ABSTRACT
Background: At present few data have clearly showed an increased frequency of idiopathic central precocious puberty (CPP) in females during the COVID-19 pandemic. The role of environmental factors is not fully understood and various hypotheses have been formulated. Aims of the Study: To evaluate retrospectively the incidence of newly diagnosed CPP and other pubertal disorders (premature thelarche, early puberty, fast puberty and precocious menarche) in two regions of Italy (Tuscany and Emilia-Romagna) during and after the lockdown for COVID-19. Patients and Methods: The study included 440 females evaluated for pubertal disorders into the Centres of Florence, Parma, Reggio Emilia and Modena between the 1 January 2020 into the 31 December 2021. Subjects with endocrine or chronic diseases were excluded. Monthly incidence rates and clinical features were compared with a control group of patients evaluated for the same problems into 2019. Result(s): Our data confirmed a higher frequency of CPP in females (261 patients, mean age 7.6 +/- 0.6 years, without significant differences between the diagnoses carried out in 2020 and 2021) compared to 2019 (52 cases, mean age 7.5 +/- 0.7 years, p < 0.0001). Interestingly, CPP cases were significantly higher also in the first two months of 2020, so before the start of Italian lockdown and just before the Sars-COV-2 pandemic was declared (21 cases vs. 7 in the same period of 2019;p < 0.0001). Our preliminar data seem also to suggest an increased frequency of the diagnoses of premature thelarche (54 patients in 2021 and 31 patients in 2020 vs 21 patients in 2019, respectively p < 0.0001 and < 0.05;between 2020 and 2021: p < 0.0001), early puberty (31 patients in 2021 and 25 patients in 2020 vs 16 patients in 2019, respectively p < 0.0001 and p < 0.05), fast puberty (20 patients in 2020 vs 5 patients in 2019 and 2021;respectively, p < 0.0001) and precocious menarche (9 patients in 2021 vs 3 patients in 2019 and 4 patients in 2020;p < 0.0001). Conclusion(s): Our data, on the one hand, confirm an increase in the frequency of new cases of CPP during and after the lockdown for COVID-19 pandemic, but also show an increase, albeit differently distributed in these 2 years of epidemic, in other pubertal development disorders. Interestingly, this could delineate different factors involved in the genesis of these disorders. Further studies and insights appear necessary to better explain these aspects.
ABSTRACT
The rapid progression of COVID-19 is an organizational challenge for all hospitals. To secure the patient overflow, the Department internal medicine of the University Hospital of Lausanne increased nurse and medical workforces as well as bed capacity by 65%, with extraordinary help from other departments. The implemented crisis management stood upon three pillars: a crisis management team, steering documents and internal communication. In this new form, the Department had already taken care of 442 COVID-19 admissions by April 16, 2020. Alongside organizational challenges, clinical issues such as rapid respiratory distress, clinical suspicions with negative PCR and treatment uncertainties in the absence of sufficient evidence were overcome. Despite the peak of the pandemic appearing to have passed, the next phase could be just as complicated.
ABSTRACT
Nosocomial COVID-19 infections are a challenge for hospitals. In order to assess possible demographic, personal, environmental or medical care related risk factors, data of nosocomial cases occurring in the Service of internal medicine at CHUV between February and March 2021 were retrospectively analyzed. Neither personal nor medical care related factors were identified as risk factor for a nosocomial infection. However, a significant number of patients with hospital-acquired COVID infection stayed in a 5-bed ward (versus 1-2 beds) and shared toilets in these rooms. Patient distancing measures and weekly screening led to a subsequent significant reduction of nosocomial SARS-CoV-2 infections.
ABSTRACT
Introduction: Transmission of SARS-CoV-2 inside the hospital has significant implications for patients and healthcare workers. Objectives: We describe a nosocomial outbreak of SARS-CoV-2 infections in the Service of Internal Medicine, the implemented infection prevention and control (IPC) measures and their impact. Methods: We report all consecutive nosocomial cases in a 206-bed service from February 8 until April 8, 2021 (weeks 6-14). Nosocomial COVID-19 cases were defined as microbiologically documented cases by PCR, diagnosed ≥ 5 days after admission. A cluster was defined based on the detection of ≥ 2 nosocomial COVID-19 cases within a given period (< 72 h) or geographically linked. IPC measures implemented on week 10 to control SARS-CoV-2 transmissions in all non- COVID units were: systematic screening at day 3 after admission;weekly screening of all patients by PCR on saliva;and decreasing the occupancy of all patient rooms with 5 patients to 3. Results: 69 cases were identified, with 57 attributed to 21 clusters and 12 cases considered isolated. Median age was 74 years (IQR 65, 80) and 40.6% were female. All cases had a previous negative test and median time from admission to positive test was 12 days (IQR 8, 17). 45.1% of nosocomial cases were completely asymptomatic. 60.9% of patients stayed in rooms with 5-patients. Death occurred in 23.2% of cases. The incidence of nosocomial cases was the highest between weeks 8 and 10 with 18 and 17 new cases per week, respectively. After the introduction of IPC measures on week 10, there was a rapid decrease in the number of cases until complete absence of new cases on week 14. Conclusion: Nosocomial infections were frequently asymptomatic, potentially hampering fast diagnosis which is crucial for control of transmission, and were associated with high mortality rate. The implementation of additional IPC measures led to a gradual decrease in nosocomial transmissions and allowed controlling the outbreak.