Defining SARS-CoV-2 breakthrough infection needing hospitalization in mass vaccination era: from disease-centered to patient-centered care

After the implementation of mass vaccination campaigns, breakthrough infections by SARS-CoV-2 are being increasingly observed worldwide, due to high pervasiveness of viral spread, emergence of novel variants, progressive ease of restrictive measures and waning protection against infection. Although breakthrough infections have generally lower clinical severity than COVID-19 in unvaccinated subjects, a consistent number of patients may still require hospitalization. These patients are generally old, frail and with a high number of comorbidities. Despite COVID-19-related symptoms are generally milder, they may still exhibit complicated clinical course for their intrinsic clinical complexity. The organization of hospital care should thus consider the changing epidemiology of patients admitted with SARS-CoV-2 infection in the post-vaccine era, to improve the quality and appropriateness of care

Fishes and their parasites in the water district of Massaciuccoli (Tuscany, Central Italy)

This study has been conducted in the district of Massaciuccoli (lake, marsh and reclaimed areas with drainage channels) in Tuscany region (Central Italy). The aim of the research was to detect the presence of parasites in fishes, in particular of Opisthorchis felineus, which causes an important zoonosis. Between 2010-2012, the health status of 381 fishes was monitored, morphometric characteristics were determined, and parasites were searched for and identified. Of the 381 examined fishes, 189 were free of parasites while 192 were infected, among them 91 presented multiple infections. Opisthorchis felineus was not found in any of the examined fishes

Emissions and energy consumption of a plug-in hybrid passenger car in Real Driving Emission (RDE) test

Abstract In the next years, the number of circulating plug-in hybrid electric vehicles was expected to increase worldwide. Hybrid electric/gasoline powertrain is considered a promising solution to meet the future goals of greenhouse gas emission reduction by road transport sector. This paper investigates the emissive and energetic behaviour of a plug-in hybrid electric passenger car over on road testing. Measurements of CO, CO2, NOx exhaust emissions and of main electric motor parameters were carried out by using portable emission measurement system over urban, rural and motorway routes in Naples (Italy). Routes were selected for complying with European Real Driving Emission (RDE) legislation. Moreover, an additional urban route, characterised by strong road grade and non-RDE compliant, was investigated. RDE test allowed to assess the influence of the battery state of charge, hybrid mode (charge sustaining and charge depleting), road grade and vehicle air conditioning on the exhaust emission and energy consumption. An overall advantage of charged battery and charge depleting mode was observed in terms of CO2 emissions and fuel consumption. CO and NOx emissions are strongly influenced by driving when the vehicle's internal combustion engine starts. When it occurs in motorway patterns, CO and NOx peak emissions are observed at tailpipe. Pure electric driving, with consequent zero emissions, are guaranteed over urban strong uphill when battery is full charged

First recovery of bird acanthocephalan Sphaerirostris lanceoides in an Eurasian badger (Meles meles) in Italy

Esemplari di cistacanti parzialmente e completamente evertiti dell'acantocefalo Sphaerirostris lanceoides sono stati rilevati nell'intestino di 1 tra 5 tassi (Meles meles) raccolti in Italia e già deceduti al momento del loro ritrovamento. Questa è la prima segnalazione di S. lanceoides nel tasso

Accounting for frailty and multimorbidity when interpreting high-sensitivity troponin I tests in oldest old

Background Older patients evaluated in Emergency Departments (ED) for suspect Myocardial Infarction (MI) frequently exhibit unspecific elevations of serum high-sensitivity troponin I (hs-TnI), making interpretation particularly challenging for emergency physicians. The aim of this longitudinal study was to identify the interaction of multimorbidity and frailty with hs-TnI levels in older patients seeking emergency care. Methods A group of patients aged≥75 with suspected MI was enrolled in our acute geriatric ward immediately after ED visit. Multimorbidity and frailty were measured with Cumulative Illness Rating Scale (CIRS) and Clinical Frailty Scale (CFS), respectively. The association of hs-TnI with MI (main endpoint) was assessed by calculation of the Area Under the Receiver-Operating Characteristic Curve (AUROC), deriving population-specific cut-offs with Youden test. The factors associated with hs-TnI categories, including MI, CFS and CIRS, were determined with stepwise multinomial logistic regression. The association of hs-TnI with 3-month mortality (secondary endpoint) was also investigated with stepwise logistic regression. Results Among 268 participants (147 F, median age 85, IQR 80–89), hs-TnI elevation was found in 191 cases (71%, median 23 ng/L, IQR 11–65), but MI was present in only 12 cases (4.5%). hs-TnI was significantly associated with MI (AUROC 0.751, 95% CI 0.580–0.922, p = 0.003), with an optimal cut-off of 141 ng/L. hs-TnI levels ≥141 ng/L were significantly associated with CFS (OR 1.58, 95% CI 1.15–2.18, p = 0.005), while levels <141 ng/L were associated with the cardiac subscore of CIRS (OR 1.36, 95% CI 1.07–1.71, p = 0.011). CFS, but not hs-TnI levels, predicted 3-month mortality. Conclusions In geriatric patients with suspected MI, frailty and cardiovascular multimorbidity should be carefully considered when interpreting emergency hs-TnI testing

Implementing a multidisciplinary rapid geriatric observation unit for non-critical older patients referred to hospital: observational study on real-world data

Background: Geriatric rapid observation units may represent an alternative to hospitalization in older patients with non-critical acute illness. Aims: To describe the characteristics and outcomes of patients admitted to a geriatric observation unit called URGe (Unità Geriatrica Rapida), implemented in an Italian hospital and characterized by multidisciplinary medical staff with geriatric expertise, fast-track access to diagnostic resources, regular use of point-of-care ultrasound and predicted length of stay (LOS) < 72 h. Methods: The medical records of patients admitted to URGe during a 3-month period (452 subjects, 247 F and 205 M, median age 82 years, IQR 77-87) were retrospectively examined. The primary study endpoint was transferral from URGe to regular wards. Baseline covariates included demographics, comprehensive geriatric assessment, acute illnesses, comorbidities, vital signs and routine laboratory tests. Results: Despite elevated burden of multimorbidity (median number of chronic diseases 4, IQR 2-5) and frailty (median Rockwood Clinical Frailty Scale score 4, IQR 3-6), only 137 patients (30.3%) required transferral from URGe to regular wards. The main factors positively associated with this outcome were Rockwood score, fever, cancer and red cell distribution width (P < 0.05 on multivariate logistic regression model). The rate of complications (mortality, delirium, and falls) during URGe stay was low (0.5%, 7% and 2%, respectively). Overall duration of hospital stay was lower than that of a group of historical controls matched by age, sex, main diagnosis, multimorbidity and frailty. Conclusions: The URGe model of acute geriatric care is feasible, safe and has the potential of reducing unnecessary hospitalizations of older patients

Trials clinici nella nefrolitiasi: di che cosa abbiamo bisogno? Presente e futuro della ricerca clinica

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