Cardiac damage in covid-19: An undertreated threat to survival

Introduction: Cardiac injury occurs in about 20-30% of patients hospitalized for COVID-19 and influence the prognosis but many aspects like the role of age and magnitude of cardiac damage in determining the prognosis, remains vague. Hypothesis: Age and magnitude of cardiac damage may influence the mortality of patients hospitalized for COVID-19. Methods: We considered all patients consecutively admitted at a third-level European Hospital for COVID-19 between February and June 2020. Cardiac injury was defined as a high-sensitivity cardiac Troponin I (hs-cTnI) value greater than the upper reference limit (URL) of 47 ng/dL. Firstly, we analyzed the data by hs-cTnI across age tertiles (<62 years, 62-73 years and >73 years). Then, we compared patients with no-damage, mid-damage (hs-cTnI up to 10-fold URL) and high-damage (more than 10-fold URL). The primary endpoint was in-hospital mortality. Results: We enrolled 543 patients (median age 69, 67% males);hs-cTnI was available in 509. The survival was lower in elderly patients and high levels of hs-cTnI worsened the prognosis across all age tertiles (Fig. 1A). Surprisingly, the magnitude of cardiac damage did not influence the overall in-hospital mortality (Fig. 1B), but patients with high-damage died earlier (survival at 15 days: 86% nodamage vs 61% mid-damage vs 49% high-damage;p<0.001). Of note, among patients with highdamage, only 7 received coronary angiography, cardiac magnetic resonance or heart biopsy. Conclusions: Cardiac injury dramatically increased the mortality across all ages in patients hospitalized for COVID-19. The magnitude of cardiac damage did not influence overall in-hospital mortality but almost all patients with high-damage died within 15 days from admission. A secondlevel diagnostic test was performed seldomly in high-damage patients, suggesting that the unexpected high burden of the first COVID-19 wave negatively influenced the health system and our clinical daily practice.

Acute and mid-term outcomes of patients with st-elevation myocardial infarction during the covid-19 pandemic

Introduction. A reduction of admissions for ST-eievation myocardial infarction (STEMI) has been reported worldwide during the coronavirus disease 2019 (COVID-19) pandemic. However, most available data refer to March-April 2020. Lombardy region dramatically faced with COVID-19 both in the first (February 22th-June 11th) and in the second (September 14th-December 31th) outbreaks of 2020, and our center served as hub for STEMI with the network of care that was not modified by the decree of the healthcare Authorities, leading to an unbiased comparison with previous years. We aimed to compare admission, time of assistance, and outcomes of STEMI patients undergoing primary PCI (pPCI) during the first-outbreak, the second-outbreak, and the inter-outbreak phase of the COVID-19 pandemic, with the same corresponding periods of the previous year (2019). Methods. All consecutive patients who were hospitalized at Foundation IRCCS Polyclinic San Matteo (Pavia) for STEMI and underwent pPCI from February 22th to June H∗ (first COVID-19 outbreak), from September 14th to December 31th (second COVID-19 outbreak), and from June 12th to September 13m (inter-outbreak period) 2020 were included. Rates of admission and mortality at six months of the three study periods were compared with the corresponding periods of 2019. Survival analysis was made by applying the Kaplan-Meier method. The number of daily admission (NoDA) was calculated dividing the number of cumulative admissions by the number of days for each study period. Results. A total of 231 STEMI patients underwent pPCI from February 22 to December 31,2020: 86 during the first-outbreak, 71 during the second-outbreak and 74 during the inter-outbreak period. Although NoDA was reduced during both outbreaks, the difference with the previous year was greater during the second-outbreak: First-outbreak 0.77 (95% CI, 0.60-0.95) vs 0.88 (95% CI, 0.72-1.04) p=0.36;second-outbreak 0.64 (95% CI, 0.51-0.78) vs 0.87 (95% CI, 0.70-1.04) p=0.035. On the contrary, in the inter-outbreak period, we found a significant increase in NoDA compared to 2019, 0.78 (95% CI, 0.60-0.98) vs 0.51 (95% CI, 0.39-0.63) p=0.016. During the year 2020, a total of 19 in-hospital deaths was reported, with 12 of them occurring during the first outbreak (first outbreak 14% vs second outbreak 8.5% vs inter-outbreak 1.3%, p=0.015). Freedom from all-cause of death at 6-month was not different between 2020 and 2019 during all the three study periods: First-outbreak (95.9% vs 96.7, log-rank test p=0.78), second-outbreak (95.3% vs 95.4%, log-rank test p=0.97), inter-outbreak (94.2% vs 97.5%, log-rank test p=0.42). Conclusion. The reduction of admissions for STEMI was greater during the second rather than the first COVID-19 outbreak compared to the corresponding periods of 2019. Although high rates of in-hospital death, especially during the first-outbreak, were reported, survival at 6 months was not different compared to the previous year within all the three study periods.

