BAL sensitivity and specificity in interstitial pneumonia

Introduction and Purpose of the study: The sensitivity of genomic tests to identify SARS-CoV2 is around 65-75%. It is very common to find clinical and radiological pictures suggestive of infection but with a negative nasopharyngeal swab. The aim of our study was to use BAL fibrobronchoscopy in subjects with negative swab but with clinical and radiological signs suggesting SARS-CoV2 infection. Materials and Methods: 52 subjects admitted to the observation area (gray area) Covid of the F. Miulli Hospital in 2020 were examined. All had negative nasopharyngeal swab (even in several determinations), also performed on sputum, but a clinical and radiological picture (Ground Glass Opacity with or without consolidations) suggestive of infection. In all subjects a fibrobronchoscopy with BAL was performed with the microbiological research also of bacteria and other viruses (pneumo plus film array). The examination was performed about 10 days after the onset of symptoms. Results: The BAL allowed microbiological diagnosis (Covid and non-Covid) in 30.8% of cases, while the positivity rate for SARSCoV 2 was 11.5%. Conclusions: Our data shows that the negativity of BAL in the search for the SARS-CoV 2 virus agrees with the outcome of the nasopharyngeal and sputum swab (89.5%), highlighting 11.5% of positive subjects. However, BAL negativity does not exclude SARS-CoV2 etiology, especially in typical radiological cases. The time interval between the onset of infection and BAL may have allowed the clearance of the virus.

Impact of the COVID-19 pandemic on the health activities of a hospital

Introduction: In 2020, the Covid-19 pandemic exploded in our country. Many hospitals have been dedicated to the care of Covid+patients with the consequent closure of ordinary wards. The F. Miulli hospital allocated approximately 200 places out of a total of 600 to Covid patients in 2020. 529 were the subjects hospitalized in the Covid area in 2020. Purpose of the study: Evaluate the impact of pandemic on access to the emergency room, hospital admissions and surgical interventions. Materials and Methods: The number of healthcare services (hospitalization from the emergency room and outpatient services) of the F. Miulli Hospital (Acquaviva delle Fonti, BA) in the years 2020/2021 were compared, through a retrospective analysis. Results: In 2020 21,207 subjects were hospitalized against 22,887 in 2021 (-1,680). Outpatient day service activity decreased by 7,817 (-40%) visits in 2020, while NHS outpatient activity decreased by 244,466 visits, equal to 24% of the total. Elective surgeries fell by 15%. Conclusions: The impact of the pandemic has led to a significant reduction in welfare benefits for the entire population. Also, in our area, the reduction in outpatient visits and surgical interventions has led to a significant increase in waiting lists. In addition, the screening programs for oncological diseases (6% reduction in 2020) requires a new schedule for the recovery of visits and for the management of planned assistance to the population.

16-months post-discharge outcome in a cohort of confirmed COVID-19 subjects

Background: Little is known about the long-term re-hospitalization of patients with confirmed infection by SARS CoV 2 discharged from hospital. Aim: The aim of our retrospective cohort study was to identify death and re-hospitalization outcomes in a 16-month follow-up in a population of subjects already hospitalized for Covid-19. Materials and Methods: The study was conducted in the metropolitan area of Bari (population: 472,385 inhabitants) by examining the patients hospitalized from 17/03/2020 to 28/05/2021 at the Covid Unit of the F. Miulli hospital in Acquaviva delle Fonti. Results: 1238 patients (754 males, 60.9%, median 70 years) were hospitalized in Covid Unit: 1060 (85.6%) (M 60.1% median 71 years) were hospitalized in non-intensive wards, while 178 (14.4%) (M 65.7%, median 69 aa), passed through the IT. At follow-up, 922 subjects were still alive;66 deceased (7.2% of the total, 37.8% males, median 80 years). Analyzing only the data of patients residing in the metropolitan area, where the hospital is the reference, 780 patients discharged alive were examined. Of these, 11.2% were rehospitalized at least once, 30 died (4.3%). Mortality on re-admission to hospital was 17.2%. A third of the re-admissions were unrelated to Covid. Infections, pneumonia and cardiovascular disease were the most represented reason for hospitalization. Conclusions: Data show that at a follow-up of 16 months 92.8% of the subjects were still alive, while 7.2% had died, mainly elderly women. 11.2% of those discharged from the Covid ward have been re-admitted to the hospital at least once.

