Characteristics and risk factors for in-hospital mortality in 243 elderly patients with COVID-19 in Santorso, Italy: a retrospective study.

Large proportion of deaths from SARS-CoV-2 infections occurred worldwide, especially in elderly patients. The aim of this research is to investigate the potential risk factors for mortality in the elderly patients with COVID-19. 65 years old or older patients with COVID-19 admitted to the Hospital «Alto Vicentino¼ of Santorso, Vicenza, from 23th February to 25th May 2020, were enrolled in this retrospective cohort study. Data of demographics, clinical features, comorbidities and blood tests were collected and compared for different outcomes. Charlson Comorbidity Index (CCI), Barthel Index (BI) and Modified Early Warning Score (MEWS) were evaluated. Univariate and multivariate logistic regression analyses were performed to explore risk factors for death. 243 patients with mean age 81,3±8,4 years were enrolled, of which 121 (49,8%) were females. This cohort included 11 (4,5%) mild, 131 (53,9%) moderate, 94 (38,7%) severe, 7 (2,9%) critical cases. CCI and BI were 2,8±2,1 points and 31,3±34,9 points respectively. Lethality rate was 28,4% (69 cases). Univariate logistic regression showed a significant increase in mortality risk with increasing age, CCI, polypharmacy, MEWS, Severity Index and reduced BI. Among blood tests thrombocytopenia, high CRP and elevated LDH showed a significant correlation with mortality. In the multivariate logistic regression high CCI, low BI and thrombocytopenia remained to be predictors of death. Tools, which evaluate functional dependence like BI and multiple morbidity like CCI, can be useful in identifying the elderly patients with COVID-19 at greater risk.

COVID-19 therapies and their impact on QT interval prolongation: A multicentre retrospective study on 196 patients.

BACKGROUND: SARS-CoV-2 infection has caused a global pandemic. Many of the medications identified to treat COVID-19 could be connected with QTc prolongation and its consequences. METHODS: Non-ICU hospitalized patients of the three centres involved in the study from the 19th of March to the 1st of May were included in this retrospective multicentre study. Relevant clinical data were digitally collected. The primary outcome was the incidence of QTc prolongation ≥ 500 ms, the main secondary outcomes were the Tisdale score ability to predict QTc prolongation and the incidence of ventricular arrhythmias and sudden deaths. RESULTS: 196 patients were analysed. 20 patients (10.2%) reached a QTc ≥ 500 ms. Patients with QTc ≥ 500 ms were significantly older (66.7 ± 14.65 vs 76.6 ± 8.77 years p: 0.004), with higher Tisdale score (low 56 (31.8%) vs 0; intermediate 95 (54.0%) vs 14 (70.0%); high 25 (14.2%) vs 6 (30.0%); p: 0.007) and with higher prognostic lab values (d-dimer 1819 ± 2815 vs 11486 ± 38554 ng/ml p: 0.010; BNP 212.5 ± 288.4 vs 951.3 ± 816.7 pg/ml p < 0.001; procalcitonin 0.27 ± 0.74 vs 1.33 ± 4.04 ng/ml p: 0.003). After a multivariate analysis the Tisdale score was able to predict a QTc prolongation ≥ 500 ms (OR 1,358 95% CI 1,076-1,714p: 0,010). 27 patients died because of COVID-19 (13.7%), none experienced ventricular arrhythmias, and 2 (1.02%) patients with concomitant cardiovascular condition died of sudden death. CONCLUSIONS: In our population, a QTc prolongation ≥ 500 ms was observed in a minority of patients, no suspected fatal arrhythmias have been observed. Tisdale score can help in predicting QTc prolongation.

Microfabricated fractal branching networks.

In this article, we demonstrate how a combination of engineering and biological techniques could lead to the realization of branched microstructures that can be used for the repair of damaged vascularized tissue. Recursive "treelike" networks were first generated by using fractal algorithms based on Murray's equation for vascular branching as well as allometric scaling rules. Two- and three-dimensional branching patterns with different levels of complexity were then microfabricated from poly-lactide-co-glycolide (PLGA) by using the pressure-assisted microsyringe (PAM) system developed in our laboratory. Human endothelial cells isolated from umbilical cords were seeded on the microfabricated branched scaffolds to evaluate their effectiveness in supporting site-specific cell adhesion. The results show that cell densities on the networks increase with complexity up to the sixth level and are then constant independent of branching level. The implications of this finding are discussed in terms of contact inhibition of "capillaries."

Microsyringe-based deposition of two-dimensional and three-dimensional polymer scaffolds with a well-defined geometry for application to tissue engineering.

A technique for controlled deposition of biomaterials and cells in specific and complex architectures is described. It employs a highly accurate three-dimensional micropositioning system with a pressure-controlled syringe to deposit biopolymer structures with a lateral resolution of 5 microm. The pressure-activated microsyringe is equipped with a fine-bore exit needle and a wide variety of two- and three-dimensional patterns on which cells to be deposited can adhere. The system has been characterized in terms of deposition parameters such as applied pressure, motor speed, line width and height, and polymer viscosity, and a fluid dynamic model simulating the deposition process has been developed, allowing an accurate prediction of the topological characteristics of the polymer structures.

Usefulness of transesophageal echocardiography during open heart surgery of mitral stenosis.

BACKGROUND: The aim of this study was to verify if the use of intraoperative transesophageal echocardiography (TEE), by detecting mitral insufficiency or residual stenosis during surgery, may improve medium term results in patients with severe mitral stenosis who undergo open heart valvuloplasty. METHODS: This prospective study included twenty-two patients (20 women and 2 men) with a mean age of 49+/-13 years with severe mitral stenosis. Mean follow-up was 32 months (range 12-55 months). All the patients underwent transthoracic echocardiography (TrE) before surgery and intraoperative TEE. Before surgery the mean transmitral gradient was 11+/-6.8 mmHg, the mean pressure half time (PHT) area was 0.89+/-0.19 cm2, the mean echo score was 8.9+/-2.2. Intraoperative TEE before the repair showed a mean echo score of 7.9+/-1.8. RESULTS: Two patients with unsatisfactory repair at TEE underwent immediate valve replacement. In the remaining patients, mean transmitral gradient and PHT valve area before discharge was 5.2+/-3 mmHg and 2.5 cm2. No patients had more than trivial mitral regurgitation. During the follow-up two patients had to be reoperated. Patients with poor immediate (2 patients) or medium term results (2 patients), had a mean echocardiographic score of 12.24, while patients with a satisfactory medium term outcome had a mean score of 7.27 (p<0.001). CONCLUSIONS: Intraoperative TEE may guide the surgeon in the assessment of valvuloplasty. However the absence of mitral regurgitation after repair and at discharge cannot predict the medium term results, which are related to the degree of the disease of the mitral valve.