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EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-292250


Background: Several restrictive measures have been taken to prevent the spread of SARS-CoV-2, restricting the access to outpatient follow-ups, increasing waiting lists in chronic diseases, such as obstructive sleep apnea (OSA). The aim of study is to evaluate the benefits and the barriers of telemedicine in a sleep clinic. Methods: . Subjects with diagnosis of OSA treated with continuous positive airway pressure (CPAP) were surveyed with a phone-questionnaire to assess the difficulties and knowledge of remote monitoring systems (telemedicine). Furthermore, the participants were divided into two groups according to the favor of telemedicine visits, POSITIVE (in-favor) and NEGATIVE (in favor of in-person visits) and compared with statistical methods. Results: . Fifty-three OSA participants (85% men), aged 67,9±7,5 yrs and BMI 36,0±8,0 kg/m 2 were enrolled in the study. The comparison of POSITIVE (24/53) and NEGATIVE (29/53) groups showed some significant differences: knowledge of telemedicine ( p =0,001), high education level ( p =0,01) and high computer skills ( p =0,001) are the main factors influencing the acceptance of telemedicine. In addition, 57% of overall participants seem more likely to conduct a remote visit in the future. Conclusions: . Although telemedicine is a useful tool, a majority of patients in our study preferred in-person visits. However, they are willing to conduct telemedicine visits in the future, so our findings suggest that improving patient computer skills and updating technological systems in order to facilitate patients' access may be important strategies to boost acceptance of telemedicine.

Front Med (Lausanne) ; 8: 707602, 2021.
Article in English | MEDLINE | ID: covidwho-1344275


Background: In the current coronavirus disease-2019 (COVID-19) pandemic, lung ultrasound (LUS) has been extensively employed to evaluate lung involvement and proposed as a useful screening tool for early diagnosis in the emergency department (ED), prehospitalization triage, and treatment monitoring of COVID-19 pneumonia. However, the actual effectiveness of LUS in characterizing lung involvement in COVID-19 is still unclear. Our aim was to evaluate LUS diagnostic performance in assessing or ruling out COVID-19 pneumonia when compared with chest CT (gold standard) in a population of SARS-CoV-2-infected patients. Methods: A total of 260 consecutive RT-PCR confirmed SARS-CoV-2-infected patients were included in the study. All the patients underwent both chest CT scan and concurrent LUS at admission, within the first 6-12 h of hospital stay. Results: Chest CT scan was considered positive when showing a "typical" or "indeterminate" pattern for COVID-19, according to the RSNA classification system. Disease prevalence for COVID-19 pneumonia was 90.77%. LUS demonstrated a sensitivity of 56.78% in detecting lung alteration. The concordance rate for the assessment of abnormalities by both methods increased in the case of peripheral distribution and middle-lower lung location of lesions and in cases of more severe lung involvement. A total of nine patients had a "false-positive" LUS examination. Alternative diagnosis included chronic heart disease (six cases), bronchiectasis (two cases), and subpleural emphysema (one case). LUS specificity was 62.50%. Collateral findings indicative of overlapping conditions at chest CT were recorded also in patients with COVID-19 pneumonia and appeared distributed with increasing frequency passing from the group with mild disease (17 cases) to that with severe disease (40 cases). Conclusions: LUS does not seem to be an adequate tool for screening purposes in the ED, due to the risk of missing some lesions and/or to underestimate the actual extent of the disease. Furthermore, the not specificity of LUS implies the possibility to erroneously classify pre-existing or overlapping conditions as COVID-19 pneumonia. It seems more safe to integrate a positive LUS examination with clinical, epidemiological, laboratory, and radiologic findings to suggest a "virosis." Viral testing confirmation is always required.

J Clin Med ; 10(2)2021 Jan 15.
Article in English | MEDLINE | ID: covidwho-1031141


BACKGROUND: The highly variable manifestation of the COVID-19 disease, from completely asymptomatic to fatal, is both a clinical and a public health issue. The criteria for discharge of hospitalized patients have been based so far on the negative result of Real-Time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) tests, but the persistence of viral fragments may exceed that of the integral virus by weeks. The aim of our study was to verify the clearance of the virus at viral culture in patients hospitalized for COVID-19 that have clinically recovered but are still positive on nasopharyngeal swab. METHODS: The study was conducted in hospitalized patients with positive RT-PCR on nasopharyngeal swab. Patients included were from asymptomatic to severe cases and performed nasopharyngeal control swabbing on day 14 for asymptomatic patient or at least three days after remission of symptoms. RT-PCR positive specimens were sent to a biosafety level 3 laboratory for viral culture. RESULTS: We performed a combined analysis of RT-PCR and a highly sensitive in vitro culture from 84 samples of hospitalized patients. The average age was 46 ± 20.29, and 40.5% of the subjects had radiologically confirmed pneumonia, with average PaO2 of 72.35 ± 12.12and P/F ratio of 315 ± 83.15. Ct values for the N gene were lower in the first swab than in the control one (p < 0.001). The samples from 83 patients were negative at viral culture, and RT-PCR on the respective supernatants always confirmed the absence of viral growth. CONCLUSIONS: Our preliminary results demonstrate that patients clinically recovered for at least three days show the viral clearance at viral culture, and presumably they continued to not be contagious.