Worse impact of second wave COVID-19 pandemic in adults but not in children with inflammatory bowel disease: an Italian single tertiary center experience.
Sonia CarparelliM. PastoreMaria Rosa ValvanoAntonio MarsegliaAnna LatianoOrazio PalmieriMaría GuerraGiuseppina MartinoFrancesco PerriFabrizio Bossa
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Abstract:
From September 2020, a second wave of COVID-19 pandemic started. We aimed at exploring the impact of SARS-CoV-2 infection in IBD patients during the two waves.All IBD patients with a confirmed diagnosis of SARS-CoV-2 infection were enrolled. They were sorted into two groups (those infected before September 2020, and those from September 2020 to January 2021) and compared by demographic and clinical data.Twenty-five patients (out of about 600 with a follow-up visit) were infected with SARS-CoV-2 (4.1%). Sixteen were male and the mean age was 46.5 ± 14.3 years (range 24-74). Six were smokers and 11 had comorbidities; 2 were on steroids and 17 on immunosuppressants or biologics. Three patients (12%) needed hospitalization and other three patients were treated with azithromycin, steroids and LMWH, all of them during the second wave. No patient died or developed any sequelae. Two subjects were infected during the first wave (0.3 vs. 3.83, p<0.0001). Non-significant differences were found between the two groups.A higher number of IBD patients were infected during the second wave. No patient developed a severe form of pneumonia, even those treated with immunosuppressants or biologics. No risk factor for hospitalization was found.Keywords:
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Alles auf einen Blick: Auf der Webseite der DRG erhalten Sie aktuelle Informationen der Radiologie zur SARS-CoV-2-Pandemie. Dort finden Sie beispielsweise Empfehlungen für die radiologische Versorgung oder zur unterstützenden Diagnostik durch die CT.
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Combination Casirivimab and Imdevimab and Development of Symptomatic COVID-19 in SARS-CoV-2 Infection
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Introduction Pancreatic trauma is rare and is usually associated with adjacent organ and vascular injuries, which adds to the high morbidity and mortality. In the American Association for the Surgery of Trauma (AAST) pancreatic trauma (PT) grading system, the higher grades are a composite of less and more severe extents of injuries. We hereby present an observational study of PT with management based on an indigenous algorithmic approach. Our protocol incorporating both the extent of disruption of the main pancreatic duct (MPD) and its amenability to interventions (endoscopic, radiological, or surgical) is pragmatic. Methods Ours is a retrospective observational study of 28 consecutive cases of PT, done over a three-year period in an academic institution, by an expert Surgical Gastroenterology unit. All patients diagnosed with PT on a contrast abdominal CT scan were included. After stabilization, they were stratified and managed according to an indigenous protocol. The primary outcome measure was treatment success in terms of recovery. The secondary outcome measure was morbidity of any form. Results One patient with Grade 1 PT was operated on for associated hollow viscus injury. Two patients with AAST Grade 2 and two patients with AAST Grade 3 injury were managed successfully without surgery. Twelve of 21 patients with Grade 3 PT underwent Kimura’s splenic vessel preserving distal pancreatectomy. Distal pancreatectomy with splenectomy and central pancreatectomy with Roux-en-Y pancreaticojejunostomy (PJ) was done for 7/21 and 2/21 patients, respectively, with Grade 3 PT. Two with Grade 5 injury underwent trauma Whipple. The overall mortality and morbidity rates in our series were 15.7% and 64%, respectively. Conclusion The pathogenesis in PT is a dynamic process and shows temporal evolution. These patients require serial and periodical clinical and radiological monitoring, especially in those managed conservatively initially. PT can be low or high grade. Patients with isolated low-grade PT can be managed according to the standard step-up approach for acute pancreatitis. A carefully selected subgroup of patients with partial MPD disruption either in the head or body of the pancreas can be managed by endotherapy. Complete distal parenchymal transections require early surgery tailored to individual patients in the form of either splenic vessel preserving distal pancreatectomy (SPDP) or distal pancreatectomy with splenectomy (DP+S). Damage control surgery is the dictum in unstable patients with Grades 4 and 5 injuries not responding to resuscitative measures. A trauma Whipple can be done in a carefully selected subgroup of stable patients with proximal massive disruptions in an experienced hepato-pancreatico-biliary (HPB) unit.
