Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 1.046
Filter
Add filters

Year range
1.
Monaldi Arch Chest Dis ; 90(3)2020 Jul 15.
Article in English | MEDLINE | ID: covidwho-649882

ABSTRACT

Italy is currently experiencing an epidemic of coronavirus disease 2019 (Covid-19). Aim of our study is to identify the best predictors of Intensive Care Unit (ICU) admission in patients with Covid-19. We examined 28 patients admitted to the Emergency Department (ED) and subsequently confirmed as cases of Covid-19. Patients received, at the admission to the ED, a diagnostic work-up including: patient history, clinical examination, an arterial blood gas analysis (whenever possible performed on room air), laboratory blood tests, including serum concentrations of interleukin-6 (IL-6), lung ultrasound examination and a computed tomography (CT) scan of the thorax. For each patient, as gas exchange index through the alveolocapillary membrane, we determined the alveolar-arterial oxygen gradient (AaDO⁠2) and the alveolar-arterial oxygen gradient augmentation (AaDO⁠2 augmentation). For each patient, as measurement of hypoxemia, we determined oxygen saturation (SpO2), partial pressure of oxygen in arterial blood (PaO⁠2), PaO⁠2 deficit and the ratio between arterial partial pressure of oxygen by blood gas analysis and fraction of inspired oxygen (P/F). Patients were assigned to ICU Group or to Non-ICU Group basing on the decision to intubate. Areas under the curve (AUC) and receiver operating characteristic (ROC) curve were used to compare the performance of each test in relation to prediction of ICU admission. Comparing patients of ICU Group (10 patients) with patients of Non-ICU Group (18 patients), we found that the first were older, they had more frequently a medical history of malignancy and they were more frequently admitted to ED for dyspnea. Patients of ICU Group had lower oxygen saturation, PaO⁠2, P/F and higher heart rate, respiratory rate, AaDO⁠2, AaDO⁠2 augmentation and lactate than patients of Non-ICU Group. ROC curves demonstrate that age, heart rate, respiratory rate, dyspnea, lactate, AaDO2, AaDO2 augmentation, white blood cell count, neutrophil count and percentage, fibrinogen, C-reactive protein, lactate dehydrogenase, glucose level, international normalized ratio (INR), blood urea and IL-6 are useful predictors of ICU admission. We identified several predictors of ICU admission in patients with Covid-19. They can act as fast tools for the early identification and timely treatment of critical cases since their arrival in the ED.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Critical Care , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Adult , Aged , Aged, 80 and over , Blood Gas Analysis , Coronavirus Infections/complications , Emergency Service, Hospital , Female , Hospitalization , Humans , Italy , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Predictive Value of Tests , ROC Curve , Risk Factors
2.
PLoS Comput Biol ; 16(5): e1007879, 2020 05.
Article in English | MEDLINE | ID: covidwho-638069

ABSTRACT

In this work, we aim to determine the main factors driving self-initiated behavioral changes during the seasonal flu. To this end, we designed and deployed a questionnaire via Influweb, a Web platform for participatory surveillance in Italy, during the 2017 - 18 and 2018 - 19 seasons. We collected 599 surveys completed by 434 users. The data provide socio-demographic information, level of concerns about the flu, past experience with illnesses, and the type of behavioral changes voluntarily implemented by each participant. We describe each response with a set of features and divide them in three target categories. These describe those that report i) no (26%), ii) only moderately (36%), iii) significant (38%) changes in behaviors. In these settings, we adopt machine learning algorithms to investigate the extent to which target variables can be predicted by looking only at the set of features. Notably, 66% of the samples in the category describing more significant changes in behaviors are correctly classified through Gradient Boosted Trees. Furthermore, we investigate the importance of each feature in the classification task and uncover complex relationships between individuals' characteristics and their attitude towards behavioral change. We find that intensity, recency of past illnesses, perceived susceptibility to and perceived severity of an infection are the most significant features in the classification task and are associated to significant changes in behaviors. Overall, the research contributes to the small set of empirical studies devoted to the data-driven characterization of behavioral changes induced by infectious diseases.


