Characteristics of 1573 healthcare workers who underwent nasopharyngeal swab testing for SARS-CoV-2 in Milan, Lombardy, Italy.

OBJECTIVES: The management of healthcare workers (HCWs) exposed to confirmed cases of coronavirus disease 2019 (COVID-19) is still a matter of debate. We aimed to assess in this group the attack rate of asymptomatic carriers and the symptoms most frequently associated with infection. METHODS: Occupational and clinical characteristics of HCWs who underwent nasopharyngeal swab testing for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a university hospital from 24 February 2020 to 31 March 2020 were collected. For those who tested positive and for those who tested positive but who were asymptomatic, we checked the laboratory and clinical data as of 22 May to calculate the time necessary for HCWs to then test negative and to verify whether symptoms developed thereafter. Frequencies of positive tests were compared according to selected variables using multivariable logistic regression models. RESULTS: There were 139 positive tests (8.8%) among 1573 HCWs (95% confidence interval, 7.5-10.3), with a marked difference between symptomatic (122/503, 24.2%) and asymptomatic (17/1070, 1.6%) workers (p < 0.001). Physicians were the group with the highest frequency of positive tests (61/582, 10.5%), whereas clerical workers and technicians had the lowest frequency (5/137, 3.6%). The likelihood of testing positive for COVID-19 increased with the number of reported symptoms; the strongest predictors of test positivity were taste and smell alterations (odds ratio = 76.9) and fever (odds ratio = 9.12). The median time from first positive test to a negative test was 27 days (95% confidence interval, 24-30). CONCLUSIONS: HCWs can be infected with SARS-CoV-2 without displaying any symptoms. Among symptomatic HCWs, the key symptoms to guide diagnosis are taste and smell alterations and fever. A median of almost 4 weeks is necessary before nasopharyngeal swab test results are negative.

Decreased prostaglandin-I2 stability in acute myocardial infarction.

It has been demonstrated that under certain conditions the in-vitro half-life of biologically active PGI2 in plasma is extremely shortened, which may result in-vivo in a local haemostatic imbalance. In 36 patients suffering from acute myocardial infarction a sequential change in in-vitro half-life of synthetic PGI2 was therefore studied during 3 weeks. 21 patients admitted turning out not to develop myocardial infarction served as follow-up controls. During and shortly after the acute episode the plasmatic half-life of PGI2 in-vitro was shortened by about 40%, improving continuously thereafter. No certain influence of either risk factors, sex or age could be discovered. A possible influence of various drugs administered in the hospital period has been excluded in 43 patients with proven coronary artery disease. No such changes occurred during acute angina pectoris attack in 12 patients. It remains to be established, whether the short-lasting destabilisation of PGI2 may be an acute disease-associated finding, or an important pathogenetic factor.

Comparison of bopindolol and atenolol in chronic stable angina pectoris.

The efficacy of bopindolol and atenolol in the treatment of patients with chronic stable angina pectoris have been compared in a double blind, randomized study. Both bopindolol 1 mg and atenolol 100 mg for 6 weeks increased mean exercise time (25% and 22%, respectively, compared to placebo), time to angina (27% and 25%), and time to 1 mm of ST-segment depression (32% and 20%). Both drugs reduced ST-segment depression similarly at maximal and submaximal work levels. There was no significant difference in their antianginal efficacy.

Comparison of the acute haemodynamic effects of bopindolol and propranolol at rest and during supine exercise.

The acute cardiovascular effects of two beta-adrenoceptor blocking agents, bopindolol and propranolol, were compared in a randomized study in 16 male patients with coronary heart disease. All patients had had an uncomplicated acute myocardial infarction at least 8 weeks earlier. The two drugs reduced the arterial blood pressure to the same extent, both at rest and during exercise. As heart rate and stroke volume were also decreased, cardiac output was reduced, whereas systemic vascular resistance was increased at rest and during exercise. Left ventricular filling pressure was increased. No statistically significant differences in these variables were seen between the two groups.

Haemodynamic effects of short-term treatment with bopindolol in essential hypertension.

Ten patients (mean age 53 years) with essential hypertension have been studied at rest and during exercise following oral treatment for 6 weeks with a new beta-adrenoceptor blocking agent, bopindolol. The treatment caused a significant decrease in systolic and diastolic arterial blood pressure and heart rate, both at rest and during exercise. Stroke volume fell, too, and therefore so did cardiac output, whereas the systemic vascular resistance was increased. Left ventricular filling pressure was elevated both at rest and during exercise following bopindolol therapy. However, a different haemodynamic pattern was noted in patients with elevated total peripheral resistance prior to therapy (Group 1) compared to patients with normal or subnormal peripheral resistance (Group 2). A decrease in systemic vascular resistance seemed to be the cause of the fall in blood pressure in Group 1, as the expected increase in vascular resistance did not occur, whereas a reduction in cardiac output was of greater importance in Group 2. During exercise the lowering of arterial blood pressure in both groups was mediated by a reduction in cardiac output.

