[What factors contributed to the higher incidence rate of in-hospital falls at the time of Covid 19? A paradigm shift?] / Quali sono I fattori contribuenti la caduta dei pazienti in ospedale al tempo del Covid 19? Un cambio di paradigma?

The COVID-19 pandemic has put a strain on all health systems as there has been a growing rapidity in the demand for health care from COVID 19 positive patients in hospitals around the world. With the intensification of the pandemic, determining in real time the consequent needs for health resources (beds, personnel, equipment) has in fact become the fundamental priority for many countries to ensure health services consistent with the health needs expressed by the population. In Italy, the demand has often been satisfied with the conversion of existing beds and the remodeling of the healthcare offer or where the available resources allow it also with the opening of new beds dedicated to pandemic assistance. This work analyzes the falls detected at the time of COVID in patients and hospitalized in direct hospital beds (600 beds) of a Local Health Authority of Lazio (ASL ROMA 2). Although the data on the incidence of falls recorded in the three centers were equal to 2.21 every 1000 days of beds occupied and that the data recorded are lower than those reported in the literature, it is also true that the increase in average hospital stay and the reduction in the rotation rate of beds had an impact on the still low occupancy rates compared to the literature data.The COVID-19 pandemic has put a strain on all health systems as there has been a growing rapidity in the demand for health care from COVID 19 positive patients in hospitals around the world. With the intensification of the pandemic, determining in real time the consequent needs for health resources (beds, personnel, equipment) has in fact become the fundamental priority for many countries to ensure health services consistent with the health needs expressed by the population. In Italy, the demand has often been satisfied with the conversion of existing beds and the remodeling of the healthcare offer or where the available resources allow it also with the opening of new beds dedicated to pandemic assistance. This work analyzes the falls detected at the time of COVID in patients and hospitalized in direct hospital beds (600 beds) of a Local Health Authority of Lazio (ASL ROMA 2). Although the data on the incidence of falls recorded in the three centers were equal to 2.21 every 1000 days of beds occupied and that the data recorded are lower than those reported in the literature, it is also true that the increase in average hospital stay and the reduction in the rotation rate of beds had an impact on the still low occupancy rates compared to the literature data. In fact, the scientific literature shows that in England and Wales, whose national health service is very similar to the Italian one, the falls of patients in hospitals with optimal bed occupancy rates and optimal average hospitalization rates (equal to 4.5 days in general medicine, 3.5 days in general surgery, 3 days in orthopedics) represent the first sentinel event in terms of incidence and frequency, albeit with a very variable damage detection. The average falls is 6.63 falls per 1,000 bed-occupied days, which equates to approximately 1,700 falls per year in an 800-bed hospital with an optimal occupancy rate. Regarding damage, the literature documents that physical injuries and fractures occur in 30-50% of events and fractures occur in 1-3% of cases. The data collected in ASL ROMA 2 have documented that despite the increase in staff dedicated to assistance by 15 - 30%, an increase due to the application of COVID pathways and to the activities of compression of the risk of circulation of the virus among hospitalized patients , the rate of falls has nevertheless increased by 13.5% despite the persistence of standards of quality and safety of patients in care activities, debunking the paradigm that falls can be caused by an undersizing of the care staff and by the possible overcrowding of the emergency departments - urgency.

Author Correction: Features of fragile people with SARS-CoV-2 infection in isolation in a COVID-19 hotel in Rome, Italy.

Correction to: European Review for Medical and Pharmacological Sciences 2022; 26 (7): 2631-2638-DOI: 10.26355/eurrev_202204_28501-PMID: 35442479, published online on 15 April 2022. After publication, at the request of the Italian Ministry of Health, the authors asked to insert the following statement in the Acknowledgments section: "This research was funded by the Italian Ministry of Health (RC 2022)". There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/28501.

Features of fragile people with SARS-CoV-2 infection in isolation in a COVID-19 hotel in Rome, Italy.

