Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo'.

On 21 February 2020, a resident of the municipality of Vo', a small town near Padua (Italy), died of pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection1. This was the first coronavirus disease 19 (COVID-19)-related death detected in Italy since the detection of SARS-CoV-2 in the Chinese city of Wuhan, Hubei province2. In response, the regional authorities imposed the lockdown of the whole municipality for 14 days3. Here we collected information on the demography, clinical presentation, hospitalization, contact network and the presence of SARS-CoV-2 infection in nasopharyngeal swabs for 85.9% and 71.5% of the population of Vo' at two consecutive time points. From the first survey, which was conducted around the time the town lockdown started, we found a prevalence of infection of 2.6% (95% confidence interval (CI): 2.1-3.3%). From the second survey, which was conducted at the end of the lockdown, we found a prevalence of 1.2% (95% CI: 0.8-1.8%). Notably, 42.5% (95% CI: 31.5-54.6%) of the confirmed SARS-CoV-2 infections detected across the two surveys were asymptomatic (that is, did not have symptoms at the time of swab testing and did not develop symptoms afterwards). The mean serial interval was 7.2 days (95% CI: 5.9-9.6). We found no statistically significant difference in the viral load of symptomatic versus asymptomatic infections (P = 0.62 and 0.74 for E and RdRp genes, respectively, exact Wilcoxon-Mann-Whitney test). This study sheds light on the frequency of asymptomatic SARS-CoV-2 infection, their infectivity (as measured by the viral load) and provides insights into its transmission dynamics and the efficacy of the implemented control measures.

Successful control measures to treat the transmission of Candida auris in Northern Italian Hospital.

Candida auris has emerged globally as a multidrug-resistant health care-associated fungal pathogen. In the literature, nosocomial outbreaks are reported worldwide. In addition, C. auris diffusion occurs in high-dependency settings with infections typically affecting critically ill patients, resulting in life-threatening disease. We describe the first documented case of C. auris in northeastern Italy and the measures applied to contain the transmission that led to zero collateral infections.

Fatigue in hemodialysis patients: A single-center cross-sectional study.

BACKGROUND: Fatigue is a highly prevalent condition among people affected by chronic disease, with consequent poor health-related quality of life and lower survival rates. Fatigue is one of the most common and debilitating symptoms also experienced by hemodialysis (HD) patients after HD sessions, and given the non-specific manifestations and its invisible nature, it is under-recognized and under-treated by healthcare professionals. The complexity of fatigue's pathogenesis and the lack of measurement tools make the development of nursing interventions and practices specifically targeted at its recognition and therapy difficult. We aimed to investigate the prevalence and severity of fatigue, identify predictor variables in HD patients, and promote healthcare professionals' awareness and recognition of fatigue. MATERIALS AND METHODS: A single-center, cross-sectional study was conducted among 140 patients treated at the HD unit between August 2019 and March 2020 at the Nephrology, Dialysis, and Transplantation Unit of Padova University Hospital. We assessed patient's fatigue by Chalder's Fatigue Questionnaire, pain by Numeric Rating Scale and activities of daily living by Barthel Index. Demographic and clinical characteristics were taken from medical records. RESULTS: The findings of this study indicate that age, dialysis vintage, inter-dialysis weight gain, and ultra-filtration rate are proportionally related to reported levels of fatigue. Hemoglobin, iron, ferritin, and number of sleep hours before HD session present a significant inverse correlation to fatigue. CONCLUSION: The complexity of fatigue's pathogenesis makes a better understanding of this phenomenon difficult, nevertheless, healthcare professionals should develop interventions and practices targeted at its identification and management.

Going to war with COVID-19: Strategies for SARS-CoV-2 management in the Padua Nephrology and Dialysis Unit's hemodialysis facility.

BACKGROUND: The recent SARS-CoV-2 outbreak represents a global health emergency, and dialysis patients are a high-risk population. Patients with end-stage renal disease (ESRD) in hemodialysis facilities require specific protocols to be planned and promptly executed for the management of suspected/confirmed cases of COVID-19 with respect to prevention, protection, screening, and isolation. MATERIALS AND METHODS: In order to prevent the spread of SARS-CoV-2 in our Hemodialysis Unit, we adopted individual protection measures accompanied by measures to minimize contacts among hemodialysis patients with suspicious symptoms as well as other patients and medical staff. We provided our patients detailed instructions to be followed in the event of their having symptoms compatible with SARS-CoV-2 infection or having contacts with SARS-CoV-2-positive subjects. Ultimately, four possible scenarios and care paths were developed and implemented in collaboration with the Infectious Diseases and Emergency Units at the Padua University Hospital. RESULTS: The application of this strategy has resulted in the nearly 200 patients treated in our hemodialysis facilities while there were only 2 cases of COVID-19 (1% incidence rate) with no deaths. CONCLUSION: We attribute the low COVID-19 incidence noted so far for patients in our hemodialysis facilities to the early detection and prompt isolation of suspected patients per our specific plan along with the prompt application of preventive measures.