Severity level and ventilation procedures in COVID-19 patients in a semi-intensive care unit

Introduction and Purpose of the study: SARS-CoV2 infection is characterized by massive involvement of the respiratory system. During the various waves, the patients admitted to the Covid wards presented different degrees of pulmonary involvement and numerous comorbidities. Administration of oxygen therapy was the prevalent measure in almost all subjects. The aim of our study was to verify the level of severity and ventilation procedures in a group of subjects hospitalized for SARS-CoV2 infection. Materials and Methods: 388 subjects admitted to the semi-intensive Covid Unit of the F. Miulli Hospital in 2020 were retrospectively analyzed, by examining the SDOs. The main diagnoses and procedures performed were identified. A severity cluster was identified characterized by death, ventilation and hospitalization in the semi-intensive area (cut off at 14 days). Results: 82 were the deceased (21.1%). The main diagnoses most represented were: 84.2% respiratory failure, 3.3% heart failure, 2.5% pulmonary embolism and 1.5% septicemia. Regarding the procedures, 31.9% underwent C-PAP ventilation, while 0.7% underwent non-invasive mechanical ventilation. 64% of the subjects had a severe degree of disease evidenced by the composite cluster of deaths, ventilation and at least 14 nights in semi-intensive care. Conclusions: Our data shows that in the face of almost all patients with respiratory failure, about one third underwent ventilation procedures (C-PAP and NIV). More than half of the subjects had a severe degree of disease.

Prevalence of HCV in people hospitalized for COVID-19

Introduction: In our country, the percentage of subjects infected with HCV is about 2% of the general population, with a gradient that increases from the North to the South and the islands. The decline in hepatitis C treatments is sensationally evident. The WHO had set the goal of its elimination by 2030, a result made achievable thanks to the new direct-acting antiviral drugs (DAA), which allow the virus to be eradicated in definitively, quickly and without side effects. The pandemic has slowed both screening and treatment. Purpose of the study: Evaluate the prevalence of subjects positive for hepatitis C antigen (HCV +) in all hospitalized for Covid-19. Materials and Methods: 839 subjects admitted to the Covid Unit of the F. Miulli Hospital in Acquaviva delle Fonti were retrospectively assessed. Results: The prevalence of HCV+subjects was 4.7%. No statistically significant differences were found when comparing the main laboratory tests. No difference emerged regarding the outcomes (length of hospitalization and death) which are similar in the two groups. Conclusions: The prevalence of HCV+subjects in the Covid-19 population is double that of the general population. A project is underway in our hospital which provides for the screening of all over 50 year olds hospitalized in order to bring out HCV+subjects and direct them to an outpatient diagnostic confirmation path and any specific eradicating therapy.

Peripheral nervous system affection in SARS-CoV-2 infection: A case of post-CoViD acute inflammatory demyelinating polyradiculoneuropathy with bilateral facial nerve palsy

Background: Peripheral nervous (PNS) system involvement in SARS-CoV-2 infection has been described as a consequence of direct neurotropic invasion or parainfectious autoimmune spinal nerve demyelination in the clinical form of acute inflammatory demyelinating polyraduculoneuropathy (AIDP). Few cases have been described with cranial nerves involvement too. Description of the case: A 62 year-old male patient was admitted in March 2020 to our CoViD Unit in Miulli Hospital in Acquaviva delle Fonti (Bari) for recent onset of cough, fever, with interstitial pneumonia with peripheral and central ground glass opacities and consolidation at lungs CT. Oropharyngeal swab tested positive for SARS-CoV-2. Despite an early clinical and radiological remission, the swab became negative after two months. In May, he came back to our attention for chest pain and fever with echocardiography documenting pericardial effusion;SARS-CoV-2 swab was positive again. Some weeks later, he presented weakness in both legs ascending to arms, with severe fatigue and iporeflexia followed in a few days by bilateral facial palsy. Cerebrospinal fluid (CSF) analysis and electromyography (EMG) were suggestive for AIDP, so we started infusion of human immunoglobulins, with immediate partial recovery followed by complete recovery in a few weeks after rehabilitation. Conclusions: The persistence of SARS-CoV-2 induces an abnormal immunological activation that may result in neurologic issues such as involvement of peripheral nervous system (PNS) with spinal - and in some cases - cranial nerves inflammatory demyelination.

