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1.
J Clin Med ; 11(4)2022 Feb 19.
Article in English | MEDLINE | ID: covidwho-1715434

ABSTRACT

Correlation between risk of graft-versus-host disease (GvHD) and CD3+ counts within the peripheral blood stem cell graft has recently been reported in the setting of post-transplant cyclophosphamide (PT-Cy). We aimed to investigate the benefit of the addition of a single dose of anti-T lymphocyte globulin (ATLG 5 mg/kg) to PT-Cy in this setting. Starting in 2019, all patients receiving PBSC transplant containing CD3+ counts above 300 × 106/kg (study group) received a post-transplant dose of ATLG in addition to standard PT-Cy. The study was designed as a real-life analysis and included all consecutive Hematopoietic Stem Cell Transplantation (HSCT) recipients according to the above-mentioned inclusion criterion (n = 21), excluding cord blood and bone marrow donors. Using a 1:2 matched-pair analysis, we compared the outcomes with a historical population who received PT-Cy only (control group). We found a delayed platelet engraftment (29% vs. 45% at 30 days, p = 0.03) and a non-significant trend toward higher risk of poor graft function (29% vs. 19%, p = 0.52). The addition of ATLG impacted long-term immune reconstitution on the CD4+ subsets, but this did not translate into higher rate of relapse or viral infection. Acute GvHD was not significantly impacted, but 1-year cumulative incidence of chronic GvHD was significantly lower in the study group (15% vs. 41%, p = 0.04). Survival outcomes were comparable. In conclusion PT-Cy and ATLG was overall safe and translated into a low rate of chronic GvHD incidence.

2.
Risk Manag Healthc Policy ; 14: 2221-2229, 2021.
Article in English | MEDLINE | ID: covidwho-1262573

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) epidemic is an infectious disease which was declared a pandemic and hit countries worldwide from the beginning of the year 2020. Despite the emergency vigilance plans, health systems in all countries experienced a different ratio of lethality, amount of admissions to intensive care units and quarantine management of positive patients. The aim of this study is to investigate whether some epidemiological estimates could have been useful in understanding the capacity of the Italian Regional Health Services to manage the COVID-19 epidemic. METHODS: We have compared data between two different Italian regions in the Northern part of Italy (Lombardy and Veneto) and the national data to determine whether different health strategies might be significant in explaining dissimilar patterns of the COVID-19 epidemic in Italy. Data have been extracted from a public database and were available only in an aggregated form. RESULTS: The regions in question displayed two different health policies to face the COVID-19 epidemic: while Veneto's health service was largely territorially oriented, Lombardy's strategy was more hospital-centered. DISCUSSION: The key to facing epidemics like this one consists in identifying solutions outside of hospitals. This however requires there be well-trained general practitioners and enough healthcare personnel working outside hospitals.

3.
PLoS One ; 16(2): e0247854, 2021.
Article in English | MEDLINE | ID: covidwho-1102388

ABSTRACT

The first case of Coronavirus Disease 2019 in Italy was detected on February the 20th in Lombardy region. Since that date, Lombardy has been the most affected Italian region by the epidemic, and its healthcare system underwent a severe overload during the outbreak. From a public health point of view, therefore, it is fundamental to provide healthcare services with tools that can reveal possible new health system stress periods with a certain time anticipation, which is the main aim of the present study. Moreover, the sequence of law decrees to face the epidemic and the large amount of news generated in the population feelings of anxiety and suspicion. Considering this whole complex context, it is easily understandable how people "overcrowded" social media with messages dealing with the pandemic, and emergency numbers were overwhelmed by the calls. Thus, in order to find potential predictors of possible new health system overloads, we analysed data both from Twitter and emergency services comparing them to the daily infected time series at a regional level. Particularly, we performed a wavelet analysis in the time-frequency plane, to finely discriminate over time the anticipation capability of the considered potential predictors. In addition, a cross-correlation analysis has been performed to find a synthetic indicator of the time delay between the predictor and the infected time series. Our results show that Twitter data are more related to social and political dynamics, while the emergency calls trends can be further evaluated as a powerful tool to potentially forecast new stress periods. Since we analysed aggregated regional data, and taking into account also the huge geographical heterogeneity of the epidemic spread, a future perspective would be to conduct the same analysis on a more local basis.


