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  • 1
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    COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal Vol. 41, No. 32 ( 2020-08-21), p. 3045-3054
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 41, No. 32 ( 2020-08-21), p. 3045-3054
    Abstract: An increase in out-of-hospital cardiac arrest (OHCA) incidence has been reported in the very early phase of the COVID-19 epidemic, but a clear demonstration of a correlation between the increased incidence of OHCA and COVID-19 is missing so far. We aimed to verify whether there is an association between the OHCA difference compared with 2019 and the COVID-19 epidemic curve. Methods and results We included all the consecutive OHCAs which occurred in the Provinces of Lodi, Cremona, Pavia, and Mantova in the 2 months following the first documented case of COVID-19 in the Lombardia Region and compared them with those which occurred in the same time frame in 2019. The cumulative incidence of COVID-19 from 21 February to 20 April 2020 in the study territory was 956 COVID-19/100 000 inhabitants and the cumulative incidence of OHCA was 21 cases/100 000 inhabitants, with a 52% increase as compared with 2019 (490 OHCAs in 2020 vs. 321 in 2019). A strong and statistically significant correlation was found between the difference in cumulative incidence of OHCA between 2020 and 2019 per 100 000 inhabitants and the COVID-19 cumulative incidence per 100 000 inhabitants both for the overall territory (ρ 0.87, P & lt; 0.001) and for each province separately (Lodi: ρ 0.98, P & lt; 0.001; Cremona: ρ 0.98, P & lt; 0.001; Pavia: ρ 0.87, P & lt; 0.001; Mantova: ρ 0.81, P & lt; 0.001). Conclusion The increase in OHCAs in 2020 is significantly correlated to the COVID-19 pandemic and is coupled with a reduction in short-term outcome. Government and local health authorities should seriously consider our results when planning healthcare strategies to face the epidemic, especially considering the expected recurrent outbreaks.
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehaa508
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2001908-7
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  • 2
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    End-tidal carbon dioxide (ETCO2) and ventricular fibrillation amplitude spectral area (AMSA) for shock outcome prediction in out-of-hospital cardiac arrest. Are they two sides of the same coin?
    Elsevier BV ; 2021
    In:  Resuscitation Vol. 160 ( 2021-03), p. 142-149
    Details
    In: Resuscitation, Elsevier BV, Vol. 160 ( 2021-03), p. 142-149
    Type of Medium: Online Resource
    ISSN: 0300-9572
    URL: Article
    DOI: 10.1016/j.resuscitation.2020.10.032
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2010733-X
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  • 3
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    Changing the stroke network during pandemic scenarios does not affect the management of patients with a positive Cincinnati prehospital stroke scale
    Springer Science and Business Media LLC ; 2023
    In:  Neurological Sciences
    Details
    In: Neurological Sciences, Springer Science and Business Media LLC
    Abstract: Time plays a crucial role in the management of stroke, and changing the prehospital emergency network, altering the HUB and spoke relationship in pandemic scenarios, might have an impact on time to fibrinolysis or thrombectomy. The aim of this study was to evaluate the time-dependent stroke emergency network in Lombardy region (Italy) by comparing 2019 with 2020 and early 2021. Three parameters were investigated: (i) time of arrival of the first vehicle at the scene, (ii) overall duration of missions, and (iii) number of patients transported by emergency vehicles. Methods Data analysis process conducted using the SAS-AREU portal (SAS Institute, USA). Results The number of patients with a positive CPSS was similar among the different pandemic waves. Mission duration increased from a mean time (SD) of 52.9 (16.1) min in 2019 to 64.1 (19.7) in 2020 and 55.0 (16.8) in 2021. Time to first vehicle on scene increased to 15.7 (8.4) min in 2020 and 16.0 (7.0) in 2021 compared to 2019, 13.6 (7.2) ( P   〈  0.05). The number of hospital with available stroke units decreased from 46 in 2019 to 10 during the first pandemic wave. Conclusions The pandemic forced changes in the clinical mission of many hospitals by reducing the number of stroke units. Despite this, the organization of the emergency system allowed to identify strategic hospitals and thus avoid excessive transport time. The result was an adequate time for fibrinolysis/thrombectomy, in agreement with the guidelines. Coordinated management in emergency situations makes it possible to maintain service quality standards, despite the unfavorable scenario.
