Clinical characteristics and risk factors associated with COVID-19 mortality in a non-Intensive Care Unit.

Introduction: The Coronavirus disease 2019 caused by a new Coronavirus (SARS-CoV-2) throughout the pandemic period has been characterised by a wide spectrum of clinical manifestations, courses, and outcomes. In particular, most patients with severe or critical symptoms re-quired hospitalization. The demographic and clinical characteristics of patients upon admission to the hospital, as well as pre-existing medical conditions, seem to have affected the clinical out-come. Predictive factors of inauspicious outcome in non-Intensive Care Unit hospitalized patients were investigated. Methods: A retrospective, single-centre, observational study of 239 patients with confirmed COVID-19 disease admitted during the first waves of the pandemic to the Infectious Disease Operative Unit of a hospital in Southern Italy was conducted. Demographic characteristics, under-lying diseases, and clinical, laboratory, and radiological findings were collected from the patient's medical records. Information about in-hospital medications, days of admission, and out-come were also considered. Inferential statistical analysis was performed to evaluate the association between patients' characteristics upon hospital admission and during in-hospital length of stay and death. Results: Mean age was 67.8 ± 15.8 years; 137/239 (57.3%) patients were males, and 176 (73.6%) had at least one comorbidity. More than half of patients (55.3%) suffered from hypertension. The length of stay in hospital was 16.5 ± 9.9 days and mortality rate of 12.55%. In multivariable logistic regression analysis, predictors of mortality of COVID-19 patients included age (OR, 1.09; CI, 1.04-1.15), Chronic Kidney Disease (OR, 4.04; CI, 1.38-11.85), and need of High Flow Oxygen therapy (OR, 18.23; CI, 5.06-65.64). Conclusions: Patients who died in the hospital had shorted length of stay than that of the surviving patients. Older age, pre-existent chronic renal disease and need of supplemental oxygen represented independent predictors of mortality in patients hospitalized in non-Intensive Care Unit with COVID-19. The determination of these factors allows retrospectively a greater understanding of the disease also in comparison with the successive epidemic waves.

Kinetics of Humoral Immunity against SARS-CoV-2 in Healthcare Workers after the Third Dose of BNT162b2 mRNA Vaccine.

Protection provided by COVID-19 vaccines is compromised due to waning immunity over time. This study aimed to assess the level of antibodies anti-S-RBD of SARS-CoV-2 in a cohort of healthcare workers before and, on average, one and four months after the third dose of the BNT162b2 vaccine. The determination of antibodies was carried out in serum samples using an electrochemiluminescence immunoassay (ECLIA). All 34 participants (10 males, 24 females, 19 participants <50 years old, 15 participants ≥50 years old) showed a significant antibody level increase after the booster dose. Subsequently, a significant decrease in the antibody concentration was observed, with a reduction of about 60% after 150 days from the booster. Six subjects were infected by SARS-CoV-2 after the booster and showed a significantly higher antibody concentration on average four months after the third dose compared to naïve ones. Male and female participants had a similar trend in the antibody decline, while older subjects, compared to the younger ones, had a slightly slower decrease, even if they developed a lower level of antibodies after the third dose. These findings support the importance of the booster dose and underline the need for surveillance programs to better understand the antibody kinetics and optimize vaccination strategies.

Risk management and communication plans from SARS to COVID-19 and beyond.

OBJECTIVE: Nowadays, due to globalisation, the likelihood that infectious diseases spread rapidly is extraordinarily high. SARS and COVID-19 are two diseases of the Coronavirus family, which developed in China and then spread internationally, causing global public health emergencies. This study investigates the role that risk management and communication systems played in mitigating these emergencies, to establish how they should be improved in the future. METHODS: A narrative review was carried out to investigate different knowledge domains, such as risk management and communication, risk assessment and indicators, epidemiological and clinical data, diagnostic methods, vaccines, public health and social measures. RESULTS: On one side, risk management systems assess the main data, knowledge, and indicators on epidemiology, diagnostics, and vaccines (science-based); on the other side, they apply public health and social measures (socially-based). Decision-makers, in fact, implement their actions by constantly balancing these two sides (policy-based). CONCLUSIONS: A correct crisis management approach should support the governance of pandemics, by harmonising the actual risks assessed by experts with those perceived by the general population. It should incorporate not only the biological, but even the environmental, social and economic aspects of virus emergencies, towards establishing a suitable framework to deal with possible future pandemics.

Antibody Response in Healthcare Workers before and after the Third Dose of Anti-SARS-CoV-2 Vaccine: A Pilot Study.

