COVID-19 emergency: from a general hospital to a covid hospital in one week, an Italian experience.

Abstract: Aim of this letter is to describe the reconversion process of our general hospital, in just one week, into a COVID-19 Hospital. The working strategy allowed to quickly find the spaces, identify the working group, reshape the hospital organizational structure, redesign the flows and patient/health workers pathways. The hospital provided for a progressive activation of COVID-19 beds following the philosophy of the intensity of care. The main results were on management, flows, PPE and hygiene areas. Although some problems came out in the beginning, this fast hospital reconversion model may be replicated in the future to face similar epidemic or pandemic outbreaks.

Cardiac involvement in patients with myotonic dystrophy: characteristic features of magnetic resonance imaging.

Structural alterations of the myocardium, such as fibrosis and fatty infiltration, were observed in post-mortem examinations in patients with myotonic dystrophy, a familial multisystem neuromuscular disease with frequent cardiac involvement. To identify structural and anatomical abnormalities of the heart, 14 patients, aged 45 +/- 14 years, belonging to seven families, suffering from myotonic dystrophy were studied. Twelve-lead ECG, high resolution signal-averaged ECG, 24 h Holter monitoring, bidimensional echocardiography and cardiac magnetic resonance (MRI) were performed in all patients. Atrioventricular and/or intraventricular conduction disturbances were present in 11 patients; no major arrhythmias were recorded by Holter monitoring. Ventricular late potentials were present in four patients, absent in eight and not assessed in two (due to left bundle branch block). Echocardiogram showed abnormal findings (left ventricular hypertrophy, mitral valve prolapse, wall motion abnormalities) in eight patients. MRI revealed various cardiac alterations in 11 cases, specifically: left ventricular hypertrophy in seven, right ventricular hypertrophy in two, right ventricular enlargement in six, area of fatty infiltration and fibrosis in the right ventricle in six and in both ventricles in three. Although no clear correlations between the extent of fibro-lipomatous infiltrations and severity of cardiac dysfunction were found, fatty infiltrations were always observed in the most severely diseased patients and were frequently associated with the presence of more advanced conduction disturbances.(ABSTRACT TRUNCATED AT 250 WORDS)

[The behavior of late potentials in myocardial infarct patients undergoing myocardial revascularization]. / Comportamento dei potenziali tardivi in pazienti con infarto miocardico sottoposti a rivascolarizzazione miocardica.

Ventricular late potentials recorded on the body surface in patients with old myocardial infarction (MI) are considered to reflect slow conduction, due to the presence in the infarct border zone of viable myocardium within scarred tissue. To assess the prevalence of late potentials in a population with old MI and no malignant arrhythmias and to verify whether myocardial revascularization may influence the substrate responsible for the occurrence of late potentials, 80 patients with old MI (75 males, 5 females), aged 55 +/- 9 years, undergoing coronary surgery, were studied. A Marquette MAC15 HiRes electrocardiogram recorder was used to identify late potentials before and after surgery. Late potentials were defined following the most accepted criteria reported in the literature. Statistical analysis was performed using logistic regression to determine the association of several clinical, hemodynamic and surgical variables with the presence of late potentials. Late potentials were present in 28 patients (35%) before surgery and disappeared in 11 (39%) after surgery. Inferior MI and female sex were the only independent predictors of the presence of preoperative late potentials. On the other hand, persistence of late potentials after surgery was related to the presence of inferior MI and left ventricle aneurysm. These data suggest that revascularization is capable of abolishing late potentials, probably due to functional recovery of perinecrotic hibernated myocardium. With particular anatomic conditions (inferior MI, aneurysm), this functional recovery seems not to be sufficient for the disappearance of late potentials.