ABSTRACT
Background: During Covid-19 pandemic, several patients (pts) suffering from ARDS underwent tracheostomy. Decannulation was managed in different step-down units and no standardized procedures are available. Aim(s): To compare time of decannulation and clinical management of tracheostomized pts for Covid-19 ARDS in rehabilitation (R) vs respiratory wards (RW). Method(s): This retrospective, multicenter study compared tracheostomized pts for Covid-19 ARDS, admitted to RW (51 pts) and R (45 pts) from March 2020 to May 2021. Demographic and clinical data, duration of tracheostomy and standard of care in both settings were collected. Result(s): No differences were showed in demographic and clinical data, except the prevalence of Invasive Ventilation (IV): 59% pts in RW vs 38% pts in R (p=0.04). All pts were weaned from IV;time of weaning did not differ in the two wards (median days: 0 [IQR: 0-6.5] in R vs 1 [IQR: 0-7] in RW;p=0.17). In both settings, more than 90% of pts were decannulated and decannulation time was not different (median days: 13 [IQR: 7.5-18.5] in R vs 14 [IQR: 9-17.5] in RW;p=0.67). High flow therapy was more used in R (69% vs 47% pts in RW;p=0.03). The assessment of swallowing was performed in 93% pts in R vs 63% pts in RW (p<0.01). Dysphagia was showed in 43% vs 37% of screened pts in R e RW respectively (p=0.08). The physiotherapy (FT) was carried out in 100% pts in R vs 84% pts in RW (p=0.17). Conclusion(s): The setting of care does not affect time or success of decannulation in Covid-19 tracheostomized pts, probably thanks to FT implementation in both wards. High prevalence of dysphagia was detect indicating the need for swallowing screening and speech therapy.
ABSTRACT
Background: Tracheotomy is a routine procedure for patients requiring prolonged mechanical ventilation (MV) in intensive care units (ICUs), included Covid-19 ARDS, for which few data about decannulation are available. Aim(s): To compare time to decannulation between Covid-19 and no-Covid-19 ARDS and identify possible predictive factors. Method(s): In this retrospective, multicenter study, 96 tracheotomized patients, admitted from March 2020 to May 2021 in 5 pulmonary wards after an ICU stay due to Covid-19 ARDS, are compared to 32 tracheotomized ARDS patients not associated to Covid-19 admitted before its outbreak. Clinical, demographic data and comorbidities are analyzed. Result(s): Median age is lower in Covid-19 group;sex prevalence, body mass index (BMI) and frailty do not differ between the two groups as well as timing of decannulation (median days: 14 [IQR 9-22] vs 13 [IQR 8-18] in noCovid-19 and Covid-19 ARDS, respectively;p=0.08). In a multivariate linear regression analysis, Medical Research Council (MRC) scale (beta -0.33;p<0.0001), duration of steroids (beta 0.28;p=0.001), clinical complications (beta 0.27;p=0.004), PaO2/FiO2 ratio (beta -0.25;p=0.007) and history of smoke (beta 0.18;p=0.04) significantly predict timing of decannulation in both groups. Conclusion(s): Timing of decannulation in Covid-19 ARDS patients is not different from no-Covid-19 ARDS. In Covid19 patients, past knowledge about decannulation and the need of relieve post-ICU setting avoid the delay in decannulation time if compared to no-Covid-19 patients. ICU-acquired weakness, evaluated by MRC scale, seems to be a strong predictor of longer time to decannulation in the two groups.