The SARS-CoV-2 pandemic led to the development of various vaccines. The BNT162b2 mRNA vaccine was the first approved due to its efficacy in eliciting a humoral immunity response after the second dose. However, a decrease in the antibody concentration was observed over time. Therefore, the administration of a third dose was scheduled, primarily for frail people and workers of essential public activities. The aim of this study was to assess the level of antibodies against the spike (S) RBD of SARS-CoV-2 in healthcare workers before and after the third dose of BNT162b2 vaccine, according to sex, age, and the time interval between vaccine doses and tests. All 37 (12 males, 25 females, 19 < 50 years old, 18 ≥ 50 years old) healthcare workers recruited showed a consistent antibody titer increase after the third dose. Data analysis showed that the antibody concentration before the third dose significantly decreased as the time interval up to the test increased, and a significantly higher level was shown in young than older people. Cluster analysis revealed that young females had a higher antibody level than older females before the third dose (p < 0.05). This study indicated the benefit of the third dose of BNT162b2 vaccine and its effect on leveling up the humoral immune response.

The Role of ABO Blood Type in Patients with SARS-CoV-2 Infection: A Systematic Review.

The SARS-CoV-2 infection has caused over 422 million contagions and 5.8 million deaths resulting in a global health crisis. Several studies have investigated the risk factors predisposing to the infection and reported that the host susceptibility can be linked to the ABO blood group, but the current evidence is controversial. We systematically searched for articles in EMBASE, PubMed, and Cochrane library published up to 7 May 2021 to explore the association of the ABO blood group with the susceptibility to SARS-CoV-2 infection. All studies in people undergoing SARS-CoV-2 test controls were included. Odds ratios were obtained in each study and then synthesised by using meta-analysis. Overall, 22 articles were selected and more than 1,200,000 individuals of whom 74,563 resulted positive to SARS-CoV-2 and 1,166,717 resulted negative, were included in the meta-analysis. Overall, 487,985 subjects had blood group A, 151,879 had group B, 52,621 had group AB, and 548,795 had group O. Group O was slightly less associated with infection, as compared to the other three blood groups (OR = 0.91, 95% CI = 0.85-0.99, p = 0.02). Conversely, group A was slightly more associated with infection, as compared to the other three groups (OR = 1.06, 95% CI = 1.00-1.13, p = 0.04). This meta-analysis shows associations between blood groups and SARS-CoV-2 infection and supports the hypothesis that blood type O may have a slightly lower risk of infection, whereas blood type A may have a slightly higher risk of infection.

Atrial fibrillation with aberrant ventricular conduction after receiving Bamlanivimab/Etesevimab: a case report.

Coronavirus Disease 2019 (COVID-19) is affecting millions of people globally. Several neutralizing monoclonal antibodies have been developed to limit the progression and complications of the disease. These treatments provide immediate and passive immunity. The combination therapy with Bamlanivimab plus Etesevimab led to a lower incidence of COVID-19-related hospitalization and death and a faster reduction in the SARS-CoV-2 viral load. No or rare cases of cardiovascular side effects are reported. We present the case of a high-risk 79-years-old woman who developed atrial fibrillation with aberrant ventricular conduction after administration of neutralizing monoclonal-antibodies Bamlanivimab plus Etesevimab. The woman with a history of insulin-dependent diabetes and Grade II follicular Non-Hodgkin Lymphoma previously vaccinated with two doses of Pfizer COVID-19 vaccine, presented with malaise, headache, and SARS-CoV-2 nasal swab reverse transcription-polymerase chain reaction tested positive for the infection. She received a single dose of Bamlanivimab (70 mg) + Etesevimab (1400 mg). After about a week, she developed atrial fibrillation with uncontrolled response to frequent premature ventricular complexes and aberrant ventricular conduction. This case presents a high-risk woman with SARS-CoV-2 infection who developed a serious adverse cardiovascular event some days after receiving neutralizing monoclonal antibodies. Risk factors including sex, age, anxiety related to isolation and infection, and COVID-19 itself may have all contributed to atrial fibrillation. Arrhythmia may rarely occur after monoclonal-antibodies treatment, although recommended timing to monitor patients is from 1 to 24 h after the administration of these antibodies. Appreciation of this potential association is important for evaluating monoclonal-antibody treatments' safety and optimizing patient monitoring and follow-up.

Role of ABO blood system in COVID-19: Findings from a southern Italian study.

