An Update of Carbazole Treatment Strategies for COVID-19 Infection

The Coronavirus disease 2019 (COVID-19) outbreak was declared by the World Health Organization (WHO) in March 2020 to be a pandemic and many drugs used at the beginning proved useless in fighting the infection. Lately, there has been approval of some new generation drugs for the clinical treatment of severe or critical COVID-19 infections. Nevertheless, more drugs are required to reduce the pandemic's impact. Several treatment approaches for COVID-19 were employed since the beginning of the pandemic, such as immunomodulatory, antiviral, anti-inflammatory, antimicrobial agents, and again corticosteroids, angiotensin II receptor blockers, and bradykinin B2 receptor antagonists, but many of them were proven ineffective in targeting the virus. So, the identification of drugs to be used effectively for treatment of COVID-19 is strongly needed. It is aimed in this review to collect the information so far known about the COVID-19 studies and treatments. Moreover, the observations reported in this review about carbazoles as a treatment can signify a potentially useful clinical application;various drugs that can be introduced into the therapeutic equipment to fight COVID-19 or their molecules can be used as the basis for designing new antivirals. © 2023 by the authors.

Lung Ultrasound and High-Resolution Computed Tomography in Suspected COVID-19 Patients Admitted to the Emergency Department: A Comparison

Objective: To analyze the diagnostic accuracy of lung ultrasonography (LUS) and high-resolution computed tomography (HRCT), to detect COVID-19. Materials and Methods: This study recruited all patients admitted to the emergency medicine unit, due to a suspected COVID-19 infection, during the first wave of the COVID-19 pandemic. These patients also who underwent a standardized LUS examination and a chest HRCT. The signs detected by both LUS and HRCT were reported, as well as the sensitivity, specificity, positive predictive value, and negative predictive value for LUS and HRCT. Results: This cohort included 159 patients, 101 (63%) were diagnosed with COVID-19. COVID-19 patients showed more often confluent subpleural consolidations and parenchymal consolidations in lower lung regions of LUS. They also had "ground glass” opacities and "crazy paving” on HRCT, while pleural effusion and pulmonary consolidations were more common in non-COVID-19 patients. LUS had a sensitivity of 0.97 (95% CI 0.92–0.99) and a specificity of 0.24 (95% CI 0.07–0.5) for COVID-19 lung infections. HRCT abnormalities resulted in a 0.98 sensitivity (95% CI 0.92–0.99) and 0.1 specificity (95% CI 0.04–0.23) for COVID-19 lung infections. Conclusion: In this cohort, LUS proved to be a noninvasive, diagnostic tool with high sensitivity for lung abnormalities that were likewise detected by HRCT. Furthermore, LUS, despite its lower specificity, has a high sensitivity for COVID-19, which could prove to be as effective as HRCT in excluding a COVID-19 lung infection.

OVERSTITCH SUTURE OF PARIETAL DEFECTS AFTER ESD AND EFTR IS FEASIBLE, SAFE AND REDUCE THE NEED FOR HOSPITALIZATION

Background and aim: Endoscopic submucosal dissection (ESD) and endoscopic full thickness resection (EFTR) are recognized as valid advanced techniques for the treatment of pre-neoplastic/neoplastic lesions of the gastrointestinal tract. However, complication rate and need of hospitalization still remain a matter of discussion. The application of suturing devices have been suggested as an option to prevent complications and reduce hospital stay. The aim of our study was to analyse the feasibility and safety of Overstitch suturing devices applied after large and deep ESD/EFTR. The secondary aim was to evaluate the efficacy of suturing system to reduce hospital stay and complication rate. Materials and methods: From September 2020 to November 2021 (in Covid-19 pandemic era) all consecutive patients sutured with Apollo SX Overstich after complex resection were prospectively enrolled. Feasibility, complications, hospital stay were analyzed. Results: Fourteen patients(6 female, mean 79 +-8 yo) were enrolled;lesions were located in the stomach (3), in the rectum (7), in the sigmoid colon (2), in the descending colon (2). Final diagnosis were 10 HGD/T1 (sm1) and 4 lesions T1 (sm2/3) or T2 colo-rectal cancer. Eight patients were treated with ESD as outpatients whereas 4 underwent eFTR as inpatients with uneventful medium hospital stay of 4.7 days (range 4-6). Overstich suture was feasible in all the lesions, and all locations. No major complications occurred. One minor complications (colonic luminal stenosis) occurred and was successfully treated with temporaray placement of covered metal stent. (Figure Presented) Conclusions: Endoscopic overstitch system is safe and a useful tool to close large wall defect after ESD/EFTR.