Clinical characteristics and laboratory biomarkers changes in COVID-19 patients requiring or not intensive or sub-intensive care: a comparative study.

BACKGROUND: Identifying risk factors for severe novel-coronavirus disease (COVID-19) is useful to ascertain which patients may benefit from advanced supportive care. The study offers a description of COVID-19 patients, admitted to a general ward for a non-critical clinical picture, with the aim to analyse the differences between those transferred to the intensive (ICU) and/or sub-intensive care (SICU) units and those who were not. METHODS: This observational retrospective study includes all COVID-19 patients admitted to the Infectious Diseases Unit. Clinical, laboratory, radiological and treatment data were collected. The primary outcome was a composite of need of transfer to the ICU and/or SICU during the hospitalization. Patients who did not require to be transferred are defined as Group 1; patients who were transferred to the ICU and/or SICU are defined as Group 2. Demographic, clinical characteristics and laboratory findings at the 1st, 3rd and last measurements were compared between the two groups. RESULTS: 303 were included. The median age was 62 years. 69 patients (22.8%) met the primary outcome and were defined as Group 2. The overall fatality rate was 6.8%. Group 2 patients were predominantly male (76.8% vs. 55.1%, p < 0.01), had a higher fatality rate (14.5% vs. 3.8%, p < 0,01), had more hypertension (72.4% vs. 44%, p < 0,01) and diabetes (31.9% vs. 21%, p = 0.04) and were more likely to present dry cough (49.3% vs. 25.2%, p < 0.01). Overall, chest X-ray at admission showed findings suggestive of pneumonia in 63.2%, and Group 2 were more likely to develop pathological findings during the hospitalization (72.7% vs. 17.2%, p = 0.01). At admission, Group 2 presented significantly higher neutrophil count, aspartate-transaminase and C-Reactive-Protein. At the 3rd measurement, Group 2 presented persistently higher neutrophil count, hepatic inflammation markers and C-Reactive-Protein. Group 1 presented a shorter duration from admission to negativization of follow-up swabs (20 vs. 35 days, p < 0.01). CONCLUSIONS: The presence of comorbidities and the persistent observation of abnormal laboratory findings should be regarded as predisposing factors for clinical worsening.

Radiological management of COVID-19: structure your diagnostic path to guarantee a safe path.

The current COVID-19 outbreak is requiring a tremendous effort not only regarding the diagnostic and therapeutic approach but also in terms of global management of the delivered care. Hospital administrations had to provide a prompt response to a rapidly evolving emergency characterized by the necessity of giving access to an enormous number of infected patients, guaranteeing appropriate care to patients in need of other types of treatment, and simultaneously preserving the well-being of healthcare providers. To optimize the diagnostic pathway during the current COVID-19 outbreak, the hospital administration of our tertiary center applied a highly structured framework assigning specific tasks to the different units composing the Department of Imaging. In particular, since the beginning of the pandemic, a mobile CT scanner in a truck was rented and became operative for all patients with a confirmed diagnosis of COVID-19 and another CT was assigned for all suspected cases. The success and efficacy of the management applied by our administration is demonstrated by the fact that during the outbreak, the radiological workflow was never interrupted. In fact, despite the national lockdown only a 29.3% decrease of CT scans occurred compared to the previous year. Moreover, none of the healthcare providers of the Department contracted the infection at work. Thus, according to the experience gained in our center, we recommend to all hospital administrations facing the COVID-19 outbreak to promptly adapt their resources, creating precise and safe pathways for their diagnostic units.

Predictors of Early Readmission in Patients With Cirrhosis After the Resolution of Bacterial Infections.

