ABSTRACT
Background: COVID-19 infections has sometimes been associated with acute pancreatitis (AP), but the mechanisms of pancreatic injury are not fully understood. Among vaccines against SARS-COV-2 infection, a new technology based on mRNA was first utilized against COVID-19. Here we report 3 cases of AP following administration of mRNA vaccines. Case Report: Three patients (2 women, 1 man;age 84, 47, 20 respectively) were hospitalized in our ward for abdominal pain and nausea. All patients underwent COVID-19 vaccination with mRNA vaccine the same day. Laboratory analysis revealed increased level of lipase and amylase (lipase UI/L 10423,1083,380) consistent with AP diagnosis. No alcohol consumption was referred, no previous AP episodes were reported in all patients. Abdomen US and CT scan don't revealed other causes of AP. All AP observed in our patients were interstitial edematous pancreatitis (IEP), with complete resolution after treatment. The 45 years-old patient received the booster dose of vaccine without problems. At this moment the other 2 patients didn't underwent a new vaccination. Conclusions: At our best knowledge, in literature 4 cases (3 women, 1 man) reporting AP following mRNA vaccines, 3 IEP and 1 necrotizing pancreatitis, were described. In their case-report, Ozaka et al supposed an immune-mediated mechanism based on molecular mimicry, leading to pancreatic injury. More data are needed to better define the correlation between the two events and the possible mechanisms involved.
ABSTRACT
Background: SARS-CoV-2 infection is a respiratory pandemic illness whose linking with thromboembolic complications has been underlined. Sometimes, stroke can be a complication in CoViD- 19 patients. Description of the case: A 62-year-old male came to our attention after a week of asthenia, fever, nausea, dry cough;no cardiovascular risk factors nor other diseases were reported in his clinical history. An RT-PCR test for SARS-CoV-2 was positive. A chest X-Ray showed bilateral pneumonia with widespread interstitial involvement. He was immediately treated with dexamethasone, low molecular weight heparin and oxygen therapy. Because of desaturation (pO2 38.2 mmHg) non-invasive ventilation - CPAP was started, associated to prone positioning. After two days of initial good response with NIV, the patient was found unresponsive with respiratory acidosis (pH 7.25, pCO2 69 mmHg). He was then intubated and centralised to the Intensive Care Unit;there, trying to extubate the patient because of the respiratory improvement, he was still unresponsive. A brain CT scan found multiple supra and subtentorial strokes, even involving the encephalic trunk, with secondary hydrocephalus. An epiaortic CT angio scan showed occlusion of carotid siphons, vertebral arteries and Willis' polygon. The patient, unresponsive with mydriasis and areflexic, tetraplegic, was diagnosed with cerebral death. Conclusions: Thromboembolic complications in SARS-CoV-2 interstitial pneumonia, even in patients without comorbidities or cardiovascular risk factors, can result as strokes with high morbidity and mortality.
ABSTRACT
Background and Aim of the study: The trial aims to investigatethe development of SARS-Cov-2 pandemic in the area of DestraSecchia of Mantuan 'Oltrepò', a district comprising 13 municipalities with about 45.000 inhabitants, with low population density.In the area there are also several nursing home and one hospital,with the characteristics of first level emergency and urgent care.Materials e Methods: After a demographic survey, we consideredthe general mortality data, from January 1st to April 15th 2020,comparing it with the average of the years 2015/19. We evaluatethe onset of the disease in the area, with temporal, topographicaland demographic criteria. We studied the event in the hospital,analyzing hospitalizations for COVID-19, from February 21st toApril 21th 2020, detecting the specific characteristics of patientsand their outcomes.Results: During the all period the increase in the general mortalitywas 39.5% with a slight prevalence in men and in the old age. 313patients were counted on the territory, with a prevalence of women,of whom 58 died. Lethality was 18.5%. Among the 233 hospitalizations, there were 60 deaths with a prevalence of men. The moreadvanced ages and the presence of comorbidities, in particular thenumber of associated comorbidities and the presence of heart disease, have all conditioned the poor prognosis (p<0.05). Conclusions: The trial allowed to know the temporal evolution ofthe phenomenon in the Destra Secchia district, showing an increased mortality, especially in the older age and in multi-comorbid patients.