RESUMEN
Syncope is a common clinical presentation, often may remain unexplained. PE is thought to be an uncommon cause of syncope. Hormone therapy (HT) is a known risk factor for thromboembolic disease (TD). The new coronavirus SARS-CoV-2 (COVID-19)pandemic has emerged in China and spread around the world. A higher prevalence of PE has been described in critically ventilated patients with COVID-19 but few data exist on the prevalence of TD in asymptomatic patients. We present a case of insidious development of PE probably promoted by the COVID19 infection. A previously healthy 51 year old female, obese (BMI 34 kg/m2), was admitted to the emergency department for syncope (third generation assays negative for Covid19). She reported HT for 4 months. She was tachypnoic (22 breaths/min), peripheral oxygen (SpO2) was 94% (room air). EKG: sinus tachycardia (137 beats/min) with S1Q3T3 aspect;arterial blood gases: moderate hypoxemia (PaO2 61.2 mmHg). ETT: dilated and hypocontractile right ventricle, D-shape aspect of the IVS, dilated inferior vena cava (23 mm), estimated PAP65 mmHg. We administered parenteral anticoagulant therapy and O2 therapy. We suspected PE, which was confirmed by contrast chest CT;no lung parenchymal involvement was documented.Later, we found RT-PCR assays positive for Covid19. PE should be suspected in all patients with syncope. The prevalence of TD in Covid19 asymptomatic patients is partially studied. Although current guidelines do not recommend the use of thromboprophylaxis in outpatient COVID-19, we believe that each case must be evaluated individually. More studies are needed to evaluate the risk-benefit ratio.
RESUMEN
Introduction: Recent studies have shown that bats are the reservoir hosts of several novel viruses, increasing the interest in bats as potential vectors of zoonotic pathogens. Several studies investigated the presence of infectious agents in bats, but their impact on the individual host and their importance on bat mortality is largely unknown. The aim of this study was to describe the microbiological and histopathological findings in 77 deceased bats belonging to nine European species (families Vespertilionidae and Molossidae). Materials and Methods: Bat carcasses were collected in the Piedmont region (Italy) by the Unconventional Rehabilitation Centre (CANC), Torino University, and submitted to necropsy. Species, age and sex of each bat were recorded. Virological (orthoreovirus, coronavirus, flavivirus, rhabdovirus, poxvirus, kobuvirus) and histopathological examinations were performed on the main organs (liver, spleen, kidney, gut, lung, heart and brain). Results: Traumatic injuries (fractures, haemorrhages, skin lesions;43%) and predation injuries (8.4%) represented the two main causes of death. Regardless of species, age and sex, the pathological examination revealed inflammatory/degenerative lesions mainly involving liver (non-suppurative hepatitis and vacuolar degeneration;20.8%) and lung (bronchopneumonia;29.9%). Coronavirus, flavivirus, rhabdovirus and kobuvirus were not detected. Poxviruses were detected in three lungs, two with pneumonia, and 14.3% of animals were positive for reoviruses. Conclusions: This study demonstrates the importance of inflammatory lesions in bat mortality, and shows that bats can harbour infectious agents. However, there is no evidence that Italian bats may represent a severe risk for human health.