A rare case of cerebral venous thrombosis and disseminated intravascular coagulation temporally associated to the covid-19 vaccine administration

Globally, at the time of writing (20 March 2021), 121.759.109 confirmed COVID-19 cases have been reported to the WHO, including 2.690.731 deaths. Globally, on 18 March 2021, a total of 364.184.603 vaccine doses have been administered. In Italy, 3.306.711 confirmed COVID-19 cases with 103.855 deaths have been reported to WHO. In Italy, on 9 March 2021, a total of 6.634.450 vaccine doses have been administered. On 15 March 2021, Italian Medicines Agency (AIFA) decided to temporarily suspend the use of the AstraZeneca COVID-19 vaccine throughout the country as a precaution, pending the rulings of the European Medicines Agency (EMA). This decision was taken in line with similar measures adopted by other European countries due to the death of vaccinated people. On 18 March 2021, EMA’s safety committee concluded its preliminary review about thromboembolic events in people vaccinated with COVID-19 Vaccine AstraZeneca at its extraordinary meeting, confirming the benefits of the vaccine continue to outweigh the risk of side effects, however, the vaccine may be associated with very rare cases of blood clots associated with thrombocytopenia, i.e., low levels of blood platelets with or without bleeding, including rare cases of cerebral venous thrombosis (CVT). We report the case of a 54-year-old woman who developed disseminated intravascular coagulation (DIC) with multi-district thrombosis 12 days after the AstraZeneca COVID-19 vaccine administration. A brain computed tomography (CT) scan showed multiple subacute intra-axial hemorrhages in atypical locations, including the right frontal and the temporal lobes. A plain old balloon angioplasty (POBA) of the right coronary artery was performed, without stent implantation, with restoration of distal flow, but with persistence of extensive thrombosis of the vessel. A successive thorax angio-CT added the findings of multiple contrast filling defects with multi-vessel involvement: at the level of the left upper lobe segmental branches, of left interlobar artery, of the right middle lobe segmental branches and of the right interlobar artery. A brain magnetic resonance imaging (MRI) in the same day showed the presence of an acute basilar thrombosis associated with the superior sagittal sinus thrombosis. An abdomen angio-CT showed filling defects at the level of left portal branch and at the level of right suprahepatic vein. Bilaterally, it was adrenal hemorrhage and blood in the pelvis. An evaluation of coagulation factors did not show genetic alterations so as the nasopharyngeal swab ruled out a COVID-19 infection. The patient died after 5 days of hospitalization in intensive care

Radiological assessment of dementia: the Italian inter-society consensus for a practical and clinically oriented guide to image acquisition, evaluation, and reporting

Background: Radiological evaluation of dementia is expected to increase more and more in routine practice due to both the primary role of neuroimaging in the diagnostic pathway and the increasing incidence of the disease. Despite this, radiologists often do not follow a disease-oriented approach to image interpretation, for several reasons, leading to reports of limited value to clinicians. In our work, through an intersocietal consensus on the main mandatory knowledge about dementia, we proposed a disease-oriented protocol to optimize and standardize the acquisition/evaluation/interpretation and reporting of radiological images. Our main purpose is to provide a practical guideline for the radiologist to help increase the effectiveness of interdisciplinary dialogue and diagnostic accuracy in daily practice. Results: We defined key clinical and imaging features of the dementias (A), recommended MRI protocol (B), proposed a disease-oriented imaging evaluation and interpretation (C) and report (D) with a glimpse to future avenues (E). The proposed radiological practice is to systematically evaluate and score atrophy, white matter changes, microbleeds, small vessel disease, consider the use of quantitative measures using commercial software tools critically, and adopt a structured disease-oriented report. In the expanding field of cognitive disorders, the only effective assessment approach is the standardized disease-oriented one, which includes a multidisciplinary integration of the clinical picture, MRI, CSF and blood biomarkers and nuclear medicine

Diffuse glioblastoma resembling acute hemorrhagic leukoencephalitis

We report the case of a young man with sudden onset of diplopia after an upper respiratory tract infection. Based on the first radiological findings acute hemorrhagic leukoencephalitis, a variant of acute disseminated encephalomyelitis, was suspected and treatment with high dose intravenous dexamethasone was started but it was stopped for intolerance. The patient clinically worsened, developing gait instability, ataxia and ophthalmoplegia; brain MRI performed 20 days later showed severe progression of the disease with subependymal dissemination. After brain biopsy of the right temporal lesion the histological diagnosis was glioblastoma. These findings suggest that MRI features of acute hemorrhagic leukoencephalitis may dissimulate the diagnosis of diffuse glioma/glioblastoma. This case underscores the importance of considering diffuse glioma in the differential diagnosis of atypical signs and symptoms of acute hemorrhagic leukoencephalitis and underlines the relevant role of integrating neuroradiologic findings with neuropathology

