The use of CytoSorb in a septic shock patient with ARDS due to Sars Cov-2

Background: Septic shock is a clinical condition of sepsis aggravated by circulatory, cellular and metabolic dysregulation. Diagnostic criteria include the need for vasopressors to maintain a PAM>65 and serum lactate levels>2 under adequate fluid therapy. Early identification of critically septic patients is necessary to allow early and adequate treatment with improved prognosis. In this case report we evaluate the haemodynamic impact of CytoSorb therapy in a case of septic shock in a patient with ARDS Sars cov2. Method(s): Patient with Sars Cov-2 ARDS was admitted to our department. He was intubated and had a SOFA Score 7. On day 15 the patient presented an increase in PCT CRP and WBC levels with the need for norepinephrine infusion. Empirical antibiotic therapy was started and after 24 hours also CytoSorb Therapy. Four CytoSorb cartridge columns were used. The first two were changed every 12 h and then the next two were changed every 24 h. Result(s): Two days after CytoSorb therapy there was an improvement in haemodynamic without the need of vasopressor support. There was also a reduction in inflammatory parameters and lactates. The trend of these values was shown in figure 1. Conclusion(s): In this case report we evaluated the impact of CytoSorb therapy in a case of septic shock in a patient with ARDS Sars Cov-2. The early use of hemadsorption with CytoSorb combined with re-evaluation of antibiotic therapy resulted in a marked improvement in the patient's clinical status.

Monoclonal Antibodies Anti-Covid-19: Analysis Of Efficacy And Safety Data In The Early Months Of Use

Introduction. In addition to the vaccination, other options for treating COVID-19 have been made available;such options include the monoclonal antibody (MAbs) combinations Casirivimab/Imdevimab and Bamlanivamab/Etesevimab, which have shown to reduce the chances of hospitalisation in patients at risk of severe forms of disease. The aim of this work is to define data on the use of monoclonal therapy at the hospital where our U.O.C. Pharmacy is located and also to provide a first analysis on the efficacy and safety of the treatments. Methods and materials. The period under consideration runs from March 20th to August 15th 2021. Clinical data were extracted from AIFA web records and processed using Microsoft Excel. For patients whose treatment was closed, it has been calculated: follow-up period, degree of healing, rates of negativization, average overall negativization time and for subgroups of patients identified according to specific clinical parameters. Finally, a total percentage by type of adverse reaction was established. Results. 91 treatments with one of the two MAbs combinations have been activated. The average age of patients was between 59 and 72 years. The most common symptom was fever (83,52% of patients), while the most frequently encountered risk factor was Cardio-cerebrovascular disease (59,34%). Patient files have been closed for 86 patients, 84 of which recovered and 2 deceased. Negativization rates at 7, 14, 21, 28 and 35 days were 2.60%, 27.27%, 44.16%, 74.03% and 77.92% respectively. The average time of negativization was 22.33 days;in patients treated within 3 days of onset symptom, the average time was of 18,09 days, while in those treated after 3 days it was 26.00. Only 9.09% of patients involved in the treatment experienced one or more adverse reactions to the infusion. Conclusions. The results of this work show that correctly used anti-Covid-19 MAbs are an important therapeutic resource against the new infectious agent. As observed during the experimental phase, monoclonal antibodies prove their beneficial effect when used in the early stages of infection.

Swab test in biological fluids as predictor of COVID-19 transmission risk during surgery: a prospective cross-sectional study from an Italian COVID center.

BACKGROUND: The contamination of body fluids by Severe Acute Respiratory Syndrome Coronavirus 2 during surgery is current matter of debate in the scientific literature concerning CoronaVIrus Disease 2019. Surgical guidelines were published during the first wave of the COVID-19 pandemic and recommended to avoid laparoscopic surgery as much as possible, in fear that the chimney effect of high flow intraperitoneal gas escape during, and after, the procedure would increase the risk of viral transmission. AIM: The aim of this study was to evaluate the possibility of SARS-CoV-2 transmission during surgery by searching for viral RNA in serial samplings of biological liquids. METHODS: This is a single center prospective cross-sectional study. We used a real-time reverse transcriptase (RT) polymerase chain reaction (PCR) test to perform swab tests for the qualitative detection of nucleic acid from SARS-CoV-2 in abdominal fluids, during emergency surgery and on the first post-operative day. In the case of thoracic surgery, we performed a swab test of pleural fluids during chest drainage placement as well as on the first post-operative day. RESULTS: A total of 20 samples were obtained: 5 from pleural fluids, 13 from peritoneal fluids and two from biliary fluid. All 20 swabs performed from biological fluids resulted negative for SARS-CoV-2 RNA detection. CONCLUSION: To date, there is no scientific evidence of possible contagion by laparoscopic aerosolization of SARS-CoV-2, neither is certain whether the virus is effectively present in biological fluids.

