Home Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
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Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes

  • Noemi Venditti ORCID logo , Giulio Petronio Petronio ORCID logo EMAIL logo , Melania Pinti , Giovanni Cutolo , Laura Pietrangelo ORCID logo , Laura Massini ORCID logo , Irene Magnifico ORCID logo , Marco Alfio Cutuli ORCID logo , Federica Petrone ORCID logo , Stefano Papini ORCID logo , Roberto Di Marco ORCID logo and Graziamaria Corbi ORCID logo
Published/Copyright: October 27, 2023
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Open Medicine
From the journal Open Medicine Volume 18 Issue 1

Abstract

The aim of this retrospective cohort study is to understand if and how much the preventive self-isolation approach might have been a valid model to avoid care-related infection, not only from COVID-19 but also from other non-viral infectious diseases. From March to May 2020, the healthcare and management staff of the Villa Santa Maria long-term care facilities, located in the village of Montenero di Bisaccia (Campobasso, Molise, Italy), decided to carry out a preventive self-isolation plan to safeguard the residents from SARS-CoV-2. The impact on other infectious diseases was evaluated by analyzing the antibiotic therapies prescription trend among the inpatients. Our data showed that although self-isolation protected residents and caregivers from SARS-CoV-2, it can also be associated with mobility reduction, leading to an increase in bedridden pathologies, namely, pressure ulcers and pressure sores. The simultaneous isolation of residents and caregivers in the same location significantly reduced any outside influence as a cause of possible infections.

Keywords: COVID-19/epidemiology; long term care facilities; self-isolation; antibiotic; infection; elderly; hospitalization/statistics; numerical data

1 Introduction

The newly discovered coronavirus is the cause of the infectious disease known as coronavirus disease (COVID-19). The majority of COVID 19 virus-infected individuals will experience mild to moderate respiratory disease and recover without the need for special care [1]. However, the disease has a more severe course in individuals with comorbidities such as hypertension, diabetes, cardiovascular disease, asthma, severe allergies, obesity, and chronic obstructive pulmonary disease [2]. Because of the higher prevalence of these conditions by aging, older adults are particularly affected by SARS-CoV-2, causing a more severe spectrum of clinical manifestations and higher mortality [3,4,5].

A 2020 study conducted by Yang et al. on 1,099 COVID-19 Chinese patients found that 15.1% of the infected subjects were 60 years old and above, and 27.0% presented severe symptoms [6]. This evidence has also been confirmed by in vivo animal studies where SARS-CoV-2 caused severe interstitial pneumonia with an increased viral replication in old monkeys’ lungs compared to young ones [7,8,9,10].

Elderly people who recovered from COVID-19 often experience sarcopenia, malnutrition, depression, and delirium [11]. The psychosocial impact added to the physical symptoms increased COVID-19’s long-term effects (also known as the post-COVID syndrome or Long COVID) [12].

Long-term care facility’s (LTCF) older residents were demonstrably the most at risk of adverse outcomes and mortality during the current pandemic [13].

The increase in mortality risk could be explained by the combination of a higher prevalence of comorbidities, especially chronic conditions, characterized by a low-grade inflammatory status [14,15], and the age-related immune and inflammatory responses decay [16,17]. These changes reduce the effectiveness of viral clearance, leading to an increase in cytokine release that ends with the “cytokine storm” [18]. According to recent immunological research, severe COVID-19 is characterized by an initial inability to inhibit the replication of the virus, followed by an uncontrolled hyperinflammatory response that damages the respiratory epithelium. The excessive production of various anti-viral and pro-inflammatory cytokines and chemokines results in the hyperinflammatory response, which causes immune cell recruitment, lung epithelial damage, microvascular thrombosis and hyperpermeability, as well as systemic inflammation with multiorgan damage [19].

Indeed, the high prevalence of functional and cognitive impairment and behavioral symptoms add to the risk posed to LTCF residents and environments that do not present barriers to infection control [20].

In this scenario, several government agencies (World Health Organization, the Centers for Disease Control, and the British Geriatrics Society) had drafted guidelines and statements concerning the prevention and management of COVID-19 in LTCF [21,22,23].

LTCF in Italy has been particularly affected by the COVID-19 pandemic. De Girolamo et al. [24] indicated that LTCF residents showed higher mortality rates than the community-dwelling elderly population. In addition, the risk of death among residents increased approximately four-fold during the pandemic compared with previous years (2016–2019) [24].

In the pandemic’s early stages, Italy suffered from a shortage of Personal protective equipment (PPE). Specifically, LTCFs were not prioritized in receiving new supplies. Workers and users were not sufficiently protected from the COVID-19 dissemination [25].

