Rare cases of
community-acquired pneumonia (PA-CAP) were reported in non-immunocompromised patients. We describe a case of
(PA) necrotizing cavitary CAP with a fatal outcome in a 53-year-old man ...previously infected with SARS-CoV-2, who was admitted for dyspnea, fever, cough, hemoptysis, acute respiratory failure and a right upper lobe opacification. Six hours after admission, despite effective antibiotic therapy, he experienced multi-organ failure and died. Autopsy confirmed necrotizing pneumonia with alveolar hemorrhage. Blood and bronchoalveolar lavage cultures were positive for PA serotype O:9 belonging to ST1184. The strain shares the same virulence factor profile with reference genome PA01. With the aim to better investigate the clinical and molecular characteristics of PA-CAP, we considered the literature of the last 13 years concerning this topic. The prevalence of hospitalized PA-CAP is about 4% and has a mortality rate of 33-66%. Smoking, alcohol abuse and contaminated fluid exposure were the recognized risk factors; most cases presented the same symptoms described above and needed intensive care. Co-infection of PA-influenza A is described, which is possibly caused by influenza-inducing respiratory epithelial cell dysfunction: the same pathophysiological mechanism could be assumed with SARS-CoV-2 infection. Considering the high rate of fatal outcomes, additional studies are needed to identify sources of infections and new risk factors, along with genetic and immunological features. Current CAP guidelines should be revised in light of these results.
Abstract
Background
The weakened immune system of patients on hemodialysis (HD) may prolong SARS-CoV-2 infection compared to the general population. Current international guidelines recommend ending ...isolation in conjunction with serial testing in moderately and severely immunocompromised subjects. This study aimed to estimate SARS-CoV-2 infectivity by measuring RT-PCR test positivity in HD patients. A comparison between RT-PCR test and cycle threshold (Ct) value has been performed as a secondary endpoint.
Methods
A single-center retrospective study was conducted at the University of Modena (Italy) from March 2020 to October 2022. Only patients on chronic HD therapy with COVID-19 were enrolled in the study. In our HD Center, two negative nasopharyngeal reverse transcription polymerase chain reaction (RT-PCR) results were used to end quarantine in this population. SARS-CoV-2 RT-PCR test positivity duration measured the time elapsed from a positive RT-PCR to a second negative test. Ct cut-off of 35 cycles was used to definite “high Ct value,” a condition characterized by a large number of cycles of PCR amplification to register a positive RT-PCR test.
Results
During the observational period, 159 cases of SARS-CoV-2 infections were diagnosed in 151 patients. Median age was 70.1 (54.3–81.6) years and males accounted for 59.6% of the COVID-19 population. Median duration of SARS-CoV-2 RT-PCR test positivity on the nasal mucosa accounted for 30 (IQR, 21–40.5) days. Unvaccinated patients experienced significantly longer RT-PCR test positivity compared to vaccinated patients (42 IQR,31–56 vs. 28 IQR,20–35.7 days;
p
= < 0.001). The use of high Ct value, a laboratory surrogate of SARS-CoV-2 replication, anticipated a negative RT-PCR test of 9 (IQR, 6–12) days. Multivariate linear regression analysis showed that increased age (
β
coefficient 0.31; confidence interval CI 95%, 0.14—0.43;
p
= < 0.001) and the lack of anti-SARS-CoV-2 vaccination (
β
0.49 CI95%, 11.9–22.5;
p
= < 0.001) were predictors of a prolonged RT-PCR positivity.
Conclusions
Patients with COVID-19 on HD had prolonged RT-PCR test positivity. The adoption of “high Ct value” criteria led to a significant reduction in the duration of RT-PCR test positivity compared to the use of the classical nucleic acid amplification test. In our study, the lack of SARS-CoV-2 vaccination and older age were independently associated with a longer RT-PCR positivity.
Tick-borne encephalitis (TBE), a human viral infectious disease caused by the tick-borne encephalitis virus (TBEV), is emerging in Italy, especially in the north-eastern area. No human cases of ...autochthonous TBE have been reported in Italy’s central regions (such as Emilia-Romagna, Italy). However, here we describe the first human case of TBEV infection in this region, pointing to endemic transmission of TBEV, supporting the concept of circulation of TBEV and of the presence of a possible hot spot in the Serramazzoni region in the Emilian Apennines.
Casirivimab and imdevimab (CAS/IMV) are two non-competing, high-affinity human IgG1 anti-SARS-CoV-2 monoclonal antibodies, that showed a survival benefit in seronegative hospitalized patients with ...COVID-19. This study aimed to estimate the day-28 risk of mechanical ventilation (MV) and death in individuals hospitalized for severe COVID-19 pneumonia and receiving CAS/IMV. Additionally, it aimed to identify variables measured at the time of hospital admission that could predict these outcomes and derive a prediction algorithm.