1974

History of Golf (1) The Nine Toughest Holes in the World (2) Stockie Madness (3) Bartender, One More Round for Pythium (3) Panel: 1973 Turf Problems in Review - 1974 Possible Remedies (A1-A12) Movement of Water to a Holding Pond (A13) Maintenance of Low Budget, Short Season Golf Courses (A16) Turfgrass Fertilization (A18) Determining Turfgrass Fertilizer Needs (A25) Shortage of Plant Food and How to Adjust to Supply and Cost (A29) Panel: Tricalcium Arsenate - Use and Abuse (A33-A46) Operating and Maintaining Municipal Golf Courses (A48) Maintenance of a High Budget Golf Course (A51) Trends in Agricultural Education and Where Are the Emphases (A58) Maintenance of Municipal Parks and Recreation Areas (A60) Maintenance of Grass Tennis Courts (A63) Transition from Natural to Artificial Turf (A67) Plant materials for Outlying Areas (A71) Care of University Grounds (A76) Maintenance of Industrial Sites (A79) Turfgrass Diseases and Systemic Fungicides (A81) A Look at the Future (A 84) Watering of Golf Course Turf (A92

Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy

<p>Abstract</p> <p>Background</p> <p>A relationship between quality of primary health care and preventable hospitalizations has been described in the US, especially among the elderly. In Europe, there has been a recent increase in the evaluation of Ambulatory Care Sensitive Conditions (ACSC) as an indicator of health care quality, but evidence is still limited. The aim of this study was to determine whether income level is associated with higher hospitalization rates for ACSC in adults in a country with universal health care coverage.</p> <p>Methods</p> <p>From the hospital registries in four Italian cities (Turin, Milan, Bologna, Rome), we identified 9384 hospital admissions for six chronic conditions (diabetes, hypertension, congestive heart failure, angina pectoris, chronic obstructive pulmonary disease, and asthma) among 20-64 year-olds in 2000. Case definition was based on the ICD-9-CM coding algorithm suggested by the Agency for Health Research and Quality - <it>Prevention Quality Indicators</it>. An area-based (census block) income index was used for each individual. All hospitalization rates were directly standardised for gender and age using the Italian population. Poisson regression analysis was performed to assess the relationship between income level (quintiles) and hospitalization rates (RR, 95% CI) separately for the selected conditions controlling for age, gender and city of residence.</p> <p>Results</p> <p>Overall, the ACSC age-standardized rate was 26.1 per 10.000 inhabitants. All conditions showed a statistically significant socioeconomic gradient, with low income people being more likely to be hospitalized than their well off counterparts. The association was particularly strong for chronic obstructive pulmonary disease (level V low income vs. level I high income RR = 4.23 95%CI 3.37-5.31) and for congestive heart failure (RR = 3.78, 95% CI = 3.09-4.62). With the exception of asthma, males were more vulnerable to ACSC hospitalizations than females. The risks were higher among 45-64 year olds than in younger people.</p> <p>Conclusions</p> <p>The socioeconomic gradient in ACSC hospitalization rates confirms the gap in health status between social groups in our country. Insufficient or ineffective primary care is suggested as a plausible additional factor aggravating inequality. This finding highlights the need for improving outpatient care programmes to reduce the excess of unnecessary hospitalizations among poor people.</p

L\u2019indice di deprivazione italiano a livello di sezione di censimento: definizione, descrizione e associazione con la mortalit\ue0

Obiettivo: il presente studio ha lo scopo di produrre per l\u2019intero territorio nazionale un indice di deprivazione a livello comunale e a livello di sezione di censimento basato sui dati del 2001, che risponda a esigenze di tipo epidemiologico. Setting e partecipanti: lo studio utilizza i dati del Censimento generale della popolazione e delle abitazioni del 2001. Da 280 variabili definite a livello di sezione di censimento (numero sezioni= 352.205, numero medio di abitanti= 169 con deviazione standard 225; superficie media= 0,6 km2 con deviazione standard 2,4 km2) sono state scelte cinque condizioni che concorrono operativamente a descrivere il concetto multidimensionale della deprivazione sociale e materiale: basso livello di istruzione, disoccupazione, mancato possesso dell\u2019abitazione, famiglia monogenitoriale e alta densit\ue0 abitativa. L\u2019indice \ue8 calcolato come somma di indicatori standardizzati ed \ue8 anche disponibile categorizzato in quintili di popolazione. La stessa procedura \ue8 stata applicata ai dati di frequenza aggregati a livello di comune di residenza. L\u2019associazione tra mortalit\ue0 e deprivazione \ue8 stata valutata ricorrendo alla mortalit\ue0 generale ISTAT 2000-2004. Risultati: a livello nazionale si osserva un forte gradiente Nord-Sud. L\u2019indice di deprivazione comunale (r ) ha un\u2019alta correlazione con quello calcolato in modo simile sui dati del precedente censimento 1991 (r=0,91). La mortalit\ue0 generale mostra un\u2019associazione con l\u2019indice, crescendo con il livello di deprivazione (in particolare nella popolazione fino a 64 anni e nei comuni a dimensioni maggiori). Conclusione: l\u2019indice descrive una realt\ue0 coerente con quanto noto sulla distribuzione geografica della povert\ue0 e sull\u2019impatto che ha sulla mortalit\ue0. Tale risultato avvalora il suo utilizzo a fini epidemiologici