Prognostic Value of Magnesium in COVID-19: Findings from the COMEPA Study

Magnesium (Mg) plays a key role in infections. However, its role in coronavirus disease 2019 (COVID-19) is still underexplored, particularly in long-term sequelae. The aim of the present study was to examine the prognostic value of serum Mg levels in older people affected by COVID-19. Patients were divided into those with serum Mg levels ≤1.96 vs. >1.96 mg/dL, according to the Youden index. A total of 260 participants (mean age 65 years, 53.8% males) had valid Mg measurements. Serum Mg had a good accuracy in predicting in-hospital mortality (area under the curve = 0.83; 95% CI: 0.74–0.91). Low serum Mg at admission significantly predicted in-hospital death (HR = 1.29; 95% CI: 1.03–2.68) after adjusting for several confounders. A value of Mg ≤ 1.96 mg/dL was associated with a longer mean length of stay compared to those with a serum Mg > 1.96 (15.2 vs. 12.7 days). Low serum Mg was associated with a higher incidence of long COVID symptomatology (OR = 2.14; 95% CI: 1.30–4.31), particularly post-traumatic stress disorder (OR = 2.00; 95% CI: 1.24–16.40). In conclusion, low serum Mg levels were significant predictors of mortality, length of stay, and onset of long COVID symptoms, indicating that measuring serum Mg in COVID-19 may be helpful in the prediction of complications related to the disease

The initial phases of the 2008-2009 Mt. Etna eruption: a multi-disciplinary approach for hazard assessment

Between 2007 and early 2008, the INGV monitoring networks on Etna volcano recorded a recharging phase that climaxed with a new effusive eruption on 13 May 2008, and lasted about 14 months. A dike-forming intrusion was accompanied by a violent seismic swarm, with more than 230 events recorded in the first six hours, the largest being ML = 3.9. In the meanwhile, marked ground deformation was recorded by the permanent tilt and GPS networks, and sudden changes in the summit area were detected by five continuously recording magnetic stations. Poor weather conditions did not allow direct observation of the eruptive events, but important information was provided by infrared satellite images that detected the start of lava fountains from the eruptive fissure, feeding a lava flow. This flow spread within the Valle del Bove depression, covering 6.4 km on the south-eastern flank of the volcano in a few hours. The seismicity and deformation pattern indicated that the dike-forming intrusion was propagating northwards. It produced a dry fracture field, which generated concern for the possibility that the eruptive fissures could expand downslope towards populated areas. Monitoring and modeling of the multi-disciplinary data, together with the simulations of ash dispersal and lava flows, allowed us both to infer the eruptive mechanisms and provide a correct interpretation of the ongoing phenomena, furnishing useful information for civil defense purposes. We describe how this approach of feedback between monitoring and research provides critical support to risk evaluation

Gastric leiomyosarcoma: case report and review of literature

True smooth muscle neoplasms of the wall of digestive tract are rare, in particular in the stomach, and the benign ones are prevalent. We report a case of gastric leiomyosarcoma (LMS) that we observed, diagnosed to a 71 years-old man, with important comorbidities, who had already underwent the amputation of the right lower limb. In consequence of the discovery of anaemia and melaena he underwent an endoscopy of the upper GI tract and CT scan, which showed the presence of a neoformation of the gastric wall, but because of the thrombosis of the common iliac artery and the occurrence of the clinical picture of critical ischaemia, at first the patient underwent the amputation of the left lower limb e only then an intervention of atypical gastroresection. Despite the neoplastic infiltration of the resection margins and the impossibility to undertake an adjuvant chemotherapy, the follow-up at 6, 12 and 28 months did not show a recurrence of the disease that remained in phase of clinical remission

The mutant p53-ID4 complex controls VEGFA isoforms by recruiting lncRNA MALAT1

The abundant, nuclear-retained, metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) has been associated with a poorly differentiated and aggressive phenotype of mammary carcinomas. This long non-coding RNA (lncRNA) localizes to nuclear speckles, where it interacts with a subset of splicing factors and modulates their activity. In this study, we demonstrate that oncogenic splicing factor SRSF1 bridges MALAT1 to mutant p53 and ID4 proteins in breast cancer cells. Mutant p53 and ID4 delocalize MALAT1 from nuclear speckles and favor its association with chromatin. This enables aberrant recruitment of MALAT1 on VEGFA pre-mRNA and modulation of VEGFA isoforms expression. Interestingly, VEGFA-dependent expression signatures associate with ID4 expression specifically in basal-like breast cancers carrying TP53 mutations. Our results highlight the key role for MALAT1 in control of VEGFA isoforms expression in breast cancer cells expressing gain-of-function mutant p53 and ID4 proteins

Use of bivalirudin for heparin-induced thrombocytopaenia after thrombolysis in massive pulmonary embolism: a case report