ABSTRACT
Background: to date, more than 243 million COVID-19 cases have been diagnosed globally, with 4.94 million deaths, 489.000 new cases and 8.474 deaths per day. In Italy there are currently 4.73 million cases and 132.000 deaths. It is well known that the entry of the SARS- CoV-2 virus into cells is mediated by the binding between the virus Spike-glycoprotein (S) and the membrane ACE2-receptor (ACE2-R). When SARS-CoV-2 binds to ACE2-R, with subsequent membrane fusion and virus entry into the cell, a down-regulation of these receptors occurs. ACE2 -R downregulation plays a crucial role in the pulmonary and systemic inflammatory response. A serious clinical course appears to be associated with some factors such as age, previous pathologies and comorbidities. However, also a dysregulation of the RAA system linked to a different expression of ACE-2 R and TMPRSS2 gene polymorphisms and different serum levels of soluble ACE2 (sACE2), could be associated with abnormal inflammatory and immune response to SARS-CoV-2 infection. Aim of the Study: we aimed to verify whether there is an association between the clinical course of COVID-19 patients (pts) and the presence of more frequent ACE2 and TMPRSS2 single-nucleotide polymorphisms (SNPs) and if sACE2 levels are related to specific ACE2 and TMPRSS2 polymorphic variants. Method(s): we consecutively enrolled subjects with previous documented SARS-CoV-2 infection and divided our sample into three groups: pts with asymptomatic course;pts with symptomatic course but without the need for hospitalization for COVID-19;pts with severe symptomatic course requiring hospitalization in intensive care unit. Data about age, clinical course, comorbidities, and therapies were collected. Blood samples were taken for the genetic analysis of the most frequent SNPs of the ACE2-R and TMPRSS2 detected in Italian population, in particular genotypic variants TTand CC of ACE2 SNPs 1 and 5 (rate of 5% and 14% respectively) and genotypic variants TTand CC of TMPRSS2 SNPs 2 and 3 (rate of 50% and 30% respective). Result(s): among 178 pts enrolled up to March 2022, we have so far analyzed the genetic polymorphisms of 74 pts.;21 (28%) were hospitalized for COVID-19, 38 (51%) had symptomatic course without hospitalization and 15 (21%) were completely pauci-asymptomatics. Serum concentrations of sACE2 and distribution of polymorphic variants in the three groups are summarized in Table 1. We found that sACE2 levels were higher in genotypic variant CC of SNP 1 of TMPRSS2 gene (Table 2). Considering that a high concentration of sACE2 outlines a proinflammatory condition, it could be hypothesized that the CC genotype may be a predisposing condition to the cytokine storm of COVID-19. Perspective(s): Genetic analysis of ACE2 and TMPRSS2 SNPs will help to clarify the relationship between these polymorphic variant, sACE2 levels, risk of SARS-CoV2 infection and severity of clinical presentation of COVID-19 in patients with or without CV diseases.
ABSTRACT
Background: It is well known that the entry of the SARS- CoV-2 virus into cells is mediated by the binding between the virus Spike-glycoprotein (S) and the membrane ACE2-receptor (ACE2R). When SARS-CoV-2 binds to ACE2R, with subsequent membrane fusion and virus entry into the cell, a down-regulation of these receptors occurs. ACE2R downregulation plays a crucial role in the pulmonary and systemic inflammatory response. Also ACE2 deficiency is thought to play an important role in the pathogenesis of SARS-CoV-2 infection. The down-regulation of ACE2 induced by viral infection could be particularly harmful in subjects with pre-existing ACE2 deficiency, for example due to advanced age, the presence of DM, arterial hypertension or pre-existing heart disease, including HF. Literature data suggest an association between the patient's age and comorbidities and a greater risk of severe clinical course and with a worse prognosis. However, serious clinical pictures requiring hospitalization or leading to death have also been observed in young subjects or subjects without comorbidities. Aim of the Study: we aimed to identify predicting factors of a higher risk in terms of severity of the clinical course and worse prognosis in the population of the Brescia area, affected by a large number of cases in the first period of COVID-19 outbreak. In particular, we aimed to verify whether there is correlation between levels of serum ACE2 (sACE2) and the risk of SARS-CoV-2 infection, as well as between sACE2 and the different severity of the clinical manifestations of COVID-19 in patients with and without CV diseases. Method(s): we consecutively enrolled subjects with previous documented SARS-CoV-2 infection and divided our sample into three groups: pts with asymptomatic course;pts with symptomatic course but without the need for hospitalization for COVID-19;pts with severe symptomatic course requiring hospitalization in intensive care unit. Blood samples were taken for sACE2 dosage. We compared the concentrations of sACE2 in these groups in relation to the age, clinical course, comorbidities, and ongoing therapies. Result(s): at March 2022, we enrolled 178 pts, 51 (28%) were hospitalized for COVID-19, whereas 78 (44%) had symptomatic course without hospitalization and 49 (28%) were completely pauci-asymptomatic. Only 6 pts (4%) had myocarditis or pericarditis SARS-CoV-2-related. Between hospitalized pts, male sex (67%), older age and higher BMI were most frequent. Moreover, chronic heart failure (20%), a diagnosis of cardiopathy (29%) and AF or atrial flutter (22%) were most frequent (Table 1). Plasma concentrations of sACE2 will be dosed and analyzed in relation to the clinical characteristics of each patient. Perspective(s): ACCEPTstudy will help to clarify the relationship between ACE2 molecule, the risk of SARS-CoV2 infection and the severity of clinical presentation of COVID-19 in pts with or without CV diseases.
