Discharge from the emergency department and early hospital revaluation in patients with COVID-19 pneumonia: a prospective study.

OBJECTIVE: The national health systems are currently facing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. We assessed the efficacy of outpatient management for patients with SARS-CoV-2 related pneumonia at risk of progression after discharge from the emergency department. METHODS: This was a single-center prospective study. We enrolled patients with confirmed SARS-CoV-2 pneumonia, without hypoxemic respiratory failure, and at least one of the following: age ≥ 65 years or the presence of relevant comorbidities or pneumonia extension > 25% on high resolution computed tomography. Patients with pneumonia extension > 50% were excluded. An ambulatory visit was performed after at least 48 hours, when patients were either discharged, admitted, or deferred for a further visit. As a control, we evaluated a comparable historical cohort of hospitalized patients. RESULTS: A total of 84 patients were enrolled (51 male patients; mean age, 62.8 years). Two-thirds of the patients had at least one comorbidity and 41.6% had a lung involvement > 25% on high resolution computed tomography; the mean duration of symptoms was 8.0 ± 3.0 days, and the mean PaO2/FiO2 ratio was 357.5 ± 38.6. At the end of the follow-up period, 69 patients had been discharged, and 15 were hospitalized (mean stay of 6 days). Older age and higher National Early Warning Score 2 were significant predictors of hospitalization at the first follow-up visit. One hospitalized patient died of septic shock. In the control group, the mean hospital stay was 8 days. CONCLUSION: Adopting a "discharge and early revaluation" strategy appears to be safe, feasible, and may optimize hospital resources during the SARS-CoV-2 pandemic.

Heart rate variability in cluster headache.

Eight patients with cluster headache were studied by evaluating the heart rate variability on the basis of 24-hour ECG monitoring performed during attacks (critic periods) to demonstrate if any imbalance of the autonomic nervous system was present and to determine its temporal correlation, if any, with the attack. The same monitoring allowed us to compare the patients' data during headache-free periods (intercritic periods) with those of normal controls. Our investigation demonstrated a severe sympathovagal imbalance during spontaneous attacks: the parasympathetic drive is at once increased at the onset with a mild reduction of the sympathetic drive, and all these modifications slowly disappear at the end of each attack. Comparison of the average low-frequency and high-frequency values during intercritic periods showed a significant reduction in the low-frequency values in patients, even when the low-frequency/high-frequency ratio was normal. This is highly suggestive of the presence of an autonomic nervous system dysfunction.

Salmonella enteritidis pericarditis: case report and review of the literature.

A 65-year-old male patient with primary idiopathic dermatomyositis and on regular immunosuppressive therapy was admitted to our Department for fever and dyspnea. A diagnosis of hemorrhagic Salmonella enteritidis pericarditis was made. Treatment necessitated aggressive medical/surgical supervision. A review of the pertinent literature revealed that during the last decade Salmonella enteritidis has been identified as the most frequent agent of pericarditis caused by Salmonella species apart from Salmonella typhi. This, possibly as a consequence of the widespread contamination of poultry foods by this Salmonella species and/or owing to a possible peculiar affinity of Salmonella enteritidis to the pericardium.

Favorable response to high-dose interferon-alpha in idiopathic hypereosinophilic syndrome with restrictive cardiomyopathy--case report and literature review.

The idiopathic hypereosinophilic syndrome is characterized by a prolonged overproduction of eosinophils of unknown cause in addition to specific organ damage due to eosinophil-derivated protein toxicity. Its prognosis is correlated with heart involvement that results in a restrictive cardiomyopathy. This is frequently biventricular. Isolated left ventricular infiltration has rarely been reported. The authors report a case of idiopathic hypereosinophilic syndrome with cardiac involvement obliterating the left ventricular cavity with a favorable clinical outcome following a combination therapy with interferon-alpha, hydroxyurea and prednisone. Data from other studies dealing with the treatment of idiopathic hypereosinophilic syndrome with interferon-alpha are reviewed and discussed.