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1.
Italian Journal of Medicine ; 16(SUPPL 1):84, 2022.
Article in English | EMBASE | ID: covidwho-1913073

ABSTRACT

Background: It is crucial to differentiate patients affected by COVID-19 from others who only tested positive to SARS-CoV-2 to optimize the treatments. We need to identify respiratory symptoms unrelated to SARS-CoV-2 infection. We report a case of severe cardiogenic dyspnea in a patient admitted for COVID-19. Case Report: A 79-year-old woman with nasal swab positive for SARS-CoV-2 was admitted for dyspnea and asthenia for 2 weeks. At the admission she presented with orthopnea, ankles swelling and oliguria. EKG showed atrial fibrillation and echocardiogram showed diffuse left ventricle hypokinesia, severe reduced ejection fraction, right ventricle normal dimensions and kinesia, not very modular inferior venae cavae, negative femoro popliteal CUS, absence of pericardial effusion, diffuse and homogeneous thoracic pattern B. She started furosemide and dobutamine with strict clinical and ultrasound monitoring. Because of the reduction of dyspnea and an incremented diuresis, dobutamine was stopped in the second day. On day 3 there was a worsening, echocardiogram showing a severe aortic stenosis, very small inferior venae cavea. Liquid infusion was started with caution to increase preload. Once obtained hemodynamic stabilization, the patient underwent coronary angiography. No coronary lesions were found and TAVI was performed successfully. Conclusions: The patient experimented respiratory symptoms due to acute heart failure. Dobutamine infusion made manifest a preexisting severe aortic stenosis that was successfully treated.

2.
Italian Journal of Medicine ; 16(SUPPL 1):42-43, 2022.
Article in English | EMBASE | ID: covidwho-1912901

ABSTRACT

Background and Aim of the study: Evidence suggests that most patients who recovered from COVID-19 carry residual respiratory symptoms. Aim of the study was to evaluate blood gas changes in post-COVID-19 patients. Materials and Methods: Hospitalized COVID-19 patients attending the outpatient clinic for post-COVID-19 patients in Magenta (Italy) were included in this retrospective study. They underwent blood draw (for inflammatory biomarkers and arterial blood gas analysis [ABG]) and chest high-resolution computed tomography (HRCT) scan. The primary endpoint was the assessment of blood gas exchanges after 3 months. Other endpoints included assessment of symptoms and chest HRCT scan abnormalities and changes in inflammatory biomarkers after 3 months from hospital discharge. Results: Eighty-eight patients (n=65 men) were included. Admission ABG showed hypoxia and hypocapnia and a PaO2/FiO2 of 271.4 (IQR 238-304.7) mmHg, that greatly improved after 3 months (426.19 [IQR 395.2-461.9] mmHg, p<0.001). Forty percent of patients were hypocapnic after 3 months, while inflammatory biomarkers improved. Fever, resting dyspnea, and cough were common at hospital admission and improved after 3 months, when dyspnea on exertion and arthralgias arose. On chest HRCT scan, more than half of individuals still presented interstitial involvement after 3 months. Conclusions: While inflammatory biomarkers normalized after 3 months, signs of lung damage persisted for a longer period, suggesting the need for an adequate follow-up of post-COVID- 19 patients.

3.
European Respiratory Journal ; 58:3, 2021.
Article in English | Web of Science | ID: covidwho-1700040
4.
Italian Journal of Medicine ; 15(3):51, 2021.
Article in English | EMBASE | ID: covidwho-1567615

ABSTRACT

Background: The most frequent clinical manifestations of CoViD- 19 are related to the respiratory tract. However variable clinical manifestations are often observed ranging from asymptomatic cases to the most serious complications. We report a case showing that the patient's genetic predisposition and comorbidities are likely strong influencer of the severity of CoViD-19 extra-pulmonary manifestations. Description of the case: We report a case of Takotsubo cadiomyopathy in a 81-year old woman affected by CoViD-19 without a pre-existing cardiac condition. After 25 days of hospitalization, the patient experimented fever, respiratory insufficiency and acute right lower limb ischaemia requiring urgent amputation. 4 days later, electrocardiogram and ultrasound showed myocardial suffering and kinetics alterations respectively, suggestive for Takotsubo cardiomyopathy. Despite a gradual recovery of ventricular function, patient's lung function worsened, death occurred at day 34. Conclusions: The patient experimented acute lower limb ischaemia as a vascular complication of virus infection, although it was treated with enoxaparin. We demonstrated that there was a prothrombotic predisposition: levels of homocysteine and anticoagulation proteins C and S were reduced. This case highlights a link between prothrombotic predisposition and CoViD-19-associated peripheral arterial disease.