Subject(s)
Influenza, Human/psychology , Seasons , Algorithms , Disease Susceptibility , Female , Humans , Italy , Male , Surveys and Questionnaires
3.
JMIR Mhealth Uhealth ; 8(8): e19857, 2020 08 28.
Article in English | MEDLINE | ID: covidwho-769046

ABSTRACT

BACKGROUND: The COVID-19 pandemic is the greatest public health crisis of the last 100 years. Countries have responded with various levels of lockdown to save lives and stop health systems from being overwhelmed. At the same time, lockdowns entail large socioeconomic costs. One exit strategy under consideration is a mobile phone app that traces the close contacts of those infected with COVID-19. Recent research has demonstrated the theoretical effectiveness of this solution in different disease settings. However, concerns have been raised about such apps because of the potential privacy implications. This could limit the acceptability of app-based contact tracing in the general population. As the effectiveness of this approach increases strongly with app uptake, it is crucial to understand public support for this intervention. OBJECTIVE: The objective of this study is to investigate the user acceptability of a contact-tracing app in five countries hit by the pandemic. METHODS: We conducted a largescale, multicountry study (N=5995) to measure public support for the digital contact tracing of COVID-19 infections. We ran anonymous online surveys in France, Germany, Italy, the United Kingdom, and the United States. We measured intentions to use a contact-tracing app across different installation regimes (voluntary installation vs automatic installation by mobile phone providers) and studied how these intentions vary across individuals and countries. RESULTS: We found strong support for the app under both regimes, in all countries, across all subgroups of the population, and irrespective of regional-level COVID-19 mortality rates. We investigated the main factors that may hinder or facilitate uptake and found that concerns about cybersecurity and privacy, together with a lack of trust in the government, are the main barriers to adoption. CONCLUSIONS: Epidemiological evidence shows that app-based contact tracing can suppress the spread of COVID-19 if a high enough proportion of the population uses the app and that it can still reduce the number of infections if uptake is moderate. Our findings show that the willingness to install the app is very high. The available evidence suggests that app-based contact tracing may be a viable approach to control the diffusion of COVID-19.


Subject(s)
Contact Tracing/methods , Coronavirus Infections/prevention & control , Intention , Mobile Applications , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Adolescent , Adult , Aged , Coronavirus Infections/epidemiology , Cross-Cultural Comparison , Female , France/epidemiology , Germany/epidemiology , Humans , Italy/epidemiology , Male , Middle Aged , Pneumonia, Viral/epidemiology , Surveys and Questionnaires , United Kingdom/epidemiology , United States/epidemiology , Young Adult
4.
Recenti Prog Med ; 111(6): 374-378, 2020 06.
Article in Italian | MEDLINE | ID: covidwho-768980

ABSTRACT

Bergamo is a rich and populous city of northern Italy and one of the epicentres of the worldwide pandemic CoViD-19. Despite the generosity of health workers, we are undergoing a severe humanitarian crisis that is stressing every aspect of daily life. From outside it is very hard to understand, because houses are closed for lockdown and are not destroyed as they would be in an earthquake. An outbreak is not "only" a sudden mass lethal incident, like a natural disaster, neither "only" a disease, to be treated by doctors, but a social phenomenon too. Historical and social elements are key factors for development (for example, intensive promiscuity between animals and humans) and spread of an epidemic (for example, health workers and ambulance rapidly become vector of the virus). Can medical responsibility change in times of pandemic? My answer, as anaesthetist and intensive care physician from Bergamo, is yes. When the global medical community is called on to face a pandemic of unprecedented scale, with little scientific evidence and "crazy numbers" describing the situation, honest and forthcoming advocacy is an ethical duty. Aim of this narrative report is to share a view point about the dilemma of moral responsibility.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Coronavirus Infections/psychology , Humans , Italy/epidemiology , Pneumonia, Viral/psychology
6.
Eur Respir J ; 56(2)2020 08.
Article in English | MEDLINE | ID: covidwho-744960

