COVID 19: a clue from innate immunity.

The recent COVID-19 pandemic has had a significant impact on our lives and has rapidly expanded to reach more than 4 million cases worldwide by May 2020. These cases are characterized by extreme variability, from a mild or asymptomatic form lasting for a few days up to severe forms of interstitial pneumonia that may require ventilatory therapy and can lead to patient death.Several hypotheses have been drawn up to understand the role of the interaction between the infectious agent and the immune system in the development of the disease and the most severe forms; the role of the cytokine storm seems important.Innate immunity, as one of the first elements of guest interaction with different infectious agents, could play an important role in the development of the cytokine storm and be responsible for boosting more severe forms. Therefore, it seems important to study also this important arm of the immune system to adequately understand the pathogenesis of the disease. Research on this topic is also needed to develop therapeutic strategies for treatment of this disease.

Fine-needle cytology of intraglandular parotid lymph node: A useful procedure in the management of salivary gland nodules.

BACKGROUND: Enlarged intra-parotid lymph nodes (pLNs) may be misdiagnosed at ultrasound (US) being rare entities and because of their similarities to parotid nodules. Fine-needle cytology (FNC) is used in the preoperative diagnosis of parotid nodules, and may be used on pLNs to assess their nature and the underlying pathological processes. METHODS: Twenty consecutive pLNs underwent US-guided FNC and rapid on-site evaluation (ROSE). Flow cytometry (FC) was also performed in all the cases. Immunoglobulin heavy chain (IGH) gene rearrangement PCR was performed in five cases. Data obtained were checked by follow-up and histological controls, when available. RESULTS: Ultrasound-guided FNC and ROSE identified 20 pLNs. According to FNC-FC and PCR data, pLNs were diagnosed as reactive processes(18), FL (1) and B-cell, NHL NOS (1). Clinical follow-up (18 cases) and histological assessment (three cases) confirmed FNC-FC diagnoses of reactive processes and two NHL. CONCLUSIONS: Fine-needle cytology is a sensitive procedure in the identification of pLNs. FNC is useful in the management of pLNs; it allows a simple follow-up in case of reactive processes and surgical excision in case of NHL, thus sparing useless excisions for reactive processes.

The diagnostic accuracy of fine-needle cytology of Hurthle cell lesions; A comprehensive cytological, clinical and ultrasonographic experience.

BACKGROUND: Fine-needle cytology (FNC) diagnosis and pre-operative classification of Hurthle cells (HC) lesions may be difficult. Rapid on-site evaluation (ROSE) enhances the efficiency of FNC, mainly when utilized in close combination to clinical and ultrasound (US) data. OBJECTIVE: to describe an experience on HC FNC with contextual clinical,US and ROSE evaluation and assess if this comprehensive approach improves the FNC accuracy of HC lesions. METHODS: FNC of 112 HC lesion were diagnosed and classified, according to the Bethesda system, by clinical, US and ROSE in one year. All the cases were controlled by follow-up and histology when performed. RESULTS: Eighty-five cases were diagnosed HC rich goiter or Hashimoto thyroiditis and were classified THY2; 5 cases were diagnosed hyperplastic nodular goiter and classified THY3A. Eight cases were diagnosed suspect neoplasia and classified THY3B. Two cases were diagnosed suspect HC papillary thyroid carcinoma (PTC) and classified THY4 and 2 cases were diagnosed HC-PTC and classified THY5. THY3B, THY4, THY5 and 1 THY3A were histologically controlled. FNC were confirmed in 14 out of the 17 THY3-THY5 cases. CONCLUSIONS: A comprehensive diagnostic approach that include FNC, clinical data, US and ROSE improves the diagnosis and classification of HC lesions.

Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening.

AIMS: The implementation of 12-lead ECG in the pre-participation screening of young athletes is still controversial and number of issues are largely debated, including the prevalence and spectrum of ECG abnormalities found in individuals undergoing pre-participation screening. METHODS AND RESULTS: We assessed a large, unselected population of 32,652 subjects [26 050 (80%) males], prospectively examined in 19 clinics associated to Italian Sports Medicine Federation. Most were young amateur athletes, aged 8-78 years (median 17), predominantly students (68%), engaged predominantly in soccer (39%), volleyball or basketball (8% each), athletics (6%), cycling (5%), swimming (4%). The ECG patterns were evaluated according to commonly used clinical criteria. The 12-lead ECG patterns were considered normal in 28 799 of the 32 652 athletes (88.2%) and abnormal in 3853 (11.8%). The most frequent abnormalities included prolonged PR interval, incomplete right bundle branch block (RBBB) and early repolarization pattern (total 2280, 7.0%). Distinct ECG abnormalities included deeply inverted T-waves in > 2 precordial and/or standard leads (751, 2.3%), increased R/S wave voltages suggestive of LV hypertrophy (247, 0.8%), conduction disorders, i.e. RBBB (351, 1.0%), left anterior fascicular block (162, 0.5%), and left bundle branch block (19, 0.1%). Rarely, cardiac pre-excitation pattern (42, 0.1%) and prolonged QTc interval (1, 0.03%) were found. CONCLUSION: In a large, unselected population of young athletes undergoing pre-participation screening, the prevalence of markedly abnormal ECG patterns, suggestive for structural cardiac disease, is low (<5% of the overall population) and should not represent obstacle for implementation of 12-lead ECG in the pre-participation screening program.