Following the outbreak of the global COVID-19 pandemic, from March 20 to 5 May 2020, the healthcare and management staff of the Villa Santa Maria LTCF, located in the village of Montenero di Bisaccia (Campobasso, Molise, Italy), decided to carry out a preventive self-isolation plan to safeguard the facility residents from SARS-CoV-2 infection.

The aim of this retrospective cohort study is to understand if and how much this preventive self-isolation might have been a valid experimental model to avoid care-related infectious episodes, not only from COVID-19 but also from other non-viral infectious diseases. Moreover, the effect of the isolation on antibiotic therapies (ATs) prescription was also checked.

2 Materials and methods

It was a retrospective observational study. The effect of the self-isolation was evaluated by comparing data on diseases and prescribed therapies, from March 20 to May 5, 2020, with those collected during the same period in the previous year (from March 20 to May 5, 2019). The latter group (2019) was used as a control

The study population consisted of the residents living at the LTCF “Villa Santa Maria” during both the 2019- and 2020-time frames under examination.

This report adheres to the consolidated standards for the reporting of longitudinal studies and was written according to the STROBE guidelines for Observational Studies in Epidemiology [26] (see the checklist in the Supporting Information)

At the beginning of the preventive isolation, 95 guests lived at the LTCF “Villa Santa Maria” located in a Southern Italy village, Montenero di Bisaccia (Campobasso, Molise Italy).

The patient care, feeding, and daily routines remained unchanged over the two periods under review, as well as the PPE used by caregivers. During the voluntary isolation period, for both residents and operators, the only change in routine care was the absence of contact with any other outstanding person.

In addition, as recommended by the Italian Ministry of Health, since January 22, 2020, all standard biosecurity measures and precautions have been taken to prevent airborne and contact transmission. In particular, masks, facial protection, non-sterile long-sleeve waterproof gowns, and gloves. In addition, FFP2-masks were used for procedures that might generate aerosols [27].

This is a retrospective observational cohort study from chart review and data have been collected solely from the medical record. As a result, there was no intervention and no interaction with the research subjects. All records were collected anonymously and under current Italian privacy laws (Legislative Decree no. 196 of 2003), with prior approval of the facility management. Ethics approval was not applicable for retrospective observational cohort study from chart review

The ATs, the type of antibiotic, and the pathology for which the AT was prescribed were examined. Moreover, additional information, such as age, existing diseases, use of devices and aids, and pre-existing conditions, were also taken into account to better evaluate the population characteristics.

2.1 Statistical analysis

Statistical analysis was performed by STATA 16 statistics software. Two-tailed p < 0.05 was considered statistically significant for all analyses. Categorical variables were summarized using frequencies and percentages; continuous variables were summarized using means and standard deviations since the distributions were symmetrical. For the univariate analysis, we used χ 2 tests to compare categorical variables between the groups and the Student’s t-test for independent samples to compare continuous variables between the groups.

3 Results

3.1 Study population

At the beginning of the preventive isolation, 95 guests lived at the LTCF. Twenty-four subjects were excluded because they were not present in the same period of the previous year 2019, which represented the term of comparison.

Then, the study population consisted of 71 residents living during both the time frames under examination at the LTCF.

As shown in Table 1, among the 71 subjects, 20 were men (28.17%), and 51 were women (71.83%). The mean age was 85.55 ± 9.94 years, with a median of 87. Only ten subjects were under 80 years old (14.08%), of whom 30% were men, with the remaining 70% being women.

Table 1

Residents attending the LTCF

Total, n (%) 71 (100)
Gender, n (%)
Men 20 (28.17)
Women 51 (71.83)
Age
Mean value ± SD 85.55 ± 9.94
Median 87
Under 80, n (%) 10 (14.08)
Men 3 (30.00)
Women 7 (70.00)
Autonomy in mobility, n (%) 19 (26.76)
Partial dysautonomy in mobility (using aids), n (%) 17 (23.94)
Total dysautonomy in mobility, n (%) 35 (49.29)
Incontinence, n (%) 62 (87.32)
Urinary 26 (41.93)
Uro-fecal 36 (58.06)
Fecal 0 (0.00)
Bladder catheter use, n (%) 14 (19.72)

The residents showed different degrees of self-sufficiency, intended as the capability to ambulate and continence. Thirty-five subjects had total dysautonomia in mobility (49.29%) requiring a wheelchair, while 17 were using walking aids (walkers or crutches), and only 19 subjects were fully independent in walking. Nine subjects were continent, compared to 62 incontinent (87.32%). The latter presented different degrees of incontinence, only urinary 26 (41.93%) and 36 (58.06%) uro-fecal.

