antispike protein antibody title between subgroups according to type of oncological treatment. Bivariate analysis revealed a correlation between blood levels of vitamine D, NLR and antiSpike protein title reached. Conclusion(s): Different types of Oncological treatment as Immunotherapy, Target therapy and Chemotherapy do not influence the development of antibody title response to Covid19 mRNA vaccine;Vitamin D seems to have an important role to promote humoral immunity as well as NLR.

Experience in Communicating Vaccine Side Effects in a Covid-19 Population Vaccination Centre in North-East Italy

Introduction: Our hospital operated a population vaccination centre (CVP) in Verona between March and August 2021, administering an average of 2000-2500 anti-SARS-CoV-2 vaccinations per day. Risk communication offers a methodology for assessing the risk perception of vaccines;managing high volumes of activity may need to consider the ways and processes of communicating the risk of adverse events [1-2]. Objective(s): What to improve for better risk communication in CVP during a mass-vaccination campaign;compare the differences between reports detected by hospital, regional, and national pharmacovigilance. Method(s): A fact sheet was produced based on the guidance of the ministry of health and the drug agency. It was possible to look up information regarding vaccine adverse events during online booking. Multiple videowall were installed before the medical check. Healthcare workers were trained on adverse event risk communication and reporting methods: an online dataset was collected and share online to physicians involved in the vaccination campaign. Moreover through a surveillance conducted between March and August 2021, we asked users about their level of satisfaction with the information they received regarding to clarity, completeness of information received, and informed consent form. We collected adverse event reports from the Verona hospital through 2021;we collected data from regional reports and from AIFA reports. We compared the hospital data with regional and national data. Result(s): Survey collected 3871 answers;about information area 71.10% were ''extremely satisfied''. Who were dissatisfied request for more information materials at each stage of vaccination: before (information about vaccines), during (information about procedures and side effects) and after the vaccination session (more complete information on how to report adverse events). Staff area (medical and nurse) collected 88.40% ''extremely satisfied''. AOVR collected 392 reports of adverse events (356 [99.82%] non serious and 36 [9.18%] serious);Veneto collected 15.982 (14.513 [90.82%] non serious and 1.468 [9.18%] serious);National data were 97.846 (83.967 [85.93%] non serious and 13.741 [14.06%] serious) [3-5]. Conclusion(s): The management of risk communication during the operation of a population centre (CVP) was perceived with satisfaction by the users. The values of adverse event reports received by AOVR's pharmacovigilance system are comparable with regional data and serious events are lower than national data. Integrations in risk communication may be useful at different points in the vaccination process.

Experience in Communicating Vaccine Side Effects in a Covid-19 Population Vaccination Centre in North-East Italy: An International Journal of Medical Toxicology and Drug Experience

Introduction: Our hospital operated a population vaccination centre (CVP) in Verona between March and August 2021, administering an average of 2000-2500 anti-SARS-CoV-2 vaccinations per day. Risk communication offers a methodology for assessing the risk perception of vaccines;managing high volumes of activity may need to consider the ways and processes of communicating the risk of adverse events [1-2]. Objective: What to improve for better risk communication in CVP during a mass-vaccination campaign;compare the differences between reports detected by hospital, regional, and national pharmacovigilance. Methods: A fact sheet was produced based on the guidance of the ministry of health and the drug agency. It was possible to look up information regarding vaccine adverse events during online booking. Multiple videowall were installed before the medical check. Healthcare workers were trained on adverse event risk communication and reporting methods: an online dataset was collected and share online to physicians involved in the vaccination campaign. Moreover through a surveillance conducted between March and August 2021, we asked users about their level of satisfaction with the information they received regarding to clarity, completeness of information received, and informed consent form. We collected adverse event reports from the Verona hospital through 2021;we collected data from regional reports and from AIFA reports. We compared the hospital data with regional and national data. Results: Survey collected 3871 answers;about information area 71.10% were extremely satisfied. Who were dissatisfied request for more information materials at each stage of vaccination: before (information about vaccines), during (information about procedures and side effects) and after the vaccination session (more complete information on how to report adverse events). Staff area (medical and nurse) collected 88.40% extremely satisfied. AOVR collected 392 reports of adverse events (356 [99.82%] non serious and 36 [9.18%] serious);Veneto collected 15.982 (14.513 [90.82%] non serious and 1.468 [9.18%] serious);National data were 97.846 (83.967 [85.93%] non serious and 13.741 [14.06%] serious) [3-5]. Conclusion: The management of risk communication during the operation of a population centre (CVP) was perceived with satisfaction by the users. The values of adverse event reports received by AOVRs pharmacovigilance system are comparable with regional data and serious events are lower than national data. Integrations in risk communication may be useful at different points in the vaccination process.