The impact of gender differences on the efficacy/safety of pharmacological therapy in SARS-CoV-2 infection

Background and Aim:We currently do not have a specific therapy for SARS-CoV-2 infection;experimental therapies have been improved with various drugs such as lopinavir/ritonavir, hydroxychloroquine, tocilizumab with controversial data about efficacy. The aim of the study is to highlight any gender differences in the response to the aforementioned therapies. Materials and Methods: Retrospective analysis of 234 patients, 96 F and 138 M, referring to our CoViD UNIT from March 2020 to April 2021, divided into groups based on the administered drug. Results: Lopinavir/ritonavir: in the overall cohort (M+F) the drug reduces the risk of death/ICU admission (p=0.01);this impact on the outcome is not significant in the individual groups M and F when analyzed separately. On the other hand, considering mortality alone, in the collective group this was lower in treated patients, an efficacy figure that does not differ in the two sexes after stratification by gender. Hydroxychloroquine: considering the whole cohort there is a reduced mortality in the treated (p <0.001). The impact of the drug on the risk of death/intensive care admission is comparable in the two sexes. Tocilizumab: the drug does not change the risk of death/ICU admission in the overall group;the subgroup analysis is lacking due to the small number of samples. Conclusions: The gender difference does not show a significant impact on the efficacy of the drugs considered. New studies, on larger cohorts, are needed to confirm or refute these preliminary data.

The antisynthetase syndrome as a diagnostic challenge: A case report

Background: Idiopathic inflammatory myopathies are a heterogeneous group of pathological conditions characterized by muscle inflammation, and sometimes by inflammatory involvement of other organs, such as skin (in dermatomyositis) and lungs (pulmonary interstitial disease). Description of the case: 54-year-old woman, turns to the Emergency Room of Miulli Hospital in March 2021 for worsening dyspnea. In medical history: previous recent SARS-CoV-2 infection. She is admitted to Medicine Unit, where the characteristic signs and symptoms of myositis were objected: myasthenia affecting the proximal muscles, myalgias, plantar desquamation of the feet (climber's foot) and fingers (mechanic's hands), Gottron's papules. There are also: pericardial effusion, signs of pulmonary hypertension on echocardiogram, consolidating pulmonary parenchymal changes with fibrotic evolution on HR chest CT. She is transferred to the Rheumatology Unit of the Policlinico Di Bari to perform specific autoantibody panel (positivity of ANA, anti Jo- 1, anti Ro52), electromyography (signs of myogenic suffering), MRI of the thighs (hypotrophy and adipose replacement of the muscles of the posterior lodge) and muscle biopsy, indicative of muscle inflammation. Therapy with steroid boluses and cyclosporine 5mg/kg/day, shows quick effectiveness, and she is discharged with the diagnosis of antisynthetase syndrome. Conclusions: The diagnosis of antisynthetase syndrome is not always easy, due to the clinical heterogeneity of the disease and the need for specific instrumental and laboratory tests.

Antibody responses after a double dose of SARS-CoV-2 mRNA vaccine

Background and Aim: Vaccination against SARS-CoV-2 started in Italy in January 2021. First, healthcare personnel were vaccinated. Immunization of subjects should lead to a reduction in the clinical manifestations of the disease. Aim of the study was to evaluate the antibody response after the administration of two doses of the BNT162b2 SARS-CoV-2 mRNA vaccine. Materials and Methods: We determined antibody levels at baseline (before second dose of vaccine) and 3 weeks after the second dose of the BNT162b2 SARS-CoV-2 mRNA vaccine in 92 (middle age 44±12 ) health care workers (35 male 38%, and 57 female). Written informed consent was obtained for all study participants. Results: Antibody responses was of 452 U/mL±2744 (median 36, interquartile range 9-99) vs 3154±4389 (median 1957, interquartile range 1242-3238) p<0.001 (average increase of 2702±2554). Excluding 3 cases with baseline value>1000 the response was 63±92 (median 35, interquartile range 8-78) vs 2693±2410 (median 1912, interquartile range 1241-3136) p<0.001 (average increase of 2630±2369). According to multivariate regression analysis: baseline is inversely associated with age (p <0.001) but not with sex (p=0.393);post sampling is inversely associated with age (p=0.003) but not with sex (p=0.653). Conclusions: Our data demonstrate that the antibody response after the administration of two doses of the BNT162b2 SARS-CoV-2 mRNA vaccine was obtained in 100% of the subjects studied. In particular, there is a relationship with age: younger subjects show a more robust response. Gender does not influence extent of response.

