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1.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-334460

ABSTRACT

Background: The long-term consequences of the coronavirus disease 19 (COVID-19) are likely to be frequent but results hitherto are inconclusive. Therefore, we aimed to summarize the state-of-the-art literature in relation to long COVID symptomatology, using a systematic review and meta-analysis of observational studies. Methods: A systematic search in several databases was carried out up to 12 January 2022 for observational studies reporting the incidence rate of long COVID signs and symptoms divided according to body systems affected and defined using the World Health Organization criteria. Data are reported as incidence and 95% confidence intervals (CIs). Several sensitivity and meta-regression analyses were moreover performed. Findings: Among 11,162 papers initially screened, 196 studies were included, consisting of 120,970 participants (mean age: 52.3 years;48.8% females) who were followed-up for a median of six months. The incidence of any long COVID symptomatology was 56.9% (95%CI: 52.2-61.6). General long COVID signs and symptoms were the most frequent (incidence of 31%), digestive issues the less frequent (7.7%). Higher percentage of females moderated the onset of any, neurological, general and cardiovascular long COVID symptomatology, whilst higher mean age was associated with higher incidence of psychiatric, respiratory, general, digestive and skin conditions. The incidence of long COVID symptomatology was different according to continent, age and follow-up length. Interpretation: Long COVID is a common condition in patients who have been infected with SARS-CoV-2, whether symptomatically or asymptomatically, and often regardless of the severity of the acute illness indicating the need for more cohort studies on this topic.

2.
Sensors (Basel) ; 21(24)2021 Dec 20.
Article in English | MEDLINE | ID: covidwho-1580509

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has affected hundreds of millions of individuals and caused millions of deaths worldwide. Predicting the clinical course of the disease is of pivotal importance to manage patients. Several studies have found hematochemical alterations in COVID-19 patients, such as inflammatory markers. We retrospectively analyzed the anamnestic data and laboratory parameters of 303 patients diagnosed with COVID-19 who were admitted to the Polyclinic Hospital of Bari during the first phase of the COVID-19 global pandemic. After the pre-processing phase, we performed a survival analysis with Kaplan-Meier curves and Cox Regression, with the aim to discover the most unfavorable predictors. The target outcomes were mortality or admission to the intensive care unit (ICU). Different machine learning models were also compared to realize a robust classifier relying on a low number of strongly significant factors to estimate the risk of death or admission to ICU. From the survival analysis, it emerged that the most significant laboratory parameters for both outcomes was C-reactive protein min; HR=17.963 (95% CI 6.548-49.277, p < 0.001) for death, HR=1.789 (95% CI 1.000-3.200, p = 0.050) for admission to ICU. The second most important parameter was Erythrocytes max; HR=1.765 (95% CI 1.141-2.729, p < 0.05) for death, HR=1.481 (95% CI 0.895-2.452, p = 0.127) for admission to ICU. The best model for predicting the risk of death was the decision tree, which resulted in ROC-AUC of 89.66%, whereas the best model for predicting the admission to ICU was support vector machine, which had ROC-AUC of 95.07%. The hematochemical predictors identified in this study can be utilized as a strong prognostic signature to characterize the severity of the disease in COVID-19 patients.


Subject(s)
COVID-19 , Hospital Mortality , Humans , Machine Learning , Prognosis , Retrospective Studies , SARS-CoV-2 , Survival Analysis
3.
Diagnostics (Basel) ; 11(11)2021 Nov 04.
Article in English | MEDLINE | ID: covidwho-1533837

ABSTRACT

The quality of life of people living with HIV (PLWH) has remarkably increased thanks to the introduction of combined antiretroviral therapy. Still, PLWH are exposed to an increased risk of cardiovascular diseases, diabetes, chronic kidney disease, and liver disease. Hence, the purpose of this review is to summarize the current knowledge about diagnosis and nutritional management with specific indication of macro and micronutrients intake for the main comorbidities of PLWH. In fact, a prompt diagnosis and management of lifestyle behaviors are fundamental steps to reach the "fourth 90". To achieve an early diagnosis of these comorbidities, clinicians have at their disposal algorithms such as the Framingham Score to assess cardiovascular risk; transient elastography and liver biopsy to detect NAFLD and NASH; and markers such as the oral glucose tolerance test and GFR to identify glucose impairment and renal failure, respectively. Furthermore, maintenance of ideal body weight is the goal for reducing cardiovascular risk and to improve diabetes, steatosis and fibrosis; while Mediterranean and low-carbohydrate diets are the dietetic approaches proposed for cardioprotective effects and for glycemic control, respectively. Conversely, diet management of chronic kidney disease requires different nutritional assessment, especially regarding protein intake, according to disease stage and eventually concomitant diabetes.

4.
Viruses ; 13(11)2021 10 20.
Article in English | MEDLINE | ID: covidwho-1481016

ABSTRACT

Antimicrobial resistance is an urgent threat to public health and global development; in this scenario, the SARS-CoV2 pandemic has caused a major disruption of healthcare systems and practices. A narrative review was conducted on articles focusing on the impact of COVID-19 on multidrug-resistant gram-negative, gram-positive bacteria, and fungi. We found that, worldwide, multiple studies reported an unexpected high incidence of infections due to methicillin-resistant S. aureus, carbapenem-resistant A. baumannii, carbapenem-resistant Enterobacteriaceae, and C. auris among COVID-19 patients admitted to the intensive care unit. In this setting, inappropriate antimicrobial exposure, environmental contamination, and discontinuation of infection control measures may have driven selection and diffusion of drug-resistant pathogens.


