The actual Coronavirus Disease (COVID 19) pandemic is due to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the coronavirus family. Besides the respiratory involvement, COVID 19 patients frequently develop a pro-coagulative state caused by virus-induced endothelial dysfunction, cytokine storm and complement cascade hyperactivation. It is common to observe diffuse microvascular thrombi in multiple organs, mostly in pulmonary microvessels. Thrombotic risk seems to be directly related to disease severity and worsens patients' prognosis. Therefore, the correct understanding of the mechanisms underlying COVID-19 induced prothrombotic state can lead to a thorough assessment of the possible management strategies. Hence, we review the pathogenesis and therapy of COVID 19-related thrombosis disease, focusing on the available evidence on the possible treatment strategies and proposing an algorithm for the anticoagulation strategy based on disease severity. Keywords COVID-19 • SARS-CoV-2 • Thrombosis • Anticoagulation Highlights • SARS-CoV-2 induced complement hyperactivation, endothelial dysfunction and cytokine storm have a prothrombotic effect. • COVID 19 patients develop a pro-coagulative state directly related to disease severity. • In COVID 19 critical patients, thrombotic lesions in pulmunary microvessels have a prevalence twice higher than critical non-COVID 19 patients. • Anticoagulant treatment is associated with lower mortality. Hence, we propose an algorithm for the anticoagulation strategy based on disease severity.

Introduction: Little is still known about the prognostic impact of incident arrhythmias in hospitalized patients with COVID-19. The aim of this study was to evaluate the incidence and predictors of sustained tachyarrhythmias in hospitalized patients with COVID-19, and their potential association with disease severity and in-hospital mortality. Materials and methods: This was a retrospective multicenter observation study including consecutive patients with laboratory confirmed COVID-19 admitted to emergency department of ten Italian Hospitals from 15 February to 15 March 2020. The prevalence and the type of incident sustained arrhythmias have been collected. The correlation between the most prevalent arrhythmias and both baseline characteristics and the development of ARDS and in-hospital mortality has been evaluated. Results: 414 hospitalized patients with COVID-19 (66.9 ± 15.0 years, 61.1% male) were included in the present study. During a median follow-up of 28 days (IQR: 12-45), the most frequent incident sustained arrhythmia was AF (N: 71; 17.1%), of which 50 (12.1%) were new-onset and 21 (5.1%) were recurrent, followed by VT (N: 14, 3.4%) and supraventricular arrhythmias (N: 5, 1.2%). Incident AF, both new-onset and recurrent, did not affect the risk of severe adverse events including ARDS and death during hospitalization; in contrast, incident VT significantly increased the risk of in-hospital mortality (RR: 2.55; P: .003). Conclusions: AF is the more frequent incident tachyarrhythmia; however, it not seems associated to ARDS development and death. On the other hand, incident VT is a not frequent but independent predictor of in-hospital mortality among hospitalized COVID-19 patients.

Kidney injury may be a severe complication of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and contributes to worsen the prognosis. Various pathophysiological mechanisms can contribute to organ damage and impair renal function, proving the complexity of the virus activity and the resulting immunity response. We summarized the evidence of the literature on the prevalence of kidney involvement, on the pathogenic pathways and on its management.

Introduction No data are provided about the effect of triple combination therapy with Lopinavir/Ritonavir (LPN/RTN), hydroxychloroquine (HQ) and azithromycin (AZT) on corrected QT (QTc) interval and arrhythmic risk, in COVID-19 patients. This study aims to describe the incidence of extreme QTc interval prolongation among COVID-19 patients on this experimental treatment and to identify the clinical features associated with extreme QTc prolongation. Materials and Methods Data of 87 COVID-19 patients, treated with triple combination including LPN/RTN, HQ and AZT, were analyzed. QT interval was obtained by the tangent method and corrected for heart rate using Bazett’s formula. Extreme QTc interval prolongation was considered an absolute QTc interval ≥ 500 ms or an increase in QTc intervals of 60 ms or greater (ΔQTc ≥ 60 ms) compared with baseline. Results Hypertension (66.7%) and diabetes (25.3%) were the most prevalent cardiovascular comorbidities. Twenty patients (23%) showed extreme QTc interval prolongation; no clinical, electrocardiographic or pharmacological characteristics have been associated to extreme QTc prolongation, except the history of ischemic stroke ( P= 0,007 ). One torsade de pointes (TdP) in patient with QTc extreme prolongation (QTc: 560 ms) after 5 days of therapy was recorded. Conclusions We observed a high incidence of extreme QTc interval prolongation among COVID-19 patients on triple combination therapy. Since the incidence of malignant arrhythmias seems to be not negligible, a careful electrocardiographic monitoring would be advisable.

