High Risk of Secondary Infections Following Thrombotic Complications in Patients With COVID-19

Background. This study’s primary aim was to evaluate the impact of thrombotic complications on the development of secondary infections. The secondary aim was to compare the etiology of secondary infections in patients with and without thrombotic complications. Methods. This was a cohort study (NCT04318366) of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 and June 30, 2020. Incidence rates (IRs) were calculated by univariable Poisson regression as the number of cases per 1000 person-days of follow-up (PDFU) with 95% confidence intervals. The cumulative incidence functions of secondary infections according to thrombotic complications were compared with Gray’s method accounting for competing risk of death. A multivariable Fine-Gray model was applied to assess factors associated with risk of secondary infections. Results. Overall, 109/904 patients had 176 secondary infections (IR, 10.0; 95% CI, 8.8–11.5; per 1000-PDFU). The IRs of secondary infections among patients with or without thrombotic complications were 15.0 (95% CI, 10.7–21.0) and 9.3 (95% CI, 7.9–11.0) per 1000-PDFU, respectively (P = .017). At multivariable analysis, thrombotic complications were associated with the development of secondary infections (subdistribution hazard ratio, 1.788; 95% CI, 1.018–3.140; P = .043). The etiology of secondary infections was similar in patients with and without thrombotic complications. Conclusions. In patients with COVID-19, thrombotic complications were associated with a high risk of secondary infections

Thrombectomy for ischemic stroke with large vessel occlusion and concomitant subarachnoid hemorrhage

To report our experience in treating one patient with nontraumatic subarachnoid hemorrhage (SAH) and concurrent acute ischemic stroke (AIS) due to large vessels occlusion (LVO). A man in his 50 s presented with acute right hemiparesis and aphasia. Brain CT showed a SAH in the left central sulcus; CT-angiography revealed a tandem occlusion of the left internal carotid artery and homolateral middle cerebral artery. He underwent an angiographic procedure with successful recanalization. Follow-up CT demonstrated a striatal-lenticular stroke without SAH progression. While the absolute contraindication to IVT during intracranial bleeding remains unquestionable, the potential injury/benefit from MT is still debatable. Such cases constitute a blind spot in the guidelines where physicians face the dilemma of choosing between an acute endovascular treatment with the risks of hemorrhage progression and a conservative treatment with the associated poor clinical outcome. We decided to treat our patient invasively, considering the young age, also given the absence of prognostic factors that generally predict post-procedural reperfusion injury. We believe that, in similar cases, MT should be considered-despite not free of risks and drawbacks-to avoid the detrimental consequences of untreated AIS from LVO

The VST active primary mirror support system

The 2.6-m primary mirror of the VST telescope is equipped with an active optics system in order to correct low-order aberrations, constantly monitoring the optical quality of the image and controlling the relative position and the shape of the optical elements. Periodically an image analyser calculates the deviation of the image from the best quality. VST is equipped with both a Shack-Hartmann in the probe system and a curvature sensor embedded in the OmegaCAM instrument. The telescope control software decomposes the deviation into single optical contributions and calculates the force correction that each active element has to perform to achieve the optimal quality. The set of correction forces, one for each axial actuator, is computed by the telescope central computer and transmitted to the local control unit of the primary mirror system for execution. The most important element of the VST active optics is the primary mirror, with its active support system located within the primary mirror cell structure. The primary mirror support system is composed by an axial and a lateral independent systems and includes an earthquake safety system. The system is described and the results of the qualification test campaign are discussed

The VST Auxiliary Units: A status report before their commissioning in Paranal

The VST telescope is going to be commissioned in Paranal, together with its main sub-systems, such as the Image Analysis and Auto-Guiding system. A preliminary work of fine tuning of each sub-system has been performed in Italy before their shipping to Paranal, where they are waiting for the telescope AIV to be completed in a way to start the final commissioning of the overall system. Each unit has been extensively characterized and tested, with particular care to the Active Optics Shack-Hartmann sensor and to the Auto-Guiding arm. We describe here the phases concerning the integration and test of all the VST Auxiliary Units performed in Italy before their shipping to Paranal