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1. Down Syndrome patients with COVID-19 pneumonia: A high-risk category for unfavourable outcome

Author

Serena Vita, Virginia Di Bari, Angela Corpolongo, Delia Goletti, Joaquin Espinosa, Sebastiano Petracca, Fabrizio Palmieri, Emanuele Nicastri, null Abbonizio, Chiara Agrati, Fabrizio Albarello, Gioia Amadei, Alessandra Amendola, Mario Antonini, Raffaella Barbaro, Barbara Bartolini, Martina Benigni, Nazario Bevilacqua, Licia Bordi, Veronica Bordoni, Marta Branca, Paolo Campioni, Maria Rosaria Capobianchi, Cinzia Caporale, Ilaria Caravella, Fabrizio Carletti, Concetta Castilletti, Roberta Chiappini, Carmine Ciaralli, Francesca Colavita, Massimo Cristofaro, Salvatore Curiale, Alessandra D’Abramo, Cristina Dantimi, Alessia De Angelis, Giada De Angelis, Rachele Di Lorenzo, Federica Di Stefano, Federica Ferraro, Lorena Fiorentini, Andrea Frustaci, Paola Gallì, Gabriele Garotto, Maria Letizia Giancola, Filippo Giansante, Emanuela Giombini, Maria Cristina Greci, Giuseppe Ippolito, Eleonora Lalle, Simone Lanini, Daniele Lapa, Luciana Lepore, Andrea Lucia, Franco Lufrani, Manuela Macchione, Alessandra Marani, Luisa Marchioni, Andrea Mariano, Maria Cristina Marini, Micaela Maritti, Giulia Matusali, Silvia Meschi, Francesco Messina Chiara Montaldo, Silvia Murachelli, Roberto Noto, Claudia Palazzolo, Emanuele Pallini, Virgilio Passeri, Federico Pelliccioni, Antonella Petrecchia, Ada Petrone, Nicola Petrosillo, Elisa Pianura, Maria Pisciotta, Silvia Pittalis, Costanza Proietti, Vincenzo Puro, Gabriele Rinonapoli, Martina Rueca, Alessandra Sacchi, Francesco Sanasi, Carmen Santagata, Silvana Scarcia, Vincenzo Schininà, Paola Scognamiglio, Laura Scorzolini, Giulia Stazi, Francesco Vaia, Francesco Vairo, Maria Beatrice Valli, Vita, S., Di Bari, V., Corpolongo, A., Goletti, D., Espinosa, J., Petracca, S., Palmieri, F., Nicastri, E., Abbonizio, Agrati, C., Albarello, F., Amadei, G., Amendola, A., Antonini, M., Barbaro, R., Bartolini, B., Benigni, M., Bevilacqua, N., Bordi, L., Bordoni, V., Branca, M., Campioni, P., Capobianchi, M. R., Caporale, C., Caravella, I., Carletti, F., Castilletti, C., Chiappini, R., Ciaralli, C., Colavita, F., Cristofaro, M., Curiale, S., D'Abramo, A., Dantimi, C., Angelis, A. D., Angelis, G. D., Lorenzo, R. D., Stefano, F. D., Ferraro, F., Fiorentini, L., Frustaci, A., Galli, P., Garotto, G., Giancola, M. L., Giansante, F., Giombini, E., Greci, M. C., Ippolito, G., Lalle, E., Lanini, S., Lapa, D., Lepore, L., Lucia, A., Lufrani, F., Macchione, M., Marani, A., Marchioni, L., Mariano, A., Marini, M. C., Maritti, M., Matusali, G., Meschi, S., Montaldo, F. M. C., Murachelli, S., Noto, R., Palazzolo, C., Pallini, E., Passeri, V., Pelliccioni, F., Petrecchia, A., Petrone, A., Petrosillo, N., Pianura, E., Pisciotta, M., Pittalis, S., Proietti, C., Puro, V., Rinonapoli, G., Rueca, M., Sacchi, A., Sanasi, F., Santagata, C., Scarcia, S., Schinina, V., Scognamiglio, P., Scorzolini, L., Stazi, G., Vaia, F., Vairo, F., and Valli, M. B.

