COVID-19 therapies and their impact on QT interval prolongation: A multicentre retrospective study on 196 patients.

BACKGROUND: SARS-CoV-2 infection has caused a global pandemic. Many of the medications identified to treat COVID-19 could be connected with QTc prolongation and its consequences. METHODS: Non-ICU hospitalized patients of the three centres involved in the study from the 19th of March to the 1st of May were included in this retrospective multicentre study. Relevant clinical data were digitally collected. The primary outcome was the incidence of QTc prolongation ≥ 500 ms, the main secondary outcomes were the Tisdale score ability to predict QTc prolongation and the incidence of ventricular arrhythmias and sudden deaths. RESULTS: 196 patients were analysed. 20 patients (10.2%) reached a QTc ≥ 500 ms. Patients with QTc ≥ 500 ms were significantly older (66.7 ± 14.65 vs 76.6 ± 8.77 years p: 0.004), with higher Tisdale score (low 56 (31.8%) vs 0; intermediate 95 (54.0%) vs 14 (70.0%); high 25 (14.2%) vs 6 (30.0%); p: 0.007) and with higher prognostic lab values (d-dimer 1819 ± 2815 vs 11486 ± 38554 ng/ml p: 0.010; BNP 212.5 ± 288.4 vs 951.3 ± 816.7 pg/ml p < 0.001; procalcitonin 0.27 ± 0.74 vs 1.33 ± 4.04 ng/ml p: 0.003). After a multivariate analysis the Tisdale score was able to predict a QTc prolongation ≥ 500 ms (OR 1,358 95% CI 1,076-1,714p: 0,010). 27 patients died because of COVID-19 (13.7%), none experienced ventricular arrhythmias, and 2 (1.02%) patients with concomitant cardiovascular condition died of sudden death. CONCLUSIONS: In our population, a QTc prolongation ≥ 500 ms was observed in a minority of patients, no suspected fatal arrhythmias have been observed. Tisdale score can help in predicting QTc prolongation.

Tubercular involvement of the thyroid gland: a report of two cases.

Thyroid tuberculosis is rare. In the last decade, however, the incidence of extrapulmonary forms of tuberculosis has increased. We report on 2 cases of thyroid tuberculosis. In case 1, a tubercular abscess mimicking acute thyroiditis was found which was correctly diagnosed by fine-needle aspiration biopsy (FNAb). No evidence of active disease was noticed. Pleural thickening on chest X-ray was the only sign compatible with a previous infection. In case 2, tubercular thyroiditis with lymph node enlargement was also diagnosed by FNAb in a reevaluation setting. In both cases treatment with antitubercular drugs resulted in complete recovery. Thyroid tuberculosis should be kept in mind in the differential diagnosis of thyroid nodules, notably in patients with a history of tuberculous disease. FNAb represents the main approach to making the diagnosis.

[The accuracy of the fine needle aspiration biopsy in 1250 thyroid nodules]. / Affidabilità diagnostica della biopsia con ago sottile in 1250 nodi tiroidei.

Between 1989 and 1998 a total of 1250 thyroid nodes underwent Fine Needle Aspiration Biopsy (FNAB). Of these 150 went on to surgery with subsequent histological examination which proved positive for malignant neoplasm in 35 nodes. The remaining 115 nodes presented benign lesions. The cytological diagnoses were preventatively broken down into three groups: a) benign; b) malignant; c) suspected malignancy. Group a) included 53 nodes; histology confirmed the diagnosis of a benign lesion in 50 of these nodes (True Negatives), while 3 proved malignant (False Negatives). The cytological diagnosis of malignancy was reached in 24 nodes (group b) and subsequent histology confirmed the malignancy in 18 cases (True Positives) while the remaining 6 nodes tested negative for neoplasm (False Positives). Group c) included those thyroid nodes which cytology classified as follicular neoplasms and for which histology was required to reach a diagnosis of malignancy or benignity; for this reason these cases were not used in the evaluation of diagnostic reliability. Of these 15 (20.5%) proved malignant and 58 (79.5%) benign (44 follicular adenomas and 14 micro-macrofollicular struma nodes). On the basis of the above data, the diagnostic accuracy of FNAB is 88.3%, sensitivity 85.7% and specificity 89.3%. These findings are substantially in agreement with the international literature which considers cytological testing highly reliable. In analyzing the cases which were not confirmed by histology, it was interesting to note that among the 4 false positives--defined as the "presence of atypical cells in a lymphocyte infiltration context"--a full three were thyroadenitis nodes for which the presence of atypical cells is quite common. The three false negative nodes, on the other hand, included two cysts for which cytology did not reveal neoplastic cells. The present experience suggests the following: 1) FNAB is still the most reliable technique for the diagnosis of thyroid neoplasms; 2) the presence of atypical cells in thyroid node lesions is not always indication of a malignancy; 3) cysts must be subject to careful follow-up since they can mask a malignant neoplasm.

Galectin-3 is a presurgical marker of human thyroid carcinoma.

Galectin-3 is a carbohydrate-binding protein endowed with an affinity for beta-galactosides. It has been shown to play an important role in cell-cell and cell-matrix interactions and in pre-mRNA splicing. Furthermore, it is involved in the control of cell growth, neoplastic transformation, and metastasis. Interestingly, high levels of galectin-3 expression have been recently described in malignant thyroid neoplasias, but not in adenomas or in normal thyroid tissue. We investigated galectin-3 expression in human presurgical specimens obtained by fine-needle aspiration biopsy. We analyzed galectin-3 expression by immunoperoxidase staining in both paraffin-embedded cytological thyroid sediments (cell blocks) obtained by fine-needle aspiration biopsy and their histological counterparts. A total of 64 samples were examined: 17 follicular carcinomas; 18 papillary carcinomas; and 29 follicular adenomas. All cell blocks and histological samples of papillary carcinomas expressed high levels of galectin-3 at either the cytoplasmic or nuclear level. Among follicular carcinomas, all histological samples expressed galectin-3, whereas 14 of 17 corresponding cell blocks were positive in the cytoplasm. No evidence of cytoplasmic galectin-3 expression was observed in 26 of 29 follicular adenomas. Hence, cytoplasmic galectin-3 staining seems to be a reliable, easy, and cheap marker for presurgical diagnosis of follicular carcinomas and an even more suitable one for papillary carcinomas.

Chemotherapy with dacarbazine and 5-fluorouracil in advanced medullary thyroid cancer.

BACKGROUND: Experience with chemotherapeutic agents in the management of advanced medullary thyroid carcinoma (MTC) is limited and controversial. However, since MTC is a neuroendocrine neoplasm, we considered the possibility that cytotoxic drugs previously used in the treatment of these tumours could also have activity in MTC. PATIENTS AND METHODS: Five patients (4 females and 1 male, aged 22-71 years) with locally advanced or metastatic MTC received 5 day intravenous courses of dacarbazine (DTIC) (250 mg/sqm) and 12 hour infusion 5-fluorouracil (450 mg/sqm), given every 4 weeks. Six cycles were administered to 4 patients and four to 1 patient. RESULTS: Three partial responses lasting 9, 10+ and 8+ months were observed; one patient had stable disease and one progressive disease. Toxicity was acceptable with grade I thrombocytopenia and grade II leukopenia occurring in one patient, and grade II nausea and vomiting in four patients. CONCLUSIONS: In our experience, treatment of advanced thyroid carcinoma with DTIC and 5-FU appeared to have significant activity and was well tolerated.