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Background: During the first pandemic phase of COVID-19, an epidemiological study, named First survey, was conducted on the population of a small rural area in northern Italy. In spring 2020, the results showed how a prolonged lockdown slowed down the spread of the virus., Methods: After contacting positive First Survey subjects and their families, those who decided to join voluntarily underwent a blood test to assess the presence of qualitative lgG about 2 months after the previous one. This was to determine if IgG persisted in individuals who tested positive in the First Survey as well as to assess the antibody status of their close family members, to determine if they were unintentionally infected., Results: Based on serological analysis, 35.1% of the samples contained blood IgG. In subjects who tested positive during the First Survey, 62.5% remained IgG positive more than 2 months later. Among family members who were exposed to a positive relative, 23.7% were infected. Linear regression analysis showed that the presence of an infected person within a household resulted in the infection spreading to the others, but not excessively. Induced isolation extinguished the infection regardless of the extent of the contagion (intra-family or extra-family). Micro-outbreaks of SARS-Cov-2 infection which arose in the same household from extra-familial infections played a decisive role on the statistical significance of IgG-positive subjects ( p  < 0.001)., Discussion: The study reveal 52.6% of the IgG-positive subjects in the Second Survey came from the First Survey and 47.4% were family members previously in contact with positive subjects. Data suggest that there have been undiagnosed patients feeding the spread of the virus since the beginning of the pandemic. In conclusion, for future pandemics, it will be necessary: i) to ensure the rapid isolation of symptomatic patients and the early identification of their close contacts, ii) to carry out the maximum number of tests in the shortest possible time, both on symptomatic and asymptomatic subjects, and iii) to implement information campaigns to make people aware of their risks, and implement clear, non-conflicting communication., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Bassanello, Geppini, Bonsembiante, Coli, Farencena, D’Aquino, Gambaro, Buja and Baldovin.)

The emergence of severe acute respiratory syndrome type 2 coronavirus (SARS-CoV-2) and its complications have demonstrated the devastating impact of a new infectious pathogen. The organisational change promulgated by the isolation of affected communities is of extreme importance to achieve effective containment of the contagion and good patient care. The epidemiological study of the population of a small rural community in the North East of Italy revealed how much the virus had circulated during Spring, 2020, and how contagion has evolved after a prolonged lockdown. In the 1st phase, NAAT (Nucleic Acid Amplification Testing) was performed in cases with more or less severe symptoms and a study was performed to trace the infection of family members. Only 0.2% of the population tested positive on NAAT, via nasopharyngeal swab during this 1st phase. In the 2nd phase a random sample of the general population were tested for circulating anti-Sars-Cov-2 immunoglobulins. This showed that approximately 97.9% of the population were negative, while 2.1% (with positive IgG at a distance) of the population had contracted the virus in a mildly symptomatic or asymptomatic form. The main symptom in subjects who developed immunity was fever. Antibodies were found in subjects with forced coexistence with quarantined or infected subjects. The mutual spatial distance by categories has shown higher relative prevalence of IgG positive and IgM negative cases in close proximity but also far from the infected, with respect to an intermediate distance. This suggests that subjects living in thinly populated areas could come in contact with the virus more likely due to intentional/relational proximity, while those living nearby could also be infected through random proximity., (© 2021. The Author(s).)

