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1.
Minerva Cardiol Angiol ; 70(2): 160-166, 2022 04.
Article in English | MEDLINE | ID: covidwho-1786557

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has rapidly spread globally. Due to different testing strategies, under-detection of positive subjects and COVID-19-related-deaths remains common. Aim of this analysis was to assess the real impact of COVID-19 through the analysis of 2020 Italian all-cause mortality data compared to historical series. METHODS: We performed a retrospective analysis of 2020 and 2015-2019 all-cause mortality data released by the Italian National Institute for Statistics (ISTAT) for the time period January 1st-March 21st. This preliminary sample included 1084 Italian municipalities showing at least 10 deaths during the above-mentioned timeframe and an increase in mortality of more than 20% as compared to the previous five years (2015-2019), with a resulting coverage of 21% of Italian population. The difference between 2020 observed and expected deaths (mean of weekly deaths in 2015-2019) was computed, together with mortality rate ratio (MRR) for each of the four weeks following detection of the first autochthonous COVID-19 case in Italy (February 23rd, 2020 - March 21st, 2020), as well as for this entire timeframe. Subgroup analysis by age groups was also performed. RESULTS: Overall MRR was 1.79 [1.75-1.84], with an observed excess mortality of 8750 individuals in the investigated sample, which in itself outweighs Italian Civil Protection report of only 4,825 COVID-19-related deaths across Italy, as of March 21. Subgroup analysis did not show any difference in mortality rate in '0-14 years' age group, while MRRs were significantly increased in older age groups, in particular in patients >75 years (MRR 1.84 [1.79-1.89]). In addition, week-by-week analysis showed a progressive increase in MRR during this period, peaking in the last week (March 15th, 2020 - March 21st, 2020) with an estimated value of 2.65 [2.53-2.78]. CONCLUSIONS: The analysis of all-cause mortality data in Italy indicates that reported COVID-19-related deaths are an underestimate of the actual death toll. All-cause death should be seen as the epidemiological indicator of choice to assess the real mortality impact exerted by SARS-CoV-2, given that it also best reflects the toll on frail patient subsets (e.g. the elderly or those with cardiovascular disease).


Subject(s)
COVID-19 , Cardiovascular Diseases , Aged , Cardiovascular Diseases/epidemiology , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
2.
Minerva Cardiol Angiol ; 2022 02 25.
Article in English | MEDLINE | ID: covidwho-1780402

ABSTRACT

The challenges to academic and professional development and career advancement of women in cardiology (WIC), imposed by the pandemic, not only impinge the female cardiologists' "leaky pipeline" but also make the "leakiness" more obvious. This consensus document aims to highlight the pandemic challenges WIC face, raise awareness of the gender equity gap, and propose mitigating actionable solutions derived from the data and experiences of an international group of female cardiovascular clinicians and researchers. This changing landscape has led to the need for highly specialized cardiologists who may have additional training in critical care, imaging, advanced heart failure, or interventional cardiology. Although women account for most medical school graduates, the number of WIC, particularly in mentioned sub-specialties, remains low. Moreover, women have been more affected by systemic issues within these challenging work environments, limiting their professional progression, career advancement, and economic potential. Therefore, it is imperative that tangible action points be noted and undertaken to ensure the representation of women in leadership, advocacy, and decision-making, and increase diversity in academia. Strategies to mitigate the negative impacts of the pandemic need to be taken during this COVID-19 pandemic to ensure WIC have a place in the field of Cardiology.

