A Multi-Center Study Investigating Long COVID-19 in Healthcare Workers from North-Eastern Italy: Prevalence, Risk Factors and the Impact of Pre-Existing Humoral Immunity—ORCHESTRA Project

: Introduction: The impact of long-COVID-19 syndrome is rather variable, since it is influenced by several residual confounders. This study aimed to investigate the prevalence of long COVID-19 in healthcare workers (HCWs) from four university hospitals in north-eastern Italy: Trieste, Padua, Verona, and Modena-Reggio Emilia. Methods: During the period June 2022-August 2022, HCWs were surveyed for past COVID-19 infections, medical history, and any acute as well as post-COVID-19 symptoms. The prevalence of long COVID-19 was estimated at 30-60 days or 61+ days since first negative swab following first and second COVID-19 episode. Furthermore, the risk of long COVID-19 was investigated by multivariable logistic regression. Results were expressed as the adjusted odds ratio (aOR) with a 95% confidence interval (95%CI). Results: 5432 HCWs returned a usable questionnaire: 2401 were infected with SARS-CoV-2 at least once, 230 were infected at least twice, and 8 were infected three times. The prevalence of long COVID-19 after a primary COVID-19 infection was 24.0% at 30-60 days versus 16.3% at 61+ days, and 10.5% against 5.5% after the second SARS-CoV-2 event. The most frequent symptoms after a first COVID-19 event were asthenia (30.3%), followed by myalgia (13.7%), cough (12.4%), dyspnea (10.2%), concentration deficit (8.1%), headache (7.3%), and anosmia (6.5%), in decreasing order of prevalence. The risk of long COVID-19 at 30-60 days was significantly higher in HCWs hospitalized for COVID-19 (aOR = 3.34; 95%CI: 1.62; 6.89), those infected with SARS-CoV-2 during the early pandemic waves-namely the Wuhan (aOR = 2.16; 95%CI: 1.14; 4.09) or Alpha (aOR= 2.05; 95%CI: 1.25; 3.38) transmission periods-and progressively increasing with viral shedding time (VST), especially 15+ days (aOR = 3.20; 95%CI: 2.07; 4.94). Further determinants of long COVID-19 at 30-60 days since primary COVID-19 event were female sex (aOR = 1.91; 95%CI: 1.30; 2.80), age >40 years, abnormal BMI, or administrative services (reference category). In contrast, HCWs vaccinated with two doses before their primary infection (aOR = 0.57; 95%CI: 0.34; 0.94), undergraduate students, or postgraduate medical trainees were less likely to experience long COVID-19 at 30-60 days. Apart from pandemic waves, the main determinants of long COVID-19 at 30-60 days were confirmed at 61+ days. Conclusions: The risk of long COVID-19 following primary infection increased with the severity of acute disease and VST, especially during the initial pandemic waves, when more virulent viral strains were circulating, and susceptibility to SARS-CoV-2 was higher since most HCWs had not been infected yet, COVID-19 vaccines were still not available, and/or vaccination coverage was still building up. The risk of long COVID-19 therefore decreased inversely with humoral immunity at the individual level. Nevertheless, the prevalence of long COVID-19 was remarkably lower after SARS-CoV-2 reinfections regardless of vaccination status, suggesting that hybrid humoral immunity did not increase protection against the syndrome compared to immunity mounted by either natural infection or vaccination separately. Since the risk of long COVID-19 is currently low with Omicron and patients who developed the syndrome following SARS-CoV-2 infection in the early pandemic waves tend to return to a state of full health with time, a cost-effective approach to screen post-COVID-19 symptoms during the Omicron time could be restricted to vulnerable individuals developing severe disease and/or with prolonged VST

SARS-CoV-2 Breakthrough Infections: Incidence and Risk Factors in a Large European Multicentric Cohort of Health Workers.