Table 2 reports residents’ underlying diseases stratified by use or not of ATs. Sixteen (22.53%) out of the 71 subjects were on AT, i.e., 9 women and 7 men. The most common chronic diseases were grouped by apparatus or system.

Table 2

Residents and related underlying diseases with or without AT

Total AT 2019 No AT 2019 p value
Resident, n (%) 71 (100) 16 (22.54) 55 (77.46)
Gender, n (%) 0.115
Men 20 (28.17) 7 (43.75) 13 (23.64)
Women 51 (71.83) 9 (56.25) 42 (76.36)
Cardiovascular conditions, n (%)
Arterial hypertension 42 (59.15) 9 (56.25) 33 (60.00) 0.788
Cardiopathy 22 (30.98) 4 (25.00) 18 (32.73) 0.556
Arrhythmias including atrial fibrillation 12 (16.90) 2 (12.50) 10 (18.18) 0.594
PMK carriers 2 (2.82) 0 (0.00) 2 (3.64) 0.439
Neurological conditions, n (%)
Cognitive impairment 20 (28.17) 5 (31.25) 15 (27.27) 0.756
Alzheimer’s disease (AD) 3 (4.23) 0 (0.00) 3 (5.45) 0.340
Dementia other than AD 12 (16.90) 3 (18.75) 9 (16.36) 0.823
Depressive-anxious status 9 (12.68) 0 (0.00) 9 (16.36) 0.083
Stroke with hemiparesis and motor aphasia 8 (11.27) 1 (6.25) 7 (12.73) 0.471
Psychiatric conditions 5 (7.04) 0 (0.00) 5 (9.09) 0.211
Parkinson’s disease 3 (4.22) 2 (12.50) 1 (1.82) 0.062
Musculoskeletal conditions, n (%)
Femur Fractures 14 (19.72) 1 (6.25) 13 (23.64) 0.124
Ischial pubic fractures 3 (4.22) 0 (0.00) 3 (5.45) 0.340
Fractures – other sites 2 (2.82) 0 (0.00) 2 (3.64) 0.439
Previous fractures 1 (1.41) 0 (0.00) 1 (1.82) 0.587
Arthrosis 7 (9.86) 4 (25.00) 3 (5.45) 0.021
Sensory conditions, n (%)
Hypoacusis 21 (29.58) 3 (18.75) 18 (32.72) 0.281
Hypovision 5 (7.04) 1 (6.25) 4 (7.27) 0.888
Metabolic conditions, n (%)
Diabetes Mellitus Type II in OHD1 therapy 9 (12.68) 4 (25.00) 5 (9.09) 0.092
Diabetes Mellitus Type II in insulin therapy 3 (4.22) 1 (6.25) 2 (3.64) 0.647
Thyroidopathies 5 (7.04) 1 (6.25) 4 (7.27) 0.888
Oncological conditions, n (%)
Previous pathologies 5 (7.04) 2 (12.50) 3 (5.45) 0.332
Ongoing pathologies 2 (2.82) 0 (0.00) 2 (3.64) 0.439
Disease number, n (%) 0.155
0 disease 1 (1.41) 1 (6.25) 0 (0.00)
1 disease 7 (9.86) 1 (6.25) 6 (10.91)
2 diseases 11 (15.49) 4 (25.00) 7 (12.73)
≥3 diseases 52 (73.24) 10 (62.50) 42 (76.36)

1OHD, Oral Hypoglycemic Drugs.

Data on comorbidity showed that most residents were affected by three or more pre-existing conditions (73.24%; Table 2). No statistically significant differences were found between the groups except for the higher prevalence of arthrosis (p = 0.021) in the AT group.

3.2 Effect of voluntary isolation (2020) on the prevalence of COVID-19 among residents.

During the 46 days voluntary isolation (from March 20 to May 5, 2020) periodic molecular swabs for COVID-19 screening were carried out by the Molise Department of Hygiene and Territorial Prevention on both residents and LTCF staff. No cases of SARS-CoV-2 infection were recorded during this period among the 71 LTCF residents and operators.

3.3 Effect of voluntary isolation (2020) on AT and non-viral infectious diseases

Table 3 shows the number of subjects with acute infections requiring AT during the two study periods. The voluntary isolation did not cause any significant change in the number of subjects requiring AT for bronchitis and cystitis recurrence. On the other hand, there was a reduction in tonsillitis (–2 cases from 2019 to 2020), with an increased number of acute non-previous bedridden conditions, namely, pressure ulcers and pressure sores (Table 3). Overall, a reduction of 31.25% in the number of subjects with acute infections requiring AT during voluntary isolation (2020) was observed.