ABSTRACT

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) has globally strained medical resources and caused significant mortality. OBJECTIVE: To develop and validate a machine-learning model based on clinical features for severity risk assessment and triage for COVID-19 patients at hospital admission. METHOD: 725 patients were used to train and validate the model. This included a retrospective cohort from Wuhan, China of 299 hospitalised COVID-19 patients from 23 December 2019 to 13 February 2020, and five cohorts with 426 patients from eight centres in China, Italy and Belgium from 20 February 2020 to 21 March 2020. The main outcome was the onset of severe or critical illness during hospitalisation. Model performances were quantified using the area under the receiver operating characteristic curve (AUC) and metrics derived from the confusion matrix. RESULTS: In the retrospective cohort, the median age was 50 years and 137 (45.8%) were male. In the five test cohorts, the median age was 62 years and 236 (55.4%) were male. The model was prospectively validated on five cohorts yielding AUCs ranging from 0.84 to 0.93, with accuracies ranging from 74.4% to 87.5%, sensitivities ranging from 75.0% to 96.9%, and specificities ranging from 55.0% to 88.0%, most of which performed better than the pneumonia severity index. The cut-off values of the low-, medium- and high-risk probabilities were 0.21 and 0.80. The online calculators can be found at www.covid19risk.ai. CONCLUSION: The machine-learning model, nomogram and online calculator might be useful to access the onset of severe and critical illness among COVID-19 patients and triage at hospital admission.


Subject(s)
Coronavirus Infections/diagnosis , Hospital Mortality/trends , Machine Learning , Pneumonia, Viral/diagnosis , Triage/methods , Adult , Age Factors , Aged , Area Under Curve , Belgium , China , Clinical Laboratory Techniques , Cohort Studies , Coronavirus Infections/epidemiology , Decision Support Systems, Clinical , Female , Hospitalization/statistics & numerical data , Humans , Internationality , Italy , Male , Middle Aged , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Predictive Value of Tests , ROC Curve , Reproducibility of Results , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Factors , Survival Analysis
7.
Psychiatr Danub ; 32(Suppl 1): 5-9, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-743579

ABSTRACT

The COVID-19 epidemic has been a major global public health problem during past months in Italy and in several other Countries and on the date of publication of this article, is still a serious public health problem. The health staff, engaged in the care of the sick and in the prevention of the spread of the infection have been subjected to a further increase in psychological difficulties and work-related stress, related to the workload for the continuous influx of sick and intense and close working shifts for the viral emergency. The SAVE-9 (Stress and Anxiety to Viral Epidemics - 9 items) scale has been developed as a tool for assessing work anxiety and stress in response to the viral epidemic of health professionals working to prevent the spread of the virus and to treat infected people.


Subject(s)
Anxiety/diagnosis , Coronavirus Infections/psychology , Health Personnel/psychology , Occupational Stress/diagnosis , Pneumonia, Viral/psychology , Betacoronavirus , Humans , Italy , Pandemics
8.
S Afr Med J ; 110(6): 12944, 2020 05 08.
Article in English | MEDLINE | ID: covidwho-743506
9.
Psychiatr Danub ; 32(Suppl 1): 15-20, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-743503

