Concealed SARS-CoV-2 interstitial pneumonia unmasked by infarct-like acute myocarditis

A 38-year-old otherwise healthy man presented to the emergency department for sudden-onset oppressive chest pain. On admission, vital parameters were within normal limits and physical examination was unremarkable. Since the ECG showed mild ST-segment eleva- tion in the inferior leads (Panel A), he underwent urgent coronary angiography which ruled out obstructive coronary artery disease (Panel B). Transthoracic echocardiogram showed preserved left ven- tricular (LV) ejection fraction with inferolateral wall hypokinesis. The peak of high-sensitive troponin I was 4038 ng/L (normal value <20). Acute myocarditis was suspected, and a cardiac magnetic resonance (CMR) was performed. High signal intensity (SI) of the mid-basal LV lateral wall on T2 short tau inversion recovery (STIR) sequences con- sistent with myocardial oedema (Panel C) and subepicardial late gado- linium enhancement in the same location (Panel D) were detected. Unexpectedly, areas of high SI on T2-STIR images were also noted on both lungs (Panel C), suggesting a pulmonary inflammatory pro- cess. Despite an initially negative chest X-ray, computed tomography revealed bilateral ground-glass opacity with multifocal consolidation and thickening of interlobular septa consistent with interstitial pneumonia (Panel E). Considering the ongoing coronavirus outbreak, a nasopharyngeal swab was obtained resulting positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. The patient remained free from either cardiovascular or respiratory symptoms and presented only mild fever (37.5C). Laboratory tests detected an increase of transaminases and C-reactive protein (6.73 mg/dL; normal value <0.5) with stable lymphocytopenia. After 20 days of hospitalization, he was discharged with the diagnosis of infarct-like myocarditis associated with subclinical SARS-CoV-2 respiratory infection. Acute myocarditis in the setting of SARS-CoV-2 infection has been anecdotally reported and its mechanism remains to be elucidated. So far, the SARS-CoV-2 genome has never been detected within the myocardium, suggesting an immune-mediated inflammatory myocardial injury. For the first time we reported a case of subclinical SARS-CoV-2 interstitial pneumonia occasionally unmasked by CMR performed for acute myocarditis

Magnetic resonance urography of congenital abnormalities - what the radiologist needs to know

Congenital abnormalities of the kidney and urinary tract include a wide range of malformations ranging from asymptomatic to life-threatening conditions. Although pediatric urogenital system imaging is based on the use of US (pre- and postnatal), voiding cystourethrography and scintigraphic study, magnetic resonance (MR) urography plays a fundamental role in the classification and management of congenital abnormalities of the kidney and urinary tract, giving an overview of the different clinical pictures, thanks to its panoramicity and high anatomical detail. In fact the anomalies of the urinary tract are phenotypically variable because they can affect simultaneously several segments of different embryonic derivation, with complex clinical pictures; they can appear both as isolated phenotypes or as complex malformative conditions, involving renal parenchyma, collecting system and bladder. A deep knowledge of this complex embryogenesis and its possible phenotypic patterns allows a correct interpretation of MR urography images. We describe the embryology and pathophysiology of congenital abnormalities of the kidney and urinary tract as well as MR urography technique and findings. Congenital abnormalities of the kidney and urinary tract are classified into four groups: (1) obstruction (proximal, middle and distal), (2) budding with respect to the Wolffian duct (site and number of ureter), (3) ascent and rotation (ectopia, malrotation and fusion of kidney) and (4) anomaly of metanephric differentiation (dysplasia, megapolicalycosis)

Time, intersubjectivity, and musical relationship in Alfred Schutz

In questo lavoro, affronto alcuni aspetti della relazione tra tempo e intersoggettività in Alfred Schutz . Presento una sintesi dell’architettura metodologica del sociologo austriaco, delineando la specificità della relazione tra tempo e coscienza. Prendo in esame la trattazione dell’esperienza musicale come esempio di declinazione peculiare di una serie di dinamiche temporali connesse alla costituzione intersoggettiva dei significati. Infine, espongo alcune tesi di autori che si sono occupati della relazione tra tempo, intersoggettività e musica in Schutz. La relazione musicale è un esempio di contesto dotato di senso, non oggetto di concettualizzazione, che esemplifica la relazione tra senso soggettivo ed esperienza dell’altro. La teoria dell’appresentazione di Schutz è il centro del processo di costituzione dei significati della prensione dell’altro. L’emersione dei significati è legata alle dinamiche dei poli passivi e attivi della coscienza e alla costituzione, nella we-relation, di una dimensione radicalmente intersoggettiva nella quale si supera la distinzione cartesiana tra interno ed esterno.Time, intersubjectivity, and musical relationship in Alfred Schutz Riccardo Venturini In this work I tackle certain aspects of the relationship between time and intersubjectivity in Alfred Schutz. I present a summary of the methodological architecture of the Austrian sociologist, outlining the specificity of the relationship between time and consciousness. I discuss the treatment of the musical experience as an example of the peculiar declination of a series of temporal dynamics connected to the intersubjective creation of meanings. Finally, I set out some thoughts related to the debate on the relationship between time, intersubjectivity and music in Schutz. The musical relationship is a context endowed with meaning, not the object of conceptualization, that allows us to identify in a paradigmatic way the relationship between the subjective sense and experience of the other. The theory of appresentation of Schutz is the center of the process of constitution of meaning of the understanding of the other. The emergence of meaning is related to the dynamics of the passive and active poles of the consciousness and the constitution, in the we-relation, of a radically intersubjective dimension that exceeds the Cartesian distinction between inside and outside

Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance-IR or diabetes mellitus-T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Modelling human choices: MADeM and decision‑making

Research supported by FAPESP 2015/50122-0 and DFG-GRTK 1740/2. RP and AR are also part of the Research, Innovation and Dissemination Center for Neuromathematics FAPESP grant (2013/07699-0). RP is supported by a FAPESP scholarship (2013/25667-8). ACR is partially supported by a CNPq fellowship (grant 306251/2014-0)

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men