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.

Study Type – Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Primary renal synovial sarcoma is a very rare renal neoplasm. Since 2000, when this tumour was first described, only case reports have been published in the medical literature. This study is the first to describe the clinical and pathological features of primary renal synovial sarcoma and it found a relationship between these characteristics. Median overall and disease‐free survival were reported, and the risk of relapse for patients with non‐metastatic disease at diagnosis was found to be 36%. Different histological sub‐types, also described in other synovial sarcomas, were found in primitive renal tumours and directly related to tumour extension at diagnosis, different patterns of immunohistochemical stain and genetic alterations. OBJECTIVE To describe, for the first time, the clinical characteristics of primary renal synovial sarcoma (SS) and to examine the association of histological features with the expression of immunohistochemical markers. PATIENTS AND METHODS We collated published data on all cases of primary renal SS, from its first description in 2000 to September 2011. Data on clinical and pathological characteristics were extracted and used to create a database. Disease‐free survival (DFS) and overall survival (OS) rates were estimated using the Kaplan–Meier method with Rothman's 95% confidence intervals (CIs) and compared across the groups using the log‐rank test. The associations between tumour extension and histological features were evaluated using the non‐parametric Spearman rank test. A chi‐squared test was used to assess the differences between groups. RESULTS In the overall cohort, the median OS was 48 months (95% CI, 14.1–81.9). Cox analysis showed that the risk of death at diagnosis was greatly increased in patients with metastatic disease compared with those with non‐metastatic disease (hazard ratio [HR]: 343.9, 95% CI, 2.8–42 000; P= 0.017). The median DFS was 33.0 months (95% CI, 16.8–49.2), and patients who develop metastatic disease have a very poor prognosis with a median survival of 6 months (95% CI, 5.1–6.9). Microscopic features were monophasic, biphasic and poorly differentiated synovial sarcoma in 76, 16 and 8% of patients, respectively. Significant differences in expression of immunohistochemical markers or genetic mutation were found between different subtypes. CONCLUSIONS Despite its retrospective nature, this study shows that renal SS comprises different histological subtypes, which are characterized by specific immunohistochemical stains and by specific translocations. When diagnosed at metastatic stage, the prognosis was very poor compared with that for non‐metastatic disease, even though one out of three patients with non‐metastatic disease had disease relapse. Cooperative efforts and publication of cases with adequate follow‐up are necessary to better define prognosis and therapeutic strategies for this rare disease.

Chronic conventional disease-modifying anti-rheumatic drugs masking severe SARS-CoV-2 manifestations in an elderly rheumatic patient Dear Editor, In early 2020 a new beta-corona virus (SARS-CoV-2) spread all over the world, and with a high incidence in Europe, especially in Italy [1 , 2]. SARS-CoV-2 infection may lead to a wide range of clinical presentations, from an asymptomatic form to a severe acute respiratory syndrome [3]. The symptoms more frequently observed were fever, chills, myalgia or fatigue, followed by a dry cough and dyspnea 3-7 days later. The age and the presence of chronic comorbidities (hypertension, cardiovascular disease, diabetes, chronic lung, kidney or cerebrovascular disease or malignancy) have been considered as the major risk factors for acute respiratory distress syndrome (ARDS) and the need for intensive care in COVID-19 patients [4]. ARDS is an immunopathologic event with hyper-activity of the systemic inflammatory response that induces cytokine storm, that increase pro-inflammatory cytokines like interferons, interleukins (IL), tumor necrosis factor Letter to the Editor / Journal of Infection xxx (xxxx) xxx

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Background: The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the related disease (COVID-19) has rapidly spread to a pandemic proportion, increasing the demands on health systems for the containment and management of COVID-19. Nowadays, one of the critical issues still to be pointed out regards COVID-19 treatment regimens and timing: which drug, in which phase, for how long? Methods: Our narrative review, developed using MEDLINE and EMBASE, summarizes the main evidences in favor or against the current proposed treatment regimens for COVID-19, with a particular focus on antiviral agents. Results: Although many agents have been proposed as possible treatment, to date, any of the potential drugs against SARS-CoV-2 has shown to be safe and effective for treating COVID-19. Despite the lack of definitive evidence, remdesivir remains the only antiviral with encouraging effects in hospitalized patients with COVID-19. Conclusions: In such a complex moment of global health emergency, it is hard to demand scientific evidence. Nevertheless, randomized clinical trials aiming to identify effective and safe drugs against SARS-CoV-2 infection are urgently needed in order to confirm or reject the currently available evidence.