ABSTRACT

BACKGROUND: This study seeks to explore the use of humor during the period of isolation caused by lockdown measures imposed in Italy as a result of the Coronavirus SARS-CoV-2 pandemic. SUBJECTS AND METHOD: The study is based on a non-clinical sample. The ad hoc questionnaire measures people's readiness to search for, publish and distribute humorous material during lockdown. It investigates the intentions behind sending content via social media (WhatsApp or similar) and the emotions experienced on receiving such content. RESULTS: The responses have been analyzed quantitatively, and using Excel's IF function they have been analyzed qualitatively. In the present sample of 106 Italian respondents, searching for content was less common than publishing it (yes 44.34%, no 54.72%). Positive emotions were more frequently the motivation (total 61.32%). A high percentage sent amusing content via social media or SMS (79%). Responses demonstrating a desire to lessen the situation's negative impact or a desire for cohesion were common. Receiving material was similarly associated with positive emotions and a sense of being close to others. CONCLUSIONS: humorous material appears to have served as a means of transmitting positive emotions, distancing oneself from negative events and finding cohesion.


Subject(s)
Coronavirus Infections/psychology , Pneumonia, Viral/psychology , Wit and Humor as Topic , Betacoronavirus , Humans , Italy , Pandemics , Social Media , Surveys and Questionnaires
11.
In Vivo ; 34(5): 3033-3038, 2020.
Article in English | MEDLINE | ID: covidwho-740634

ABSTRACT

BACKGROUND/AIM: SARS-CoV-2 pandemic imposed extraordinary restriction measures and a complete reorganization of the Health System. The aim of the study was to evaluate the impact of COVID-19 on emergency surgical department accesses. PATIENTS AND METHODS: Patients admitted to surgical emergency departments was retrospectively recorded during the Lockdown (March 11, 2020-May 3, 2020) and compared with the same number of days in 2019 and immediately before Lockdown (January 16, 2020-March 10, 2020). Diagnoses, priority levels, modes of patient's transportation, waiting times and outcomes were analysed. RESULTS: During the lockdown phase, we ob-served a reduction in the access to emergency surgical departments of 84.45% and 79.78%, com-pared with the Pre-Lockdown2019 and Pre-Lockdown2020 groups, respectively. Patient's transportation, hospitalization and patients discharge with indications to an outpatient visit, waiting and total times exhibited a significant difference during the lockdown (p<0.005). CONCLUSION: We observed a reduction of surgical emergency accesses during the lockdown. Implementing the use of the regional systems and preventing overcrowding of emergency departments could be beneficial for reducing waiting times and improving the quality of treatments for patients.


Subject(s)
Coronavirus Infections/epidemiology , Emergency Service, Hospital/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology , Surgery Department, Hospital/statistics & numerical data , Betacoronavirus/pathogenicity , Female , Health Systems Plans , Hospitalization , Humans , Italy/epidemiology , Male , Retrospective Studies
12.
Chirurgia (Bucur) ; 115(4): 469-475, 2020.
Article in English | MEDLINE | ID: covidwho-740630

ABSTRACT

Background: The Covid-19 pandemic in Northern Italy has slowed down the clinical surgical activity. A system of hub and spoke hospitals was set up to take care of oncological patients with the consequent almost complete abolition of the elective surgical activity for non-oncological pathologies. Methods: We retrospectively analyzed the surgical volumes of 4 different non academic general hospitals in Lombardy belonging to 4 different provinces. The quarter March April May 2019 was compared with the same period of 2020. All different procedures were listed. The cost analysis was performed using the DRG system. Results: In the four hospitals involved the surgical procedures reduced from 1903 to 350 with a drop of the 81.6%. Procedures for cancer from 403 to 161 with a drop of 60.1%. Procedures for benign disease from 1310 to 118 with a drop of the 91%. Emergencies from 190 to 71 with a drop of the 62.6%. State refund for the procedures performed from 6.708.023 to 1.678.154 with a drop of 75%. Conclusions: Elective surgery was dramatically impaired by the Covid-19 pandemic. Above all procedures for non oncological and non urgent patients were particularly affected. In view of a possible second wave of the pandemic, the surgical planning must select patients not only on onco logical criteria but rather on clinical ones. An ad hoc hub and spoke hospitals pathway has to be implemented for benign surgical diseases by whoever is facing the Covid pandemic at its spike.