5.
Italian Journal of Medicine ; 14(4):251-252, 2020.
Article in English | Web of Science | ID: covidwho-1022081
6.
Italian Journal of Medicine ; 14(SUPPL 2):117, 2020.
Article in English | EMBASE | ID: covidwho-993789

ABSTRACT

Background and Aims: COVID-19 caused a high influx of patientssuffering from respiratory complications showing a picture of cytokine perturbation with high levels of IL-6. Anti-IL6 drugstocilizumab and sarilumab are under investigation to understandtheir effectiveness.Materials and Methods: We retrospectively collected data about112 consecutive hospitalized in our center:50 (IL6 group) treatedwith tocilizumab or sarilumab and 62 treated with the standardof care (CONTROL group), with the aim to determine whether antiIL6 drugs are effective in improving prognosis and reducing hospitalization times and mortality. Results: To date 84% of IL6 group patients have been dischargedand only 2 are still recovered in Intensive Care. 6 patients died: 3due to severe respiratory failure within a framework of severeARDS, One suffered an acute myocardial infarction and one diedof massive pulmonary thromboembolism. There were no seriousadverse events or infectious complications. Compared to the CONTROL group they showed a lower mortality rate, same complications and days of hospitalization.Conclusions: Anti-IL6 drugs seem to be effective in treatment ofmedium to severe forms of COVID-19 pneumonia reducing the riskof mortality due to multi-organ failure, acting at the systemic leveland reducing inflammation and microvascular complications. However, it is essential to identify the best time for treatment, which,if delayed, is useless and counterproductive. Further studies andongoing clinical trials will help us to better define patients eligibleas candidates for more aggressive intervention.

7.
Italian Journal of Medicine ; 14(SUPPL 2):123-124, 2020.
Article in English | EMBASE | ID: covidwho-984576

ABSTRACT

Background and Aim of the study: To speculate on the role ofCD11/CD18 on inflammation and prothrombotic state inducedby COVID19.Patient sand Results: In a 65-year-old patient affected by COVID19 we studied the expression level of CD11b on peripheralblood CD14+ monocytes. At admission the expression of CD11bwas 8231 MFI (Mean Fluorescence Intensity) units. The patientwas treated with enoxaparin and tocilizumab.CD11b, expressionfell to 4582 MFI units over 7 days. In accordance with this, IL6values were also hyper - expressed (IL6 243,4 pg/mL;L<7pg/mL) while value after 8 days was 18 pg/mL, showing a reduction in value, congruent with the improvement of the patient.Conclusions: Physiological significance of factor X and fibrinogenbinding with activated CD11b/CD18 in vivo, is one of the possiblebridges between inflammation and thrombosis. The role of anti IL6drugs on the expression of CD11bCD/18 on monocytesmacrophages was previously studied in inflammation in atherosclerosis and in myocardial ischemia;our data seems to confirmthe hypothesis that the interaction between CD11b/CD18, endothelial cells platelets, factor X and fibrinogen plays a fundamental role in favoring inflammation and thrombosis. Overproductionof early response proinflammatory results in what has been described as an inflammatory storm. Advances in cytokine biologyand molecular biology have led to the development of novel immunologic approaches to the treatment of COVID19 lung injurythat target the cytokine. Increasing expression of CD11b/CD18induced by COVID19 play a key role in in bridging inflammationand thrombosis.

8.
Italian Journal of Medicine ; 14(SUPPL 2):113, 2020.
Article in English | EMBASE | ID: covidwho-984485

ABSTRACT

Background: Although myocarditis can be a severe cardiac complication of COVID-19 patients, few data are available in the literature about the incidence and clinical significance in patientsaffected by SARS-CoV-2Methods: This study aims to investigate the incidence and theclinical-laboratory features of myocarditis in a cohort of patientshospitalized for COVID-19. We retrospectively evaluated all theconsecutive patients admitted for COVID-19 in our Medicine Department between March 4 to May 20, 2020. Age, sex, in-hospitaldeath, length of stay, comorbidities, serum cardiac markers, interleukin-6, electrocardiogram, echocardiogram and therapy wererecorded. Results: 1169 patients with COVID-19 were included in the studyperiod;no one was excluded. 12 patients (1%) had acute myocarditis;5 (41.7%) were men, mean age was 76 (SD 11.34);length of stay was 38 days on average (SD 8);3 (25%) patientsdied. 8 (66.7%) had a history of cardiac disease;7 (58.33%) patients had other comorbidities like diabetes, chronic obstructivepulmonary disease, or renal insufficiency.Conclusions: COVID-19 patients who experimented myocarditiswere older, had a higher frequency of previous cardiac diseaseand significantly more prolonged hospitalization and a lower valueof interleukin-6 than myocarditis patients without comorbidities.This is suggesting different myocarditis related pathogenetic mechanisms. Further studies, specifically designed on this issue, arewarranted.

