Ongoing Ace-Inhibitor or Atii-Antagonist Treatment Doesn't Impact on Outcome nor on Sequelae of Patients with Moderate to Severe Covid-19 Pneumonia

Introduction: COVID-19 pandemic still represents a major clinical problem worldwide. Many studies are actively being carried out to better understand prognostic factors of outcome as well as optimal treatment. Aim(s): ACE-2 receptor is highly expressed on the surface of cardiac and pulmonary cells, and it is used by coronaviruses to enter host cells;this makes the role of ACE-inhibitors and Angiotensin Receptor Blockers (ARBs) drugs controversial. Moreover, it is still unclear whether these drugs may have any impact on sequelae. Method(s): In this retrospective study, we analysed a group of 244 hypertensive unvaccinated patients (134 on ACE-inhibitors, 110 on ARBs) admitted for moderate to severe COVID-19 pneumonia. As shown in Table 1, the two groups were homogeneous. Of these patients, 46 (20 treated with ACE-I and 26 treated with ARBs) came to a follow-up visit after a mean of 260 days;they underwent a quality-of-life assessment, laboratory and radiologic tests and spirometry (with DLCO). Result(s): A total of 20 of 110 (18%) patients under treatment with ARBs and 23 of 134 (17%) died during hospitalization (p = 0.8, NS). At discharge, biochemical, radiological and respiratory data were not significantly different. We did not find any significant difference in terms of radiological alterations, lung fibrosis, spirometry data, DLCO, persisting effort dyspnea. Biochemical data were substantially super-imposable in the two groups. Conclusion(s): In conclusion, we could not detect any difference in outcome nor in complications type or number in the two groups of hypertensive patients undergoing treatment with ACE-inhibitor or ARBs. This result seems to support and to strengthen the idea that ACE-inhibitors and ARBs do not play a significant role in onset, evolution and outcome of moderate to severe COVID-19 pneumoniae. Although the number of follow-up patients is small, we did not find any difference in follow-up sequelae in both groups.

COVID-19 pandemic - related chilblains: clinical and immunological characterization of an Italian cohort

Introduction: During COVID-19 pandemic, acute acral chilblain-like lesions (ACBLL), reminiscent of lupus pernio, were observed during both first and second COVID-19 peak among patients with highly suspected (but mostly unconfirmed) infection with SARS-CoV-2.The aetiology of this phenomenon has not been elucidated yet and pathogenetic mechanism remains unknown. Several studies have investigated cytokine and chemokine profile in patients with COVID-19 but an accurate characterization of ACBLL patients is lacking. Objectives: We aimed to describe the clinical, laboratory and immunological features of children presenting with ACBLL referred to our Institute during the COVID-19 pandemic spread. Methods: We prospectively collected data of children referred to our Institute from April 1st 2020 to February 28th 2021. We investigate the presence of SARS-CoV2 infection through RT-PCR from nasopharingeal swabs and three different serologic kit. All patients underwent a laboratory work-up including coagulation, viral serology and autoantibodies panel. Finally, we analysed peripheral blood IFN signature, a panel of inflammatory biomarkers in serum/plasma by a flow cytometry bead array (CXCL10, CXCL9, IL-6, IL-1β,TNFα) and the presence of SARS-CoV2 T specific lymphocytes. Results: We examined 36 children during the first peak, and 11 children during the second COVID-19 peak (F: 28 median age 12 y), at a median delay of 26 days after symptoms onset (2-73 days). Fifteen patients (31%) presented non-specific systemic symptoms preceding ACBLL onset. Nine patients (19%) reported a possible contagion from a close contact. All patients presented stereotypical features resembling classical chilblains with acral erythematousedematous violaceous plaques and nodules localized on the toes (n= 35, 74%), the fingers (n=5, 10%) or on both sites (n=7, 15%). SARSCoV- 2 RNA detection resulted negative except for 2 patients. Furthermore, ten patients observed during the first wave showed a recurrence during the second (F:6), which developed 1-4 weeks after the second COVID-19 peak the clinical features were comparable to those of the previous episode. Five of them (50%) reported nonspecific systemic symptoms before onset and/or close contact with SARS-CoV2 positive subject. Repeated SARS-CoV-2 specific IgG/IgA tests were negative for all patients except for three cases (two of them with positive swabs). Neither common virus serology nor coagulation studies revealed significative results. Two patients presented positive ANA and anti β2 glycoprotein, respectively. A positive IFN signature was detected in 12/ 33 patients (36%).Among the 35 patients tested, the cytokine array showed high levels of IP10 (n= 35, range 12.4-739 pg/ml, n.v. 0.0-0.2 pg/ml) and a mild increase of IL-6 (n=21, range 2.4-401 pg/ml, n.v. 0.5-2.2pg/ml), without alterations of CXCL9, IL-1β and TNFa. The detection of SARS-CoV2 specific lymphocytes showed the presence of SARS-CoV2 specific lymphocytes in 9/17 (52%) patients tested (validated with positive and negative controls), only one of them with a positive serological test. Conclusion: Albeit the pathogenetic mechanism of ACBLL remains to be elucidated, our preliminary results showed a significant increase in serum IP10 levels, not frankly associated with a peripheral blood IFN signature, which is instead a characteristic of pernio-related chilblains. We also proved the presence of a T-specific memory against in 50% of the tested patients, despite the negativity of coltures and serological tests, strengthening the link between SARS-CoV2 infection and this peculiar clinical manifestation.

