Analysis of prognostic factors in COVID-19 hospitalized patients: an Italian single-center case-control study.

OBJECTIVE: COVID-19 clinical presentation ranges from asymptomatic infection to an inflammatory cytokine storm with multi-organ failure and fatal outcomes. The identification of high-risk patients for severe disease is crucial to plan an early treatment and intensive follow-up. We aimed to investigate negative prognostic factors in a group of patients hospitalized for COVID-19. PATIENTS AND METHODS: 181 patients (90 men and 91 women, mean age 66.56 ± 13.53 years) were enrolled. Each patient received a work-up including medical history, clinical examination, arterial blood gas analysis, laboratory blood tests, feasible ventilatory support required during hospital stay, intensive care setting required, duration of illness and length of hospital stay (>or<25 days). For the assessment of the severity of COVID-19, three main indicators were considered: 1) the intensive care unit (ICU) admission 2) the hospitalization length >25 days; 3) the need of non-invasive ventilation (NIV). RESULTS: The independent risk factor associated with the ICU admission were lactic dehydrogenase elevation (p=0.046), C reactive protein elevation (p=0.014) at hospital admission and direct oral anticoagulant home therapy (p=0.048); for hospital length >25 days: early corticosteroid therapy (p=0.035); for NIV treatment: ferritin elevation at hospital admission (p=0.006). CONCLUSIONS: The presence of the above factors may be useful to identify patients at high risk of developing a severe COVID-19 that need an early treatment and intensive follow-up.

Analysis of Prognostic Factors in Covid-19 Hospitalized Patients: An Italian Single-Center Prospective Study

Introduction: COVID-19 clinical presentation ranges from asymptomatic infection to an inflammatory cytokine storm with multi-organ failure and fatal outcomes. The identification of high-risk patients for severe disease is crucial in order to plan an early treatment and intensive follow-up. Aim(s): we aimed at investigating negative prognostic factors in a group of patients hospitalized for COVID-19. Method(s): 181 patients (83 men and 98 women, age 69.50 +/- 15.75 years) were enrolled. Each patient received a work-up including medical history, clinical examination, arterial blood gas analysis, laboratory blood tests, feasible ventilatory support required during hospital stay, intensive care setting required, duration of illness and length of hospital stay (> or<25 days). For the assessment of the severity of COVID-19, four main indicators were considered: (1) the intensive care unit (ICU) admission (2) the hospitalization length> 25 days;(3) the need of non-invasive ventilation (NIV);(4) death. Result(s): The independent risk factor associated with the ICU admission were: male gender (p = 0.02), gamma glutamyl transpeptidase elevation (p = 0.014), C reactive protein elevation (p = 0.09) at hospital admission and direct oral anticoagulant home therapy (p = 0.048);for hospital length>25 days: early corticosteroid therapy (p = 0.026) d-dimer elevation at hospital admission (p = 0.009), the presence of at least three comorbidities (p = 0.038);for NIV treatment: ferritin and C reactive protein elevation at hospital admission (p = 0.006 and p = 0.008 respectively), body overweight (p<0.01) and early corticosteroid therapy (0.018);for in-hospital death: body overweight (p = 0.012), age (p = 0.047), antiplatelet therapy (p = 0.03), creatinine values elevation (p = 0.025). Conclusion(s): The presence of the above factors may be useful to identify patients at high risk of developing a severe COVID-19 that need an early treatment and intensive follow-up.