BACKGROUND: COVID-19 is a worldwide infection caused by SARS-CoV-2 and infects humans by binding to the ACE2 receptor. Blood group ABO glycoproteins can influence the binding of the virus to ACE2. The role of ABO blood system in the susceptibility to infection as well as in the clinical outcome of infected patients is still controversial and needs to be clarified. METHODS: We conducted a retrospective study of 167 patients positive for SARS-CoV-2 who underwent nasopharyngeal swab, and of a control group represented by 891 subjects negative for SARS-CoV-2, to assess the association between ABO and Rh blood system and occurrence of SARS-CoV-2 infection, clinical presentation, and outcome of disease. RESULTS: In the cohort of patients positive for SARS-CoV-2, no statistically significant difference in the distribution of ABO blood types compared with controls was observed. Patients with blood type A had a higher risk of developing symptomatic disease (p = 0.002; odds ratio [OR = 3.592]; 95% confidence interval [CI] = 1.576-8.187) compared to patients with blood types B, AB, and O. Patients with blood types B (p = 0.021; OR = 0.293; 95%CI = 0.099-0.869) and O (p = 0.018; OR = 0.417; 95%CI = 0.199-0.871) showed a lower risk in comparison to the other groups. The clinical progression to mild/moderate and severe/critical disease and the mortality showed no association. Moreover, no relationship with Rh blood type was found. CONCLUSIONS: Our findings support a role of ABO blood type in the development of symptomatic disease with a higher risk in subjects with blood type A and a protective effect of blood types B and O. Blood types do not seem, however, to play a role in susceptibility, progression to severe disease, and death.

Clinical features of COVID-19 and SARS epidemics. A literature review.

SARS-CoV-2, responsible for the current pandemic, is a novel strain of the Coronaviridae family, which has infected humans as a result of the leap to a new species. It causes an atypical pneumonia similar to that caused by SARS-CoV in 2003. SARS-CoV-2 has currently infected more than 9,200,000 people and caused almost 480,000 deaths worldwide. Although SARS-CoV-2 and SARS-CoV have similar phylogenetic and pathogenetic characteristics, they show important differences in clinical manifestations. We have reviewed the recent literature comparing the characteristics of the two epidemics and highlight their peculiar aspects. An analysis of all signs and symptoms of 3,365 SARS patients and 23,280 COVID-19 patients as well as of the comorbidities has been carried out. A total of 17 and 75 studies regarding patients with SARS and COVID-19, respectively, were included in the analysis. The analysis revealed an overlap of some symptoms between the two infections. Unlike SARS patients, COVID-19 patients have developed respiratory, neurological and gastrointestinal symptoms, and, in a limited number of subjects, symptoms involving organs such as skin and subcutaneous tissue, kidneys, cardiovascular system, liver and eyes. This analysis was conducted in order to direct towards an early identification of the infection, a suitable diagnostic procedure and the adoption of appropriate containment measures.

Efficacy and safety of human papillomavirus vaccination in HIV-infected patients: a systematic review and meta-analysis.

The prophylactic vaccines available to protect against infections by HPV are well tolerated and highly immunogenic. People with HIV have a higher risk of developing HPV infection and HPV-associated cancers due to a lower immune response, and due to viral interactions. We performed a systematic review of RCTs to assess HPV vaccines efficacy and safety on HIV-infected people compared to placebo or no intervention in terms of seroconversion, infections, neoplasms, adverse events, CD4+ T-cell count and HIV viral load. The vaccine-group showed a seroconversion rate close to 100% for each vaccine and a significantly higher level of antibodies against HPV vaccine types, as compared to the placebo group (MD = 4333.3, 95% CI 2701.4; 5965.1 GMT EL.U./ml for HPV type 16 and MD = 1408.8, 95% CI 414.8; 2394.7 GMT EL.U./ml for HPV type 18). There were also no differences in terms of severe adverse events (RR = 0.6, 95% CI 0.2; 1.6) and no severe adverse events (RR = 0.6, 95% CI 0.9; 1.2) between vaccine and placebo groups. Secondary outcomes, such as CD4 + T-cell count and HIV viral load, did not differ between groups (MD = 14.8, 95% CI - 35.1; 64.6 cells/µl and MD = 0.0, 95% CI - 0.3; 0.3 log10 RNA copies/ml, respectively). Information on the remaining outcomes was scarce and that did not allow us to combine the data. The results support the use of the HPV vaccine in HIV-infected patients and highlight the need of further RCTs assessing the effectiveness of the HPV vaccine on infections and neoplasms.