Learning from the past in the COVID-19 era: rediscovery of quarantine, previous pandemics, origin of hospitals and national healthcare systems, and ethics in medicine

After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece—the cradle of medicine—to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well

Concerning the unexpected prothrombotic state following some coronavirus disease 2019 vaccines

Currently, the world is coping with the COVID-19 pandemic with a few vaccines. So far, the European Medicine Agency has approved four of them. However, following widespread vaccination with the recombinant adenoviral vector-based Oxford-AstraZeneca vaccine, available only in the United Kingdom and Europe, many concerns have emerged, especially the report of several cases of the otherwise rare cerebral sinus vein thrombosis and splanchnic vein thrombosis. The onset of thrombosis particularly at these unusual sites, about 5–14 days after vaccination, along with thrombocytopenia and other specific blood test abnormalities, are the main features of the vaccine side effects. The acronym vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) has been coined to name this new condition, with the aim of highlighting the difference from the classic heparin-induced thrombocytopenia (HIT). VIPIT seems to primarily affect young to middle-aged women. For this reason, the vaccine administration has been stopped or limited in a few European countries. Coagulopathy induced by the Oxford- AstraZeneca vaccine (and probably by Janssen/Johnson & Johnson vaccine as well in the USA) is likely related to the use of recombinant vector DNA adenovirus, as experimentally proven in animal models. Conversely, Pfizer and Moderna vaccines use mRNA vectors. All vaccineinduced thrombotic events should be treated with a nonheparin anticoagulant. As the condition has some similarities with HIT, patients should not receive any heparin or platelet transfusion, as these treatments may potentially worsen the clinical course. Aspirin has limited rational use in this setting and is not currently recommended. Intravenous immunoglobulins may represent another potential treatment, but, most importantly, clinicians need to be aware of this new unusual postvaccination syndrome

Post-failure evolution analysis of a rainfall-triggered landslide by multi-temporal interferometry SAR approaches integrated with geotechnical analysis

Persistent Scatterers Interferometry (PSI) represents one of the most powerful techniques for Earth's surface deformation processes' monitoring, especially for long-term evolution phenomena. In this work, a dataset of 34 TerraSAR-X StripMap images (October 2013–October 2014) has been processed by two PSI techniques - Coherent Pixel Technique-Temporal Sublook Coherence (CPT-TSC) and Small Baseline Subset (SBAS) - in order to study the evolution of a slow-moving landslide which occurred on February 23, 2012 in the Papanice hamlet (Crotone municipality, southern Italy) and induced by a significant rainfall event (185 mm in three days). The mass movement caused structural damage (buildings' collapse), and destruction of utility lines (gas, water and electricity) and roads. The results showed analogous displacement rates (30–40 mm/yr along the Line of Sight – LOS-of the satellite) with respect to the pre-failure phase (2008–2010) analyzed in previous works. Both approaches allowed detect the landslide-affected area, however the higher density of targets identified by means of CPT-TSC enabled to analyze in detail the slope behavior in order to design possible mitigation interventions. For this aim, a slope stability analysis has been carried out, considering the comparison between groundwater oscillations and time-series of displacement. Hence, the crucial role of the interaction between rainfall and groundwater level has been inferred for the landslide triggering. In conclusion, we showed that the integration of geotechnical and remote sensing approaches can be seen as the best practice to support stakeholders to design remedial works.Peer ReviewedPostprint (author's final draft

Right ventricular diastolic function in post-surgical Tetralogy of Fallot patients: A pilot study to make a comparison between echocardiography and cardiac MRI

Background: right ventricular (RV) systolic dysfunction is associated with poor outcomes in Tetralogy of Fallot (ToF) patients. Conversely, the influence of diastolic dysfunction in this setting is poorly known. In addition, evaluation of RV diastolic function by cardiac MRI is rarely performed.Materials and methods: twenty-four surgically treated ToF patients were enrolled in the study (54% males; median age at study: 28 (18–50) years; median age at surgery: 1.9 (0.4–8.2) years. They were studied by echocardiography to assess RV diastolic function in terms of traditional and TDI-derived parameters. At cardiac MRI, RV diastolic function was assessed by using phase-contrast analysis of flow through the tricuspid valve in short axis view. Diastolic dysfunction was graded as impaired relaxation, pseudo-normal, or restrictive physiology.Results: fifteen (62.5%) ToF subjects had echocardiographic evidence of diastolic dysfunction and eleven (45.8%) at cardiac MRI. Statistically significant correlation between echocardiographic and cardiac MRI parameters of diastolic dysfunction was weak (p < 0.05). The degree of RV diastolic dysfunction (expressed as E/E' at TDI) was associated with right atrial volume indexed for body surface area at cardiac MRI (p < 0.0001). Greater number of interim palliative procedures was associated with higher E/E' (RV diastolic dysfunction) at echocardiography (p < 0.0003).Conclusions: diastolic dysfunction, as determined by echocardiography and cardiac MRI-derived measures, is prevalent in ToF. These measures are weakly associated with each other. Notwithstanding the limitations of this pilot study, the development of cardiac MRI parameters capable of correlating with RV relaxation is needed in ToF setting

Relationship Between Short-Term Blood Pressure Variability and Subclinical Renal Damage in Essential Hypertensive Patients

The authors aimed to analyze the relationship between subclinical renal damage, defined as the presence of microalbuminuria or an estimated glomerular filtration rate (eGFR) between 30&nbsp;mL/min/1.73&nbsp;m(2) and 60&nbsp;mL/min/1.73&nbsp;m(2) and short-term blood pressure (BP) variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24-hour BP, and SD of daytime and nighttime BP. A total of 328 hypertensive patients underwent 24-hour ambulatory BP monitoring, 24-hour albumin excretion rate determination, and eGFR calculation using the Chronic Kidney Disease Epidemiology Collaboration equation. ARV of 24-hour systolic BP (SBP) was significantly higher in patients with subclinical renal damage (P=.001). This association held (P=.04) after adjustment for potential confounders. In patients with microalbuminuria, ARV of 24-hour SBP, weighted SD of 24-hour SBP, and SD of daytime SBP were also independently and inversely related to eGFR. These results seem to suggest that in essential hypertension, short-term BP variability is independently associated with early renal abnormalities

Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics

The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase

Has COVID-19 Delayed the Diagnosis and Worsened the Presentation of Type 1 Diabetes in Children?

Objective: To evaluate whether the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Italy. Research design and methods: This was a cross-sectional, Web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetic ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between 20 February and 14 April in 2019 and 2020. Results: Fifty-three of 68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared with 2019. Among those newly diagnosed patient who presented in a state of DKA, the proportion with severe DKA was 44.3% in 2020 vs. 36.1% in 2019 (P = 0.03). There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed severe acute respiratory syndrome coronavirus 2. Conclusions: The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any "second wave" requires strategies to educate and reassure parents about timely emergency department attendance for non-COVID-19 symptoms

Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0-18 years

After a previous survey on the incidence of diabetic ketoacidosis (DKA) at onset of type 1 diabetes in children in 2013-2014 in Italy, we aimed to verify a possible decline in the incidence of DKA at onset during a national prevention campaign

The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019