A 68-year-old man was referred to the emergency department 6 h after onset of sudden acute dyspnoea. Immediate ECG showed sinus tachycardia with the typical S1-Q3-T3 pattern and incomplete right bundle branch block. The echocardiogram showed the presence of mobile thrombus in the right atrium, a distended right ventricle with free wall hypokinesia and displacement of the interventricular septum towards the left ventricle. Lung spiral computed tomography (CT) showed bilateral pulmonary involvement and confirmed the picture of a thrombotic system in the right atrium and caval vein. Thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA) and heparin (alteplase 10 mg bolus, then 90 mg over 2 h) was administered. Six hours after thrombolysis bleeding gums and significant reduction in platelet count (around 50,000) were observed. Heparin was discontinued and bivalirudin (0.1 mg/kg bolus and 1.75 mg/kg per h infusion) plus warfarin was initiated and continued for 5 days until the international normalised ratio (INR) was within the therapeutic range (2.0–3.0) for 2 consecutive days, with concomitant platelet count normalisation. Lung spiral and lower abdominal CT before discharge did not show the presence of clots in the pulmonary arteries of the right and left lung. This case suggests that bivalirudin could offer promise for use in patients with heparin-induced thrombocytopaenia (HIT) after thrombolysis for massive pulmonary embolism

A complex case of fatal calciphylaxis in a female patient with hyperparathyroidism secondary to end stage renal disease of graft and coexistence of haemolytic uremic syndrome

Background. Calciphylaxis is a potentially fatal complication of persistent secondary hyperparathyroidism; its cause is still not clear. Unfortunately there is no close relation in severity of clinical picture, serological and pathological alteration. For this reason the prognosis is difficult to establish. Administration of sodium thiosulphate may reduce the precipitation of calcium crystals and improve the general clinical conditions before surgical parathyroidectomy, which seems the only therapeutic approach able to reduce the mortality risk in these patients. Methods and Results. A 60 year old female patient suffering from End Renal Stage Disease, on haemodialysis from 2001 due to the onset of haemolytic uremic syndrome, underwent a kidney transplant in April 2008. After transplantation there was a recurrence of the haemolytic uremic syndrome, with temporary worsening of the graft. Six months later there was a definite loss of graft and return to dialysis treatment. On April 2010 a severe systemic calciphylaxis related to secondary hyperparathyroidism was diagnosed. The patient underwent parathyroidectomy but, because of the unimproved clinical picture, treatment with sodium thiosulphate was initiated. There was only improvement in cutaneous lesions. The worsening general clinical condition of the patient caused death due to general septic complications. Conclusions. The coexistence of haemolytic uremic syndrome and secondary hyperpathyroidism makes the prognosis poor and, in this case, therapy, which counteracts calcium crystals precipitation, has no effect. Preventive parathyroidectomy can be considered as the only possible treatment

Thrombolysis for massive pulmonary embolism in pregnancy: a case report

Mortality from pulmonary embolism (PE) in pregnancy might be related to challenges in targeting the right population for prevention. Such targeting could help ensure that the correct diagnosis is suspected and adequately investigated, and allow the initiation of the timely and best possible treatment of this disease. In the literature to date only 18 case reports of thrombolysis in pregnant women with PE have been reported, and showed beneficial effects for both mother and fetus in terms of mortality and complications with acceptable bleeding risks. We present here the case of a pregnant patient with massive PE who underwent successful thrombolysis. A 26-year-old pregnant (at 24 weeks) woman was admitted 4 h after onset of sudden acute dyspnea and chest pain. An immediate electrocardiogram showed a typical S1-Q3-T3 pattern. The echocardiogram showed a distended right ventricle with free-wall hypokinesia and displacement of the interventricular septum toward the left ventricle. Thrombolysis with recombinant tissue plasminogen activator (alteplase 10 mg bolus, then 90 mg over 2 h) was administered. Pelvic examination and ultrasound showed regular fetal heart beat, and regular placental and liquid presence. No problems developed for the mother or fetus in the subsequent days or at discharge. In conclusion, in pregnant patients with life-threatening massive PE, thrombolytic therapy can be administered, and the use of echocardiographic, laboratory, and clinical data can be useful tools to achieve a rapid diagnosis and make a therapeutic decision, but additional studies need to be performed to further define its use

Changes in the eruptive style of Stromboli Volcano before the 2019 paroxysmal phase discovered through SOM clustering of seismo-acoustic features compared with camera images and GBInSAR data

Two paroxysmal explosions occurred at Stromboli on 3 July and 28 August 2019, the first of which caused the death of a young tourist. After the first paroxysm an effusive activity began from the summit vents and affected the NW flank of the island for the entire period between the two paroxysms. We carried out an unsupervised analysis of seismic and infrasonic data of Strombolian explosions over 10 months (15 November 2018–15 September 2019) using a Self-Organizing Map (SOM) neural network to recognize changes in the eruptive patterns of Stromboli that preceded the paroxysms. We used a dataset of 14,289 events. The SOM analysis identified three main clusters that showed different occurrences with time indicating a clear change in Stromboli’s eruptive style before the paroxysm of 3 July 2019. We compared the main clusters with the recordings of the fixed monitoring cameras and with the Ground-Based Interferometric Synthetic Aperture Radar measurements, and found that the clusters are associated with different types of Strombolian explosions and different deformation patterns of the summit area. Our findings provide new insights into Strombolian eruptive mechanisms and new perspectives to improve the monitoring of Stromboli and other open conduit volcanoes