Is recurrence possible in coronavirus disease 2019 (COVID-19)? Case series and systematic review of literature.

Can a patient diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) be infected again? This question is still unsolved. We tried to analyze local and literature cases with a positive respiratory swab after recovery. We collected data from symptomatic patients diagnosed with SARS-CoV-2 infection in the Italian Umbria Region that, after recovery, were again positive for SARS-CoV-2 in respiratory tract specimens. Samples were also assessed for infectivity in vitro. A systematic review of similar cases reported in the literature was performed. The study population was composed of 9 patients during a 4-month study period. Among the new positive samples, six were inoculated in Vero-E6 cells and showed no growth and negative molecular test in culture supernatants. All patients were positive for IgG against SARS-CoV-2 nucleoprotein and/or S protein. Conducting a review of the literature, 1350 similar cases have been found. The presumptive reactivation occurred in 34.5 days on average (standard deviation, SD, 18.7 days) after COVID-19 onset, when the 5.6% of patients presented fever and the 27.6% symptoms. The outcome was favorable in 96.7% of patients, while the 1.1% of them were still hospitalized at the time of data collection and the 2.1% died. Several hypotheses have been formulated to explain new positive respiratory samples after confirmed negativity. According to this study, the phenomenon seems to be due to the prolonged detection of SARS-CoV-2 RNA traces in respiratory samples of recovered patients. The failure of the virus to replicate in vitro suggests its inability to replicate in vivo.

Burden of measles using disability-adjusted life years, Umbria 2013-2018.

BACKGROUND AND AIM: The low measles vaccination coverage contributes to the re-emerging of measles in Italy. This study aimed to estimate the measles burden, expressed in Disability Adjusted Life Years (DALYs), in Umbria, for the period 2013-2018. METHODS: Data on measles cases in Umbria were obtained from the MoRoNet. While data related to the resident population, were obtained from the website of the National Institute of Statistics. The estimated DALYs was calculated using the Burden of Communicable Diseases in Europe toolkit. The results are expressed in DALYs per year, per case and per 100,000 subjects, for acute illness and for sequelae. RESULTS: The estimated incidence in mean for the entire period was 52.50 cases per year. Resulting in an average loss of 3.10 DALYs per year. CONCLUSIONS: The data obtained from this analysis provide important information on the impact of measles in the Umbria region, and offer useful data to the Health Authorities that can be used to reduce measles incidence in the region.

Unplanned migration flow: the acceptance system response, Perugia.

BACKGROUND AND AIM OF THE WORK: Since several years, Italy is facing an important flow of immigration. Umbria is not a region of disembarkation of refugees, nevertheless is one of the Italian regions with the highest rate of foreign population compared to the total resident population. Aim of this paper is to collect data on migrants and refugees' health care services access, focusing on migrants' characteristics arrived and living in Umbria. METHODS: We conducted a retrospective cohort study at the Local Health Unit Umbria of Perugia, Italy. Descriptive analysis was performed in order to identify the characteristics of the migrants living in Perugia area. Data analysis was performed using Excel® software. All frequencies are expressed as percentage. RESULTS: Between 2015-2017, 2,688 migrants came to Umbria Region. The mean age is 23.6 years, almost all are male, and however the majority of female comes from Nigeria. Only 25.5% of migrants durably sojourned in Umbria Region, and only half of them are residents and received the assignment of general practitioner. CONCLUSIONS: Unplanned migration may cause an abrupt rupture of the social-cultural supports that sustain both psychological and physical well-being. Regional Health Service should collect data on migrants and refugees' health and their health care services access, in order to offer an efficient and appropriate regional health system.

Identikit of the Umbrian traveller: analysis of clinical activity in a travel medicine unit, Italy.

A travel medicine clinic is the proper medical centre aimed to provide updated recommendations before any journey. The study aim was to assess the number of accesses during 2016 at the Travel Medicine Clinic of the Local Health Unit in the Umbria Region. An electronic ad hoc database was developed. Paper-based data referring to 2016 were recorded in this electronic registry, developed on Microsoft Office Access®. In 2016, 891 subjects came in our clinic in order to get information before travelling. In our sample, 53.3% were male and the mean age was 35.33 years ± 0.58. Almost half had a higher education, and 20% were foreign. Vaccines against food- and water-borne diseases were the most frequently administered. Approximately, 74% of the attenders were suggested to do an anti-malaria prophylaxis (Mefloquine in one-half, approximately). Every traveller received a pre-travel counselling. Performance activity of our clinic and the adherence to preventive protocols in case of international travels, have been assessed.

