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
Purpose Considering the case study presented, the purpose of this paper is to analyse the impact of the pandemic in local services for homeless people. Drawing from the concept of ontological security, it will be discussed how different services' levels of "housing adequacy" shaped remarkably different experiences of the pandemic for homeless people and social workers in terms of health protection and agency. Design/methodology/approach This paper focuses on a case study concerning homeless services for people during the COVID-19 pandemic in the metropolitan and suburban area of Turin, in Northern Italy. In-depth interviews with social workers and participant observation during online meetings of workers from the shelters constitute the empirical data that have been collected during the first wave of the pandemic in Italy. Findings According to the findings, the pandemic showed shelters as unsafe places that reduce homeless people's decision power and separate them from the rest of the citizenship. Instead, Housing First projects emerged as imore inclusive and safermore inclusive and safer spaces, able to enhance people's power over their own lives. The pandemic did not create emerging issues in the homeless services system or discontinuities: rather, it amplified pre-existing problematic aspects. Originality/value The case study presented provides empirical insights to recognise at the political and organisational level the importance of housing as a measure of individual and collective security, calling for an intervention to tackle homelessness in terms of housing policies rather than exclusively social and emergency treatment.