Design as the Mediator of New Social Health Culture. Towards a Co-benefits Model

The COVID-19 pandemic accelerated the need for change, raising questions about the current approach to health. The re-definition of the role of health and well-being towards an interdisciplinary approach is knowledge-driven and technology-enabled and the focus of innovation is shifting from the treatment of disease to prediction and prevention. The new model of the ‘co-benefit belt' through design activates a process of systemic improvement and extends beyond the digital, pursuing the logic of interaction. The role of Design as a mediator is emphasized, lending itself to emergency situations, to the design of protection devices by implementing multifunctional and shared protection dynamics, intervening in rethinking the universe of devices with Human Centered Design approaches, optimizing methods and processes. The case study presented describes the development of the research project funded by the Campania Region, "Smart&Safe”. Design for new individual protection devices”, among the initiatives to fight against Covid-19. The research proposes an update in the redesign of individual Personal Protective Equipment (PPE), to explore a new dimension of the project that highlights the transition to an Individual and Intelligent Protection System (IIPS), reflecting on the various levels of safety faced during health emergencies. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Scrivere per curare. Un'esperienza di adozione del Diario del Paziente in Terapia Intensiva

This research focuses beyond the doors of an open ICU: a hospital ward with a high degree of complexity and organizational innovation in which the most recent events in the health emergency from COVID-19 pose new difficulties and unprecedented challenges. First of all, the scope of application of the Patient Diary tool is defined starting from the reference literature up to its introduction in the Neuroreanimation department of the AOUC, Florence (Italy). The Di.Te. project's main numbers and the qualitative study's main themes are presented. Finally, a summary reflection on the patient's diary is proposed as a channel for dialogue between all the interacting actors in the ward and as a tool for co-constructing the treatment path. © FrancoAngeli.

A Possible New Diagnostic Method for Early Diagnosis of Cryptococcus Infection in Lymphoma Patient Co-Infected with SARS-CoV-2

A Cryptococcus subspecies, neoformans, represents the most pathogenic infection for humans, particularly in immunocompromised hosts (e.g., cancer patients, drug users). In the present study, we described a 67-year old woman with non-Hodgkin lymphoma who developed an infectious disease sustained by Cryptococcus neoformans. Biochemical data documented a decrease in lymphocytes count while clinical evaluation was suggestive on meningeal infection. The microbiological analysis of the serum, using a dilution pattern through the CrAg lateral flow assay (Immy, Norman, OK 73069, USA) detected the antigen of Cryptococcus (dilution 1/1280), and a treatment with liposomal amphotericin B (3 mg/kg id) plus flucytosine (100 mg/kg per day orally in four divided doses) were started, showing an improvement of symptoms. This case report suggests that an antigen dilution can be used to perform a rapid diagnosis and to quickly start the pharmacological treatment.

Pediatric Minimal Change Disease and AKI following the Pfizer-BioNTech COVID-19 Vaccine: Causal or incidental correlation?

The global coronavirus 2019 (COVID-19) pandemic required vaccination even in children to reduce infection. We report on the development of acute kidney injury (AKI) and minimal change disease (MCD) nephrotic syndrome (NS), shortly after the first injection BNT162b2 COVID-19 vaccine (Pfizer-BioNTech). A 12-year-old previously healthy boy was referred to our hospital with complaints of peripheral edema and nephrotic range proteinuria. Nine days earlier he had received his first injection BNT162b2 COVID-19 vaccine (Pfizer-BioNTech). Seven days after injection, he developed leg edema, which rapidly progressed to anasarca with significant weight gain. On admission, serum creatinine was 1.3 mg/dL and 24-hour urinary protein excretion was 4 grams with fluid overload. As kidney function continued to decline over the next days, empirical steroid treatment and renal replacement therapy with ultrafiltration were started and kidney biopsy was performed. Seven days after steroid therapy, kidney function began to improve, gradually returning to normal. The association of MCD, nephrotic syndrome and AKI hasn't been previously described following the Pfizer-BioNTech COVID-19 vaccine in pediatric population, but this triad has been reported in adults. We need further similar case reports to establish the real incidence of this possible vaccine side effect. © 2022 Società Italiana di Nefrologia - Anno 39 Volume 6 n° 4.

Impact of the healthcare reorganization of the Local Health Authority services in Rieti (Italy) during the SARS-CoV-2 pandemic.

