Clinical characteristics of coronavirus disease (COVID-19) early findings from a teaching hospital in Pavia, North Italy, 21 to 28 February 2020

We describe clinical characteristics, treatments and outcomes of 44 Caucasian patients with coronavirus disease (COVID-19) at a single hospital in Pavia, Italy, from 21\u201328 February 2020, at the beginning of the outbreak in Europe. Seventeen patients developed severe disease, two died. After a median of 6 days, 14 patients were discharged from hospital. Predictors of lower odds of discharge were age>65 years, antiviral treatment and for severe disease, lactate dehydrogenase >300 mg/dL

Lack of SARS-CoV-2 RNA environmental contamination in a tertiary referral hospital for infectious diseases in Northern Italy

none140noNAnoneColaneri M.; Seminari E.; Piralla A.; Zuccaro V.; Di Filippo A.; Baldanti F.; Bruno R.; Mondelli M.U.; Brunetti E.; Di Matteo A.; Maiocchi L.; Pagnucco L.; Mariani B.; Ludovisi S.; Lissandrin R.; Parisi A.; Sacchi P.; Patruno S.F.A.; Michelone G.; Gulminetti R.; Zanaboni D.; Novati S.; Maserati R.; Orsolini P.; Vecchia M.; Sciarra M.; Asperges E.; Sambo M.; Biscarini S.; Lupi M.; Roda S.; Chiara Pieri T.; Gallazzi I.; Sachs M.; Valsecchi P.; Perlini S.; Alfano C.; Bonzano M.; Briganti F.; Crescenzi G.; Giulia Falchi A.; Guarnone R.; Guglielmana B.; Maggi E.; Martino I.; Pettenazza P.; Pioli di Marco S.; Quaglia F.; Sabena A.; Salinaro F.; Speciale F.; Zunino I.; De Lorenzo M.; Secco G.; Dimitry L.; Cappa G.; Maisak I.; Chiodi B.; Sciarrini M.; Barcella B.; Resta F.; Moroni L.; Vezzoni G.; Scattaglia L.; Boscolo E.; Zattera C.; Michele Fidel T.; Vincenzo C.; Vignaroli D.; Bazzini M.; Iotti G.; Mojoli F.; Belliato M.; Perotti L.; Mongodi S.; Tavazzi G.; Marseglia G.; Licari A.; Brambilla I.; Daniela B.; Antonella B.; Patrizia C.; Giulia C.; Giuditta C.; Marta C.; Rossana D.; Milena F.; Bianca M.; Roberta M.; Enza M.; Stefania P.; Maurizio P.; Elena P.; Antonio P.; Francesca R.; Antonella S.; Maurizio Z.; Guy A.; Laura B.; Ermanna C.; Giuliana C.; Luca D.; Gabriella F.; Gabriella G.; Alessia G.; Viviana L.; Claudia L.; Valentina M.; Simona P.; Marta P.; Alice B.; Giacomo C.; Irene C.; Alfonso C.; Di Martino R.; Di Napoli A.; Alessandro F.; Guglielmo F.; Loretta F.; Federica G.; Alessandra M.; Federica N.; Giacomo R.; Beatrice R.; Maria S.I.; Monica T.; Nepita Edoardo V.; Calvi M.; Tizzoni M.; Nicora C.; Triarico A.; Petronella V.; Marena C.; Muzzi A.; Lago P.; Comandatore F.; Bissignandi G.; Gaiarsa S.; Rettani M.; Bandi C.Colaneri, M.; Seminari, E.; Piralla, A.; Zuccaro, V.; Di Filippo, A.; Baldanti, F.; Bruno, R.; Mondelli, M. U.; Brunetti, E.; Di Matteo, A.; Maiocchi, L.; Pagnucco, L.; Mariani, B.; Ludovisi, S.; Lissandrin, R.; Parisi, A.; Sacchi, P.; Patruno, S. F. A.; Michelone, G.; Gulminetti, R.; Zanaboni, D.; Novati, S.; Maserati, R.; Orsolini, P.; Vecchia, M.; Sciarra, M.; Asperges, E.; Sambo, M.; Biscarini, S.; Lupi, M.; Roda, S.; Chiara Pieri, T.; Gallazzi, I.; Sachs, M.; Valsecchi, P.; Perlini, S.; Alfano, C.; Bonzano, M.; Briganti, F.; Crescenzi, G.; Giulia Falchi, A.; Guarnone, R.; Guglielmana, B.; Maggi, E.; Martino, I.; Pettenazza, P.; Pioli di Marco, S.; Quaglia, F.; Sabena, A.; Salinaro, F.; Speciale, F.; Zunino, I.; De Lorenzo, M.; Secco, G.; Dimitry, L.; Cappa, G.; Maisak, I.; Chiodi, B.; Sciarrini, M.; Barcella, B.; Resta, F.; Moroni, L.; Vezzoni, G.; Scattaglia, L.; Boscolo, E.; Zattera, C.; Michele Fidel, T.; Vincenzo, C.; Vignaroli, D.; Bazzini, M.; Iotti, G.; Mojoli, F.; Belliato, M.; Perotti, L.; Mongodi, S.; Tavazzi, G.; Marseglia, G.; Licari, A.; Brambilla, I.; Daniela, B.; Antonella, B.; Patrizia, C.; Giulia, C.; Giuditta, C.; Marta, C.; D'Alterio, Rossana; Milena, F.; Bianca, M.; Roberta, M.; Enza, M.; Stefania, P.; Maurizio, P.; Elena, P.; Antonio, P.; Francesca, R.; Antonella, S.; Maurizio, Z.; Guy, A.; Laura, B.; Ermanna, C.; Giuliana, C.; Luca, D.; Gabriella, F.; Gabriella, G.; Alessia, G.; Viviana, L.; Meisina, Claudia; Valentina, M.; Simona, P.; Marta, P.; Alice, B.; Giacomo, C.; Irene, C.; Alfonso, C.; Di Martino, R.; Di Napoli, A.; Alessandro, F.; Guglielmo, F.; Loretta, F.; Federica, G.; Albertini, Alessandra; Federica, N.; Giacomo, R.; Beatrice, R.; Maria, S. I.; Monica, T.; Nepita Edoardo, V.; Calvi, M.; Tizzoni, M.; Nicora, C.; Triarico, A.; Petronella, V.; Marena, C.; Muzzi, A.; Lago, P.; Comandatore, F.; Bissignandi, G.; Gaiarsa, S.; Rettani, M.; Bandi, C

