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1.
ERS Monograph ; 2021(94):1-13, 2021.
Article in English | EMBASE | ID: covidwho-2321584

ABSTRACT

The major morbidity and mortality from COVID-19 is due to acute viral pneumonitis that evolves to ARDS. Furthermore, COVID-19 patients may be affected by extrarespiratory involvement, including cardiac, renal, neurological and vascular complications. Different hospitals reorganised their logistical structures to optimise the care of COVID-19 patients and ensure infection control, and the public health scenario worldwide was characterised by the rapid spread of multidisciplinary units specifically dedicated to COVID-19 patients. This chapter describes the personal experience and clinical case of a previously healthy and active patient who suffered from severe COVID-19. Two other cases of patients hospitalised because of severe acute respiratory failure due to COVID-19 are also discussed.Copyright © ERS 2021.

2.
ERS Monograph ; 2021(94):180-196, 2021.
Article in English | EMBASE | ID: covidwho-2314985

ABSTRACT

This chapter explores the currently available knowledge (as at October 2021) about the long-term clinical consequences of COVID-19. Distinction between cardiorespiratory and extra-cardiorespiratory sequelae can facilitate understanding of the post-COVID sequelae problem and may aid the clinical management of patients. The strength of the recommendations is highlighted at the end of each paragraph.Copyright © ERS 2021.

3.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2285029

ABSTRACT

The SARS-CoV-2 is the betacoronavirus responsible for the coronavirus disease 2019 (COVID-19) pandemic. Severe COVID-19 affects approximately 10-15% of patients and results in prolonged morbidity and mortality. Little is known about the immunophenotypic changes of the lung parenchyma driven by the viral infection in patients who die of severe COVID-19. Ultrasound-guided lung biopsies (LB) were collected (IRB approval#1561/21) within few hours from death in 15 severe COVID-19 patients between November 2020 and January 2021, in two patients who underwent lung transplantation after COVID-19 and in one patient who had surgery for bacterial superinfection during COVID-19 disease. All samples underwent histologic and immunohistochemistry evaluation and molecular profiling using the nCounter Host Response and Coronavirus Panel plus. As controls, lungs from end-stage usual interstitial pneumonia (UIP;n=9) and from lobectomy for lung cancer (Norm;n=5) were used. Eleven lungs (61%) were positive for SARS-CoV-2 RNA. Signs of diffuse alveolar damage (DAD) were observed in 6 patients (30%). COVID-19 lungs showed a marked macrophage infiltration with M2 polarization compared with controls. Globally, COVID-19 lungs showed distinct molecular profiles from UIP or Norm lungs. Specifically, a marked upregulation of interferon-genes that was directly correlated with SARS-CoV-2 genes was seen in COVID-19 lungs. COVID-19-specific genes signatures (Log2FC >1.5;adj p<0.05) obtained using VENN diagram showed impairment of the STAT3-pathway accompanied by the upregulation of the NFkB signaling. Results herein provide new insights into lung alterations induced by severe COVID-19 and suggest novel potential targets for therapeutic intervention.

4.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2279138

ABSTRACT

Background: Continuous positive airway pressure (CPAP) can improve oxygenation in severe COVID-19 pneumonia. Objective(s): To assess whether CPAP-associated improvements in oxygenation can inform clinical outcomes in patients with severe COVID-19 pneumonia. Method(s): Retrospective study in patients with severe COVID-19 pneumonia treated with CPAP in three academic respiratory units in Milan, Italy. Arterial gas analysis obtained before and 1 hour after starting CPAP. CPAP failure defined as either death in the respiratory units while on CPAP or need for intubation. Result(s): 211 patients (mean age 64 years, 74% males) were included. Baseline median PaO2was 68 (57-83) mmHg, PaO2/FiO2(P/F) ratio was 129 (91-179) mmHg and alveolar-arterial (A-a) O2 gradient was 310 (177-559) mmHg. On CPAP, PaO2and P/F increased to 100 (79-141) (p<0.001) and 195 (132-257;p<0.001) mmHg and A-a gradient decreased to 240 (188-308;p<0.001) mmHg. 42 (19.9%) patients died in the respiratory units while on CPAP and 51 (24.2%) required intubation. There was a substantial overlap of baseline and CPAP-associated values of PaO2, P/F ratio and A-a gradient in CPAP failures and successes (Figure). CPAP-associated changes in PaO2, P/F ratio and A-a gradient in both groups were similar. Conclusion(s): CPAP-associated improvements in oxygenation cannot be used to inform clinical outcomes of the individual patient with severe COVID-19 pneumonia.

