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1.
Blood Transfusion ; 20(6):495-504, 2022.
Article in English | MEDLINE | ID: covidwho-2154555

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), increases thrombotic risk in hospitalised patients. The rate of thrombosis in patients with COVID-19 is unclear. The role of heparin, frequently used in the management of hospitalised patients, also needs to be clarified. In this study, we investigated the efficacy and safety of enoxaparin given at prophylactic or therapeutic dose in hospitalised patients with COVID-19, and evaluated its role in the development of disease in terms of mortality, and incidence of thrombotic and bleeding events.

2.
Clinical and Translational Imaging ; 10(SUPPL 1):S97, 2022.
Article in English | EMBASE | ID: covidwho-1894699

ABSTRACT

Background-Aim: The inflammatory cascade in patients (pts) with COVID-19 may lead to pulmonary embolism (PE), worsening prognosis. Lung perfusion SPECT/CT (Q-scan) in symptomatic pts discharged after COVID-19 can confirm or rule out pulmonary vascular involvement, helping the differential diagnosis with other respiratory diseases. We aim to investigate an innovative methodology, based on radiomic features and formal methods, as a virtual second look able to detect perfusion abnormalities to better define appropriate patient-centered diagnostic and therapeutic strategies. Methods: A total of 23 pts with a recent history of COVID-19, without any previous pulmonary disease (e.g. lung cancer, emphysema, or pathological findings at CT such as lung bullae) were enrolled for Q-scan for persistent dyspnea 1 month after discharge. They were classified as negative (14 pts) and positive (9 pts) for lung perfusion abnormalities by visual and semiquantitative analysis. Q-Lung® software by GE Healthcare was used to obtain percent evaluation of pulmonary lobar perfusion (cts/volume % for each lobe), assuming as a normal value any defect lower than 10% for each lobe. We analysed these data using an innovative methodology based on formal methods techniques centered on mathematical logical reasoning, to build a formal and rigorous representation of a system merging patients clinical conditions and disease-specific characteristics, to confirm or exclude the disease. Results: In a comparative analysis with Q-Scan results, the model showed concordant features in 13/23 pts, identifying perfusion defects in 8/9 pts with a positive Q-Scan, and excluding perfusion defects in 5/14 pts with a negative Q-Scan. Discordant results were observed in the remaining 10/23 pts, in particular in negative pts: however, in this sub-group, the Q-Lung semiquantitative analysis revealed perfusion defects lower than 10% per lobe, which we considered unsignificant but may deserve further evaluation. Conclusions: Although our data are still preliminary and based on a limited population, this methodology based on formal methods showed promising concordance with Q-scan results and needs to be implemented with further analyses including co-registered CT data. When compared to artificial intelligence techniques, this mathematical reasoning may enable (i) to use a reduced dataset of patients and/ or images, without having any impact on the robustness of the model;(ii) to produce an intuitive model easy to understand;(iii) to represent a rigorous and formal tool that may be used by medical specialists in a clinical setting.

3.
Clinical and Translational Imaging ; 10(SUPPL 1):S91-S92, 2022.
Article in English | EMBASE | ID: covidwho-1894690

ABSTRACT

Background-Aim: Post-mortem studies showed that in patients with COVID-19 the poor prognosis is due not only to the worsening of the ventilation function but it can be related to the perfusion impairment due to massive pulmonary thrombosis or micro-thromboembolism. We aimed to investigate the clinical impact of lung perfusion (Q) scintigraphy in patients discharged after COVID-19 disease but still symptomatic for dyspnea. Methods: 33 patients (pts), discharged at least 1 month after COVID- 19, underwent Q scan at T0 (1-3 months after acute disease) and at T1 (after 6 months if lung perfusion defects were evident at T0). Inclusion criteria were (1) residual dyspnea: mild (12/33pts), at minimal motor activity (9/33) and after prolonged effort (12/33), (2) No thromboembolism at CT pulmonary angiography during hospitalization. Exclusion criteria were: previous history of lung disease (e.g. Cancer, COPD, emphysema) or abnormal pulmonary CT findings (e.g. lung bullae). Planar and Q-SPECT/CT images were obtained for evaluation of lobar or segmental or subsegmental peripheral perfusion defects for each bronchopulmonary segment. Perfusion images were qualitatively and semiquantitatively analysed. Q-lung software by GE Healthcare was used for SPECT/CT images for obtaining percent evaluation of pulmonary lobar perfusion (counts/volume % for each lobe), considering as normal a value of defect within: - 5%/each lobe, if represented in ≥ 1 lobe. Q-scan was then compared with high resolution CT (HRCT) obtained during hospitalization in the acute phase (T-acute) and repeated after 1-3 months (T0). Significant pulmonary perfusion defects at Q scan were considered for addressing targeted therapy. Results: At T0: preserved lung perfusion was observed in 17/33 pts, thus excluding the vascular cause for the symptoms. Lung perfusion defects were detected in 16/33 patients who underwent T0 and T1 control. Defects were scored as following: severe (7 pts with dyspnea at minimal motor activity), at least one wedge-shaped peripheral defect estimated as ≥ 50% of a pulmonary segment without corresponding HRCT abnormalities, suggesting a new CTPA within 3 months and an appropriate therapeutic strategy;moderate (6 pts with dyspnea after prolonged effort): consisting in multiple (>3) subsegmental defects;-mild: (3 pts with mild dyspnea ≤ 3 sub-segmental defects). At T1 lung perfusion improvement (≥ 10% vs pathological lobe in T0), was observed in a total of 8/16 pts. Conclusions: In the age of precision medicine, Q scan-SPECT/CT in pts with recent COVID-19 can address clinical knowledge and management of SARS-CoV-2-induced lung abnormalities, suggesting the differential diagnosis with respiratory disease of different etiology and the appropriate patient-centered therapeutic strategies.