Background: Microvascular integrity is an essential determinant of favorable late outcome in reperfused myocardial infarction. Coronary flow reserve (CFR) can be assessed by transthoracic Doppler echocardiography and provides a functional estimate of microvascular integrity downstream from the patent infarct-related vessel., Objective: We sought to assess the effects of CFR in predicting late left ventricular (LV) remodeling in patients with reperfused acute anterior myocardial infarction treated with primary angioplasty., Methods: In all, 31 patients admitted with acute anterior myocardial infarction underwent primary angioplasty of the infarct-related vessel. After angioplasty, angiographic thrombosis in myocardial infarction (TIMI) grade and myocardial blush were scored. On the first day, all underwent stress echocardiography and CFR evaluation of left anterior descending coronary artery by transthoracic Doppler. All patients had resting 2-dimensional echocardiography at 1, 3, and 6 months for assessment of LV function., Results: CFR could be successfully assessed in 31 patients. After 6 months 5 patients showed LV dilatation (group I), whereas 26 patients did not show significant variation (group II). On day 1, CFR was higher (group I = 1.43 +/- 0.11 vs group II = 1.67 +/- 0.26, P =.005) and the deceleration time of diastolic left anterior descending coronary artery flow velocity was longer (group I = 212 +/- 41.4 milliseconds vs group II = 286 +/- 106.7 milliseconds, P <.02) in patients without, compared with those with LV remodeling, whereas there was no difference in angiographic parameters., Conclusion: Early assessment of CFR and the pattern of baseline diastolic coronary flow velocity by transthoracic Doppler echocardiography is feasible, safe, and more useful than angiographic indices in identifying patients at high risk of remodeling in spite of successful primary angioplasty.

Plasma-exchange (PE) represents an effective therapeutic approach employed in several immunological nephropathies, poisonings and various other diseases. Hemodynamic changes during intermittent flow PE were studied--using the thermodilution technique--in 8 patients (3 male and 5 female) aged between 36 and 73 years (mean 46.4). The mean values for the following parameters were measured before, during every cycle--exchanging about 300 ml of fresh frozen plasma--and at the end of the session: mean arterial pressure (MAP), heart rate (HR), cardiac index (Cl), stroke index (SI), total peripheral resistence (TPR), central venous pressure (CVP), pulmonary arterial pressure (PAP) and pulmonary capillary wedge pressure (PCWP). During the first exchange the systemic circulation showed hemodynamic changes similar that of an acute hemorrhagic condition: decrease in MAP (from 106 to 97 mmHg), Cl (from 4.27 to 3.7 L/m'/m2), SI (from 53 to 49 ml/beat/m2) and CVP (from 6.9 to 4.4 mmHg); increase in TPR (from 1230 to 1339) dynes/sec/cm-5), while HR showed only mild changes. In the following cycles all the parameters progressively returned toward the previous values. During the first cycle the pulmonary circulation showed a decrease in PAP (from 15.5 to 13 mmHg) and PCWP (from 8.9 to 6.6 mmHg). PAP also increased constantly in the following cycles reaching at the end of the session levels which were higher than the initial ones. Our data demonstrate that in PE treatment especially when is employed a low volume of fluid, has to be substituted at every cycle in order to prevent the major hemodynamic complications i.e. hypovolemic shock and heart failure.

The authors have compared the clinical and metabolic effects of two high ceiling diuretics, muzolimine (M) and furosemide (F), by i.v. and oral routes in 40 patients classified in four groups with different degrees of renal failure. The study demonstrated a more pronounced effectiveness of M than F by oral administration, while it appeared equal to F when given i.v. The urine volume and Na+ excretion were significantly increased during M treatment compared to oral F in each group. Calcium urinary excretion was reduced with M while P was increased compared with F. BUN, creatinine and uric acid were temporarily increased in the 3rd and 4th groups, probably due to extracellular fluid volume contraction, associated also with transient change in GFR. M at a lower dosage than F has demonstrated an effective diuretic response irrespective the degree of renal impairment. From its pharmacological properties, M appears a safe and active diuretic agent, particularly at a high dosage in patients with severe renal failure, and is notable for its lack of important side effects.

In eighteen months, eleven Sparks mandrils have been implanted in ten patients who presented serious vascular access problems. So far nine mandrils have been anastomosed and six are functioning. In one patient the apparatus, inserted in the right leg, clotted after 108 dialyses and was reinserted in the left arm; after a further forty dialyses the patient died from causes not connected with dialysis. Another patient's Sparks mandril thrombosed from infection on the fourth post-operative day. Using a single needle apparatus, 693 dialyses have been carried out with particular problems either for the patients or the grafts.