5.
Coronaviruses ; 2(1):27-29, 2021.
Article in English | EMBASE | ID: covidwho-2249053

ABSTRACT

Italy was the first western nation affected by the pandemic and was observed as a pilot case in the management of the new coronavirus epidemic. The outbreak of COVID-19 disease has been challeng-ing in Italy. On June 25, 2020 there were 239,821 total cases, of which 33,592 were deaths nationwide. Three lessons emerged from this experience that can serve as a blueprint to improve future plans for the outbreak of viruses. First, early reports on the spread of COVID-19 can help inform public health officials and medical practitioners in effort to combat its progression;second, inadequate risk assessment related to the urgency of the situation and limited reporting to the virus has led the rapid spread of COVID-19;third, an effective response to the virus had to be undertaken with coherent system of actions simultaneously.Copyright © 2021 Bentham Science Publishers.

6.
Journal of Physical Education and Sport ; 23(1):143-151, 2023.
Article in English | Scopus | ID: covidwho-2238552

ABSTRACT

Problem statement. The COVID-19 pandemic effect led to a reduction in psychological, social, and physical wellbeing, due to social isolation and sedentariness. Interventions are needed to prevent and improve wellbeing, especially among adult women, for whom the greatest health problems arisen. Ecological exercise can produce greater health benefits than indoor training, including improved humor, self-esteem, physical fitness and reduced stress, anxiety, and depression. Nordic Walking (NW) is an ecological activity, whose beneficial effects can be extended to both healthy people and those with diseases. However, we had to try to understand the motivations that make an individual, especially in adulthood, choose to engage in physical activity (PA), using the push-pull motivational framework. Purpose. The aim of the study was to investigate the adult women's motivations to practice PA post-COVID-19, the relationship among the variables analyzed, and their perceptions about the intention to practice NW in the future, to improve their physical, social, and mental wellbeing. Methods. A convenience sample of 65 women (50.07 ± 7.85 years old) was recruited for the study. A structured questionnaire was formulated, based on a thorough literature review, consisting of three sections: demographic characteristics, pull-push motivational factors to PA and future intention to perform NW. Results. Most adult women did not perform PA because of the boredom caused by the repetition of exercises and for fear of infection. However, they would prefer to practice outdoor activities in the future, including NW, through a teaching method different from the prescriptive one, the solution to which could be the heuristic learning. Motivations to take part in PA course varied according to the age: the younger ones had the need to improve their mental and physical state, while the older ones the need for social and autonomy. Conclusions. Future studies should focus on implementing an original and innovative protocol, that is not performance-oriented, but also aimed to improve social and mental wellbeing. The utility of the study is to provide more information to wellness instructors to attract potential customers to participate in PA courses. © JPES.

7.
Pulmonology ; 28(6): 419-420, 2022.
Article in English | MEDLINE | ID: covidwho-2126565

Subject(s)
Vaccination , Humans
8.
European Respiratory Journal ; 56(4), 2021.
Article in English | GIM | ID: covidwho-1523277

ABSTRACT

To evaluate outcomes of COVID-19 patients with pneumonia-related hypoxaemic acute respiratory failure (hARF) undergoing continuous positive airway pressure therapy (CPAP) treatment, hence, a multicentre, observational, prospective study was conducted between 7 March 2020 and 21 April 2020 in three high-dependency units (HDU) at two hospitals in Milan, Italy. The primary outcome was CPAP failure defined as the occurrence of either intubation or death due to any cause during hospital high-dependency units (HDU) stay while secondary outcomes included the weaning from CPAP to oxygen therapy (CPAP success), all-cause in-hospital and 30-day mortality. A total of 157 patients with hARF (median (IQR) PaO2/FIO2 ratio 142.9 (96.7-203.2)) underwent helmet CPAP with an initial median (IQR) FIO2 of 0.6 (0.5-0.6) and mean positive end-expiratory pressure (PEEP) of 10.8+or-2.3 cmH<sub>2</sub>O. The most prevalent comorbidities were arterial hypertension (44.0%), diabetes (22.9%), ischaemic cardiac disease (17.2%) and chronic arrhythmia (10.8%). Hypoxaemia generally improved when CPAP treatment was initiated: median (IQR) values of PaO2/FIO2 ratio at baseline on oxygen therapy (142.9 (96.7-203.2)) significantly improved when helmet CPAP was used after 6 h (205.6 (140.0-271.1), p<0.0001). However, an increase of at least 30% in PaO2/FIO2 ratio during helmet CPAP application in comparison to oxygen therapy was found only in 52% of the population. Median (IQR) duration of helmet CPAP treatment was 6 days. Only 4 patients discontinued helmet CPAP because of intolerance. CPAP failure was observed in 70 (44.6%) patients: 34 (21.7%) were intubated and 36 (22.9%) died during the HDU stay. 87 (55.4%) patients improved during the HDU stay, weaned to oxygen therapy and transferred to the general ward. No patients were intubated during the first hours after CPAP initiation or under high emergency conditions. Among those who died in HDU, pneumonia-related deaths were detected in 26 patients, while non-pneumonia related in 10 patients, including pulmonary embolisms (n=5), end-stage renal failure (n=2), cerebrovascular accident (n=1), end-stage heart failure (n=1) and septic shock (n=1). Among the 34 patients who were intubated in HDU and transferred to the ICU, nine (26.5%) died. A total of 65 (41.4%) patients had a Do-Not-Intubate (DNI) status on HDU admission: 36 died and 29 survived. At the multivariable analysis, CPAP failure was associated with the severity of pneumonia on admission (HR (95% CI) 2.9 (1.3-6.2), p=0.009) and higher baseline values of interleukin-6 (HR (95% CI) 1.0 (1.0-1.0), p<0.009). The all-cause in-hospital and 30-day mortality rates were 28.7% and 28.0%, respectively.