Background: The research aimed to investigate the incidence of SARS-CoV-2 breakthrough infections and their determinants in a large European cohort of more than 60,000 health workers. Methods: A multicentric retrospective cohort study, involving 12 European centers, was carried out within the ORCHESTRA project, collecting data up to 18 November 2021 on fully vaccinated health workers. The cumulative incidence of SARS-CoV-2 breakthrough infections was investigated with its association with occupational and social-demographic characteristics (age, sex, job title, previous SARS-CoV-2 infection, antibody titer levels, and time from the vaccination course completion). Results: Among 64,172 health workers from 12 European health centers, 797 breakthrough infections were observed (cumulative incidence of 1.2%). The primary analysis using individual data on 8 out of 12 centers showed that age and previous infection significantly modified breakthrough infection rates. In the meta-analysis of aggregated data from all centers, previous SARS-CoV-2 infection and the standardized antibody titer were inversely related to the risk of breakthrough infection (p = 0.008 and p = 0.007, respectively). Conclusion: The inverse correlation of antibody titer with the risk of breakthrough infection supports the evidence that vaccination plays a primary role in infection prevention, especially in health workers. Cellular immunity, previous clinical conditions, and vaccination timing should be further investigated

Metabolic constituents of grapevine and grape-derived products

The numerous uses of the grapevine fruit, especially for wine and beverages, have made it one of the most important plants worldwide. The phytochemistry of grapevine is rich in a wide range of compounds. Many of them are renowned for their numerous medicinal uses. The production of grapevine metabolites is highly conditioned by many factors like environment or pathogen attack. Some grapevine phytoalexins have gained a great deal of attention due to their antimicrobial activities, being also involved in the induction of resistance in grapevine against those pathogens. Meanwhile grapevine biotechnology is still evolving, thanks to the technological advance of modern science, and biotechnologists are making huge efforts to produce grapevine cultivars of desired characteristics. In this paper, important metabolites from grapevine and grape derived products like wine will be reviewed with their health promoting effects and their role against certain stress factors in grapevine physiology

Use of free flaps in maxillofacial surgery. A review of 200 clinical cases

Aim. Microvascular \uadflaps \uadare \uadtoday a fun\uadda\uadmen\uadtal recon\uadstruc\uadtion tech\uadnique in \uadthe \uadfield of max\uadil\uadlo\uadfa\uadcial sur\uadgery \uadthanks to \uadtheir \uadhigh reli\uadabil\uadity \uadand \uadthe avail\uadabil\uadity of dif\uadfer\uadent tis\uadsues in \uadterms of qual\uadity \uadand quan\uadtity. Methods. The \uadresults \uadobtained in 200 \uadmicro-sur\uadgi\uadcal recon\uadstruc\uadtion pro\uadce\uaddures of \uadthe \uadhead \uadand \uadface \uadare ana\uadlysed. Reconstruction fol\uadlowed can\uadcer abla\uadtion in 159 cas\uades, \uadand \uadwas \uaddue to \uadfacial par\uadal\uady\uadsis, lim\uadit\uaded \uadmouth open\uading, oste\uador\uada\uaddi\uado\uadnec\uadro\uadsis or \uadsevere max\uadil\uadlary atro\uadphy in \uadthe remain\uading 41 cas\uades. Flaps \uadused \uadwere: fib\uadu\uadla (73 cas\uades), fas\uadcia-cuta\uadne\uadous com\uadpo\uadnent of fore\uadarm (75 cas\uades), rec\uadtus abdom\uadi\uadnis mus\uadcle (13 cas\uades), lat\uadis\uadsi\uadmus dor\uadsi mus\uadcle (28 cas\uades), \uadiliac \uadcrest (7 cas\uades), par\uada\uadscap\uadu\uadlar \uadsystem (2 cas\uades) omen\uadtum (1 \uadcase), lat\uader\uadal bra\uadchi\uadal\uadis (1 \uadcase). Postoperative mon\uadi\uadtor\uading com\uadprised \uadboth clin\uadi\uadcal exam\uadina\uadtion \uadand Doppler scan\uadning; 48 com\uadplete\uadly con\uadcealed \uadflaps \uadwere mon\uadi\uadtored by Doppler scan\uadning \uadalone. Results. The suc\uadcess \uadrate \uadwas 95.5%. In 14 cas\uades, sur\uadgi\uadcal re-explo\uadra\uadtion of \uadthe \uadflap \uadwas \uadrequired \uadfor vas\uadcu\uadlar insuf\uadfi\uadcien\uadcy; 78% of \uadthese \uadflaps \uadwere \uadsaved. Neither \uadprior sur\uadgi\uadcal inter\uadven\uadtion, \uadnor \uadprior irra\uaddi\uada\uadtion of \uadthe sur\uadgi\uadcal \uadfield, \uadnor \uadthe pres\uadence of meta\uadbol\uadic dis\uadeas\uades neg\uada\uadtive\uadly influ\uadenced \uadthe suc\uadcess \uadrate. Conclusion. The \uadlow \uadrates of fail\uadure \uadand com\uadpli\uadca\uadtions, togeth\uader \uadwith \uadthe \uadgood \uadresults in mor\uadpho\uadlog\uadi\uadcal \uadand func\uadtion\uadal \uadterms, \uadmake micro\uadvas\uadcu\uadlar \uadflaps \uadone of \uadthe \uadmost sig\uadnif\uadi\uadcant recon\uadstruc\uadtion meth\uadods \uadfor \uadthe \uadoral \uadand max\uadil\uadlo\uadfa\uadcial \uadarea, in par\uadtic\uadu\uadlar \uadfor exten\uadsive \uaddefects