Impact of SARS-CoV-2 vaccination on a population of healthcare professionals

Background and Aim: In January 2021, vaccination against CoViD-19 was started in Italy. F. Miulli Regional Hospital, in Acquaviva delle Fonti (BA), has prepared a vaccination plan in order to cover the entire health care population which, starting from January 6, 2021, led to the vaccination of 1,700 subjects. Purpose of the study was to evaluate the impact of SARS-CoV-2 vaccination on healthcare personnel. Primary outcomes were: the number of infections detected after vaccination and hospitalizations for SARS-CoV-2 infection. Materials and Methods: Nasopharyngeal swabs were analyzed with reverse transcription-polymerase chain reaction techniques. Vaccination campaign was carried out in the period January-February 2021. The data were compared according to three periods: time 0: March-April 2020;time 1: October2020-January 2021;time 2 (post vaccine): February-April 2021. Results: The swabs analyzed were respectively: Time 0: 1.077;Time 1: 9.043;Time 2: 4.013. The positive tests and their percentage, relative to the swabs examined in the three times, are: Time 0: 17 cases (1.57%);Time 1: 137 cases (1.51%);Time 2: 15 cases (0.37%). Furthermore, none of the positive subjects at time 2 required hospitalization, compared to 3.2% of hospitalizations which occurred between time 0 and time 1. Conclusions: Vaccination against SARS-CoV-2 resulted in a 75.3% reduction in infections in vaccinated subjects and a 100% reduction in hospitalizations, indicating a high protective effect for both infection and disease expression.

Retrospective analysis of clinical and laboratory findings of a cohort of CoViD-19 patients treated with remdesivir

Background and Aim of the study: CoViD-19 pandemic required to the physicians the necessity to gain effective treatments against this infectious disease;one of the tried drugs is remdesivir. The aim of our study is to analyze clinical and laboratory features of a cohort of CoViD-19 patients treated with remdesivir. Materials and Methods:We evaluated retrospectively data of 22 patients (18 men and 4 women), considering two main items: the trend of inflammation markers (erythrocyte sedimentation rate, Creactive protein, interleukin-6, D-dimers, lymphocyte count, ferritin) and the severity of respiratory failure, comparing data between admission and discharge. Results: At admission, 85,7% of patients showed signs of acute respiratory failure (P/F ratio <300) and needed oxygen therapy but only 9,1% of them had this condition at discharge. Moreover, ESR, CRP and IL-6 levels were high at admission but showed a significant reduction at discharge;lymphocyte count was instead reduced at the beginning of the disease and increased after treatment;no significative variations were observed for D-dimer and ferritin levels. Finally average hospital stay was 4 days lower than the one of the cohort of patients non treated with remdesivir. Conclusions: Our results indicate that patients treated with remdesivir showed a good outcome in terms of respiratory function and reduction of inflammation state. However, a larger cohort of patients and the comparison with control patients are necessary to better investigate potential benefits of remdesivir.

Differences between SARS-CoV-2 pandemic first and second waves: survey on hospitalized CoViD-19 patients

Background and Aim: The CoViD-19 pandemic experienced two main waves: February-June 2020 and October 2020-February 2021 respectively. The F. Miulli Hospital has activated intensive and semi-intensive care, pulmonology and infectious disease departments, for a total of 240 beds. Aim of the study was to evaluate differences between the two waves, in relation to the length of hospitalization and mortality. Materials and Methods: We collected data from 1005 subjects (619 men). Age, gender, length of hospital stay, and deaths were analyzed. Results: In the second wave we found a higher percentage of deaths (25.8 vs 19.4%;p=0.043) and among these a higher prevalence of males (66 vs 44.7%;p=0.007);furthermore, in the subjects hospitalized during the second wave, we observed a lower average age of the deceased (78±13 vs 82±8 years;p=0.019) and a shorter duration of hospitalization (18±13 vs 21±14 days;p=0.004). No significant difference was observed in the prevalence of males, however most affected (62.4% second wave vs 59.1% first wave), and in mean age (69±15 seconds vs 68±18 first wave). Conclusions: The second wave showed greater lethality especially for males and younger subjects. Despite this, the duration of hospitalization was shorter, a condition probably linked to the experience acquired by the health professionals involved in the assistance and to a wider network of local structures capable of welcoming CoViD patients. The impact of the variants on the severity of the disease remains to be assessed.

