Effect of Lactoferrin on Clinical Outcomes of Hospitalized Patients with COVID-19: The LAC Randomized Clinical Trial.

As lactoferrin is a nutritional supplement with proven antiviral and immunomodulatory abilities, it may be used to improve the clinical course of COVID-19. The clinical efficacy and safety of bovine lactoferrin were evaluated in the LAC randomized double-blind placebo-controlled trial. A total of 218 hospitalized adult patients with moderate-to-severe COVID-19 were randomized to receive 800 mg/die oral bovine lactoferrin (n = 113) or placebo (n = 105), both given in combination with standard COVID-19 therapy. No differences in lactoferrin vs. placebo were observed in the primary outcomes: the proportion of death or intensive care unit admission (risk ratio of 1.06 (95% CI 0.63-1.79)) or proportion of discharge or National Early Warning Score 2 (NEWS2) ≤ 2 within 14 days from enrollment (RR of 0.85 (95% CI 0.70-1.04)). Lactoferrin showed an excellent safety and tolerability profile. Even though bovine lactoferrin is safe and tolerable, our results do not support its use in hospitalized patients with moderate-to-severe COVID-19.

Tracheal Stenosis After Tracheostomy for Mechanical Ventilation in COVID-19 Pneumonia - A Report of 2 Cases from Northern Italy.

BACKGROUND The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic is still to be determined, and the complication rate of the tracheostomy in COVID-19 patients is still unknown. Postintubation tracheal stenosis is a well-known risk of prolonged endotracheal intubation, but it is too early to define the existence of any difference among the COVID-19 cohort of patients and non-COVID-19 patients. This report is of 2 cases of COVID-19 pneumonia that required tracheostomy and prolonged endotracheal intubation, which were followed by delayed tracheal stenosis.   CASE REPORT Case 1. A 54-year-old male was admitted to our hospital (Biella, Italy) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The patient underwent orotracheal intubation, progressively improving his breathing function, and was discharged after 20 days. Ten days later, the patient presented with severe respiratory distress. Computed tomography (CT) scan and bronchoscopy showed signs of tracheal stenosis. We administered intravenous steroids for 10 days. The patient showed increasing improvement in his breathing function and was discharged with no other signs of respiratory distress. Case 2. A 43-year-old male was admitted to our hospital for SARS-CoV-2 infection. The patient underwent orotracheal intubation, progressively improving his breathing function, and was discharged after 25 days. Eighteen days later, the patient came to our emergency room with severe respiratory distress. CT scan and bronchoscopy showed signs of tracheal stenosis. The patient had to undergo tracheal resection. CONCLUSIONS The 2 cases presented in this report have shown that even when patients recover from severe COVID-19 pneumonia requiring tracheostomy and mechanical ventilation, tracheal stenosis should be recognized as a potential complication and careful follow-up is required.

Incidental Diagnosis After a Car Accident: A Rare Case of Asymptomatic Uncorrected Tetralogy of Fallot.

Tetralogy of Fallot (TOF) is a heterogeneous congenital heart disease that is occasionally diagnosed during adulthood. However, although they are often asymptomatic, adult patients with uncorrected TOF often have a poor prognosis. Poor outcomes indicate the importance of the identification and management of these patients, especially in the context of intercurrent disease or noncardiac surgery. We describe a case of clinically silent TOF in a 51-year-old woman. TOF was unmasked during a major noncardiac surgery for a polytrauma and successfully treated with the cooperation of a multidisciplinary team. (Level of Difficulty: Advanced.).

[Efficacy of eculizumab in a case of pregnancy-associated aHUS]. / Efficacia di eculizumab in un caso di SEU atipica associata alla gravidanza.

Pregnancy-associated thrombotic microangiopathy (TMA) is a rare condition, but it is burdened by a significant perinatal and maternal morbidity as well as mortality. We describe the case of a 33-year-old woman, who developed a TMA at the 36th week of gestation characterized by increased LDH, haptoglobin consumption, schistocytes, thrombocytopenia and acute renal failure requiring dialysis. There were not gestational hypertension nor proteinuria until the day of hospitalization. ADAMTS 13 deficiency was ruled out and the patient did not have diarrhea. She was initially treated with caesarean section, plasma infusion and plasmapheresis with no benefit. Five days after the onset of TMA, a temptative diagnosis of atypical uremic syndrome (aHUS) was made and the patient was switched to eculizumab. Antibiotic prophylaxis and anti-meningococcal A,B, C, W135 and Y vaccination was performed. TMA rapidly resolved and renal function completely recovered. The newborn had a normal perinatal course. A complement dysregulation was ruled out by testing for mutations on CFH, CFHR3-R1, CFI, MCP, CFB, C3 and for anti CFH antibodies. In conclusion the differential diagnosis of aHUS with HELLP syndrome is often not straightforward. The severity and persistence of TMA, the high mortality associated to peripartum TMA and the risk for irreversible kidney failure require an early therapeutic decision as to the use of eculizumab.