Subject(s)
Coronavirus Infections/epidemiology , General Surgery/trends , Pneumonia, Viral/epidemiology , Surgical Procedures, Operative/statistics & numerical data , Betacoronavirus , Humans , Italy , Pandemics , Retrospective Studies , Treatment Outcome
13.
Monaldi Arch Chest Dis ; 90(3)2020 Sep 02.
Article in English | MEDLINE | ID: covidwho-740518

ABSTRACT

Lung Ultrasound (LUS) is regarded to be potentially useful to diagnose lung injury in older adults living in nursing homes with suspected COVID-19 pneumonia. We aimed at evaluating presence lung injury among senior nursing home residents by LUS performed with portable wireless scanner echography. The study population consisted of 150 residents with a mean age of 88 years (85% female) residing in 12 nursing homes in Northern Italy. Subjects had to have a history of recent onset of symptoms compatible with COVID-19 pneumonia or have been exposed to the contagion of patients carrying the disease. COVID-19 testing was performed with SARS-CoV-2 nasal-pharyngeal (NP) swabs. Positive subjects to LUS scanning were considered those with non-coascelent B-lines in >3 zones, coalescent B-lines in >3 zones and with iperdensed patchy non-consolidated lungs. Sixty-three percent had positive NP testing and 65% had LUS signs of pulmonary injury. LUS had a sensitivity of 79% in predicting positive NP testing. Sixteen percent of residents tested negative for SARSCoV-2 carried the signs of COVID-19 lung injury at LUS. There were 92 patients (61%) with current or recent symptoms.Positivity to LUS scanning was reported in 73% of residents with symptoms, while it was 53% in those without (P=0.016). A positive NP testing was observed in 66% of residents with symptoms and in 57% of those without (P=0.27). We conclude that assessment of LUS by portable wireless scanner echography can be profitability utilized to diagnose lung injury among senior nursing home residents with or without symptoms compatible with COVID-19 pneumonia.


Subject(s)
Coronavirus Infections , Lung Injury/diagnostic imaging , Pandemics , Pneumonia, Viral/diagnosis , Point-of-Care Testing , Ultrasonography , Aged, 80 and over , Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Female , Homes for the Aged/statistics & numerical data , Humans , Italy/epidemiology , Male , Nursing Homes/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Predictive Value of Tests , Sensitivity and Specificity , Ultrasonography/instrumentation , Ultrasonography/methods , Wireless Technology
14.
Med Lav ; 111(4): 247-248, 2020 Aug 31.
Article in English | MEDLINE | ID: covidwho-738603

ABSTRACT

At the time of writing, the COVID-19 pandemic is assuming a distinct shape as do healthcare systems around the world. Some countries resisted to the tsunami and are now re-opening their industrial and commercial activities while re-organizing to face a possible new wave. Others are still struggling not to be overwhelmed by the most significant public health challenge of the last century. In Italy, after a strict lockdown, almost all activities are re-opening, trying to navigate between Scylla (epidemics and its economic consequences) and Cariddi (economic recession and its adverse health effects) bearing in mind that there is collinearity between the circulation of money and spreading of the virus and that there is a serious risk of a vicious spiral which could affect the society. The prolonged lockdown deemed to prevent the spreading of the virus also reduced the circulation of money, and hence tax revenues, thus it will ultimately result in fewer finances available for social security and Public Health (3). The main political issue will then be the definition of a right point of equilibrium between risks and benefits, between action and precaution. As scientists, we are called to distinguish between what we know and what is unknown, between data and opinions, between facts and beliefs. [...].