ABSTRACT
BACKGROUND: The final diagnosis of COVID-19 pneumonia relies on a clinical and radiological picture, along with SARS-CoV2 RNAdetection in the oral and nasal-pharyngeal swab. The latter, has a high rate of false negative results, even in presence of symptoms and radiological abnormalities suggestive for COVID-19. In case of an atypical or indeterminate radiological pattern, the need of excluding COVID-19 and ruling out other differential diagnoses would be necessary. In such settings, the role of invasive procedures for obtaining samples from the lower respiratory tract such flexible bronchoscopy has been debated, due to the risk of contagion. The aim of this study was to evaluate the role of flexible bronchoscopy with bronchial washing during the pandemic of COVID-19. We aimed to define the value of bronchial washing in patients with an atypical or indeterminate chest CT-scan pattern for viral pneumonia. METHODS: We retrospectively reviewed patients with an atypical or indeterminate CTscan pattern for COVID-19 pneumonia and a negative test for SARS-CoV2 RNAon oral/ nasal-pharyngeal swabs, who underwent bronchoscopy for bronchial washings to exclude or confirm the diagnosis of SARS-CoV2 pneumonia. RESULTS: Among the 44 patients included with an atypical or indeterminate chest CT-scan pattern for COVID-19 pneumonia, no SARS-CoV2 RNAwas detected in the bronchial washing. CONCLUSIONS: The role of bronchoscopy in the diagnosis of COVID-19 pneumonia is negligible in indeterminate or atypical patterns on chest CT scan. However, we should not shy away from these invasive procedures in these profiles of cases to exclude bronchoscopically diagnosed differential diagnoses like other infections and non-infectious causes.
ABSTRACT
A vast majority of COVID-19 patients experience fatigue, extreme tiredness and symptoms that persist beyond the active phase of the disease. This condition is called post-COVID syndrome. The mechanisms by which the virus causes prolonged illness are still unclear. The aim of this review is to gather information regarding post-COVID syndrome so as to highlight its etiological basis and the nutritional regimes and supplements that can mitigate, alleviate or relieve the associated chronic fatigue, gastrointestinal disorders and continuing inflammatory reactions. Naturally-occurring food supplements, such as acetyl L-carnitine, hydroxytyrosol and vitamins B, C and D hold significant promise in the management of post-COVID syndrome. In this pilot observational study, we evaluated the effect of a food supplement containing hydroxytyrosol, acetyl L-carnitine and vitamins B, C and D in improving perceived fatigue in patients who recovered from COVID-19 but had post-COVID syndrome characterized by chronic fatigue. The results suggest that the food supplement could proceed to clinical trials of its efficacy in aiding the recovery of patients with long COVID.
Subject(s)
COVID-19/complications , Dietary Supplements , Acetylcarnitine/administration & dosage , Adult , Aged , COVID-19/diet therapy , COVID-19/pathology , COVID-19/psychology , COVID-19/virology , Dietary Supplements/adverse effects , Fatigue/etiology , Female , Gastrointestinal Diseases/etiology , Humans , Male , Middle Aged , Phenylethyl Alcohol/administration & dosage , Phenylethyl Alcohol/analogs & derivatives , Pilot Projects , SARS-CoV-2/isolation & purification , Self Report , Surveys and Questionnaires , Vitamins/administration & dosage , Post-Acute COVID-19 SyndromeABSTRACT
Background: During the lockdown period in Italy, from March 11th to May 4th 2020, a progressive increase in COVID-19 cases occurred in all Italian regions, in particular in the Lombardy Region. The current rise in COVID- 19 cases has led to an increasing involvement of hospitals, in order to face the Coronavirus outbreak, shifting healthcare resources towards the management of COVID+ patients. This has led, on the other hand, to a progressive decrease in hospital admissions due to conditions not associated with SARS-CoV2 infection. During COVID-19 outbreak period, it has been observed a decrease in hospital admissions for acute myocardial infarction. This phenomenon put in serious difficulty the clinical management of COVID-free patients with cardiovascular disease, at the beginning of phase 2 (starting from May 4 2020). Purpose: In this scenario, we aimed to verify the impact of telemedicine during lockdown, in comparison with the same period in 2019. Materials and method: We analyzed 12-lead ECGs recorded by 5000 country pharmacies, evaluated and stored in one telemedicine platform provided by Health Telematic Network (HTN), in cooperation with our Cardiology