Children with Kawasaki disease or Kawasaki-like syndrome (MIS-C/PIMS) at the time of COVID-19: are they all the same? Case series and literature review.

Since the coronavirus disease 2019 (COVID-19) outbreak started, children have been considered marginally involved compared to adults, with a quite significant percentage of asymptomatic carriers. Very recently, an overwhelming inflammatory activation, which shares clinical similarities with Kawasaki disease (KD), has been described in children exposed to COVID-19. We report three KD-like cases that occurred during the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a highly affected area of Northern Italy. The clinical presentation was characterized by the presence of unremitting fever, diarrhea and elevated inflammatory markers. Case #1 and Case #2 occurred one week apart and shared other clinical features: laboratory tests confirmed COVID-19 exposure and high inflammatory activation with myocardial involvement. Case #3 followed a more typical pattern for KD. Interestingly, this patient showed lower levels of procalcitonin, C-reactive protein, D-dimers, and ferritin compared to the other two cases, whereas platelet count was higher. We hypothesize that SARS-CoV-2 might act in children as a trigger, either inducing a classical KD phenotype or causing a systemic inflammatory response leading to a severe KD-like phenotype, eventually characterized by myocardial impairment. We think that bringing these cases and their differences to the attention of the rheumatology community during the COVID-19 pandemic will be beneficial in order to highlight the importance of early diagnosis and to increase awareness of this new phenomenon.

Role of cardiovascular magnetic resonance in suspected cardiac amyloidosis: late gadolinium enhancement pattern as mortality predictor.

BACKGROUND: Cardiac magnetic resonance (CMR) has gained a central role in the diagnosis of cardiac amyloidosis (CA). While the diagnostic role of a typical late gadolinium enhancement (LGE) pattern (global subendocardial enhancement coupled with accelerated contrast washout) has been identified, evidence is still conflicting regarding the prognostic role of such examination. METHODS AND RESULTS: We retrospectively analysed all patients referring for CMR at Niguarda Hospital (Milan, Italy) from January 2006 to January 2015 for suspected CA. Primary outcome was all-cause mortality. We identified 42 patients and divided them into 2 groups, according to the presence (Group A) or absence (Group B) of a typical amyloidosis LGE pattern. At the end of the follow-up (median 37 months, interquartile range 10-50 months), 31 patients (74%) had died. The hazard ratio for all-cause death was 3.2 (95% confidence interval [CI] 1.5-6.4, p < 0.01) for Group A versus Group B. Median survival time was 17 months (95% CI 7-42 months) for Group A and 70 months (95% CI 49-94 months) for Group B (p < 0.01). Multivariate analysis did not find any adjunctive predictive role for biventricular volumes and ejection fraction, indexed left ventricular mass, transmitral E/e' at echocardiography, age at diagnosis or serum creatinine. CONCLUSION: In our population, a typical LGE pattern was significantly associated with higher mortality. Moreover, patients with a typical LGE pattern showed a globally worse prognosis. Our data suggest that the LGE pattern may play a central role in prognostic stratification of patients with suspected CA, thus prompting further diagnostic and therapeutic measures.

Restless legs syndrome and multiple sclerosis: a population based case-control study in Catania, Sicily.

BACKGROUND AND PURPOSE: A population-based case-control study in the city of Catania, Sicily, was carried out to determine restless legs syndrome (RLS) prevalence and its association with multiple sclerosis (MS). METHODS: Patients were randomly selected from a cohort of MS patients resident in the study area and a group of age and sex matched controls was enrolled from the general population. RLS was diagnosed according to the International Restless Legs Syndrome Study Group criteria. RESULTS: In total, 152 MS patients and 431 controls were included in the study. A significantly higher prevalence of RLS amongst MS patients (14.5%) compared with controls (6.0%) was detected, corresponding to an almost threefold increased risk (odds ratio 2.7, 95% confidence interval 1.4-5.0) of developing RLS. Spinal cord lesions in MS patients were associated with a higher risk of RLS (odds ratio 3.7, 95% confidence interval 1.1-13.5). CONCLUSION: RLS was strongly associated with MS, with a significantly higher risk in patients presenting spinal cord lesions.

