Effect of COVID-19 on cardiorenal axis: known or unknown universe?

Recent findings have confirmed relationships between coronavirus disease (COVID-19) and multiple organ dysfunction. The prevalence of cardiac and renal involvement in COVID-19 has been increasingly reported and is a marker of severe disease that not only directly or indirectly affects the organs, but may also exacerbate the underlying comorbid illness. In addition, patients affected by the new coronavirus present a systemic inflammatory condition that results in damage to several tissues, especially the heart, kidneys, and vessels. It is well known that the heart and kidneys are closely related, so that any change in one of the organs can lead to damage to the other, establishing the so-called cardiorenal syndrome. Herein, we explore some case reports of patients with COVID-19 who had heart and kidney abnormalities, consequently resulting in worse prognosis of the disease. These results highlight the importance of understanding the cause and effect between the cardiac and renal systems and the course of early SARS-CoV-2 infection.

Effect of COVID-19 on cardiorenal axis: known or unknown universe?

Recent findings have confirmed relationships between coronavirus disease (COVID-19) and multiple organ dysfunction. The prevalence of cardiac and renal involvement in COVID-19 has been increasingly reported and is a marker of severe disease that not only directly or indirectly affects the organs, but may also exacerbate the underlying comorbid illness. In addition, patients affected by the new coronavirus present a systemic inflammatory condition that results in damage to several tissues, especially the heart, kidneys, and vessels. It is well known that the heart and kidneys are closely related, so that any change in one of the organs can lead to damage to the other, establishing the so-called cardiorenal syndrome. Herein, we explore some case reports of patients with COVID-19 who had heart and kidney abnormalities, consequently resulting in worse prognosis of the disease. These results highlight the importance of understanding the cause and effect between the cardiac and renal systems and the course of early SARS-CoV-2 infection.

Influence of high-normal serum TSH levels on major cardiovascular risk factors and Visceral Adiposity Index in euthyroid type 2 diabetic subjects.

Although several observations indicate that serum TSH levels in the high normal range are related to cardiovascular (CVD) risk factors in the general population, similar data are limited in diabetic subjects. The aim of this study was to investigate the potential associations between TSH serum levels within the normal range and major metabolic and non-metabolic CVD risk factors in a cohort of euthyroid type 2 diabetic subjects. Thyroid hormones, TSH levels, anthropometric parameters, lipid profile, glucose control, and blood pressure were measured in 490 euthyroid type 2 diabetic subjects, consecutively attending two outpatient diabetic units in Southern Italy. In all subjects, we also calculated the Visceral Adiposity Index (VAI), an obesity-related index associated with CVD risk. Diabetic women showed higher mean serum TSH levels and lower FT4 concentration than diabetic men, while FT3 levels were comparable in the two genders. Stratifying the study population according to quartiles of TSH levels, subjects in the highest TSH quartile were more likely to be female and younger, with higher values of BMI and waist circumference (P = 0.05 both), higher triglycerides (P = 0.002) and non-HDL cholesterol concentrations (P = 0.01), higher VAI values (P = 0.02), and lower FT4 levels (P = 0.05), when compared to those in the lowest quartile. At multivariate analysis, a younger age, female gender, triglycerides levels, and waist circumference were independently associated with higher TSH levels. In conclusion, in type 2 diabetic subjects with no evidence of thyroid disease, higher TSH concentrations within the normal range were more frequent in women and in younger subjects, and they were associated with visceral obesity and higher triglycerides concentrations, two well-known CVD risk factors.

Fetal ovarian cysts: prenatal diagnosis and management. Report of two cases and review of literature.

The Authors report two cases of antenatally diagnosed fetal ovarian cysts. In the first case the cysts underwent spontaneous resolution. In the second case the newborn was submitted to adnexectomy for cyst torsion. A review of the literature is reported.

Untreated endometrial adenocarcinoma: a case report.

The authors report a case of a patient in a terminal stage of endometrial carcinoma presenting a tibial metastasis, who survived twelve years without any treatment after diagnosis.

[Cabergoline in the inhibition of lactogenesis and suppression of lactopoiesis]. / La cabergolina nell'inibizione della lattogenesi e la soppressione della lattopoiesi.