Table 3

Number of subjects affected by acute infection requiring AT in 2019 and 2020

n (%) 2019 (n = 71) 2020 (n = 71) Change p value
Bronchitis 7 (9.86) 6 (8.45) −1 0.559
Tonsillitis 2 (2.82) 0 (0.00) −2 —
Cystitis 7 (9.86) 1 (1.41) −6 0.739
Pressure ulcers 0 (0.00) 2 (2.82) +2 —
Pressure sores 0 (0.00) 2 (2.82) +2 —
Total acute infections 16 (22.54) 11 (15.49) −5 0.232
Percentual change in number of subjects treated in 2020 vs 2019 −31.25%

The antibiotic types used for the treatment of infectious diseases are shown in Table 4. A comparison of the 2020 data with the same period in the previous year (2019) showed no significant changes in the administration of amoxicillin, ceftriaxone, and ciprofloxacin. In 2019, the most used antibiotic drug was ciprofloxacin, as expected by the higher incidence of bronchitis in this period, while, in 2020, ceftriaxone was more frequently used. Overall, there was a 27.78% decrease in the number of antibiotics used in 2020 compared to 2019 (Table 4).

Table 4

Antibiotic prescription in 2019 and 2020

n (%) 2019 (n = 18) 2020 (n = 13) Change p value
Amoxicillin 4 (22.22) 2 (15.38) −2 0.497
Ceftriaxone 5 (27.78) 5 (38.46) 0 0.862
Ciprofloxacin 7 (38.89) 2 (15.38) −5 0.379
Fosfomycin 1 (5.55) 0 (0.00) −1 —
Thiamphenicol 1 (5.55) 0 (0.00) −1 —
Piperacillin 0 (0.00) 3 (23.08) +3 —
Sulfamethoxazole/trimethoprim 0 (0.00) 1 (7.69) +1 —
Total number of antibiotics used 18 13 −5 0.357
Percentual change in antibiotics prescribed in 2020 vs 2019 −27.78%

AT duration (in days) for the two observation periods was analyzed for each antibiotic prescribed (Table 5). Despite Fosfomycin, thiamphenicol, and sulfamethoxazole/trimethoprim having the lowest mean durations, they were prescribed in only one of the periods studied (2019 for the first two and 2020 for the third, respectively, Table 4). The average days of piperacillin therapy in 2020 were the highest with a mean value of 23.3 ± 11.4 and a median value of 20 days. Regarding the three antibiotics prescribed in both study periods (i.e., amoxicillin, ceftriaxone, and ciprofloxacin), a significant difference was observed only for the latter (p = 0.0308, Table 5). On the other hand, treatment durations with amoxicillin and ceftriaxone remained almost unchanged in both observed periods (p = 0.117 and p = 0.900, respectively, Table 5).

Table 5

AT duration (days) in 2019 and 2020

Year 2019 2020 p value
Fosfomycin, days
Range (min–max), 0–2 —
Mean value +/− SD 2.00 ± 0.00 0 —
Median 2 0
Thiamphenicol, days
Range (min–max) 0–6 —
Mean value +/− SD 6.00 ± 0.00 0 —
Median 6 0
Sulfamethoxazole/trimethoprim, days
Range (min–max) — 0–3
Mean value +/− SD 0 3.00 ± 0.00 —
Median 0 3
Piperacillin, days
Range (min–max) — 14–36 —
Mean value +/− SD 0 23.3 ± 11.4 —
Median 0 20 —
Amoxicillin, days
Range (min–max) 4–8 0–4
Mean value +/− SD 6 ± 1.41 4 ± 0.00 0.117
Median 6 4
Ceftriaxone, days
Range (min–max) 6–12 5–14
Mean value +/− SD 7.6 ± 2.61 7.83 ± 3.25 0.900
Median 6 7
Ciprofloxacin, days
Range (min–max) 5–6 6–16
Mean value +/− SD 5.75 ± 0.46 11 ± 7.07 0.0308
Median 6 11

Finally, the prescribed antibiotics and the pathologies diagnosed in the two study periods were analyzed (Table 6). For amoxicillin, always prescribed in monotherapy, a reduction in case numbers was observed in 2020 compared to 2019. In the first period, this antibiotic was used for bronchitis, cystitis, and tonsillitis treatment (6 cases total), while in the second one, only for two cases of pressure ulcers. Ceftriaxone’s prescription remains unchanged, and it was used for bronchitis treatment. Ciprofloxacin was used in 2019 for five cystitis cases, in four cases in mono and one in poly AT, while in 2020, this drug was adopted in one case of pressure sore in association with other AT. On the other hand, bronchitis treatment with ciprofloxacin remained unchanged in both periods. Fosfomycin and thiamphenicol were prescribed for cystitis and bronchitis, respectively, in 2019 only in association with other antibiotics, as well as piperacillin and sulfamethoxazole/trimethoprim that was prescribed for bronchitis in polytherapy, pressure sores, and cystitis in monotherapy only during 2020.