OBJECTIVES: In patients with cirrhosis, infections represent a frequent trigger for complications, increasing frequency of hospitalizations and mortality rate. This study aimed to identify predictors of early readmission (30 days) and of mid-term mortality (6 months) in patients with liver cirrhosis discharged after a hospitalization for bacterial and/or fungal infection. METHODS: A total of 199 patients with cirrhosis discharged after an admission for a bacterial and/or fungal infection were included in the study and followed up for a least 6 months. RESULTS: During follow-up, 69 patients (35%) were readmitted within 30 days from discharge. C-reactive protein (CRP) value at discharge (odds ratio (OR)=1.91; P=0.022), diagnosis of acute-on-chronic liver failure during the hospital stay (OR=2.48; P=0.008), and the hospitalization in the last 30 days previous to the admission/inclusion in the study (OR=1.50; P=0.042) were found to be independent predictors of readmission. During the 6-month follow-up, 47 patients (23%) died. Age (hazard ratio (HR)=1.05; P=0.001), model of end-stage liver disease (MELD) score (HR=1.13; P<0.001), CRP (HR=1.85; P=0.001), refractory ascites (HR=2.22; P=0.007), and diabetes (HR=2.41; P=0.010) were found to be independent predictors of 6-month mortality. Patients with a CRP >10 mg/l at discharge had a significantly higher probability of being readmitted within 30 days (44% vs. 24%; P=0.007) and a significantly lower probability of 6-month survival (62% vs. 88%; P<0.001) than those with a CRP ≤10 mg/l. CONCLUSIONS: CRP showed to be a strong predictor of early hospital readmission and 6-month mortality in patients with cirrhosis after hospitalization for bacterial and/or fungal infection. CRP values could be used both in the stewardship of antibiotic treatment and to identify fragile patients who deserve a strict surveillance program.

A novel case-finding strategy based on artificial intelligence for the systematic identification and management of individuals with osteoporosis or at varying risk of fragility fracture.

An artificial intelligence-based case-finding strategy has been developed to systematically identify individuals with osteoporosis or at varying risk of fragility fracture. This strategy has the potential to close the critical care gap in osteoporosis treatment in primary care, thereby lessening the societal burden imposed by fragility fractures. BACKGROUND: Osteoporotic fractures represent a major cause of morbidity and, in older adults, a precursor of disability, loss of independence, poor quality of life and premature death. Despite the detrimental health impact, osteoporosis remains largely underdiagnosed and undertreated worldwide. Subjects at risk for osteoporosis-related fractures are identified either via organised screening or case finding. In the absence of a population-based screening policy, subjects at high risk of fragility fractures are opportunistically identified when a fracture occurs or because of other clinical risk factors (CRFs) for osteoporotic fracture and areal bone mineral density (aBMD) measured by dual-energy X-ray absorptiometry (DXA). PURPOSE: This paper describes the development of a novel case-finding strategy, named Osteoporosis Diagnostic and Therapeutic Pathway (ODTP), which enables to identify subjects with osteoporosis or at varying risk of fragility fracture. This strategy is based on a specifically designed software tool, named "Bone Fragility Query" (BFQ), which analyses the electronic health record (EHR) databases of General Practitioners (GPs) to systematically identify individuals who should be prescribed DXA-BMD measurement, vertebral fracture assessment (VFA) and anti-osteoporosis medications (AOM). CONCLUSIONS: The ODTP through BFQ tool is a feasible, convenient and time-saving osteoporosis model of care for GPs during routine clinical practice. It enables GPs to shift their focus from what to do (clinical guidelines) to how to do it in the primary health care setting. It also allows a systematic approach to primary and secondary prevention of fragility fractures, thereby overcoming clinical inertia and contributing to closing the gap between evidence and practice for the management of osteoporosis in primary care.

The role of an integrated referral program for patients with liver disease: A network between hub and spoke centers.

INTRODUCTION: Access to Liver transplantation (LT) can be affected by several barriers, resulting in delayed referral and increased risk of mortality due to complications of the underlying liver disease. AIM: To assess the clinical characteristics and outcomes of patients with acute or chronic liver disease referred using an integrated referral program. MATERIALS AND METHODS: An integrated referral program was developed in 1 October 2017 based on email addresses and a 24/7 telephone availability. All consecutive adult patients with liver disease referred for the first time using this referral program were prospectively collected until 1 October 2021. Characteristics and outcomes of inpatients were compared with a historical cohort of patients referred without using the integrated referral program (1 October 2015-1 October 2017). Patients were further divided according to pre- and post-Covid-19 pandemic. RESULTS: Two hundred eighty-one referred patients were considered. End stage liver disease was the most common underlying condition (79.3%), 50.5% of patients were referred as inpatients and 74.7% were referred for LT evaluation. When inpatient referrals (n = 142) were compared with the historical cohort (n = 86), a significant increase in acute liver injury due to drugs/herbals and supplements was seen (p = 0.01) as well as an increase in End stage liver disease due to alcohol-related liver disease and NASH, although not statistically significant. A significant increase in referrals for evaluation for Trans-jugular intrahepatic portosystemic shunt placement was seen over time (5.6% vs. 1%; p = 0.01) as well as for LT evaluation (84.5% vs. 81%; p = 0.01). Transplant-free survival was similar between the study and control groups (p = 0.3). The Covid-19 pandemic did not affect trends of referrals and patient survival. CONCLUSIONS: The development of an integrated referral program for patients with liver disease can represent the first step to standardize already existing referral networks between hub and spoke centers. Future studies should focus on the timing of referral according to different etiologies to optimize treatment options and outcomes.

