Thrombotic complication in non-hospitalized COVID-19 patients: An underestimated phenomenon?

Thrombotic complications are quite frequent during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, especially during severe disease and in hospitalized patients. The incidence of thrombotic complications in mild disease is not clear and probably few cases have been identified. We reported a case of a 60-year-old man with no previous history admitted to our unit for splenic infarct and a floating clot into the descending aorta without signs of severe disease. Several mechanisms to clarify prothrombotic state have been described. However, the exact prevalence of thromboembolic phenomenon is probably underestimated. There is no consensus about the treatment and the indications for preventing these complications in non-hospitalized patients. Thrombotic events should be suspected also in healthy patients with symptoms suggestive for coronavirus disease infection but without severe COVID-19 pneumonia. Further analysis should be performed to stratify the risk in non-hospitalized patients and the indications for prophylactic treatment. © 2022 The Author(s).

SARS-CoV-2 neuropathology: Evidence from a post-mortem autopsy series in Padova, Italy

Introduction: SARS-CoV-2 is a novel strain of Coronavirus that mainly targets the respiratory tract, but with important implications also for the CNS. Data deriving from autopsy studies supports the neuroinvasive potential of SARS-CoV-2, even though infection appears to be limited to sparse cells within the brainstem and was not associated with the severity of neuropathological changes. Objectives: In the following study, we assess the neuropathological changes of 14 patients who died following a diagnosis of Sars-CoV-2 infection in Padova, Italy from March 2020 to January 2021. Methods: The cerebrum, cerebellum, brainstem, cranial nerves and meninges were sampled and histopathological evaluation was performed by histochemistry and immunohistochemistry for GFAP, CD8, CD61, CD68 and HLA-DR antibodies. SARS-CoV-2 proteins and RNA were investigated through immunohistochemistry, RTPCR and in-situ hybridization. Results: Small vessel thromboses were identified in two patients, while fresh territory ischaemic lesions were identified in three patients. Astrogliosis and microglial activation were more pronounced at the level of the brainstem in all subjects. SARS-CoV-2 proteins were found within the brainstem and meninges of 4 patients. In one patient, SARS-CoV-2 proteins and RNA were identified throughout the whole rostrocaudal extent of the brainstem and basal ganglia, with prominent involvement of neurons and oligodendrocytes in the mesencephalon, rostral pons and medulla. Conclusion: Although limited by the number of our cohort, the study contributes to define the neuroinvasive potential of SARS-CoV-2 within the CNS. In line with available literature, SARS-CoV-2 invasion does not appear to correlate with the severity of neuropathological changes.

How covid-19 pandemic impacted integrated care pathways for lung cancer: the experience of two Italian centers in veneto region

Background: COVID-19 pandemic has represented a historic challenge to healthcare systems. The management of cancer care has become a crucial issue for clinical services to cancer patients. During the COVID-19 pandemic, raising evidence has been published on lung cancer care but no data have been presented on the integrated care pathways (ICP) impact. Materials and methods: We retrospectively reviewed the ICPs of consecutive lung cancer patients who accessed two Centres before and after COVID-19 pandemic: the Veneto Institute of Oncology (IOV)/University Hospital of Padua and University Hospital of Verona. Sixteen indicators about oncology, radiaton therapy, thoracic surgery, pathology and pneumology were developed using groupfacilitation techniques taking into account their reproducibility, significance, measurability. We report data extracted from electronic medical records and linked softwares, about MDT performance at the two participating Centres, and preliminary data about pathological and oncological indicators in Padua. Additional data about both complete ICPs will be presented at the Conference. Results: We compared data about ICP performance in two window periods: 1/3/2019-30/4/2019 and 1/3/2020- 30/4/2020. MDT meetings were reshaped in order to discuss those cases where more than two specialists were required and whenever possible on a web-basis;therefore, it determined an average reduction of patients discussed of 57.5%. Preliminary data from Padua showed that median time between diagnostic procedure and diagnosis was reduced from 11 days in 2019 to 7.5 days in 2020, mostly due to a prioritization of oncological procedures over any other. Moreover, a 39% reduction of first oncological visits was observed between the two time frames;this was linked to a reduction of out of region second opinion and to optimization of outpatient access. Among patients under oncological treatment, 12(4%) and 8(2%) patients received treatment within 30 days from death in 2019 and 2020, respectively. Conclusions: Based on the experience the two Centres went through, we identified the key steps in ICP impacted by a pandemic such COVID-19 so to proactively put in place robust service provision in thoracic oncology.