Association of COVID-19 outcomes with diabetes in the Veneto region (north-east italy): Epidemiological insights for the endemic phase?

BACKGROUND AND AIMS

Diabetes mellitus is a prevalent chronic disease in patients who die of COVID-19. The aim of this study was to investigate the clinical and metabolic characteristics of diabetic patients with COVID-19 during the pre-vaccination phase.

METHODS AND RESULTS

A retrospective cohort study was conducted from February 2020 to February 2021 to examine the clinical and metabolic profiles of unvaccinated diabetic patients affected by COVID-19. Data were collected from claim databases, hospital discharge records, and clinical records within a healthcare district located in northeastern Italy with a population of 936,000. Potential prognostic indicators including sex, age, Body Mass Index (BMI), duration and type of diabetes, metabolic control, and the use of antidiabetic, antihypertensive, lipid-lowering, and antiplatelet therapies were investigated. For hospitalized patients, additional variables were recorded, such as length of hospital stay, blood pressure at admission, comorbidities, D-dimer levels, blood glucose (BG), in-hospital insulin and corticosteroid therapies, requirement for mechanical ventilation (i.e., orotracheal or tracheostomy), admission to the Intensive Care Unit (ICU), and mortality. Diabetic patients hospitalized for COVID-19 with a poorer prognosis were characterized by advanced age, longer diabetes duration, hypertension, higher usage of sulfonylureas, and lower usage of dietotherapy alone, metformin, Glucagon-Like Peptide-1 Receptor agonists (GLP1-Ra), and Renin-Angiotensin-Aldosterone System inhibitors (RAAS-i).

CONCLUSION

Considering the potential for COVID-19 to become endemic, special care should be taken in managing older diabetic patients' treatments.

[Domestic accidents: a study on children attending the emergency department of the city of Padua]

OBJECTIVE

This study analyzes the causes of domestic accidents in children (age <15) living in the Local Social Sanitary Unit of Padua (Ulss). ME Italy, with regard to the circumstances of the accident and the socioeconomic level of the family.

METHOD

the subjects were recruited in the Emergency Department of the local hospital between January 15 and March 15, 2004 following an accident at home (n=392). Each case was contacted on that occasion, and a telephone interview was made to one of the parents at a later stage. The latter was accepted by 74% cases.

RESULTS

The bimonthly incidence of domestic accidents in the Ulss of Padua was 7.74% per hundred. The incidence was higher in males than in females and in pre-school than in school age. Only 5% children required hospitalisation. Falls are the most frequent type of accident (65%), one third of the events occurred in the living room, half of them occurred during free games.

CONCLUSION

The incidence of the Ulss of Padua is higher than the national incidence: the gap is limited to pre-school age for which the incidence of Padua, age-standardized on Italian population and extrapolated for three months, is 18.8% per hundred while tri-monthly national incidence is 11.7% per hundred. No differences in rates were noticed in school age (6.5% per hundred for Padua vs. 6.4% per hundred for Italy). Findings regarding the circumstances of injuries are consistent with other surveys carried out in Italy and elsewhere. No particular causing factor of accidents emerged. However, the avoidability of accidents attributable to the adult's behaviour is to be noticed.

Two different dosages of yeast derived recombinant hepatitis B vaccines: a comparison of immunogenicity

The efficacy of a 10 or 20 micrograms antigen load of HB recombinant vaccines is still being debated. A comparison of anti-HBs titres in two groups of healthy subjects vaccinated by the same schedule (0, 1 and 6 months) employing recombinant HB vaccines with different antigen loads, 20 micrograms (group A, 251 subjects) and 10 micrograms (group B, 256 subjects) was carried out. A seroprotection rate of 99.6 and 99.2% was observed for group A and group B, respectively, at the end of primary immunization. No statistically significant difference in seroprotection rate was observed. Group A showed significantly higher GMTs than group B for all age groups and for both sexes except for males above 25 years. The difference was more marked for younger age groups and for the female sex. These data support the higher immunogenicity of vaccine with 20 micrograms antigen load as compared to vaccines with 10 micrograms antigen load.

