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Identification of risk factors for severe outcome of Sars-Cov-2 infection is an important issue in COVID-19 management. Much attention has been focused on comorbidities as well as drugs taken by patients. Usage of proton pump inhibitors (PPIs) appears to potentially influence disease course. These drugs are known to reduce stomach acid and also modulate the immune system. Their use, prior to and during COVID-19 infection, seems to predispose to the development of more severe pneumonia and therefore to a greater risk of mortality. Instead, the use of Histamine receptor 2 antagonists (H2RAs) seems to be associated with a better outcome in patients with COVID-19, in terms of symptoms, risk of intubation and death. As PPIs are essential for treatment of many disorders, usage of these drugs should be balanced considering the benefits and risk ratio, in order to guarantee their correct use for the necessary time. It remains to be clarified whether the detrimental effects, in terms of COVID19 severe outcome, are due to PPIs or to the underlying disease for which they are administered. New controlled-randomized trials are required to better understand their impact in SARS-COV-2 infections. *Vanvitelli/Monaldi COVID Group: Adriano Cristinziano, Carolina Delle Donne, Cecilia Calabrese, Fabio Perrotta, Filippo Scialò, Francesco Lassandro, Gennaro Mazzarella, Giorgio Paoli, Leonardo De Luca, Maria Galdo, Miriam Buonincontro, Roberta Cianci, Rosalba Donizzetti, Stefano Sanduzzi Zamparelli, Tullio Valente, Vito D’Agnano, Vittorio Bisogni

Since the beginning of 2020, the new pandemic caused by SARS-CoV-2 and named coronavirus disease 19 (COVID 19) has changed our socio-economic life. In just a few months, SARS-CoV-2 was able to spread worldwide at an unprecedented speed, causing hundreds of thousands of deaths, especially among the weakest part of the population. Indeed, especially at the beginning of this pandemic, many reports highlighted how people, suffering from other pathologies, such as hypertension, cardiovascular diseases, and diabetes, are more at risk of severe outcomes if infected. Although this pandemic has put the entire academic world to the test, it has also been a year of intense research and many important contributions have advanced our understanding of SARS-CoV-2 origin, its molecular structure and its mechanism of infection. Unfortunately, despite this great effort, we are still a long way from fully understanding how SARS-CoV-2 dysregulates organismal physiology and whether the current vaccines will be able to protect us from possible future pandemics. Here, we discuss the knowledge we have gained during this year and which questions future research should address.

Viral infections are frequent among patients with thoracic malignancies prompted by dysregulation of innate and adaptative immune response. Clinical symptoms and radiological findings of both viral pneumonia and lung adenocarcinoma may overlap resulting in diagnostic and clinical challenges.We present the case of a women admitted to our department presenting with an acute manifestation of coronavirus OC43 pneumonia with underlying undiagnosed lung adenocarcinoma.

Intercostal artery pseudoaneurysms (IAP) are extremely rare but its sudden rupture represents a life-threatening complication. We report an unusual case of a late intercostal artery pseudoaneurysm, after a video-assisted thoracoscopic surgery, presenting as a large intra-parenchymal lung mass. Diagnosis was made by biphasic computed tomography angiography and contrast-enhanced pulsed-wave doppler ultrasound. To minimize the risk of aneurysm bleeding immediate angiographic embolization was planned and successfully performed.IAP should be considered in presence of lung mass in patients who have previously undergone an intervention with intercostal approach to prevent life-threatening complications.

Pulmonary sequestration (PS) is a rare congenital broncho-pulmonary malformation. The main feature of this disease is that partial lung tissues separate from the main lung during the embryonic period, receiving blood supply from systemic circulation arteries. Pathogenesis of PS is not clear, and categorized into congenital and acquired PS. We report a case of a 38 year old woman smoker with medical history characterized by difficult to treat asthma with frequent exacerbations and infections since childhood. CT scan showed a partial PS of left lower lobe, supplied by an abnormal artery arising from supradiaphragmatic aortic diverticulum. Surgical treatment through a lung sequestrectomy and laterobasal segment resection was performed.

Introduction: Nontuberculous mycobacterial lung infections are relatively common in immunocompromised patients but are now increasingly being diagnosed in immunocompetent individuals. These organisms are not always pathogenic bacteria when isolated from human samples. The identification of which isolates are contaminants or colonizers is based on internationally accepted criteria. The clinical significance of the isolation of nontuberculous mycobacteria (NTM) from respiratory specimens in Italy is unknown. Objective: study was performed to evaluate the local epidemiology of NTM pulmonary infection in Naples in patients with positive respiratory specimens, and also to describe the clinical and radiological features of NTM pulmonary disease in immunocompetent patients with or without pre-existing lung disease. Methods: Between December 2006 and September 2009, the clinical records and radiological examinations of 39 patients with 55 positive cultures for NTM species by sputum or bronchial wash or lavage were reviewed. Results: According to microbiological, clinical and radiological criteria, our study identified 16 patients with NTM lung infection as a ‘disease’ group and 23 patients in a ‘contamination’ group but without disease. M. intracellulare (n = 7, 41.2%), followed by M. kansasii (n = 5, 29.4%) were the most common NTM found in the ‘disease’ group. We detected a high number of M. gordonae isolates in respiratory samples obtained by fibrobronchoscopy. Conclusions: We evaluated the clinical significance of isolations in our reference centre in Naples. Forty-one of all patients have ‘disease’, M. intracellulare and M. kansasii are mainly responsible. NTM species were analyzed in relation to their frequency. Assumptions were made about low pathogenic NTM isolations. Please cite this paper as: Del Giudice G, Iadevaia C, Santoro G, Moscariello E, Smeraglia R and Marzo C. Nontuberculous mycobacterial lung disease in patients without HIV infection: a retrospective analysis over 3 years. Clin Respir J 2011; 5:203–210.