As of January 2020, a new pandemic has spread from Wuhan and caused thousands of deaths worldwide. Several studies have observed a relationship between coronavirus disease (COVID-19) infection and the cardiovascular system with the appearance of myocardial damage, myocarditis, pericarditis, heart failure and various arrhythmic manifestations, as well as an increase in thromboembolic risk. Cardiovascular manifestations have been highlighted especially in older and more fragile patients and in those with multiple cardiovascular risk factors such as cancer, diabetes, obesity and hypertension. In this review, we will examine the cardiac involvement associated with SARS-CoV-2 infection, focusing on the pathophysiological mechanism underlying manifestations and their clinical implication, taking into account the main scientific papers published to date.

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Background: Immune checkpoint inhibitors (ICIs) have transformed treatment of a variety of different cancer types. Published patient-reported quality of life (QOL) data have been largely limited to phase III trials. The size and heterogeneity of this literature can make patient education about ICIs difficult. The aim of this meta-analysis was to quantitatively summarize change QOL in patients receiving ICI for cancer.Methods: Two meta-analyses were conducted on publications of PD-1/PD-L1 and/or CTLA-4 inhibitors that provided mean-level QOL using the EORTC QLQ-C30 and/or EQ-5D. One meta-analysis examined change in QOL in patients treated with ICIs from pretreatment to follow-up approximately 12-24 weeks later. The second meta-analysis compared QOL at follow-up in ICI versus non-ICI regimens in randomized trials. Moderator analyses examined ICI regimen, comparator regimen, disease site, age, gender, follow-up period, and risk of bias.Results: Of 20,323 publications identified, 26 met inclusion criteria. The first metaanalysis, encompassing 26 studies and 6,965 patients, indicated QOL did not change over time in patients treated with ICIs (P > .05). Significant moderators included ICI regimen, cancer type, sex, and risk of bias (P values <.05). In the second metaanalysis of 16 studies and 6,536 patients (ICI n¼3,588, non-ICI n¼2,948), better QOL was observed in ICI versus non-ICI regimens (P < .05). Significant moderators included ICI regimen, cancer type, age, and risk of bias (P values <.05).Conclusions: This study is among the first to quantitatively summarize QOL in patients treated with ICIs. Findings suggest ICI recipients report overall stable QOL and better QOL than patients treated with non-ICI regimens. Results confirm that despite immune-related toxicities, ICIs are generally well-tolerated.Legal entity responsible for the study: The authors.

e20693 Background: The waiting room is one of the most emotional place in oncological divisions; indeed, it's presumed that the waiting moment makes increase thoughts most related to the experience of disease and its treatment, making them sometimes unbearable. At present, any evaluation of the emotional states in the waiting room doesn't exist, therefore we analyzed the most prevailing emotions and feelings for patients in this context. The identification of them should address also ways to improve patients well being in these moments. Primary objective was to prospectively evaluate the prevailing emotional state patients and feelings in oncological waiting rooms; secondary endpoint is to develop a questionnaire to be further validated and useful to quantify how changes in the environment, as people and furnishings, could reduce prevailing emotional intensity. Methods: A committee of psychoncologists, oncologists, psychiatrists, volunteers, nurses, past patients, and statisticians identified the emotional states considered most important (relationship with environment, surrounding people and treatment, recurrent thoughts about disease and life, fears and things that could ease the wait and prevailing emotions) and developed a questionnaire. In May 2008 for two consecutive weeks this questionnaire was administered by the same dedicated nurse to all the outpatients afferred to our Oncology Department. The compilation of questionnaire was spontaneous and anonymous and it collected also age, sex, whether the patient was under treatment or in follow up and whether was accompanied. Results: In two consecutive weeks 300 questionnaires have been collected in the waiting rooms. Statistical analysis showed that the most prevailing emotions are sadness (51%), fear (29%), anger (17%) and joy (7%). A positive disposition (Cronbach alpha 0.60) and anxiety (Cronbach alpha 0.64) were also assessed. No differences in answers were revealed among patients waiting for follow up and patients waiting for chemotherapy and among different ages. Conclusions: The level of negative feelings seems higher than in other conditions and suggests that active intervention to improve the waiting in waiting rooms is warranted. A further validated questionnaire is ongoing also to evaluate emotions intensity. No significant financial relationships to disclose.