Introduction: The Pandemic of Argumentation

This chapter introduces the volume and contextualises its scope, which covers communicative aspects of the current COVID-19 pandemic as well as the epidemic of misinformation from the perspective of argumentation theory. Argumentation theory is uniquely placed to understand and account for the challenges of public reason as expressed through argumentative discourse. The book thus focuses on the extent to which the forms, norms and functions of public argumentation have changed in the face of the COVID-19 pandemic. This question is investigated along descriptive, normative and prescriptive research lines at the core of the COST Action project CA 17132: European network for Argumentation and Public PoLicY analysis (APPLY). Contributions are divided into three groups, which (i) examine various features and aspects of public and institutional discourse about the COVID-19 pandemic, (ii) scrutinise the way health policies have been discussed, debated, attacked and defended in the public sphere, and (iii) consider a range of measures meant to improve the quality of public discourse, and public deliberation in particular, in such a way that concrete proposals for argumentative literacy are brought to light. © 2022, The Author(s).

COVID-19: identifying the main outcome predictors. A retrospective cohort study in Northern Italy.

OBJECTIVE: The need for efficient drugs and early treatment of patients with SARS-CoV-2 infection developing COVID-19 symptoms is of primary importance in daily clinical practice and it is certainly among the most difficult medical challenges in the current century. Recognizing those patients who will need stronger clinical efforts could effectively help doctors anticipate the eventual need for intensification of care (IoC) and choose the best treatment in order to avoid worse outcomes. PATIENTS AND METHODS: We enrolled 501 patients, consecutively admitted to our two COVID hospitals, and collected their clinical, anamnestic and laboratory data on admission. The aim of this retrospective study was to identify those data that are strictly associated with COVID-19 outcomes (IoC and in-hospital death) and that could somehow be intended as predictors of these outcomes. This allowed us to provide a "sketch" of the patient who undergoes, more often than others, an intensification of care and/or in-hospital death. RESULTS: Males were found to have a double risk of needing an IoC (OR=2.11) and a significant role was played by both the PaO2/FiO2 ratio on admission (OR=0.99) and serum LDH (OR=1.01). The main predictors of in-hospital death were age (OR=1.08) and the PaO2/FiO2 ratio on admission (OR=0.99). CONCLUSIONS: Male patients with high serum LDH on admission are those who undergo more often an intensification of care among COVID-19 inpatients. Both age and respiratory performances on admission modify the prognosis within the hospitalization period.

The specialist training of emergency psychologists. Contributions from the XIII Field Camp of Psychologists for the Peoples - Federation (OdV)

This narrative-report presents the activities of the 13th Field Camp of Italian Emergency Psychologists which, due to the restrictions caused by the Covid-19 pandemic, was held remotely one year after the planned date, on 9 and 17 April 2021. The voluntary organisation Psicologi per i Popoli - Federazione (OdV), on the strength of the training experience of the Field Camps that since 2006 it has been planning and - together with the association Psicologi per i Popoli - Trentino (ODV) - it has been managing at the Centro di Addestramento della Protezione Civile in Marco di Rovereto, puts at the centre of this online event the theme of the training of emergency-urgency psychologists. This training should be accredited by means of a postgraduate specialisation that also legitimises access to the emergency and urgency services of the National Health Service through competitive exams. The article also presents the results of the groups' work in proposing guidelines for the definition of "operational models" for emergency intervention.

