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Barotrauma occurs in a significant number of patients with COVID-19 interstitial pneumonia undergoing mechanical ventilation. The aim of the current study was to investigate whether the Brixia score (BS) calculated on chest-X-rays acquired at the Emergency Room was associated with barotrauma. We retrospectively evaluated 117 SARS-CoV-2 patients presented to the Emergency Department (ED) and then admitted to the intensive care unit (ICU) for mechanical ventilation between February and April 2020. Subjects were divided into two groups according to the occurrence of barotrauma during their hospitalization. CXRs performed at ED admittance were assessed using the Brixia score. Distribution of barotrauma (pneumomediastinum, pneumothorax, subcutaneous emphysema) was identified in chest CT scans. Thirty-eight subjects (32.5%) developed barotrauma (25 pneumomediastinum, 24 pneumothorax, 24 subcutaneous emphysema). In the barotrauma group we observed higher Brixia score values compared to the non-barotrauma group (mean value 12.18 vs. 9.28), and logistic regression analysis confirmed that Brixia score is associated with the risk of barotrauma. In this work, we also evaluated the relationship between barotrauma and clinical and ventilatory parameters: SOFA score calculated at ICU admittance and number of days of non-invasive ventilation (NIV) prior to intubation emerged as other potential predictors of barotrauma., Competing Interests: The authors declare no conflict of interest.

Purpose: Pulmonary embolism (PE) in COVID-19 patients can play a key role in precipitating clinical conditions. We aimed to evaluate PE distribution on CTA and to investigate any possible association with D-dimer (DD), pulmonary stage of disease and prognosis., Method: COVID-19 patients of two affiliated Hospitals, undergone a CTA examination for PE suspicion, were retrospectively enrolled. Comorbidities, laboratory tests and clinical outcomes (hospitalization, discharge, death) were assessed. A parenchymal stage (early, progressive, peak, absorption) for lung involvement was assigned., Results: A cohort of 114 patients (mean age 61 years; 26.3 % females) with severe COVID-19 pneumonia were evaluated. At last follow-up 25 (21.9 %) were hospitalized, 72 (63.2 %) discharged, 17 (14.9 %) dead. Eighty-eight patients (77.2 %) had at least one comorbidity, being cardiovascular ones the most frequent (44.7 %). CTA revealed PE in 65 patients (57 %), with concomitant pulmonary trunk and/or main arteries involvement in 16.9 %. PE defects were ubiquitous in 18.5 % of cases. The predominant parenchymal stages were the progressive (24.6 %) and peak (67.7 %). DD levels showed a significant correlation with PE occurrence and extent in pulmonary branches, despite anticoagulant therapies; trend of correlation with pulmonary stages was also noted., Conclusions: PE is a frequent complication in severe COVID-19 patients, particularly during central parenchymal stages and despite ongoing anticoagulant therapy. CTA and DD levels play a crucial role in the assessment of suspected PE, despite anticoagulant therapies, along with proper information about lung involvement extent., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Polysensitization is quite frequent in allergic children and may cause difficulties for the allergist in prescribing allergen-specific immunotherapy. This study aimed at evaluating the clinical effectiveness of 1 year of sublingual immunotherapy (SLIT) in a cohort of Italian allergic children with polysensitization. This open study was performed on 51 polysensitized children (34 boys; mean age, 11.8 years; range, 5.2-17.7 years) with allergic rhinitis and/or mild to moderate asthma. All of them were treated with SLIT for 1 year. The kind and the number of prescribed allergen extracts, the type of diagnosis, the severity of symptoms, and the use of drugs were evaluated at baseline and after 1 year. The adverse events to SLIT were also evaluated. Forty-two children were treated with a single extract, four with two different extracts and three with a mix of allergens. SLIT treatment induced a significant reduction in the number of sensitizations (p = 0.018); significant improvement of allergic rhinitis classification and severity; significant reduction of ocular, nasal, and bronchial symptoms (p < 0.01 for all); and drugs use (p < 0.01 for all drugs). No systemic reactions to SLIT were observed. This open study provides evidence that polysensitization is not an obstacle for prescribing SLIT in polysensitized children. Indeed, SLIT efficacy on clinical parameters is significant after 1 year and the therapy is safe.

Background: The natural history of respiratory allergy is commonly characterized by a worsening of symptom severity, frequent comorbidity of rhinitis and asthma, and polysensitization to aeroallergens. The polysensitization phenomenon starts since childhood and is rare to find monosensitized adult patients. However, there are few studies investigating the characteristics of polysensitized patients., Methods: This study was performed on a large cohort of patients with allergic rhinitis (assessed by ARIA criteria) and/or mild to moderate asthma (assessed by GINA). The kind and the number of sensitizations, their patterns, and the relation with quality of life (QoL) measured by the Juniper's RQLQ guestionnaire, were evaluated., Results: Globally 418 patients (50.2% males, 49.8% females, mean age 26.4 years, range 3.5-65 years, 64 smokers, 371 non-smokers) were enrolled: 220 had allergic rhinitis alone, and 198 allergic rhinitis and asthma. The mean number ofsensitizations was 2.6. Three hundred-five patients (73%) had persistent rhinitis (PER), 220 of them with moderate-severe form. There was no significant derence in rate of rhinitis and asthma in monosensitized or polysensitized patients. Most patients were sensitized to pollens, whereas only 24.2% of them were sensitized to perennial allergens. Polysensitization was significantly associated with some issues of QoL, confirming previous findings, but not with number ofsensitizations., Conclusions: This study provides data confirming for poly-sensitized patients the relevance of ARIA classification of AR. PER is the most common form of AR in this cohort, symptoms are frequently moderate-severe, and asthma is present in about the half of patients with AR.

Few studies have focused on the impact of gastroesophageal reflux disease on general health and on work absenteeism. Our aim was to evaluate the prevalence and severity of symptoms suggestive of gastroesophageal reflux disease in two samples of Italian employees. We interviewed 424 subjects of S. Matteo Hospital staff and 344 subjects of the Military Factory of Pavia regarding the frequency and severity of heartburn and acid regurgitation during the last 12 months. Subjects were specifically asked whether symptoms interfered with the quality of work activities or determined work absenteeism. In all, 91% of eligible subjects responded. The prevalence rate per 100 of any heartburn or regurgitation experienced at least monthly was 21. This value increased to 45% taking into consideration symptoms experienced occasionally. Mild or moderate symptoms were more frequent than severe symptoms (P < 0.001). Only 2.6% of subjects answered that symptoms have a negative influence on the quality of their work. No work absenteeism was recorded. The study confirms that typical gastroesophageal reflux symptoms are common conditions, but mainly of mild or moderate degree.