    Type of Medium: Online Resource
    ISSN: 1590-1874 , 1590-3478
    URL: Article
    DOI: 10.1007/s10072-023-07046-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1481772-X
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  • 4
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    Development of a Novel Framework to Propose New Strategies for Automated External Defibrillators Deployment Targeting Residential Out-Of-Hospital Cardiac Arrests: Application to the City of Milan
    MDPI AG ; 2020
    In:  ISPRS International Journal of Geo-Information Vol. 9, No. 8 ( 2020-08-17), p. 491-
    Details
    In: ISPRS International Journal of Geo-Information, MDPI AG, Vol. 9, No. 8 ( 2020-08-17), p. 491-
    Abstract: Public Access Defibrillation (PAD) is the leading strategy in reducing time to first defibrillation in cases of Out-Of-Hospital Cardiac Arrest (OHCA), but PAD programs are underperforming considering their potentiality. Our aim was to develop an analysis and optimization framework, exploiting georeferenced information processed with Geographic Information Systems (GISs), specifically targeting residential OHCAs. The framework, based on an historical database of OHCAs, location of Automated External Defibrillators (AEDs), topographic and demographic information, proposes new strategies for AED deployment focusing on residential OHCAs, where performance assessment was evaluated using AEDs “catchment area” (area that can be reached within 6 min walk along streets). The proposed framework was applied to the city of Milan, Lombardy (Italy), considering the OHCA database of four years (2015–2018), including 8152 OHCA, of which 7179 (88.06%) occurred in residential locations. The proposed strategy for AEDs deployment resulted more effective compared to the existing distribution, with a significant improvement (from 41.77% to 73.33%) in OHCAs’ spatial coverage. Further improvements were simulated with different cost scenarios, resulting in more cost-efficient solutions. Results suggest that PAD programs, either in brand-new territories or in further improvements, could significantly benefit from a comprehensive planning, based on mathematical models for risk mapping and on geographical tools.
    Type of Medium: Online Resource
    ISSN: 2220-9964
    URL: Article
    DOI: 10.3390/ijgi9080491
    Language: English
    Publisher: MDPI AG
    Publication Date: 2020
    detail.hit.zdb_id: 2655790-3
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  • 5
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    Generating High-Granularity COVID-19 Territorial Early Alerts Using Emergency Medical Services and Machine Learning
    MDPI AG ; 2022
    In:  International Journal of Environmental Research and Public Health Vol. 19, No. 15 ( 2022-07-25), p. 9012-
    Details
    In: International Journal of Environmental Research and Public Health, MDPI AG, Vol. 19, No. 15 ( 2022-07-25), p. 9012-
    Abstract: The pandemic of COVID-19 has posed unprecedented threats to healthcare systems worldwide. Great efforts were spent to fight the emergency, with the widespread use of cutting-edge technologies, especially big data analytics and AI. In this context, the present study proposes a novel combination of geographical filtering and machine learning (ML) for the development and optimization of a COVID-19 early alert system based on Emergency Medical Services (EMS) data, for the anticipated identification of outbreaks with very high granularity, up to single municipalities. The model, implemented for the region of Lombardy, Italy, showed robust performance, with an overall 80% accuracy in identifying the active spread of the disease. The further post-processing of the output was implemented to classify the territory into five risk classes, resulting in effectively anticipating the demand for interventions by EMS. This model shows state-of-art potentiality for future applications in the early detection of the burden of the impact of COVID-19, or other similar epidemics, on the healthcare system.
