Circulation of SARS-CoV-2 Among Asylum Seekers: A Real-Life Experience to Address Health Equity in Piacenza, Italy

Aim of the Study: We aimed to evaluate the virus spreading among a migrant population previously excluded by community surveillance programs. Method(s): We conducted a retrospective study, collecting data about people without SARS-CoV-2-related symptoms who attended the outpatient clinic for undocumented migrants from November 1, 2020, to April 30, 2021. Patients who performed a nasopharyngeal swab and serologic test to evaluate the presence of antibody anti-SARS-CoV-2 were enrolled. Result(s): Overall, 240 people were included in our study. Of them, 15 (6.3%) were female, with a median age of 27.0 years (interquartile range [IQR], 24.3-32.1 years). Thirty-seven patients (15.4%) tested positive for SARS-CoV-2 at the nasopharyngeal swab during the study period. Of these, 16 had positive or low positive results for immunoglobulin G (IgG) and 3 tested positive for both IgG and IgM. Besides, 22 participants (9.2%) resulted positive to serological testing, but negative to polymerase chain reaction testing. The median age of SARS-CoV-2 positive patients (n = 59) was significantly higher than negative (29.6 [IQR, 25.0-35.0] vs 26.8 [IQR, 24.2-31.5], P = 0.022). Among positive patients, the most frequent nationality was Bangladeshi, with 24 people (40.7%, P < 0.001). The highest percentage of positive was found among the same nationality (51.1% of Bangladeshi tested positive). Conclusion(s): Our data underline the significantly higher prevalence of SARS-CoV-2 infection in the undocumented migrant population in respect of the general population of Piacenza province in the same period (15.4% vs 5.9%, P < 0.001). The extension of surveillance programs to the whole population, thus including undocumented people, is crucial to curb the spreading of the virus.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Axillary lymph node hypermetabolism (ALNH) related to COVID-19 vaccination in cancer patients undergoing 18F-FDG PET/CT: a single centre study on 500 cases

Background-Aim: The aim of the present study was to investigate the occurrence and characteristics of axillary lymph node hypermetabolism (ALNH) after COVID-19 vaccination in a large series of cancer patients undergoing 18F-FDG PET/CT. Methods: We retrospectively reviewed a consecutive series of 500 cancer patients (267 males and 233 females, aged 22-91 years, mean age: 64.9 years) who underwent 18F-FDG PET/CT after COVID-19 vaccination (period: March-October 2021). Twenty of these patients were studied twice for a total of 520 PET/CT studies;135/520 studies were carried out after the first dose of vaccine and the remaining 385/520 studies after the second dose. All FDG PET/CT studies were acquired at the same nuclear medicine Centre according to standardized acquisition procedure protocols, using a Discovery 710 system (GE Healthcare). PET images were analysed both qualitatively and semiquantitatively calculating SUV max at the level of hypermetabolic lymph nodes. Results: ALNH ipsilateral to COVID-19 vaccination was observed in 176/520 studies (33.8%). Among the 176 positive studies, HALN was considered vaccine-related (Group 1) in 130/176 cases (74%), metastatic (Group 2) in 34/176 cases (19.3%) and equivocal (Group 3) in the remaining 12/176 cases (6.8%). SUV max was 3.5 ± 2.21 in Group 1, 8.95 ± 5.83 in Group 2 and 3.912 ± 1.66 in Group 3 (p<0.0001). Among the 130 Group 1 cases, 31 were studied after vaccine dose 1 (subgroup 1A) and 99 after vaccine dose 2 (subgroup 1B) with SUV max equal to 3.12 ± 1.72 in the former subgroup and 3.62 ± 2.34 in the second subgroup (p = 0.27). Furthermore, in the subgroup 1A, SUV max was 3.68 ± 2.01 in the first week after vaccination, 2.76 ± 1.57 in the second week and 2.52 ± 1.2 in the third week (p = 0.567), while in the subgroup 1B the corresponding SUV max values were 5.51 ± 3.03, 3.81 ± 2.01 and 3.17 ± 1.96 (p<0.001). After third week post-vaccination, FDG lymph node avidity was observed in 2/31 subgroup 1A cases and in 27/99 subgroup 1B cases. Conclusions: In our series, the overall prevalence of vaccine-related ALNH was 25% (130/520). Vaccine-related hypermetabolic lymph nodes showed a significantly lower SUV max than that observed in metastatic lymph nodes. Equivocal findings were seen in<7% of cases. No statistically significant difference in SUV max was seen after dose 1 and dose 2 vaccinations. However, after the second vaccination, the SUV max was statistically higher in the first week rather than later. Finally, FDG lymph node uptake may persist beyond the third week, mainly after the second vaccination.