INTRODUCTION AND AIMS: 1) Evaluate the capacity of cabergoline to inhibit lactogenesis by the administration of a single dose of 1 mg within 24 h of birth, primary inhibition. 2) Evaluate the capacity of cabergoline to suppress lactopoiesis (lactation) by the administration of 0.25 mg twice a day for 2 days, secondary inhibition. 3) Evaluate the collateral effects of cabergoline at these two doses. 4) Evaluate the reduction rate of prolactin (PRL) at 4 and 14 days after cabergoline administration. EXPERIMENTAL PROTOCOL: A prospective study was performed from 1/2/1995 to 31/1/1996 in 100 puerperae with indications for lactation with follow-up at 4 and 14 days after drug administration. The study was performed in the Division of Gynecology and Obstetrics of Sanremo Hospital in collaboration with the Analysis Service. RESULTS: Cabergoline inhibited primary and secondary lactation in all the puerperae examined. In 92% of cases lactation was suppressed following a single dose whereas a second treatment cycle was required in 8%. Twenty-two cases reported slight collateral effects without the need to resort to additional treatment. In 4 cases the collateral effects were of moderate intensity and it was necessary to administer symptomatic treatment. Mean levels of serum PRL at 4 and 14 days after cabergoline administration were respectively 12.5 and 18.2 ng/ml. CONCLUSIONS: Cabergoline, a new dopaminergic drug with long-term inhibition of PRL production and secretion, can inhibit lactogenesis and lactopoies in 92% of cases at a dose of 1 mg; it can reduce long-term PRL levels (18.2 ng/ml) and in 4% it is necessary to resort to symptomatic treatment of the undesirable effects caused.

[Infectious complications of diagnostic hysteroscopy]. / Complicanze infettive dopo isteroscopia diagnostica.

AIM: To evaluate whether diagnostic hysteroscopy may cause pelvic inflammatory disease; to evaluate whether there is a group of patients with a high risk of developing pelvic inflammatory disease. EXPERIMENTAL DESIGN: A prospective study of 300 non-consecutive hysteroscopies with a follow-up 20 days after the test. SETTING: The study was performed at Sanremo Hospital (Regione Liguria, USL 1 Imperiese, Sanremo Hospital Board) through the Hysteroscopy Clinic of the Gynecology Division (Head: Dott. G. Armentano) and Microbiology Service of the Test Laboratory. PATIENTS: A total of 300 non-consecutive patients undergoing hysteroscopy for any indication were enrolled during 1992 of whom 253 completed the study. The main criteria used for selection were the possibility of performing an atraumatic hysteroscopy and immediately prior to this a cervical smear for the direct and/or cultured assay of aerobic and anaerobic bacteria, fungi, microplasms, Chlamydia, protozoa. METHOD: Hysteroscopy was performed in all cases without cervical dilatation, following the disinfection of the cervix using povidone-iodine 10%, using a hysteroscope with a diameter of 5 mm (Microhysteroscope Hamou I-Storz); CO2 was used as the means of distending the uterine cavity and was supplied by an electronically controlled insufflator (Hysteroinsufflator acc. Hamou-Storz). RESULTS: Germs were identified in the cervical canal in 35 out of 253 women an the incidence of positivity decreased with age. A positive correlation was also found with the type of indication for hysteroscopy. Pelvic inflammatory disease developed in 2 cases out of 253 (0.79%) and both cases belonged to the group with germs in the cervical canal; in both cases the etiological agent was Chlamydia trachomatis. No case of pelvic inflammatory disease was observed in the group of patients without germs in the cervical canal. CONCLUSIONS: Patients under the age of 35, with hysteroscopic indications relating to sterility and painful pelvic syndrome, must be regarded as being at higher risk of developing posthysteriscopic pelvic inflammatory disease.

Ranitidine in the treatment of reflux oesophagitis in pregnancy.

A patient suffering from reflux oesophagitis under treatment with ranitidine continued the treatment throughout her pregnancy (450 mg/die). The ranitidine was delivered into the maternal blood serum and the amniotic fluid up to the 17th week of pregnancy, then into the blood serum of the maternal and umbilical cord immediately after delivery, and into the serum of the newborn 24 hours after birth. The authors report the values and comment on them.

Intestinal injury in cesarean section.

A case of intestinal injury when suturing the hysterotomy during cesarean section is examined. This is a gross and accidental complication that, however, may occur even to a skillful surgeon. The intestinal overstretching and the bilateral bleeding of the hysterotomy wound are predisposing factors: then the control of the posterior uterine wall before closing the abdomen is opportune.

Colorectal carcinoma in pregnancy: a case report.

The Author reports a colorectal carcinoma case in pregnancy; he reviews the literature on the diagnostic and therapeutic possibilities of these cases and probable reciprocal influences between tumor and pregnancy.

Decalcifying algodystrophy of the hip in pregnancy. A case report.

Description of a case of decalcifying algodystrophy of the hip in pregnancy, an infrequent syndrome of unknown etiology, characterised by pain in the hips, radiographic picture showing demineralization of the head of the femur and of the acetabulum, leaving unchanged the articular rima; generally rapid and with spontaneous regression after delivery.