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Videoconferencing , Betacoronavirus , Editorial Policies , Humans , Italy , Pandemics
15.
Nat Commun ; 11(1): 4264, 2020 08 26.
Article in English | MEDLINE | ID: covidwho-733526

ABSTRACT

The pressing need to restart socioeconomic activities locked-down to control the spread of SARS-CoV-2 in Italy must be coupled with effective methodologies to selectively relax containment measures. Here we employ a spatially explicit model, properly attentive to the role of inapparent infections, capable of: estimating the expected unfolding of the outbreak under continuous lockdown (baseline trajectory); assessing deviations from the baseline, should lockdown relaxations result in increased disease transmission; calculating the isolation effort required to prevent a resurgence of the outbreak. A 40% increase in effective transmission would yield a rebound of infections. A control effort capable of isolating daily  ~5.5% of the exposed and highly infectious individuals proves necessary to maintain the epidemic curve onto the decreasing baseline trajectory. We finally provide an ex-post assessment based on the epidemiological data that became available after the initial analysis and estimate the actual disease transmission that occurred after weakening the lockdown.


Subject(s)
Communicable Disease Control/standards , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Basic Reproduction Number , Betacoronavirus , Communicable Disease Control/trends , Coronavirus Infections/transmission , Forecasting , Geography , Hospitalization/statistics & numerical data , Hospitalization/trends , Humans , Italy/epidemiology , Models, Theoretical , Pneumonia, Viral/transmission , Social Isolation
17.
Eur J Cardiothorac Surg ; 58(3): 598-604, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-733389

ABSTRACT

OBJECTIVES: There is currently a lack of clinical data on the novel beta-coronavirus infection [caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] and concomitant primary lung cancer. Our goal was to report our experiences with 5 patients treated for lung cancer while infected with SARS-CoV-2. METHODS: We retrospectively evaluated 5 adult patients infected with SARS-CoV-2 who were admitted to our thoracic surgery unit between 29 January 2020 and 4 March 2020 for surgical treatment of a primary lung cancer. Clinical data and outcomes are reported. RESULTS: All patients were men with a mean age of 74.0 years (range 67-80). Four of the 5 patients (80%) reported chronic comorbidities. Surgery comprised minimally invasive lobectomy (2 patients) and segmentectomy (1 patient), lobectomy with en bloc chest wall resection (1 patient) and pneumonectomy (1 patient). Mean chest drain duration was 12.4 days (range 8-22); mean hospital stay was 33.8 days (range 21-60). SARS-CoV-2-related symptoms were fever (3 patients), persistent cough (3 patients), diarrhoea (2 patients) and syncope (2 patients); 1 patient reported no symptoms. Morbidity related to surgery was 60%; 30-day mortality was 40%. Two patients (1 with a right pneumonectomy, 74 years old; 1 with a lobectomy with chest wall resection and reconstruction, 70 years old), developed SARS-CoV-2-related lung failure leading to death 60 and 32 days after surgery, respectively. CONCLUSIONS: Lung cancer surgery may represent a high-risk factor for developing a severe case of coronavirus disease 2019, particularly in patients with advanced stages of lung cancer. Additional strategies are needed to reduce the risk of morbidity and mortality from SARS-CoV-2 infection during treatment for lung cancer.


Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Coronavirus Infections/diagnosis , Cross Infection/prevention & control , Lung Neoplasms/surgery , Pneumonia, Viral/diagnosis , Severe Acute Respiratory Syndrome/diagnosis , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/mortality , Clinical Laboratory Techniques , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/mortality , Elective Surgical Procedures/methods , Female , Follow-Up Studies , Hospital Mortality , Humans , Italy , Length of Stay , Lung Neoplasms/complications , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Male , Pandemics , Pneumonectomy/methods , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Retrospective Studies , Sampling Studies , Severe Acute Respiratory Syndrome/complications , Severe Acute Respiratory Syndrome/mortality , Thoracic Surgery, Video-Assisted/methods , Treatment Outcome
18.
J Exp Clin Cancer Res ; 39(1): 171, 2020 Aug 27.
Article in English | MEDLINE | ID: covidwho-733038