Table 6

Acute infection requiring AT and antibiotic prescribed in 2019 and 2020

Antibiotic 2019 2020
Acute infection requiring AT Mono/Poly AT Case number Acute infection requiring AT Mono/Poly AT Case number
Amoxicillin Bronchitis Mono 2 Pressure ulcers Mono 2
Cystitis Mono 2
Tonsillitis Mono 2
Ceftriaxone Bronchitis Mono 2 Bronchitis Mono 3
Poly 2
Poly 3
Ciprofloxacin Bronchitis Poly 2 Bronchitis Poly 1
Cystitis Mono 4 Pressure sores Poly 1
Poly 1
Fosfomycin Cystitis Poly 1 —
Thiamphenicol Bronchitis Poly 1 —
Piperacillin — Bronchitis Poly 2
Pressure sores Mono 1
Sulfamethoxazole/trimethoprim — Cystitis Mono 1

4 Discussion

Lockdowns and additional restrictive measures were adopted worldwide to reduce the pandemic impact on healthcare. Containment measures that can reduce the infection spread include isolating infected residents in single rooms and limiting social activities. This latter solution may not be practicable in many LTCFs with limited housing capacity, so the infected are often grouped as an alternative to single isolation [28].

Long-term preventive self-isolation measures implemented in LTCFs during the COVID-19 pandemic can have significant implications for the health and well-being of the residents, although these measures are intended to mitigate the spread of the virus, they can give rise to various health challenges for the elderly population residing in these facilities. The potential long-term effect on residents must be acknowledged and mitigated through a holistic and compassionate approach that considers both physical and mental aspects [29].

Even before the pandemic, the effects of social isolation and loneliness on LTCFs residents were well known, especially for those most at risk. Although it is difficult to assess their impact on residents’ life quality, the introduction of social distancing policies may cause harm to this vulnerable population [30,31].

As expected, COVID-19 mortality increased significantly in LTCFs. In Europe, 30–70% of all deaths occurred among nursing home residents [32]. In 2020, 2 months observational study conducted in an Italian nursing home revealed an increase in mortality of 40%, compared to 6.4% in the previous year [33].

In this scenario, the 46 days of voluntary preventive self-isolation carried out by the health care and management staff of the LTCF “Villa Santa Maria,” protected residents and caregivers from SARS-CoV-2 infection and ensured elderly well-being (social activities and accommodation were not altered).

Special remarks must be made about infectious diseases in older people compared to younger individuals. Indeed, diseases are relatively more frequent and severe due to pre-existing conditions which contribute to increased death rates in the elderly [34]. Among these, advanced age together with cardiovascular, neurological, musculoskeletal, skin lesions, sensory deficits, metabolic, oncological, and respiratory pathologies are the most relevant.

The population under investigation had many risk factors for infection disease: the median age of 87 years, high prevalence of total dysautonomia in mobility (49.29%), and the occurrence of three or more previous diseases (73.24%) were the main ones. According to the literature, the most frequent treatment indications for ATs were Respiratory tract infections (RTIs), Urinary tract infections (UTIs), and Skin and soft tissue infections (SSTIs). On the other hand, the most often prescribed antibiotics were amoxicillin and penicillin-class drugs, cephalosporins, and fluoroquinolones [35,36,37,38]. These data are in agreement with those reported for the study population in both periods (Tables 3 and 4).

Penicillin is often chosen to treat susceptible pathogens infecting lungs, urinary tract, skin and soft tissues, bones and joints, gastrointestinal tract, and inflamed meninges. In 2019, amoxicillin was used in six cases (Table 6). On the other hand, in 2020, the number of prescriptions was reduced by one-third (Table 6). In the same way, the ureidopenicillin piperacillin was prescribed only in 2020 for three cases (Table 6), due to its extended-spectrum activity [39].

Cephalosporins, prescribed for bronchitis in both periods (Table 6), belong to the β-lactam antibiotics with favorable pharmacokinetics, relative safety, efficacy, and a broad antimicrobial spectrum; for these reasons, they are often recommended for the treatment of the infection in the elderly [40]. In an epidemiological survey on the incidence and treatment of Community-acquired pneumonia (CAP) in Italy conducted in 2006 by Viegi et al. among 699 subjects with suspected CAP, cephalosporins were prescribed in more than a quarter of cases (27.1%) [41]. According to the authors, these findings agree with previous epidemiological data showing that third-generation cephalosporins are the most frequent prescriptions in initial antibiotic therapy for community-acquired lower RTI in Italy [42].