Subject(s)
COVID-19/epidemiology , Epidemiological Monitoring , Social Media , Emergency Medical Services , Forecasting , Humans , Italy/epidemiology , Pandemics
4.
PLoS One ; 16(2): e0246513, 2021.
Article in English | MEDLINE | ID: covidwho-1099923

ABSTRACT

Castiglione D'Adda is one of the municipalities more precociously and severely affected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) epidemic in Lombardy. With our study we aimed to understand the diffusion of the infection by mass serological screening. We searched for SARS-CoV-2 IgGs in the entire population on a voluntary basis using lateral flow immunochromatographic tests (RICT) on capillary blood (rapid tests). We then performed chemioluminescent serological assays (CLIA) and naso-pharyngeal swabs (NPS) in a randomized representative sample and in each subject with a positive rapid test. Factors associated with RICT IgG positivity were assessed by uni- and multivariate logistic regression models. Out of the 4143 participants, 918 (22·2%) showed RICT IgG positivity. In multivariable analysis, IgG positivity increases with age, with a significant non-linear effect (p = 0·0404). We found 22 positive NPSs out of the 1330 performed. Albeit relevant, the IgG prevalence is lower than expected and suggests that a large part of the population remains susceptible to the infection. The observed differences in prevalence might reflect a different infection susceptibility by age group. A limited persistence of active infections could be found after several weeks after the epidemic peak in the area.


Subject(s)
COVID-19 Serological Testing/methods , COVID-19/epidemiology , COVID-19/transmission , Antibodies, Viral/blood , COVID-19/blood , COVID-19/diagnosis , COVID-19 Serological Testing/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Italy/epidemiology , Male , Mass Screening/methods , Prevalence , SARS-CoV-2/genetics , SARS-CoV-2/pathogenicity
6.
Preprint in English | medRxiv | ID: ppmedrxiv-20212415

ABSTRACT

The first case of Coronavirus Disease 2019 in Italy was detected on February the 20th in Lombardy region. Since that date, Lombardy has been the most affected Italian region by the epidemic, and its healthcare system underwent a severe overload during the outbreak. From a public health point of view, therefore, it is fundamental to provide healthcare services with tools that can reveal possible new health system stress periods with a certain time anticipation, which is the main aim of the present study. Moreover, the sequence of law decrees to face the epidemic and the large amount of news generated in the population feelings of anxiety and suspicion. Considering this whole complex context, it is easily understandable how people "overcrowded" social media with messages dealing with the pandemic, and emergency numbers were overwhelmed by the calls. Thus, in order to find potential predictors of possible new health system overloads, we analysed data both from Twitter and emergency services comparing them to the daily infected time series at a regional level. Particularly, we performed a wavelet analysis in the time-frequency plane, to finely discriminate over time the anticipation capability of the considered potential predictors. In addition, a cross-correlation analysis has been performed to find a synthetic indicator of the time delay between the predictor and the infected time series. Our results show that Twitter data are more related to social and political dynamics, while the emergency calls trends can be further evaluated as a powerful tool to potentially forecast new stress periods. Since we analysed aggregated regional data, and taking into account also the huge geographical heterogeneity of the epidemic spread, a future perspective would be to conduct the same analysis on a more local basis.