Modena experience of first year of Diagnostic and Therapeutic Care pathways of utero and cervix cancer

Background: Gynecological cancers of the uterus and cervix are common malignancies in women. The correct management of these tumors involves many figures. Material and methods: Therefore, to respond to these multidisciplinary needs in June 2019 in Azienda Ospedialiero-Universitaria of Modena was born a Diagnostic and Therapeutic Care Pathways (DTCP) with gynaecologists, radiotherapists, medical oncologists, radiologists, nuclear medical doctors, pathologists, anaesthesiologists, a nurse Case Manager and a patients' association representative. A molecular biologist, endocrinologists and nutritionists have already enriched the team after the first year of activity. The group performs weekly collegial discussions of clinical cases and cohort visits, continued in the COVID era. Results: The new diagnoses in the first year of activity were 53 endometrial cancers (EC) and 24 cervical ones (CC). The median age at diagnosis was 51 years between EC patients and 70 years in CC. 87% of EC were endometrioid subtypes, while 65% CC were squamous cell ones. 70% EC patients (pts) were stage (st) I (52% IA and 48% IB), 5,5% st II, 9,4% st III and 11,3% st IV. Immunohistochemical analysis for estrogen and progesterone receptor, p53 and mismatch repair (MMR) proteins were performed on 20 EC. All tumours tested are p53 negative. We found 3 pts who had MMR deficiency, none of them diagnosed with Lynch syndrome at the subsequent genetic counselling. After surgery, 66% pts in st I underwent observation and 34% made radiotherapy (RT). Among st II pts, 1 patient performed RT, one other platinum- based chemotherapy (pCT) and the third did not perform any adjuvant treatment for ECOG. All except one st III pts (67%) underwent pCT with RT. Among st IV one received surgery, pCT and palliative RT, the others (83%) made pCT. Most CC were diagnosed in early st. 9 pts underwent upfront surgery, followed in 2 cases with RT and in 3 with RT and pCT. One patient received neoadjuvant chemo-RT. Radical RT with weekly cisplatin was performed in 9 pts, other 4 pts made RT alone due to advanced age and/or ECOG. One patient started observation for age, ECOG and absence of symptoms. Conclusions: In our experience, DTCP allows the optimization of the diagnostic and therapeutic strategy in EC and CC pts, especially in most complex cases.

Development and implementation of a system for the automated removal of parts produced by Fused Deposition Modeling

Additive manufacturing (AM) processes are characterized by a high degree of flexibility regarding the manufacture of complex geometries due to the tool-free layerwise build-up principle. A well-established AM method is Fused Deposition Modeling (FDM), in which the part is produced by melting thermoplastic material in an extrusion process. However, fully automated operation of FDM is not possible due to the usually manual removal of finished parts, which reduces the overall productivity of the process. To compensate for this disadvantage, the development and implementation of a system for automated part removal for FDM is presented in this paper. The system enables the removal of finished parts from the building platform and thus the start of new build-up processes without the need for human interaction or the removal of the entire building platform as described in existing approaches. By applying this system, the productivity of FDM could be increased significantly while also reducing the need for human presence in the context of COVID-19. © 2021 The Authors. Published by Elsevier B.V.

Spontaneous Pneumomediastinum without Pneumothorax in Non-ventilated COVID-19 Pneumonia: A Case Report

Spontaneous pneumomediastinum (SPM) is among the rare complications of Coronavirus Disease-19 (COVID-19) and usually involves patients with a severe form of disease who are undergoing treatment with invasive/non-invasive ventilation or high-flow oxygen therapy. A very low percentage of SPM cases are detected in non-ventilated COVID-patients, the underlying causes of which are still to be understood. We report here on the case of a 65-year-old patient with no clinical history of cardiovascular or pulmonary disease who developed SPM within a few days following hospital admission. SPM was detected on chest CT-angiography, and was unrelated to high-flow oxygen treatment.

Statin therapy and COVID-19: A retrospective cohort study in a province of Northern Italy