This is a retrospective, observational cohort study conducted in 12 hospitals in Italy. Adult patients who were consecutively hospitalized from November 2021 to February 2022 receiving CAS/IMV were included. A multivariable logistic regression model was used to identify predictors of MV or death by day 28 from treatment initiation, and β-coefficients from the model were used to develop a risk score that was derived by means of leave-one-out internal cross-validation (CV), external CV, and calibration. Secondary outcome was mortality.
A total of 480 hospitalized patients in the training set and 157 patients in the test set were included. By day 28, 36 participants (8%) underwent MV and 28 died (6%) for a total of 58 participants (12%) experiencing the composite primary endpoint. In multivariable analysis, four factors age, PaO
/FiO
ratio, lactate dehydrogenase (LDH), and platelets were independently associated with the risk of MV/death and were used to generate the proposed risk score. The accuracy of the score in the area under the curve (AUC) was 0.80 and 0.77 in internal validation and test for the composite endpoint and 0.87 and 0.86 for death, respectively. The model also appeared to be well calibrated with the raw data.
The mortality risk reported in our study was lower than that previously reported. Although CAS/IMV is no longer used, our score might help in identifying which patients are not likely to benefit from monoclonal antibodies and may require alternative interventions.
We hypothesized that frailty acts as a measure of health outcomes in the context of LT. The aim of this study was to explore frailty index across LT, as a measure of morbidity and mortality. This was ...a retrospective observational study including all consecutive 47 HIV+patients who received LT in Modena, Italy from 2003 to June 2015.
frailty index (FI) was constructed from 30 health variables. It was used both as a continuous score and as a categorical variable, defining 'most frail' a FI > 0.45. FI change across transplant (deltaFI, ΔFI) was calculated as the difference between year 1 FI (FI-Y1) and pre-transplant FI (FI-t0). The outcomes measures were mortality and "otpimal LT" (defined as being alive without multi-morbidity).
Median value of FI-t0 was 0.48 (IQR 0.42-0.52), FI-Y1 was 0.31 (IQR 0.26-0.41). At year five mortality rate was 45%, "optimal transplant" rate at year 1 was 38%. All the patients who died in the post-LT were most frail in the pre-LT. ΔFI was a predictor of mortality after correction for age and MELD (HR = 1.10, p = 0.006) and was inversely associated with optimal transplant after correction for age (HR = 1.04, p = 0.01).
We validated FI as a valuable health measure in HIV transplant. In particular, we found a relevant correlation between FI strata at baseline and mortality and a statistically significant correlation between, ΔFI and survival rate.
BACKGROUNDThe prognostic value of within-day sCr variation serum creatinine variation is unknown in the setting of the novel coronavirus disease 2019 (COVID-19). We evaluated the prognostic ...significance of 24-hour serum creatinine variation in COVID-19 patients. METHODSA monocentric retrospective analysis was conducted in COVID-19 patients not admitted to the intensive care unit. Three groups were subdivided based on 24 hours serum creatinine variation from admission. In the stable kidney function group, 24-hour serum creatinine variation ranged from +0.05 to -0.05 mg/dL; in the decreased kidney function group, 24-hour serum creatinine variation was >0.05 mg/dL; in the improved kidney function group, 24-hour serum creatinine variation was <-0.05 mg/dL. RESULTSThe study population included 224 patients with a median age of 66.5 years and a predominance of males (72.3%). Within 24 hours of admission, renal function remained stable in 37.1% of the subjects, whereas it displayed improved and deteriorated patterns in 45.5% and 17.4%, respectively. Patients with decreased kidney function were older and had more severe COVID-19 symptoms than patients with stable or improved kidney function. About half of patients with decreased kidney function developed an episode of acute kidney injury (AKI) during hospitalization. Decreased kidney function was significantly associated with AKI during hospitalization (hazard ratio HR, 4.6; 95% confidence interval CI, 1.9-10.8; p < 0.001) and was an independent risk factor for 30-day in-hospital mortality (HR, 5.5; 95% CI, 1.1-28; p = 0.037). CONCLUSIONCOVID-19 patients with decreased kidney function within 24 hours of admission were at high risk of AKI and 30-day in-hospital mortality.
The role of excessive inspiratory effort in promoting alveolar and pleural rupture resulting in air leak (AL) in patients with SARS-CoV-2 induced acute respiratory failure (ARF) while on spontaneous ...breathing is undetermined.
