Pulmonary embolism in patients with COVID-19 pneumonia: When we have to search for it?

Background

COVID-19 is still a global challenge in regard for management and therapy. Pulmonary embolism (PE) seems to have a higher prevalence in COVID-19 instead of non-COVID patients. Clinical and laboratory parameters related with PE are still unknown.

Methods

We conducted a retrospective unicentre study in Alto Vicentino Hospital between March 1st, 2020, and January 31st, 2021 in patients admitted for COVID-19 tested with a RT-PCR nasal swab. Data about patients studied with computed tomography pulmonary angiogram (CTPA) because of PE suspicion were collected, as their clinical and laboratory parameters too.

Results

2621 patients were admitted for COVID-19 in Alto Vicentino Hospital between March 1st, 2020, and January 31st, 2021 and in 267 of them a CTPA was performed finding 50 PE (18.7%). Only non-Caucasian race (OR = 5.44; 95% CI 1.22–24.35; p = 0.027) and previous VTE (OR = 5.3; 95% CI 1.09–26.17; p = 0.039) were found to be independently associated with PE.

Conclusion

PE is a frequent complication of COVID-19 and clinician need high degree of suspicion because clinical and laboratoristic parameters cannot drive diagnosis.

Brain 18F-FDG and 18F-Flumetamol PET Imaging of Fragile X-Associated Tremor Ataxia Syndrome

ABSTRACT

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a rare movement disorder caused by a 55-to-200 CGG-trinucleotide expansion premutation in the FMR1 gene. Core diagnostic criteria are tremor, ataxia, and T2-weighted hyperintensity of the middle cerebellar peduncles on MRI, but FXTAS encompass a broad spectrum of neurological symptoms. FXTAS pathophysiology is largely unknown, and some animal models and neuropathology findings suggest possible overlap with Alzheimer disease. We report the combined PET imaging of a genetically confirmed FXTAS patient, presenting reduced temporal-frontal 18F-FDG uptake, and pathological cortical deposition of amyloid to 18F-flumetamol PET scan. This report may offer clues to FXTAS pathophysiology.

Fontes de variação da produção e composição de leite em vacas Holandesa, Jersey e Girolando

Este estudo teve o objetivo de quantificar os efeitos do grupo genético, estresse térmico e a contagem de células somáticas (ECS) sobre a produção de leite de vacas das raças Holandesa, Jersey e genótipos da raça Girolando, em clima subtropical. Foram utilizados 14181 registros de controle leiteiro mensal das raças Girolando, Jersey e Holandesa, durante 7 anos. As vacas foram mantidas em pastagens, com suplementação alimentar e acesso à sombra. Dados de estação meteorológica foram utilizados para a determinação do Índice de Temperatura e Umidade (THI). Ano, ordem da lactação, período de lactação, THI e ECS foram fixados como covariáveis. A raça Holandesa obteve maior produtividade, exceto de gordura. Na raça Girolando, a produção de leite e lactose não diferiu da raça Jersey, sendo os demais parâmetros de produção inferiores a esta raça. As concentrações de componentes do leite (%) foram maiores no leite da raça Jersey, exceto o teor de lactose. A raça Holandesa apresentou os menores teores de componentes do leite, exceto de lactose. O aumento de ECS resultou em diminuição da produção de leite que totalizou 26,3; 35,43 e 28,25% nas raças Girolando, Jersey e Holandesa, respectivamente. A elevação do THI teve maiores efeitos na raça Holandesa, na qual o aumento do THI diminuiu 12,4% da concentração de gordura e 5,5% de sólidos totais no leite. Conclui-se que a maior produtividade foi obtida com a raça Holandesa e maior qualidade com a raça Jersey. ECS acima de um diminui linearmente a produção de leite em todas as raça. Raças com maior proporção de genes da raça Holandesa são mais susceptíveis ao estresse térmico.

Diagnosing mild cognitive impairment in Parkinson's disease: which tests perform best in the Italian population?

Mild cognitive impairment (MCI) is common in patients with Parkinson's disease (PD) and should be recognized early because it represents a predictor of PD-related dementia and worse disease course. Diagnostic criteria for PD-related MCI (PD-MCI) have recently been defined by a Movement Disorders Society (MDS) task force. The present study explored which neuropsychological tests perform best for a level II (i.e., comprehensive neuropsychological assessment) diagnosis of PD-MCI according to the MDS task force criteria in Italian-speaking PD patients. To this aim, we assessed a comprehensive 23-item neuropsychological battery, derived the best-performing 10-test battery (i.e., two tests per domain for each of the five cognitive domains), and explored its accuracy for diagnosing PD-MCI in comparison to the full battery in a group of PD patients. A secondary aim was to explore the role of this battery for subtyping PD-MCI according to single-domain vs. multiple-domain involvement. The 10-test battery showed 73% sensitivity and 100% specificity for diagnosing PD-MCI, and 69% sensitivity and 100% specificity for PD-MCI subtyping. In patients older than 70 years, we derived a slightly different 10-test battery with 84% sensitivity and 100% specificity for PD-MCI diagnosis, and 86% sensitivity and 100% specificity for PD-MCI subtyping. These 10-item neuropsychological batteries might represent a good trade-off between diagnostic accuracy and time of application, and their role in PD-MCI diagnosis and subtyping should be further explored in future prospective studies.

[Management of chronic heart failure: clinical features and resource utilization among patients managed by the general practitioner. Pilot project in the province of Udine (Italy)]

RATIONALE

In the management of heart failure the general practitioner (GP) plays an important role. However, international studies proved that the GP differs in the management of these patients from the cardiologist. This pilot study aims at investigating if such differences persist in the Italian community.

MATERIALS AND METHODS

Seventy patients with heart failure have been enrolled prospectively by 10 GPs in the Udine district (ASL 4). All of them have been evaluated at the first and subsequent visits, both with respect to clinical and instrumental parameters, overall resource consumption and quality of life.

RESULTS

We observed a high degree of heterogeneity in the follow up patterns; a low coordination between GP and cardiologists in managing patients; several co-morbidities; high social burden; a good adherence to treatment guidelines; a moderate workload, subjectively evaluated from the GP.

CONCLUSIONS

This experience motivated the need of further research in the field, and, from the point of view of the daily practice, the need of integrating hospital and community management of patients with heart failure.