ABSTRACT

The Covid-19 pandemic has challenged hard the national health systems worldwide. According to the national policy issued in March 2020 in response to the evolving Covid-19 pandemic, several hospitals were re-configured as Covid-19 centers and elective surgery procedures were rescheduled according to the most recent recommendations. In addition, Covid-19 protected cancer hubs were established, including the Regina Elena National Cancer Institute of Rome, Central Italy. At our Institute, the Breast Surgery Department continued working under the sign of a multidisciplinary approach. The number of professional figures involved in case evaluation was reduced to a minimum and interactions took place in the full respect of the required safety measures. Treatments for benign disease, pure prophylactic surgery and elective reconstructive procedures were all postponed and priority was assigned to the histologically-proven malignant breast tumors and highly suspicious lesions. From March 15th though April 30th 2020, we treated a total of 79 patients. This number is fully consistent with the average quantitative standards reached by our Department under ordinary circumstances. Patients were mostly discharged the day after surgery and none was readmitted due to surgery-related late complications. More generally, post-operative complications rates were unexpectedly low, particularly in light of the relatively high number of reconstructive procedures performed in this emergency situation. A strict follow up was performed based on the close contact with the surgical staff by telephone, messaging apps and telemedicine.Patients ascertainment for their Covid-19 status prior to hospital admission and hospital discharge allowed to maintain the "no-Covid-19" status at our Institution. In addition, during the aforementioned time window, none of the care providers developed SARS-CoV-2 infection or disease, as shown by the results of anti-SARS-CoV-2 immunoglobulin M and G profiling. In conclusions, elective breast cancer surgery procedures were successfully performed in a lockdown situation due to a novel viral pandemic. The well-coordinated regional and hospital efforts in terms of medical resource re-allocation and definition of clinical priorities allowed to maintain high quality standards of breast cancer care while ensuring safety to the cancer patients and care providers involved.


Subject(s)
Betacoronavirus/isolation & purification , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/surgery , Carcinoma, Lobular/surgery , Coronavirus Infections/prevention & control , Mastectomy/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Patterns, Physicians'/standards , Adult , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Breast Neoplasms/virology , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/virology , Carcinoma, Lobular/pathology , Carcinoma, Lobular/virology , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Female , Follow-Up Studies , Humans , Italy/epidemiology , Middle Aged , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Prognosis , Receptor, ErbB-2/metabolism , Receptors, Estrogen/metabolism , Receptors, Progesterone/metabolism
19.
Crit Care ; 24(1): 529, 2020 08 28.
Article in English | MEDLINE | ID: covidwho-733031

ABSTRACT

BACKGROUND: Whether respiratory physiology of COVID-19-induced respiratory failure is different from acute respiratory distress syndrome (ARDS) of other etiologies is unclear. We conducted a single-center study to describe respiratory mechanics and response to positive end-expiratory pressure (PEEP) in COVID-19 ARDS and to compare COVID-19 patients to matched-control subjects with ARDS from other causes. METHODS: Thirty consecutive COVID-19 patients admitted to an intensive care unit in Rome, Italy, and fulfilling moderate-to-severe ARDS criteria were enrolled within 24 h from endotracheal intubation. Gas exchange, respiratory mechanics, and ventilatory ratio were measured at PEEP of 15 and 5 cmH2O. A single-breath derecruitment maneuver was performed to assess recruitability. After 1:1 matching based on PaO2/FiO2, FiO2, PEEP, and tidal volume, COVID-19 patients were compared to subjects affected by ARDS of other etiologies who underwent the same procedures in a previous study. RESULTS: Thirty COVID-19 patients were successfully matched with 30 ARDS from other etiologies. At low PEEP, median [25th-75th percentiles] PaO2/FiO2 in the two groups was 119 mmHg [101-142] and 116 mmHg [87-154]. Average compliance (41 ml/cmH2O [32-52] vs. 36 ml/cmH2O [27-42], p = 0.045) and ventilatory ratio (2.1 [1.7-2.3] vs. 1.6 [1.4-2.1], p = 0.032) were slightly higher in COVID-19 patients. Inter-individual variability (ratio of standard deviation to mean) of compliance was 36% in COVID-19 patients and 31% in other ARDS. In COVID-19 patients, PaO2/FiO2 was linearly correlated with respiratory system compliance (r = 0.52 p = 0.003). High PEEP improved PaO2/FiO2 in both cohorts, but more remarkably in COVID-19 patients (p = 0.005). Recruitability was not different between cohorts (p = 0.39) and was highly inter-individually variable (72% in COVID-19 patients and 64% in ARDS from other causes). In COVID-19 patients, recruitability was independent from oxygenation and respiratory mechanics changes due to PEEP. CONCLUSIONS: Early after establishment of mechanical ventilation, COVID-19 patients follow ARDS physiology, with compliance reduction related to the degree of hypoxemia, and inter-individually variable respiratory mechanics and recruitability. Physiological differences between ARDS from COVID-19 and other causes appear small.