Subjects
0301 basic medicine, Microbiology (medical), Pediatrics, medicine.medical_specialty, Down syndrome, immuneactivation, 030106 microbiology, Case Report, medicine.disease_cause, NO, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, 0302 clinical medicine, medicine, Clinical significance, lcsh:RC109-216, 030212 general & internal medicine, COVID-19 pneumonia, ComputingMethodologies_COMPUTERGRAPHICS, Coronavirus, Immune activation, business.industry, General Medicine, Immune dysregulation, medicine.disease, Vaccination, Pneumonia, Infectious Diseases, medicine.anatomical_structure, business, Trisomy, Respiratory tract
Abstract

Graphical abstract, Highlights • Pro-inflammatory factors play a central role in COVID-19 severity and mortality. • Down Syndrome is characterized by immune dysregulation and respiratory infections. • Down Syndrome patients with COVID-19 are at high-risk for unfavourable outcome., We report two cases of COronaVIrus Disease-19 in patients with Down Syndrome and describe the identification, diagnosis, clinical course, and management of the infection. Down Syndrome, which is caused by trisomy 21, is characterized by immune dysregulation, anatomical differences in the upper respiratory tract, and higher rate of comorbidities. All these risk factors can contribute to more severe clinical presentations of COVID-19. It is essential to raise awareness of the clinical relevance of SARS-COV-2 infection in DS patients, as well in other most vulnerable patients in order to improve their management and treatment and to candidate these individuals for vaccination, once available.

Published
2021

2. 2019-novel Coronavirus severe adult respiratory distress syndrome in two cases in Italy: An uncommon radiological presentation

Author

Fabrizio Albarello, Elisa Pianura, Federica Di Stefano, Massimo Cristofaro, Ada Petrone, Luisa Marchioni, Claudia Palazzolo, Vincenzo Schininà, Emanuele Nicastri, Nicola Petrosillo, Paolo Campioni, Petersen Eskild, Alimuddin Zumla, Giuseppe Ippolito, Maria Alessandra Abbonizio, Chiara Agrati, Gioia Amadei, Alessandra Amendola, Mario Antonini, Raffaella Barbaro, Barbara Bartolini, Martina Benigni, Nazario Bevilacqua, Licia Bordi, Veronica Bordoni, Marta Branca, Maria Rosaria Capobianchi, Cinzia Caporale, Ilaria Caravella, Fabrizio Carletti, Concetta Castilletti, Roberta Chiappini, Carmine Ciaralli, Francesca Colavita, Angela Corpolongo, Salvatore Curiale, Alessandra D’Abramo, Cristina Dantimi, Alessia De Angelis, Giada De Angelis, Rachele Di Lorenzo, Federica Ferraro, Lorena Fiorentini, Andrea Frustaci, Paola Gallì, Gabriele Garotto, Maria Letizia Giancola, Filippo Giansante, Emanuela Giombini, Maria Cristina Greci, Eleonora Lalle, Simone Lanini, Daniele Lapa, Luciana Lepore, Andrea Lucia, Franco Lufrani, Manuela Macchione, Alessandra Marani, Andrea Mariano, Maria Cristina Marini, Micaela Maritti, Giulia Matusali, Silvia Meschi, Francesco Messina Chiara Montaldo, Silvia Murachelli, Roberto Noto, Emanuele Pallini, Virgilio Passeri, Federico Pelliccioni, Antonella Petrecchia, Maria Pisciotta, Silvia Pittalis, Costanza Proietti, Vincenzo Puro, Gabriele Rinonapoli, Martina Rueca, Alessandra Sacchi, Francesco Sanasi, Carmen Santagata, Silvana Scarcia, Paola Scognamiglio, Laura Scorzolini, Giulia Stazi, Francesco Vaia, Francesco Vairo, Maria Beatrice Valli, Albarello, F., Pianura, E., Di Stefano, F., Cristofaro, M., Petrone, A., Marchioni, L., Palazzolo, C., Schinina, V., Nicastri, E., Petrosillo, N., Campioni, P., Eskild, P., Zumla, A., Ippolito, G., Abbonizio, M. A., Agrati, C., Amadei, G., Amendola, A., Antonini, M., Barbaro, R., Bartolini, B., Benigni, M., Bevilacqua, N., Bordi, L., Bordoni, V., Branca, M., Capobianchi, M. R., Caporale, C., Caravella, I., Carletti, F., Castilletti, C., Chiappini, R., Ciaralli, C., Colavita, F., Corpolongo, A., Curiale, S., D'Abramo, A., Dantimi, C., Angelis, A. D., Angelis, G. D., Lorenzo, R. D., Stefano, F. D., Ferraro, F., Fiorentini, L., Frustaci, A., Galli, P., Garotto, G., Giancola, M. L., Giansante, F., Giombini, E., Greci, M. C., Lalle, E., Lanini, S., Lapa, D., Lepore, L., Lucia, A., Lufrani, F., Macchione, M., Marani, A., Mariano, A., Marini, M. C., Maritti, M., Matusali, G., Meschi, S., Montaldo, F. M. C., Murachelli, S., Noto, R., Pallini, E., Passeri, V., Pelliccioni, F., Petrecchia, A., Pisciotta, M., Pittalis, S., Proietti, C., Puro, V., Rinonapoli, G., Rueca, M., Sacchi, A., Sanasi, F., Santagata, C., Scarcia, S., Scognamiglio, P., Scorzolini, L., Stazi, G., Vaia, F., Vairo, F., and Valli, M. B.