4.
Aims Geosciences ; 8(1):137-158, 2022.
Article in English | Web of Science | ID: covidwho-1726168

ABSTRACT

In recent months, the COVID-19 pandemic has been fervently considered from the perspective of various disciplines in the scientific community. Many of the proposed approaches are tied to reflections on the imminent and future effects of the pandemic. This contribution begins with a study of the recent past in Italy, analyzing the hurdles in politics that came to light due to the wave of COVID-19 infections worldwide. Particularly, the research considers the criticality of the geographical scale of reference in Italy's political actions. COVID-19 induced a need for the government to interact with people locally, especially through small municipalities in geographically central, inner areas, is emphasized. The main aim of this research is to attribute to this specific COVID-19 disaster the instrumental role of turning on the lights on the need to intervene in the inner areas of Italy, often very neglected. So the focus of the work is on inner areas and the probable catalysis of the political management dynamics that concern them, as an effect of the COVID's impacts. The pandemic is, therefore, only the contingent phenomenon which, in this case, can perhaps accelerate political interventions in inner areas. To explain the reason for this, we show how the vulnerability of inner areas, already generally risky, has become one of the weak links in the chain of protection from COVID-19 in terms of a geographical scattering phenomenon.

7.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1632481

ABSTRACT

Introduction: Neuropilin-1 has been recently identified as a co-factor needed for the entry of SARSCoV-2 in host cells and has been linked to neurologic symptoms of COVID-19 (Science 2020). Emerging evidence indicates that exosomal microRNAs (miRNAs) are involved in a number of physiologic and pathologic processes. However, to our knowledge, exosomal miRNAs have not been hitherto investigated in COVID-19. Hypothesis: Since we have recently demonstrated that miR-24 targets the 3'UTR of the gene encoding for Neuropilin-1 and this miRNA is expressed in human brain endothelial cells, we hypothesized an association between plasma levels of CD31 extracellular vesicles (EVs) enriched in miR-24 and the risk of cerebrovascular manifestations in patients hospitalized for COVID-19. Methods and Results: We obtained plasma from >300 COVID-19 patients;as control COVID-19 negative populations, we obtained plasma from healthy donors and patients hospitalized for cerebrovascular disorders. CD31 EVs were isolated from plasma on hospital admission, and miR24 levels were quantified. When comparing patients with vs without cerebrovascular disorders, we found that plasma levels of CD31 EV miR-24 were significantly different between these populations. We did not find any significant difference among groups when assessing circulating free levels of miR-24. Using a multiple regression analysis, adjusting for age, hypertension, and diabetes, the association between EV miR-24 and cerebrovascular complications in COVID-19 patients was confirmed (P<0.05). Conclusions: This is the first study showing a significant association between EV non-coding RNAs and clinical outcome in COVID-19 patients. Our results are relevant for basic researchers, because we identified an unprecedented significant association between EV miR-24 and cerebrovascular disorders, which could be helpful to better understand the molecular mechanisms underlying the pathophysiology of cerebrovascular events in COVID-19, as well as for clinicians, inasmuch as this association may help healthcare professionals in identifying COVID-19 patients who are at high risk of developing cerebrovascular disease.

