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BACKGROUND AND AIMS Acute kidney injury (AKI) is a common complication in patients affected by coronavirus disease-19 (COVID-19) and its development is associated with high mortality [1]. However, it is also clear that the COVID-19 pandemic has effects on the management of diseases not directly related to COVID-19 [2]. In this study, we investigated the impact of the COVID-19 pandemic on general intrahospital AKI incidence and outcomes. METHOD We performed a retrospective cohort study comparing data on AKI epidemiology and outcomes of patients hospitalized from January 2016 to December 2019 (pre-COVID-19 period) and from January to December 2020 (COVID-19 period, including both SARS-CoV-2 negative and positive patients). AKI was defined and classified by evaluating the kinetics of intra-hospital creatinine (comparing the peak to the minimum serum creatinine level, considered as the basal value) [3]. The prevalence of chronic kidney disease (CKD) (i.e. eGFR 30 days were excluded. RESULTS A total of 51 681 patients during the pre-COVID-19 period and 10 ,062 during the COVID-19 period (9026 SARS-CoV-2 negative and 1036 SARS-CoV-2 positive patients) were analysed. Patients admitted in the COVID-19 period were significantly older, with a higher prevalence of males and a reduced prevalence of chronic conditions. In-hospital AKI incidence was 31.7% during the COVID-19 period (30.5% in SARS-CoV-2 negative patients and 42.2% in SARS-CoV-2 positive ones) as compared with 25.9% during the pre-COVID-19 period (P CONCLUSION Overall, we found that AKI was more common and severe in the COVID-19 period, regardless of SARS-CoV-2 infection, when compared with patients admitted to the same hospital during the four years before the pandemic. So, we provide evidence that the COVID-19 pandemic has changed general in-hospital AKI epidemiology. These findings call attention to the need to adapt the resources dedicated to the prevention and management of the intra-hospital AKI in response to health emergencies.

To evaluate the impact of the Coronavirus Disease-19 (COVID-19) pandemic on the epidemiology of acute kidney injury (AKI) in hospitalized patients, we performed a retrospective cohort study comparing data of patients hospitalized from January 2016 to December 2019 (pre-COVID-19 period) and from January to December 2020 (COVID-19 period, including both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative and positive patients). AKI was classified by evaluating the kinetics of creatinine levels. A total of 51,681 patients during the pre-COVID-19 period and 10,062 during the COVID-19 period (9026 SARS-CoV-2-negative and 1036 SARS-CoV-2-positive) were analyzed. Patients admitted in the COVID-19 period were significantly older, with a higher prevalence of males. In-hospital AKI incidence was 31.7% during the COVID-19 period (30.5% in SARS-CoV-2-negative patients and 42.2% in SARS-CoV-2-positive ones) as compared to 25.9% during the pre-COVID-19 period (p < 0.0001). In the multivariate analysis, AKI development was independently associated with both SARS-CoV-2 infection and admission period. Moreover, evaluating the pre-admission estimated glomerular filtration rate (eGFR) we found that during the COVID-19 period, there was an increase in AKI stage 2–3 incidence both in patients with pre-admission eGFR < 60 mL/min/1.73 m2 and in those with eGFR ≥ 60 mL/min/1.73 m2 (“de novo” AKI). Similarly, clinical outcomes evaluated as intensive care unit admission, length of hospital stay, and mortality were significantly worse in patients admitted in the COVID-19 period. Additionally, in this case, the mortality was independently correlated with the admission during the COVID-19 period and SARS-CoV-2 infection. In conclusion, we found that during the COVID-19 pandemic, in-hospital AKI epidemiology has changed, not only for patients affected by COVID-19. These modifications underline the necessity to rethink AKI management during health emergencies.

Confronting the SARS-CoV-2 outbreak has allowed us to appreciate how efficiently highly-resourced settings can respond to crises. However even such settings are not prepared to deal with the situation, and lessons are only slowly being learnt. There is still an urgent need to accelerate protocols that lead to the implementation of rapid point-of-care diagnostic testing and effective antiviral therapies. In some high-risk populations, such as dialysis patients, where several individuals are treated at the same time in a limited space and overcrowded areas, our objective must be to ensure protection to patients, the healthcare team and the dialysis ward. The difficult Italian experience may help other countries to face the challenges. The experience of the Lombardy underlines the need for gathering and sharing our data to increase our knowledge and support common, initially experience-based, and as soon as possible evidence-based position to face this overwhelming crisis.

