The complexity of immunology: a rare adverse event following a Pfizer-BioNTech vaccine booster shot.

OBJECTIVE: Several mRNA vaccines have been developed to tackle the global pandemic. Despite their remarkable clinical efficacy, they are not devoid of severe short- and long-term adverse events. CASE PRESENTATION: In this paper, we describe a rare delayed adverse event (arterial and venous renal thrombosis with myocardial injury) in an otherwise healthy adult female, which occurred three months after she received a booster shot of Pfizer COVID-19 vaccine.  The patient was successfully treated for subacute renal ischemia with intra-arterial urokinase, and her myocardial injury was diagnosed with imaging (contrast-enhanced thoracic CT and cardiac magnetic resonance) and percutaneous coronary intervention. Deferred post-vaccine myocarditis was diagnosed and resolved with steroid therapy. CONCLUSIONS: In this paper, we report a useful clinical case for the pharmacovigilance database. Although scientific evidence confirms that the benefits of vaccination far outweigh the risk of adverse events, we would like to point out how important watchful observation is in the medium and long term, especially when the subject belongs to a specific risk category.

EUS-GUIDED GALLBLADDER DRAINAGE: A VALUABLE OPTION IN THE COVID-19 ERA

Background and aim: In the beginning of 2020 COVID-19 pandemic rapidly affected every country and overwhelmed many healthcare systems. In 2020 in northern Italy, the first western country to be affected, the prevalence was high and it brought a burden beyond the capacity of hospitals to manage, particularly in intensive care units (ICUs) [1]. This experience has shown that intensive care and ventilator support may be needed for extended durations. Patients experience consequences of severe respiratory illness and post-intensive care illness. Endoscopic procedures, such as endoscopic ultrasound-guided gallbladder transmural drainage (EUSGBD), can reduce surgical interventions, intensive care admissions, and longterm complications. In accordance with Tokyo guidelines, laparoscopic surgical cholecystectomy is the best treatment for acute cholecystitis (AC). Alternatives for high-risk patients must be considered, since morbidity and mortality are not negligible, and the traditional alternative is percutaneous trans-hepatic gallbladder drainage. EUS-GBD is efficient and safe, with a low rate of adverse events. A 2016 systematic review by Anderloni and others that evaluated stent outcomes showed pooled technical and clinical success rates in 98.6% and 94.4% of cases, respectively. Materials and methods: A 54-year-old man who had been admitted to a rehabilitation unit after prolonged ICU hospitalization for severe COVID-19 pneumonia, was referred to the surgical unit for AC and sepsis. Medical therapy could not improve his condition, and he rapidly worsened. Results: Due to his recent ICU admission, further intubation was strongly discouraged. Following multidisciplinary evaluation, he was moved to the endoscopy suite for drainage. EUS-GBD was achieved using a 10x15-mm electrocautery-enhanced lumen-apposing metal stent (Video 1). Up to now his follow-up is regular and after prolonged rehabilitation he can be considered for elective surgery. Conclusions: The patient didn't experience any symptom related to recurrent cholecystitis nor long term complications. EUS-GBD is a valuable option in order to reduce surgical interventions and intensive-care admissions. The Covid-19 pandemic has prompted further use of interventional endoscopic ultrasound as an alternative to surgery.

Eus-guided gallbladder drainage to the rescue in a patient that recovered from covid-19

The COVID-19 pandemic has rapidly affected every country and overwhelmed many healthcare systems. Intensive caretreatment may be needed for extended durations. Patients experience consequences of respiratory illness and post-intensive care illness (1,2). Endoscopic procedures, such as endoscopic ultrasound-guided gallbladder transmural drainage, can reduce surgicalinterventions, intensive-care admissions, and long-term complications (3). EUS-guided gallbladder drainage is efficient and safe, with a low rate of adverse events. A 54-year-old man, recently recovered from severe COVID-19+ pneumonia and still judged unfit for futhher intubation, wastreated by EUS-guided gallbladder drainage for severe acute cholecistytis by a 10x15-mm electrocautery-enhanced lumen-apposing stent.

Geophysical recipe to model the Covid-19 epidemic

A metaheuristic method to perform stochastic inverse modeling of geophysical data is applied to model the diffusion of the Covid-19 epidemic outbreak in Italy and its most impacted regions. We adopted a generalized SEIR epidemiological model to predict quarantined, recovered and death cases in the medium term (30 days). The observed data were extracted from the official national repository and fitted using a Particle Swarm Optimization solver to provide a set of model solutions as probable scenarios. We discuss the effectiveness of policies taken by different regions and how they could have impacted past and future infection scenarios. © 2019 EAGE.