SARS-CoV-2 and finding of vein thrombosis: can IMPROVE and IMPROVEDD scores predict COVID-19 outcomes?

OBJECTIVE: Diffuse thrombosis represents one of the most predominant causes of death by COVID-19 and SARS-CoV-2 infection seems to increase the risk of developing venous thromboembolic diseases (VTE). Aim of this study is to analyze the relationship between validated predictive scores for VTE such as IMPROVE and IMPROVEDD and: (1) Intensification of Care (IoC, admission to Pulmonology Department or Intensive Care Unit) (2) in-hospital mortality rate 3) 30-days mortality rate. PATIENTS AND METHODS: We retrospectively evaluated 51 adult patients with laboratory diagnosis of SARS-CoV-2 infection and calculated IMPROVE and IMPROVEDD scores. All patients underwent venous color-Doppler ultrasound of the lower limbs to assess the presence of superficial vein thrombosis (SVT) and/or deep vein thrombosis (DVT). Patients with normal values of D-dimer did not receive heparin therapy (LMWH); patients with ≥ 4 ULN values of D-dimer or with a diagnosis of DVT were treated with therapeutic LMWH dosage, while the remaining patients were treated with prophylactic LMWH dosages. RESULTS: We found strong relations between IMPROVE score and the need for IoC and with the in-hospital mortality rate and between the IMPROVEDD score and the need for IoC. We defined that an IMPROVE score greater than 4 points was significantly associated to in-hospital mortality rate (p = 0.05), while an IMPROVEDD score greater than 3 points was associated with the need for IoC (p = 0.04). Multivariate logistic analysis showed how IMPROVE score was significantly associated to in-hospital and 30-days mortality rates. CONCLUSIONS: IMPROVE score can be considered an independent predictor of in-hospital and 30-days mortality.

Sexual dysfunctions in multiple sclerosis.

AIM: The aim of this study was to analyze the sexual dysfunction in patients affected by multiple sclerosis. METHODS: From January 2005 to December 2007, 221 consecutive patients, 97 women and 124 men, were included in the study. Age range was 20+/-65 years (average 38.77). Fifty-two patients, 14 women (26.9%) and 38 men (73%), among those who have had sexual dysfunctions, showed their will to tackle their problem, and were thus taken into consideration by the Department of Andrology. Sexual activity of these patients has been estimated by self-administered questionnaire, through the International Index of Erectile Function (IIEF) for men and Index of Female Sexual Arousal (IFSA) for women. All 64 patients started a domiciliary therapy with sildenafil 50 mg, and in case of failure, sildenafil 100 mg. Results have been estimated for men according to the IIEF questionnaire and to the answers to the third and fourth question, concerning the capacity to have and keep an adequate erection during a sexual intercourse, and for women according to the IFSA questionnaire and to the answers given to questions number 1, 5, 6, and 10. RESULTS: Among the 124 male patients, 25 (20.1%) had a serious deficiency of the erectile function (score IIEF<10), 11 (8.8%) had a moderate deficiency (score from 11 to 16), and 20 (16.12%) had a light deficiency (score from 17 to 25). Twenty-five patients affected with serious erectile deficiency, also reported a contemporaneous decrease of libido. Among the 97 female patients, 22 (28.86%) of them reported a serious decrease of the genital sensitivity and of the sexual desire; 22 (22.68%) of them reported instead a serious decrease of the vaginal lubrication; 9 (9.2%) reported a moderate decrease of the sensitivity, and 10 (10.30%) reported a moderate decrease of the vaginal lubrication. According to Disability Scale Expanded Score 52 male patients showed a 2.6 mean score (range 1.5-7); 14 female patients showed a 2.9 mean score (range 3-6). The answers to IIEF questions number three and four, and to the IFSA questions number 1, 5, 6 and 10 reported the achievement and keeping of an adequate erection after a follow-up of 4 sexual intercourse, and lubrication and sensitivity during a sexual intercourse in all the cases analysed. CONCLUSION: Sildenafil has been effective and safe in the treatment of sexual dysfunctions for both sexes. In all analysed patients sexual deficiency was due to the neurological and central nervous system on which depend different dysfunctions correlated with the extension and the gravity of the multiple sclerosis. IIEF questions number 13 and 14 and IFSA questions number 21 and 22 showed a clear improvement of the sexual life quality of these patients, after sildenafil therapy.

[A rare cause of acute abdomen: perforation of cecal diverticulum]. / Una causa non frequente di addome acuto: perforazione di diverticolo ciecale.

The Authors, after a brief review of the literature on the frequency and localization of large bowel diverticular disease report a case of perforation of a cecal diverticulum operated on emergency. They also add some brief comments on the interesting aspects of the case, its diagnostic difficulties and operating technique.

[A personal variant of the Vayre and Petit Pazos technique in the surgical repair of inguinal hernia]. / Una variante personale alla tecnica di Vayre e Petit Pazos per la correzione chirurgica dell'ernia inguinale.

The authors describe a personal modification of Vayre and Petit Pazo's surgical technique for the cure of the inguinal hernia, that is a different application of the mersilene mesh. Out of 1,200 operations performed for the inguinal hernia repair from 1979 throughout 1988, the technique was used in 50 cases with good results and without recurrences at a follow up ranging from six months to seven years.

[A rare occurrence of adrenal ectopy im the spermatic cord. A short clinical note]. / Un raro riscontro di ectopia surrenalica nel cordone spermatico. Breve nota clinica.

The authors describe a rare case of adrenal ectopy in the spermatic cord of a child, casually discovered during surgery of inguinal hernia. The adrenal cortex was totally represented.