Health surveillance program for CoViD-19 in hospital

Background and Aim: In February 2020, the pandemic phase of CoViD-19 began in Italy. Healthcare workers were at the forefront of care and were immediately exposed to the risk of infection. Aim of the study was to evaluate the impact of the health surveillance system on the spread of infections in a health population Materials and Methods: The cases of infection in the period February 2020 - February 2021 were examined, compared to the number of molecular swabs performed on the health personnel of the F. Miulli Regional Hospital, in Acquaviva delle Fonti (BA). Results: A total of 14,133 molecular swabs were performed (on average 1,177 per month), finding 169 positive cases (equal to 1.19% of total swabs), on average 14 cases per month. The program included a schedule for performing swabs based on the level of risk of the healthcare staff. The tracking system put in place by the prevention service made it possible to minimize the spread of the infection. In addition, a continuous training program for operators on the use of personal protective equipment has been established, with random checks on correct use. Discussion: The health surveillance system, through the execution of periodic molecular swabs for all staff, together with the constant use of personal protective equipment, has made it possible to minimize the spread of the infection in the population of health workers with considerable benefits also on the safety level of hospitalized patients.

Characteristics and risk factors associated with critical illness in pediatric COVID-19

INTRODUCTION: Little is known regarding the course and severity of pediatric COVID-19. We describe critical illness in pediatric patients with PCR+ SARS-CoV2 infection and identify factors associated with PICU admission and organ dysfunction. METHODS: This is a retrospective chart review of 77 pediatric patients age 1 day to 21 years admitted to two New York City pediatric hospitals within the Northwell Health system between February 1 and April 24, 2020 with PCR+ SARS-CoV-2. Descriptive statistics were used to describe the hospital course and laboratory results and bivariate comparisons were performed on variables to determine differences. RESULTS: Forty-seven patients (61%) were admitted to the general pediatric floor and thirty (39%) to the PICU. The majority (97%, n=68) survived to discharge, 1.3% (n=1) remain admitted, and one (1.3%) died. Of PICU patients, 46.7% experienced significant organ dysfunction (pSOFA>=2) during admission. Patients aged 12 years or greater were more likely to be admitted to a PICU compared to younger patients (p=0.015). Presence of an underlying comorbidity was not associated with need for PICU admission (p=0.23) or organ dysfunction (p=0.87). Initial white blood cell count (WBC), platelet count, and ferritin were not associated with need for PICU admission. Initial C-reactive protein was associated with both need for PICU admission (p=0.005) and presence of organ dysfunction (p=0.001). Initial WBC was associated with organ dysfunction (p=0.034). Presenting thrombocytopenia was associated with organ dysfunction (p=0.003). Common indications for PICU admission included hypoxia (50%), hemodynamic instability (20%), diabetic ketoacidosis (6.7%), mediastinal mass (6.7%), apnea (6.7%), acute chest syndrome (6.7%), and cardiac dysfunction (6.7%). CONCLUSIONS: Need for PICU admission in COVID-19 was associated with age over 12 years and elevated initial CRP. Organ dysfunction was associated with elevated admission CRP and WBC and decreased platelet count. These factors may be useful in determining risk for critical illness and organ dysfunction in pediatric COVID-19.

