Comparison of the characteristics, morbidity and mortality of COVID-19 between first and second/third wave in a hospital setting in Lombardy: a retrospective cohort study.

Coronavirus disease 2019 (COVID-19) represents a major health problem in terms of deaths and long-term sequelae. We conducted a retrospective cohort study at Montichiari Hospital (Brescia, Italy) to better understand the determinants of outcome in two different COVID-19 outbreaks. A total of 634 unvaccinated patients admitted from local emergency room to the Internal Medicine ward with a confirmed diagnosis of SARS-CoV-2 infection and a moderate-to-severe COVID-19 were included in the study. A group of 260 consecutive patients during SARS-CoV-2 first wave (from February to May 2020) and 374 consecutive patients during SARS-CoV-2 2nd/3rd wave (from October 2020 to May 2021) were considered. Demographic data were not significantly different between waves, except a lower prevalence of female sex during first wave. Mortality was significantly higher during the 1st wave than in the following periods (24.2% vs. 11%; p < 0.001). Time from symptoms onset to hospital admission was longer during first wave (8 ± 6 vs. 6 ± 4 days; p < 0.001), while in-hospital staying was significantly shorter (10 ± 14 vs. 15 ± 11 days; p < 0.001). Other significant differences were a larger use of corticosteroids and low-molecular weight heparin as well less antibiotic prescription during the second wave. Respiratory, bio-humoral and X-ray scores were significantly poorer at the time of admission in first-wave patients. After a multivariate regression analysis, C-reactive protein and procalcitonin values, % fraction of inspired oxygen on admission to the Internal Medicine ward and length of hospital stay and duration of symptoms were the strongest predictors of outcome. Concomitant anti-hypertensive treatment (including ACE-inhibitors and angiotensin-receptor blockers) did not affect the outcome. In conclusion, our data suggest that earlier diagnosis, timely hospital admission and rational use of the therapeutic options reduced the systemic inflammatory response and were associated to a better outcome during the 2nd/3rd wave.

Adaptation and validation of the Italian Pediatric Voice Handicap Index.

OBJECTIVE: To evaluate the internal consistency, reliability and clinical validity of the Italian version of the Pediatric Voice Handicap Index (pVHI). PATIENTS AND METHODS: The parents of 30 children with dysphonia and 43 asymptomatic children were included in the study. Each parent was asked to complete the Italian pVHI autonomously. The voice of each child was assessed perceptually through the GRB parameters of the GRBAS scale. Internal consistency was analyzed through Cronbach's α coefficient. For test-retest reliability analysis, the Italian pVHI was filled twice, with a 2-week interval, and the scores obtained were compared through the Pearson correlation test. Clinical validity was assessed comparing the scores obtained in the pathological and the control group using the Mann-Whitney test. Finally, the correlation between pVHI and the perceptual parameters was assessed. RESULTS: All of the parents filled in the entire questionnaire autonomously. An optimal internal consistency was found (α = 0.95); the test-retest reliability in the parents of both groups of children was high (r > 0.88). The control group scored significantly lower than the pathological group (p = 0.0001). The pVHI scores positively correlated with perceptual assessment of voice disorders. CONCLUSION: The Italian pVHI is easily administered, highly reproducible, and exhibits excellent clinical validity.