Tolerability and safety of high-intensity continuous and intermittent exercise in COVID-19

Aim: We assessed safety of high-intensity [IV1] constant-load exercise (CLE) and intermittent exercise (HIIT) in 14 post-severe-COVID-19 patients (63+/-13 years;78.6% male;BMI: 28+/-5, without comorbidities) between July 2020 and April 2021 after 55+/-22 days of COVID-induced acute respiratory failure. Method(s): The crossover study balanced exercise intensity between CLE at 70% of peak work rate (WRpeak) to the limit of tolerance (Tlim) and HIIT including 1 min exercise at 100% WRpeak, alternated with 1 min at 40% WRpeak to Tlim. Gas exchange, ventilation, electrocardiography and symptoms were assessed. Result(s): Exercise endurance time and total work output were not different between HITT and CLE (Table 1). At Tlim, none of the ventilatory or cardiovascular responses differed between HITT and CLE and there was no difference in the intensity of symptoms (Table 1). Conclusion(s): Individuals with ongoing symptomatic COVID-19 could safely undertake high intensity exercise performed continuously or intermittently.

Modena experience of first year of Diagnostic and Therapeutic Care pathways of utero and cervix cancer

Background: Gynecological cancers of the uterus and cervix are common malignancies in women. The correct management of these tumors involves many figures. Material and methods: Therefore, to respond to these multidisciplinary needs in June 2019 in Azienda Ospedialiero-Universitaria of Modena was born a Diagnostic and Therapeutic Care Pathways (DTCP) with gynaecologists, radiotherapists, medical oncologists, radiologists, nuclear medical doctors, pathologists, anaesthesiologists, a nurse Case Manager and a patients' association representative. A molecular biologist, endocrinologists and nutritionists have already enriched the team after the first year of activity. The group performs weekly collegial discussions of clinical cases and cohort visits, continued in the COVID era. Results: The new diagnoses in the first year of activity were 53 endometrial cancers (EC) and 24 cervical ones (CC). The median age at diagnosis was 51 years between EC patients and 70 years in CC. 87% of EC were endometrioid subtypes, while 65% CC were squamous cell ones. 70% EC patients (pts) were stage (st) I (52% IA and 48% IB), 5,5% st II, 9,4% st III and 11,3% st IV. Immunohistochemical analysis for estrogen and progesterone receptor, p53 and mismatch repair (MMR) proteins were performed on 20 EC. All tumours tested are p53 negative. We found 3 pts who had MMR deficiency, none of them diagnosed with Lynch syndrome at the subsequent genetic counselling. After surgery, 66% pts in st I underwent observation and 34% made radiotherapy (RT). Among st II pts, 1 patient performed RT, one other platinum- based chemotherapy (pCT) and the third did not perform any adjuvant treatment for ECOG. All except one st III pts (67%) underwent pCT with RT. Among st IV one received surgery, pCT and palliative RT, the others (83%) made pCT. Most CC were diagnosed in early st. 9 pts underwent upfront surgery, followed in 2 cases with RT and in 3 with RT and pCT. One patient received neoadjuvant chemo-RT. Radical RT with weekly cisplatin was performed in 9 pts, other 4 pts made RT alone due to advanced age and/or ECOG. One patient started observation for age, ECOG and absence of symptoms. Conclusions: In our experience, DTCP allows the optimization of the diagnostic and therapeutic strategy in EC and CC pts, especially in most complex cases.

New management and trauma incidence in hand surgery during the phase 1 of COVID-19 pandemic in a referral hand surgery and microsurgery center into the outbreak in North Italy

BACKGROUND: This is a retrospective study of the casuistry occurred at the Hand Surgery and Microsurgery HUB Center of Emilia-Romagna during the months of March and April 2020 in the peak of Phase 1 of COVID-19 pandemic in Italy, comparing the data with the same period in 2019. METHODS: A more relevant reduction of 92.3% in elective surgery and a significantly less relevant reduction of 37.2% in emergencies was recorded. Replantation did not present reduction while cutting lesions of tendons and saw injuries increased such as the injuries during domestic activities. RESULTS: The incidence of hand trauma looks not only at the traditional field of artisanal and industrial injuries, but also to the most recorded accidents in daily life activities. The data evidenced the significantly increase of the injuries occurring in the domestic environment. The 72.8% of emergencies was treated in day-service with significantly reduction in hospitalization, costs and infective risks. Telemedicine implementation has experienced to upgrade the relationship in the emergency network. CONCLUSIONS: Hand injuries remained a major issue also during the lockdown. A functional and skill emergency service and day-service during the phase 1 COVID-19 pandemic played a relevant role in efficacy and efficiency. The utility of telemedicine was greatly limited by liability and risk management issues.