Influence of atenolol and bopindolol on circadian heart rate.

The effects of a cardioselective beta-adrenoceptor blocker without intrinsic sympathomimetic activity (ISA) (atenolol) and a noncardioselective beta-adrenoceptor blocker with ISA (bopindolol) on circadian heart rate were studied in 10 patients (2 women and 8 men) with an average age of 52 years and the following diagnoses: coronary heart disease (n = 4) and hypertension (n = 6). The patients were treated in a randomized crossover study with 100 mg atenolol p.o. and 1 mg bopindolol p.o. Atenolol lowered the averaged circadian heart rate (HR) significantly (p less than 0.001), from 70-59 beats/min. The HR decreased during the day and also at night. After bopindolol the average circadian HR decreased only slightly, from 69-64 beats/min. HR was reduced during the day but not during the night. Nine out of 10 patients receiving atenolol developed hourly HRs less than 55 beats/min compared to 3 patients on bopindolol. There was a significant increase of hourly segments (HR less than 55 beats/min) from 11-85 and also for hourly segments with HR less than 50 beats/min from 0-46 with atenolol, whereas no significant change could be detected under bopindolol. Both drugs produced similar reductions in exercise-induced increases in HR and systolic blood pressure and these effects persisted for more than 24 h.

[Long-term ECG in clinical practice]. / Das Langzeit-EKG in Klinik und Praxis.

Long-term ECG monitoring is one of the greatest advances in clinical cardiology over the past 15 years. The recording examination including Holter technology is described. The clinical value of long-term ECG monitoring is compared with routine ECG and exercise testing. A survey on normal population data is made. Major indications for long-term ECG monitoring are detection of occult arrhythmias, evaluation of subjective symptoms such as palpitations, dizziness or syncope, recognition of pacemaker dysfunction, identification of high-risk patients with coronary heart disease and both evaluation as well as monitoring of drug therapy.

[Acute myocardial infarction in patients over 70]. / Akuter Myokardinfarkt bei Patienten über 70 Jahren.

History and clinical course were studied in 299 patients with acute myocardial infarction. 133 patients aged 70 and older (group 2) were compared to 166 patients under 70 (group 1). Hospital mortality of the total group was 23%. The mortality rate among the older patients (31%) was significantly higher than among the younger patients (17%) (p less than 0.01). The major cause of death in both groups was cardiogenic shock. It is noteworthy that in eight cases from group 2 pulmonary embolism was diagnosed at autopsy in spite of the fact that the patients were receiving prophylactic antithrombotic therapy. Analyzing the histories, it was noticed that group 2 had a significantly higher percentage of hypertension and left heart failure, whereas in group 1 significantly more smokers and hyperlipidemics were found. During hospitalization left ventricular enlargement and insufficiency were diagnosed more often in the elderly. It may be assumed that this fact is one of the reasons for the increased mortality of group 2.

[Comparison of 24-hour long-term electrocardiogram and exercise testing in the detection of ventricular arrhythmias (author's transl)]. / Der Stellenwert des langzeit-EKG und der Ergometrie zur Erfassung von ventrikulären Arrhythmien.

The incidence of ventricular arrhythmias was investigated in 100 patients with a mean age of 53 years with symptom-limited maximal bicycle exercise testing and 24-hour long-term electrocardiogram. 47% of the patients developed ventricular ectopic beats under exercise and 78% in the long-term electrocardiogram. Repetitive forms such as couplets and ventricular tachycardias were found to be three times as frequent with monitoring than with exercise. Therefore it may be concluded that 24-hour monitoring was superior to exercise testing in the detection of incidence and severity of ventricular ectopies. In contrast, there was no significant difference between the two method when comparing exercise testing with the first hour of monitoring. Therefore it may be concluded that exercise testing exposes the grades of ectopic activity occurring during the first hour of the monitoring session. Two-thirds of patients without arrhythmias under exercise had no or insignificant ventricular arrhythmias under monitoring, whereas two-thirds of patients with exercise-induced arrhythmias had advanced grade ventricular ectopic activity with monitoring.

The effect of intrinsic sympathomimetic activity of beta-adrenoceptor blockers on circadian heart rate.

