ABSTRACT
The diagnosis of coronavirus disease 2019 (COVID-19) is made by the detection of viral RNA by polymerase chain reaction on nasopharyngeal swabs. In some patients the test is falsely negative, while other biological samples are positive. The aim of the study is to identify characteristics and prognostic factors for swab negativity in COVID-19 patients with deep aspirate bronchus (BA)-confirmed disease. Multicentric retrospective case-control study of patients admitted for COVID-19 between March and November 2020 in two internal medicine units of the AOU Careggi and in the Internal Medicine of the Hospital of Varese. Were enrolled patients aged =18 years hospitalized for COVID-19 with viral RNA isolation on biological specimen, considering as cases the patients negative to swab but positive to BA. For each case, four controls with positive swab at admission were enrolled. The study included 95 patients, 19 cases and 76 controls. The mean time between symptoms onset and swab was 2.65 +/- 1.9 days in cases, with a statistically significant (P=0.003) difference compared to controls (5.53 +/- 3.0 days). Patients with negative swab had a longer mean length of stay and more frequent adverse outcome than controls. Swabbing within a short time of symptoms onset is a predictor for false negative. Patients with repeated negative swabs have a worse clinical picture with longer hospital stay, greater need for non-invasive ventilation and higher frequency of adverse outcome.
ABSTRACT
Background and Aim: The diagnosis of Covid 19 is made by the detection of viral RNA by PCR on nasopharyngeal swabs. In some patients the test is falsely negative, while other biological samples are positive. The aim of the study is to identify characteristics and prognostic factors for swab negativity in COVID-19 patients with BA-confirmed disease. Materials and Methods: Multicentre retrospective case-control study of patients admitted for COVID-19 between March and November 2020 in two internal medicine units of the AOU Careggi and in the Internal Medicine of the Hospital of Varese. Enrolled patients aged ≥18 years hospitalized for Covid with viral RNA isolation on biological specimen, considering as cases the patients negative to swab but positive to BA. For each case, four swab-positive controls at admission. Results: Included 95 patients, 19 cases and 76 controls. Advanced mean age, male predominance. The mean time between symptoms onset and swab was 2.65±1.9 days in cases, with a statistically significant difference compared to controls (5.53±3.0 days). Longer mean length of stay and more frequent adverse outcome in patients with negative swab than in controls. Conclusions: Swabbing within a short time of symptoms onset is a predictor for false negative. Patients with repeated negative swabs have a worse clinical picture with longer hospital stay, greater need for non-invasive ventilation and higher frequency of adverse outcome.
ABSTRACT
Background: Arterial catheterization is frequently used in the management of critically ill patients, but their use in internal medicine is limited by the lack of monitoring systems and fewer nursing staff. The aim of our study is to demonstrate the safety of arterial catheters in the internal medicine ward. Materials and Methods: We conducted a retrospective cohort study between January 2018 and December 2021 at the Department of Internal Medicine 1 of the AOU Careggi. All patients with arterial catheters were enrolled. Patients with SARS-CoV2 infection were excluded. We conducted a univariate analysis on the association between self-removal of the device and complications. Results: We enrolled 488 patients. Mean age was 74.26±14.85 years. The main site of arterial access was radial artery (84.83%), followed by femoral artery (10.45%). The average length of stay of the device was 6.39±5.01 days, and in 3.48% there was an accidental self-removal of the device. The most frequent complication was mild bleeding (1.6%), followed by infection of the insertion site (0.8%) and distal embolization (0.3%). Delirium occurred in 20.3% of patients, and an association was found between delirium and self-removal of the arterial catheter (p <0.001, OR 5.35, CI 2.05-13-94). However, there was no association between delirium and any complications (p=1.000). Conclusions: arterial catheterization is a low-complication procedure;the internist should acquire this competence to deal with the presence of critically ill patients and the development of subintensive therapy units.
ABSTRACT
Introduction: Rarely, lactic acidosis can be a life-threatening medication side effect. Hence, determining the etiology of lactic acidosis early in patients is necessary to choose the correct therapeutic intervention. Although lactic acidosis as an adverse drug reaction of linezolid is a well-recognized and documented clinical entity. Case Report: A 90-years-old woman was hospitalized for Sars- CoV-2 related pneumonia, due to an increase of CRP, WBC count and appearance of new opacities on chest CT, it has been decided to start an atimicrobial therapy with Linezolid, suspecting an MRSA superinfection. After six doses she presented an episode of consciusness alteration, lethargy and allucinations.The head CT any bleeding or mass effect has been demonstrate, but blood gas analysis showed a significant lactic acid increase and an important HOC3- reduction. After the suspencion of Linezolid lactate rapidly decrease. Conclusions: Several publications demonstrate that linezolid induces lactic acidosis by disrupting crucial mitochondrial functions, rarely with a rapid onset.It is important that internist are aware that linezolid can cause lactic acidosis not only after a long threatment period but also after few somministration, and that often it may mimic a common disease like cerebrovascular accident. In conclusion, linezolid should be suspected in the differential diagnosis if lactic acidosis exists with an uncommon clinical picture.