Two-month stop in mammographic screening significantly impacts on breast cancer stage at diagnosis and upfront treatment in the COVID era.

INTRODUCTION: The present analysis aims to evaluate the consequences of a 2-month interruption of mammographic screening on breast cancer (BC) stage at diagnosis and upfront treatments in a region of Northern Italy highly affected by the severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) virus. METHODS: This retrospective single-institution analysis compared the clinical pathological characteristics of BC diagnosed between May 2020 and July 2020, after a 2-month screening interruption, with BC diagnosed in the same trimester of 2019 when mammographic screening was regularly carried out. RESULTS: The 2-month stop in mammographic screening produced a significant decrease in in situ BC diagnosis (-10.4%) and an increase in node-positive (+11.2%) and stage III BC (+10.3%). A major impact was on the subgroup of patients with BC at high proliferation rates. Among these, the rate of node-positive BC increased by 18.5% and stage III by 11.4%. In the subgroup of patients with low proliferation rates, a 9.3% increase in stage III tumors was observed, although node-positive tumors remained stable. Despite screening interruption, procedures to establish a definitive diagnosis and treatment start were subsequently carried out without delay. CONCLUSION: Our data showed an increase in node-positive and stage III BC after a 2-month stop in BC screening. These findings support recommendations for a quick restoration of BC screening at full capacity, with adequate prioritization strategies to mitigate harm and meet infection prevention requirements.

Retrospective study in clinical governance and financing system impacts of the COVID-19 pandemic in the hand surgery and microsurgery HUB center.

INTRODUCTION: The authors presented a retrospective study in the surgical activity of the HUB center for Hand Surgery and Microsurgery in Emilia-Romagna comparing the data between March and April 2020, in the peak of Covid pandemic, with the same period in 2019. MATERIALS AND METHODS: During the two months period of March-April 2020 versus 2019 the authors analyzed the surgical procedures performed in elective and emergency surgery with hospitalization and Day or Outpatient surgery regime. Surgical treatments with no hospitalization were planned in the Day-Surgery Service. The financing system impacts were analyzed according to the Diagnosis Related Groups (DRG), the costs accounting method mostly used in European countries. RESULTS: An overall reduction of 68.5% was recorded in surgical procedures, with a more relevant reduction of 92.3% in elective surgery and a significantly less relevant reduction of 37.2% in urgent one. Replantation did not present a reduction in number of cases, while cutting lesions of tendons at the hand and fingers increased such as the bone and ligament injuries during domestic accidents. The negative impact in the financial system recorded a reduction of 32.5%. DISCUSSION: The epidemiology of hand trauma looks not only at the artisanal and industrial injuries, but also mostly at the accidents in daily life activities. The data of the study evidenced the significantly increase in the injuries occurring in the domestic environment. Elective surgery was canceled. The 86% of surgical procedures performed were urgent ones and the 72.8% of these were possible in Day and Outpatient surgery with significantly reduction in hospitalization. All procedures followed a rigid process for patient and healthcare workers with regard for personal protection and safety. Telemedicine was arranged in emergencies, and economic damage was analyzed also in the following rebound effect during summer period. CONCLUSIONS: The significantly less reduction recorded in urgent surgery vs the more relevant reduction in elective one showed how the hand injuries remained a major issue also during the lockdown. The data highlighted the relevant role of the organizational aspects of the surgical procedures and planning in hand trauma. Despite the financial impact of the elective surgery, the presence of a functional and skill Emergency Service and Day-Surgery Service resulted fundamental in the efficacy and efficiency of the patient management and in containment of economic damage. The telemedicine was significantly limited by liability and risk management issues.