Incidence of PTSD in COVID-19 survivors of critical illness and the therapeutic efficacy of steroids in the prevention of PTSD

RATIONALE: Post Traumatic Stress Disorder (PTSD) is characterized by intense, disturbing thoughts and flashbacks to traumatic events that can significantly reduce quality of life. An estimated 25-44% of survivors of critical illness develop clinically significant PTSD. Trauma leads to decreased glucocorticoid levels and upregulation of the cortisol receptor sensitivity, which may explain the hyper-arousal and avoidance seen in PTSD. Exogenous steroids may help attenuate this change. Previously published studies demonstrate steroids' efficacy in preventing PTSD when given during hospitalization. Data on PTSD specifically in patients hospitalized with Coronavirus-19 (COVID-19) remains sparse whilst utilization of corticosteroid in these patients is growing. Here we describe the incidence of PTSD in critically ill survivors of COVID-19 and explore steroids' role in the prevention of PTSD. METHODS: This is a multicenter retrospective cohort study of patients admitted to the University of Maryland Medical System for critical illness due to COVID-19 between March-December, 2020 and seen for follow up in the post-COVID clinic. Patient's demographic data, underlying medical conditions, and therapies received during hospitalization were collected and manually extracted through retrospective chart review. Patients were screened for PTSD via PTSD Checklist 5 (PCL-5) in outpatient setting. Those with PCL-5 score of 33 or greater were considered to have probable PTSD. We calculated descriptive statistics of demographic and clinical characteristics and performed nonparametric comparisons between groups using the Fishers exact test for categorical variables and the Mann Whitney U test for discrete variables. RESULTS: Twenty-eight patients were included in the study. Age ranged from 29 to 75 years old. Half of patients were female, 50% were African American, 28.6% Caucasian, 10.7% were Hispanic or Latino, and 10.7% were Asian. Four patients (14.3%) required extracorporeal membrane oxygenation (ECMO), seventeen (60.7%) required mechanical ventilation. The majority (78.6%) of the patients received solumedrol, hydrocortisone, prednisone, or dexamethasone as therapy for Acute Respiratory Distress Syndrome (ARDS), shock, or COVID-19 pneumonia. Seven patients developed PTSD (25%). There was no difference in demographics, past medical history, or ECMO utilization when comparing patients with and without PTSD. There was no difference in the usage of steroids (dose or duration) when comparing patients with and without PTSD. CONCLUSION: The incidence of PTSD in COVID-19 survivors is in line with the historical rate of PTSD in the general population of critical illness survivors. The use of corticosteroids had no effect on reducing the incidence of PTSD or the PCL-5 scores in this cohort of patients.

Adaptive reuse process of the Historic Urban Landscape post-Covid-19. The potential of the inner areas for a "new normal"

Often in the past, the great disasters (environmental calamities, earthquakes, epidemics) activated unexpressed energies, triggering transformations of the built environment, able to give rise to unexpected conditions of economic, cultural and social development. The fragility of settlement systems in the face of unexpected threats brings out the need for a new planning, changing our gaze on the city. The new framework of needs drawn by the pandemic and the renewed sensitivity towards the combination of health - sustainability rekindle the spotlight on inner areas. These emerged as "reservoirs of resilience", areas to look at, in order to reach an eco-systemic balance. The aim of the paper is to return an experience of adaptive reuse of the Historical Urban Landscape in an inner area of Southern Italy, where the needs of health and safety of the community are integrated with the transmission of the built heritage to future generations. The goal is the promotion of inclusive prosperity scenarios, towards the so-called "new normality". Starting from an in-depth literature review on the cases of pandemics in history and the strategies implemented, the research identifies health security requirements at the scale of the Historic Urban Landscape and design solutions aimed at reactivating lost synergies between communities and places.