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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.
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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.
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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.
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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.
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Background and Aim of the study: In the course of the epidemic,COVID 19 disease first appeared severely and then with a gradualreduction in symptoms. Aim of the study was to compare the clinical characteristics of patients hospitalized in two different periodsfrom March to May.Materials and Methods: 174 patients, 161 subjects admitted inthe period March 17 / April 17 and 13 subjects admitted in theperiod April 17 / May 17, at the Covid Unit of F. Miulli Hospital inAcquaviva delle Fonti (Ba), were studied.Results: From the comparison of the two periods, there is a clearreduction in hospitalizations (161 vs 13). The number of asymptomatic or mildly complicated patients is significantly greater inthe second group. The rate of patients hospitalized with severepneumonia (19.9%) or ARDS (6.8%) in the first period is higherthan the patients of the second period (7.7% and 0%). In March/ April, 3.1% of patients needed ICU admission while no patientwas admitted to ICU in the past thirty days. The length of stay wasalso significantly higher in the first period (21 ± 8 days vs 8 ± 2days) as well as mortality (14% vs 11%). IL 6, d-dimers and fibrinogen values were lower (but not statistically significant) in theApril / May period.Discussion and Conclusions: Our sample, although of limitedsize, shows a significant difference in the clinical evolution of theCOVID 19 infection in the two study periods. The reduction inlength of stay, severe respiratory failure and mortality indicate alikely attenuation in coronavirus virulence in the last month of thepandemic spread.
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Background and Aim of the study: Tocilizumab (TCZ), a monoclonal antibody against IL-6 receptor, has been recently employedas a treatment for SARS-Cov2-associated pneumonia (COVID),due to the central role of IL-6 on the citokyne-storm associatedhyperinflammatory syndrome. Aim of this observational retrospective study was to evaluate effectiveness and safety of TCZ for thetreatment of COVID.Materials and Methods: We retrospectively evaluated, from 16thMarch 2020 to 7th April 2020, outcomes of 16 patients affected bynasopharyngeal swab-confirmed SARS-COV-2 Pneumonia who received TCZ i.v. treatment (8 mg/kg once or twice in 12 hours). Weevaluated clinical features, Arterial Blood Gas Test (ABG), laboratoryfindings collected at baseline and after consecutive two days. Results: We analyzed 16 patients (M/F: 12/4) with mean age (±SD) 69±9 years and mean disease duration 15±5 days. At baseline, mean CRP level was 14±10 mg/dl and IL-6 249±264 pg/ml.To evaluate respiratory improvement after treatment, we collectedABG data at 6,24 and 48 hours;we observed a rapid improvement of P/F ratio to 165,6±55,4 mmHg (p=0,01). We also observed a significant reduction of CRP levels to 6±6 mg/dl(p=0,0002) and a rapid increase of IL-6 serum levels to941±1317 pg/ml (p=0,05). Clinically we observed a global improvement in ten patients, while six died for infective complications. No adverse event was detected following TCZ administration.Conclusions: In our real-life experience TCZ treatment was effective and safe in a group of patients affected by SARS COV2-associated pneumonia.
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Background and Aim of the study: A novel coronavirus (SARSCoV2) in 2019 has been recognized as the responsible of an interstitial pneumonia characterized by a severe acute respiratorysyndrome initially reported in China with a subsequent pandemicoutbreak. Aim of this observational retrospective cohort study wasto describe the CT findings of this new disease in a cohort of patients treated in our COVID Unit.Materials and Methods: TC scan of 49 patients with naso-pharyngeal swab confirmed SARS CoV2 pneumonia admitted toCOVID Unit of F. Miulli General Hospital from 19th March 2020 to03rd May 2020 were retrospectively analyzed.Results: The cohort included 49 patients (42 males, 86%;7 female, 14%);mean age 63,2 years (SD 14,8). Radiological findings distribution was bilateral in the whole cohort;peripheralinvolvement was constant (n=46 [93%]), in some cases exclusively subpleural (n=10;20%), with pleuric sparing in few cases(n=7, 14%). 2 patients had central distribution of alterations (4%).The great part of the cohort showed mixed (central/periferic) distribution (n=29 [60%]). Radiological phenotypes were: predominant ground-glass (GG) (n=20 [41%]), consolidative (C) (n=3,6%) and mixed pattern (n=23, 47%).Conclusions: SARS-CoV2 is characterized by a wide range of CTfeatures with a frequently mixed presence of ground glass and consolidative with a periferic and central - usually bilateral - distribution. Combining assessment of imaging with clinical and laboratory findings could facilitate early diagnosis of COVID-19.
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Background and Aim of the study: From March 2020 to May2020 we treated 133 SARS-CoV-2 patients in our COVID Unit at'F. Miulli' Hospital, 15 of these were also affected by severe acuterespiratory syndrome that needed CPAP support. The aim of thestudy was to evaluate the clinical features of patients with severerespiratory failure treated with CPAP compared to those with milderone that didn't require it.Materials and Methods: A retrospective observational study on133 patients was performed. Patients have been divided into twogroups: those who needed CPAP (15) and those who didn't (118)to compare comorbidities and the supportive medical therapy.Results: 80% of the patients treated with CPAP were males (age71 ± 12). Only 13% were smokers;the most frequent comorbidities were heart failure (20%) and renal failure (40%);pre-existentrespiratory diseases, high blood pressure and diabetes mellitusdidn't show a significant impact on the respiratory outcome. Comparing the 2 groups we found a significant difference about theprobability to be transferred in Intensive Care Unit, higher in CPAPtreated patients (p 0,034). We also found differences between thetwo groups about the medical therapy support, in particular theuse of diuretics, resulted significantly higher (p 0,002) in CPAPtreated patients.Conclusions: A severe respiratory failure related to COVID 19 ap pears to be more frequently associated with kidney and heart disease rather than pre-existing worst respiratory situation and so requires in association with C-PAP support also a more substantialmedical therapy.