Quinolones are helpful in the treatment of complicated UTIs, bacterial prostatitis, SSTIs, pneumonia, malignant otitis externa, and bacterial diarrhea caused by susceptible pathogens [43].

The largest differences in AT duration (days) were observed in this scenario for ciprofloxacin (i.e., from 5.75 ± 0.46 to 11 ± 7.07 days, p 0.0308; Table 5). This increase was due to the treatment of a bronchitis case (16 days) in 2020 (Tables 5 and 6). Along with bronchitis, ciprofloxacin was used to treat cystitis and pressure sores in 2019 and 2020, respectively (Table 6).

Fosfomycin, used for one case of cystitis in 2019 (Table 6), is a broad-spectrum drug with excellent bactericidal activity against Gram-positive and negative microorganisms. It is considered the first-choice oral drug for uncomplicated UTI caused by Gram-negative bacteria [44]. Due to its pharmacokinetic characteristics, dosage adjustments are not required in elderly patients, pregnant patients, or in cases of renal or hepatic insufficiency [45].

Thiamphenicol, prescribed for one case of bronchitis in 2019 (Table 6), is a broad-spectrum bacteriostatic antimicrobial agent indicated against certain Gram-positive cocci, which can exert a bactericidal effect at 2–4 times the minimum inhibitory concentration. Due to its pharmacokinetic properties, it is quickly absorbed orally, parenterally, and by aerosol. One of its derivates, the acetylcysteine glycinate ester, is particularly indicated in the treatment of RTIs with dense or mucopurulent secretions. Indeed, after parenteral or aerosol administration, it is hydrolyzed in the lungs with rapid release of thiamphenicol and N-acetylcysteine (NAC). The mucolytic activity of NAC and its ability to inhibit bacterial adhesion facilitates the removal of secretions and the elimination of pathogens from the epithelial cells of the respiratory tract [46].

Together with Fosfomycin, the trimethoprim/sulfamethoxazole combination, prescribed for one cystitis case in 2020, is most commonly used to treat uncomplicated UTIs. Due to its tolerability, the spectrum of activity against suspected uropathogens and favorable pharmacokinetic profiles make it suitable for administration to the elderly. Indeed, this drug concentrates more in urine rather than serum, ensuring greater efficacy. In addition, the strong action against Gram-negative aerobic strains and limited interference on the anaerobic vaginal and fecal microbiota appears to provide a better long-term outcome [47].

This is the first study providing information on the prevalence of non-viral infectious episodes and their incidence in elderly LTCF residents under ATs by using a self-isolation model. The simultaneous isolation of residents and caregivers in the same location significantly reduced any outside influence as a cause of possible infections. Also, the investigated population, being the same in both periods, ensures the consistency of the two analyzed groups.

Nevertheless, as a retrospective chart review, some limitations regarding sampling must be pointed out. The population was small (only 16 and 11 out of 71 subjects in AT in 2019 and 2020, respectively), and only some medical information was available. Moreover, the unavailability of microbiological characterization did not allow a more in-depth analysis of infection epidemiology in LTCFs

To sum up, the observed infection reduction trend is not significant due to the sample’s small size and the subject’s lower exposure to etiological agents from outside. Even though our data showed that self-isolation could be associated with subject mobility reduction, and increasing bedridden pathologies, namely, pressure ulcers and pressure sores (Table 3), there are also benefits from self-isolation in LTCFs as a preventive measure. These include infection control, protection of residents, prevention of healthcare system overload, and staff transmission [48]. Despite these advantages, there are also some implications and limitations that affect both residents and caregivers, thus implementing self-isolation measures can strain LTCF staff, who may face increased workload and burnout, impacting the quality of care provided to residents. Particular relevance is also the ethical considerations, balancing infection control measures with the rights and well-being of residents raises ethical dilemmas that require careful consideration [49].

Self-isolation measures in LTCFs have the potential to prevent infectious disease outbreaks and protect vulnerable residents. However, these measures also come with a range of implications and limitations, including adverse effects on mental health, cognitive well-being, and quality of life. It is essential for LTCFs to balance infection control efforts with strategies to address the potential negative impacts and ensure the overall well-being of their resident. Therefore, it is essential to balance infection control efforts with strategies to address the potential negative impacts and ensure the overall well-being of their residents.

Finally, more studies should be planned to better evaluate the performance of this model over a more extended period (more than 46 days), recruiting a larger population

belonging to different nursing homes. This would provide a better understanding of the role played by other factors, such as intraindividual variability in different communities and the management of infectious diseases in LTCFs.

# Co-first authors.

Acknowledgements

The authors would like to thank the Montenero di Bisaccia operating unit “Villa Santa Maria” (Istituto Dottrina Cristiana) and its director, Mother Superior Sister Aurora together with the medical director, Dr. Piccirilli, and all the medical staff for providing the clinical data required for the study.

