Clinical course of SARS-CoV-2 infection in patients with severe acquired brain injury and a disorder of consciousness: an observational study.

Purpose: SARS-CoV-2 infection can cause the coronavirus disease (COVID), ranging from flu-like symptoms to interstitial pneumonia. Mortality is high in COVID pneumonia and it is the highest among the frailest. COVID could be particularly serious in patients with severe acquired brain injury (SABI), such as those with a disorder of consciousness. We here describe a cohort of patients with a disorder of consciousness exposed to SARS-CoV-2 early after their SABI.Materials and methods: The full cohort of 11 patients with SABI hospitalized in March 2020 in the IRCCS Fondazione Don Gnocchi rehabilitation (Milan, Italy) was recruited. Participants received SARS-CoV-2 testing and different clinical and laboratory data were collected.Results: Six patients contracted SARS-CoV-2 and four of them developed the COVID. Of these, one patient had ground-glass opacities on the chest CT scan, while the remaining three developed consolidations. No patient died and the overall respiratory involvement was mild, requiring in the worst cases low-flow oxygen.Conclusions: Here we report the clinical course of a cohort of patients with SABI exposed to SARS-CoV-2. The infection spread among patients and caused COVID in some of them. Unexpectedly, COVID was moderate, caused at most mild respiratory distress and did not result in fatalities.

Percutaneous treatment of Hepatocellular carcinoma exceeding 3 cm: combined therapy or microwave ablation? Preliminary results.

PURPOSE: To compare MWA and RFA combined with TACE for HCC nodules exceeding 3 cm. METHODS: 19 lesions submitted to MWA (G1) were retrospectively compared with a combined treatment group (G2) matching by tumor characteristics (mean size 43 and 45 mm in G1 and G2, respectively). Technical success, complications, complete ablation (CA), and maintained CA (mCA) were evaluated. RESULTS: Technical success was achieved in all cases. Overall mortality was zero, both in G1 and G2. No significant differences were found in complications rates (3 in G1 and 2 in G2). CA was obtained in 11 (58 %) HCC in G1 and 15 (79 %) in G2 (p = n.s.). CA was obtained in 75.5 % (G1) and 89 % (G2) nodules up to 4 cm, 45 % and 70 % nodules >4 cm, respectively. At statistical analysis, size resulted as predictor for CA only in G1 (mean diameter of CA vs non-CA 39.9 vs. 47.7 mm, p = 0.021). During follow-up (13.1 and 14.4 months in G1 and G2), mCA occurred in 6/19 (32 %) nodules in G1, 8/19 (42 %) in G2. CONCLUSION: MWA and combined therapy are comparable as for safety. No significant differences were found in terms of technique effectiveness. Larger randomized studies should be designed to confirm MWA as a valid alternative to combined therapy.