Risk of Seven-Day Worsening and Death: A New Clinically Derived COVID-19 Score

This monocentric, retrospective, two-stage observational study aimed to recognize the risk factors for a poor outcome in patients hospitalized with SARS-CoV-2 infection, and to develop and validate a risk score that identifies subjects at risk of worsening, death, or both. The data of patients with SARS-CoV-2 infection during the first wave of the pandemic were collected and analyzed as a derivation cohort. Variables with predictive properties were used to construct a prognostic score, which was tried out on a validation cohort enrolled during the second wave. The derivation cohort included 494 patients; the median age was 62 and the overall fatality rate was 22.3%. In a multivariable analysis, age, oxygen saturation, neutrophil-to-lymphocyte ratio, C-reactive protein and lactate dehydrogenase were independent predictors of death and composed the score. A cutoff value of 3 demonstrated a sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 93.5%, 68.5%, 47.4% and 97.2% for death, and 84.9%, 84.5%, 79.6% and 87.9% for worsening, respectively. The validation cohort included 415 subjects. The score application showed a Se, Sp, PPV and NPV of 93.4%, 61.6%, 29.5% and 98.1% for death, and 81%, 76.3%, 72.1% and 84.1% for worsening, respectively. We propose a new clinical, easy and reliable score to predict the outcome in hospitalized SARS-CoV-2 patients

Clinical and Epidemiological Study on Tubercular Uveitis in a Tertiary Eye Care Centre in Italy

PURPOSE: To describe frequency, clinical characteristics, and visual prognosis of tubercular uveitis (TBU) in a nonendemic country. METHODS: We retrospectively reviewed 3743 charts of patients with endogenous uveitis visited from 2008 to 2018 at a tertiary referral centre in Rome, Italy. We included immunocompetent patients with diagnosis of TBU. Patients were divided in two groups: patients with history of uveitis without a previous diagnosis of TBU (group A) and patients at their first episode of TB uveitis (group B). RESULTS: TBU was diagnosed in 28 (0.75%) out of 3743 patients. Twelve (42.9%) patients came from tuberculosis endemic areas. All patients received specific antitubercular treatment (ATT) and were evaluated for a mean follow-up of 3.2 ± 2.9 years. Group A showed a greater number of ocular complications when compared with group B. ATT was effective in reducing the frequency of recurrences of uveitis in patients of group B. CONCLUSION: Intraocular inflammation can be the first manifestation of tuberculosis. Our data highlight that early diagnosis and specific treatment of TBU may allow to decrease recurrences and to improve visual outcomes

Is physician assessment of alcohol consumption useful in predicting risk of severe liver disease among people with HIV and HIV/HCV co-infection?

Background: Alcohol consumption is a known risk factor for liver disease in HIV-infected populations. Therefore, knowledge of alcohol consumption behaviour and risk of disease progression associated with hazardous drinking are important in the overall management of HIV disease. We aimed at assessing the usefulness of routine data collected on alcohol consumption in predicting risk of severe liver disease (SLD) among people living with HIV (PLWHIV) with or without hepatitis C infection seen for routine clinical care in Italy. Methods: We included PLWHIV from two observational cohorts in Italy (ICONA and HepaICONA). Alcohol consumption was assessed by physician interview and categorized according to the National Institute for Food and Nutrition Italian guidelines into four categories: abstainer; moderate; hazardous and unknown. SLD was defined as presence of FIB4 > 3.25 or a clinical diagnosis of liver disease or liver-related death. Cox regression analysis was used to evaluate the association between level of alcohol consumption at baseline and risk of SLD. Results: Among 9542 included PLWHIV the distribution of alcohol consumption categories was: abstainers 3422 (36%), moderate drinkers 2279 (23%), hazardous drinkers 637 (7%) and unknown 3204 (34%). Compared to moderate drinkers, hazardous drinking was associated with higher risk of SLD (adjusted hazard ratio, aHR = 1.45; 95% CI: 1.03-2.03). After additionally controlling for mode of HIV transmission, HCV infection and smoking, the association was attenuated (aHR = 1.32; 95% CI: 0.94-1.85). There was no evidence that the association was stronger when restricting to the HIV/HCV co-infected population. Conclusions: Using a brief physician interview, we found evidence for an association between hazardous alcohol consumption and subsequent risk of SLD among PLWHIV, but this was not independent of HIV mode of transmission, HCV-infection and smoking. More efforts should be made to improve quality and validity of data on alcohol consumption in cohorts of HIV/HCV-infected individuals

Switching to dual/monotherapy determines an increase in CD8+ in HIV-infected individuals: An observational cohort study

Background: The CD4/CD8 ratio has been associated with the risk of AIDS and non-AIDS events. We describe trends in immunological parameters in people who underwent a switch to monotherapy or dual therapy, compared to a control group remaining on triple antiretroviral therapy (ART). Methods: We included patients in Icona who started a three-drug combination ART regimen from an ART-naïve status and achieved a viral load ≤ 50 copies/mL; they were subsequently switched to another triple or to a mono or double regimen. Standard linear regression at fixed points in time (12-24 months after the switch) and linear mixed model analysis with random intercepts and slopes were used to compare CD4 and CD8 counts and their ratio over time according to regimen types (triple vs. dual and vs. mono). Results: A total of 1241 patients were included; 1073 switched to triple regimens, 104 to dual (72 with 1 nucleoside reverse transcriptase inhibitor (NRTI), 32 NRTI-sparing), and 64 to monotherapy. At 12 months after the switch, for the multivariable linear regression the mean change in the log10 CD4/CD8 ratio for patients on dual therapy was -0.03 (95% confidence interval (CI) -0.05, -0.0002), and the mean change in CD8 count was +99 (95% CI +12.1, +186.3), taking those on triple therapy as reference. In contrast, there was no evidence for a difference in CD4 count change. When using all counts, there was evidence for a significant difference in the slope of the ratio and CD8 count between people who were switched to triple (points/year change ratio = +0.056, CD8 = -25.7) and those to dual regimen (ratio = -0.029, CD8 = +110.4). Conclusions: We found an increase in CD8 lymphocytes in people who were switched to dual regimens compared to those who were switched to triple. Patients on monotherapy did not show significant differences. The long-term implications of this difference should be ascertained

Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

Peer reviewe

A systematic methodology for the identification of major accidents induced by malicious manipulation of the bpcs and the sis in a process plant

Cyber-attacks aimed to interfere with the Basic Process Control System (BPCS) and the SIS (Safety Instrumented System) of industrial facilities where large quantities of hazardous substances are stored or handled may have consequences comparable to those of conventional major accidents due to internal causes. While consolidated approaches exist to manage and control the cybersecurity of IT (Information Technology) and OT (Operational Technology) systems of a plant, there is an evident lack of operating procedures for assessing the actual link between malicious manipulations of the BPCS and the SIS (OT system) and the major accidents that can be induced. In the present study a specific operating systematic methodology, PHAROS, was developed to address the identification of major accident scenarios achievable by remote manipulation of the physical components of the plant (e.g. automatic valves, pumps, compressors, etc.). The methodology exploits a reverse-HazOp concept and it also supports the definition of the specifications for the design and management of barriers aimed at the prevention and mitigation of such scenarios. The application of PHAROS to a demonstrative case study evidenced first that both the BPCS and the SIS typically need to be attacked in order to induce major accidents, and second, that passive/inherent safeguards have a key role with respect to the success of the considered malicious attack in case they are properly designed

A systematic procedure for the identification of major accident hazards induced by malicious manipulations of the control and safety instrumented systems

Cybersecurity threats on the industrial automated control systems (IACSs) are becoming a growing concern for the industrial facilities, and in particular for those where large quantities of hazardous substances are stored or handled (i.e. Seveso sites in Europe). Cyber-attacks on the control (BPCS) and safety instrumented (SIS) systems of Seveso plants may have consequences comparable to those of conventional major accidents due to internal causes. While consolidated approaches exist to manage and control the cybersecurity of IT and OT systems of a facility, there is an evident lack of procedures for assessing the actual link between malicious manipulations of the OT system (BPCS plus SIS) and the major accidents that can be triggered. In the present study a specific methodology (PHAROS) was developed to address the identification of major accident scenarios achievable by remote manipulation of the plant physical components. The methodology exploits a reverse-HazOp concept and it also supports the definition of the specifications for the design and management of barriers aimed at the prevention and mitigation of such scenarios. The application of PHAROS to a demonstrative case study evidenced first that both the BPCS and the SIS typically need to be attacked in order to induce major accidents, and second, that passive/inherent safeguards have a key role with respect to the success of the considered malicious attack in case they are properly designed

Primary T-cell lymphoma of central nervous system (PTCLCNS): A case with unusual presentation and review of the literature

[No abstract available

Physical security barriers and protection distances for seveso sites

Seveso III Directive (2012/18/EU) requires operators to demonstrate that they have identified major accident hazards and scenarios, and that they have implemented adequate actions to prevent such accidents. Safety reports issued under the Seveso Directive specifically address accident scenarios caused by technical or human failures. Scenarios caused by intentional acts are usually not considered, even if they have a wide potential to harm the workers and the exposed population in the vicinity of Seveso sites. The present contribution focuses on the characterization of physical security-related scenarios in the framework of safety and security management of Seveso sites, identified taking advantages of the potential synergies between safety and security studies. The role of physical security barriers is explored. Finally, the use of protection distances from critical and vulnerable units is presented to support the selection of the barriers. Copyright \ua9 2019, AIDIC Servizi S.r.l

Analysis of events involving the intentional release of hazardous substances from industrial facilities

Industrial infrastructures, in particular those where hazardous substances are stored or handled, may be the target of malicious acts aiming at the disruption of normal operations. In the present study a toolbox of complementary and synergic techniques (Correspondence Analysis (CA), Fishbone Diagrams, Cause-Consequence Chains, Adversary Sequence Diagram, Root Cause Analysis) was applied to the in-depth analysis of physical security- and cybersecurity-related events that affected the process industry. The unprecedented original set of information obtained provides novel insights concerning these events. Clear correlations among security threats, including cyber-threats, and specific industrial sectors, as well as among the final scenarios and the different security threats from which they originate were identified by CA. In particular, vandalism resulted strongly correlated with the transportation of hazardous substances, and theft of materials with oil and gas pipelines. When considering chemical and petrochemical sites, cyber-attacks and the use of improvised explosives resulted to be the most common attack modes performed by the threat actors. Personnel and vehicle gateways resulted key elements when designing the Physical Protection System (PPS) of a facility. Insiders having the permission to enter the site bypass such controls, and were responsible of several successful attacks. Overall, the results confirm the concreteness of security-related events in the process industry and provide an original structured and detailed insight on the attack patterns experienced to date. Moreover, the results and the data obtained provide a novel set of baseline information for the application of SVA (Security Vulnerability Assessment) or SRA (Security Risk Assessment) methodologies in facilities where hazardous substances are stored or processed