Background and Aims: The outbreak by SARS-CoV-2 has soon stolen the spotlight worldwide: specific strategies able to adequately limit the inflammatory response to the virus are still needed even if many drugs were thought to be somehow effective. Statins, in particular, were chosen for their anti-inflammatory properties. The aim of our work was to evaluate the role of statin therapy in a cohort of patients hospitalized for COVID-19, trying to understand whether such drugs were able to improve the patients’ outcomes. Methods: We retrospectively evaluated 501 adult inpatients admitted to the two COVID-hospitals of Ferrara’s territory, dividing them into two groups: ST=patients (on statin therapy on admission) and NST=patients (not on statin therapy). We searched for differences between groups in terms of anamnestic, clinical and laboratory data and then of disease outcomes. Results: We found significant differences between groups in terms of age, comorbidities, procalcitonin and CPK serum levels: ST patients were older, more comorbid, with lower procalcitonin and higher CPK serum levels. Male gender was the only independent predictor of needing intensification of care, while age and the Charlson Comorbidity Index (CCI) were good predictors of in-hospital and 30-day mortality. Differences were also found in the survival functions between the groups. Conclusions: After a period of observation of 100 days, ST patients, despite their older age and their greater load of comorbidities, have similar survival functions to NST patients. Adjusted for age and CCI, the survival functions of the ST group are considerably more favorable than those of the second group.

Early Prediction of COVID-19 Outcome: Contrasting Clinical Scores and Computational Intelligence Methods

Triaging incoming patients is critical for an optimal allocation of hospital resources, especially during a pandemic, when these tend to be quickly depleted. A typical approach for predicting patients’ outcomes relies on clinical scores such as the Charlson Comorbidity Index (CCI). CCI-based triaging is a reliable approach for estimating the mortality risk in the general patients’ population. However, this score is not optimized for predicting mortality in specific populations such as the one represented by COVID inpatients, often the most represented population in the emergency department cohorts during the current pandemic. Motivated by this, this chapter describes the development of a new COVID-19-specific clinical score: The General Assessment of SARS-CoV-2 patients Score (GASS). The score builds on the clinical experience gained during the first phase of the pandemic, and it is based on both clinical and laboratory data. It was aimed at predicting the 30-day mortality outcome of hospitalized COVID-19 patients and showed markedly better accuracy than the CCI. Furthermore, this chapter introduces an additional predictive model based on a classical Computational Intelligence method. Specifically, it describes the development and validation of a feedforward artificial Neural Network (NN) that automatically maps patients’ clinical and laboratory data to a 30-day mortality-risk score. Critically, the NN-based method was shown to be more accurate at predicting 30-day mortality of COVID-19 patients than both the CCI and GASS scores. However, the intrinsic black-box nature of the NN-based method makes it hard to reach an intuitive understanding of the internal computations underlying its decision process. This might affect its general acceptance among clinicians, and lead them to prefer using the GASS score. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

SARS-CoV-2 infection and H1N1 vaccination: does a relationship between the two factors really exist? A retrospective analysis of a territorial cohort in Ferrara, Italy.

OBJECTIVE: SARS-CoV-2 has been compared with other strains of coronaviruses, SARS-CoV and MERS-CoV, and with the flu viruses: all of them manifest themselves with respiratory symptoms and, although their genetic patterns are similar, the spread of SARS-CoV-2 infection has quickly reached global dimensions, demonstrating that SARS-CoV-2 is a virus with greater spreading capacity, albeit less lethal. Compared with influenza viruses, coronaviruses have a longer incubation period and the patients with coronaviruses' syndromes develop more severe diseases requiring frequent hospitalizations and intensive care admissions. The aim was to explore the relationships between seasonal influenza vaccination and coronavirus infection and to understand whether this hypothetic role by the flu vaccines modifies SARS-CoV-2 infection's outcomes. PATIENTS AND METHODS: In this retrospective, multicenter study, we enrolled 952 patients diagnosed with SARS-CoV-2 infection; 448 were admitted to our two main hospitals in Ferrara territory, while the remaining 504 were isolated at home. We compared the group of patients who had been vaccinated for influenza in the previous 12 months to that of unvaccinated patients. RESULTS: Significant differences were found for both the need for hospitalization and 30-day mortality between vaccinated and unvaccinated patients. We found age to be the only independent risk factor for a worse 30-day prognosis, while gender, influenza vaccinations and age itself were independent risk factors for undergoing hospitalization. CONCLUSIONS: In our groups of patients, we found a relationship between seasonal influenza vaccinations and SARS-CoV-2 infection. Age seems to be the main risk factor for short-term mortality in COVID-19 inpatients, while the influenza vaccination is, together with gender and age itself, a determining factor in predicting the need for hospitalization.

SARS-CoV-2 and finding of vein thrombosis: can IMPROVE and IMPROVEDD scores predict COVID-19 outcomes?