  1. Funding information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  2. Author contributions: Conceptualization: G.P.P., M.P., N.V., G.C, L.P., L.M., I.M., M.A.C., R.D.M., and G.C.; methodology: R.D.M.; software: G.P.P. and G.C.; validation: G.C. and R.D.M; formal analysis: G.C.; investigation: N.V., M.P., and G.C.; data curation: G.P.P., N.V., M.P., and G.C.; writing – original draft preparation: L.P., L.M., I.M., and M.A.C.; writing – review and editing: G.C., R.D.M, N.V., and G.P.P.; supervision: R.D.M.; project administration: R.D.M.; and funding acquisition: R.D.M.; software formal analysis data curation: F.P.; Conceptualization methodology: investigation validation writing – review and editing: SP. All authors have read and agreed to the published version of the manuscript.

  3. Conflict of interest: Roberto Di Marco, and Giulio Petronio Petronio serve as Editors in Open Medicine journal, but it did not affected peer-review process. There is no other conflict of interest.

  4. Data availability statement: The data that support the findings of this study are available from Istituto Dottrina Cristiana (Largo Istituto Dottrina Cristiana, 1, 67100 L’Aquila AQ), U.O. RSD e Casa di Riposo “Villa Santa Maria,” Montenero di Bisaccia (Cb) 86036, Italy, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the medical director, Dr. Piccirilli.

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Received: 2023-07-20
Revised: 2023-09-19
Accepted: 2023-09-19
Published Online: 2023-10-27

© 2023 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  159. Mechanisms by which spinal cord stimulation intervenes in atrial fibrillation: The involvement of the endothelin-1 and nerve growth factor/p75NTR pathways
  160. Analysis of two-gene signatures and related drugs in small-cell lung cancer by bioinformatics
  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
  169. Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia
  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
https://doi.org/10.1515/med-2023-0822
Keywords for this article
COVID-19/epidemiology; long term care facilities; self-isolation; antibiotic; infection; elderly; hospitalization/statistics; numerical data
Creative Commons
BY 4.0