    Type of Medium: Online Resource
    ISSN: 1660-4601
    URL: Article
    DOI: 10.3390/ijerph19159012
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2175195-X
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  • 6
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    Geospatial Correlation Analysis between Air Pollution Indicators and Estimated Speed of COVID-19 Diffusion in the Lombardy Region (Italy)
    MDPI AG ; 2021
    In:  International Journal of Environmental Research and Public Health Vol. 18, No. 22 ( 2021-11-19), p. 12154-
    Details
    In: International Journal of Environmental Research and Public Health, MDPI AG, Vol. 18, No. 22 ( 2021-11-19), p. 12154-
    Abstract: Background: the Lombardy region in Italy was the first area in Europe to record an outbreak of COVID-19 and one of the most affected worldwide. As this territory is strongly polluted, it was hypothesized that pollution had a role in facilitating the diffusion of the epidemic, but results are uncertain. Aim: the paper explores the effect of air pollutants in the first spread of COVID-19 in Lombardy, with a novel geomatics approach addressing the possible confounding factors, the reliability of data, the measurement of diffusion speed, and the biasing effect of the lockdown measures. Methods and results: all municipalities were assigned to one of five possible territorial classes (TC) according to land-use and socio-economic status, and they were grouped into districts of 100,000 residents. For each district, the speed of COVID-19 diffusion was estimated from the ambulance dispatches and related to indicators of mean concentration of air pollutants over 1, 6, and 12 months, grouping districts in the same TC. Significant exponential correlations were found for ammonia (NH3) in both prevalently agricultural (R2 = 0.565) and mildly urbanized (R2 = 0.688) areas. Conclusions: this is the first study relating COVID-19 estimated speed of diffusion with indicators of exposure to NH3. As NH3 could induce oxidative stress, its role in creating a pre-existing fragility that could have facilitated SARS-CoV-2 replication and worsening of patient conditions could be speculated.
    Type of Medium: Online Resource
    ISSN: 1660-4601
    URL: Article
    DOI: 10.3390/ijerph182212154
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2175195-X
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  • 7
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    Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry
    Springer Science and Business Media LLC ; 2021
    In:  World Journal of Emergency Surgery Vol. 16, No. 1 ( 2021-12)
    Details
    In: World Journal of Emergency Surgery, Springer Science and Business Media LLC, Vol. 16, No. 1 ( 2021-12)
    Abstract: The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods. Methods A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography. Results During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p 〈 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p 〈 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p 〈 0.05) and intentional falls (8.4% vs 1.2%, p 〈 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p 〈 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p 〈 0.001). Conclusions The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals.
    Type of Medium: Online Resource
    ISSN: 1749-7922
    URL: Article
    DOI: 10.1186/s13017-021-00383-y
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2233734-9
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  • 8
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    Mapping Spatiotemporal Diffusion of COVID-19 in Lombardy (Italy) on the Base of Emergency Medical Services Activities
    MDPI AG ; 2020
    In:  ISPRS International Journal of Geo-Information Vol. 9, No. 11 ( 2020-10-27), p. 639-
    Details
    In: ISPRS International Journal of Geo-Information, MDPI AG, Vol. 9, No. 11 ( 2020-10-27), p. 639-
    Abstract: The epidemic of coronavirus-disease-2019 (COVID-19) started in Italy with the first official diagnosis on 21 February 2020; hence, it is now known how many cases were already present in earlier days and weeks, thus limiting the possibilities of conducting any retrospective analysis. We hypothesized that an unbiased representation of COVID-19 diffusion in these early phases could be inferred by the georeferenced calls to the emergency number relevant to respiratory problems and by the following emergency medical services (EMS) interventions. Accordingly, the aim of this study was to identify the beginning of anomalous trends (change in the data morphology) in emergency calls and EMS ambulances dispatches and reconstruct COVID-19 spatiotemporal evolution on the territory of Lombardy region. Accordingly, a signal processing method, previously used to find morphological features on the electrocardiographic signal, was applied on a time series representative of territorial clusters of about 100,000 citizens. Both emergency calls and age- and gender-weighted ambulance dispatches resulted strongly correlated to COVID-19 casualties on a provincial level, and the identified local starting days anticipated the official diagnoses and casualties, thus demonstrating how these parameters could be effectively used as early indicators for the spatiotemporal evolution of the epidemic on a certain territory.
