The first cases of Coronavirus disease-2019 (COVID-19) were reported on 21 February in the small town of Vo’ near Padua in the Veneto region of Italy. This event led to 19,286 infected people in the region by 30 June 2020 (39.30 cases/10,000 inhabitants). Meanwhile, Rovigo Local Health Unit n. 5 (ULSS 5), bordering areas with high epidemic rates and having one of the world’s oldest populations, registered the lowest infection rates in the region (19.03 cases/10,000 inhabitants). The aim of this study was to describe timing and event management by ULSS 5 in preventing the propagation of infection within the timeframe spanning from 21 February to 30 June. Our analysis considered age, genetic clusters, sex, orography, the population density, pollution, and economic activities linked to the pandemic, according to the literature. The ULSS 5 Health Director General’s quick decision-making in the realm of public health, territorial assistance, and retirement homes were key to taking the right actions at the right time. Indeed, the number of isolated cases in the Veneto region was the highest among all the Italian regions at the beginning of the epidemic. Moreover, the implementation of molecular diagnostic tools, which were initially absent, enabled health care experts to make quick diagnoses. Quick decision-making, timely actions, and encouraging results were achieved thanks to a solid chain of command, despite a somewhat unclear legislative environment. In conclusion, we believe that the containment of the epidemic depends on the time factor, coupled with a strong sense of awareness and discretion in the Health Director General’s decision-making. Moreover, real-time communication with operating units and institutions goes hand in hand with the common goal of protecting public health.

Patients with COVID-19 and metabolic-dysfunction associated fatty liver disease (MAFLD) appear to be at higher risk for severe manifestations, especially in the youngest decades. Our aim was to examine whether patients with MAFLD and/or with increased liver fibrosis scores (FIB-4) are at risk for severe COVID-19 illness, using a machine learning (ML) model. Six hundred and seventy two patients were enrolled for SARS-CoV-2 pneumonia between February 2020 and May 2021. Steatosis was detected by ultrasound or computed tomography (CT). ML model valuated the risks of both in-hospital death and prolonged hospitalizations (> 28 days), considering MAFLD, blood hepatic profile (HP), and FIB-4 score. 49.6% had MAFLD. The accuracy in predicting in-hospital death was 0.709 for the HP alone and 0.721 for HP + FIB-4; in the 55–75 age subgroup, 0.842/0.855; in the MAFLD subgroup, 0.739/ 0.772; in the MAFLD 55–75 years, 0.825/0.833. Similar results were obtained when considering the accuracy in predicting prolonged hospitalization. In our cohort of COVID-19 patients, the presence of a worse HP and a higher FIB-4 correlated with a higher risk of death and prolonged hospitalization, regardless of the presence of MAFLD. These findings could improve the clinical risk stratification of patients diagnosed with SARS-CoV-2 pneumonia.

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Objective: Recent studies found that insomnia is an independent risk factor for cardiovascular diseases, particularly arterial hypertension. Among the hypertensive population, insomnia could contribute to a worse blood pressure (BP) profile. In a sample of hypertensive patients, we compared those with and without insomnia with the aim of evaluating possible differences in BP, its variability, and breathing pattern. Design and method: We conducted a case-control study on patients with and without insomnia, based on the Insomnia Severity Index (ISI) questionnaire. Patients were recruited from the general practitioner's registry and were sent an invitation e-mail. All of them had long-lasting hypertension. One-hundred-and-fifty patients replied to the ISI questionnaire. Among them, twenty people with insomnia were selected (ISI greater than or equal to 15) and matched, based on their gender and age (±3 years), to 20 controls (with ISI lower than 15). All participants underwent night-time cardiorespiratory and 24-hour blood pressure monitoring by using a new cuff-less device that can estimate beat-to-beat BP (SomnoTouch-NIBP). Results: Comparing the two groups (insomnia vs. non-insomnia), no differences were observed in BP profile and all the respiratory indices, including the apnea-hypopnea index(AHI), the number of desaturations, and peripheral oxygen saturation (SpO2) values. Even the average BP and the indices of BP variability, such as the standard deviation (SD), the pressure coefficient of variation (CV), the BP dipping, and the nocturnal BP fluctuations (NBPF), were similar between the groups. Interestingly, to obtain the same average BP control, the insomnia group required a greater number of antihypertensive drugs (2,85 ± 0,88 vs. 1,95 ± 1,00 in the non-insomnia group; p<0.01). Conclusions: Patients with insomnia may need more antihypertensive medications to achieve the same average BP as patients without insomnia. Anyhow, they did not show, as expected, higher BP variability. How much beat-to-beat BP estimations are reliable compared to BP measurements by standard cuff-based devices is still under debate.