We describe the first case of acute cardiac injury directly linked to myocardial localization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a 69-year-old patient with flu-like symptoms rapidly degenerating into respiratory distress, hypotension, and cardiogenic shock. The patient was successfully treated with venous-arterial extracorporeal membrane oxygenation (ECMO) and mechanical ventilation. Cardiac function fully recovered in 5 days and ECMO was removed. Endomyocardial biopsy demonstrated low-grade myocardial inflammation and viral particles in the myocardium suggesting either a viraemic phase or, alternatively, infected macrophage migration from the lung.

Severe COVID-19 is characterized by overproduction of immune mediators, but the role of interferons (IFNs) of the type I (IFN-I) or type III (IFN-III) families remains debated. We scrutinized the production of IFNs along the respiratory tract of COVID-19 patients and found that high levels of IFN-III, and to a lesser extent IFN-I, characterize the upper airways of patients with high viral burden but reduced disease risk or severity. Production of specific IFN-III, but not IFN-I, members, denotes patients with a mild pathology and efficiently drives the transcription of genes that protect against SARS-CoV-2. In contrast, compared to subjects with other infectious or non-infectious lung pathologies, IFNs are over-represented in the lower airways of patients with severe COVID-19 that exhibit gene pathways associated with increased apoptosis and decreased proliferation. Our data demonstrate a dynamic production of IFNs in SARS-CoV-2-infected patients and show IFNs play opposing roles at distinct anatomical sites.

Introduction: Providing peripheral intravenous access is one of the most commonly performed technical procedures in hospitals and it is mandatory for all patients undergoing surgery. Obtaining peripheral intravenous access may be difficult and this may cause delays in patient management, increased risk of adverse events and hospitalization costs. The aim of this study is to develop and validate a scale to identify patients at risk of peripheral difficult intravenous access, applicable to any adult patient undergoing surgery. Methods: A monocentric, observational study was conducted on adult surgical patients between September 2015 and April 2016. The primary outcome was the identification of parameters that could detect peripheral difficult intravenous access. Several parameters were taken into consideration, including patient details, healthcare professionals, and setting. The sample data were randomly divided into two subsets: a multivariate analysis was performed on the first one to define the Enhanced Adult DIVA score; the second subset was used for its validation. Results: We included 1006 patients (607 in the derivation, 399 in the validation cohorts respectively). The peripheral intravenous access was difficult in 127 patients (12.6%). The EA-DIVA score was devised with a score ranging from 0 to 12. The receiver operating characteristic (ROC) curve area under the curve (AUC) in the validation subset was 0.94. The validation study suggested a cutoff score of 8, which maximizes sensitivity (85.5%) and specificity (89.2%) in detecting difficult peripheral intravenous access, with a positive predictive value of 56% and a negative predictive value of 97.5%. Discussion: The EA-DIVA score is a simple tool to identify patients at high risk of peripheral difficult intravenous access. Its implementation is recommended in order to optimize peripheral intravenous access procedures.