Department, Federfarma (Pharmacists' National Association), and Italian National Health Institute. Results: During the lockdown period, were recorded 6,104 ECGs in territorial pharmacies, compared to 17,280 ECGs done in the same period in 2019. Chest pain symptom represented the cause of recording ECG in 298 patients (4.88%) during the lockdown period, compared to 402 patients (2.33%) in the same period in 2019, with an increase of 109.86%. In the Lombardy Region, during lockdown period, were reported 118 accesses to territorial pharmacies for chest pain (about 39.50% of total cases in Italy). Among these, 36 accesses were in the province of Brescia (about 30.50%), whereas 28 of them were in the province of Bergamo (about 23.73%). Among ECGs performed, 8 showed typical abnormalities of acute myocardial infarction with ST elevation (STEMI, 2.68%) in the lockdown period, compared to 7 STEMIs (1.74%) detected in the same period in 2019, with an increase of 54.17%. These patients were referred to Emergency Department (ED) suddenly, for the therapeutic intervention. Conclusion: These data shown that a large number of patients with cardiovascular symptoms preferred to go to territorial pharmacies rather than hospitals during the COVID outbreak period. Telemedicine played a prominent role in managing patients with cardiovascular symptoms at home. Moreover, this service allowed patients with STEMI to access to the hospitals faster, avoiding the risks of a serious diagnostic delay. Furthermore, by analyzing the data of Lombardy Region, it was possible to show how a significant component of access to local pharmacies for chest pain occurred in the region most affected by the COVID-19 outbreak.
ABSTRACT
Background: During the lockdown in Italy, from March 11th to May 4th 2020, a progressive increase in COVID-19 cases occurred in all Italian regions, in particular in Lombardy. The current rise in COVID-19 cases has led to an increasing involvement of hospitals, in order to face the Coronavirus outbreak, shifting healthcare resources towards the management of COVID+ patients. This has led, on the other hand, to a progressive decrease in hospital admissions due to conditions not associated with SARSCoV2 infection. In other European countries interested by a national lockdown, a decrease in registered new-onset atrial fibrillation (AF) cases was observed. Undiagnosed AF patients can develop complications that could potentially translate into poorer long-term outcomes. Purpose: In this scenario, we aimed to verify the impact of telemedicine (TLM) during lockdown, in comparison with the same period in 2019. Materials and method: We analyzed 12-lead ECGs recorded by 5000 country pharmacies, evaluated and stored in one TLM platform provided by Health Telematic Network (HTN), in cooperation with our Cardiology Department, Federfarma, and Italian National Health Institute. Results: During the lockdown period in 2020, 6,104 ECGs were performed in territorial pharmacies, compared to 17,280 ECGs recorded in the same period in 2019. Among ECGs performed, we detected AF in 344 patients (5.64%) in lockdown period, compared to 393 cases (2.27%) detected in the same period in 2019, with an increase of 40.25%. We detected also Atrial Flutter in 32 patients (0.52%) in lockdown period, compared to 25 cases (0.14%) detected in the same period in 2019. The difference was +26.92%. Moreover, we found Paroxysmal Supraventricular Tachycardia in 8 patients (0.13%) during lockdown, compared to 6 cases (0.03%) detected in the same period in 2019, with an increase of 23.07%. In lockdown period, a total of 384 patients (6.29%) were referred to ED because of symptomatic tachyarrhythmia, compared to 424 patients (3.47%) referred to ED in the same period in 2019, with an increase of 55.16%. In the Lombardy Region, during lockdown, were reported 194 cases of tachyarrhythmia in territorial pharmacies (about 50.52% of all cases in Italy). Among these, 93 cases of tachyarrhythmia were in the Brescia area (about 47.94%), whereas 50 cases were in the Bergamo one (about 25.77%). Conclusion: These data shown that, during the COVID outbreak, a large number of patients with CV symptoms preferred to go to territorial pharmacies rather than the closer hospital. TLM played a prominent role in managing patients with CV symptoms at home. Moreover, this service allowed to refer to the hospital only patients with clinically relevant tachyarrhythmia, avoiding the risks of treatment delay. This once again underlines how TLM network provided by pharmacies may become an important tool offered to citizens, especially during coronavirus pandemic emergency, within the Italian National Health System.
