Globally, at the time of writing (20 March 2021), 121.759.109 confirmed COVID-19 cases have been reported to the WHO, including 2.690.731 deaths. Globally, on 18 March 2021, a total of 364.184.603 vaccine doses have been administered. In Italy, 3.306.711 confirmed COVID-19 cases with 103.855 deaths have been reported to WHO. In Italy, on 9 March 2021, a total of 6.634.450 vaccine doses have been administered. On 15 March 2021, Italian Medicines Agency (AIFA) decided to temporarily suspend the use of the AstraZeneca COVID-19 vaccine throughout the country as a precaution, pending the rulings of the European Medicines Agency (EMA). This decision was taken in line with similar measures adopted by other European countries due to the death of vaccinated people. On 18 March 2021, EMA’s safety committee concluded its preliminary review about thromboembolic events in people vaccinated with COVID-19 Vaccine AstraZeneca at its extraordinary meeting, confirming the benefits of the vaccine continue to outweigh the risk of side effects, however, the vaccine may be associated with very rare cases of blood clots associated with thrombocytopenia, i.e., low levels of blood platelets with or without bleeding, including rare cases of cerebral venous thrombosis (CVT). We report the case of a 54-year-old woman who developed disseminated intravascular coagulation (DIC) with multi-district thrombosis 12 days after the AstraZeneca COVID-19 vaccine administration. A brain computed tomography (CT) scan showed multiple subacute intra-axial hemorrhages in atypical locations, including the right frontal and the temporal lobes. A plain old balloon angioplasty (POBA) of the right coronary artery was performed, without stent implantation, with restoration of distal flow, but with persistence of extensive thrombosis of the vessel. A successive thorax angio-CT added the findings of multiple contrast filling defects with multi-vessel involvement: at the level of the left upper lobe segmental branches, of left interlobar artery, of the right middle lobe segmental branches and of the right interlobar artery. A brain magnetic resonance imaging (MRI) in the same day showed the presence of an acute basilar thrombosis associated with the superior sagittal sinus thrombosis. An abdomen angio-CT showed filling defects at the level of left portal branch and at the level of right suprahepatic vein. Bilaterally, it was adrenal hemorrhage and blood in the pelvis. An evaluation of coagulation factors did not show genetic alterations so as the nasopharyngeal swab ruled out a COVID-19 infection. The patient died after 5 days of hospitalization in intensive care.
The recent outbreak of a new Coronavirus has developed into a global pandemic with about 10.5 million reported cases and over 500,000 deaths worldwide. Our prospective paper reports an updated analysis of the impact that this pandemic had on the Italian agri-food sector during the national lockdown and discusses why and how this unprecedented economic crisis could be a turning point to deal with the overall sustainability of food and agricultural systems in the frame of the forthcoming European Green Deal. Its introductory part includes a wide-ranging examination of the first quarter of pandemic emergency, with a specific focus on the primary production, to be understood as agriculture (i.e., crops and livestock, and their food products), fisheries, and forestry. The effect on the typical food and wine exports, and the local environment tourism segments is also taken into account in this analysis, because of their old and deep roots into the cultural and historical heritage of the country. The subsequent part of the paper is centered on strategic lines and research networks for an efficient socio-economic and territorial restart, and a faster transition to sustainability in the frame of a circular bio-economy. Particular emphasis is given to the urgent need of investments in research and development concerning agriculture, in terms of not only a fruitful penetration of the agro-tech for a next-generation agri-food era, but also a deeper attention to the natural and environmental resources, including forestry. As for the rest of Europe, Italy demands actions to expand knowledge and strengthen research applied to technology transfer for innovation activities aimed at providing solutions for a climate neutral and resilient society, in reference to primary production to ensure food security and nutrition quality. Our expectation is that science and culture return to play a central role in national society, as their main actors are capable of making a pivotal contribution to renew and restart the whole primary sector and agri-food industry, addressing also social and environmental issues, and so accelerating the transition to sustainability.
Rationale: Gender-related differences in asthma prevalence, pathophysiology and clinical features induced by sex steroids have been investigated, however, how gender influences response to asthma treatments in routine clinical practice have not yet been elucidated fully. This aspect is crucial for montelukast considering the jeopardization of asthmatic patients that benefit from this treatment and the existence of evidence of gender differences in leukotriene levels. Therefore, to fulfill this medical need, we investigated the role of gender on a set of montelukast' effectiveness surrogates in adults and pediatric patients with asthma.Methods: The study settings were Napoli 2 Local Health Unit (southern Italy) and the entire Danish territory. The study population was composed of adult and pediatric patients with asthma. Cumulative incidence curves, unadjusted and adjusted Cox regression were used as statistical models to compare aforementioned outcomes between genders.Results: Adult Italian male users of montelukast had a statistically lower persistence in montelukast treatment compared to female users. In the adjusted analyses, they had a higher hazard of montelukast' withdrawal (Hazard Ratio [HR] 1.07; 95% Confidence Interval [CI] 1.01–1.14), add-on/switch to a long-term treatment for asthma following montelukast withdrawal (HR 1.72; 95%CI 1.39–2.12), and rescue therapy with short-acting β2 agonist (HR 1.24; 95%CI 1.04–1.47). In the adult Danish cohort, we also found that male users had higher a hazard of rescue therapy with oral corticosteroids (HR 1.10; 95%CI 1.04–1.16). In the pediatric cohorts, no statistically significant differences were observed between genders for aforementioned outcomes.Conclusions: In adults, male gender was associated with increased hazards of montelukast discontinuation, add-on/switch to a long-term treatment for asthma following montelukast withdrawal, and rescue therapy with oral corticosteroids or short-acting β2 agonist when compared to the female gender. As expected, these associations were reversed or absent in pediatric patients.
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