[Download Italian Movie The Storm
Amancio Mccrae
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Objective: Approximately 5% of patients with coronavirus disease 2019 (COVID-19) develop a life-threatening pneumonia that often occurs in the setting of increased inflammation or "cytokine storm". Anti-cytokine treatments are being evaluated but optimal patient selection remains unclear, and the aim of our study is to address this point.
Methods: Between February 29 to April 6, 2020, 111 consecutive hospitalized patients with COVID-19 pneumonia were evaluated in a single centre retrospective study. Patients were divided in two groups: 42 severe cases (TOCI) with adverse prognostic features including raised CRP and IL-6 levels, who underwent anti-cytokine treatments, mostly tocilizumab, and 69 standard of care patients (SOC).
Results: In the TOCI group, all received anti-viral therapy and 40% also received glucocorticoids. In TOCI, 62% of cases were ventilated and there were three deaths (17.8 10.6 days, mean follow up) with 7/26 cases remaining on ventilators, without improvement, and 17/26 developed bacterial superinfection. One fatality occurred in the 15 TOCI cases treated on noninvasive ventilation and one serious bacterial superinfection. Of the 69 cases in SOC, there was no fatalities and no bacterial complications. The TOCI group had higher baseline CRP and IL-6 elevations (p < 0.0001 for both) and higher neutrophils and lower lymphocyte levels (p = 0.04 and p = 0.001, respectively) with the TOCI ventilated patients having higher markers than non-ventilated TOCI patients.
Conclusion: Higher inflammatory markers, more infections and worse outcomes characterized ventilated TOCI cases compared to ward based TOCI. Despite the confounding factors, this suggests that therapy time in anti-cytokine randomized trials will be key.
An exceptionally strong upper-level storm and low-pressure center has played havoc this week with the weather across large parts of Europe, especially Italy, where high winds, intense thunderstorms, and a landslide caused at least 11 deaths. Most of the fatalities were from falling trees as a powerful squall line ripped across the length of the Italian peninsula on Monday afternoon. One man died in a wind surfing accident off the coast of the Emilia-Romagna district, and a woman near Trento in northern Italy died after a landslide engulfed her home, according to the Associated Press.
Northwest of Rome, a wind gust to 202 km/hr (126 mph) was recorded on the island of Montecristo. This is just shy of the nation's record-high gust of 210 km/hr, according to independent weather researcher Maximiliano Herrera.
In Venice, strong winds blowing onshore from the Mediterranean caused storm surge of up to five feet, which, combined with heavy rainfall, resulted in the worst flooding the city has seen in a decade, with water levels reaching 154cm (61.4 inches).
People make their way on a flooded street in Campi di Bisenzio, in the central Italian Tuscany region, Friday, Nov. 3, 2023. Record-breaking rain provoked floods in a vast swath of Tuscany as storm Ciaran pushed into Italy overnight Friday, trapping people in their homes, inundating hospitals and overturning cars. At least three people were killed, and four were missing. (AP Photo/Gregorio Borgia)
A woman hugs her rescued cat in Campi di Bisenzio, in the central Italian Tuscany region, Friday, Nov. 3, 2023. Record-breaking rain provoked floods in a vast swath of Tuscany as storm Ciaran pushed into Italy overnight Friday, trapping people in their homes, inundating hospitals and overturning cars. At least three people were killed, and four were missing. (AP Photo/Gregorio Borgia)
Firefighters rescue a resident in Campi di Bisenzio, in the central Italian Tuscany region, Friday, Nov. 3, 2023. Record-breaking rain provoked floods in a vast swath of Tuscany as storm Ciaran pushed into Italy overnight Friday, trapping people in their homes, inundating hospitals and overturning cars. At least three people were killed, and four were missing. (AP Photo/Gregorio Borgia)
A man makes is way on a flooded street in Campi di Bisenzio, in the central Italian Tuscany region, Friday, Nov. 3, 2023. Record-breaking rain provoked floods in a vast swath of Tuscany as storm Ciaran pushed into Italy overnight Friday, trapping people in their homes, inundating hospitals and overturning cars. At least three people were killed, and four were missing. (AP Photo/Gregorio Borgia)
French President Emmanuel Macron greets a child as he meets with members of the public during a visit after the storm Ciaran in Daoulas, Brittany, Friday, Nov.3 2023. The storm receded in northern France and the Atlantic coast on Friday, but heavy rains continued in some regions (Yoan Valat, Pool via AP)
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