ABSTRACT
Background. During the lockdown period in Italy, from March 11th to May 4th 2020, a progressive increase in COVID-19 cases occurred in all Italian regions, in particular in the Lombardy Region. The current rise in COVID-19 cases has led to an increasing involvement of hospitals, in order to face the Coronavirus outbreak, shifting healthcare resources towards the management of COVID+ patients. This has led, on the other hand, to a progressive decrease in hospital admissions due to conditions not associated with SARS-CoV2 infection. During COVID-19 outbreak period, it has been observed a decrease in hospital admissions for acute myocardial infarction. This phenomenon put in serious difficulty the clinical management of COVID-free patients with cardiovascular disease, at the beginning of phase 2 (starting from May 4 2020). Purpose. In this scenario, we aimed to verify the impact of telemedicine during lockdown, in comparison with the same period in 2019. Materials and method. We analyzed 12-lead ECGs recorded by 5000 country pharmacies, evaluated and stored in one telemedicine platform provided by Health Telematic Network (HTN), in cooperation with our Cardiology Department, Federfarma (Pharmacists' National Association), and Italian National Health Institute. Results. During the lockdown period, were recorded 6,104 ECGs in territorial pharmacies, compared to 17,280 ECGs done in the same period in 2019. Chest pain symptom represented the cause of recording ECG in 298 patients (4.88%) during the lockdown period, compared to 402 patients (2.33%) in the same period in 2019, with an increase of 109.86%. In the Lombardy Region, during lockdown period, were reported 118 accesses to territorial pharmacies for chest pain (about 39.50% of total cases in Italy). Among these, 36 accesses were in the province of Brescia (about 30.50%), whereas 28 of them were in the province of Bergamo (about 23.73%). Among ECGs performed, 8 showed typical abnormalities of acute myocardial infarction with ST elevation (STEMI, 2.68%) in the lockdown period, compared to 7 STEMIs (1.74%) detected in the same period in 2019, with an increase of 54.17%. These patients were referred to Emergency Department (ED) suddenly, for the therapeutic intervention. Conclusion. These data shown that a large number of patients with cardiovascular symptoms preferred to go to territorial pharmacies rather than hospitals during the COVID outbreak period. Telemedicine played a prominent role in managing patients with cardiovascular symptoms at home. Moreover, this service allowed patients with STEMI to access to the hospitals faster, avoiding the risks of a serious diagnostic delay. Furthermore, by analyzing the data of Lombardy Region, it was possible to show how a significant component of access to local pharmacies for chest pain occurred in the region most affected by the COVID-19 outbreak.
ABSTRACT
Background. During the lockdown period in Italy, from March 11th to May 4th 2020, a progressive increase in COVID-19 cases occurred in all Italian regions, in particular in the Lombardy Region. The current rise in COVID-19 cases has led to an increasing involvement of hospitals, in order to face the Coronavirus outbreak, shifting healthcare resources towards the management of COVID+ patients. This has led, on the other hand, to a progressive decrease in hospital admissions due to conditions not associated with SARS-CoV2 infection. At the same time, the regional governments have provided for the suspension of all outpatient activities, with the exception of the non-deferrable one. It was decided to postpone any elective intervention, referring to COVID free hospitals any urgent or emergency intervention. Purpose. We aimed to verify the impact of coronavirus outbreak in the management of patients with high risk of morbidity and mortality, followed at the Cardiology Outpatient Clinic of our hospital, that was a Hub center for COVID patients. Materials and method. We compared the total number of Day Hospital (DH) visits for worsening heart failure (WHF), severe aortic stenosis waiting for Transcatheter Aortic Valve Implantation (TAVI) and atrial fibrillation (AF) requiring electrical cardioversion (ECV) between March 4th and May 4th of 2019 with those that refer to the same period in 2020. Then, we evaluated the same data in the 30 days following the end of the lockdown (May-June 2020). Results. As reported in Figure 1, the number of DH visits during March-May 2019 was approximately double compared to the ones in the same interval time in 2020 (81 vs 34 patients). Instead, in just one month (18/05-18/06/2020) there was a significant increase in the number of accesses for WHF (globally 22), if compared with those (21 in total) during the entire lockdown (lasting three months, from 04/03 to 04/05/2020). Figure 1. Number of MAC accesses in the indicated periods. C = heart failure;T = TAVI;F = atrial fibrillation. March-May 2019 March-May 2020 May-June 2020 Conclusion. These data confirm how the COVID outbreak impacted negatively on the appropriate management and timing of therapeutic intervention for severe cardiovascular disease, in particular those with high risk of events and mortality, especially in the regions with highest number of hospitalizations and deaths for SARS-CoV-2.