Placental acute inflammation infiltrates and pregnancy outcomes: a retrospective cohort study

Chorioamnionitis can be either an infection or a sterile inflammation. This study aims to analyze the prevalence of acute inflammatory lesions of the placenta, the association with a positive result of the microbiological examination, and the fetal-maternal outcomes. This retrospective study considered all single, consecutive pregnancies and their placental pathological examination during 2014–2017. The evidence of funisitis, chorionic vasculitis, and chorioamnionitis was assessed by a pathologist, including stage and grade. Moreover, maternal fever, placental microbiological examination, and neonatal outcomes were also recorded. Among the 5910 pregnancies in the considered period, 1770 had a placental pathological examination, and 358 (6.06%) had acute placental inflammation. Microbiological examination was performed in 125 cases, revealing 64 cases with a positive microbiological outcome. In the presence of acute placental inflammation, there was a higher rate of neonatal cardiopulmonary resuscitation, admission to neonatal intensive care unit, and postnatal death of the newborn. Multivariate analysis inferred that acute inflammation of membranes was a risk factor for neonatal cardiopulmonary resuscitation (OR 2.12; CI.95 1.36–3.31; p < 0.05), acute funisitis was a risk factor for admission to intensive neonatal care unit (OR 3.2; CI.95 1.67–6.12; p < 0.05), and chorionic vasculitis was a risk factor for postnatal death of the newborn (OR 5.38; CI.95 1.37–21.06; p < 0.05). The prevalence of chorioamnionitis was 6.06%, and about half of the cases were sterile inflammation. Chorioamnionitis was associated with higher rates of adverse fetal and neonatal outcomes; in particular, chorionic vasculitis was a risk factor for postnatal death

Vertical increase in mandibular reconstructive surgery with fibula flap : double barrel and osteogenetic distraction

Aim. The free fibula flap is today considered the gold standard for mandibular reconstructions, and provides an adequate length of bone of the correct consistency for this procedure. The disadvantage is the lack of thickness, which does not offer an adequate vertical dimension for the newly constructed mandible, in particular when the procedure must be followed by osseointegrated tooth implants. Two methods have been developed to increase the vertical dimension of the new mandible: the double-barrel method and osteogenetic distraction. Methods. Between April 1995 and October 2003 at the Division of Maxillofacial Surgery, San Paulo Hospital, Milan, 63 fibula free flaps were positioned; 17 were at the maxilla and 46 at the mandible. Results. Among the mandibular reconstructions, in 4 cases the double-barrel technique was applied, with the intent of optimising the vertical dimension of the reconstructed mandible. In 2 cases in which the double-barrel technique could not be applied, osteogenetic distraction was performed on the new mandible in order to achieve a vertical increase in the various bone sectors. Conclusion. Application of these techniques made it possible to achieve adequate bone thickness in the new mandible, so as to optimise future prosthetic rehabilitation of the tooth arch