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Objectives: The diagnosis of early onset of myasthenia gravis in the emergency room represents a real challenge, especially when symptoms of presentation are atypical and nonspecific features. Material and methods: We described a case of 33 years old woman who went to the Emergency Department of Pescia (Pistoia, Italy) for a spontaneous intense frontal headache associated with the presence of rhinolalia and unilateral shoulder girdle disorders, initially misdiagnosed. Results: The atypical and initially mild presentation of the disease contributed to the delay in diagnosis; the progression of motor disturbances subsequently led to the definition of the clinical pattern. In particular, the patient showed AChR antibody positivity, associated with a thymoma. Conclusions: Despite being a well-known pathology and widely described in the literature, myasthenia gravis at onset is still a difficult diagnosis in cases of atypical presentation or with infrequent symptoms. [ABSTRACT FROM AUTHOR]

Recent epidemiological reports on Chinese population affected by novel coronavirus showed a wide spread of clinical and biochemical alterations, suggesting a relationship between progression of lung damage to acute respiratory distress syndrome and the systemic inflammatory response, triggering an irreversible multiple organ damage and disseminated intravascular coagulation. Bedside ultrasound assessment provides integrated information, describing a multisystemic and dynamic clinical scenario for every patient. Furthermore, this approach allows to concentrate multiple information in the hands of a single operator, also limiting the risk of exposure to infection for healthcare professionals. As per our experience, herewith reported, we described the characteristics of 10 patients with SARS-CoV-2 infection. Ultrasound findings were related to clinical information, blood test analysis, and results of instrumental tests, such as chest X-ray and chest computed tomography. According to our ultrasound data, COVID-19 appears to be a systemic pathology even in those cases of mild to moderate disease. By this multisystem ultrasound approach, we could immediately recognize patients with a diffuse organ involvement and a more severe clinical pattern; moreover, we can protect healthcare workers and limit infection within health facilities. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the prognostic value of electrocardiography (ECG) alone or in combination with echocardiography in patients with acute pulmonary embolism and normal blood pressure. Methods: Consecutive adult patients presenting to the emergency department at Azienda Ospedaliero-Universitaria Careggi with the first episode of pulmonary embolism were included. Patients with systolic blood pressure less than 100 mm Hg were excluded. ECG and echocardiography were performed within 1 hour from diagnosis and evaluated in a blinded fashion. Right ventricular strain was diagnosed in the presence of one or more of the following ECG findings: complete or incomplete right ventricular branch block, S1Q3T3, and negative T wave in V1-V4. The main outcome measurement was clinical deterioration or death during in-hospital stay. The association of variables with the main outcome was evaluated by multivariate Cox survival analysis. Results: A total of 386 patients with proved pulmonary embolism were included in the study; 201 patients (52%) had right ventricular dysfunction according to echocardiography, and 130 patients (34%) showed right ventricular strain. Twenty-three patients (6%) had clinical deterioration or died. At multivariate survival analysis, right ventricular strain was associated with adverse outcome (hazard ratio 2.58; 95% confidence interval, 1.05-6.36) independently of echocardiographic findings. Patients with both right ventricular strain and right ventricular dysfunction (26%) showed an 8-fold elevated risk of adverse outcome (hazard ratio 8.47; 95% confidence interval, 2.43-29.47). Conclusion: Right ventricular strain pattern on ECG is associated with adverse short-term outcome and adds incremental prognostic value to echocardiographic evidence of right ventricular dysfunction in patients with acute pulmonary embolism and normal blood pressure. [Copyright &y& Elsevier]