Impact of Coronavirus Disease 2019 Pandemic on Crowding: A Call to Action for Effective Solutions to “Access Block”

Introduction: Healthcare patterns change during disease outbreaks and pandemics. Identification of modified patterns is important for future preparedness and response. Emergency department (ED) crowding can occur because of the volume of patients waiting to be seen, which results in delays in patient assessment or treatment and impediments to leaving the ED once treatment is complete. Therefore, ED crowding has become a growing problem worldwide and represents a serious barrier to healthcare operations.Methods: This observational study was based on a retrospective review of the epidemiologic and clinical records of patients who presented to the Foundation IRCCS Policlinic San Matteo in Pavia, Italy, during the coronavirus disease 2019 (COVID-19) outbreak (February 21–May 1, 2020, pandemic group). The methods involved an estimation of the changes in epidemiologic and clinical data from the annual baseline data after the start of the COVID-19 pandemic.Results: We identified reduced ED visits (180 per day in the control period vs 96 per day in the pandemic period; P < 0.001) during the COVID-19 pandemic, irrespective of age and gender, especially for low-acuity conditions. However, patients who did present to the ED were more likely to be hemodynamically unstable, exhibit abnormal vital signs, and more frequently required high-intensity care and hospitalization. During the pandemic, ED crowding dramatically increased primarily because of an increased number of visits by patients with high-acuity conditions, changes in patient management that prolonged length of stay, and increased rates of boarding, which led to the inability of patients to gain access to appropriate hospital beds within a reasonable amount of time. During the pandemic, all crowding output indices increased, especially the rates of boarding (36% vs 57%; P < 0.001), “access block” (24% vs 47%; P < 0.001), mean boarding time (640 vs 1,150 minutes [min]; P 0.001), mean “access block” time (718 vs 1,223 min; P < 0.001), and “access block” total time (650,379 vs 1,359,172 min; P < 0.001).Conclusion: Crowding in the ED during the COVID-19 pandemic was due to the inability to access hospital beds. Therefore, solutions to this lack of access are required to prevent a recurrence of crowding due to a new viral wave or epidemic

