COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Post-operative ileus in elderly patients

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Quality of life in elderly patients after inguinal hernioplasty

Background and aim Inguinal hernia is the most frequent abdominal wall her- nias in elderly population. Surgical treatment must be aware of the cardiovascular and respiratory disease these patients are often affected by. Inguinal hernia is responsi- ble to impair the quality of life (QoL). Aim of this study was to evaluate the QoL through the Short-Form (SF)-36 questionnaire in a cohort of elderly patients undergoing inguinal hernioplasty. Materials and methods Fifteen male patients of age ≥75 years affected by sympto- matic unilateral uncomplicated inguinal hernia were included in this study. All patients undergoing inguinal hernioplasty in local anaesthesia according to the Liech- tenstein technique. The SF-36 questionnaire was adminis- tered to each patient the day before and 6 months after surgery. Global analysis of the 8 domains of SF-36 and 2 comprehensive indexes of SF-36, Physical Component Summary (PCS) and Mental Component Summary (MCS) were performed. Results Inguinal hernioplasty originated no postoperative com- plications, in particular no patients complained of chronic pain after surgery. Six months after surgery, all 8 domains of SF-36, and MCS and PCS scores improved remarkably as compared with the preoperative time. Conclusion Inguinal hernioplasty in elderly patient is a safe and effec- tive procedure. Although the major surgical stress observed in these subjects, the improvement of QoL, as attested by significantly increased in SF-36 scores, repre- sent a clear-cut indication for elective inguinal hernia repair

Advances in Recovering Noble Metals from Waste Printed Circuit Boards (WPCBs)

An extensive investigation on the noble metal (NM) content in different classes of waste printed circuit boards (WPCBs: random access memories, RAMs; network interface controllers, NICs; motherboards; TV, DVD/CD player, hard-drive, and mobile phone PCBs) has been performed to define the most appropriate case study and provide a robust database useful for workers in the waste valorization field. Following accurate selection, mechanical comminution, representative sampling, quantitative digestion, and analytical characterization (ICP-AES), RAMs and mobile phone PCBs confirmed to be the “richest” source, while TV PCBs are the “poorest” one in term of NM content. Accordingly, the RAM case study has been employed for the application of a new NMs recovery method, previously set up on finely comminuted waste electric and electronic equipment underwent materials enrichment by mechanical separation. Despite the very large amount of vitreous-plastic and metallic materials present in the mixture, satisfactory NM recovery yields (Cu 70%, Ag 92%, Au 64%) with limited byproduct formation have been obtained using safe and recyclable reagents in mild conditions: citric acid for base metal leaching, ammonia in oxidizing environment for Cu and Ag separation and recovery, triiodide aqueous solution for gold recovery, at room pressure, and 25–100 °C. The reported results provide useful quantitative parameters for assessing the profitability of an industrial scale-up of the new sustainable NMs recovery method

An overview on multimodal imaging for the diagnostic workup of pleural mesothelioma

: Pleural mesothelioma (PM) is an aggressive disease that has a strong causal relationship with asbestos exposure and represents a major challenge from both a diagnostic and therapeutic viewpoint. Despite recent improvements in patient care, PM typically carries a poor outcome, especially in advanced stages. Therefore, a timely and effective diagnosis taking advantage of currently available imaging techniques is essential to perform an accurate staging and dictate the most appropriate treatment strategy. Our aim is to provide a brief, but exhaustive and up-to-date overview of the role of multimodal medical imaging in the management of PM

Dose Reduction Strategies for Pregnant Women in Emergency Settings

In modern clinical practice, there is an increasing dependence on imaging techniques in several settings, and especially during emergencies. Consequently, there has been an increase in the frequency of imaging examinations and thus also an increased risk of radiation exposure. In this context, a critical phase is a woman's pregnancy management that requires a proper diagnostic assessment to reduce radiation risk to the fetus and mother. The risk is greatest during the first phases of pregnancy at the time of organogenesis. Therefore, the principles of radiation protection should guide the multidisciplinary team. Although diagnostic tools that do not employ ionizing radiation, such as ultrasound (US) and magnetic resonance imaging (MRI) should be preferred, in several settings as polytrauma, computed tomography (CT) nonetheless remains the examination to perform, beyond the fetus risk. In addition, protocol optimization, using dose-limiting protocols and avoiding multiple acquisitions, is a critical point that makes it possible to reduce risks. The purpose of this review is to provide a critical evaluation of emergency conditions, e.g., abdominal pain and trauma, considering the different diagnostic tools that should be used as study protocols in order to control the dose to the pregnant woman and fetus