8.
European Journal of Nuclear Medicine and Molecular Imaging ; 48(SUPPL 1):S404-S404, 2021.
Article in English | Web of Science | ID: covidwho-1609910
9.
Italian Journal of Medicine ; 15(3):6, 2021.
Article in English | EMBASE | ID: covidwho-1567576

ABSTRACT

Background and Aim: We evaluated the effect of CoViD-19 on the therapy of type 2 diabetic CoViD-19 inpatients (T2DM) during a 3-month period (between November 2020 and February 2021). Materials and Methods: We evaluated 432 in-patients all affected with CoViD-19 pneumonia and T2DM. They were 337 male (78%) and 95 female (22%) with mean age 70± 5 yrs and HbA1c 9±0.7%. Their diabetic therapy, along with antibiotic and steroid therapy was always switched to a basAl bolus regimen wheter they used at home oral, incretin or insulin therapy. Results: The T2DM CoViD-19 pneumonia inpatients had a BMI 28±3 kg/sm and an average of total insulin daily dosage (TDD) at hospitalization of 54±7 IU/day and at discharge of 77±8 IU/day. Initially at hospitalization we performed an i.v insulin infusion protocol to achieve blood glucose values <200 mg/dl for at least 48 hrs in195 pts (45%). The switch to basal bolus insulin therapy was made on the 3rd day of hospitalization. The major amount of insulin was administered before lunch and supper (both covering 40% of TDD) with 20% of TDD at night as basal. The major cause of this increase (40%) of TDD is in part due to the inflammatory state and partly to steroid therapy. We didn't detect any hypoglycemia. Conclusions: We were forced to use an enormous amount of insulin, both iv and on basal bolus regimen to achieve a slight blood glucose control. The need to further evaluate for inpatients the use of other drugs (GLP1-RA) combined to insulin regimen seems appropriate.

10.
Minerva Pneumologica ; 59(2):24-26, 2020.
Article in English | EMBASE | ID: covidwho-846138

ABSTRACT

BACKGROUND: High flow nasal cannula (HFNC) showed better oxygenation than standard oxygen therapy delivered through a face mask in acute respiratory failure for all causes. HFNC may offer an alternative in patients with acute hypoxemia and potentially reduce mortality. It was widely applied in China during the COVID-19 emergency. However, no data have been published about settings and protocols. The purpose of this paper was to report a single center experience on effectiveness and safety of HFNC in weaning of COVID-19 associated respiratory failure. METHODS: We retrospectively analyzed patient records from Sub-intensive Care Unit (Cotugno Hospital, Naples, Italy). Four patients (3F;age: 60±9.23 years;BMI: 27.5±5.2) were de-escalated from ventilation (3 Helmet CPAP, 1 invasive mechanical ventilation) to HFNC oxygen therapy. All patients were admitted for severe acute respiratory failure and pneumonia due to SARS-COV-2 (PaO2/Fio2 at baseline: 104±42.3 mmHg) and showed a typical progressive stage at chest imaging. Weaning was initiated following a stable period of ventilation (PaO2/Fio2 in last days of first respiratory support: 377±60.2 mmHg). HFNC was set on 34 °C, with flow ranging from 50 to 60 L/min and FiO2 from 40 to 60%. RESULTS: Right after initiation of HFNC (day 1), the mean PaO2/Fio2 was 238 mmHg (±65), without clinical signs of respiratory distress. No difference was observed on lactate. After 3 days of therapy mean PaO2/Fio2 increased to 377 mmHg (±106.3). All patients recovered from respiratory failure (PaO2>60 mmHg in room air) after 7 days (±3.2). CONCLUSIONS: HFNC might be helpful in weaning severe respiratory distress. Clinical effectiveness and comfort should be assessed within 3 days. The correct timing should be ruled by PaO2/Fio2 during ventilation and clinical signs of distress. Further evidence is required for firm conclusions.

11.
Minerva Pneumologica ; 59(2):47-48, 2020.
Article in English | EMBASE | ID: covidwho-845667
12.
Minerva Pneumologica ; 59(2):41-43, 2020.
Article in English | EMBASE | ID: covidwho-845666

ABSTRACT

The coronavirus disease 2019 (COVID-19) pneumonia was a recent worldwide outbreak. During chest computed tomography (CT) we may observe pulmonary parenchymal opacity, as sign of COVID-19. Very few have reported pneumothorax and pneumomediastinum as complications of severe COVID-19 pneumonia. We describe a 44-year-old male admitted to our department after the onset of sudden chest pain and high fever and evidence on computed tomography of spontaneous pneumothorax and pneumomediastinum, subsequently confirming COVID-19 pneumonia.

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