A case of multisystem inflammatory syndrome and shock after COVID-19 in an adult

INTRODUCTION: We describe a case of a critically ill adult patient with a history of COVID-19 who presents with new cardiomyopathy, fever, and rash. He was successfully treated with IVIg and corticosteroids with immediate and dramatic improvement in cardiac function and fever. We propose the post-COVID-19 inflammatory syndrome affects adults though it has been widely reported in children. METHODS: A 42-year-old male with no known past medical history presented to our hospital with three days of fevers, a diffuse rash, bilateral conjunctivitis, diarrhea, and worsening encephalopathy. On arrival, he was febrile to 105F and hypotensive to 88/61 mmHg despite fluid resuscitation. The patient had no medical history. He was admitted to the medical intensive care unit and treated with norepinephrine for shock and treated with broad spectrum antibiotics. Transthoracic echocardiography showed severely reduced LV systolic function. EKG showed sinus tachycardia at 142BPM without ST-segment abnormality. Labs showed thrombocytopenia, lymphopenia, hyponatremia, and elevated C-reactive protein. He was admitted to our intensive care unit for presumed septic shock requiring norepinephrine. PCR testing for COVID-19 was negative but on day three, the patient reported a history of COVID-19 one month ago. His COVID-19 antibody test was positive. On day four he received 1mg/kg of IVIg, 1mg/kg of intravenous methylprednisolone BID, and 81mg of aspirin daily. This treatment course was based on our children's hospital's protocol for treating children with MIS-C. After 24 hours of treatment, the patient was afebrile and his LV dysfunction and encephalopathy had totally resolved. RESULTS: Several syndromes have been ascribed to COVID-19, including pneumonia, myocardial injury, thrombosis, and renal failure. A separate entity has been described after COVID-19 in children, MIS-C. This syndrome, considered a post-infectious inflammatory state, shares many similarities with Kawasaki Disease and there are several reports of treatment with IVIg and steroids. Our patient was successfully treated using the protocol developed at our children's hospital for MIS-C. A multisystem inflammatory syndrome that mimics KD can occur after COVID-19 in adults. This presumed vasculitis can cause myocardial dysfunction and shock.

Tocilizumab treatment for SARS-CoV2 pneumonia:when and where?

Background and Aim of the study: Intravenous administration ofTocilizumab (TCZ), a monoclonal antibody against interleukin-6(IL-6) receptor, has been proven to be an effective treatment forSars-COV2-associated pneumonia. In our observationalretrospective study we compared different outcomes measures inpatients with different settings and timing of treatment.Materials and Methods: We included patients affected bynasopharyngeal swab-confirmed SARS COV-2 pneumonia whoreceived TCZ treatment admitted to the COVID Unit of F. MiulliHospital (BA), from 16th March to 7th April 2020. Outcomemeasures were pO2/FiO2 ratio (P/F) and CRP serum levels atbaseline and at 6,24 and 48 hours after intravenous administrationof TCZ. We compared patients treated in intensive care unit (ICP)and non-intensive unit (NICP) even with respect to the duration ofthe disease, shorter (SD) or longer (LD) than 16 days.Results: We analyzed 16 patients;mean disease duration 15±5days. At baseline, mean CRP was 14±10 mg/dl and P/F 144±44mmHg. 6 hours after TCZ P/F improved significantly in NICP(p=0.03) but not in ICP, confirmed at 48h (NICP p=0.002, ICPp=0.23). Comparison between SD and LD showed that P/F earlyimproved(24h) only in SD (p=0.03). At 48 h, P/F improved in bothgroups (SD p=0.05, LD p=0.03). CRP decreased both in ICP(p=0.01) and NICP (p=0.04);in regard of timing, only in SDpatients (p=0.002) it decreased significantly.Conclusions: Our real-life experience suggests that TCZadministration is effective when early performed in subjectsadmitted to non-intensive therapy.

Pericardial and neurological localization of persistentSARS-CoV2 infection: The case of a patient with coexistenceof pericarditis and Guillain-Barrè Syndrome

