Potential of outpatient steroid therapy in elderly patients with early COVID-19.

Corticosteroids lower mortality in hospitalized patients with COVID-19 pneumonia requiring oxygen support. In this observational retrospective study (September 2020-June 2021), we explored the association between receiving home corticosteroids without oxygen supply and 30-day mortality in hospitalized patients with COVID-19 pneumonia. Among a total of 794 COVID-19 pneumonia patients, 763 were included into the study (males 68%; mean age 65 ±12 years), of whom 197 (26%) received home corticosteroids (mean daily prednisone equivalent-dose 40 mg ± 12 mg; range 10-50 mg; median 50 mg; IQR 25-50 mg; for 4 days). The overall 30-day mortality of the study population was 12%. The risk of death-adjusted for age, comorbidities, administration of remdesivir and respiratory failure severity-was lower (HR 0.405; p = 0.024) in patients receiving home corticosteroids. After stratifying the study population by age categories, home corticosteroids were associated with an adjusted decrease in mortality risk in patients > 77 years (HR 0.346; p = 0.040). Home corticosteroids may lower the 30-day mortality in elderly COVID-19 patients.

Neck circumference as reliable predictor of mechanical ventilation support in adult inpatients with COVID-19: A multicentric prospective evaluation.

AIMS: COVID-19 is especially severe for elderly subjects with cardiometabolic and respiratory comorbidities. Neck circumference (NC) has been shown to be strongly related to cardiometabolic and respiratory illnesses even after adjustment for body mass index (BMI). We performed a prospective study to investigate the potential of NC to predict the need for invasive mechanical ventilation (IMV) in adult COVID-19 inpatients. MATERIALS AND METHODS: We prospectively and consecutively enrolled COVID-19 adult patients admitted to dedicated medical wards of two Italian hospitals from 25 March to 7 April 2020. On admission, clinical, biochemical and anthropometric data, including BMI and NC were collected. As primary outcome measure, the maximum respiratory support received was evaluated. Follow-up time was 30 days from hospital admission. RESULTS: We enrolled 132 subjects (55.0-75.8 years, 32% female). During the study period, 26 (19.7%) patients underwent IMV. In multivariable logistic regression analyses, after adjusting for age, sex, diabetes, hypertension and COPD, NC resulted independently and significantly associated with IMV risk (adjusted OR 1.260-per 1 cm increase 95% CI:1.120-1.417; P < .001), with a stronger association in the subgroup with BMI ≤30 Kg/m2 (adjusted OR 1.526; 95% CI:1.243-1.874; P < .001). NC showed a good discrimination power in predicting patients requiring IMV (AUC 0.783; 95% CI:0.684-0.882; P < .001). In particular, NC > 40.5 cm (>37.5 for females and >42.5 for males) showed a higher and earlier IMV risk compared to subjects with lower NC (Log-rank test: P < .001). CONCLUSIONS: NC is an easy to measure parameter able to predict the need for IMV in adult COVID-19 inpatients.

Spinal lesions by infectious spondylodiscitis and hepatocellular carcinoma presenting as spinal metastasis in an HIV-HCV co-infected patient.

Back pain and spine tenderness over the involved spine segment are common clinical findings of a number of relative benign conditions. However, back pain may be the presenting symptom of vertebral metastases in patients with systemic cancer, including hepatocellular carcinoma, a not uncommon complication in HCV-HIV infected patients. We describe a case of a 51-year-old intravenous drug user with HIV and HCV co-infection who developed dorsal spondylodiscitis due to Pseudomonas aeruginosa, which improved following antibiotic therapy. Three months after the end of therapy, the patient referred recurrence of back pain. The MRI showed different vertebral lesions of the dorsal spine and costal arch which turned out to be hepatocellular carcinoma metastasis at the histological examination. The patient had never been treated with the interferon-ribavirine combination therapy because of a major depressive syndrome. Interferon-free regimens are urgently required for HIV-HCV coinfected patients, especially when interferon-based regimens are contraindicated.

Diagnosis, management and outcome of clinically- suspected spinal infection.

OBJECTIVES: Spontaneous spinal infection (SI) is a quite rare but serious entity. This study aimed to evaluate outcome and follow-up data of SI cases without a microbiological diagnosis (suspected SI). METHODS: We undertook a retrospective, comparative study of 82 spontaneous SI cases in adults presenting over an 11-year period to two Italian hospitals. RESULTS: The diagnostic yields of blood culture, percutaneous needle biopsy of spine, and surgical sample culture were 43.6%, 72.7%, and 91.6%, respectively. Overall, causative organisms were identified in 60 (73.2%) cases, the most frequently isolated pathogens being Staphylococcus aureus and Mycobacterium tuberculosis. The median diagnostic delay was similar (p=0.39) in pyogenic (1 month) and suspected (0.5 month) SI cases, and longer in tuberculous cases (4 months) than in the other SI case groups (p=0.069 and p=0.062, respectively). All patients received antibiotic treatment, and 21 (25.5%) underwent surgery, that was required more frequently in tuberculous (40.7%) than in pyogenic (25.0%) and suspected SI cases (9.1%) (p=0.028). Of 67 patients who completed a 1-year follow-up period, 24 had persisting painful disability that was more frequent in tuberculous (66.7%) cases than in pyogenic (21.7%) and suspected SI (15.0%) cases (p=0.03). CONCLUSIONS: Although a microbiological diagnosis was not achieved in nearly a quarter of SI cases, both diagnostic delay and outcome were similar to those of pyogenic SI cases. Earlier recognition of tuberculous SI is mandatory, as this is associated with the highest long-term morbidity.

Aortic-right atrium fistula complicating Austrian Syndrome: a case report and literature review.

The triad of pneumonia, meningitis, and endocarditis due to Streptococcus pneumoniae is known as Austrian syndrome. We report a case with an aortic-right atrium fistula in a 39-year-old woman who had undergone splenectomy for Hodgkin's lymphoma. The review of literature shows that the prevalence of Austrian syndrome is decreasing from 19% to 3% of patients with pneumococcal endocarditis in recent years. This case emphasizes that diagnosis of endocarditis should be considered early in every patient with pneumococcal meningitis or bacteremia, particularly in immunocompromised patients.