Overordering of tumor marker for outpatients revealed by performance indicators and the impact of a health policy intervention: An observational study using administrative records.

PURPOSE: The overuse of laboratory tests contributes to impair health systems effectiveness, tumor markers (TMs) being a paradigmatic example. In the present study we applied indicators of TMs appropriateness developed from administrative datasets to appraise regionwide overordering in the clinical practice. PATIENTS AND METHODS: TMs ordered to outpatients in the Veneto Region over 6 years were obtained from the eletronic Outpatients' Records of Diagnostic and Therapeutic Procedures. TMs orders were examined as aggregated data or stratified according to disease codes, gender, age, and requests per patient. TMs recommended only for specific malignancies were examined using epidemiological data obtained from Veneto Tumor Registry. RESULTS: A total of 5,821,251 TMs were ordered in 4,382,159 patients over 6 years. Overall, 3,252,389 (55.9%) TMs were ordered without appropriate disease codes (ranging from 77.0% for PSA to 17.5% for CA15.3). TM orders declined over 6 years (-13.4%), with a noticeable reduction of orders without appropriate disease codes (-21.3%). Orders decreased sharply from 2015 to 2016, after the enactment of a national Decree-Law aimed at improving appropriateness, and remained stable thereafter. However, the rate of inappropriate TMs requests still remained elevated (44.4%) in the last year of observation, with orders of TMs being much higher than expected on the basis of prevalence and incidence figures of specific malignancies. CONCLUSIONS: Indicators developed from administrative datasets were effective in assessing the overordering of TMs and the impact of interventions to improve appropriateness. The developed indicators could be considered for other diagnostic tests.

Assessing the physicochemical stability and intracellular trafficking of mRNA-based COVID-19 vaccines.

The emergence of SARS-CoV-2 in Wuhan, China in 2019 has had a profound impact on humanity in every facet. While vaccines against this viral pathogen have been approved a year later, limitations to this therapeutic intervention persist, such as drug sensitivity to transportation and storage conditions, as well as significant financial losses from non-injected resuspended vials. Our research delves into the effects of thermal denaturation (4 - 40 °C) and light irradiation (720 and 10460 kJ/m2) on the mRNA-based vaccines BNT162b2 from BioNTech/Pfizer and mRNA-1273 from Moderna. We also investigated vaccine stability following incubation in syringes to simulate potential interactions with silicon oil. By assaying the effects of these stressors via biochemical and biophysical methods, we aim to elucidate the physicochemical properties, integrity, and stability of these mRNA-based vaccines. Furthermore, the incorporation of a fluorophore into both vaccines allowed us to monitor their localization within cells and assess their capacity to evade vesicular transport mechanisms, thus evaluating the differences between the two formulations. A comprehensive understanding of the aforementioned attributes can enable the establishment of optimal storage and manipulation conditions for these vaccines, thereby ensuring their safe and efficacious application while minimizing the waste of functional and safe therapeutic agents.

Physical and psychological reconditioning in long COVID syndrome: Results of an out-of-hospital exercise and psychological - based rehabilitation program.

