Stroke and pulmonary embolism in moderate CoViD-19

Background: Venous thromboembolism, arterial thrombosis and thrombotic microangiopathy substantially contribute to increased morbidity and mortality in CoViD-19. We report a case of 56-year old man that presented with stroke and was found to have CoViD- 19 pneumonia complicated by pulmonary embolism (PE). Description of the case: A 55-year-old man with history of hypertension presented to the emergency department after a transient loss of consciousness. He was found to have left lateral hemianopia and lower right quadrantanopsia and head CT confirmed bilateral stroke in the posterior cerebral artery territory. MR angiography excluded atherosclerosis/dissection of the vertebral and basilar artery and a positive nasopharingeal swab PCR test revealed SARS-CoV-2 infection. The patient was admitted and ASA 100 mg and enoxaparin 40 mg per day were started. He experienced dry cough and fever and 10 days after admission presented atypical chest pain. CT Angiography revealed multiple confined ground glass opacities with segmental bilateral PE. Therapeutic dose of enoxaparin was started and after 5 days switched to edoxaban 60 mg per day. The patient progressively recovered and a complete work up excluded patent foramen ovale and any other cause predisponing to combined presence of venous and arterial thrombosis Conclusions: CoViD-19 has presented many diagnostic challanges in patients with neurologic and respiratory findings: thromboembolic disease may even be the initial or unique presentation. The early recognition of these phenotipes of the disease play a dramatic role in the CoViD-19 management.

Coronavirus e cronicità, due battaglie da vincere sullo stesso campo (il territorio) e anche con una “nuova” figura (l’infermiere di famiglia e di comunità)

Until just a month ago, it was clear a challange against chronic diseases. It is useless to extend life if you cannot increase the quality, both in a social and more strictly sanitary sense. Today, due to Covid-19, much of the resources and attention are concentrated on the hospital phase. In addition, people make fewer visits, resulting in their health worsening. But if it is in the territory that we must continue “to hold on” for the fight against chronic diseases, it is always in the territory that we can win the “battle” against the infectious emergency, favoring home management as much as possible. Furthermore, it has been shown that patients with obesity-related diseases, such as hypertension, diabetes and cardiovascular disease, have an increased risk of developing complications if affected by Covid-19. But obesity itself can be a risk factor for the development of complications related to the pro-inflammatory state. The problem is that most Healthcare Systems do not consider it a disease and are therefore not focused on its management. At this point the battles against Coronavirus and chronic diseases are faced with widely overlapping tools and organizational models. This document proposes the Chronicity Plan relaunch and the investment in the figure of the family and community nurse. Copyright © FrancoAngeli.