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Background: The long-term effects of COVID-19, which can vary significantly in type and timing, are considered relevant and impacting on the well-being of individuals. The present study aims to assess the incidence of outpatient care in the post-acute phase of SARS-CoV-2 infection in two Italian regions., Methods: The study has a multicentre, population-based, pre-post, repeated measures design to compare the incidence rate of access to outpatient visits and diagnostics before and after SARS-CoV-2 infection, considering a follow-up of 24 months. The study made use of previously recorded large-scale healthcare data available in the administrative databases of the Emilia-Romagna (E-R) and Veneto regions. Analyses were carried out separately in the two regions and results were pooled using random effects meta-analysis., Results: There were 27,140 subjects in E-R and 22,876 in Veneto who were included in the analysis. The pooled outputs showed an increase in rates of outpatient visits and diagnostics starting from month 2 after SARS-CoV-2 infection (IRR = 1.68, 95% CI = 1.56-1.81) with a peak at month 4 (IRR = 2.05, 95% CI = 1.95-2.15); the increase continued with reduced intensity up to month 15. Stratified analysis revealed that subjects with severe acute COVID-19 had a higher increase in rates (up to IRR = 3.96, 95% CI = 2.89-5.44), as well as patients with no comorbidities (up to IRR = 2.71, 95% CI = 2.60-2.83)., Conclusion: Long-term effects of COVID-19 include an increase in the healthcare burden especially in the first months after the acute infection. The increased demand for resources can last up to two years after infection in particular subgroups of patients such as subjects admitted to hospital during the acute phase due to the severe presentation of the disease., Competing Interests: Declarations. Ethics approval and consent to participate: This study involving human participants was reviewed and approved by Comitato Etico Area Vasta Emilia Nord (on 8-th February 2022), Comitato Etico Area Vasta Emilia Centro (on 19-th January 2022), and Comitato Etico della Romagna (on 18-th February 2022) for the E-R cohort, and by Comitato Etico per la Sperimentazione Clinica delle Province di Verona e Rovigo (on 21-st July 2021) for the Veneto Cohort. Written informed consent was not provided because this study was considered an exemption to Art. 14 of the General Data Protection Regulation (GDPR), due to the disproportionate effort to provide the information to data subjects about the existence of the study processing operation and that personal (health) data were processed for scientific purposes. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: A major limitation of current predictive prognostic models in patients with COVID-19 is the heterogeneity of population in terms of disease stage and duration. This study aims at identifying a panel of clinical and laboratory parameters that at day-5 of symptoms onset could predict disease progression in hospitalized patients with COVID-19., Methods: Prospective cohort study on hospitalized adult patients with COVID-19. Patient-level epidemiological, clinical, and laboratory data were collected at fixed time-points: day 5, 10, and 15 from symptoms onset. COVID-19 progression was defined as in-hospital death and/or transfer to ICU and/or respiratory failure (PaO 2 /FiO 2 ratio < 200) within day-11 of symptoms onset. Multivariate regression was performed to identify predictors of COVID-19 progression. A model assessed at day-5 of symptoms onset including male sex, age > 65 years, dyspnoea, cardiovascular disease, and at least three abnormal laboratory parameters among CRP (> 80 U/L), ALT (> 40 U/L), NLR (> 4.5), LDH (> 250 U/L), and CK (> 80 U/L) was proposed. Discrimination power was assessed by computing area under the receiver operating characteristic (AUC) values., Results: A total of 235 patients with COVID-19 were prospectively included in a 3-month period. The majority of patients were male (148, 63%) and the mean age was 71 (SD 15.9). One hundred and ninety patients (81%) suffered from at least one underlying illness, most frequently cardiovascular disease (47%), neurological/psychiatric disorders (35%), and diabetes (21%). Among them 88 (37%) experienced COVID-19 progression. The proposed model showed an AUC of 0.73 (95% CI 0.66-0.81) for predicting disease progression by day-11., Conclusion: An easy-to-use panel of laboratory/clinical parameters computed at day-5 of symptoms onset predicts, with fair discrimination ability, COVID-19 progression. Assessment of these features at day-5 of symptoms onset could facilitate clinicians' decision making. The model can also play a role as a tool to increase homogeneity of population in clinical trials on COVID-19 treatment in hospitalized patients., (© 2021. The Author(s).)

Background: In recent years, Nocardia farcinica has been reported to be an increasingly frequent cause of localized and disseminated infections in the immunocompromised patient. However, recent literature is limited. We report a case of left thigh phlegmon caused by N. farcinica that occurred in a patient with leprosy undergoing treatment with prednisone for leprosy reaction., Case Presentation: We describe the case of left thigh phlegmon caused by Nocardia farcinica in a 54-year-old Italian man affected by multi-bacillary leprosy. The patient had worked in South America for 11 years. Seven months after his return to Italy, he was diagnosed with leprosy and started multi-drug antibiotic therapy plus thalidomide and steroids. Then, during therapy with rifampicin monthly, minocycline 100 mg daily, moxifloxacin 400 mg daily, and prednisone (the latter to treat type 2 leprosy reaction), the patient complained of high fever associated with erythema, swelling, and pain in the left thigh. Therefore, he was admitted to our hospital with the clinical suspicion of cellulitis. Ultrasound examination and Magnetic Resonance Imaging showed left thigh phlegmon. He was treated with drainage and antibiotic therapy (meropenem and vancomycin replaced by daptomycin). The responsible organism, Nocardia farcinica, was identified by 16S rRNA sequencing in the purulent fluid taken out by aspiration. The patient continued treatment with intravenous trimethoprim/sulfamethoxazole and imipenem followed by oral trimethoprim/sulfamethoxazole and moxifloxacin. A whole-body computed tomography did not reveal dissemination to other organs like the lung or brain.The patient was discharged after complete remission. Oral therapy with trimethoprim/sulfamethoxazole, moxifloxacin, rifampicin monthly, clofazimine and thalidomide was prescribed to be taken at home. One month after discharge from the hospital the patient is in good clinical condition with complete resolution of the phlegmon., Conclusion: N. farcinica is a rare infectious agent that mainly affects immunocompromised patients. Presentation of phlegmon only without disseminated infection is unusual, even in these kinds of patients. In any case, a higher index of suspicion is needed, as diagnosis can easily be missed due to the absence of characteristic symptoms and the several difficulties usually encountered in identifying the pathogen.