OBJECTIVE: Temporary COVID-19 hotels have been established in Italy to assist the homeless people that test positive for SARS-CoV-2 and require isolation. This observational study aimed to investigate the characteristics of the subjects who were isolated at the Casa tra Noi COVID-19 hotel in Rome between October 2020 and May 2021 and to estimate the duration of SARS-CoV-2 positivity according to their main socio-demographic, behavioural and clinical features. SUBJECTS AND METHODS: Socio-demographic data, clinical history, and anamnestic data of guests were collected by the clinicians reviewing the medical documentation and face-to-face interviewing. Nasopharyngeal swabs were performed every 7 days and the presence of SARS-CoV-2 was assessed by RT-PCR. Median duration of SARS-CoV-2 positivity according to socio-demographic, behavioral factors and clinical condition was calculated. RESULTS: The 196 guests (161 males, 82.1%) had a median age of 41 years (IQR: 30-53), and were mostly African (87, 44.4%). Only asymptomatic/paucisymptomatic infections were observed. Almost half of the individuals (84, 42.9%) were affected by at least one co-morbidity, the frequency of which was higher among women (57.1% vs. 39.8%, p=0.06). The date of the negative SARS-CoV-2 molecular test was known for 144 guests (73.5%). Among these, the median duration of positivity was 21 days (IQR: 14-26) and did not significantly vary with age, country of origin, smoking status, alcohol or drug abuse. Among the co-morbidities, only infectious diseases significantly modified the duration of positivity, which increased from 21 to 34 days (p=0.013). CONCLUSIONS: Hotel guests were frequently affected by physical/mental co-morbidities. Duration of SARS-CoV-2 positivity was significantly prolonged only in individuals affected by an infectious disease.

[Diagnosis of severity as a basic parameter in the treatment of acute biliary pancreatitis]. / La diagnosi di gravità come parametro fondamentale per il trattamento della pancreatite acuta biliare.

BACKGROUND: Acute biliary pancreatitis (ABP) still retains high morbidity (15-50%) and mortality (20-35%). Therefore it appears to be crucial to clearly assess the aetiological factors (50% of idiopathic are in fact biliary pancreatitis) and to establish their severity in order to plan the appropriate treatment. METHODS: 58 ABP patients were diagnosed by ultrasound (77.5%) or by laboratory findings (22.4%). Following Ranson and APACHE II scoring 17 cases (29.3%) were classified as severe, 41 (70.6%) as mild. All patients with severe ABP, had emergency ERCP + ES (within 24-48 hrs) followed by LC (< or = 10 days). Patients with mild ABP had LC within 10 days; in these cases IOC was always done. RESULTS: In severe cases operative endoscopy cured pancreatic inflammation in 12 cases. Subsequent LC never showed serious morbidity, apart from subcutaneous emphysema in one case. In 5 cases laparotomy was required since pancreatic necrosis was present, with 60% mortality. In patients with mild pancreatitis LC was successfully performed in all cases, with 7.3% morbidity. IOC showed choledochal stones in 31.7% of cases, while in severe cases stones in the biliary tree were shown in 88.2% of cases. CONCLUSIONS: In conclusion ABP treatment is always surgical, and almost always with minimally-invasive procedures in severe cases (ERCP + ES with LC < or = 10 days) if surgery is performed within 24-48 hrs as well as in mild cases (LC + IOC) when surgery is done within 10 days.

[Acute biliary pancreatitis: mini-invasive treatment]. / Pancreatite acuta biliare: trattamento mini-invasivo.