Dealing with st-elevation myocardial infarction during the covid-19 pandemic

Introduction. The deleterious side effects of coronavirus disease 2019 (COVID-19) pandemic on the care of patients with ST-elevation myocardial infarction (STEMI) have been reported worldwide, with most data about the period between March-April 2020. In the Lombardy region we dramatically faced with COVID-19 both in the first (February 22th-June 11th) and in the second (September 14th-December 31th) outbreaks of 2020: Our center served as hub for STEMI patients with the network of care that was not modified by the decree of the healthcare Authorities, leading to an unbiased comparison with previous years. We aimed to compare admission, time of assistance and outcomes of STEMI patients undergoing primary PCI (pPCI) during the first-outbreak, the second-outbreak, and the inter-outbreak period of COVID-19 pandemic. Methods. All consecutive patients who were referred to Foundation IRCCS Polyclinic San Matteo (Pavia) for STEMI and underwent pPCI during the first COVID-19 outbreak, the second COVID-19 outbreak, and from June 12th to September 13th (inter-outbreak period) of 2020 were included. Data regarding baseline characteristics, clinical presentation, index procedure and hospitalization were collected and compared between the three study periods. The primary-outcome was in-hospital death. Incidence rate of STEMI admission and of primary-outcome were compared between the three study phases calculating the incidence rate ratios (IRR). Results. A total of 231 STEMI patients were included: 86 underwent pPCI during the first COVID-19 outbreak, 71 during the second COVID-19 outbreak, and 74 during the inter-outbreak period. Regarding the rate of STEMI admission, no differences were found between the three periods (IRR = 1.2, p=0.280 for first-outbreak vs second-outbreak;IRR = 0.98, p=0.918 for first-outbreak vs inter-outbreak;IRR = 0.83, p=0.255 for second-outbreak vs inter-outbreak). Cardiac arrest as clinical presentation occurred in 24 patients, with a higher rate during the first outbreak (first-outbreak 16.3% vs second-outbreak 8.7% vs inter-outbreak 5.4%, p=0.069);14 patients presented with cardiogenic shock (first-outbreak 9.3% vs second-outbreak 4.3% vs inter-outbreak 4%, p=0.294), needing circulatory support with intra-aortic-balloon-pump in 9 cases (first-outbreak 3.5% vs second-outbreak 4.3% vs inter-outbreak 4%, p=0.702). While the time interval "first medical contact-first ECG" was similar between the three periods, the time interval "first ECG-balloon" was lower during the first-outbreak: Respectively, first-outbreak 96.5 (56.5-226) min vs second outbreak 115.5 (60-240.5) min vs inter-outbreak 125 (49-197) min, p=0.920, and tirst-outbreak (83-137) mm vs second-outbreak 112.5 (88-160) min vs inter-outbreak 126 (86-176) min, p=0.059. Overall, a total of 19 in-hospital deaths were reported, with 12 of them occurring during the first outbreak (first-outbreak vs second-outbreak IRR 1.6, p=0.343;first-outbreak vs inter-outbreak IRR 8.7, p=0.009;second-outbreak vs inter-outbreak IRR 5.4, p=0.09). Conclusion. For patients with STEMI undergoing pPCI in the COVID-19 pandemic, despite a shorter time to treatment in the first outbreak, we found a higher rate of in-hospital death during the first-outbreak compared to the inter-outbreak period and no significant differences comparing the first-outbreak with second-outbreak and second-outbreak with the inter-outbreak period.