Verifying the Theory of Climate Affecting Lethality of COVID-19 by an Analysis in Two Climatic Zones of Chile

Introduction: The study of seasonal influences on the COVID-19 pandemic can take advantage of the unique position of Chile and its different climatic profiles in the north-south extension. The purpose is to verify the influence of seasonal climate changes on the COVID-19 in the temperate and sub-arctic areas of Chile. Methods: We monitored the evolution of CFR in temperate versus sub-boreal regions, reporting from the John Hopkins University COVID-19 Center on the CFR in each province in midwinter, spring, and early summer. Results: CFR worsened from mid-winter to mid-spring in the temperate zone of Chile, while in the sub-boreal area the CFR improves in the same period, (Kruskal Wallis Test, p=0.004). In the temperate zone after the increase in late winter-early spring, CRF tends to stabilize;on the contrary in the sub-boreal zone, there is a more marked tendency to worsen the CFR at the same time (Kruskal Wallis Test, p=0.010). The temperate zone of Chile shows a CFR increasing until spring-like temperate Europe, unlike Europe CFR does not decrease in summer, but the mean minimum temperature in temperate Chile is lower in summer than in temperate Europe. In Patagonian, CFR remains stable or drops from winter to spring but increases in early summer. Conclusion: The temperate and sub-boreal zones of Chile have a markedly different CFR variation profile during the COVID-19 pandemic.

Exercise in Older Adults to Prevent Depressive Symptoms at the Time of Covid-19: Results of a Randomized Controlled Trial with Follow-Up

Background: This study aimed to verify, through a randomized controlled trial, whether a medium-intensity mixing/aerobic/anaerobic exercise (accessible to older adults even with mild chronic diseases) can effectively counteract depressive episodes. A characteristic of the trial was that the follow-up coincided (unscheduled) with the lockdown due to Covid-19. Methods: Participants (N=120) were randomized into an intervention group, performing physical exercise, and a control group. Participants, aged 65 years and older, belonged to both genders, living at home, and cleared a medical examination, were evaluated with a screening tool to detect depressive episodes, the PHQ9, at pre-treatment, end of the trial (12-week), and follow-up (48-week). Results: A decrease in the frequency of depressive episodes after the trial (T1) was found in both groups;however, a statistically significant difference was observed only in the control group (p=0.0039). From T1 to follow-up (conducted during the lockdown), the frequency of depressive episodes increased in the control group, reaching a frequency equal to the time of study entry (p=0.788). In the experimental group, the frequency of depressive episodes did not change at the end of the trial but reached a statistically significant difference compared to the start of the study (p = 0.004) and was higher than the control group (p=0.028). Conclusion: Moderate-intensity physical exercise can be conducted safely, benefitting older adults even suffering from mild chronic disorders. Physical exercise seems to guarantee a long-term preventive effect towards depressive symptoms, especially in serious stressful situations such as the lockdown due to the Covid-19 pandemic. Clinical Trial Registration Number (NCT03858114).

The neutrophil/lymphocyte ratio as a prognostic factor in COVID-19 patients: a case-control study.

OBJECTIVE: SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) has been identified in China as responsible for viral pneumonia, now called COVID-19 (Coronavirus Disease 2019). Patients infected can develop common symptoms like cough and sore throat, and, in severe cases, acute respiratory syndrome and even death. To optimize the available resources, it is necessary to identify in advance the subjects that will develop a more serious illness, therefore requiring intensive care.The neutrophil / lymphocyte ratio (NLR) parameter, resulting from the blood count, could be a significant marker for the diagnosis and management of risk stratification. PATIENTS AND METHODS: A retrospective, single-center case-control observational study was conducted. The differential cell count of leukocytes, the NLR and the clinical course of patients hospitalized in intensive care with COVID-19 were analyzed, comparing them with other patients (COVID-19 and non-COVID-19) and healthy individuals selected among workers of the Teaching Hospital Policlinico Umberto I in Rome. RESULTS: 370 patients (145 cases and 225 controls) were included in the case-control study, 211 males (57%) and 159 females (43%). The average age of the population was 63 years (SD 16.35). In the group of cases, out of 145 patients, 57 deaths and 88 survivors were recorded, with a lethality rate of 39.3%. The group of cases has an NLR of 7.83 (SD = 8.07), a much higher value than the control group where an NLR of 2.58 was recorded (SD = 1.93) (p <0.001). The Neutrophils / Lymphocytes ratio may prove to be a diagnostic factor for COVID-19, an NLR> 3.68 revealed an OR 10.84 (95% CI = 6.47 - 18.13) (p <0.005). CONCLUSIONS: The value of NLR considered together with the age variable allows a risk stratification and allows the development of diagnostic and treatment protocols for patients affected by COVID-19. A high neutrophil to lymphocyte ratio suggests worse survival. Risk stratification and management help alleviate the shortage of medical resources and reduce the mortality of critically ill patients.