9.
Research and Practice in Thrombosis and Haemostasis ; 5(SUPPL 2), 2021.
Article in English | EMBASE | ID: covidwho-1508945

ABSTRACT

Background : Covid-19 infection is associated with a widespread global activation of coagulation and affected patients are at an increased risk of thrombosis. Aims : Heparin therapy is effective in various setting in preventing thromboembolic complications and aim of this study was to assess heparin response in COVID-19 patients through anti-FXa test. Methods : In 52 patients, M:F ratio 59:41, median age 59 years old, admitted in different intensity of care units of our hospital, treated with different regimens of heparin (100 U/kg every 24 h in low intensity care, 70 U/kg every 12 h in intermediate intensity care and 100 U/kg every 12 h in intensive care unit), anti-FXa levels were measured immediately before and 3 h after subcutaneous enoxaparin administration. On the same samples thrombin generation tests were performed. Results : Patients treated with 100 U/kg every 24 h and 70 U/ kg every 12 h had median anti-FXa basal levels in the prophylactic range, respectively 0.18 and 0.22 U/ml, while patients treated with 100 U/kg every 12 h were in the anticoagulant range (0.37 U/ ml). Despite heparin therapy thrombin generation was elevated in COVID-19 patients, indicating a high level of coagulation activation. Conclusions : In conclusion we demonstrated that the biological response to enoxaparin in COVID-19 patients is in the expected range using anti-FXa assay and patients are not resistant to heparin therapy.

10.
European Journal of Neurology ; 28(SUPPL 1):292, 2021.
Article in English | EMBASE | ID: covidwho-1307726

ABSTRACT

Background and aims: Although COVID-19 infection predominantly manifests with respiratory symptoms, recent studies have also reported the occurrence of neurological involvement in the acute phase as well as in the follow-up of recovered subjects Methods: Our study focuses on assessing the prevalence of neurological sequelae in COVID-19 patients hospitalized at Ospedale Maggiore Policlinico in Milan. Seventy-five COVID-19 recovered subjects followed a general follow-up protocol including pneumological, infectious and cardiovascular assessment 5-10 months after the onset of SARS-CoV2 infection;among them, a subset of 53 patients was evaluated through a self-administered 18-item questionnaire developed ad-hoc addressing sensory, motor and cognitive neurological symptoms. Results: Collected data has shown that 77.4% patients developed at least one neurological sequela, and 46.3% presented with more than three symptoms. Among symptomatic patients, the most prevalent manifestations were insomnia (65.9%) and daytime sleepiness (46.3%), followed by walking difficulties (31.7%). Other less frequent symptoms were headache (15.1%), hyposmia and hypogeusia (15.1%), and tremor (9.4%). Prevalence of symptoms 18-item questionnare showing the distribution of neurological manifestations Conclusion: Post-COVID-19 manifestations are reported in about 90% of recovered patients. This preliminary study suggests that neurological findings represent a significant part of such manifestations. We are currently expanding the questionnaire to a larger cohort of patients and correlating our findings with patients' demographical and clinical features, as well as with the severity of the previous SARSCoV2 infection. Currently, the same questionnaire is also being validated and administered to age-and sex-matched healthy controls who have not developed symptoms suggestive of Covid-19, and a cohort of non-COVID-19 hospitalized patients.