Standardized Clinical, Functional, and Radiological Pulmonary Follow-Up in Patients Discharged with Diagnosis of COVID-19 from an Italian Hospital -Preliminary Data

Aim: To describe the standardized methodology of the clinical-functional-radiological pulmonary follow-up (F-up) planned for COVID-19 patients discharged from the Pisa University Hospital, Italy. Methods: COVID-19 patients are identified by Hospital Discharge Form code. One month after discharge (T1), symptoms are assessed through a telephone questionnaire. Three months after discharge (T3), patients are proposed to undergo: pulmonary visit, spirometry, plethysmography, DLCO, ABG analysis (if SpO2<95%), chest CT, chest ultrasound, blood test, salivary test. Subsequent F-up for individual patients is based on the combination of standardized comparisons of chest CT (T3 vs. baseline), lung function (presence/absence of spirometric and/or DLCO abnormalities at T3) and respiratory symptoms (T3 vs. T1), as follows: (A) worsening/occurrence of COVID-19 pneumonia chest CT signs, regardless of functional abnormalities and/or respiratory symptoms;F-up is planned at 6 months (T6), with chest CT and clinical-functional evaluation. (B) stability/improvement of COVID-19 pneumonia, with (B1) or without (B2) functional abnormalities and/or respiratory symptoms;F-up is planned at 12 months (T12) with chest CT for both (B1) and (B2), and at T6 with clinical-functional evaluation for (B1). (C) complete resolution of COVID-19 pneumonia, regardless of functional abnormalities and/or respiratory symptoms;F-up is planned at T12, with clinical-functional evaluation. Results: Up to 08/10/2020, n=316 patients were discharged (17% hospitalized ≥3 days in ICU). Up to 01/12/2020, n=162/316 (51,3%) underwent T3-F-up;n=60/316 patients (18.9%) waiting for T3-F-up;n=38/316 (18%) lost to F-up;n=31/316 (9.8%) refusing F-up;n=20/316 (6.3%) died after discharge. Among patients who completed T3-F-up, n=12/162 (7,4%), n=33/162 (20,4%), n=32/162 (19,7%), and n=85/162 (52,5%) were assigned to F-up (A), (B1), (B2), and (C), respectively. The worse the radiological imaging, the higher the median age of the patients (74-, 67-, 68-, and 56-years median age, respectively). In n=65/162 (40,1%) patients, chest CT detected collateral findings (e.g., pulmonary nodules). 57,4% of patients showed normal lung function tests, while 24.5% showed a reduction of DLCO. 64,1% of patients were asymptomatic, 32.7% showed improved/stable, and 3% showed worsening respiratory symptoms. Conclusions: More than half hospitalized COVID-19 patients shows complete resolution of pneumonia chest CT signs and normal lung function at T3-F-up. For a disease whose natural history is yet unknown, a standardized clinical-functional-radiological pulmonary evaluation may serve as tentative guideline for planning F-up. To date such an approach is ongoing and under evaluation.

Facemask: from pandemic to marketplace iconicity

As a result of Covid-19 outbreak, surgical facemasks first emerged as a pandemic icon to then expand into a marketplace icon, with substantial transformations in their meanings, uses, and commercial expressions. This essay contends that facemasks have become a (post-)pandemic marketplace icon by articulating tensions in the socio-cultural, the public media, and the economic sphere. Relying upon secondary-data retrieved from mass media and scientific articles boomed during the pandemic, we propose a theoretically eclectic appraisal of (1) facemasks’ iconisation, (2) the distinct systems raising masks to that iconic status, and (3) the “Marketplace Icons” series more broadly. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

COVID-19 and orthodontics: An approach for monitoring patients at home

Aim: The aim of this study was to test an experimental approach involving the remote monitoring of orthodontic patients through the use of their smartphones. Background: Due to the COVID-19 emergency, dental offices were asked to stop elective treatments;suddenly orthodontic patients found themselves isolated at home, without the possibility of monitoring by their orthodontists. The use of telemonitoring via smartphones can be a quick way to recover the orthodontist-patient relationship, monitor and continue the treatment. Objective: The purpose of this study was to propose an innovative, simple and reliable approach for the remote management of orthodontic patients. Methods: 137 patients were contacted verbally by phone and via WhatsApp®;they were asked to send a set of photographs taken with their smartphone. They were asked to complete a questionnaire to evaluate the effectiveness of the approach. Descriptive statistics (frequency with percent) of questionnaire results and the presence of procedural errors while taking pictures were calculated. Correlations between different questionnaire answers were analyzed with the Chi-Square test. Variables with p < 0:05 were declared as significant. Results: The majority of patients considered that this approach was positive and they did not feel abandoned. Difficulties emerged from a technical point of view, that is, in terms of photoshoot, and part of the patients expressed perplexity regarding the fact that telemonitoring can replace completely an outpatient visit. Conclusion: The use of telemonitoring managed to recreate a relationship with the orthodontist, especially in emergency periods.