Prevention is better than healing: preliminary data from the Castelli-Early-CoV-19 (CEC-19) observational study

Background: Since April 2021, at Internal Medicine of Castelli Hospital started the administration of early anti-COVID-19 therapies. Materials and Methods: Initially only Monoclonal Antibodies (MAbs) were available;lately the oral antiviral (OA) therapy Molnupiravir. These drugs are reserved to positive patients, with recent symptoms onset and affected by risk factors for development of severe bilateral interstitial pneumonia. Results: 271 patients were treated with MAbs (M/F 142/129, median age 63, SD 13.87, IQR 18). Risk factors 50 patients obese (BMI>30), 187 with cardio-cerebrovascular diseases, 35 uncompensated diabetes mellitus, 83 chronic lung diseases, 45 immunosuppresed, 6 neurological disorders;105 had more than 1 risk factor. Until now, 196 patients reached one month follow-up;10 were hospitalized for COVID-19 complications, 7 discharged, 1 is still hospitalized, 2 died. Among the remaining 186 patients, 11 were still positive, but clinically recovered;the remaining 175 were healed and negative. To date 28 patients were treated with Molnupiravir (M/F 14/14, median age 64, DS 15.4, IQR 21). 8 obese, 21 cardio-cerebrovascular disorders, 10 chronic lung diseases, 3 uncompensated diabetes mellitus, 1 immunosuppressed. At one week follow-up no adverse effect nor hospitalization were reported. Conclusions: Early treatment of SARs Cov 2 appears to be well tolerated and able to avoid hospitalizations of patients at risk. This result allows us to hypothesize a saving of about 4500 € per patient treated with Monoclonals and about 5000 € with Antivirals treatment.

NEW MEDICAL-LEGAL PROBLEMS IN THE SCHOOL FIELD: DISTANCE LEARNING DURING COVID-19 EMERGENCY

The Coronavirus emergency has led, also in schools, to significant management and organizational problems related to guaranteeing health safety for both school staff and students. The use of dad (distance learning) and DID (integrated digital teaching) methods, while on the one hand it has offered the possibility of reducing the spread of the infectious risk, on the other hand gives rise to new responsibilities both for teachers and parents of minors, not easy to resolve, even in the face of an obvious legislative deficiency as a result of too rapid emergency investment. Who should take care of the students during the lessons not in presence? Who is responsible for their learning and safety? Who and how should intervene if students or the teacher run into problems during a distance lesson? What protection are there for minors but also for schools? What is the role of parents in this context? The current legislation does not adapt to the telematic social context and does not make it possible to clarify any responsibilities in schools. The same authors, at the end of the examination, propose solutions to some of the numerous problems emerged, as an exclusive further point of reflection. The Authors, motivated by the national chaos generated by the non-organizational uniformity, propose numerous ideas for reflection, with references both to the jurisprudential field and to the more specifically scientific-medicolegal one, not only limited to current events, but also with a view to a presumed future increasingly massive use of tools for the digitization of educational processes and education, pending a clarifying intervention by the Legislator, in concert with the institutions. © 2021 Giuffre Editore SpA. All rights reserved.

The Phon Effect In The Abandoned Mummified

Social isolation, confinement in the domestic context up to abandonment, phenomena as serious as they are frequent in modern society, has been emphasized by the advent of the Sars-Covid19 pandemic. The authors report the case of a 39-year-old woman found lifeless and in a partial state of mummification ("hair dryer effect"), lying on her back on the bed and covered, in part, by a quilt. At the foot of the bed a hairdryer was found connected to the electrical outlet. The environmental conditions favored the initiation of special transformative putrefactive processes, such as that of mummification. Investigating a mummified body found, to determine the cause and manner of death, can be difficult for the forensic pathologist. For the definition of the time of death we generally use the degree of evolution of postmortal transformative phenomena which, as we move away from the moment of death, offer less and less possibilities to delimit this period within narrow time limits, especially when these phenomena are strongly affected by the environmental factors in the context of which the corpse has stayed, as occurred in the present case. A careful analysis of the places where the death occurred and the circumstantial data possibly available to the coroner can provide useful data for the proper assessment of the case. The reporting of this event must be considered an important isolated case study for the analysis of the mummification process, as well as a warning light on an increasingly widespread social problem. © 2021, Journal of Legal, Ethical and Regulatory Issues. All Rights Reserved.