Background More than 20% of hospitalized patients with coronavirus disease 2019 (COVID-19) develop acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) admission. The long-term respiratory sequelae in ICU survivors remain unclear. Research question what are the major long-term pulmonary sequelae in critical COVID-19 survivors? Study Design and Methods Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-minute walking test (6MWT)) and chest computed tomography (CT). Results 125 ICU patients with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%), and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median (IQR) distance in the 6MWT was 400 (362;440) meters. CT scans were abnormal in 70.2% of patients, showing reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT had worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT were age and length of invasive mechanical ventilation during the ICU stay. Interpretation Pulmonary structural abnormalities and functional impairment are highly prevalent in surviving ICU patients with ARDS secondary to COVID-19 3 months after hospital discharge. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months post discharge.

Our findings suggest that early oseltamivir administration was associated with favourable outcomes among critically ill ventilated patients with 2009 H1N1 virus infection.

PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock.

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BackgroundMutational analysis of the KRAS gene has recently been established as a complementary in vitro diagnostic tool for the identification of patients with colorectal cancer who will not benefit from anti-epidermal growth factor receptor (EGFR) therapies. Assessment of the mutation status of KRAS might also be of potential relevance in other EGFR-overexpressing tumors, such as those occurring in breast cancer. Although KRAS is mutated in only a minor fraction of breast tumors (5%), about 60% of the basal-like subtype express EGFR and, therefore could be targeted by EGFR inhibitors. We aimed to study the mutation frequency of KRAS in that subtype of breast tumors to provide a molecular basis for the evaluation of anti-EGFR therapies.MethodsTotal, genomic DNA was obtained from a group of 35 formalin-fixed paraffin-embedded, triple-negative breast tumor samples. Among these, 77.1% (27/35) were defined as basal-like by immunostaining specific for the established surrogate markers cytokeratin (CK) 5/6 and/or EGFR. KRAS mutational status was determined in the purified DNA samples by Real Time (RT)-PCR using primers specific for the detection of wild-type KRAS or the following seven oncogenic somatic mutations: Gly12Ala, Gly12Asp, Gly12Arg, Gly12Cys, Gly12Ser, Gly12Val and Gly13Asp.ResultsWe found no evidence of KRAS oncogenic mutations in all analyzed tumors.ConclusionsThis study indicates that KRAS mutations are very infrequent in triple-negative breast tumors and that EGFR inhibitors may be of potential benefit in the treatment of basal-like breast tumors, which overexpress EGFR in about 60% of all cases.

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An 8-year-old boy consulted about a 1-year asymptomatic plaque on the left dorsal side of the spine. The patient had had no previous antecedents to note and presented no injury or scratch marks in the region. Upon physical examination, we observed a 3.5 · 2.0 cm in size ovalshaped plaque that extended laterally outwards from the spine with a slight blaschkoid pattern. The surface presented a slightly raised appearance, flesh colored with lightly hyperpigmented edges ( Fig. 1a).A biopsy was performed which showed an epidermis with acanthosis and papillomatosis. The dermis and the hypodermis did not seem to be affected, however, a colloid iron stain showed diffuse blue deposits in the upper dermis between the collagen bundles. Accordingly, the patient was diagnosed with mucinous nevus. No treatment was started, and the lesion remained stable in the following months. Case 2A 14-year-old girl was seen in consultation for a two-year history of a brown lesion on her back. The lesion was largely asymptomatic, and there was no antecedent of trauma or scratching in this area. Cutaneous examination showed a solitary brownish, firm plaque, 3 cm in diameter located on the lumbosacral region ( Fig. 1b). There were no other skin or mucosal abnormalities.An incisional biopsy from the solitary plaque was performed, and the histopathologic pictures showed an acanthotic epidermis with thin, elongated rete ridges and minimal basket-weave hyperkeratosis (Fig. 2a).The striking feature was the massive deposit of mucinous material in the whole dermis that stained positive with alcian blue at pH 2.5 (Fig. 2b). With the van Gieson stain, the density of elastic fibers was shown to be slightly reduced. Masson trichrome staining failed to demonstrate collagen fiber alterations. There were no abnormalities in eccrine sweat glands.Results of laboratory studies were within normal limits. Case 3A 14-year-old girl, twin sister of the previous case, presented with a well-defined plaque in the same area similar to her sister that had appeared some months previously. 1283

Neutrophilic dermatoses comprise a wide spectrum of diseases characterized histologically by the presence of an aseptic neutrophilic infiltrate in the skin. The neutrophilic infiltrate may move from the epidermis to the dermis and the subcutis, resulting in distinct clinicopathological conditions. There have been a few reports on a peculiar pustular dermatosis involving the cutaneous flexures and arising in patients with autoimmune diseases or immunological abnormalities. We report a patient who developed amicrobial pustulosis of the folds soon after she was diagnosed with Hashimoto's thyroiditis (HT). To our knowledge, the association of APF with HT is a novel finding that has not previously been described. We believe that this combination is not just coincidental, but may share similar immunopathological mechanisms.