1 The effect of a beta-adrenoceptor blocker without intrinsic sympathomimetic activity (propranolol) and a beta-adrenoceptor blocker with ISA (pindolol) on circadian heart rate was studied in 10 patients (3 women and 7 men) with an average age of 55 years and the following diagnoses: coronary heart disease (n = 7) and hypertension (n = 3). The therapy was carried out in a randomized, cross-over study, with 3 x 40 mg propranolol and 3 x 5 mg pindolol. 2 Propranolol lowered the averaged circadian heart rate significantly (P less than 0.001) from 78 to 68 beats/min. The rate decreased both during the day and at night and the reduction was greater the higher the control value. The minimal hourly heart rate also decreased significantly (P less than 0.005) from 65 to 69 beats/min. 3 After pindolol the averaged circadian heart rate was not markedly changed. It reached a stable rate of around 70 beats/min. At a heart rate of below 70 beats/min an increase in rate was observed, whereas above 70 beats/min a reduction was found. The mean heart rate during the day remained unchanged. There was a significant relationship between the level of the control heart rate and the decrease in rate (r = 0.85, P less than 0.005). 4 In a bicycle exercise test of 1 Watt/kg body weight over a period of 6 min, both beta-adrenoceptor blockers lowered blood pressure and heart rate to the same extent.

[Optimized sequential pacing of atrium and ventricle (author's transl]. / Die optimierte sequentielle Stimulation von Vorhof und Kammer. Ein Fallbericht.

A new stimulation system for pacemaker is described, which was implanted in a 49 years old patient. The new pacemaker stimulates the atrium when needed, the ventricle when needed and both when needed and can be inhibited completely. At a faster atrial activity and disturbed atrio-ventricular conduction the pacemaker synchronizes the ventricle at the appropriate rate. Thus the optimized stimulation comes very near to the physiologic rhythm of the heart.

[Electrocardiographic changes during long-term monitoring in a case of cardiac rupture after myocardial infarction (author's transl)]. / Elektrokardiographische Veränderungen während Langzeit-Ekg-Uberwachung bei Herzruptur nach Myokardinfarkt.

Electrocardiographic changes in long-term electrocardiogram are described in a patient with inferior myocardial infarction and cardiac rupture. In a monitoring period of more than seven hours, malignant arrhythmias could be diagnosed, which are not specific for cardiac rupture. During the last minutes, sinus bradycardia, slow nodal rhythm, and idioventricular escape rhythm could be diagnosed.

[Contribution of long-term ECG monitoring in analysing cardiac arrhythmias (author's transl)]. / Die Bedeutung der Langzeit-EKG-Uberwachung zur Erfassung von Arrhythmien.

Long-term analysis is one of the greatest advances in clinical cardiology within the last 15 years. With the introduction of computers exact quantification and qualification of arrhythmias, over long periods has become possible. Major indications for long-term ECG monitoring are detection of occult arrhythmias, evaluation of subjective symptoms such as palpitations, dizziness or syncope, recognition of pacemaker dysfunction, identification of high-risk patients with coronary heart disease and evaluation, as well as monitoring of drug therapy.

[Influence of physical training on resting and exercise haemodynamics in patients after acute myocardial infarction (author's transl)]. / Ruhe- und Belastungshämodynamik vor und nach Rehabilitation beim akuten Myokardinfarkt.

Resting and exercise haemodynamics were investigated in 17 patients with acute myocardial infarction after hospital treatment at the end of the third week. After 8 weeks of physical training measurements were repeated. The data were analyzed for the whole group and also with respect to enddiastolic pulmonary pressure (PAEDP) during exercise (50 Watts). Group I: (PAEDP less than 20 mm Hg) was regarded as normal. Group II: (PAEDP greater than 20 mm Hg) as pathological. Systolic and diastolic blood pressure during rest and exercise were not influenced by the training programme in the total group nor on subdivision into groups I and II. Resting heart frequency was reduced by 5 beats per minute in the total group after rehabilitation, but there was an increase of 10 beats per minute (p less than 0.05) on exercise in group I. Resting double product remained unchanged in all groups, but during exercise an increase from 15.8 +/- 3.4 to 18.1 +/- 4.1 (p less than 0.05) was noticed in group I. The reduction in double product during exercise in group II was insignificant. Under resting conditions PAEDP remained unchanged, but during exercise the mean PAEDP in the total group increased from 21.2 +/- 6.0 mm Hg to 24.3 +/- 6.0 mm Hg after rehabilitation. 15 out of 17 patients showed pathological values after rehabilitation. Increase in heart frequency and PAEDP may be interpreted as signs of heart failure during exercise. Therefore, an intensive exercise programme three weeks after acute myocardial infarction may be premature.

Cystic lymphangioma of stomach and jejunum: report of one case.

A case of cystic lymphangioma of stomach and jejunum is reported. The patient, a woman aged 58, was referred to the hospital for a melena of 4 days duration, which was interpreted as related to an old history of hypertrophic gastritis and duodenal ulcer. A conservative treatment with transfusions, cimetidine i.v., and gastric washout with antacids was started, but the hemorrhage appeared unresponsive, so an explorative laparotomy was performed. At the operation a soft pliable cystic mass in the anterior wall of the stomach was found; a smaller one was felt in the second jejunal loop. A Billroth II gastroduodenal resection was performed. The diagnosis of nature was only microscopic. At 9 months follow-up the patient is well, free of the disease.