Background: SARS-CoV2 infection is frequently associated withcardiovascular and neurological manifestations, but pericardiumand Peripheral Nervous System (PNS) are rarely involved. Case Report: A 61 year-old man was admitted in March 2020 tothe Covid Unit of Miulli Hospital in Acquaviva delle Fonti (Bari) forfever, cough and oropharyngeal swab positive for SARS-CoV2. Hiscomorbidities were hypertension and obesity. Laboratory testsshowed high levels of inflammatory proteins and the presence ofIgM for Chlamydia. Computed Tomography (CT) documented pneumonia with bilateral peripheral and central ground glass opacitiesand little areas of consolidation. He was treated with hydroxychloroquine, ritonavir and quinolone. Despite an early clinical andradiological remission, the swab became negative after twomonths. In May the patient returned for chest pain and fever.SARS-CoV2 swab resulted positive again. Transthoracic Echocardiography (TTE) documented mild pericardial effusion that reducedafter ibuprofen. In June the patient presented to the EmergencyDepartment for weekness in both legs and arms, severe fatigueand evidence of simmetric iporeflexia. He tested negative forSARS-CoV2. Cerebrospinal Fluid (CSF) and Electromyography(EMG) were diagnostic for Guillain-Barrè Syndrome (GBS), AcuteInflammatory Demyelinating Polyradiculoneuropathy (AIDP) type,so we started infusion of human immunoglobulins. Conclusions: The persistence of SARS-CoV2 viral RNA induces anabnormal immunological activation that may damage pericardiumand Peripheral Nervous System (PNS).

Impact of gender on the immune response in SARS-CoV2infection

Background and Aim of the study: Data on the recent SARS-Cov-2 pandemic show that women have a lower incidence of infectionsand more favorable outcomes. It is not clear whether the sex disparities occur in all age groups and whether it may depend on adifferent immune response. The aim of the study was to verify thedifferences between males (M) and females (F), comparing theimmune response and the outcomes in the two groups.Methods: We studied all SARS-Cov-2 infected patients hospitalized from the 10th of March to 31th of May 2020. At the time ofadmission, in addition to the common laboratory tests and inflammatory parameters (IL6, CRP), we evaluated B and T cells (CD3),helper/suppressor ratio (CD4/CD8), and NK cells (CD56). Results: 152 patients, 91 M (59.8%) were analyzed. The averageage was 68±17 years;the F group was older (76±14 vs 63±16;p <0.001), with a higher percentage of subjects >75 years: 59%vs 27.9% (p <0.001). A higher CD4/CD8 ratio was found in subjects >75 years of age compared to those aged 60-75 (2.3±1.2vs 1.9±1.4;p<0.05) and in F group (2.8±2.3 vs 2.2±1.4;p<0.05). Interestingly, an inverse correlation between IL6 and CD3was found in both sexes, but highly significant in the M group(p<0.001;r-0.48). Finally, a higher number of in-hospital deathswere found in the F group: 23.9% vs 9.9% (p <0.03).Conclusions: SARS-Cov-2 infection affects mainly M subjects,that show an inverse correlation between IL6 and CD3 cells. TheF group over 75 years has a higher CD4 / CD8 ratio and highermortality.

Laboratory characteristics of patients affectedby SARS-CoV2 pneumonia after tocilizumab treatment

Background and Aim of the study: Tocilizumab (TCZ), an IL-6 receptor (IL-6R) blocker, emerged as an effective drug for patientswith severe COVID-19 associated Pneumonia. The aim of this observational retrospective study was to evaluate the laboratory characteristics of patients who received i.v. TCZ treatment. Materials and Methods: We collected serum levels of IL-6, procalcitonin (PCT), C-reactive protein(CRP), D-Dimers and CD4/CD8ratio, to evaluate the systemic inflammatory state, of 16 patientsaffected by nasopharyngeal swab confirmed SARS COV-2 Pneumonia who received TCZ (8 mg/kg once or twice in 12 hours).Blood samples for analysis were collected before and after theadministration.Results: Baseline serum levels of laboratory parameters were:CRP 14±10 mg/dl,IL-6 249±264 pg/dl, D-dimers 1872±1833pg/ml, CD4/CD8 ratio 2,4±1,2, PCT 0,61±0,91 pg/ml. After TCZadministrations we observed a rapid increase of IL-6 serum levelsto 941±1317 pg/dl (p=0,05), CD4/CD8 ratio to 3,1±2,3 (trendp=0,07) while D-Dimers didn't decrease significantly. CRP levels,after the administration, decreased to 6±6 mg/dL(p=0,0002)while PCT levels showed no significant variations.Conclusions: The anti-inflammatory effect of TCZ administrationis suggested by the variations in laboratory characteristic, most ofall represented by a decrease of CRP levels and an increase of IL-6 levels, as a result of the displacement of the interleukin from itsreceptor.