Among all patients with COVID-19 related ARF admitted to a respiratory intensive care unit (RICU) and receiving non-invasive respiratory support, those developing an AL were and matched 1:1 by means of PaO2/FiO2 ratio, age, body mass index-BMI and subsequent organ failure assessment (SOFA) with a comparable population who did not (NAL group). Esophageal pressure (ΔP
) and dynamic transpulmonary pressure (ΔP
) swings were compared between groups. Risk factors affecting AL onset were evaluated. The composite outcome of ventilator-free-days (VFD) at day 28 (including ETI, mortality, tracheostomy) was compared between groups.
Air leak and NAL groups (
= 28) showed similar ΔP
, whereas AL had higher ΔP
(20 16-21 and 17 11-20,
= 0.01, respectively). Higher ΔP
(OR = 1.5 95%CI1-1.8,
= 0.01), positive end-expiratory pressure (OR = 2.4 95%CI1.2-5.9,
= 0.04) and pressure support (OR = 1.8 95%CI1.1-3.5,
= 0.03), D-dimer on admission (OR = 2.1 95%CI1.3-9.8,
= 0.03), and features suggestive of consolidation on computed tomography scan (OR = 3.8 95%CI1.1-15,
= 0.04) were all significantly associated with AL. A lower VFD score resulted in a higher risk (HR = 3.7 95%CI 1.2-11.3,
= 0.01) in the AL group compared with NAL. RICU stay and 90-day mortality were also higher in the AL group compared with NAL.
In spontaneously breathing patients with COVID-19 related ARF, higher levels of ΔP
, blood D-dimer, NIV delivery pressures and a consolidative lung pattern were associated with AL onset.
Pretendemos problematizar arte e loucura, inicialmente discutindo a experiência do pesquisador em relação às imagens do mundo, com o testemunho e a figura do louco e, consequentemente, com o fora que ...ela evoca. Em seguida nos colocamos diante do muro, situação-limite na qual a loucura enquanto catástrofe e a arte enquanto via poética vêm compor um limiar, ausência que Blanchot transpõe à linguagem para dar a ver outras constelações possíveis, tanto de palavras quanto de seus inomináveis. Por fim, com Walter Benjamin, pomos a história da loucura a contrapelo, e, mergulhados no Ateliê de Escrita do Hospital Psiquiátrico São Pedro, desvelamos que a arte pode, na relação com a loucura, tornar-se a linguagem essencial na perigosa travessia em direção à experiência, transpondo a vivência desse estado assustador para trazer ao mundo outro sentido, reconhecendo outros modos de existência que podem vir a ser outras poéticas de vida.
Limited and wide-ranging data are available on the recurrent
infection (rCDI) incidence rate.
We performed a cohort study with the aim to assess the incidence of and risk factors for rCDI. Adult ...patients with a first CDI, hospitalized in 15 Italian hospitals, were prospectively included and followed-up for 30 d after the end of antimicrobial treatment for their first CDI. A case-control study was performed to identify risk factors associated with 30-day onset rCDI.
Three hundred nine patients with a first CDI were included in the study; 32% of the CDI episodes (99/309) were severe/complicated; complete follow-up was available for 288 patients (19 died during the first CDI episode, and 2 were lost during follow-up). At the end of the study, the crude all-cause mortality rate was 10.7% (33 deaths/309 patients). Two hundred seventy-one patients completed the follow-up; rCDI occurred in 21% of patients (56/271) with an incidence rate of 72/10,000 patient-days. Logistic regression analysis identified exposure to cephalosporin as an independent risk factor associated with rCDI (RR: 1.7; 95% CI: 1.1-2.7,
= 0.03).
Our study confirms the relevance of rCDI in terms of morbidity and mortality and provides a reliable estimation of its incidence.
Este texto foi escrito pelos integrantes do grupo de pesquisa Corpo, Arte e Clínica após o falecimento de nossa querida orientadora, professora e amiga Tania Mara Galli Fonseca, cuja presença em ...nossas vidas deixa marcas da ordem do indizível. O texto foi lido em voz alta junto à comunidade acadêmica no evento Temas em Debate, em 25/10/2019. Na plateia havia pessoas que a admiravam e amavam, tanto por sua pessoa quanto por seu significativo trabalho de escrita e pesquisa, sua incessante produção de pensamento diante dos mais sensíveis pulsares revolucionários da vida coletiva. Para quem endereçaríamos nossas escritas dali para frente? - nos perguntávamos uns aos outros. Com vozes embargadas de saudade e dor, em torno de pequenas luzes que brilhavam como vagalumes na escuridão, dedicamos à Tania esse texto. Escrito a muitas mãos, assim como ela nos ensinou, buscamos palavras para homenageá-la ao colocarmos nossa saudade em movimento.
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