Public health and clinical approach to proactive Prevalence of symptoms-based diagnosis of mild SARS-CoV-2 infection in southern Tuscany

Background

To date, it is unknown how many Italians have had or have a mild SARS-CoV-2 infection, because of the lack of epidemiological studies involving the general population.

Study design

Aim of this study was to investigate the prevalence/incidence of a symptoms-based mild SARS-CoV-2 infection in southern Tuscany, by using an online survey.

Methods

An anonymous random middle-aged sample of 3,460 individuals completed the survey. A symptom-score ≥5, calculated on 195 patients with RT-PCR COVID-19 disease (sensitivity/specificity of 0.815/0.780 respectively) was used for the diagnosis.

Results

This cut-off highlighted that 12.3% of all the population might have had a SARS-CoV-2 infection, while 3.9% of them might have it at the time of the survey. Female sex (OR=1.334 [1.029-1.728]; p=0.030), obesity status (OR=1.961 [1.304-2.949]; p=0.001), asthma (OR=2.035 [1.433-2.890]; p=0.0001), autoim-mune diseases (OR=2.103 [1.381-3.201]; p=0.001), were all risk factors for showing mild SARS-CoV-2 infection. Instead, the elderly had a low probability to develop mild forms of the disease (OR=0.984 [0.975-0.994]; p=0.001).

Conclusion

A remarkable number of subjects in Southern Tuscany may have already had a mild SARS-CoV-2 infection. Symptoms scores might be used to screen subjects with a suspected infection. Female sex, obesity, asthma, autoimmune diseases may be factors linked with mild forms of COVID-19 disease.

Repair of giant hernias using more prosthesis

Giant incisional hernias with total loss of substance are an ominous pathological condition characterized by massive depletion of muscular and fascial tissue, by complete loss of the anatomical and physiological function of the abdominal wall and by severe respiratory and visceral involvement. Over a 10-year period we operated 270 patients with voluminous incisional hernias, 12 of which had a total loss of substance. There was no intraoperative mortality. One patient died of myocardial infarction on the fifth and one died of intestinal occlusion and peritonitis the 11th postoperative day. Early postoperative complications occurred in only one patient who had skin necrosis with an infection at the polypropylene mesh. This was successfully treated with systemic antibiotic therapy and topical medication of the wound. There was also one minor recurrence over the pubis 1 year after the operation that required a new operation to replace the mesh. No respiratory complications occurred and all patients were normally active. The good results reported in our series encourage us to continue in this direction even though these patients are at high risk.

[Complicated extremely large hernias. The technical problems]

The surgical repair of giant hernias is a serious problem. To return the viscera that are contained within the hernia sac, to the abdominal cavity, we can cause an increase of abdominal pressure, that influences the motion of the diaphragm. In fact, post-operative acute respiratory failure is always possible, in these patients. To have a good operation, the preoperative preparation by physiotherapy is very important, it helps the patient to utilize at most his pulmonary capacity. In the surgical repair of these cases, it is necessary to increase the volume of the abdominal cavity by some different techniques, in order that the intra-abdominal pressure does not increase too much. The reabsorbable prosthesis is placed in direct contact with viscera and fixed to the peritoneum and posterior rectus sheaths, so that it allows to increase the volume of the abdominal cavity. Dacron mesh is fixed to fascia and muscles and assures a long-time contentitive function. To choose the right operation depends on every single case, so the techniques are different and they often can not be codified. In the text there are described three complicated cases and the surgical repair that has been used. The last case describes a personal techniques that uses two prosthesis to create a new peritoneal cavity and a new pre-peritoneal space. The results obtained let us say that the surgery which has a functional base and the alloplastic prostheses have permitted to operate some clinical cases very difficult.

[Strain gauges for measuring the tension at the site of sutures. Use of the original instrument with a personal technic]

The Authors have developed an instrumentation suitable for suture line tension measuring during plastic operations for large incisional hernias. A full description is given of the measuring technique and of the original instrumentation, including two steel bars called "fachiri" and an electric measuring system with strain gauges. With the employment of this technique, relaxing incisions of the muscle aponeurosis can be reduced to the minimum. Being the suture line tension one of the most important causes of relapsing, the Authors believe that this technique provides a sure advantage for the long term results of plastic operations.