COVID-19 case fatality ratio of Latino America countries with temperate climate partially follows european and oceania trends according to seasonal change

The objective of our study is, therefore, to verify whether the trend of the pandemic regarding the lethality of the virus is similar in Argentina and Chile to that which emerged in the temperate countries of Europe and Oceania. The CFRs were derived from the John Hopkins University database. To check the trend of the Case Fatality Ratio and Argentina, Chile we calculated this index on the same dates in which it was calculated for comparison in European countries and in Australia and New Zealand: i.e., May 6th and from May 6th to the September 21st. We continued comparing the other countries of the southern hemisphere, recalculating the CFR as of 11th November. For comparing a period of year homogeneous, late spring, we calculate the change if CFR from 20th March to 15th April in the North Hemisphere. Our study's results seem to confirm in Latin America a possible influence of the climate and the changing of the seasons in the lethality of the virus. For the same exceptions, it is evident that the study shows that this factor is not the only one nor probably the most important. The obvious exception concerns Argentina, which does not show any summer improvement of the CFR, unfortunately;for this, nation-specific data are not available to verify if the trend is homogeneous in the different climates that the vast territory presents. Other very important factors come into play, among which the diffusivity of the virus also seems to play a role. © 2020 by the authors.

The Climate in the European Union and the Enlarged European Region is a Determinant of the COVID-19 Case Fatality Ratio

Climate could influence the COVID-19 pandemic, but while no evidence has been advanced on the influence of colder climates, some studies have provided data to support a possible heat-related protective factor. The objective is to verify whether areas with a Cold Temperate Climate (TC) have a higher Case Fatality Ratio (CFR) for COVID-19 than areas with a Cold Climate (CC) or with a Mediterranean Climate (MC) in the European Union and the Enlarged European Region. Countries or regions were subdivided into 3 groups according to the Koppen climate classification system: TC (Cfa, Cfb and Cfc in the Koppen system);MC (Csa, Csb);CC (D and E in the Koppen system). The total number of cases and the total number of deaths were detected on 13 August 2020 on the COVID-19 Map-Johns Hopkins Coronavirus Resource Center-the CFR was thus calculated by area. Living in TC areas is strongly associated with risk of a high Case Fatality Ratio for COVID-19, OR for MC=0.42, IC 95% 0.41-0.43;OR for CC=0.33, IC 95% 0.33-0.35. The results are confirmed in the EU, OR per MC=0.85, CI 95% 0.84-0.87;OR per CC=0.63, IC 95% 0.61-0.65.The study found that the IC in a humid temperate climate is associated with higher CFR with respect to the coldest and warmest temperate climates in Europe. This does not appear to be the only determinant of the pandemic.

Is the inversion in the trend of the lethality of the covid-19 in the two hemispheres due to the difference in seasons and weather?

The climate has an influence on the COVID-19 virus lethality. The aim of this study is to verify if the summer weather coincided with the decrease of the Case Fatality Ratio (CFR) in Europe and if, on the contrary, an inverse trend was observed in Australia and New Zealand. To verify our hypothesis, we considered the largest European countries (Germany, UK, France, Italy, and Spain), plus Belgium and the Netherlands. Furthermore, we compared these countries with Australia and New Zealand. For each country considered, we have calculated the CFR from the beginning of the pandemic to May 6th and from May 6th to September 21st (late summer in Europe, late winter in the southern hemisphere). The CFRs were calculated from the John Hopkins University database. According to the results, in all European countries, a progressive decrease in CFR is observed. A diametrically opposite result is found in Australia where, on the contrary, the CFR is much higher at the end of September (at the end of winter) than on May 6th (mid-autumn), and the risk of dying if we count the infection is higher in September. In New Zealand, there are no statistically significant differences between the two surveys. The present study was based on public access macro data. © 2020 by the authors.

The decrease in the physical activity levels during the COVID-19 social distancing period

Aim: Social distancing policies to combat the pandemic of COVID-19 directly impacted the physical activity (PA) index of the population. This study aimed to analyze the factors associated with insufficient leisure-time PA and the changing behavior of residents of the city of Sao Paulo, the epicenter of the pandemic in Brazil. Method(s): The questionnaire used in this research was made available online and included questions on demographics and physical activity. A total of 1.096 adult residents of Sao Paulo completed the questionnaire between July 8th and August 8th, 2020. Result(s): For individuals who were already physically active before the restrictions, a total of 55.8% of the sample kept insufficiently active during the quarantine. Factors such as education, working conditions, and direct relationship with Covid-19 care were associated with decreased leisure-time PA practice, impacting 57.6% of the sample, especially females. People with less formal education, those who possibly changed their routines to working from home, and those who were directly connected to Covid cases were not able to maintain a daily PA routine. Conclusion(s): The data presented here warn about the impacts of the pandemic on engagement in PA, suggesting the need for incentives from intersectoral public policies on sports, leisure, and health to perform these activities. Copyright © 2022 Universidade Estadual Paulista - UNESP. All rights reserved.