Subjects
0301 basic medicine, ARDS, medicine.disease_cause, 0302 clinical medicine, SARS-COV2, 030212 general & internal medicine, Lung, Respiratory Distress Syndrome, Respiratory distress, Ground glass opacitie, General Medicine, Crazy-paving, Infectious Diseases, medicine.anatomical_structure, Italy, Severe acute respiratory syndrome-related coronavirus, Radiological weapon, Disease Progression, Middle East Respiratory Syndrome Coronavirus, Radiology, medicine.symptom, Presentation (obstetrics), Coronavirus Infections, Ground glass opacities, Adult, Microbiology (medical), China, medicine.medical_specialty, Mediastinal lymphadenopathy, Middle East respiratory syndrome coronavirus, Pneumonia, Viral, 030106 microbiology, Article, NO, lcsh:Infectious and parasitic diseases, Lesion, Betacoronavirus, 03 medical and health sciences, medicine, Humans, LS7_2, lcsh:RC109-216, Pandemics, Enlarged pulmonary vessel, SARS-CoV-2, business.industry, COVID-19, CT-scan, Enlarged pulmonary vessels, medicine.disease, Tomography, X-Ray Computed, business
Abstract

Highlights • The first two patients identified in Italy with COVID-19 presented remarkable imaging findings who progressed in adult respiratory distress syndrome. • Uncommon elements such as pleural effusions, a tubular and enlarged appearance of pulmonary vessels with a sudden caliber reduction and mediastinal lymphadenopathy were noted during the follow-up. • The vessels appearance during the follow up, resembling a “feeding vessel sign”, could be an early alert radiological sign to predict initial lung deterioration., Introduction Several recent case reports have described common early chest imaging findings of lung pathology caused by 2019 novel Coronavirus (SARS-COV2) which appear to be similar to those seen previously in SARS-CoV and MERS-CoV infected patients. Objective We present some remarkable imaging findings of the first two patients identified in Italy with COVID-19 infection travelling from Wuhan, China. The follow-up with chest X-Rays and CT scans was also included, showing a progressive adult respiratory distress syndrome (ARDS). Results Moderate to severe progression of the lung infiltrates, with increasing percentage of high-density infiltrates sustained by a bilateral and multi-segmental extension of lung opacities, were seen. During the follow-up, apart from pleural effusions, a tubular and enlarged appearance of pulmonary vessels with a sudden caliber reduction was seen, mainly found in the dichotomic tracts, where the center of a new insurgent pulmonary lesion was seen. It could be an early alert radiological sign to predict initial lung deterioration. Another uncommon element was the presence of mediastinal lymphadenopathy with short-axis oval nodes. Conclusions Although only two patients have been studied, these findings are consistent with the radiological pattern described in literature. Finally, the pulmonary vessels enlargement in areas where new lung infiltrates develop in the follow-up CT scan, could describe an early predictor radiological sign of lung impairment.

Published
2020
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3. Risk and predictive factors of prolonged viral RNA shedding in upper respiratory specimens in a large cohort of COVID-19 patients admitted to an Italian reference hospital.

