Background and Aim. Lung ultrasound (LUS) is a convenient imaging modality in the setting of coronavirus disease-19 (COVID-19) because it is easily available, can be performed bedside and repeated over time. We herein examined LUS patterns in relation to disease severity and disease stage among patients with COVID-19 pneumonia. Methods. We performed a retrospective case series analysis of patients with confirmed SARS-CoV-2 infection who were admitted to the hospital because of pneumonia. We recorded history, clinical parameters and medications. LUS was performed and scored in a standardized fashion by experienced operators, with evaluation of up to 12 lung fields, reporting especially on B-lines and consolidations. Results. We included 96 patients, 58.3% men, with a mean age of 65.9 years. Patients with a high-risk quick COVID-19 severity index (qCSI) were older and had worse outcomes, especially for the need for high-flow oxygen. B-lines and consolidations were located mainly in the lower posterior lung fields. LUS patterns for B-lines and consolidations were significantly worse in all lung fields among patients with high versus low qCSI. B-lines and consolidations were worse in the intermediate disease stage, from day 7 to 13 after onset of symptoms. While consolidations correlated more with inflammatory biomarkers, B-lines correlated more with end-organ damage, including extrapulmonary involvement. Conclusions. LUS patterns provide a comprehensive evaluation of patients with COVID-19 pneumonia that correlated with severity and dynamically reflect disease stage. LUS patterns may reflect different pathophysiological processes related to inflammation or tissue damage; consolidations may represent a more specific sign of localized disease, whereas B-lines seem to be also dependent upon generalized illness due to SARS-CoV-2 infection.
<b><i>Introduction:</i></b> Overweight and obesity are associated with a more severe COronaVirus Disease 19 (COVID-19). Adipose tissue-related chronic inflammation could be a promoter for the occurrence of the cytokine storm that predicts aggravation of COVID-19. The primary aim was to investigate if this increased risk for more severe COVID-19 was associated with a higher inflammatory response. <b><i>Methods:</i></b> We enrolled patients <75 years old hospitalized in a medical COVID-19 ward with SARS-CoV-2-related pneumonia. Patients were classified according to BMI as normal weight, overweight, and obesity. Laboratory parameters were measured at admission and every second day during the hospital stay. <b><i>Results:</i></b> Ninety patients (64.4% males; median age 61 years) were enrolled. Invasive mechanical ventilation (IMV) was needed in 9% of the patients with normal weight, in 32.4% of the patients with overweight, and in 12.9% of the patients with obesity (<i>p</i> = 0.045). Maximal C-reactive protein (CRP) level during hospital stay was 92 (48–122) mg/L in patients with normal weight, 140 (82–265) mg/L in patients with overweight, and 117 (67–160) mg/L in patients with obesity (<i>p</i> = 0.037). Maximal ferritin values were 564 (403–1,379) μg/L in patients with a normal weight, 1,253 (754–2,532) μg/L in patients with overweight, and 828 (279–1,582) μg/L in patients with obesity (<i>p</i> = 0.015). <b><i>Conclusion:</i></b> Patients with overweight and obesity required more IMV and had higher peaks of CRP and ferritin than patients with normal weight during COVID-19.
We have shown 4 that exposure to tocilizumab was associated with de novo liver function test abnormalities in patients with COVID-19. From that data set, we selected only patients with clinical characteristics similar to those of the patients presented by Guaraldi and colleagues (eg, respiratory rate ≥30 breaths per minute, peripheral blood oxygen saturation <93% in room air, and a PaO 2 /FiO 2 ratio of <300 mm Hg). We identified 367 patients, 60 (16%) of whom were treated with tocilizumab. Despite of having a similar extent of liver function test abnormalities at admission (appendix p 2), patients treated with tocilizumab more frequently had a worsening of liver function tests during hospitalisation and had liver function tests that exceeded 3-times the upper limit of normal, com pared with those not treated with tocilizumab (52% vs 29%, respectively; appendix p 2). Alanine aminotransferase concentrations at days 7 (range 5-9), 14 (12-16), and 21 (19-23) after admission were significantly higher in patients treated with tocilizumab than controls (p<0•05). Although no patient treated with tocilizumab developed acute liver failure, we strongly suggest monitor ing liver func tion tests in patients with COVID-19 who are treated with tocilizumab. SP, RV, and PA report grants from Cassa di Risparmio di Padova e Rovigo (Cariparo) during the study. PA also reports personal fees from Biovie, Grifols, Sequana Medical, and grants from Boehringer Ingelheim, outside the submitted work. COVID-LIVER study group members are listed in the appendix (p 3).
Haemophilus parainfluenzae endocarditis is a rare but dangerous disease. With this work, we intend to show the importance of early diagnosis and appropriate treatment in order to avoid complications. We also highlight the importance of local epidemiology to choose antibiotic prophylaxis for high‐risk procedures in selected predisposed patients.
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