Background: The need to contain the spread of the SARS-CoV-2 pandemic has forced national and local organizations to define and implement targeted emergency response and management measures. As the knowledge about the infection grew, a wider range of organizational measures were deployed. Methods: This study involves the SARS-CoV-2 infected people managed by the Local Health Authority of Rieti (Italy). Diagnostic test waiting times and hospital admission rates in the Province of Rieti are investigated as the pandemic evolved. Trends were analyzed in relation to the tempora spreading of SARS-CoV-2, to the organizational actions taken by the Local Health Authority of Rieti, and to the deployment of actions across the territory. A municipalities classification of the province of Rieti was conducted after a cluster analysis based on the diagnostic test waiting times and the hospital admission rates. Results: Our findings show a declining trend, thus indicating a possible positive effect of the measures taken to contain the pandemic. The cluster analysis of the municipalities of the Province of Rieti makes evident an inhomogeneous geographical distribution of examined parameters (diagnostic test waiting times and the hospital admission rates), demonstrating the capability of Local Health Authority of Rieti to reach even the most disadvantaged areas and implying that the differences are due to the demographical variabilities. Conclusion: Despite some limitations, this study outlines the importance of management measures in response of the pandemic. These measures should adapt to social, cultural and geographical nature of the territory involved. The findings of the present study will contribute to the update of further pandemic preparedness plans of the Local Health Authorities.

Acute heart damage and COVID-19: a case study

Background: COVID-19 disease is characterized by respiratory symptoms, but acute cardiovascular complications are reported in severe infections that adversely affect prognosis. Clinical Case: A patient is hospitalized for fever, chest pain, and dyspnoea. Clinical examination: pulmonary and peripheral congestion, low blood pressure values, oxygen saturation in ambient air 91%. Increased myocardiocytolysis and inflammatory indices. Nasopharyngeal swab: positive for COVID-19. Chest CT scan: interstitial pneumonia. ECG: sinus tachycardia, changes in ventricular repolarization. Echocardiogram: left ventricle dilated, hypertrophic and with severe global systolic dysfunction. Therapy: furosemide, high flow oxygen alternating CPAP, antiretrovirals, antibiotics, low molecular weight heparin, beta blocker. Cardiac MRI: focal edema of the anterior wall. Coronary angiography: moderate coronary artery disease. Control chest CT scan: resolution of pulmonary interstitial disease. Cardiac MRI after 2 months: improvement of the overall systolic function of the left ventricle. Conclusions: An entity defined as “acute myocardial damage” characterized by an increase in troponin with ECG and/or echocardiographic changes, is reported in COVID patients. These forms are not related to coronary artery disease but are the consequence of the septic state and the excessive activation of the infectious- inflammatory systems and can manifest themselves with myocarditis/stress myocardiopathy causing heart failure and left ventricular systolic dysfunction.

Retrospective analysis of clinical and laboratory findings of a cohort of CoViD-19 patients treated with remdesivir

Background and Aim of the study: CoViD-19 pandemic required to the physicians the necessity to gain effective treatments against this infectious disease;one of the tried drugs is remdesivir. The aim of our study is to analyze clinical and laboratory features of a cohort of CoViD-19 patients treated with remdesivir. Materials and Methods:We evaluated retrospectively data of 22 patients (18 men and 4 women), considering two main items: the trend of inflammation markers (erythrocyte sedimentation rate, Creactive protein, interleukin-6, D-dimers, lymphocyte count, ferritin) and the severity of respiratory failure, comparing data between admission and discharge. Results: At admission, 85,7% of patients showed signs of acute respiratory failure (P/F ratio <300) and needed oxygen therapy but only 9,1% of them had this condition at discharge. Moreover, ESR, CRP and IL-6 levels were high at admission but showed a significant reduction at discharge;lymphocyte count was instead reduced at the beginning of the disease and increased after treatment;no significative variations were observed for D-dimer and ferritin levels. Finally average hospital stay was 4 days lower than the one of the cohort of patients non treated with remdesivir. Conclusions: Our results indicate that patients treated with remdesivir showed a good outcome in terms of respiratory function and reduction of inflammation state. However, a larger cohort of patients and the comparison with control patients are necessary to better investigate potential benefits of remdesivir.

