C88 EFFECT OF SARS–COV2 INFECTION ON ACUTE CORONARY SYNDROME: A RETROSPECTIVE OBSERVATIONAL STUDY

Introduction

In Northern Italy, from October 2020 to April 2021, the second wave of COVID–19 pandemic recorded the highest incidence of infections ever. In this semester, the Lombardy region alone counted 43,318 positive cases and 16,710 deaths. It is well known how COVID–19 leads to a negative prognosis in acute coronary syndrome (ACS). This study aims to analyze the dramatic consequences of SARS–CoV2 infection on patients with concomitant ACS during the worst pandemic period ever recorded in Northern Italy.

Materials and Methods

The study enrolled 255 consecutive patients who have been hospitalized for ACS (STEMI or NSTEMI) from October 2020 to April 2021, both from the hub and spoke hospitals. Two subgroups are compared: the first is composed of patients who have tested positive for at least one molecular SARS–CoV2 swab (at admission or during hospitalization), the other group is composed of patients who have been tested negative to SARS–CoV2 swab. Major clinical data, risk factors (RF), comorbidities, laboratory findings, reperfusion times, drug therapy, complications and in–hospital mortality were systematically collected.

Results

Patients main characteristics are shown in Table 1. No differences have been observed in clinical history, RF and comorbidities in the subgroups. At admission, the incidence of acute pulmonary edema (APE) and respiratory symptoms was significantly higher in the SARS–CoV2 group, respectively 14% (p = 0.005) and 18% (p = 0.017). No differences in the “onset to door” and “door to needle” delays have been recorded. The incidence of the composite in–hospital complications is markedly increased in SARS–CoV2 group. Compared to negative patients, a higher mortality rates (18% Vs. 4%; p = 0.017), higher incidences of acute renal failure (ARF) (18% Vs. 5%; p = 0.037), cardiogenic shock (14% Vs. 3%; p = 0.033) and a wider prescription of inotropes (23% Vs. 10%; p = 0.009) in the SARS–CoV2 cohort.

Conclusion

The study confirms the negative prognostic impact of COVID–19 infection on ACS, recording a significantly higher rate of all major complications, both related to ischemia with multiorgan failure and interstitial pneumonia. Higher incidence of APE, cardiogenic shock and ARF has been observed in SARS–CoV2 positive subgroup, which is corroborated by a quadrupled risk of in–hospital mortality in the COVID–19 cohort.

Diagnosis of pediatric anti-NMDAR encephalitis at the onset: A clinical challenge

BACKGROUNDS

To investigate the clinical and instrumental features at the onset addressing to the diagnosis of anti-NMDAR encephalitis.

METHODS

Twenty children (age: 15 months-17 years; 7 males, 13 females) with initial suspected diagnosis of autoimmune encephalitis, observed between January 2008 and March 2018, were included. The final diagnosis was anti-NMDAR encephalitis in 7 children, other/probable autoimmune encephalitis in 7 children, and primary psychosis in the remaining 6 children.

RESULTS

At the clinical onset, anxiety disorder was the main symptom that helped in distinguishing the group of psychotic children from children with non-infectious encephalitis (P = 0.05 OR = 0.001), while epileptic seizures strongly predicted anti-NMDAR encephalitis (P = 0.04 OR = 28.6). At the onset, anti-NMDAR encephalitis could be distinguished from other/probable autoimmune encephalitis for the presence of sleep/wake rhythm alteration (P = 0.05 OR = 15). Among the symptoms occurring during the hospitalization, movement disorders (P = 0.031 OR = 12) were predictive of non-infectious encephalitis rather than primary psychosis. More specifically, the occurrence of language impairment (P = 0.03 OR = 33), epileptic seizures (P = 0.04 OR = 28.6) and catatonia (P = 0.03, OR = 33), were predictive of anti-NMDAR encephalitis. Also at this stage, anxiety disorder (P = 0.03 OR = 0.033) was predictive of primary psychosis.

CONCLUSION

Our findings suggest that at the clinical onset epileptic seizures and sleep/wake rhythm alteration represent the main features addressing to the diagnosis of anti-NMDAR encephalitis rather than primary psychosis and other/probable autoimmune encephalitis, while anxiety disorder could be a solid predictor of primary psychosis.

Thermal Transformations and Stability of Organometallic Materials with Electrical and Optical Properties: The Case of Polycrystalline cis-[Ir(CO)2Cl(C5H5N)]

In this paper the solid-state transformations under heating of cis-[Ir(CO)2Cl(C5H5N)] are discussed. The complexity of the transformations was revealed by integrating infrared spectroscopy, conventional and bidimensional X-ray diffraction, thermal analysis, and hot stage optical microscopy. During heating anisotropic expansion of the lattice along the Ir-Ir stacking takes place. Then cis-[Ir(CO)2Cl(C5H5N)] undergoes an irreversible solid-solid phase transition to a lattice of higher symmetry followed by a reversible transition into the amorphous phase. Under proper cooling a partial recrystallization takes place. Experiments in the presence of oxygen must be carried out in short time periods to avoid oxidation from Ir(I) to Ir(III).

Determination of the quadratic hyperpolarizability of trans-4-[4-(dimethylamino)styryl]pyridine and 5-dimethylamino-1,10-phenanthroline from solvatochromism of absorption and fluorescence spectra: a comparison with the electric-field-induced second-harmonic generation technique

For fluorescent compounds, the combined use of absorption and emission solvatochromic data allows to estimate indirectly the cavity radius of the molecule in solution, a very critical parameter in the application of the solvatochromic method for the determination of the quadratic hyperpolarizability beta of dipolar molecules. For two test compounds, trans-4-[4-(dimethylamino)styryl]pyridine (DASP) and 5-dimethylamino-1,10-phenanthroline (DAPHEN), the beta values so obtained are compared with those obtained by the EFISH (Electric Field Induced Second-Harmonic generation) technique. For DAPHEN, the versatility of the method described in this work in the presence of more than one electronic transition contributing to the non-linear optical response is demonstrated.

Developing family planning nurse practitioner protocols

This article focuses on the process of development of protocols for family planning nurse practitioners. A rationale for the use of protocols, a definition of the types and examples, and the pros and cons of practice with protocols are presented. A how-to description for the development process follows, including methods and a suggested tool for critique and evaluation. The aim of the article is to assist nurse practitioners in developing protocols for their practice.