    Type of Medium: Online Resource
    ISSN: 2220-9964
    URL: Article
    DOI: 10.3390/ijgi9110639
    Language: English
    Publisher: MDPI AG
    Publication Date: 2020
    detail.hit.zdb_id: 2655790-3
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  • 9
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    Detection of patients with COVID-19 by the emergency medical services in Lombardy through an operator-based interview and machine learning models
    BMJ ; 2023
    In:  Emergency Medicine Journal
    Details
    In: Emergency Medicine Journal, BMJ
    Abstract: The regional emergency medical service (EMS) in Lombardy (Italy) developed clinical algorithms based on operator-based interviews to detect patients with COVID-19 and refer them to the most appropriate hospitals. Machine learning (ML)-based models using additional clinical and geospatial epidemiological data may improve the identification of infected patients and guide EMS in detecting COVID-19 cases before confirmation with SARS-CoV-2 reverse transcriptase PCR (rtPCR). Methods This was an observational, retrospective cohort study using data from October 2020 to July 2021 (training set) and October 2021 to December 2021 (validation set) from patients who underwent a SARS-CoV-2 rtPCR test within 7 days of an EMS call. The performance of an operator-based interview using close contact history and signs/symptoms of COVID-19 was assessed in the training set for its ability to determine which patients had an rtPCR in the 7 days before or after the call. The interview accuracy was compared with four supervised ML models to predict positivity for SARS-CoV-2 within 7 days using readily available prehospital data retrieved from both training and validation sets. Results The training set includes 264 976 patients, median age 74 (IQR 55–84). Test characteristics for the detection of COVID-19-positive patients of the operator-based interview were: sensitivity 85.5%, specificity 58.7%, positive predictive value (PPV) 37.5% and negative predictive value (NPV) 93.3%. Contact history, fever and cough showed the highest association with SARS-CoV-2 infection. In the validation set (103 336 patients, median age 73 (IQR 50–84)), the best-performing ML model had an AUC of 0.85 (95% CI 0.84 to 0.86), sensitivity 91.4% (95 CI% 0.91 to 0.92), specificity 44.2% (95% CI 0.44 to 0.45) and accuracy 85% (95% CI 0.84 to 0.85). PPV and NPV were 13.3% (95% CI 0.13 to 0.14) and 98.2% (95% CI 0.98 to 0.98), respectively. Contact history, fever, call geographical distribution and cough were the most important variables in determining the outcome. Conclusion ML-based models might help EMS identify patients with SARS-CoV-2 infection, and in guiding EMS allocation of hospital resources based on prespecified criteria.
    Type of Medium: Online Resource
    ISSN: 1472-0205 , 1472-0213
    URL: Article
    DOI: 10.1136/emermed-2022-212853
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2027092-6
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  • 10
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    Phytochemical screening and toxicity of Crambe abyssinica Hochst extracts on Solanum lycopersicum L., Euphorbia heterophylla L., Bidens pilosa L. and Glycine max (L.) Merril
    EDUFU - Editora da Universidade Federal de Uberlandia ; 2019
    In:  Bioscience Journal Vol. 35, No. 5 ( 2019-08-19)
    Details
    In: Bioscience Journal, EDUFU - Editora da Universidade Federal de Uberlandia, Vol. 35, No. 5 ( 2019-08-19)
    Abstract: This study aimed to identify the main groups of secondary compounds from Crambe abyssinica and evaluate the bioactivity of the hexane, ethyl acetate and methanol extracts on the seed germination and seedling development of tomato, wild poinsettia, hairy beggartick and soybean. The phytochemical screening considered the presence or absence of total saponins, triterpenoids, flavonoids, coumarins, tannins, phenols and alkaloids. In the seeds it was evaluated: germination percentage, germination velocity index, average germination time, index of allelopathic effects, shoot and root length and seedlings dry matter. In the phytochemical screening it was observed that each solvent extracted different compounds. Flavonoids were found only in the ethyl acetate extract and saponin only in the methanol extract. A high allelopathic effect of hexane, ethyl acetate and methanolic extracts of crambe on the bio-indicator species tomato was observed. The hexane and ethyl acetate extracts also showed inhibitory effect on the weed hairy beggartick and did not present negative effects on soybean. There is the possibility of isolating the bio-active compounds of crambe and use them as a bio-herbicide to the alternative control of the weed hairy beggartick.
    Type of Medium: Online Resource
    ISSN: 1981-3163 , 1516-3725
    URL: Article
    DOI: 10.14393/BJ-v35n5a2019-42328
    Language: Unknown
    Publisher: EDUFU - Editora da Universidade Federal de Uberlandia
    Publication Date: 2019
    detail.hit.zdb_id: 2401404-7
    SSG: 12
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