Pulmonary arteriovenous Malformations (PAVMs) are a rare vascular alteration characterized by abnormal communications between the pulmonary arteries and veins resulting in an extracardiac right-to-left (R-L) shunt. The majority of PAVMs are associated with an autosomal dominant vascular disorder also known as Osler-Weber- Rendu Syndrome. PAVMs appearance can be both single and multiple. Clinical manifestations include hypoxemia, dyspnea cyanosis, hemoptysis and cerebrovascular ischemic events or abscesses. We report a case of an 18 year old female with severe respiratory failure caused by a relapse of multiple unilateral pulmonary arterovenous fistula. Symptoms at admission include dyspnea, cyanosis and clubbing. The patient underwent pulmonary angio-TC scan, brain CT and echocardiography. The thoracic angio-CT scan showed the presence of PAVMs of RUL and RLL; a marked increase of right bronchial artery caliber and its branches with an aneurismatic dilatation was also observed. The patient underwent percutaneous transcatheter embolization using Amplatzer Vascular Plug IV; a relevant clinical and functional improvement was subsequently recorded. Embolization is effective in the treatment of relapsing PAVMS.

A fibroelastose pleuroparenquimatosa idiopatica (FEPPI) e uma doenca rara que afeta a pleura e os pulmoes. Em 2013, a FEPPI foi considerada uma doenca pulmonar intersticial (DPI) rara em uma declaracao conjunta da American Thoracic Society/European Respiratory Society sobre a classificacao das pneumonias intersticiais idiopaticas.(1) Caracterizada por fibrose e espessamento do tecido pleural e subpleural (fibroelastose subpleural), a FEPPI afeta predominantemente a periferia dos lobos pulmonares superiores, com perda de volume, como inicialmente descreveram Frankel et al. em 2004.(2) Ate o momento, nao mais de quarenta casos de FEPPI foram descritos na literatura em ingles. Atualmente, alem de nao haver consenso a respeito dos criterios diagnosticos usados para classificar a FEPPI, nao se sabe se a doenca e de fato uma entidade especifica nova. Embora a etiologia seja desconhecida, a FEPPI esta relacionada com infeccoes, transplante de medula ossea, autoimunidade e, possivelmente, predisposicao genetica. Clinicamente, pacientes com FEPPI geralmente apresentam sintomas respiratorios cronicos como dispneia e tosse seca. O diagnostico de FEPPI baseia-se em achados clinicos, radiologicos e histopatologicos. A TCAR de torax mostra consolidacoes subpleurais pronunciadas com espessamento irregular; distorcao, geralmente nos lobos pulmonares superiores (“capa pleural”); bronquiolectasias subpleurais; opacidades reticulares e, em alguns casos, faveolamento leve. Essas caracteristicas sao semelhantes as de outras formas de fibrose pulmonar idiopatica. No entanto, na FEPPI, elas sao vistas principalmente nos lobos superiores, e sao raras ou ausentes nos lobos inferiores.(3,4) As caracteristicas histologicas da FEPPI sao fibrose subpleural homogenea e fibras elasticas abundantes (vistas por meio de tecnicas de coloracao de fibras elasticas).(5)

Nontuberculous mycobacterial lung infections are relatively common in immunocompromised patients but are now increasingly being diagnosed in immunocompetent individuals. These organisms are not always pathogenic bacteria when isolated from human samples. The identification of which isolates are contaminants or colonizers is based on internationally accepted criteria. The clinical significance of the isolation of nontuberculous mycobacteria (NTM) from respiratory specimens in Italy is unknown.study was performed to evaluate the local epidemiology of NTM pulmonary infection in Naples in patients with positive respiratory specimens, and also to describe the clinical and radiological features of NTM pulmonary disease in immunocompetent patients with or without pre-existing lung disease.Between December 2006 and September 2009, the clinical records and radiological examinations of 39 patients with 55 positive cultures for NTM species by sputum or bronchial wash or lavage were reviewed.According to microbiological, clinical and radiological criteria, our study identified 16 patients with NTM lung infection as a 'disease' group and 23 patients in a 'contamination' group but without disease. M. intracellulare (n = 7, 41.2%), followed by M. kansasii (n = 5, 29.4%) were the most common NTM found in the 'disease' group. We detected a high number of M. gordonae isolates in respiratory samples obtained by fibrobronchoscopy.We evaluated the clinical significance of isolations in our reference centre in Naples. Forty-one of all patients have 'disease', M. intracellulare and M. kansasii are mainly responsible. NTM species were analyzed in relation to their frequency. Assumptions were made about low pathogenic NTM isolations.