3.
Nutrients ; 12(6)2020 Jun 08.
Article in English | MEDLINE | ID: covidwho-1725884

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) global pandemic is a devastating event that is causing thousands of victims every day around the world. One of the main reasons of the great impact of coronavirus disease 2019 (COVID-19) on society is its unexpected spread, which has not allowed an adequate preparation. The scientific community is fighting against time for the production of a vaccine, but it is difficult to place a safe and effective product on the market as fast as the virus is spreading. Similarly, for drugs that can directly interfere with viral pathways, their production times are long, despite the great efforts made. For these reasons, we analyzed the possible role of non-pharmacological substances such as supplements, probiotics, and nutraceuticals in reducing the risk of Sars-CoV-2 infection or mitigating the symptoms of COVID-19. These substances could have numerous advantages in the current circumstances, are generally easily available, and have negligible side effects if administered at the already used and tested dosages. Large scientific evidence supports the benefits that some bacterial and molecular products may exert on the immune response to respiratory viruses. These could also have a regulatory role in systemic inflammation or endothelial damage, which are two crucial aspects of COVID-19. However, there are no specific data available, and rigorous clinical trials should be conducted to confirm the putative benefits of diet supplementation, probiotics, and nutraceuticals in the current pandemic.


Subject(s)
Coronavirus Infections/diet therapy , Coronavirus Infections/prevention & control , Diet , Dietary Supplements , Pandemics/prevention & control , Pneumonia, Viral/diet therapy , Pneumonia, Viral/prevention & control , Probiotics/therapeutic use , Ascorbic Acid/therapeutic use , Betacoronavirus , COVID-19 , Humans , SARS-CoV-2 , Vitamin D/therapeutic use
4.
Panminerva Med ; 63(3): 324-331, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1504553

ABSTRACT

BACKGROUND: New messenger RNA (mRNA) and adenovirus-based vaccines (AdV) against Coronavirus disease 2019 (COVID-19) have entered large scale clinical trials. Since healthcare professionals (HCPs) and armed forces personnel (AFP) represent a high-risk category, they act as a suitable target population to investigate vaccine-related side effects, including headache, which has emerged as a common complaint. METHODS: We investigated the side-effects of COVID-19 vaccines among HCPs and AFP through a 38 closed-question international survey. The electronic link was distributed via e-mail or via Whatsapp to more than 500 contacts. Responses to the survey questions were analyzed with bivariate tests. RESULTS: A total of 375 complete surveys have been analyzed. More than 88% received an mRNA vaccine and 11% received AdV first dose. A second dose of mRNA vaccine was administered in 76% of individuals. No severe adverse effects were reported, whereas moderate reactions and those lasting more than 1 day were more common with AdV (P=0.002 and P=0.024 respectively). Headache was commonly reported regardless of the vaccine type, but less frequently, with shorter duration and lower severity that usually experienced by participants, without significant difference irrespective of vaccine type. CONCLUSIONS: Both mRNA and AdV COVID-19 vaccines were safe and well tolerated in a real-life subset of HCPs and AFP subjects.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Headache/chemically induced , Vaccination/adverse effects , Adolescent , Adult , Aged , COVID-19/transmission , Cross-Sectional Studies , Female , Headache/diagnosis , Headache/epidemiology , Health Care Surveys , Health Personnel , Humans , Incidence , Male , Middle Aged , Occupational Health , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Young Adult
5.
Forensic Sci Int ; 325: 110851, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1244737

ABSTRACT

BACKGROUND AND AIM: COVID-19 is an extremely challenging disease, both from a clinical and forensic point of view, and performing autopsies of COVID-19 deceased requires adequately equipped sectorial rooms and exposes health professionals to the risk of contagion. Among one of the categories that are most affected by SARS-Cov-2 infection are the elderly residents. Despite the need for prompt diagnoses, which are essential to implement all isolation measures necessary to contain the infection spread, deceased subjects in long-term care facilities are still are often diagnosed post-mortem. In this context, our study focuses on the use of post-mortem computed tomography for the diagnosis of COVID-19 infection, in conjunction with post-mortem swabs. The aim of this study was to assess the usefulness of post-mortem whole CT-scanning in identifying COVID-19 pneumonia as a cause of death, by comparing chest CT-findings of confirmed COVID-19 fatalities to control cases. MATERIALS AND METHODS: The study included 24 deceased subjects: 13 subjects coming from long-term care facility and 11 subjects died at home. Whole body CT scans were performed within 48 h from death in all subjects to evaluate the presence and distribution of pulmonary abnormalities typical of COVID-19-pneumonia, including: ground-glass opacities (GGO), consolidation, and pleural effusion to confirm the post-mortem diagnosis. RESULTS: Whole-body CT scans was feasible and allowed a complete diagnosis in all subjects. In 9 (69%) of the 13 cases from long-term care facility the cause of death was severe COVID 19 pneumonia, while GGO were present in 100% of the study population. CONCLUSION: In the context of rapidly escalating COVID-19 outbreaks, given that laboratory tests for the novel coronavirus is time-consuming and can be falsely negative, the post-mortem CT can be considered as a reliable and safe modality to confirm COVID-19 pneumonia. This is especially true for specific postmortem chest CT-findings that are rather characteristic of COVID-19 fatalities.