Persistence of anti-HBs antibodies in health care personnel vaccinated with plasma-derived hepatitis B vaccine and response to recombinant DNA HB booster vaccine

Long-term persistence of specific antibodies after primary immunization against HBV infection has been reported. In this study, we evaluated the persistence of anti-HBs in vaccinees 6 years after primary immunization and the response to a booster dose using a recombinant DNA yeast-derived HB vaccine. An 85.4% seroprotection rate was observed after 6 years with a significantly higher seroprotective rate in those subjects who received four doses of vaccine primary immunization as compared with those who received three doses (93.9% versus 67.2%, p < 0.001). One month after receiving the booster dose, 98.6% of the subjects had an anamnestic type of response. The GMTs were found to decrease progressively with increasing age. The antibody levels after booster dose were higher than those attained at the end of primary immunization and reflected the trend seen before the administration of the booster. These results are consistent with the existence of an effective immunological memory in HB vaccine responders. Subjects who received four doses during primary immunization were better seroprotected and had a higher seroprotection rate after the booster dose.

[Drugs and health. 1. An experience with health education in a scholastic environment]

The paper describes the aim and the realization of a health education project on "Drugs and Health". The scheme was undertaken by the Hygiene Institute of the University of Padua, at the request of the ULSS (Local Health Unit) n. 31, of Adria (Rovigo), and it was directed to the teachers of the local "Grammar School" and indirectly also to the pupils and their families. At the end of the training programme, the teachers did not only learn the fundamental concepts on drugs and their correct use, but were also able in their turn to spread the acquired knowledge. During the six sessions, in which the project was divided, various aspects of the problems were studied. An active methodology was used: at the beginning a questionnaire was distributed, then the main subject was treated and finally the answers to the questionnaires were discussed. The meetings with the teachers and the pupils were organized in the same way. The subjects of the meetings were the following: 1st meeting: "What do I know about drugs?" 2nd meeting: "How do I use drugs?" 3rd meeting: "Do I use drugs correctly?" 4th meeting: "Why don't I use drugs properly?" 5th meeting: "Consequences of improper use of drugs" 6th meeting: "How can I improve my approach to the use of drugs?" Ten teachers of different disciplines, each responsible for a class of about 25 pupils, attended the meetings. All the teachers agreed to apply the proposed methodology to their classes. This methodology enabled both teachers and pupils to identify wrong concepts, or incorrect usage, autonomously. An important number of pupils have benefited from the educational project. Moreover, as part of health education scheme, a questionnaire on the domestic presence, use, conservation, and disposal of drugs was distributed to a number of pupils to involve their families. The results of this survey will be described in another paper.

[Drugs and health. 2. Study on the presence, use, storage and disposal of drugs in a sample of families in Adria (Rovigo) Local Health Unit 31, Venetian region]

As part of a health education scheme for the schools on "Drugs and Health", a questionnaire was distributed to a number of pupils in order to ascertain the domestic presence, use, conservation, and disposal of drugs. The questionnaire proved a very effective system for the extension of the educational project to the families of the pupils, but the information thus gathered was only of limited value. On the average, in the family 12.8 different type of drugs were present, mainly ethical drugs (76.6%). Most drugs were Articulars, Analgesics-antipyretics and Bronchopulmonary drugs. Only 30.2% of the drugs kept at home were currently used. Self-treatment (14.9%) and self-prescription (8.1%) were noted, as well as improper use of the drugs (5.9%). No answer to the questionnaire mentioned the presence of expired drugs: probably they were disposed of during the survey at home. Although these facts showed the positive effects of the educational project, nonetheless it was not possible to establish the real number of drugs kept at home. The way the answers to the questionnaire were biased and the fact that it was meant to be part of the project, have reduced the objectivity of the information thus obtained, underlining, however, its educational value.