11.
Journal of Physical Education and Sport ; 21:612-617, 2021.
Article in English | Scopus | ID: covidwho-1148359

ABSTRACT

Problem Statement. One of the major current problems in the motor and sports field concerns the impact of the COVID-19 epidemic on the economy of fitness and sports centers, which risk a permanent closure due to the prolonged blocking of activities. For a future restart, it is necessary to find adaptive and / or compensatory strategies, such as outdoor activities.Purpose. The study investigates some elements of current motor practice and the possibility of organizing / participating in outdoor fitness classes. The utility is to summarize the state of the art, even if currently dynamic, to hypothesize a new adaptive and / or compensatory strategy for the possible change in current lifestyles.Methods. The sample is made up of 224 motor science students from the University of Salerno because they are future experts and, in the abstract, interpreters of a healthy and active lifestyle tending to performance. A structured questionnaire was prepared with Google Forms and emailed to students. Data were analyzed using cluster analysis and descriptive statistics, to calculate the variables expressed as a percentage.Results. The second lockdown did not stop the practice of physical activity (78.6%) in motor science students. 57.6% declared that they practiced outdoor motor activities, individually (60.16%), on the street (55.47%), without a mask (71.09%) and maintaining social distancing (97.66%). The majority (94.64%) have never practiced or organized outdoor fitness classes;however, 64.3% in the future are willing to plan / take part in outdoor fitness classes. An obstacle could be represented by the lack of spaces or paths, as stated by 74.11%.Conclusions. From the result of the study, an evolving phenomenon emerges preliminarily which, at times, compensates for the current emergency state and, proactively, can be adaptive.Given the local nature of the data, it can be used for the establishment and new training in motor sciences, called Sport, Exercise and Wellness Management. © 2021, Editura Universitatii din Pitesti. All rights reserved.

12.
Teoria ta Metodika Fizicnogo Vihovanna ; 20(4):242-247, 2020.
Article in English | Scopus | ID: covidwho-1027402

ABSTRACT

Research purpose. The present study aims to examine the changes in physical activity levels during the lockdown due to COVID-19 in Italy. In particular, it aims to assess whether people have continued to exercise at home, how much the home environment has influenced the desire to train and what people think about Smart-fitness and sport in general. Materials and methods. A sample of 268 people from the province of Salerno participated in the study, with an average age of 26 years. To achieve the tasks set, the study relied on the following methods: Analysis of scientific literature, formulation and administration of a questionnaire and data analysis through methods of mathematical statistics. A structured questionnaire was prepared, disseminated through social networks. To analyze the data, the Social Sciences Statistical Package (SPSS) and descriptive statistics were used to calculate the demographic variables. The factor analysis was also calculated to verify the characteristics of the sport considered important by the participants. Results. The results obtained made it possible to understand the main type of physical activity carried out during the quarantine (aerobic activity 35 %, functional training 27 %, anaerobic activity 19 %), the time dedicated to each session (52.8 % practice for 1 hour) and the weekly frequency of the same (42.9 % practice physical activity continuously more than times a week). It was also understood the reasons that prompted the interviewees to train, the way they planned their session and the equipment used. Finally, it was shown that the majority of the sample (64.17%) knew smart fitness considering it an interesting activity, and the influence attributed to the home environment by a scale of values from 1 to 5. Furthermore, the factor analysis shows us the most relevant aspects wich respondents attributed to sport. More frequently, respondents place greater importance on being loyal and correct, on the contrary, lower values are attributed to the importance of earning money, and not to disappoint others. Conclusions. The study found that COVID-19 did not stop athletes, who quickly adapted to the new situation. The home environment has proved to be very influential on the desire to train, despite this, they hope to return to the gym as soon as possible. © 2020 OVS LLC. All rights reserved.

14.
Clin Microbiol Infect ; 26(7): 880-894, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-172186

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19), which has rapidly become epidemic in Italy and other European countries. The disease spectrum ranges from asymptomatic/mildly symptomatic presentations to acute respiratory failure. At the present time the absolute number of severe cases requiring ventilator support is reaching or even surpassing the intensive care unit bed capacity in the most affected regions and countries. OBJECTIVES: To narratively summarize the available literature on the management of COVID-19 in order to combine current evidence and frontline opinions and to provide balanced answers to pressing clinical questions. SOURCES: Inductive PubMed search for publications relevant to the topic. CONTENT: The available literature and the authors' frontline-based opinion are summarized in brief narrative answers to selected clinical questions, with a conclusive statement provided for each answer. IMPLICATIONS: Many off-label antiviral and anti-inflammatory drugs are currently being administered to patients with COVID-19. Physicians must be aware that, as they are not supported by high-level evidence, these treatments may often be ethically justifiable only in those worsening patients unlikely to improve only with supportive care, and who cannot be enrolled onto randomized clinical trials. Access to well-designed randomized controlled trials should be expanded as much as possible because it is the most secure way to change for the better our approach to COVID-19 patients.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/therapeutic use , Betacoronavirus/drug effects , Coronavirus Infections/drug therapy , Off-Label Use/ethics , Pneumonia, Viral/drug therapy , COVID-19 , Coronavirus Infections/epidemiology , Humans , Intensive Care Units/statistics & numerical data , Italy/epidemiology , Lung Diseases/drug therapy , Lung Diseases/pathology , Lung Diseases/virology , Pandemics , Pneumonia, Viral/epidemiology , Respiration, Artificial/methods , SARS-CoV-2
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