A new risk assessment model for the stratification of the thromboembolism risk in medical patients: the TEVere Score.

BACKGROUND: In hospitalized medical patients, the venous thromboembolism (VTE) risk is notable. Nevertheless, the available assessment model (TPF) is generally underused. In this work, we propose an ex novo risk assessment model based on the elaboration of the clinical data exhibited by the VET patients. Differently from previous studies, the proposed approach does not exploit pre-established models, resulting in a more valid and easy-to-use score. METHODS: We performed a double case-control observational study. For each case of VTE, we enrolled two consecutive patients without VTE of equal sex and age group (18-50, 50-55, 55-60, 60-65, 65-70, 70-75, 75-80, >80 years). The study involved both the EM and the IM Departments of 23 hospitals and universities in Lazio and Umbria (Italy). RESULTS: We analyzed the data of 1215 patients, 409 with VTE (50% - deep venous thrombosis [DVT], 9.9% - pulmonary embolism [PE], 40.1% - PE+DVT) and 806 case-control. 365 patients (30%) were in charge to the EM department, while 850 patients (70%) to the IM one. The VET risk factors with more statistical significance (P<0.01) are: previous VTE, active cancer, known thrombophilic condition, immobilization, chronic venous insufficiency, hyperhomocysteinemia, central venous catheter, recent hospitalization. Obesity, recent surgery, family history of VTE, hormone therapy and treatment with drugs that stimulate hematopoiesis are resulted at intermediate statistical significance (P<0.05 but >0.01). A multiple logistic regression was used with robust standard errors and forward selection of the candidate variables using the Bayesian information criterion. A new score is developed, the "TEVere Score", which shows a higher specificity and sensitivity (respectively 43.3 and 87.5, with accuracy 72.1) compared with the Padua, the Kuscer and the Chopard Score. TEVere Score also exhibits a greater predictive validity for thromboembolism risk (AUROC 0.7266; 95% CI: 0.71 to 0.73) than the Kuscer Score (AUROC 0.6891; 95% CI: 0.67 to 0.70) (P=0.0093). CONCLUSIONS: The TEVere Score has proven to exhibit a higher accuracy than the other scores commonly used in clinical practice to stratify the thromboembolism risk.

[Prevalence of arterial hypertension treatment LHU 2 population in Umbria: a comparison between two data sources]. / La prevalenza degli ipertesi in trattamento nella AUSL 2 dell'Umbria: confronto tra due fonti di dati.

OBJECTIVE: verify the consistency of two independent sources of data concerning the prevalence of arterial hypertension under pharmacological treatment. DESIGN: the pharmacological prescriptions database (A) and the Studio PASSI (Italian behavioural risk factor survey) (B) were assessed. Data selection was carried out according with the presence of at least one prescription of antihypertensive drug during the year 2004 (A), the statement of being under treatment with antihypertensive drugs (B). Prevalence rates were calculated. SETTING: resident population registered in the list of Umbrian Local Health Unit 2 (LHU 2); age range: 18-69 years. PARTICIPANTS: A) the pharmacological prescriptions database: 43,146 subjects selected from the 2004 archive, B) Studio PASSI: representative random sample of 200 persons drawn out from the resident population registered in the 2005 record of the LHU2 list. MAIN OUTCOME MEASURES: prevalence rate for arterial hypertension with pharmacological treatment. RESULTS: both studies showed similar prevalence rates: A) pharmacological prescriptions database = 17.2% (95% CI 17.1-17.4) and B) PASSI = 15.0% (95% CI10.4-20.7). Age and gender distribution were also comparable. Moreover, the PASSI survey produced additional socio-economical information. CONCLUSION: the hypothesis that the pharmacological prescription database can be used to monitor in a simple, timely and reproducible way major health-related events was validated. Small size surveys - such as the PASSI study - may add further information to the analysis of large administrative databases and they may serve to periodically verify the consistency of these databases when assessed for epidemiological purposes.

Incidence, mortality and survival trends of cutaneous melanoma in Umbria, Italy. 1978-82 and 1994-98.

Many studies have reported increasing incidence rates of cutaneous melanoma during the last 30-40 years; the highest have been observed in Australia and New Zealand (27.9/100,000 among males and 25.0 among females) and in North America (10.9/100,000 among males and 7.7 among females). In Italy, from 1994-1998, in the areas covered by cancer registries (23% of Italian population), the incidence rate for males was 8.5 and for females, 1.9/100,000. The aim of the present study was to describe incidence, mortality and survival from cutaneous melanoma in the Umbrian population during the periods 1978-1982 and 1994-1998.