Observing and modeling long-term persistence of P. noctiluca in coupled complementary marine systems (Southern Tyrrhenian Sea and Messina Strait).

In the Mediterranean Sea, the Strait of Messina (MS) is a very peculiar area, connecting highly different regions and representing a privileged observatory for an early comprehension and assessment of ecosystems shifts. It is hypothesized that the outbreaks observed near the coast of many sites in the Mediterranean Sea may be the result of transport of permanent populations of P. noctiluca in pelagic waters to the coast, caused by specific hydrodynamic conditions. By both visual observations and numerical experiments our objective is twofold: (A) to help clarify whether the basin of the Aeolian Islands Archipelago (AIA), in the Southern Tyrrhenian Sea (STS), may be the site from which large populations of P. noctiluca are transported to the MS, and (B) to evaluate whether the upwelling turbulent system of the MS can be an energetic opportunity for this species. It should offer a rich habitat without jeopardizing the overall survival of the population, that is subject to stranding due to strong currents. Although very different, the two involved ecosystems (AIA and MS ) are complementary for the success of Pelagia noctiluca life cycle. Outputs obtained by coupling the 3D hydrodynamic model (SHYFEM) with a Lagrangian particle tracking model support the hypothesis of a connectivity between these two ecosystems, particularly in the first half of the year, indicating the coastal areas around the AIA as potential optimal source location for Pelagia larval stages. We support the very attractive hypothesis that two connected systems exist, the former one favours Pelagia's reproduction and acts as a nursery and the latter favours its growth due to higher productivity. We speculate that the reproductive population of the AIA is not permanent, but is renewed every year by individuals who have fed and quickly grown in the MS and who are passively transported by downwelling along canyon "corridors".

Hydrodynamic patterns favouring sea urchin recruitment in coastal areas: A Mediterranean study case.

In invertebrate fisheries, sea urchin harvesting continues to grow with dramatic consequences for benthic ecosystems. The identification of areas with a marked natural recruitment and the mechanisms regulating it is crucial for the conservation of benthic communities and for planning the sustainable harvesting. This study evaluates the spatial distribution and density of recruits of the edible sea urchin Paracentrotus lividus along the Sinis + Peninsula (Sardinia) and explores its significant relationships with the local oceanographic features. Our results reveal that recruitment is favoured in areas with slow currents and high levels of confinement and trapping of the water masses. Analysis of the residual circulation indicates that the presence of local standing circulation structures promotes the sea urchin recruitment process. Our findings emphasize the importance of managing local sea urchin harvesting as a system of populations with their demographic influence mainly dependent on the most important ecological driver that is the recruitment.

Efficacy and gastrointestinal tolerability of beta-cyclodextrin-piroxicam and tenoxicam in the treatment of chronic osteoarthritis.

Thirty patients aged 26 to 70 years with a history of chronic osteoarthritis of at least eight years were randomly assigned to receive 20 mg daily of beta-cyclodextrin-piroxicam (beta-CDP) or tenoxicam for eight weeks. Both drugs effectively reduced pain, inflammation, and functional limitations of the affected joints. Endoscopy revealed minor posttreatment hemorrhagic lesions and erosions; these tended to be less severe in the group treated with beta-CDP than with tenoxicam. Slight to moderate gastrointestinal symptoms were reported by one patient treated with beta-CDP and three patients treated with tenoxicam; the symptoms were poorly correlated with endoscopic findings. It is concluded that both drugs are safe and effective in the control of symptoms in patients with chronic osteoarthritis.

Arrhythmias during dipyridamole test. Report of 3 cases.

The authors report three cases in which the dipyridamole test provoked: (1) junctional rhythm with AV dissociation; (2) sinus arrest; (3) 2:1 AV block. The three cases described above draw attention to the possible effect of dipyridamole on the AV conduction, which is not yet completely known. This unwanted effect suggests that careful ECG monitoring should be performed during the dipyridamole test.