SARS-CoV-2 infection in patients with inflammatory bowel disease: comparison between the first and second pandemic waves

In Italy, the incidence of SARS-CoV-2 infection peaked in April and November 2020, defining two pandemic waves of coronavirus disease 2019 (COVID-19). This study compared the characteristics and outcomes of patients with inflammatory bowel disease (IBD) and SARS-CoV-2 infections between pandemic waves.MethodsObservational longitudinal study of IBD patients with SARS-CoV-2 infection. Patients with established diagnoses of IBD and of SARS-CoV-2 infection were consecutively enrolled in two periods: (i) first wave, from 1 March 2020 to 31 May 2020; and (ii) second wave, from 15 September to 15 December 2020.ResultsWe enrolled 937 IBD patients (219 in the first wave, 718 in the second wave). Patients of the first wave were older (mean & PLUSMN; SD: 46.3 & PLUSMN; 16.2 vs. 44.1 & PLUSMN; 15.4 years, p = 0.06), more likely to have ulcerative colitis (58.0% vs. 44.4%, p < 0.001) and comorbidities (48.9% vs. 38.9%; p < 0.01), and more frequently residing in Northern Italy (73.1% vs. 46.0%, p < 0.001) than patients of the second wave. There were no significant differences between pandemic waves in sex (male: 54.3% vs. 53.3%, p = 0.82) or frequency of active IBD (44.3% vs. 39.0%, p = 0.18). The rates of negative outcomes were significantly higher in the first than second wave: pneumonia (27.8% vs. 11.7%, p < 0.001), hospital admission (27.4% vs. 9.7%, p < 0.001), ventilatory support (11.9% vs. 5.4%, p < 0.003) and death (5.5% vs. 1.8%, p < 0.007).ConclusionBetween the first and second SARS-CoV-2 pandemic waves, demographic, clinical and geographical features of IBD patients were different as were the symptoms and outcomes of infection. These differences are likely due to the different epidemiological situations and diagnostic possibilities between the two waves

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p &lt; 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Multiple myeloma - oral radiological evidences

Objective: The aim of this article is to summarize the main radiological evidences induced by multiple myeloma at the jaws level. Materials and Methods: The analysis examines the main case reports and reviews on the matter. All relevant publications were searched through the PubMed search engine, using the following keywords: "Multiple Myeloma" and "Radiological evidences", "Maxilla", "Jaw", "TMJ". The purpose of our review is to highlight how oral radiological investigation is extremely useful in detecting any bone alterations associated with cases of multiple myeloma. In addition, we investigate the sites of the jaws where direct bone alteration is more frequently, and we perform a differential diagnosis with other focal alterations of the jaws or those that are the result of certain drug therapies (bisphosphonates). Our research stresses the concept that early diagnosis of multiple myeloma at the jaws level may prevent unnecessary and inadequate treatments. Results: From the evaluation of our research, it is evident that osteolytic lesions are one of the fundamental signs of multiple myeloma, especially in areas undergoing intense hematopoietic activity. Among the radiological techniques used for diagnosis, the most sensitive one appears to be the three-dimensional technique, such as CT or Cone Beam, whereas two-dimensional radiographs (orthopantomography) appear to be exhaustive only when the lesion is very extensive. Conclusions: It is evident that the dentist figure plays not only a supportive role, but also a fundamental part in the diagnostic process, as lesions that may anticipate a systemic manifestation are often encountered at the oral level.Sin financiaciónNo data 2020UE

A meta-analysis and trial sequential analysis comparing nonoperative versus operative management for uncomplicated appendicitis: a focus on randomized controlled trial