2001; 08

F e r r a t a S t o r t i F o u n d a t i o n potentially useful in emergencies, 5 but few clinical trials have assessed their performance in this setting. Moreover, D-dimer assays have not been sufficiently investigated in patients with thrombosis of the great saphenous vein (GSV); this thrombosis should be considered separately from other superficial venous thromboses because of the possible progression of the thrombus to the deep system 14 and the potential risk of pulmonary embolisation. Design and Methods Patients Patients presenting spontaneously or referred by a general practitioner (GP) with symptoms of swelling and/or pain and/or inflammation in the lower limbs, and for whom the physician in charge at the ER suspected acute DVT or GSV thrombosis, were considered eligible for the study. Exclusion criteria were 1) signs and/or symptoms of acute pulmonary embolism (PE), 2) previous episode of VT in the same leg and/or objectively documented PE and 3) ongoing oral anticoagulant therapy. Taking into account the signs and symptoms at presentation, 2 eligible patients were classified as suspected as having 1) DVT, or 2) thrombosis of the GSV, involving at least one vein proximal to the deep system (at the cross or in the popliteal fossa), or 3) both of the previous. After the physical examination, all patients underwent compression ultrasonography (C-US) and blood sampling for D-dimer assay. Methods Compression ultrasonography was performed by operators (in charge at the ER or the Vascular Surgery Department) unaware of D-dimer results, using a high-resolution, electronically focused linear array transducer (7.5 MHz probe). The entire deep venous system between the proximal common femoral vein at the cross and the distal veins of the legs was evaluated as was the entire saphenous vein between its junction to the proximal deep venous system and the distal saphenous segment. Ultrasonography was performed using the currently accepted criteria for diagnosing VT; 3 briefly, C-US results were considered abnormal if a vein or venous segment was not fully compressible. Blood for D-dimer assay was drawn at presentation and tested by technicians unaware of C-US test results. Venous blood (9 vol.), anticoagulated with tri-sodium citrate (1 vol.), was taken in the ER from a forearm vein and sent to the central laboratory; results were available within 30 min. The Dimertest® (Dade Behring) was performed as previously described. The Dimertest® was compared to another agglutination reference method; the correlation was r=0.94 and the regression equation was y=1.19×. Intra-assay (within run) reproducibility was determined for 10 replications of 3 plasma samples that contained different levels of XDP. The results were equivalent for all replicates. Inter-assay (run to run) reproducibility was determined using 10 plasma samples with XDP titers ranging from 1 to 16. In 10 runs, the replications of these specimens did not vary by more than one titer. Statistical analysis and ethics Sensitivity, specificity, positive and negative predictive values for D-dimer were calculated using standard methods (2×2 tables); C-US was considered as the reference test. When indicated, 95% confidence intervals were calculated. Paired t-test and Pearson's χ 2 test were applied when indicated; a p value < 5% (two-tailed) was considered statistically significant. Patients gave oral consent to the study. Results Four hundred and seventy-eight consecutive patients were considered during the period February 1999-December 2000. Sixty-four patients were excluded (31 because evaluated in a setting other than the emergency unit, 4 because on oral anticoagulation, 20 because were lacking the D-dimer and 5 the C-US test results, 4 because of a recurrent DVT episode). Thus, 414 patients were considered eligible and included in the analysis. Among these, DVT was clinically suspected in 298 patients (of whom 177 were female [59.4%] and 121 males) and GSV thrombosis in 116 