Systemic inflammatory markers and psychophysical olfactory scores in coronavirus disease 2019 patients: is there any correlation?

OBJECTIVE: To analyse the correlations between olfactory psychophysical scores and the serum levels of D-dimer, C-reactive protein, ferritin, lactate dehydrogenase, procalcitonin and neutrophil-to-lymphocyte ratio in coronavirus disease 2019 patients. METHODS: Patients underwent psychophysical olfactory assessment with the Connecticut Chemosensory Clinical Research Center test, and determination of blood serum levels of the inflammatory markers D-dimer, C-reactive protein, ferritin, lactate dehydrogenase, procalcitonin and neutrophil-to-lymphocyte ratio within 10 days of the clinical onset of coronavirus disease 2019 and 60 days after. RESULTS: Seventy-seven patients were included in this study. D-dimer, procalcitonin, ferritin and neutrophil-to-lymphocyte ratio correlated significantly with severe coronavirus disease 2019. No significant correlations were found between baseline and 60-day Connecticut Chemosensory Clinical Research Center test scores and the inflammatory markers assessed. CONCLUSION: Olfactory disturbances appear to have little prognostic value in predicting the severity of coronavirus disease 2019 compared to D-dimer, ferritin, procalcitonin and neutrophil-to-lymphocyte ratio. The lack of correlation between the severity and duration of olfactory disturbances and serum levels of inflammatory markers seems to further suggest that the pathogenetic mechanisms underlying the loss of smell in coronavirus disease 2019 patients are related to local rather than systemic inflammatory factors.

Early combination treatment with existing HIV antivirals: an effective treatment for COVID-19?

OBJECTIVE: Since no effective therapy exists, we aimed to test existing HIV antivirals for combination treatment of Coronavirus disease 19 (COVID-19). MATERIALS AND METHODS: The crystal structures of SARS-CoV-2 main protein (Mpro) (PDB ID: 6Y2F) and SARS-CoV-2 RNA-dependent RNA polymerase (RdRp) (PDB ID: 7BV2) both available from Protein Data Bank were used in the study. Automated Docking by using blind and standard method both on Mpro and RdRp bound to the modified template-primer RNA was performed with AutoDock 4.2.6 program suite. Lamarckian genetic algorithm (LGA) was used for structures docking. All inhibitors were docked with all bonds completely free to rotate. RESULTS: Our molecular docking findings suggest that lopinavir, ritonavir, darunavir, and atazanavir activated interactions with the key binding sites of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) protease with a better inhibition constant (Ki) for lopinavir, ritonavir, and darunavir. Furthermore, we evidenced the ability of remdesivir, tenofovir, emtricitabine, and lamivudine to be incorporated in SARS-CoV-2 RdRp in the same protein pocket where poses the corresponding natural nucleoside substrates with comparable Ki and activating similar interactions. In principle, the four antiviral nucleotides might be used effectively against SARS-CoV-2. CONCLUSIONS: The combination of a protease inhibitor and two nucleoside analogues, drugs widely used to treat HIV infection, could be evaluated in clinical trials for the treatment of COVID-19.

Does Angiotensin II receptor blockers increase the risk of SARS-CoV-2 infection? A real-life experience.

