Liver involvement in patients with COVID-19 infection: A comprehensive overview of diagnostic imaging features

During the first wave of the pandemic, coronavirus disease 2019 (COVID-19) infection has been considered mainly as a pulmonary infection. However, different clinical and radiological manifestations were observed over time, including involvement of abdominal organs. Nowadays, the liver is considered one of the main affected abdominal organs. Hepatic involvement may be caused by either a direct damage by the virus or an indirect damage related to COVID-19 induced thrombosis or to the use of different drugs. After clinical assessment, radiology plays a key role in the evaluation of liver involvement. Ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) may be used to evaluate liver involvement. US is widely available and it is considered the first-line technique to assess liver involvement in COVID-19 infection, in particular liver steatosis and portal-vein thrombosis. CT and MRI are used as second- and third-line techniques, respectively, considering their higher sensitivity and specificity compared to US for assessment of both parenchyma and vascularization. This review aims to the spectrum of COVID-19 liver involvement and the most common imaging features of COVID-19 liver damage

Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study)

Purpose: Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU). Methods: Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap). Results: Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO2. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU). Conclusion: Almost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort

Beyond food: Framing ecosystem services value in peri-urban farming in the post-Covid era with a multidimensional perspective. The case of Cascina Biblioteca in Milan (Italy)

The idea that it is possible to overcome the post-covid crisis starting from urban projects is becoming increasingly popular (Balducci, 2020). This moment becomes a precious opportunity to experiment with innovative, multidisciplinary and multi-scalar methodologies for an urban planning and design capable of condensing apparently distant concepts and approaches that are nonetheless congenial to the same goals. In this sense, multifunctional agriculture (MFA) recognizes multiple functions including food production, environmental preservation and social inclusion, which can be identified as Ecosystem Services (ESs). In our contribution, the case study of a multifunctional farmhouse in the Milan suburban area is proposed as an opportunity to test an integrated preliminary evaluation model to support decisions concerning urban planning and design, with the goal of maximizing the performance of the ecosystem services provided in MFA field

Le Aree Interne Italiane. Un banco di prova per interpretare e progettare i territori marginali | Inner Areas in Italy. A testbed for interpreting and designing marginal territories

The book “Inner Areas in Italy. A testbed for interpreting and designing marginal territories” is a timely contribution to the international academic and policy debate on ‘Inner Peripheries’ and on the possible measures to reduce inequalities among different regions in Europe. The National Strategies for the Inner Areas (SNAI), a groundbreaking experience of place-sensitive interventions addressing marginal areas, was promoted in Italy in the framework of the EU Cohesion Policies 2014-2020. Inner Areas were identified by SNAI, starting from 2012, due to their remoteness, environmental and architectural fragility, relative poverty, marginality and shrinking trends. The authors of the proposed book elaborate on the outcomes of the first funding cycle of SNAI (2014-2020) and look towards the coming cycle, thanks to the contribution of more than 150 young researchers, gathered under the umbrella of the recently born National Network of Young Researchers for Inner Areas in Italy. Through the different chapters this collective text returns the richness of the multidisciplinary discussions that took place in June and July 2020 during the workshop organized by the Network of Young Researchers for Inner Areas committee and contributes to the international debate on how to analyze, manage and design marginal territories, characterized by high degrees of fragility and exposed at various risks

Le Aree Interne Italiane. Un banco di prova per interpretare e progettare i territori marginali | Inner Areas in Italy. A testbed for interpreting and designing marginal territories