patients (66 female [56.8%] and 50 males). Among patients on heparin or low molecular weight heparin at the time of referral to the ER, 34 (11.4%) belonged to the DVT group and 20 (17.2%) to the GSV group Among patients clinically suspected of having a DVT, C-US was positive in 93 cases (31.8%, 7 of whom had distal DT [7.5%]), while in those suspected of having GSV thrombosis, C-US was positive in 52 (44.8%); four patients (7.6%) had concomitant involvement of the common femoral vein (CFV) at the cross The sensitivity, specificity, the positive and negative predictive values of the D-dimer assay in patients with suspected DVT and suspected GSV thrombosis are reported in The D-dimer assay is a relatively new tool. In combination with other diagnostic tests (such as C-US) or standardized pre-test clinical probability, this assay can be effectively used for refuting acute VTE at referral. 6-8 Several D-dimer assays have become available including classical ELISAs, latex agglutination tests, immunofiltration assays and whole blood Ddimer tests. These assays are useful if the results are rapidly available and the test has a high sensitivity with a reasonable specificity. These two characteristics vary widely in the published reports. 11 This heterogeneity can be explained by methodologic differences between studies (study design, selected cut-off value and diagnostic reference standard used) as well as clinical differences (study population and indication for D-dimer testing). Therefore, it is essential that each D-dimer assay is evaluated in the local setting and the specific population for which the test is proposed. In this respect, it appeared appropriate to us to set up diagnostic strategies suitable for the particular setting of an emergency unit. The results of our investigation permit us to make some considerations; first of all, although the overall accuracy of the Dimertest® is almost equivalent to that of other latex assays, 11 it appears slightly lower that that reported in recent investigations. Regarding the first issue, we used the D-dimer assay currently employed in our Institution, a semiquantitative latex assay, without an automated method for measurement; specifically, we did not evaluate the diagnostic accuracy of the test at cutoffs different from those suggested by the manufacturer. © F e r r a t a S t o r t i F o u n d a t i o n dimer assay. The situation is clearly different in patients with DVT, when the exclusion of the aforementioned variables improved the diagnostic accuracy of the assay, thus increasing the negative predictive value to 92.8%. Although anticoagulant therapy has been proven to be associated with low D-dimer concentration, 13 no data are currently available on the effect of a short-course of heparin on D-dimer accuracy. The role of a few days of heparin (2.5 days, median in our DVT patients) in reducing D-dimer levels can be debated; moreover, dosage and type of heparin widely varied among our patients. Nevertheless, taking into account these limits, our study demonstrated that even this anticoagulant approach may affect Ddimer results. Because the common practice of initiating heparin treatment if diagnostic imaging for acute venous thromboembolism is not immediately available, this information may have considerable clinical impact both on the first diagnosis of the diseases and, particularly, on the prospective of reducing the need for C-US in patients with a low suspicion of DVT and a negative D-dimer assay. Therefore, although the D-dimer assay may help ER physicians to make a diagnosis in patients with recent DVT, as a sole and simple laboratory assay, the test cannot absolutely exclude VT. At the present, the Ddimer test must be part of a combined approach that requires standardized evaluation of clinical probability along with objective tests (such as C-US) for confirming or refuting the clinical suspicion of VT. Contributions and Acknowledgments SS was responsible for the conception and th