Subject(s)
COVID-19/diagnosis , Lung/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Autopsy/methods , Case-Control Studies , Female , Humans , Male , Middle Aged , Pleural Effusion/diagnostic imaging , Retrospective Studies , Sensitivity and Specificity , Whole Body Imaging
7.
Panminerva Med ; 2021 Feb 10.
Article in English | MEDLINE | ID: covidwho-1076992

ABSTRACT

BACKGROUND: The COVID-19 pandemic with the stay-at-home orders and lockdown has dramatically forced athletes to stop team training and competitions, causing deep changes in habits and lifestyle. Aim of this study was to evaluate in a retrospective single center study the cardiovascular (CV) health and fitness of elite football player after COVID-19 lockdown in Italy and to compare such findings with the 2019 off-season period, in order to identify potential differences in the CV features and outcomes. METHODS: All 29 professional Football players of the first male team were enrolled before resuming training and competition after COVID-19 lockdown and underwent several exams including physical examination, resting and stress electrocardiography (ECG), echocardiography, spirometry and blood tests. RESULTS: Median age was 27 years (23; 31), with no athlete being COVID-19 positive at the time of the evaluation. In comparison with the usual off-season 2-month detraining, significant differences were found for left ventricular (LV) mass (189g [172; 212] vs. 181g [167; 206], p=0.024) and LV mass index for body surface area (94g/m2 [85; 104] vs 88g/m2 [79.5; 101.5], p=0.017), while LV mass/fat free mass remained unchanged (2.8 g/Kg [2.6; 2.9] vs 2.9 g/Kg [2.6; 3.2], p=0.222). Respiratory function and metabolic profile were improved, while no significant changes were found in ECG findings, at rest and during exercise. CONCLUSIONS: Prolonged abstinence from training and competitions induced by lockdown elicited significant changes in comparison with off-season in parameters ascribable to detraining, as the changes in LV mass, in respiratory function and in metabolic profile.

8.
Int J Cardiol ; 329: 251-259, 2021 04 15.
Article in English | MEDLINE | ID: covidwho-1002620

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has caused an unprecedented change in the apparent epidemiology of acute coronary syndromes (ACS). However, the interplay between this disease, changes in pollution, climate, and aversion to activation of emergency medical services represents a challenging conundrum. We aimed at appraising the impact of COVID-19, weather, and environment features on the occurrence of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in a large Italian region and metropolitan area. METHODS AND RESULTS: Italy was hit early on by COVID-19, such that state of emergency was declared on January 31, 2020, and national lockdown implemented on March 9, 2020, mainly because the accrual of cases in Northern Italy. In order to appraise the independent contribution on changes in STEMI and NSTEMI daily rates of COVID-19, climate and pollution, we collected data on these clinical events from tertiary care cardiovascular centers in the Lazio region and Rome metropolitan area. Multilevel Poisson modeling was used to appraise unadjusted and adjusted effect estimates for the daily incidence of STEMI and NSTEMI cases. The sample included 1448 STEMI and 2040 NSTEMI, with a total of 2882 PCI spanning 6 months. Significant reductions in STEMI and NSTEMI were evident already in early February 2020 (all p<0.05), concomitantly with COVID-19 spread and institution of national countermeasures. Changes in STEMI and NSTEMI were inversely associated with daily COVID-19 tests, cases, and/or death (p<0.05). In addition, STEMI and NSTEMI incidences were associated with daily NO2, PM10, and O3 concentrations, as well as temperature (p<0.05). Multi-stage and multiply adjusted models highlighted that reductions in STEMI were significantly associated with COVID-19 data (p<0.001), whereas changes in NSTEMI were significantly associated with both NO2 and COVID-19 data (both p<0.001). CONCLUSIONS: Reductions in STEMI and NSTEMI in the COVID-19 pandemic may depend on different concomitant epidemiologic and pathophysiologic mechanisms. In particular, recent changes in STEMI may depend on COVID-19 scare, leading to excess all-cause mortality, or effective reduced incidence, whereas reductions in NSTEMI may also be due to beneficial reductions in NO2 emissions in the lockdown phase.