OBJECTIVE: Diffuse thrombosis represents one of the most predominant causes of death by COVID-19 and SARS-CoV-2 infection seems to increase the risk of developing venous thromboembolic diseases (VTE). Aim of this study is to analyze the relationship between validated predictive scores for VTE such as IMPROVE and IMPROVEDD and: (1) Intensification of Care (IoC, admission to Pulmonology Department or Intensive Care Unit) (2) in-hospital mortality rate 3) 30-days mortality rate. PATIENTS AND METHODS: We retrospectively evaluated 51 adult patients with laboratory diagnosis of SARS-CoV-2 infection and calculated IMPROVE and IMPROVEDD scores. All patients underwent venous color-Doppler ultrasound of the lower limbs to assess the presence of superficial vein thrombosis (SVT) and/or deep vein thrombosis (DVT). Patients with normal values of D-dimer did not receive heparin therapy (LMWH); patients with ≥ 4 ULN values of D-dimer or with a diagnosis of DVT were treated with therapeutic LMWH dosage, while the remaining patients were treated with prophylactic LMWH dosages. RESULTS: We found strong relations between IMPROVE score and the need for IoC and with the in-hospital mortality rate and between the IMPROVEDD score and the need for IoC. We defined that an IMPROVE score greater than 4 points was significantly associated to in-hospital mortality rate (p = 0.05), while an IMPROVEDD score greater than 3 points was associated with the need for IoC (p = 0.04). Multivariate logistic analysis showed how IMPROVE score was significantly associated to in-hospital and 30-days mortality rates. CONCLUSIONS: IMPROVE score can be considered an independent predictor of in-hospital and 30-days mortality.

Tocilizumab and corticosteroids for covid-19 treatment in elderly patients

Background. The mortality rate for coronavirus disease-19 (COVID-19) increases with age. Some anti-inflammatory drugs such as tocilizumab or steroids have been proposed for the treatment of severe disease;however, few data are available in the elderly. Methods. A retrospective case-series of patients hospitalized between March 1st and June 15th, 2020 with confirmed COVID-19 by RT-PCR testing on throat/nasopharyngeal swabs and age ≥ 65 years was analysed. Patients were retrospectively divided into three groups according to the chosen treatment [standard of care (SOC), tocilizumab or corticosteroids] and patient characteristics and occurrence of adverse events were compared among groups. Results. Overall, 206 patients were included, 148 treated with standard of care, 42 with steroids and 16 with tocilizumab. Patients treated with steroids or Tocilizumab presented more frequently with fever (p =.003), dyspnea (p <.001), bilateral opacities/infiltrates at chest X-ray (p =.026) or CT-scan (p =.020), and more frequently required non-invasive/invasive ventilation (p <.001). Crude mortality was 27%, without differences among groups (p =.074). No specific adverse events were observed during/after the administration of steroids or tocilizumab;however, a trend towards an increased risk of secondary infections was described compared to SOC (p =.097). At multivariate logistic regression, only tocilizumab administration was an independent predictor of secondary infections (aOR = 6.72, 95% CI = 1.43-31.39, p =.015). Conclusions. Tocilizumab and corticosteroid could have a possible role for severe form of pneumonia in course of COVID-19 also in elderly patients, even if great attention to the monitoring of infectious complications should be paid in this special population.

Noncoding RNAs implication in cardiovascular diseases in the COVID-19 era.

COronaVIrus Disease 19 (COVID-19) is caused by the infection of the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2). Although the main clinical manifestations of COVID-19 are respiratory, many patients also display acute myocardial injury and chronic damage to the cardiovascular system. Understanding both direct and indirect damage caused to the heart and the vascular system by SARS-CoV-2 infection is necessary to identify optimal clinical care strategies. The homeostasis of the cardiovascular system requires a tight regulation of the gene expression, which is controlled by multiple types of RNA molecules, including RNA encoding proteins (messenger RNAs) (mRNAs) and those lacking protein-coding potential, the noncoding-RNAs. In the last few years, dysregulation of noncoding-RNAs has emerged as a crucial component in the pathophysiology of virtually all cardiovascular diseases. Here we will discuss the potential role of noncoding RNAs in COVID-19 disease mechanisms and their possible use as biomarkers of clinical use.