Background: Long Covid Syndrome (LCS) is used to describe signs and symptoms that continue or develop after acute COVID-19 infection. Natural history and treatment of this syndrome are still poorly understood, even if evidences suggest the potential role of physical rehabilitation in improving symptoms in these patients. Aim of the study: The aim of the present study was to evaluate effectiveness, safety and feasibility of an out-of-hospital multidisciplinary rehabilitation (MDR) program, based both on physical and psychological reconditioning, in reducing symptoms and improving physical fitness and psychological parameters in patients with LCS. Methods: Thirty consecutive patients with LCS (18 males, mean age 58 years) underwent an accurate medical screening process including anthropometric and muscular strength evaluation, cardiopulmonary exercise test, quality of life (QoL) and psychological appraisal before and after a MDR program. Results: At baseline, all LCS patients were strongly symptomatic and showed severe impairments in physical performance, QoL and psychological parameters. No adverse effects and dropouts were observed during the exercise training sessions. After the MDR program, COVID-19 residual symptoms significantly decreased, and significant improvements in upper and lower limb muscular strength, cardiopulmonary parameters, perceived physical and mental health, depression and anxiety were observed. Conclusions: The present study confirms the severe physical and psychological impairment of patients with LCS and suggests that a MDR program is effective, safe and feasible in these patients and could promote their physical and psychological recovery.

COVID-19 screening protocols for preoperative assessment of head and neck cancer patients candidate for elective surgery in the midst of the pandemic: A narrative review with comparison between two Italian institutions.

BACKGROUND: Preoperative screening had a key role in planning elective surgical activity for head and neck cancer (HNC) during the COVID-19 pandemic. METHODS: All patients undergoing surgery for HNC at two Italian referral hospitals (University of Padua and National Cancer Institute [NCI]) during the peak of the COVID-19 epidemic in Italy were included. Accuracy of screening protocols was assessed. RESULTS: In the Padua protocol, 41 patients were screened by pharyngeal swab. The entire sample (100%) was admitted to surgery, diagnostic accuracy was 100%. In the NCI protocol, 23 patients underwent a telephone interview, blood test, and chest CT. Twenty patients (87%) were negative and were directly admitted to surgery. In the remaining 3 (13%), pharyngeal swab was performed. The screening was repeated until a negative chest CT was found. Diagnostic accuracy was 85%. CONCLUSIONS: Dedicated screening protocols for COVID-19 allow to safely perform elective HNC surgery.

Reduced muscle mass as predictor of intensive care unit hospitalization in COVID-19 patients.

PURPOSE: To evaluate if reduced muscle mass, assessed with Computed Tomography (CT), is a predictor of intensive care unit (ICU) hospitalization in COVID-19 patients. METHODS: In this Institution Review Board approved study, we retrospectively evaluated COVID-19 patients treated in our tertiary center from March to November 2020 who underwent an unenhanced chest CT scan within three weeks from hospitalization.We recorded the mean Hounsfield Unit (Hu) value of the right paravertebral muscle at the level of the 12th thoracic vertebra, the hospitalization unit (ICU and COVID-19 wards), clinical symptoms, Barthel Index, and laboratory findings.Logistic regression analysis was applied to assess if muscle loss (Hu<30) is a predictor of ICU admission and outcome.Fisher's exact and Student's tests were applied to evaluate if differences between patients with and without muscle loss occurred (p<0.05). RESULTS: One-hundred-fifty patients matched the inclusion criteria (46 females; mean age±SD 61.3±15 years-old), 36 treated in ICU. Patients in ICU showed significantly lower Hu values (29±24 vs 39.4±12, p = 0.001). Muscle loss was a predictor of ICU admission (p = 0.004).Patients with muscle loss were significantly older (73.4±10 vs 56.4±14 years), had lower Barthel Index scores (54.4±33 vs 85.1±26), red blood-cell count (3.9±1 vs 4.6±1×1012L-1), and Hb levels (11.5±2 vs 13.2±2g/l) as well as higher white blood-cell count (9.4±7 vs 7.2±4×109L-1), C-reactive protein (71.5±71 vs 44±48U/L), and lactate dehydrogenase levels (335±163 vs 265.8±116U/L) (p<0.05, each). CONCLUSIONS: Muscle loss seems to be a predictor of ICU hospitalization in COVID-19 patients and radiologists reporting chest CT at admission should note this finding in their reports.

Psychological Distress, Fear of COVID-19, and Resilient Coping Abilities among Healthcare Workers in a Tertiary First-Line Hospital during the Coronavirus Pandemic.