). Law 180/1978 resulted from harsh debates thatinvolved many sectors of Italian society, which were held over a period ofmore than 10 years. Enormously different positions were taken on the matter,ranging from severe criticism to enthusiastic acceptance (Jones, Wilkinson, C Mosher, 1982; Palermo, 1991).Even today, a clear and useful evaluation of both the negative and positiveeffects since the approval of Law 180 is quite difficult to attain. This is not onlybecause of the intensely emotional ramifications generated both nationallyand internationally by this attempt for reform, but also because of the method-ological limitations that impede scientific research on this subject (Morosini &Veltro, 1989).We must also consider that Law 180 did not in any way change the preexist-ing set of norms specifically devoted, within the Italian criminal justice system,to mentally ill patients who commit a crime eventually. This lack in the reformhas generated several serious contradictions that are still unresolved. Any so-lution seems problematic, both in terms of management of the psychiatric pa-tient and in terms of guaranteeing public safety.

We report the results of the second self-reported juvenile delinquency survey (ISRD2), carried out in Italy 14 years after the first (ISRD1) survey (Gatti et al., 1994). The second survey differs from the first in some important respects: the questionnaire, which was drawn up by the international coordination group, has partly been changed, the sample surveyed is much larger and has been extended to 15 towns, as opposed to 3 in the first study; in addition, the current sample includes 7th-, 8th-, 9th-and 10th-grade students, while the 1992 sample comprised students from the 9th to the 13th grade. A comparison of the results of the two surveys is, therefore, particularly complex (though not impossible) and, for the moment, will not be considered. It should be pointed out that the mean age of the Italian sample is higher than that of most of the samples examined in the ISRD2 survey. This is because it includes the 10th grade, while the samples considered in the other countries are generally limited to the 7th, 8th and 9th grades. In order to compare the results of the Italian study with those of the other countries, it will therefore be necessary to exclude 10th-grade students from the analysis

Regression of left ventricular hypertrophy in hypertensive dialyzed uremic patients on long-term antihypertensive therapy. There have been no studies of the possibility of reversing the left ventricular hypertrophy (LVH) of chronically hemodialyzed hypertensive uremics (HDH) with long-term antihypertensive therapy. We have measured left ventricular sizes of eight (6 male, 2 female, aged 29 to 61 years) HDH with M-mode echocardiography, before and 12, 18 and 24 months after the start of a combined antihypertensive therapy which included ACE-inhibitors, beta-blockers and calcium-antagonists. Pre-treatment values for mean blood pressure (MBP), 116.6 ± 2.9 mm Hg, end diastolic diameter (EDD), 62.6 ± 6.6 mm, interventricular septum (IVS), 14.2 ± 3.0 mm, and left ventricular mass index (LVMi), 239 ± 61 g/m2, were all significantly higher than those for nine sex- and age-matched hemodialyzed normotensive subjects (HDN) with comparable hemoglobin (Hb) levels. During the antihypertensive treatment, both the systolic and diastolic BP decreased steadily (P = 0.0001; P = 0.0003; ANOVA) and significantly by the third month (P < 0.05; P < 0.01), reaching levels comparable to those of the HDN group after 12 months. At this time the LVMi (204 ± 67) and the IVS (13.1 ± 2.7), although both significantly lower than baseline, were still higher than in the HDN group, while the EDD was similar. After 24 months, however, both the IVS (12.3 ± 3.1) and the LVMi (161 ± 65 ) were no longer different from those of the HDN group. Thus, this study is the first to demonstrate that prolonged antihypertensive therapy with strict blood pressure control is able to considerably reduce the LVH of chronically hemodialyzed uremic patients, indicating the key role of arterial hypertension in inducing pathological growth of the LVM in these subjects.