Paolo Carraro

A man of 81 years, with previous coronary artery disease, unrecognized myocardial infarction, carrier of implanted pacemaker, presented to the cardiology department for a scheduled hospitalization to treat shortness of breath and symptoms of heart failure. There was no chest pain, ECG poorly assessable for pacemaker–induced rhythm, cardiac troponin I of 35,879 ng/L (cut–off 20). Suspecting an acute coronary syndrome (ACS), the patient undergoes immediate coronary angiography that does not showed any change compared to a previous examination. Meanwhile SARS–CoV–2 research in nasopharyngeal swab by RT–PCR was positive and after a few hours fever appears. The authors discussed the case and extensive monitoring of cardiac markers and intensive evaluation of clinical parameters were activated. Troponin I HS, CK–MB, Myoglobin (Beckman Coulter DxI), CK, AST, LDH are determined by routine methods (Beckman Coulter AU700), Troponin T (cTnT–hs Roche Diagnostics) on (Roche Cobas 8000). All markers (except Troponin T) had the typical pattern of an ACS, in accordance with their characteristic half–life of an acute insult with development of a peak and subsequent decrease in a few days. The peaks recorded were cTnI 35,789 ng/L, CK–MB 72.6 ug/L, CK 800 U/L, AST 1,51U/L, Myoglobin 244 ng/ml, LDH 600 U/L, all at time 0. Troponin T was moderately increased at presentation (3700 ng/L, cut–off 10) followed by a peak of 3,872 after 2 hours stabilizing around 2,800 ng/L for the next days and decreasing after day 7. The final diagnosis was acute COVID–19–related myocarditis.

Background & Aims: Sleep preparation/onset are associated with peripheral vasodilatation and a decrease in body temperature. The hyperdynamic syndrome exhibited by patients with cirrhosis may impinge on sleep preparation, thus contributing to their difficulties falling asleep. The aim of this study was the assessment of skin temperature, in relation to sleep‐wake patterns, in patients with cirrhosis.Methods: Fifty‐three subjects were initially recruited, and 46 completed the study. Of the final 46, 12 were outpatients with cirrhosis, 13 inpatients with cirrhosis, 11 inpatients without cirrhosis and 10 healthy volunteers. All underwent baseline sleep‐wake evaluation and blood sampling for inflammatory markers and morning melatonin levels. Distal/proximal skin temperature and their gradient (DPG) were recorded for 24 hours by a wireless device. Over this period subjects kept a sleep‐wake diary.Results: Inpatients with cirrhosis slept significantly less well than the other groups. Inpatients and outpatients with cirrhosis had higher proximal temperature and blunted rhythmicity compared to the other groups. Inpatients with/without cirrhosis had higher distal temperature values and blunted rhythmicity compared to the other groups. Inpatients and outpatients with cirrhosis had significantly lower DPG values compared to the other groups, and DPG reached near‐zero values several hours later. Significant correlations were observed between temperature and sleep‐wake variables and inflammatory markers.Conclusions: Alterations of distal/proximal skin temperature, their gradient and their time‐course were observed in patients with cirrhosis, which may contribute to their sleep disturbances.

Several scores and biomarkers, i.e., procalcitonin (PCT), were proposed to stratify the mortality risk in community-acquired pneumonia (CAP).

The mainstay of patient-oriented laboratory testing in emergency settings entails selecting number and type of tests according to valid criteria of appropriateness. Since the pattern of urgent tests requesting is variable across different institutions, we designed a joined survey between the Academy of Emergency Medicine and Care (AcEMC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) for reaching tentative consensus about the most informative diagnostic tests in emergency settings. A survey, containing the most commonly performed urgent laboratory tests and the relative clinical indications, was disseminated to eight relevant members of AcEMC and eight relevant members of SIBioC. All contributors were asked to provide numerical scores for the different laboratory parameters, where 1 indicated strongly recommended, 2 recommended in specific circumstances, and 3 strongly discouraged. The mean results of the survey were presented as the mean of responders’ values, and the parameters were finally classified as strongly recommended (mean value, 1.0-1.5), somehow recommended (mean value, 1.5-2.0), discouraged (mean value, 2.0-2.5) and strongly discouraged (mean value, 2.5-3.0). The results of the survey allowed defining a hierarchy of priority, wherein 24 tests were strongly recommended. The use of 5 common tests was instead strongly discouraged. For 16 additional parameters in the list, the consensus ranged between somehow recommended and discouraged. We hope that results presented in this joint AcEMC-SIBioC consensus document may help harmonizing panel of tests and requesting patters in emergency setting, at least at a national level.