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Intestinal ischemia in the COVID-19 era To the editor From the end of December, the world is facing the threat of a new zoonosis caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS CoV-2) which gave rise to a pandemic which is currently ongoing. The Bergamo province has been one of the most affected regions worldwide with an increase in the mortality rate in the first trimester of 2020 of + 568% [1] if compared with the first trimester of the previous four years (2015-2019). Papa Giovanni XXIII Hospital was the most affected structure with over 20 0 0 admission for COVID-19 to date [2]. We describe a case of fatal intestinal infarction whit a difficult diagnosis, which was made possible throughout by using innovative technique. A 62-year-old unconscious man was admitted to the Emergency Department of Papa Giovanni XXIII Hospital (Bergamo, Italy) with severe hypotension during the month of April 2020. The recent medical history reported by phone from his wife included three days of abdominal pain and bilious vomiting. The patient's main comorbidities were obesity, arterial hypertension, diabetes mellitus type 2 and hepatic cirrhosis (non-alcoholic steatohepatitis + hepatitis B). Blood tests revealed an increase in the blood

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Objectives: The aim of this review was to evaluate possible common pathogenic pathways and risk factors in inflammatory bowel disease (IBD) and periodontitis. Materials and Methods: A MEDLINE-PubMed research was conducted. Results: The pathogenesis of both diseases is multi-factorial leading to a substantial defect of the mucosal barrier, deregulation of the immune response and chronic inflammation of the mucosa. Environmental factors, particularly bacteria, are key factors in the pathogenesis of both diseases. Genetic predisposition is a key factor in the IBD pathogenesis, while a clear role of genetics in the pathogenesis of periodontitis is still unclear. The immune response in IBD is mediated by T lymphocytes as a consequence of a genetic trait associated with T-cell deregulation. On the other hand, in periodontitis plasma cells and lymphocytes are the predominant cells in the chronic inflammatory lesion, with the presence of B cells being proportionally larger than T cells. Conclusion: IBD and periodontitis share several factors in their aetiology and pathogenesis, although they also have distinct characteristics.

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BACKGROUND Intestinal ischemia has been described in case reports of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (coronavirus disease 19, COVID-19). AIM To define the clinical and histological, characteristics, as well as the outcome of ischemic gastrointestinal manifestations of SARS-CoV-2 infection. METHODS A structured retrospective collection was promoted among three tertiary referral centres during the first wave of the pandemic in northern Italy. Clinical, radiological, endoscopic and histological data of patients hospitalized for COVID-19 between March 1 st and May 30 th were reviewed. The diagnosis was established by consecutive analysis of all abdominal computed tomography (CT) scans performed. RESULTS Among 2929 patients, 21 (0.7%) showed gastrointestinal ischemic manifestations either as presenting symptom or during hospitalization. Abdominal CT showed bowel distention in 6 patients while signs of colitis/enteritis in 12. Three patients presented thrombosis of main abdominal veins. Endoscopy, when feasible, confirmed the diagnosis (6 patients). Surgical resection was necessary in 4/21 patients. Histological tissue examination showed distinctive features of endothelial inflammation in the small bowel and colon. Median hospital stay was 9 d with a mortality rate of 39%. CONCLUSION Gastrointestinal ischemia represents a rare manifestation of COVID-19. A high index of suspicion should lead to investigate this complication by CT scan, in the attempt to reduce its high mortality rate. Histology shows atypical feature of ischemia with important endotheliitis, probably linked to thrombotic microangiopathies.

Children with EHPVO have a high rate of bleeding episodes early in life. A stepwise approach comprising of medical, endoscopic, and surgical options provided excellent survival and bleeding control in this population.

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