Subject(s)
Acute Coronary Syndrome/epidemiology , COVID-19/epidemiology , Environmental Pollution/adverse effects , Pandemics , SARS-CoV-2 , Weather , Aged , Female , Follow-Up Studies , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Retrospective Studies , Risk Factors
9.
Minerva Cardioangiol ; 68(4): 339-346, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-890930

ABSTRACT

In recent months SARS-CoV-2 has spread rapidly throughout the world. The case fatality rate is higher in cardiovascular disease and hypertension. Other comorbidities do not seem to confer the same risk, therefore the understanding of the relationship between infection and cardiovascular system could be a crucial point for the fight against the virus. A great interest is directed towards the angiotensin 2 converting enzyme (ACE 2) which is the SARS-CoV-2 receptor and creates important connections between the virus replication pathway, the cardiovascular system and blood pressure. All cardiovascular conditions share an imbalance of the renin angiotensin system in which ACE 2 plays a central role. In the early pandemic period, much confusion has appeared about the management of therapy with angiotensin converting enzyme inhibitors and angiotensin receptor blockers especially in infected patients and in those at risk of critical illness in case of infection. In this article we will try to reorder the major opinions currently emerging on this topic.


Subject(s)
Angiotensin II Type 1 Receptor Blockers/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Coronavirus Infections/drug therapy , Pneumonia, Viral/drug therapy , Animals , Antihypertensive Agents/therapeutic use , COVID-19 , Coronavirus Infections/physiopathology , Humans , Pandemics , Pneumonia, Viral/physiopathology , Renin-Angiotensin System
12.
Minerva Cardioangiol ; 68(5): 368-372, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-125105

ABSTRACT

BACKGROUND: Infection due to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), i.e. coronavirus-associated disease 2019 (COVID-2019), may occasionally lead to acute respiratory distress syndrome (ARDS), requiring in the most severe cases extracorporeal membrane oxygenation (ECMO). Yet, limited data, if any, are currently available on the role of ECMO in critically ill patients with COVID-19. We aimed at providing a snapshot analysis of ECMO for COVID-19 in Europe. METHODS: Freely available data on ECMO in COVID-19 patients reported by the European Extracorporeal Life Support Organization (EuroELSO) were extracted and analyzed after conversion into long format. The primary outcome was the incidence of death during ECMO. Bootstrapping and logistic regression were used for inferential estimates. RESULTS: Details from a total of 333 patients treated in 90 institutions spanning 17 countries were obtained, with 22% women and mean age of 52 years. Death rate was 17.1% (95% confidence interval: 13.1% to 21.1%), even if significant between-center differences were found, with some institutions reporting 100% case fatality. Exploratory inferential analysis showed no nominally statistically significant association between death and gender (P=0.788), but a significant association was found with age, mainly due to increased case fatality in subjects >60 years (odds ratio: 4.80 [95% confidence interval 1.64 to 14.04], P=0.004). CONCLUSIONS: ECMO may play an important role in critically ill patients with COVID-19 refractory to less invasive treatments. The increased risk of early death in older patients may be used to prioritize ECMO indication in resource-conscious settings, if confirmed externally.


Subject(s)
Coronavirus Infections/therapy , Critical Illness/therapy , Extracorporeal Membrane Oxygenation/methods , Pneumonia, Viral/therapy , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/mortality , Europe/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Respiratory Distress Syndrome/complications , Respiratory Distress Syndrome/therapy , Sex Factors
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