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Several skin manifestations have been described in association with the COVID-19 pandemic since March 2020. Acral chilblain-like lesions (CBLL), usually referred to as 'COVID toes', are among the most common and characteristic ones, even though the direct causative role of SARS-CoV-2 has been debated. Indeed, although some authors have reported the detection of SARS-CoV-2 within the lesions with immunohistochemistry and electron-microscopy,1, 2 the majority of patients with CBLL have had negative tests for SARS-CoV-2 (including serological tests and nasopharyngeal and in situ-skin PCR).3 A more likely hypothesis for the causation of CBLL in the setting of the COVID-19 pandemic is the development of a high interferon response to the virus, leading to a very efficient antiviral response and the development of CBLL, similar to the scenario observed in type 1 interferonopathies.4, 5 The recent observations of CBLL following anti-SARS-CoV-2 vaccination in patients with no COVID-19 infection6, 7 support this hypothesis. We present a new case of CBLL that developed shortly after vaccination with the BNT162b2 mRNA COVID-19 vaccine and discuss the significance of this and similar observations from the literature. An 82-year-old non-smoker woman had a history of psoriasis and had been treated with methotrexate for more than 10 years. She had no history of chilblains or Raynaud's syndrome. She denied any symptoms suggestive of COVID-19 since the beginning of the pandemic and had not been in contact with patients suffering from COVID-19. She consulted urgently in our department for slightly painful lesions on both hands and feet that occurred 24 h after the first injection of the BNT162b2 mRNA vaccine. Physical examination revealed macular violaceous and erythematous lesions of the fingers and toes, suggestive of CBLL (Fig. 1). The patient reported neither general symptoms nor unusual exposure to cold. Laboratory workup yielded normal results, concerning namely markers of inflammation, renal and hepatic function and tests for autoimmunity (antinuclear antibodies, cryoglobulinaemia, complement levels, D-dimers). Histological examination of a skin biopsy taken from a lesion of the hand showed a characteristic aspect of CBLL,8 including namely a partly necrotic epidermis overlying a dense dermal lymphocytic infiltrate forming rather well-circumscribed aggregates around blood vessels, eccrine sweat glands and occasionally nerves (Fig. 2). The endothelial cells of the blood vessels of the mid dermis were occasionally prominent. Direct immunofluorescence performed on a frozen skin biopsy was negative. Serological test carried out early on day 19 after the 1st vaccination dose was negative, ruling out SARS-CoV-2 infection. A specific serological test for vaccinal anti-S antibodies was also realized and proved positive (6.38 U/mL, N < 1). The interferon signature in blood was positive (10.5, N < 2.3). Skin reactions following administration of mRNA-based anti-SARS-CoV-2 vaccines have been very recently reported. They include mainly delayed large local reactions,9 reactions at the injection site and urticarial and morbilliform rashes.5 No severe reactions were associated with these skin signs. Interestingly, some cases of CBLL have also been reported within days following mRNA vaccination.6, 7 In our patient, the clinical and histological features of the lesions were indistinguishable from the CBLL observed during the first pandemic wave in 2020. The absence of prior history of chilblains and exposure to cold argue against common chilblains. The development of CBLL after mRNA vaccination in our patient and some patients reported in the literature supports the hypothesis that these lesions are triggered by the immune response to the virus and not to a direct cytopathogenic viral effect. The presence of a positive interferon signature also supports this contention. The patient in this manuscript has given written informed consent to the publication of her case details. The authors declare that they have no conflicts of interest. None.
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