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.

[Postural hypotension: pathophysiology and clinical features (author's transl)]. / Orthostasesyndrom (Pathophysiologie und Klinik)

Circulatory regulation in response to postural changes follows mechanical rules, whereby the shifts in volume in the various organs of the body play an essential role. The change from the horizontal to the vertical position is accompanied by a decrease in pressure above the hydrostatic neutral point, i.e. in the cephalic vessels, whereas the capacious vessels in the caudal region are dilated and the venous return becomes sluggish. As a consequence of the different time courses followed by the various circulatory parameters in the wake of counter-regulatory measures, a distinction can be made between an early orthostatic instant regulatory response and a late orthostatic response. Prominent clinical features do not necessarily always consist of non-systemic dizziness, tinnitus, pallor cold sweat and, finally, orthostatic collapse, but general subjective symptoms such as deafness and tingling of the extremities, a chilly sensation and cardiac symptoms may frequently predominante. In the case of development of an autonomic neurotic symptom complex, psychoautonomic symptoms such as general sleep disturbance are observed. Apart from investigations carried out on a surgical tilting table in general practice, other procedures such as the Valsalva manoeuvre, the squatting test and, in most cases, the erect test are performed. Broadly speaking four different reaction types can be distinguished amongst cases of postural hypotension. Drugs with different therapeutic actions are selectively administered according to the pathophysiological characteristics of the individual patient and the sympathetic adrenal counter-regulatory response. Medico-mechanical measures and physical training should not be neglected.

[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.

[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.

[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.

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.

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.

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.

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.