The book “Inner Areas in Italy. A testbed for interpreting and designing marginal territories” is a timely contribution to the international academic and policy debate on ‘Inner Peripheries’ and on the possible measures to reduce inequalities among different regions in Europe. The National Strategies for the Inner Areas (SNAI), a groundbreaking experience of place-sensitive interventions addressing marginal areas, was promoted in Italy in the framework of the EU Cohesion Policies 2014-2020. Inner Areas were identified by SNAI, starting from 2012, due to their remoteness, environmental and architectural fragility, relative poverty, marginality and shrinking trends. The authors of the proposed book elaborate on the outcomes of the first funding cycle of SNAI (2014-2020) and look towards the coming cycle, thanks to the contribution of more than 150 young researchers, gathered under the umbrella of the recently born National Network of Young Researchers for Inner Areas in Italy. Through the different chapters this collective text returns the richness of the multidisciplinary discussions that took place in June and July 2020 during the workshop organized by the Network of Young Researchers for Inner Areas committee and contributes to the international debate on how to analyze, manage and design marginal territories, characterized by high degrees of fragility and exposed at various risks

Full and simplified assessment of left ventricular diastolic function in covid-19 patients admitted to ICU. feasibility, incidence, and association with mortality

Purpose: Left ventricular diastolic dysfunction (LVDD) is associated with poor outcomes in the intensive care unit (ICU). Nonetheless, precise reporting of LVDD in COVID-19 patients is currently lacking and assessment could be challenging. Methods: We performed an echocardiography study in COVID-19 patients admitted to ICU with the aim to describe the feasibility of full or simplified LVDD assessment and its incidence. We also evaluated the association of LVDD or of single echocardiographic parameters with hospital mortality. Results: Between 06.10.2020 and 18.02.2021, full diastolic assessment was feasible in 74% (n = 26/35) of patients receiving a full echocardiogram study. LVDD incidence was 46% (n = 12/26), while the simplified assessment produced different results (incidence 81%, n = 21/26). Nine patients with normal function on full assessment had LVDD with simplified criteria (grade I = 2; grade II = 3; grade III = 4). Nine patients were hospital-survivors (39%); the incidence of LVDD (full assessment) was not different between survivors (n = 2/9, 22%) and non-survivors (n = 10/17, 59%; p =.11). The E/e’ ratio lateral was lower in survivors (7.4 [3.6] vs. non-survivors 10.5 [6.3], p =.03). We also found that s’ wave was higher in survivors (average, p =.01). Conclusion: In a small single-center study, assessment of LVDD according to the latest guidelines was feasible in three quarters of COVID-19 patients. Non-survivors showed a trend toward greater LVDD incidence; moreover, they had significantly worse s’ values (all) and higher E/e’ ratio (lateral)

Inferior vena cava distensibility during pressure support ventilation: a prospective study evaluating interchangeability of subcostal and trans‐hepatic views, with both M‐mode and automatic border tracing

: The Inferior Vena Cava (IVC) is commonly utilized to evaluate fluid status in the Intensive Care Unit (ICU),with more recent emphasis on the study of venous congestion. It is predominantly measured via subcostal approach (SC) or trans-hepatic (TH) views, and automated border tracking (ABT) software has been introduced to facilitate its assessment. Prospective observational study on patients ventilated in pressure support ventilation (PSV) with 2 × 2 factorial design. Primary outcome was to evaluate interchangeability of measurements of the IVC and the distensibility index (DI) obtained using both M-mode and ABT, across both SC and TH. Statistical analyses comprised Bland-Altman assessments for mean bias, limits of agreement (LoA), and the Spearman correlation coefficients. IVC visualization was 100% successful via SC, while TH view was unattainable in 17.4% of cases. As compared to the M-mode, the IVC-DI obtained through ABT approach showed divergences in both SC (mean bias 5.9%, LoA -18.4% to 30.2%, ICC = 0.52) and TH window (mean bias 6.2%, LoA -8.0% to 20.4%, ICC = 0.67). When comparing the IVC-DI measures obtained in the two anatomical sites, accuracy improved with a mean bias of 1.9% (M-mode) and 1.1% (ABT), but LoA remained wide (M-mode: -13.7% to 17.5%; AI: -19.6% to 21.9%). Correlation was generally suboptimal (r = 0.43 to 0.60). In PSV ventilated patients, we found that IVC-DI calculated with M-mode is not interchangeable with ABT measurements. Moreover, the IVC-DI gathered from SC or TH view produces not comparable results, mainly in terms of precision