The impact of COVID-19 pandemic on breast surgery in Italy: a multi-centric retrospective observational study.

COVID-19 pandemic had an impact on surgical activities. The aim of this multi-centric, retrospective study was to evaluate the impact of the COVID-19 pandemic on breast surgery. The patients who operated during the pre-pandemic year 2019 were compared to those operated in 2020. Fourteen Breast Care Units provided data on breast surgical procedures performed in 2020 and 2019: total number of breast-conserving surgery (BCS), number of 1st level oncoplastic breast surgery (OBS), number of 2nd level OBS; total number of mastectomies, mastectomies without reconstruction, mastectomies with a tissue expander, mastectomies with direct to implant (DTI) reconstruction, mastectomies with immediate flap reconstruction; total number of delayed reconstructions, number of expanders to implant reconstructions, number of delayed flap reconstructions. Overall 20.684 patients were included: 10.850 (52.5%) operated during 2019, and 9.834 (47.5%) during 2020. The overall number of breast oncologic surgical procedures in all centers in 2020 was 8.509, compared to 9.383 in 2019 (- 9%). BCS decreased by 744 cases (- 13%), the overall number of mastectomies decreased by 130 cases (- 3.5%); mastectomy-BCS ratio was 39-61% in 2019, and 42-58% in 2020. Regarding immediate reconstructive procedures mastectomies with DTI reconstruction increased by 166 cases (+ 15%) and mastectomies with immediate expander reconstruction decreased by 297 cases (- 20%). Breast-delayed reconstructive procedures in all centers in 2020 were 142 less than in 2019 (- 10%). The outburst of the COVID-19 pandemic in 2020 determined an implemented number of mastectomies compared to BCS, an implemented number of immediate breast reconstructions, mainly DTI, and a reduction of expander reconstruction.

ANTI-NUCLEOCAPSIDE IgG ANTIBODIES: A POTENTIAL MARKER FOR A MORE ACCURATE EPIDEMIOLOGICAL MONITORING OF SARS-COV-2 INFECTION

On March 11th, 2020, the World Health Organization (WHO) declared the pandemic status of CoronaVirus Disease-19 (COVID-19) caused by SARS-CoV-2. Viral nucleic acid detection using molecular testing is the gold standard to diagnose SARS-CoV-2 infection. Asymptomatic subjects or with mild symptoms may not be subjected to molecular diagnostic tests with important repercussions on epidemiological estimate. The overall evolution especially of post-pandemic dynamics, will be probably obtained by the detection of immune response. Humoral immune response against the nucleocapsid (N) protein is related to SARS-CoV-2 infection. The detection of these antibodies could discriminate cases with from cases without history of COVID-19 for a more accurate evaluation of population exposed to SARSCoV-2. In this retrospective study, we evaluated four subclasses of SARS-CoV-2 IgG (anti-S1, anti-S2, anti-RBD, anti-N) in n.200 blood samples (February-March 2022) of health workers of Azienda Sanitaria Provinciale (ASP) di Ragusa, already vaccinated against Covid-19 in the period February-March 2022. A statistically significant association between SARS-CoV-2 infection and seropositivity to anti-N IgG (p-value <0.0001) was found. In order to evaluate the SARS-CoV-2 anti-N antibodies titer trend, the cases with a positive history for COVID-19 were classified as follows: cases with infection within three months and cases with infection after three months from serological test.No statistically association (p-value= 0.075) was found between seropositivity to anti-N IgG and SARS-CoV-2 infection within and after three months. We observed that approximately 30% of cases with a history for COVID-19 was seronegative for anti-N IgG within three months from infection.In post-pandemic period the evaluation of anti-N IgG in a time interval of less than three months could identify asymptomatic population exposed to SARS-CoV-2. Although our findings should be validated with a larger cohort, these results suggest that anti-N IgG might be used as a marker of early infection and assure a more accurate epidemiological estimate.

COVID-19 vaccination self-readiness scale: An exploratory factor analysis (EFA) in the Philippine setting

The Philippine medical community believes that COVID-19 vaccination of the majority of people (70%) would be a crucial factor in achieving herd immunity in the Philippines or in any country. However, community vaccination may not be sanctioned fully until such time people’s readiness level to be vaccinated is determined. With 582 respondents across ages this study developed a COVID-19 vaccination self-readiness instrument using basic data analytics in computer science education and psychology;and specifically, it explored factors behind people’s perception of their COVID-19 vaccination readiness. Twenty-nine initial indicators from a content validated scale were subjected to Exploratory Factor Analysis (EFA). After extraction series of rotation via Direct Oblimin and reliability analysis three components of the COVID-19 vaccination self-readiness emerged namely assured readiness (11 items alpha=0.965) conditional readiness (4 items alpha=0.820) and mandatory readiness (4 items alpha= 0.856) with 73.1% total variance explained. Findings show that there are three groups of people first those who are confidently ready to be vaccinated despite the vaccine efficacy issues the second group puts safety conditions regarding the completion of its clinical trials and the third group asserts job requirement and senior status. The new instrument may now be piloted to measure people’s level of COVID-19 vaccination self-readiness.  Confirmatory factor analysis is recommended for psychometricians and computer science educators to test the scale further.

The Expander-Implant Breast Reconstruction in the COVID Era: Which is the "Unhappy" Tissue Expander Priority?

Breast surgeons seem to agree on the fact that a same-day surgery (mastectomy and breast reconstruction) protocol provides appropriate cancer treatment during times of unprecedented resource limitations, such as in the COVID era. In this scenario, pre-pectoral implant-based breast reconstruction can be definitively considered a sustainable technique. Nevertheless, the authors focus on the management of patients who had already undergone a same day procedure with two-stage breast reconstruction, implanting a breast tissue expander during the last two-year period and have been progressively delayed according to a surgical care based on priority. We coined the expression "unhappy tissue expander" to define all those symptomatic patients for which surgery should not be delayed even during an epidemic context.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[The management of nephropathic patients during the Covid-19 pandemic: the experience of Ragusa]

The public emergency caused by Covid-19 has forced health services to reorganize in order to separate positive patients from negative ones. In nephrology, this reorganization involves several levels of assistance concerning hospitalizations, ambulatory care and haemodialysis. Within the Complex Unit of Nephrology in Ragusa, the distribution of nephro-dialytic resources has involved four different hospitals, hence ensuring haemodialysis services for asymptomatic and pauci-symptomatic Covid-19 patients as well as for patients in Covid-Unit, Sub-Intensive Therapy and Intensive Care Unit. In this complex context, we had to create a common protocol involving all the professionals who provide assistance in our Unit, across the different structures. We also report some encouraging data that seem to indicate the effectiveness of the protocols put in place.