Background The aim of this study is to provide a meta-analysis of randomized controlled trials (RCT) comparing conservative and surgical treatment in a population of adults with uncomplicated acute appendicitis. Methods A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL. We have exclusively incorporated randomized controlled trials (RCTs). Studies involving participants with complicated appendicitis or children were excluded. The variables considered are as follows: treatment complications, complication-free treatment success at index admission and at 1 year follow-up, length of hospital stay (LOS), quality of life (QoL) and costs. Results Eight RCTs involving 3213 participants (1615 antibiotics/1598 appendectomy) were included. There was no significant difference between the two treatments in terms of complication rates (RR = 0.66; 95% CI 0.61—1.04, P = 0.07, I2 = 69%). Antibiotics had a reduced treatment efficacy compared with appendectomy (RR = 0.80; 95% CI 0.71 to 0.90, p &lt; 0.00001, I2 = 87%) and at 1 year was successful in 540 out of 837 (64.6%, RR = 0.69, 95% confidence interval 0.61 to 0.77, p &lt; 0.00001, I2 = 81%) participants. There was no difference in LOS (mean difference − 0.58 days 95% confidence interval − 1.59 to 0.43, p = 0.26, I2 = 99%). The trial sequential analysis has revealed that, concerning the three primary outcomes, it is improbable that forthcoming RCTs will significantly alter the existing body of evidence. Conclusions As further large-scale trials have been conducted, antibiotic therapy proved to be safe, less expensive, but also less effective than surgical treatment. In order to ensure well-informed decisions, further research is needed to explore patient preferences and quality of life outcomes

La storia del Castello di Brescia dal Medioevo all’Ottocento

Un metodo di ricerca basato sull’incrocio tra indagine storica e analisi sistematica della documentazione cartografica consente di affrontare in modo inedito lo studio del Castello di Brescia, monumento complesso nel quale le fasi edificatorie si sono stratificate nei secoli segnando le principali vicende della Città, dall’età del libero Comune all’Unità d’Italia. Con i suoi 75.000 metri quadrati, la fortezza bresciana è una delle più grandi d’Europa: una costruzione unica, nella quale intorno al mastio di età viscontea si sviluppò un moderno sistema di mura e bastioni che ne fece una delle strutture difensive più imponenti della Terraferma veneziana. Le fonti scritte e iconografiche, poste in dialogo con le mappe antiche a loro volta rilette e reinterpretate con l’ausilio della tecnologia digitale, restituiscono una puntuale ricostruzione filologica, ricca di documentazione fotografica e capace di enucleare alcuni aspetti inediti o poco noti di una storia affascinante e straordinariamente articolata

The clinicopathologicspectrum of hypertrophiccardiomyopathy. The experience of the italian heart transplant program

Hypertrophic cardiomyopathy (HCM) is an idiopathic cardiac disease which is predominantly genetic in origin and transmitted as an autosomally dominant trait [1, 2]. The mutated genes code for altered contractile myofibrillar proteins, leading to deformed myocytes and histological evidence of extensive myocell disorganization, namely the disarray typical of hypertrophie cardiomyopathy (HCM). In the natural history of HCM endstage heart failure is relatively infrequent and associated with a pattern of left ventricular systolic impairment with cavity dilatation, which occurrs in about 10% of patients [3, 4], with a yearly incidence of 1.5% [5]. End-stage disease may coexist with premature sudden death in family members carrying the same genetic abnormality [6]. This pattern is characterized by a particularly poor prognosis, so that heart transplantation has been advocated in this subgroup of patients

Open Abdomen in Obese Patients: Pay Attention! New Evidences from IROA, the International Register of Open Abdomen

Background: Open abdomen is the cornerstone of damage control strategies in acute care and trauma surgery. The role of BMI has not been well investigated. The aim of the study was to assess the role of BMI in determining outcomes after open abdomen. Methods: This is an analysis of patients recorded into the International Register of Open Abdomen; patients were classified in two groups according to BMI using a cutoff of 30&nbsp;kg/m2. The primary outcome was in-hospital mortality; secondary outcomes were primary fascia closure rate, length of treatment, complication rate, entero-atmospheric fistula rate and length of ICU stay. Results: A total of 591 patients were enrolled from 57 centers, and obese patients were 127 (21.5%). There was no difference in mortality between the two groups; complications developed during the open treatment were higher in obese patients (63.8% vs. 53.4%, p = 0.038) while post-closure complications rate was similar. Obese patients had a significantly longer duration of the open treatment (9.1 ± 11.5&nbsp;days vs. 6.3 ± 7.5&nbsp;days; p = 0,002) and lower primary fascia closure rate (75.5% vs. 89.5%; p &lt; 0,001). No differences in fistula rate were found. There was a linear correlation between the duration of open abdomen and the BMI (Pearson’s linear correlation coefficient = 0,201; p &lt; 0,001). Conclusions: Open abdomen in obese patients seems to be safe as in non-obese patients with similar mortality; however, in obese patients the length of open abdomen is significantly higher with higher complication rate, longer ICU length of stay and lower primary fascia closure rate. Trial registration number: ClinicalTrials.gov, Identifier: NCT02382770