Subject(s)
Coronavirus Infections/physiopathology , Pneumonia, Viral/physiopathology , Respiratory Distress Syndrome, Adult/physiopathology , Aged , Betacoronavirus , Coronavirus Infections/therapy , Female , Humans , Intensive Care Units , Italy , Male , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Positive-Pressure Respiration , Respiratory Distress Syndrome, Adult/therapy , Respiratory Function Tests , Respiratory Mechanics/physiology
20.
PLoS One ; 15(8): e0238281, 2020.
Article in English | MEDLINE | ID: covidwho-732997

ABSTRACT

This is a population-based prospective cohort study on archive data describing the age- and sex-specific prevalence of COVID-19 and its prognostic factors. All 2653 symptomatic patients tested positive for SARS-CoV-2 from February 27 to April 2, 2020 in the Reggio Emilia province, Italy, were included. COVID-19 cumulative incidence, hospitalization and death rates, and adjusted hazard ratios (HR) with 95% confidence interval (95% CI) were calculated according to sociodemographic and clinical characteristics. Females had higher prevalence of infection than males below age 50 (2.61 vs. 1.84 ‰), but lower in older ages (16.49 vs. 20.86 ‰ over age 80). Case fatality rate reached 20.7% in cases with more than 4 weeks follow up. After adjusting for age and comorbidities, men had a higher risk of hospitalization (HR 1.4 95% CI 1.2 to 1.6) and of death (HR 1.6, 95% CI 1.2 to 2.1). Patients over age 80 compared to age < 50 had HR 7.1 (95% CI 5.4 to 9.3) and HR 27.8 (95% CI 12.5 to 61.7) for hospitalization and death, respectively. Immigrants had a higher risk of hospitalization (HR 1.3, 95% CI 0.99 to 1.81) than Italians and a similar risk of death. Risk of hospitalization and of death were higher in patients with heart failure, arrhythmia, dementia, coronary heart disease, diabetes, and hypertension, while COPD increased the risk of hospitalization (HR 1.9, 95% CI 1.4 to 2.5) but not of death (HR 1.1, 95% CI 0.7 to 1.7). Previous use of ACE inhibitors had no effect on risk of death (HR 0.97, 95% CI 0.69 to 1.34). Identified susceptible populations and fragile patients should be considered when setting priorities in public health planning and clinical decision making.


Subject(s)
Coronavirus Infections/epidemiology , Hospitalization/statistics & numerical data , Pneumonia, Viral/epidemiology , Age Distribution , Aged , Aged, 80 and over , Betacoronavirus , Comorbidity , Coronavirus Infections/mortality , Emigrants and Immigrants/statistics & numerical data , Female , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/mortality , Proportional Hazards Models , Prospective Studies , Risk Factors , Sex Distribution
SELECTION OF CITATIONS
SEARCH DETAIL