The COVID-19 pandemic is causing a heavy burden in hospital healthcare workers (HCW) in terms of increased work, organizational changes, risk exposure, and social stigma. The present study aims at evaluating the psychological outcome among HCWs at the final stages of the first wave of the COVID-19 pandemic. This cross-sectional and survey-based study was conducted during June 2020 among 996 HCWs of the University Hospital of Padova. All the subjects completed questionnaires investigating the perception of risk of infecting or being infected by COVID-19, psychopathological variables, and coping abilities. Compared to physicians and healthcare assistants, nurses showed higher levels of depression (p = 0.002), insomnia (p < 0.001), and generalized anxiety (p = 0.001). Females reported increased concerns about the possibility of infecting others (p = 0.046), greater anxiety (p < 0.001), COVID-19 related fears (p < 0.001), depression (p < 0.001), and post-traumatic distress (p < 0.001) than males. Being employed in a COVID-19 unit, being transferred to other units, and living with children and the elderly were factors associated with higher levels of psychological distress. Greater coping abilities were detected in physicians, and in those HCWs employed in COVID units. Our findings evidenced that the psychological consequences of the pandemic were non-homogeneously distributed across HCWs categories and pointed out the presence of specific in-hospital and out-of-hospital risk factors.

Severe acute alcoholic hepatitis: can we offer early liver transplantation?

Alcohol-related liver disease is one of the most prevalent liver diseases worldwide and is the second most common indication for liver transplantation. Most transplant programs require 6 months of abstinence prior to transplantation; commonly referred to as the "six-month rule." According to this rule, the patients admitted for severe acute alcoholic hepatitis are not eligible for liver transplantation in most transplant centers. However, there is increasing evidence that if liver transplantation is performed in selected patients after the first episode of severe decompensation with no response to steroid therapy, it represents an effective treatment. In such selected patients, the post-transplant outcomes are good with survival rates that are significantly higher when compared with patients not responding to medical therapy and not transplanted. A multidisciplinary assessment, involving several stakeholders such as a transplant hepatologist, transplant surgeon, psychologist and psychiatrist is becoming mandatory to properly evaluate the candidate to liver transplantation for alcoholic liver diseases and severe acute alcoholic hepatitis. In the clinical setting of severe acute alcoholic hepatitis, further studies are needed for the identification of accepted selection clinical and psychosocial criteria that can provide the best long-term results. The early liver transplantation option should therefore be explored within strict criteria for this setting.

An Integrated Strategy for the Prevention of SARS-CoV-2 Infection in Healthcare Workers: A Prospective Observational Study.

BACKGROUND: Since the beginning of SARS-CoV-2 outbreak, a large number of infections have been reported among healthcare workers (HCWs). The aim of this study was to investigate the occurrence of SARS-CoV-2 infection among HCWs involved in the first management of infected patients and to describe the measures adopted to prevent the transmission in the hospital. METHODS: This prospective observational study was conducted between February 21 and April 16, 2020, in the Padua University Hospital (north-east Italy). The infection control policy adopted consisted of the following: the creation of the "Advanced Triage" area for the evaluation of SARS-CoV-2 cases, and the implementation of an integrated infection control surveillance system directed to all the healthcare personnel involved in the Advance Triage area. HCWs were regularly tested with nasopharyngeal swabs for SARS-CoV-2; body temperature and suggestive symptoms were evaluated at each duty. Demographic and clinical data of both patients and HCWs were collected and analyzed; HCWs' personal protective equipment (PPE) consumption was also recorded. The efficiency of the control strategy among HCWs was evaluated identifying symptomatic infection (primary endpoint) and asymptomatic infection (secondary endpoint) with confirmed detection of SARS-CoV-2. RESULTS: 7595 patients were evaluated in the Advanced Triage area: 5.2% resulted positive and 72.4% was symptomatic. The HCW team was composed of 60 members. A total of 361 nasopharyngeal swabs were performed on HCWs. All the swabs resulted negative and none of the HCWs reached the primary or the secondary endpoint. CONCLUSIONS: An integrated hospital infection control strategy, consisting of dedicated areas for infected patients, strict measures for PPE use and mass surveillance, is successful to prevent infection among HCWs.

Feasibility of postmortem examination in the era of COVID-19 pandemic: the experience of a Northeast Italy University Hospital.

With the continuous spreading of SARS-CoV-2 and increasing number of deaths worldwide, the need and appropriateness for autopsy in patients with COVID-19 became a matter of discussion. In fact, in the COVID-19 era protection of healthcare workers is a priority besides patient management. No evidence is currently available about the real risk related to the procedure as well as to the subsequent management of the samples. We herein describe the procedure that has been used to perform the first series of postmortem examinations in the COVID center of the Padua University Hospital, Padua, Italy, after the implementation of an ad hoc operating procedure, to minimize the risk of infection for pathologists and technicians. Provided that the procedure is performed in an adequate environment respecting strict biosafety rules, our data indicate that complete postmortem examination appears to be safe and will be highly informative providing useful insights into the complex disease pathogenesis.