Author

Mondi A, Lorenzini P, Castilletti C, Gagliardini R, Lalle E, Corpolongo A, Valli MB, Taglietti F, Cicalini S, Loiacono L, Di Gennaro F, D'Offizi G, Palmieri F, Nicastri E, Agrati C, Petrosillo N, Ippolito G, Vaia F, Girardi E, Capobianchi MR, Antinori A, Zito S, Abbonizio MA, Abdeddaim A, Agostini E, Agrati C, Albarello F, Amadei G, Amendola A, Antinori A, Antonica MA, Antonini M, Bartoli TA, Baldini F, Barbaro R, Bartolini B, Bellagamba R, Benigni M, Bevilacqua N, Biava G, Bibas M, Bordi L, Bordoni V, Boumis E, Branca M, Buonomo R, Busso D, Camici M, Campioni P, Canichella F, Capobianchi MR, Capone A, Caporale C, Caraffa E, Caravella I, Carletti F, Castilletti C, Cataldo A, Cerilli S, Cerva C, Chiappini R, Chinello P, Cianfarani MA, Ciaralli C, Cimaglia C, Cinicola N, Ciotti V, Cicalini S, Colavita F, Corpolongo A, Cristofaro M, Curiale S, D'Abramo A, Dantimi C, De Angelis A, De Angelis G, De Palo MG, De Zottis F, Di Bari V, Di Lorenzo R, Di Stefano F, D'Offizi G, Donno D, Evangelista F, Faraglia F, Farina A, Ferraro F, Fiorentini L, Frustaci A, Fusetti M, Galati V, Gagliardini R, Gallì P, Garotto G, Gaviano I, Tekle SG, Giancola ML, Giansante F, Giombini E, Granata G, Greci MC, Grilli E, Grisetti S, Gualano G, Iacomi F, Iaconi M, Iannicelli G, Inversi C, Ippolito G, Lalle E, Lamanna ME, Lanini S, Lapa D, Lepore L, Libertone R, Lionetti R, Liuzzi G, Loiacono L, Lucia A, Lufrani F, Macchione M, Maffongelli G, Marani A, Marchioni L, Mariano A, Marini MC, Maritti M, Mastrobattista A, Mastrorosa I, Matusali G, Mazzotta V, Mencarini P, Meschi S, Messina F, Micarelli S, Mogavero G, Mondi A, Montalbano M, Montaldo C, Mosti S, Murachelli S, Musso M, Nardi M, Navarra A, Nicastri E, Nocioni M, Noto P, Noto R, Oliva A, Onnis I, Ottou S, Palazzolo C, Pallini E, Palmieri F, Palombi G, Pareo C, Passeri V, Pelliccioni F, Penna G, Petrecchia A, Petrone A, Petrosillo N, Pianura E, Pinnetti C, Pisciotta M, Piselli P, Pittalis S, Pontarelli A, Proietti C, Puro V, Ramazzini PM, Rianda A, Rinonapoli G, Rosati S, Rubino D, Rueca M, Ruggeri A, Sacchi A, Sampaolesi A, Sanasi F, Santagata C, Scarabello A, Scarcia S, Schininà V, Scognamiglio P, Scorzolini L, Stazi G, Strano G, Taglietti F, Taibi C, Taloni G, Nardi T, Tonnarini R, Topino S, Tozzi M, Vaia F, Vairo F, Valli MB, Vergori A, Vincenzi L, Visco-Comandini U, Vita S, Vittozzi P, Zaccarelli M, Zanetti A, and Zito S

Subjects
Adult, Aged, Cohort Studies, Female, Humans, Male, Middle Aged, Proportional Hazards Models, Severity of Illness Index, Time Factors, COVID-19 virology, RNA, Viral analysis, Respiratory System virology, SARS-CoV-2 isolation & purification, Virus Shedding
Abstract

Background: Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS)., Methods: A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from the upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between VS and clinical outcomes was evaluated through an inverse probability weighted Cox model., Results: The study included 536 subjects. The median duration of VS from symptoms onset was 18 days. The estimated 30-day probability of VC was 70.2%. Patients with comorbidities, lymphopenia at hospital admission, or moderate/severe respiratory disease had a lower chance of VC. The development of moderate/severe respiratory failure, delayed hospital admission after symptoms onset, baseline comorbidities, or D-dimer >1000ng/mL at admission independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery and reduced the probability of death/mechanical ventilation., Conclusions: Respiratory disease severity, comorbidities, delayed hospital admission and inflammatory markers negatively predicted VC, which resulted to be associated with better clinical outcomes. These findings highlight the importance of prompt hospitalization of symptomatic patients, especially where signs of severity or comorbidities are present., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2021
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5. Cosmetic approach for placement of the automatic implantable cardioverter-defibrillator in young women.

Author

Curiale S, Rosenfeld LE, and Elefteriades JA

Subjects
Adult, Electrodes, Implanted, Female, Humans, Thoracotomy methods, Arrhythmias, Cardiac therapy, Electric Countershock instrumentation, Esthetics
Abstract

A surgical approach is described for a more cosmetically acceptable placement of the automatic implantable cardioverter-defibrillator in young women. The transvenous sensing lead and the vena caval spring electrode are placed through a small subclavicular incision. The left ventricular patch electrode is placed through an anterior minithoracotomy in the crease under the left breast. A small transverse incision in the left lower quadrant is used to place the generator under the external oblique fascia in the low abdominal wall. Minimal cosmetic impairment from incisions and hardware results.

Published
1991
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