Proarrhythmic role of CoViD-19

Background: CoViD-19 infection can induce myocardial damage and heart failure, potentially complicated by arrhythmias, both as a direct consequence of CoViD-19 infection on cardiac activity, and as an effect of prescribed drug therapies. In fact, drugs such as azithromycin or hydroxychloroquine, used in CoViD-19 infection, can lengthen the QT interval with the possible risk of arrhythmias. Description of the case: A 40-year-old patient hospitalized for CoViD complains of heartbeat and atypical chest pain. Normal vital signs. ECG: rapid ventricular response atrial fibrillation. Echocardiogram: normal. Chest x-ray: bibasal interstitial pneumonia. Elevated troponin. Conclusions: Arrhythmias in patients with CoViD -19 infection are probably the consequence of direct myocardial damage or may occur as a result of metabolic disorder, hypoxia, neuro-hormonal alterations or inflammatory stress in the context of acute viremia. The onset of an arrhythmia in the presence of elevated cardiac markers may be an indication of underlying myocarditis. Since hypoxia and electrolyte abnormalities that can facilitate the onset of arrhythmias are common in the acute phase of the disease, especially in the most severe pictures, the exact arrhythmic risk of patients with less severe pictures and of patients in the post-acute phase is currently unknown. Stratification of the long-term arrhythmic risk of patients who have experienced episodes of arrhythmias in the acute phase of the disease is essential for their correct management.

Pathophysiology of thromboembolic risk in SARS-CoV-2 pneumonia

Background: SARS-CoV-2 disease may be associated with a state of hypercoagulability and an increased risk of both venous and arterial thromboembolism. Clinical and biological evidence has documented a high thromboembolic risk in the acute phase of the infection, but the incidence of the risk in the late phase of the disease requires further investigation. Description of the case: A hypertensive and diabetic patient comes to the emergency room for dyspnea and fever. It is hypotensive, tachycardic and hypoxemic. Elevated D-dimer and troponin. ECG: sinus tachycardia and right bundle branch block. Echocardiogram: hypertensive heart disease and right overload. Chest CT: bilateral interstitial pneumonia, with filling defects at the bifurcation of the right pulmonary artery. Nasopharyngeal swab for SARSCoV- 2: positive. Conclusions: SARS-CoV-2 is configured as a multidimensional disease whose characteristic physiopathological and clinical aspects are being defined: a) an increased immunological and inflammatory response with activation of a cytokine storm and consequent coagulopathy, which favours both venous thromboembolism events and thrombosis in situ in the pulmonary arterioles and alveolar capillaries;b) a high intrapulmonary shunt, which accounts for the severity of respiratory failure, attributed to a reduced hypoxic pulmonary vasoconstriction with pulmonary neoangiogenic phenomena. These patients may benefit from anticoagulant therapy initiated as early as the diagnosis of SARS-CoV-2 pneumonia.

Performance comparison of fiveextraction kits for SARS-CoV-2 RNA extraction

A new type of coronavirus, SARS-CoV-2, was identified in January 2020. Its associated disease, COVID-19, wasannounced as a pandemic by the World Health Organization in March 2020. The Ontario Institute for CancerResearch quickly engaged to support viral sequencing, not only in frontline health care workers but in cancerpatients. A key deliverable was the selection of an extraction methodology that would not impact the supply ofapproved diagnostic testing reagents. This consideration was in response to reports of possible shortages predictedearly in the pandemic and as indicated by the Public Health Agency of Canada (PHAC), through their call forreagents in April 2020. Five commercially available kits for automated nucleic acid extraction were compared. TheKingFisher Flex Purification System (ThermoFisher, 5400610) was used for nucleic acid extraction. Four kits wereselected based on availability, system compatibility, and exclusion from PHAC's call for COVID-19 testing reagents.The MagMAX CORE Nucleic Acid Purification Kit (CORE;ThermoFisher, A32702), MagMAX Total Nucleic AcidIsolation Kit (Total NA;ThermoFisher, AM1840), MagMAX Total RNA Isolation Kit (Total RNA;ThermoFisher, AM1830), and Mag-Bind Viral DNA/RNA 96 Kit (Omega;Omega BioTek, M6246-03) were evaluated. The MagMAXViral/Pathogen Kit (MVP;ThermoFisher, A42352), approved by the Food and Drug Administration of Canada fordiagnostic testing, was used as a benchmark. Test samples were prepared using Universal Human RNA (Agilent,740000), lambda DNA solution (Sigma Aldrich, ERMAD442K), SARS-CoV-2 RNA (ATCC, VR1986D) and heat-inactivated virus (ATCC, VR-1986HK). Extractions were performed by two operators on replicate samples. Protocols were assessed on reproducibility, yield, reagent availability, run time, and ease of use. The top two kits were validated with nasopharyngeal swab samples from SARS-CoV-2-positive patients. Four of five kits demonstratedreproducible yields, while yields from the Total RNA kit were inconsistent. The CORE and Omega kits possessedthe best overall extraction efficiencies (both 70%). The MVP kit and Total NA kit were 59% and 44% efficient inrecovery, respectively. The CORE and Omega kits ranked best after overall assessment. Patient samples weresubsequently extracted using both kits and successfully sequenced. Extraction kits do not all perform to the samespecification. In our hands, we found the MVP kit did not perform as well as others, despite being approved fordiagnostic use, and the Total RNA kit showed inconsistent results. Many reagents are commercially available andshould be explored as alternatives to the approved SARS-CoV-2 diagnostic reagents, particularly during a globalcrisis. Interestingly, following our validation testing, supply of the CORE kit became limited with unknown futureavailability. This illustrated the need to validate multiple methods during uncertain times in order to maintain criticaltesting.