Acute biliary pancreatitis (ABP) still retains high morbidity (15-50%) and mortality (20-35%). Therefore it appears to be crucial clearly assessing the aetiological factors (50% of idiopathic are in fact biliary pancreatitis) and establishing the severity in order to plan the appropriate treatment. Forty-nine ABP patients were diagnosed by ultrasound (75.5%) or by laboratory findings (22.5%). Following Ranson and APACHE II scoring, 15 cases (30.6%) were classified as severe, 34 (69.3%) as mild. All patients with severe ABP had emergency ERCP + ES (within 24-48 hours) followed by LC (< or = 10 days). Patients with mild ABP had LC within 10 days; in these cases IOC was always done. In severe cases operative endoscopy cured pancreatic inflammation in 11 cases. Subsequent LC never showed serious morbidity, but subcutaneous emphysema in one case. In 4 cases laparotomy was required since pancreatic necrosis was present, with 75% mortality. In patients with mild pancreatitis LC was successfully performed in all cases, with 8.8% morbidity. IOC showed choledochal stones in 32.5% of cases, while in severe cases stones in the biliary tree were showed in 80% of cases. In conclusion ABP treatment is always surgical, and almost always with minimally-invasive procedures in severe cases (ERCP + ES with LC < or = 10 days) if surgery is performed within 24-48 hours as well as in mild cases (LC + IOC) when surgery is done within 10 days.

[Unusual anatomo-clinical features of thyroid metastasis]. / Un quadro anatomo-clinico peculiare di metastasi tiroidea.

The authors report a case of metastatic tumor from clear cell carcinoma in the thyroid gland occurred in a patient who had his primary tumor previously treated with right nephrectomy. The time interval before the appearance of the metastasis was 6 years. The diagnosis was made preoperatively because of the peculiar biological behavior of the primary tumor. In fact, the metastasis and the primary presented with neoplastic invasion of the middle thyroid vein and the renal vein respectively. The ultrasound examination revealed the vein thrombus arising from the thyroid and reaching the internal jugular vein through the middle thyroid vein. Subsequent fine needle aspiration biopsy confirmed the diagnosis of metastasis from clear cell renal carcinoma. The low grade of malignancy of the primary from the clinical point of view and the absence of other metastatic locations influenced the therapeutic approach.

[Diagnostic role of ultrasound in the transplanted kidney]. / Ruolo diagnostico degli ultrasuoni nel rene trapiantato.

Among diagnostic postoperative procedures in renal cadaver transplantation echographic examination shows high sensitivity and specificity (over 80%). Urographic examination is in fact often dangerous and impossible in non-functioning grafts. Echography can reveal several liquid and solid collections such as hematomas, urinomas, abscesses, lymphatic collections and so on. Urinary obstructions caused by ureteral clots, calculi, external masses can be also detected through echographic examination. Vascular complications can be evaluated through echo and US Doppler examination showing arterial and venous complications. In most of cases acute and chronic graft rejection can be revealed through echo examination whereas in few cases diagnosis can be made only with the help of renal biopsy, laboratory findings and clinical conditions. In conclusion echography is a safe and reliable procedure in renal graft postoperative monitoring.

[Computerized tomography in pulmonary sequestration]. / Studio T.C. nel sequestro polmonare.

The authors describe two cases of intra and extralobar pulmonary sequestration and evaluate its principal clinical and pathological characteristics. They outline the key role of T.C. in the approach to this pathology. The T.C. enables to collect in a short time a large quantity of useful information for a correct diagnosis which could not be obtained by means of other methods of imaging.

[CT in the evaluation of the extension of bronchogenic carcinoma]. / La T.C. nella valutazione dell'estensione del carcinoma broncogeno.

The computed tomographic patterns in 52 patients with histologically proven lung cancer are reported. The AA. underline the not sobstitutive role of C.T. scan in pre-operative determination of bronchogenic carcinoma extension. C.T. revealed a very high diagnostic accuracy in assessing the primary tumor extension and in evaluating distant macrometastases; however, in showing hilar and mediastinal nodal involvement has not the same accuracy. The AA. think that, at the present time, a combinate C.T. study of the chest, upper abdomen and brain is, in the most number of cases, a rapid, accurate and practical method to evaluate the extension of lung cancer.