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Italian Journal of Medicine ; 16(SUPPL 1):75, 2022.
Article in English | EMBASE | ID: covidwho-1913174


Introduction and Purpose of the study: The sensitivity of genomic tests to identify SARS-CoV2 is around 65-75%. It is very common to find clinical and radiological pictures suggestive of infection but with a negative nasopharyngeal swab. The aim of our study was to use BAL fibrobronchoscopy in subjects with negative swab but with clinical and radiological signs suggesting SARS-CoV2 infection. Materials and Methods: 52 subjects admitted to the observation area (gray area) Covid of the F. Miulli Hospital in 2020 were examined. All had negative nasopharyngeal swab (even in several determinations), also performed on sputum, but a clinical and radiological picture (Ground Glass Opacity with or without consolidations) suggestive of infection. In all subjects a fibrobronchoscopy with BAL was performed with the microbiological research also of bacteria and other viruses (pneumo plus film array). The examination was performed about 10 days after the onset of symptoms. Results: The BAL allowed microbiological diagnosis (Covid and non-Covid) in 30.8% of cases, while the positivity rate for SARSCoV 2 was 11.5%. Conclusions: Our data shows that the negativity of BAL in the search for the SARS-CoV 2 virus agrees with the outcome of the nasopharyngeal and sputum swab (89.5%), highlighting 11.5% of positive subjects. However, BAL negativity does not exclude SARS-CoV2 etiology, especially in typical radiological cases. The time interval between the onset of infection and BAL may have allowed the clearance of the virus.

Italian Journal of Medicine ; 14(SUPPL 2):116, 2020.
Article in English | EMBASE | ID: covidwho-984798


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.

Italian Journal of Medicine ; 14(SUPPL 2):116, 2020.
Article in English | EMBASE | ID: covidwho-984746


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.

Italian Journal of Medicine ; 14(SUPPL 2):123, 2020.
Article in English | EMBASE | ID: covidwho-984570


Background and Aim of the study: As of 17 June 2020, Italy had237.828 cases of SARS-CoV-2 infections, with about 35.000deaths;median age of cases 61 years, median age of deceased81 years. A single-center observational cohort study was conducted to evaluate clinical features, laboratory characteristicscomparing two groups of subjects by age (>75 and <75 years)admitted in the sub-intensive therapy of the COVID Unit HospitalF. Miulli (Acquaviva delle Fonti, Bari, Italy) from 17 march to 17may 2020.Materials and Methods: The data contained in the medicalrecords were studied.Results: A total of 174 patients hospitalized (60.4% males),mean age 68 yrs, with diagnosis of SARS-CoV2, were analyzed;they were divided into two groups >75 years and <75 years (110pts and 64 pts respectively). The group of older subjects had ahigher prevalence of comorbility (heart, kidney failure, COPD);mortality was more significant in subjects >75 years (37.3% vs 0.9%)compared to young people. No difference was observed in thelength of stay (21 days on average), while the younger subjectswere treated with hydroxychloroquine more than the elderly(83.6% vs 40.6% respectively) as well as with lopinavir / ritonavir(39.4% vs 14.5%).Conclusions: Our data, although referring to a small sample ofsubjects, show that patients over 75 years of age are more fragile(die more), have better comorbidities and have been under treatedcompared to younger subjects.