Articles in the same Issue

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  3. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia
  4. circ-IARS depletion inhibits the progression of non-small-cell lung cancer by circ-IARS/miR-1252-5p/HDGF ceRNA pathway
  5. circRNA ITGA7 restrains growth and enhances radiosensitivity by up-regulating SMAD4 in colorectal carcinoma
  6. WDR79 promotes aerobic glycolysis of pancreatic ductal adenocarcinoma (PDAC) by the suppression of SIRT4
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  8. Inhibition of TERC inhibits neural apoptosis and inflammation in spinal cord injury through Akt activation and p-38 inhibition via the miR-34a-5p/XBP-1 axis
  9. 3D-printed polyether-ether-ketone/n-TiO2 composite enhances the cytocompatibility and osteogenic differentiation of MC3T3-E1 cells by downregulating miR-154-5p
  10. Propofol-mediated circ_0000735 downregulation restrains tumor growth by decreasing integrin-β1 expression in non-small cell lung cancer
  11. PVT1/miR-16/CCND1 axis regulates gastric cancer progression
  12. Silencing of circ_002136 sensitizes gastric cancer to paclitaxel by targeting the miR-16-5p/HMGA1 axis
  13. Short-term outcomes after simultaneous gastrectomy plus cholecystectomy in gastric cancer: A pooling up analysis
  14. SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways
  15. Molecular mechanism by which the Notch signaling pathway regulates autophagy in a rat model of pulmonary fibrosis in pigeon breeder’s lung
  16. lncRNA TPT1-AS1 promotes cell migration and invasion in esophageal squamous-cell carcinomas by regulating the miR-26a/HMGA1 axis
  17. SIRT1/APE1 promotes the viability of gastric cancer cells by inhibiting p53 to suppress ferroptosis
  18. Glycoprotein non-metastatic melanoma B interacts with epidermal growth factor receptor to regulate neural stem cell survival and differentiation
  19. Treatments for brain metastases from EGFR/ALK-negative/unselected NSCLC: A network meta-analysis
  20. Association of osteoporosis and skeletal muscle loss with serum type I collagen carboxyl-terminal peptide β glypeptide: A cross-sectional study in elder Chinese population
  21. circ_0000376 knockdown suppresses non-small cell lung cancer cell tumor properties by the miR-545-3p/PDPK1 pathway
  22. Delivery in a vertical birth chair supported by freedom of movement during labor: A randomized control trial
  23. UBE2J1 knockdown promotes cell apoptosis in endometrial cancer via regulating PI3K/AKT and MDM2/p53 signaling
  24. Metabolic resuscitation therapy in critically ill patients with sepsis and septic shock: A pilot prospective randomized controlled trial
  25. Lycopene ameliorates locomotor activity and urinary frequency induced by pelvic venous congestion in rats
  26. UHRF1-induced connexin26 methylation is involved in hearing damage triggered by intermittent hypoxia in neonatal rats
  27. LINC00511 promotes melanoma progression by targeting miR-610/NUCB2
  28. Ultra-high-performance liquid chromatography-tandem mass spectrometry analysis of serum metabolomic characteristics in people with different vitamin D levels
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  30. circ_0014736 induces GPR4 to regulate the biological behaviors of human placental trophoblast cells through miR-942-5p in preeclampsia
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  38. Genetic polymorphisms of MRPS30-DT and NINJ2 may influence lung cancer risk
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  40. Pyroptosis-based risk score predicts prognosis and drug sensitivity in lung adenocarcinoma
  41. Upregulation of lncRNA LANCL1-AS1 inhibits the progression of non-small-cell lung cancer via the miR-3680-3p/GMFG axis
  42. CircRANBP17 modulated KDM1A to regulate neuroblastoma progression by sponging miR-27b-3p
  43. Exosomal miR-93-5p regulated the progression of osteoarthritis by targeting ADAMTS9
  44. Downregulation of RBM17 enhances cisplatin sensitivity and inhibits cell invasion in human hypopharyngeal cancer cells
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  48. A novel long noncoding RNA AC125257.1 facilitates colorectal cancer progression by targeting miR-133a-3p/CASC5 axis
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  52. The dose limits of teeth protection for patients with nasopharyngeal carcinoma undergoing radiotherapy based on the early oral health-related quality of life
  53. miR-30b-5p targeting GRIN2A inhibits hippocampal damage in epilepsy
  54. Long non-coding RNA AL137789.1 promoted malignant biological behaviors and immune escape of pancreatic carcinoma cells
  55. IRF6 and FGF1 polymorphisms in non-syndromic cleft lip with or without cleft palate in the Polish population
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  57. Efficacy of bronchoscopic intratumoral injection of endostar and cisplatin in lung squamous cell carcinoma patients underwent conventional chemoradiotherapy
  58. Silencing of long noncoding RNA MIAT inhibits the viability and proliferation of breast cancer cells by promoting miR-378a-5p expression
  59. AG1024, an IGF-1 receptor inhibitor, ameliorates renal injury in rats with diabetic nephropathy via the SOCS/JAK2/STAT pathway
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  61. Exendin-4 regulates the MAPK and WNT signaling pathways to alleviate the osteogenic inhibition of periodontal ligament stem cells in a high glucose environment
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  67. Knockdown of circ_0005615 enhances the radiosensitivity of colorectal cancer by regulating the miR-665/NOTCH1 axis
  68. Long noncoding RNA Mhrt alleviates angiotensin II-induced cardiac hypertrophy phenotypes by mediating the miR-765/Wnt family member 7B pathway
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  74. miR-2053 inhibits the growth of ovarian cancer cells by downregulating SOX4
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  81. Vitamin D protects intestines from liver cirrhosis-induced inflammation and oxidative stress by inhibiting the TLR4/MyD88/NF-κB signaling pathway
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  83. Genomic analysis of immunogenic cell death-related subtypes for predicting prognosis and immunotherapy outcomes in glioblastoma multiforme
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  91. Overexpression of LINC00607 inhibits cell growth and aggressiveness by regulating the miR-1289/EFNA5 axis in non-small-cell lung cancer
  92. Subjective well-being in informal caregivers during the COVID-19 pandemic
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  94. Unfolded protein response inhibits KAT2B/MLKL-mediated necroptosis of hepatocytes by promoting BMI1 level to ubiquitinate KAT2B
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  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
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  105. Clinical features of varicella-zoster virus caused neurological diseases detected by metagenomic next-generation sequencing
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  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
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  113. Long non-coding RNA GNAS-AS1 knockdown inhibits proliferation and epithelial–mesenchymal transition of lung adenocarcinoma cells via the microRNA-433-3p/Rab3A axis
  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
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  116. Hsa-miR-223-3p participates in the process of anthracycline-induced cardiomyocyte damage by regulating NFIA gene
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  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
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  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
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  129. Effect of RUNX1/FOXP3 axis on apoptosis of T and B lymphocytes and immunosuppression in sepsis
  130. The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity
  131. Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU
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  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
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  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
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  157. LncRNA LINC00592 mediates the promoter methylation of WIF1 to promote the development of bladder cancer
  158. Factors associated with gastrointestinal dysmotility in critically ill patients
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  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
  169. Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia
  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
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