ABSTRACT
Introduction: Thromboembolism is a known phenomenon of coronavirus disease. Patients hospitalized with severe covid-19 demonstrate clinical and laboratory markers compatible with hypercoagulability. Case Report: A 85-old-man with a previous history of hypertension and diabetes. He presented to emergency room afebrile, oriented, cooperative (CGS 15), with cough, dyspnea and hypoxemia (oxygen saturation 88% on room air) requiring non-invasive-ventilation (C-PAP Fi O2 50% PEEP 5). Vital signs were: BP 100/70 mmHg, HR 88 bpm, RR 26/min;ECG: no arrhythmia;PCR for Sars- CoV2 was positive;the ChestX-Ray revealed bilateral consolidations. Laboratory findings at admission: WBC 10.4 K/microL, Neutrophils 9.7 K/microL, Lymphocytes 0,5 K/microL, Platelet Count 306 mm3, D-Dimer 703 ng/ml, CRP 158 mg/L. The patient started therapy with Piperacillin/Tazobactam, LMWH, steroids in addition to standard supportive care and admitted in covid department. On the second day he didn't respond to painful stimulations, neurological examination revealed bilateral babinski, left sides hemiplegia followed by absent corneal and vestibule-ocular reflexes (CGS 4);brain CT-Scan revealed acute large ischemic infarct. Laboratory findings after onset of stroke: WBC 17.6 K/microL, Neutrophils 16.4 K/microL, Lymphocytes 0,3 K/microL, Platelet Count 457 mm3, D-Dimers 7464 ng/ml, CRP 166 mg/L. Conclusions: Systemic inflammation and the potential direct action of the coronavirus may cause endothelial disfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischemic stroke.
ABSTRACT
Premises: The current pandemic period caused an intensification of the psychological difficulties experienced during hospitalization with important consequences on emotional and cognitive area of the patient. Methods: A descriptive analysis of psychological interviews and observation cards was carried out to detect emotional and cognitive reactions during the hospital stay of a sample of 88 patients who were admitted to the U.O. of Internal Medicine - Critical Area of the Garibaldi Hospital. Results: The emotional reactions manifested are mainly anxiety (87.5%) fear (67%) sadness (49%) distrust (25%) anger (9%) and despair (12%). The mood deflected in 39% of patients. The length of hospitalization in 64% ranged from 7 to 14 days, in 21% it was longer than 14 days and in 13% within 7 days with a diagnosis of transient emotional reaction in 86% of patients. The motivations related to emotional reactions were: health conditions, distance from family, inability to meet family members, sense of abandonment, fear of getting infected, changing habits, noises, limitations of personal space, loss of intimacy, undergoing painful or invasive clinical trials, relationships with medical and nursing staff. Conclusions: The pandemic and the resulting limitations may intensify the experience of strong psychophysical stress caused by hospitalization. An appropriate and continuous psychological support may improve the emotional state of the patient and consequently the doctor-patient relationship and compliance, reducing the healing time and the length of hospitalization.