OBJECTIVE: Since the start of the COVID-19 pandemic, millions of people have been infected with thousands of deaths. Few data regarding factors that increase the risk of infection are available. Our study aimed to evaluate all people living in retirement homes (PLRNH) and identify factors that could increase infection risk in a close community. MATERIALS AND METHODS: We conducted a retrospective study enrolling all PLRNH, where at least one SARS-CoV-2 infected person was present. Variables were compared with Student's t-test or Pearson chi-square test as appropriate. Uni- and multivariate analyses were conducted to evaluate variables' influence on the infection. RESULTS: We included 452 PLRNH; 144 (31.7%) were male, with a mean age of 82.2±8.6 years. People with a positive swab for SARS-CoV-2 were 306 (67.4%). A significant difference between SARS-CoV-2 infected and not infected was observed in the percentage of those receiving chronic treatment with Angiotensin II receptor blockers (ARBs) (18.6% vs. 9.5%, p=0.012). On the contrary, there was no difference in the proportion of those receiving ACE inhibitors (ACE-I) (21.2% vs. 23.6%, p=0.562). At multivariate analysis, people with mental illness and cancer had an increased risk of being infected. Furthermore, receiving ARBs as a chronic treatment was an independent predictor of infection risk [OR 1.95 (95% CI 1.03-3.72) p=0.041]. CONCLUSIONS: Our data suggest that, in close communities, such as retirement nursing homes, the receipt of ARBs increased the risk of acquiring SARS-CoV-2 infection. However, before changing an important chronic treatment in a fragile population, such as the elderly living in retirement nursing homes, clinicians should carefully evaluate the risk-benefit ratio.

A case of vasculitis-like skin eruption associated with COVID-19

Since the start of the SARS-CoV-2 outbreak, more than 4 million cases have been reported with almost 300,000 deaths. Commonly, the virus involves the respiratory system causing fever, cough, and dyspnea. On the contrary, cutaneous involvement has been infrequently reported. We described the case of a 72-year-old woman without a history of dermatologic diseases with COVID-19 who developed vasculitis-like skin eruptions. Because she has not received any treatment for COVID-19, we suggest that the dermatologic clinical picture was related to SARS-CoV-2. © Wolters Kluwer Health, Inc. All rights reserved.

Estimating the COVID-19 cash crunch: Global evidence and policy

In this paper, we investigate how the COVID-19 health crisis could affect the liquidity of listed firms across 26 countries. We stress-test three liquidity ratios for each firm with full and partial operating flexibility in two simulated distress scenarios corresponding to drops in sales of 50% and 75%, respectively. In the most adverse scenario, the average firm with partial operating flexibility would exhaust its cash holdings in about two years. At that point, its current liabilities would increase, on average, by eight times, suggesting that the average firm would have to resort to the debt market to prevent a liquidity crunch. Moreover, about 1/10th of all sample firms would become illiquid within six months. Finally, we study two different fiscal policies, tax deferrals and bridge loans, that governments could implement to mitigate the liquidity risk. Our analysis suggests bridge loans are more cost-effective to prevent a massive cash crunch. © 2020 The Author(s)

Clinical features, laboratory findings and predictors of death in hospitalized patients with COVID-19 in Sardinia, Italy.

OBJECTIVE: Since December 2019, when the first SARS-CoV2 infections have been reported, the number of cases has increased exponentially. In our University Hospital Unit, the first patient with COVID-19 was admitted on the 8th of March 2020. We aimed to investigate the predictors of death among inpatients with COVID-19. MATERIALS AND METHODS: We performed a retrospective, monocentric study, consecutively enrolling patients with SARS-CoV2 infection. Clinical, laboratory, and radiological data were collected from the 8th of March to the 8th of April 2020. We aimed to describe the most frequent clinical and laboratory features and predictors of death among patients admitted to our Unit. RESULTS: 87 patients were enrolled, 56 (64.4%) were male, with a median age of 72 (IQR 62.5-83.5) years. The majority of our population had at least one comorbidity in their medical anamnesis. Hypertension and cardiovascular disease were the most frequent, followed by obesity. Eighty (92%) patients had at least one symptom, whereas 7 (8%) were asymptomatic. The most common symptoms were fever and dyspnoea. Overall, 53 patients had lung disease confirmed at CT scan (60.9%). Twenty-five (28.7%) deaths occurred. Statistically significant predictors of death at multivariate analysis were lymphocytes count <900 cells/mm3, moderate ARDS, and lack of compliance at baseline. CONCLUSIONS: This is the first Italian experience available. Our results seem to be in line with international literature. As highlighted by our data, more studies are needed to investigate the role of lymphocytes subsets, CT scan values. Furthermore, therapy choice and timing in this challenging setting should be urgently investigated in randomized clinical trials.