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European Respiratory Journal ; 58:3, 2021.
Article in English | Web of Science | ID: covidwho-1700040
Italian Journal of Medicine ; 15(3):71, 2021.
Article in English | EMBASE | ID: covidwho-1567763


Background and Aim: Pulmonary involvement from CoViD-19 is frequent, after acute phase dyspnoea, cough, desaturation, respiratory insufficiency, can persist, pneumonia leads to interstitial disease (ground- glass) and to pulmonary fibrosis (honeycomb lung). A diagnostic algorithm can be a simple way for differential diagnoses (pulmonary embolism, PE) and to set up therapies in a systematic way. Our objective was to propose a simple and easy diagnostic algorithm, to identify with chest CT scan, excluding PE in high dimer- D patients, suggestive gait test and compatible objectivity. Methods: Prescription of: blood tests, radiological (CT chest CMC or High Resolution), respiratory physiopathology (Walking test, Global spirometry, Plethysmography, DLCO). Set drug therapies in case of PE, oral steroid (OCS) in case of extensive interstitial disease, long-acting beta 2 agonist bronchodilators (LABA), antimuscarinics (LAMA), inhaled steroids (ICS). For fibrosis and a honeycomb pattern, treatment with dipalmitoylethanolamide (PEA). Results: 258 outpatients, average 60.68 years, 115 women, 143 men, with an urgent request for pneumological visit and treated on an outpatient basis. 1 pt died during treatment, 4 pts were diagnosed with pulmonary embolism. 4 pts required a prescription for oxygen therapy. 228 pts presented ground-glass, 30 pts showed normal chest CT. Conclusions: DLCO shows progressive improvement in values after ICS treatment. Small pathway deficiency evidenced by spirometry can be treated with LABA-LAMA especially in patients with a previous history of cigarette smoking or COPD.

Italian Journal of Medicine ; 15(3):9, 2021.
Article in English | EMBASE | ID: covidwho-1567708


Aim of the study: The aim of the study was to determine the influence of fascial and soft tissue treatment on respiratory efficiency and chest mobility of men and women between 22 and 54 years old. Materials and Methods: Subjects between 22 and 54 y.o., vaccinated or healed from CoViD-19 and without any other pathologies were recruited. Fascial and soft tissues manual treatment was made on mesentery's roots, right pillar of diaphragm and ileocecal valve. Spirometry was executed before and after the treatment. Patients had been adequately instructed on how to make a spirometry. Results: FEV1 showed an average increase of 2% meanwhile FEF2575 showed an average increase of 14.38% [from 0.26% to 31.76%]. Conclusions: Although FEV1's improvement is not indicative, there is an improvement in FEF2575 indicating better spontaneous return of the diaphragm to its resting state after the treatment. The treatment doesn't act on filling because we have seen that the increase in FEV1 is not significant but it affects emptying so it could be interesting to evaluate how patients are able, after the treatment, to better empty themselves and, since better emptying is a prerequisite for better filling, whether and how the residual functional capacity improves. It is as if with the treatment we had made patients learn to better empty themselves, getting therefore a more elastic return of the diaphragm in its relaxed position. There is a gain except for smokers who always remain hyperinflated emphasizing then how the share of emphysema is already measurable for the smoker.

Italian Journal of Medicine ; 15(3):11, 2021.
Article in English | EMBASE | ID: covidwho-1567319


Background: Italy is one of the few countries globally where physicians can be criminally prosecuted. Results: The total of pending civil sector files in 2020 is rather stable however, it has suffered a net increase in the Supreme Court (+12%), an increase in the Court (+3.1%) and in the Court of Appeal (+1.1%) mainly due to CoViD-19 (C19) restrictions. Many patients or patients' families have sued physician because of the deaths due to C19. ISTAT has published the information reported by physicians in 4,942 death cards of subjects diagnosed with a positive C19 test (15.6% of the total deaths reported to the ISS Integrated Surveillance System). In the cards of deaths are certified, in addition to C19, those conditions and diseases that have played a role in determining death. Conclusions: Law No. 24/2017 states that an HP who commits an avoidable technical error can be considered not guilty if full compliance with proper national guidelines/protocols is proven and it is not a case of gross negligence (a term that is not explicitly defined by any law). In 2020 C19 pandemic no national effective guidelines/protocols were given so HPs have no official documents to refer to in order to properly treat the patients and this has led to a significant increase in cases evolving into criminal and civil proceedings for medical malpractice. A proper defensive strategy is essential both for the HP and the Hospital/Clinic to avid final conviction and, in case of evident malpractice, make recurs to the help of a mediator is highly recommendable rather than taking legal action or trying to win a trial.

Italian Journal of Medicine ; 14(SUPPL 2):124-125, 2020.
Article in English | EMBASE | ID: covidwho-984675


Background and Aim: We present the heterogeneous clinical features of SARS-CoV-2 infection in a family cluster of Varese. Two ofthe five members were healthcare workers, and all of them weretreated at home. Description of cases: First case was a 29-year woman, who wasdiagnosed with COVID-19 after close contact with affected patientsat work, despite absence of symptoms at time. She lived with herfamily. The day after testing (day 1) she developed fever and malaise,followed by arthralgia, headache and sudden loss of smell and tasteby day 2. On day 3 her father, a 53-year old ex-smoker with history of hypertension, presented with fever for 5 days with subsequentapparent recovery. On the same day, her mother, a 53-year old physician, developed arthralgia and cough without sputum. On day 5 oneof her brothers (26 years old) had fever and diarrhoea. On day 11her father presented new onset of fever (up to 41.8°C), dysgeusia,dyspnoea and desaturation on air. According to local protocol hewas treated with idrossicloroquine, antibiotics, a course of steroids,heparin and mild oxygen support with progressive improvement ofrespiratory function. On day 17 the other brother (22-year-old) reported headache, anosmia and dysgeusia. Serological testing confirmed COVID-19 infections. Conclusions: Three weeks later her father underwent a CT scanshowing sparse pulmonary infiltrates suggestive of resolvingCOVID-19 pneumonia. All members recovered, but our patient, herfather and brother still complain of hyposmia and dysgeusia afterover three months.