Subject(s)
Bacterial Infections/microbiology , COVID-19/epidemiology , Coinfection/epidemiology , Drug Resistance, Bacterial , Drug Resistance, Fungal , Mycoses/microbiology , Anti-Bacterial Agents/pharmacology , Bacteria/drug effects , Bacterial Infections/complications , Bacterial Infections/epidemiology , COVID-19/complications , Coinfection/microbiology , Drug Resistance, Multiple, Bacterial , Fungi/drug effects , Humans , Infection Control , Intensive Care Units , Mycoses/complications , Mycoses/epidemiology
5.
Antibiotics (Basel) ; 10(6)2021 May 29.
Article in English | MEDLINE | ID: covidwho-1256419

ABSTRACT

Cefiderocol is a new cephalosporin displaying against extensively resistant (XDR) Gram-negative bacteria. We report our experience with cefiderocol-based combination therapies as "rescue" treatments in immunocompromised or critically ill patients or in patients with post-surgical infections who had failed previous regimens. A total of 13 patients were treated from 1 September 2020 to 31 March 2021. In total, 5/13 (38%) patients were classified as critically ill, due to severe COVID-19 lung failure; 4/13 (31%) patients had post-surgical infections and 4/13 (31%) had severe infections in immunocompromised subjects due to solid organ transplantation (2/4) or hematological malignancy (2/4). Overall, 10/13 infections were caused by carbapenem-resistant Acinetobacter baumannii, one by KPC-positive ceftazidime/avibactam-resistant Klebsiella pneumonia and two by Pseudomonas aeruginosa XDR. Based on clinical, microbiological and hematobiochemical evaluation, cefiderocol was associated with different companion drugs, particularly with fosfomycin, high-dose tigecycline and/or colistin. Microbiological eradication was achieved in all cases and the 30-day survival rate was 10/13; two patients died due to SARS-CoV-2 lung failure, whereas one death was attributed to subsequent infections. No recurrent infections within 30 days were reported. Finally, we hereby discuss the therapeutic potential of cefiderocol and the possible place in the therapy of this novel drug.

6.
Biomed Res Int ; 2021: 8851736, 2021.
Article in English | MEDLINE | ID: covidwho-1140379

ABSTRACT

PURPOSE: This study is aimed at assessing the prevalence of pulmonary artery filling defects (PAFDs) consistent with pulmonary artery embolism (PAE) in patients with SARS-CoV-2 infection and at investigating possible radiological or clinical predictors. MATERIALS AND METHODS: Computed Tomography Pulmonary Angiographies (CTPAs) from 43 consecutive patients with a confirmed COVID-19 infection were retrospectively reviewed, taking into consideration the revised Geneva score and the D-dimer value for each patient. Filling defects within the pulmonary arteries were recorded along with pleural and parenchymal findings such as ground glass opacities, consolidation, crazy paving, linear consolidation, and pleural effusion. All these variables were compared between patients with and without PAFD. The predictive performance of statistically different parameters was investigated using the receiver operating characteristics (ROC). RESULTS: Pulmonary embolism was diagnosed in 15/43 patients (35%), whereas CTPA and parenchymal changes related to pulmonary COVID-19 disease were evident in 39/43 patients (91%). The revised Geneva score and the mean D-dimer value obtained using two consecutive measurements were significantly higher in patients with PAFD. The ROC analysis demonstrated that a mean D-dimer value is the parameter with the higher predictivity (AUC 0.831) that is a cut-off value > 1800 µg/l which predicts the probability of PAFD with a sensitivity and specificity of 70% and 78%, respectively. CONCLUSIONS: This single centre retrospective report shows a high prevalence of pulmonary artery filling defects revealed using CTPA in COVID-19 patients and demonstrates that the mean value of multiple D-dimer measurements may represent a predicting factor of this complication.


Subject(s)
COVID-19/diagnostic imaging , Computed Tomography Angiography/methods , Pulmonary Artery/diagnostic imaging , Adult , Aged , COVID-19/metabolism , COVID-19/virology , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Prevalence , Pulmonary Artery/pathology , Pulmonary Artery/virology , Pulmonary Embolism/diagnosis , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/virology , ROC Curve , Retrospective Studies , SARS-CoV-2/isolation & purification , Sensitivity and Specificity
7.
Viruses ; 13(3)2021 02 26.
Article in English | MEDLINE | ID: covidwho-1115434

ABSTRACT

Coronavirus disease 2019 (COVID-19) has afflicted tens of millions of people, fostering and unprecedent effort in vaccine development and distribution. Healthcare workers (HCW) play a key role in vaccine promotion and patient guidance, and it is likely that hesitancy among this population will have a major impact on the adoption of a successful immunization policy. To investigate HCW attitudes towards anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccination, we developed an anonymous online cross-sectional survey. 1723 Italian HCW responded. Overall, 1155 (67%) intended to be vaccinated, while 443 (26%) were not sure and 125 (7%) declared refusal. In multivariate analysis, factors associated with hesitancy were using Facebook as the main information source and being a non-physician HCW, while predictors of acceptance included younger age, being in close contact with high-risk groups and having received flu vaccination during the 2019-2020 season. Reasons for hesitancy included lack of trust in vaccine safety (85%) and receiving little (78%) or conflicting (69%) information about vaccines. According to our results, adequate investment in vaccine education for healthcare personnel appears to be urgently needed, prioritizing non-physicians and information quality spread through social media. We hope that our data could help governments and policy-makers to target communication in the ongoing COVID-19 vaccination campaign.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Health Personnel/psychology , SARS-CoV-2/immunology , Vaccination Refusal/psychology , Adult , COVID-19/epidemiology , Cross-Sectional Studies , Female , Health Knowledge, Attitudes, Practice , Health Personnel/statistics & numerical data , Humans , Italy/epidemiology , Male , Middle Aged , Surveys and Questionnaires , Vaccination Refusal/statistics & numerical data
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