7.
Acta Biomed ; 91(9-S): 29-33, 2020 07 20.
Article in English | MEDLINE | ID: covidwho-670002

ABSTRACT

On 18th February the first Italian case of Coronavirus Induced Disease 2019 (COVID19) due to secondary transmission outside China was identified in Codogno, Lombardia region. In the following days the number of cases started to rise not only in Lombardia but also in other Italian regions, although Lombardia remained and it is still the most affected region in Italy. At the moment, 234801 cases have been identified in Italy, out of which 90070 in Lombardia region. The (Severe Acute Respiratory Syndrome Coronavirus 2) SARS CoV 2 outbreak in Italy has been characterized by a massive spread of news coming from both official and unofficial sources leading what has been defined as infodemia, an over-abundance of information - some accurate and some not - that has made hard for people to find trustworthy sources and reliable guidance needed. Infodemia on SARS CoV 2 created the perfect field to build uncertainty in the population, which was scared and not prepared to face this outbreak. It is understandable how the rapid increase of the cases' number , the massive spread of news and the adoption of laws to face this outbreak led to a feeling of anxiety in the population whose everyday life changed very quickly. A way to assess the dynamic burden of social anxiety is a context analysis of major social networks activities over the Internet. To this aim Twitter represents a possible ideal tool since the focused role of the tweets according to the more urgent needs of information and communication rather than general aspects of social projection and debate as in the case of Facebook, which could provide slower responses for the fast individual and social context evolution dynamics.  Aim of the paper is to analyse the most common reasons for calling and outcomes. Furthermore, the joint analysis with Twitter trends related to emergency services might be useful to understand possible correlations with epidemic trends and predict new outbreaks.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Emergency Service, Hospital , Pneumonia, Viral/epidemiology , Social Networking , COVID-19 , Disease Outbreaks , Epidemiological Monitoring , Humans , Italy/epidemiology , Pandemics , SARS-CoV-2
8.
Preprint in English | medRxiv | ID: ppmedrxiv-20130146

ABSTRACT

The Coronavirus Disease 19 epidemic is an infectious disease which was declared as a pandemic and hit all the Countries, all over the world, from the beginning of the year 2020. Despite the emergency vigilance plans, in all the Countries, Health Systems experienced a different ratio of lethality, admissions to intensive care units and managing quarantine of positive patients. The aim of this study is to investigate if some health indicators might have been useful to understand the capacity of Italian National Health Service to manage the COVID 19 epidemic. We will compare data in two different Italian regions in the Northern part of Italy (Lombardy and Veneto) with the national data to understand if different health strategies might be significant to explain different patterns of COVID 19 epidemic in Italy. The two regions have two different health policies to face CoViD-2019 epidemic. To face epidemic like this one the answer should be outside hospitals but this means to have general practitioners well-trained and enough healthcare personnel working outside hospitals.

9.
Acta Biomed ; 91(2): 31-34, 2020 04 20.
Article in English | MEDLINE | ID: covidwho-320795

ABSTRACT

An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in December 2019 in China and was declared a pandemic on 11.03.2020 by WHO. Italy is one of the most afflicted Country by this epidemic with 136,110 confirmed cases and 16,654 deaths on 9.4.2020 (at the same date, the Ministry of Health was reporting 143,626 cases).  During these few months the National Health Service have made a great effort to cope with the increasing request of intensive care beds and all the elective activities in hospital have been suspended. Data from the different Italian regions shows different patterns of positive and dead for this syndrome. Moreover, striking differences of the observed lethality of the infections among different areas were immediately evident from the epidemic reports. It will be of critical relevance to understand the expected evolution of the first lock-down phase, driving the exhaustion of the Covid-19 outbreak.(www.actabiomedica.it).


Subject(s)
Coronavirus Infections/mortality , Coronavirus , Pandemics , Pneumonia, Viral/mortality , Betacoronavirus , COVID-19 , Coronavirus/isolation & purification , Coronavirus/pathogenicity , Coronavirus Infections/diagnosis , Disease Outbreaks , Humans , Italy/epidemiology , Pneumonia, Viral/diagnosis , SARS-CoV-2
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