ABSTRACT
Introduction: In Antiphospholipid Syndrome (APS) myocardial tissue can be involved through immune-mediated or thrombotic mechanisms, giving chest pain and increase of myocardial cytolysis markers. This may occur without any signs of myocardial injury at the moment of echocardiography, coronarography and cardiac magnetic resonance (CMR). The aim is to increase the awareness about this life-threating condition.Case summary. We present the case of 26-year-old woman few days after childbirth, affected by APS in anticoagulant therapy with previous deep vein thrombosis and without any other cardiovascular risk factors. She was symptomatic for intermittent chest-epigastric pain, fever and skin livedo reticularis. Lab Tests: TnI 750 ng/L, C-reactive protein 9.6 mg/dL, D-dimer 1693 μg/L;anemia;Antithyroid Antibodies and ANA 1:160 (SSB/LA). Blood cultures and COVID test were negative.Results. Echocardiography showed normal left/right ventricular function, but minimal pericardial effusion was present. Pulmonary Angio-CT revealed small thromboembolic event, ground-glass lungs compatible with hemorrhagic alveolitis.After a few days, the patient presented increased epigastric pain, headache, vomiting up to presenting a comatose state. Thrombotic or hemorrhagic events with cerebral CT and MR were excluded. Total-body CT was negative, except for peri-splenic and recto-uterine pouches.For the increase of TnI up to 4741 ng/L, the patient underwent coronary angiography which demonstrated non-obstructive coronary arteries. The assembled Neuro-Cardio-Rheumatology team suspected a rapidly developing Catastrophic APS which was developing quickly with multi-organ and life-threatening involvement.The patient underwent 4 cycles of plasmapheresis, intravenous human IgG and corticosteroids, with rapid clinical improvement. CMR subsequently demonstrated a small transmural late enhancement area on lateral left ventricle wall.The patient was discharged from the hospital on Day 6 post- therapies.Conclusions. APS may involve more organs, including myocardial tissue with different mechanisms of damage and high mortality rate. The presented case poses a multidisciplinary challenge, because thrombotic multiorgan microangiopathy may be not always diagnosed. Imaging methods such as CMR could be optimized with adenosine stress-CMR. Clinical attention is required among women with APS, to reach early diagnosis of myocardial thrombotic microangiopathy and to establish the best effective treatment.
ABSTRACT
Introduction: Bedside lung ultrasound (LUS) is a useful and noninvasive tool for rapid evaluation of many chest conditions. Following the onset of the COVID-19 pandemic, the use of LUS has become common practice for evaluating lung involvement and for monitoring changes in COVID-19 patients.The prognostic role of LUS in COVID-19 patients has not yet been established. Methods: We retrospectively analysed records from 448 patients (mean age 66,08) with confirmed COVID-19 by nasopharyngeal swab, admitted to our ward of COVID Medicine Unit at Ospedale del Mare in the town of Napoli between March 2020 and May 2021. We performed LUS on all patients with COVID-19 using a 14-zone method (Soldati score from 0 to 42 points) at the admission in COVID Medicine Unit within 3 days from the onset of symptoms.We evaluated the difference in LUS score between the death and survival groups. Results: The mean LUS scores were 30,93±5.01 and 21,53±7.85 in the death group compared with the survival group (weighted mean difference (WMD)=9.51,95% CI=8.20-10.82, P value <0.0001). Conclusions: The LUS score in our COVID- 19 population was associated with mortality. LUS score is important for the risk stratification in COVID-19 patients.
ABSTRACT
Biopharmaceuticals are subjected to very strict purity requirements to be marketed. At the same time, peptides and other biomolecules are industrially synthesized through techniques (e.g., solid-phase synthesis) often leading to the formation of many impurities with molecular characteristics very similar to the target product. Therefore, the purification of these mixtures via preparative chromatography can be very challenging. This typically involves ternary or central-cut separations, characterized by chromatograms where the central peak, corresponding to the target product, exhibits significant overlapping on both sides with impurities slightly more or less adsorbable. In single-column (batch) preparative chromatography, this leads to a typical yield-purity tradeoff, meaning that high purity can be obtained at the cost of low yield and vice versa, with obvious consequences on the overall production costs. This study demonstrates how this limitation can be alleviated using the continuous countercurrent operating mode, conducted on a multicolumn system, as a tool for process intensification. In particular, the Multicolumn Countercurrent Solvent Gradient Purification (MCSGP) process has been applied to the purification of an industrial crude mixture of icatibant, which is a peptidomimetic antagonist of bradykinin B2-receptor that has been recently also considered for the treatment of patients affected by COVID-19 disease. It is shown that MCSGP allows conjugating process simplicity (using only two columns) with a significant improvement in process performance, compared to the corresponding batch process. This includes all process performance parameters: yield, productivity, and buffer consumption for a given purity specification of icatibant.
ABSTRACT
Background and Aim: Our objective was to evaluate the prevalenceof comorbidities in our hospitalized population with COVID-19.Materials and Methods: Forty-two patients (64.29% males,25.71% females;mean age of 70.75 ±13.73 yrs), admitted toour Hospital between March and June 2020, had been identifiedas having laboratory-confirmed 2019-SARS-CoV infection. Results: On admission 83.33% of patients presented with dyspnea, 80.95% with cough and 78.75% with fever. Diarrhea was uncommon (19.05%). Patients were classified according to their BMI(kg/m2) as lean (18.5-25) or affected by grade 1 obesity (25-29.9), grade II obesity (30-34.9) and grade III obesity (= 35). Obesity was present in 50% of cases;grade I 35.71%, gradeII and grade III 11.90% and 2.38%, respectively. Hypertension waspresent in 92.86% of patients, COPD in 54.76%, chronic kidneydisease in 45.24%, ischemic heart disease in 35.71%, diabetesin 33,33%, dementia in 30,95% and atrial fibrillation in 7.14%.On admission to the hospital lymphocytopenia was a frequent laboratory finding (97.62%). The coagulation profile revealed an elevation of fibrinogen (66.67%) and D-dimer (85.71%) levelsdespite a normal PT and APTT. The elevation of the pro BNP levelswas observed in 61.90% and troponin levels were at the sametime elevated in 13.16% of COVID-19 patients. Twelve patients(28.5%) died. Coronary artery disease was found in 70% of them. Conclusions: Comorbidities are common in patients with COVID-19. Although COVID 19 has been initially associated to a respiratory disease, it may involve the cardiovascular system with adramatic impact.