SARS Cov-2 infection in a renal-transplanted patient: A case report

The clinical manifestation of COVID-19 can vary from an asymptomatic course to ARDS requiring invasive mechanical ventilation and extracorporeal membrane oxygenation. A kidney transplanted patient infected with SARS CoV-2 infection showed a mild disease despite immune suppression. It is possible that Immunosuppression can \u201cbe protective\u201d as the cytokine storm is an important factor in the disease story. Despite the good outcome reported in the present case report, is remains of vital importance the solid organ transplant patients use precautions in order to avoid the infection

Rapid response to COVID-19 outbreak in Northern Italy: how to convert a classic infectious disease ward into a COVID-19 response centre

none133noopenAsperges E.; Novati S.; Muzzi A.; Biscarini S.; Sciarra M.; Lupi M.; Sambo M.; Gallazzi I.; Peverini M.; Lago P.; Mojoli F.; Perlini S.; Bruno R.; Mondelli M.U.; Brunetti E.; Di Matteo A.; Seminari E.; Maiocchi L.; Zuccaro V.; Pagnucco L.; Mariani B.; Ludovisi S.; Parisi R.L.A.; Sacchi P.; Patruno S.F.A.; Michelone G.; Gulminetti R.; Zanaboni D.; Maserati R.; Orsolini P.; Vecchia M.; Colaneri M.; Di Filippo A.; Roda S.; Pieri T.C.; Sachs M.; Valsecchi P.; Alfano C.; Bonzano M.; Briganti F.; Crescenzi G.; Falchi A.G.; Guarnone R.; Guglielmana B.; Maggi E.; Martino I.; Pettenazza P.; Pioli di Marco S.; Quaglia F.; Sabena A.; Salinaro F.; Speciale F.; Zunino I.; De Lorenzo M.; Secco G.; Dimitry L.; Cappa G.; Maisak I.; Chiodi B.; Sciarrini M.; Barcella B.; Resta F.; Moroni L.; Vezzoni G.; Scattaglia L.; Boscolo E.; Zattera C.; Fidel T.M.; Vincenzo C.; Vignaroli D.; Bazzini M.; Iotti G.; Belliato M.; Perotti L.; Mongodi S.; Tavazzi G.; Marseglia G.; Licari A.; Brambilla I.; Daniela B.; Antonella B.; Patrizia C.; Giulia C.; Giuditta C.; Marta C.; Rossana D.; Milena F.; Bianca M.; Roberta M.; Enza M.; Stefania P.; Maurizio P.; Elena P.; Antonio P.; Francesca R.; Antonella S.; Maurizio Z.; Guy A.; Laura B.; Ermanna C.; Giuliana C.; Luca D.; Gabriella F.; Gabriella G.; Alessia G.; Viviana L.; Claudia L.; Valentina M.; Simona P.; Marta P.; Alice B.; Giacomo C.; Irene C.; Corcione A.; di Martino R.; di Napoli A.; Alessandro F.; Guglielmo F.; Loretta F.; Federica G.; Alessandra M.; Federica N.; Giacomo R.; Beatrice R.; Maria S.I.; Monica T.; Edoardo V.N.; Calvi M.; Tizzoni M.; Nicora C.; Triarico A.; Petronella V.; Marena C.Asperges, E.; Novati, S.; Muzzi, A.; Biscarini, S.; Sciarra, M.; Lupi, M.; Sambo, M.; Gallazzi, I.; Peverini, M.; Lago, P.; Mojoli, F.; Perlini, S.; Bruno, R.; Mondelli, M. U.; Brunetti, E.; Di Matteo, A.; Seminari, E.; Maiocchi, L.; Zuccaro, V.; Pagnucco, L.; Mariani, B.; Ludovisi, S.; Parisi, R. L. A.; Sacchi, P.; Patruno, S. F. A.; Michelone, G.; Gulminetti, R.; Zanaboni, D.; Maserati, R.; Orsolini, P.; Vecchia, M.; Colaneri, M.; Di Filippo, A.; Roda, S.; Pieri, T. C.; Sachs, M.; Valsecchi, P.; Alfano, C.; Bonzano, M.; Briganti, F.; Crescenzi, G.; Falchi, A. G.; Guarnone, R.; Guglielmana, B.; Maggi, E.; Martino, I.; Pettenazza, P.; Pioli di Marco, S.; Quaglia, F.; Sabena, A.; Salinaro, F.; Speciale, F.; Zunino, I.; De Lorenzo, M.; Secco, G.; Dimitry, L.; Cappa, G.; Maisak, I.; Chiodi, B.; Sciarrini, M.; Barcella, B.; Resta, F.; Moroni, L.; Vezzoni, G.; Scattaglia, L.; Boscolo, E.; Zattera, C.; Fidel, T. M.; Vincenzo, C.; Vignaroli, D.; Bazzini, M.; Iotti, G.; Belliato, M.; Perotti, L.; Mongodi, S.; Tavazzi, G.; Marseglia, G.; Licari, A.; Brambilla, I.; Daniela, B.; Antonella, B.; Patrizia, C.; Giulia, C.; Giuditta, C.; Marta, C.; Rossana, D.; Milena, F.; Bianca, M.; Roberta, M.; Enza, M.; Stefania, P.; Maurizio, P.; Elena, P.; Antonio, P.; Francesca, R.; Antonella, S.; Maurizio, Z.; Guy, A.; Laura, B.; Ermanna, C.; Giuliana, C.; Luca, D.; Gabriella, F.; Gabriella, G.; Alessia, G.; Viviana, L.; Claudia, L.; Valentina, M.; Simona, P.; Marta, P.; Alice, B.; Giacomo, C.; Irene, C.; Corcione, A.; di Martino, R.; di Napoli, A.; Alessandro, F.; Guglielmo, F.; Loretta, F.; Federica, G.; Alessandra, M.; Federica, N.; Giacomo, R.; Beatrice, R.; Maria, S. I.; Monica, T.; Edoardo, V. N.; Calvi, M.; Tizzoni, M.; Nicora, C.; Triarico, A.; Petronella, V.; Marena, C