Rapid initiation of antiretroviral therapy (ART) has been proven efficacious and safe, but more investigations are needed to define feasibility of rapid ART approach in real-life settings.We conducted a retrospective, observational study on newly HIVdiagnosed patients referred to our Infectious Diseases Department from September 1st, 2015, to July 31st, 2019. According to the timing of ART initiation, we distinguished 3 groups of patients (rapid, intermediate and late group) and represented the trend of virological response during a 400-days-period. The hazard ratios of each predictor on viral suppression were estimated through the Cox proportional hazard model.The median time from HIV diagnosis to the first medical referral was 15 days and the median time from the first care access to therapy start was 24 days. Among patients, 37.6% started ART within 7 days, 20.6% between 8 and 30 days, and 41.8% after 30 days. Longer time to ART start and higher baseline viral load were associated with a lower probability of viral suppression. After one year, all groups showed a high viral suppression rate (99%). In a high-income setting the rapid ART approach seems useful to accelerate viral suppression which is great over time regardless of ART initiation timing.

Background/Objectives: A recent report by the Italian Ministry of Health showed that a high proportion of Emergency Department (ED) visits exceed the maximum recommended thresholds for both waiting time and overall length of stay. As no overall quantitative data are available on the magnitude, temporal evolution, and underlying drivers of ED performance from Southern Italian regions, we analyzed ED data from the Abruzzo region during the years 2017–2024, and evaluated potential predictors of prolonged waiting and process time. Methods: Official, administrative data from all the regional EDs were collected, and information on personnel, location and organizational change was obtained through a dedicated survey. All analyses were stratified and/or adjusted by triage code, hospital, age and sex. Results: From 2017 to 2024, a total of 3,563,565 accesses were recorded in the 16 regional EDs. From 2021, waiting time for the first visit steadily and progressively increased, reaching an average of 78 min in 2024 (+56.0%), largely exceeding recommended thresholds. The most critical growth was observed for the most severe patients, as mean waiting time for yellow and red admissions peaked at 81 (+100%) and 39 (+290%) minutes (m) in 2024, respectively. The mean process time also substantially increased in post-pandemic years, especially for yellow (from 300 m to 476 m) and red codes (from 330 m to 607 m). The trend was similar for both genders, in all age-classes, and higher in larger hospitals. Multivariable analyses confirmed a significant increase in ED time over the years. Conclusions: These findings indicate critical organizational and clinical issues in the regional emergency care system, requiring immediate action. The Regional Healthcare System recently tried to reduce ED overcrowding with specific plans, the impact of which requires urgent evaluation.

BACKGROUND The effectiveness of telemedicine strategies for the efficient management of chronic diseases has been evaluated by a number of studies, and the most recent umbrella review of meta-analyses on the topic concluded that there is sufficient evidence supporting the use of telehealth for patients with diabetes, hypertension, or heart failure. However, in-depth assessments of the cost-effectiveness of telemedicine are severely lacking. OBJECTIVE This meta-analysis aimed at estimating the Incremental Cost Effectiveness Ratios (ICER) of telemedicine for the management of type II diabetes mellitus, hypertension, and heart failure. METHODS We searched multiple databases for all randomized or quasi-randomized trials (RCTs), which evaluated the cost-effectiveness of telemedicine versus standard care for managing the selected diseases. The outcomes were the ICER per Quality-Adjusted Life Year (QALY), 1 mmHg reduction of systolic blood pressure (SBP), or 1% reduction of glycated hemoglobin (HbA1c), after 12 months of follow-up. Random-effect meta-analyses were run when sufficient data were provided, and weighted ICER means were computed. RESULTS A total of 22 trials were included in the systematic review (10,978 patients): ten on hypertension, all using telemonitoring, six on hearth failure, and six on diabetes, mostly using telephone support. Meta-analyses were possible for two outcomes only, as most trials did not report a measure of dispersion: (1) the summary estimate of ICER per QALY, based upon four trials (1974 patients), was $42,623 (while the weighted mean, based upon 5 trials, was $29,477); (2) the summary estimate of ICER per 1mmHg SBP reduction, based on five studies, was $27 (while the weighted mean was $132, based upon 9 trials). The weighted means of ICER per QALY for hypertension and diabetes were $22,769 and $40,503, respectively. Finally, the weighted mean of ICER per 1% HbA1c reduction was $3546. Some of the estimates were substantially lower when only recent trials were considered. CONCLUSIONS The results support employing telemedicine as a cost-effective strategy to monitor hypertension, heart failure and, depending on the willingness to pay, diabetes. Further RCTs reporting confidence intervals for ICER are required to confirm these findings.

Background/Objectives: There is wide variability in the available estimates on the burden of Long-COVID (LC), both among adults and children. Preliminary evidence suggests that this inconsistency may be due, at least in part, to the adoption of uneven diagnostic criteria, proposed by several international entities during the course of the pandemic, but no comprehensive evaluation has been performed so far to quantify the extent of variation among children. This systematic review and meta-analysis aims to update the available epidemiological estimates of LC among pediatric subjects, and to systematically appraise the degree of variability that can be attributed to the diagnostic criteria adopted. Methods: A systematic literature search identified cohort studies providing data on LC among children and adolescents with a previous SARS-CoV-2 infection. We computed (a) proportion and (b) head-to-head meta-analyses (a) to quantify the pooled rates of LC and LC-related symptoms, and (b) to assess the likelihood of developing LC based upon selected demographic and/or clinical characteristics, respectively. Results: In total, 52 cohort studies and 960,089 subjects were included. The pooled rate of LC was 18.1% (95% CI: 13.1–23.6), ranging from 16.2% to 21.6%, according to NIH or WHO diagnostic criteria, respectively. Fatigue, respiratory and neurological symptoms were most commonly reported by LC patients. Stratified analyses showed that females, adolescents (vs. children), subjects with comorbidities, and those with a previous severe COVID-19 (as compared to asymptomatic primary infections) were more likely to develop LC (all p < 0.05). In contrast, the likelihood of LC onset did not significantly vary between individuals with ≥1 anti-SARS-CoV-2 vaccine dose, versus the unvaccinated (pooled OR: 0.92; 95% CI: 0.61–1.41). Conclusions: Although the available estimates may largely vary depending on the adopted definition, LC affects a meaningful proportion of the pediatric population; as such, common clinical criteria and diagnostic approaches are urgently needed. Moreover, given the relevant methodological heterogeneity and the generally poor-to-fair quality of a large part of the available literature, high-quality studies adopting standardized methodologies are warranted to identify at-risk populations and guide the implementation of targeted follow-up strategies.