Mobile Health (mHealth) and Advances in Noninvasive Diagnosis of Anemia: An Overview

Anemia is a public health problem that can have different causes, such as iron deficiency, vitamin deficiency, inflammation, hemolytic anemias, and anemias associated with bone marrow disease. Anemia shows a decrease in the concentration of hemoglobin, a pigmented molecule in the erythrocytes. The objectives of this review were to highlight the impact of nutritional factors on morbidity and mortality caused by anemia and to present different non-invasive approaches that use a smartphone to analyze hemoglobin levels to detect anemia. According to the records of the Brazilian Unified Health System (SUS, in the Portuguese acronym), ∼ 440,000 people checked in hospitals due to anemia between January 2015 and April 2020, with 215,000 deaths. The government spent ∼ 294 million Brazilian Reais (more than 50 million US dollars) on anemia hospitalization cases during this period. There is a worldwide search to provide noninvasive diagnostics and mobile health (mHealth) tools to help diagnosing anemia. The smartphone appears to be a viable device to detect anemia by a camera with colorimetric analysis of images providing a quantitative, instantaneous, and noninvasive result. These images can be obtained as a photograph or extracted from video frames. The review presents three different methods of detecting anemia using a smartphone: i) photoplethysmograph from video obtained from the tip of the index finger, ii) photo of the palpebral conjunctiva, and iii) fingernail photo app. Therefore, it seems urgent that these approaches may be applied in routine clinical diagnosis to allow remote, needy, low-Tech locations to have access to anemia screening.

Breast surgeons updating on the thresholds of COVID-19 era: results of a multicenter collaborative study evaluating the role of online videos and multimedia sources on breast surgeons education and training.

OBJECTIVE: Current trends show a rise of attention given to breast cancer patients' quality of life and the surgical reconstructive result. Along with this trend, surgical training quality and efficacy are gaining importance and innovative training methods such as online videos shared on social media portals, are becoming main updating tools. In hazardous times like COVID-19 pandemic nowadays, online communication becomes of vital importance and adaptation and innovation are fundamental to keep research and education alive. The authors aimed to investigate the role of video and multimedia sources on the daily activity and surgical training of a representative group of surgeons specifically dedicated to oncologic, oncoplastic and reconstructive breast surgeries. MATERIALS AND METHODS: A survey was produced and administered to 20 major Italian Breast Centers. Collected data were analyzed with Fisher's Exact Test. RESULTS: From October 2019 to March 2020, a total of 320 surveys were collected. Among the responders, there were 188 trainees (intern medical doctors and residents) and 110 faculty, 72% of them belonged to a plastic surgery environment, while 28% to general surgery environment. Almost all respondents have ever watched videos concerning breast surgery. CONCLUSIONS: The results of the study show how breast surgeons rely on videos and web platforms, mostly YouTube, when searching for training info about surgical procedures. Social media offer great opportunities for sharing knowledge and diffusion of new ideas but greater attention to their reliability is mandatory.