FIRST, SECOND AND THIRD COVID-19 PANDEMIC WAVES AND THEIR DIFFERENT IMPACTS ON STROKE CARE: EVIDENCES FROM THE TUSCANY STROKE NETWORK

Background and aims: We aim at describing the impact of the first, second and third waves of the COVID-19 pandemic on stroke services in Tuscany. We measured the global impact of the COVID-19 pandemic on the volumes of both intracranial hemmorhage (ICH) and acute ischemic stroke (AIS) hospitalizations, as well as of reperfusion treatments throughout the pandemic years 2020-21 (January1, 2020 -June 30, 2021) compared with the year 2019 control period. Methods: Retrospective, observational, multicenter study, across 3 huband- spoke stroke systems, and 22 stroke hospitals. The diagnoses were identified by their ICD-9 CM codes and/or classifications in stroke databases at participating centers. Results: In comparison with the same periods of 2019, the hospitalization volumes for ICHs and for AIS declined by 26% and 30.1% respectively during the fist pandemic wave, by 11% and 24.6% during the second wave, and by 2.5% and 4% during the third wave. Reperfusion treatments decreased by 15% during the first wave, and by 11.4% and 0.3% during the second and third waves respectively. Treated patients' functional outcome at 90days did not vary throughout the pandemic waves. Casefatality at 30days increased from 10.3% to 10.8% for AIS, and from 26.5% to 27.6% for ICH before and after the COVID-19 outbreak. Conclusions: The COVID-19 pandemic waves were associated with a decreasing decline in the volume of stroke hospitalizations, nevertheless fewer and probably the most severe patients were able to reach the hospital within the therapeutic windows. We observed different pattern of variations across the three hub-and-spoke systems.

Encephalitis during first year of SARS-COV-2 pandemic– first results of the European ENCOVID registry

Background and aims: Objective: Several preclinical and clinical investigations have argued for nervous system involvement in SARS-CoV-2 infection. No data about clinical, imaging and biomarkers presentations as well as long-term outcomes are available for SARS-CoV-2 encephalitis in comparison with infectious and autoimmune encephalitis. Methods: The ENCOVID European registry included patients with probable or definite diagnosis of encephalitis with and without SARS-CoV-2 infection admitted for hospitalization in the European recruiting centers between February 1st 2020 and March 30th, 2021. Each patient underwent a standardized assessment including full infectious screening, CSF, EEG, MRI data. Clinical presentation and laboratory markers, severity of COVID-19 disease, response to treatment and outcomes were recorded. Results: Results – Out of 155 cases screened, forty-five cases of encephalitis positive for SARS-CoV-2 infection and 63 without COVID-19 with full available data were included. SARS-CoV-2 encephalitis exhibited common presentation with aphasia and dysarthria compared to non-COVID- encephalitis and exhibited higher prevalence of patients with normal MRI but mild hyperproteinorracchia/pleocytosis. Most SARS-CoV-2 cases appeared during the onset of COVID-19 and exhibited different response to treatment and long-term outcomes compared to non COVID encephalitis. Conclusions: Conclusions –The registry identified a wide spectrum of encephalitis associated with COVID19 infection, with clinical characteristics and course different from classical infectious and autoimmune encephalitis. Biomarkers studies are warranted in order to evaluate the specific inflammatory pathways associated with SARS-Cov-2 encephalitis.

The role of the SARS-COV 2 pandemic on the delay of diagnosis in a case of multiple myeloma associated with AL amyloidosis in HIV-HBV positive patient on antiretroviral treatment

COVID-19 has devastated healthcare systems all over the world and is still raging in Italy. In many countries, patients with chronic illnesses are suffering from delay in diagnostic and treatment management. We report a challenging case of a HIV patient who experienced delay in diagnosis of multiple myeloma due to COVID-19 pandemic restrictions. Global cooperation to ensure equity and responsiveness to local contexts is essential on the difficult path ahead to ending the COVID-19 pandemic, as treatment for one potentially curable disease should not be performed at the expense of another.