9.
Italian Journal of Medicine ; 14(SUPPL 2):109, 2020.
Article in English | EMBASE | ID: covidwho-984231

ABSTRACT

Background: COVID-19, the disease caused by SARS-CoV-2, ischaracterized by multiple lung infiltrates and extensive venous andarterial thromboembolism. Little is known about the natural historyof the disease, so we plan an outpatient clinic to follow COVID-19patients.Materials and Methods: All patients discharged alive who hasdeveloped respiratory insufficiency (i.e., arterial pO2 less than 60mmHg), or have needed mechanical ventilation for at least 72hours, or had lung infiltrates >40% of pulmonary parenchyma waseligible for the study. All those patients were re-evaluated at 1 and3 months after discharge with high-resolution CT (HRCT) of thechest, blood gases, blood chemistry, and Doppler color flow of theinvolved vessels.Results: Between February and May 2020, seventy-one COVID-19 patients were re-evaluated. Of these, with HRCT study, 12(17.14%) had pulmonary fibrosis, 19 (27,14%) had ground-glassopacities and 25 (35%) had multiple lesions;15 (21,43%) wasnormal;52 (73%) had persistent hypocapnia (mean pCO2 35.9;SD 3.26);14 had to start steroid therapy again;all patients hadcomplete vein recanalization at CUS. Conclusions: Our preliminary report showed that an outpatientclinic for patients convalescent from COVID-19 is highly advisableand may result in better knowledge of the natural history of thedisease and may help to clarify which patients will need in prolonged treatment and interventions. Furthermore, we speculatedthat a high incidence of persistent hypocapnia may result frompulmonary venous vessel microthrombosis.

10.
Italian Journal of Medicine ; 14(SUPPL 2):109, 2020.
Article in English | EMBASE | ID: covidwho-984194

ABSTRACT

Background: Most studies on SARS-CoV-2 infection show thatpeople who have recovered from COVID-19 have antibodies to thevirus. No study has evaluated whether the presence of antibodiesto SARS-CoV-2 confers immunity to the infection relapse but however, to date, no human reinfections with SARS-CoV-2 have beenconfirmed.Materials and Methods: In our prospective, multicenter, cohortstudy we investigated within three months all patients, with confirmed COVID-19, discharged from two Hospitals (Legnano andMagenta Hospitals), in an area of Italy severely affected by the infection. Telephone follow-up at 1 and 2 months and clinical contact within 3 months was initiated;demographic, clinical,radiologic and laboratory data were recorded in electronic medicalrecords and updated.Results: Of 1081 patients involved, 804 (74.3%) were discharged alive. For all these patients we obtained follow-up data.In particular we reviewed the signs and symptoms of acute SARSCoV-2 infection, extending our attention also to the skin, the cardio-circulatory system, the gastro-enteric, psychic and nervousapparatus. At 1 and 2 months none has died and none has hadany signs of recurrence of infection at both telephone interviewand clinical visit.Conclusions: We are aware that our follow-up is still short, incomplete and lacking of the immunological data that will be investigated in the next months, but with our clinical observation we thinkwe have confirmed two basic points: the reinfection is very unlikelyand any antibody immunity protects against recurrence, at leastin the short term.

11.
Italian Journal of Medicine ; 14(SUPPL 2):120, 2020.
Article in English | EMBASE | ID: covidwho-984152

ABSTRACT

Background and Aim of the study: Emergence of SARS-CoV-2required enormous effort to control the spread of infection andprotect the most fragile within society. This has generated an hospital focus on the threat of known and emerging infections likelyby loosening some infection control and antimicrobial management policies. The current pandemic appears to result in an increased risk of antibiotic resistance. Many patients receiveantibiotics to keep secondary bacterial infections under controland for the need to perform invasive procedures. The stressful conditions to which staff are subjected may reduce the effectivenessof antimicrobial stewardship programs, and the massive use ofteleconsultation may have caused overprescription of antibiotics.Materials and Methods: We assessed the consumption of antibiotics, and the class of antibiotics consumed, also in relation tothe documented positivity of the culture tests,in relation to thechange in the epidemiological situation on March and April 2020compared to the same period of 2019.Results: We have documented only an increased use ofmacrolides and cephalosporins but an overall reduction in the useof antibiotics in 2020 compared to the same period of 2019, evenmore evident if we consider some classes of antibiotics,in particular carbapenems.Conclusions: It is unclear whether the consequences of thesechanges will have a positive or negative net impact on antimicrobial resistance rates;attention must be paid to controlling this pandemic but sustained efforts to address the long-term global threatof antimicrobial resistance should not be overlooked.

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