Qualitative serology in patients recovered from SARS CoV 2 infection Lee YL et al. in this journal recently reports the Dynamics of anti-SARS-Cov-2 IgM and IgG antibodies among COVID-19 patients. 1 In this study authors performed an anti-SARS-CoV-2 IgG/IgM test on 14 confirmed COVID-19 patients and 28 negative controls. Antibody response varied with different clinical manifestations and disease severity. and development of anti-SARS-CoV-2 IgM antibodies had a shorter duration of positive RT-PCR result and no worsening clinical conditions compared to those without the presence of anti-SARS-CoV-2 IgM antibodies. Previous studies have evaluated the possible role of a quick detection approach targeting viral IgM or IgG antibody using different methods. Results have been conflicting with respect to the sensitivity of this approach. Thus, antibody determination is not advocate for SARS-CoV 2 infection diagnosis. 2-4 The knowledge of antibody's significance and frequency in patients cured of SARS CoV 2 is extremely limited. We aimed to evaluate the frequency of antibodies generated against SARS CoV 2 in patients cured of the infection. We performed the Biozec COVID-19 IgM/IgG Rapid Test lateral flow immunoassay (LFIA) in 66 consecutive patients in a real-life study performed in a hospital partially devoted to COVID 19 infection. Patients with COVID-19 disease, which diagnosis was based on clinical evaluation and positive RT-PCR SARS Cov 2 identification, have been prospectively followed-up. Patients in the recovery phase of infection, after the resolution of symptoms and a negative result for the first RT-PCR test, performed the second RT-PCR determination at least 24 h afterward as well as a serologic qualitative determination of IgM / IgG to SARS CoV2. Biozec COVID-19 IgM/IgG was performed according to the manufacturer's instructions. Patients were informed that the serological test results would not influence any clinical decisions about their specific case and gave oral informed consent. We have evaluated 66 patients with confirmed SARS Cov 2 infection. The median age was 59.5 years (44-70). Thirty-two patients were women. The overall median time of symptoms was 7 days. 6-9 Thirty-seven patients had mild disease, 26 had moderate disease, and 3 severe disease. The mean neutrophils count upon diagnosis was 3690 × 109 (2470-5082) and lymphocytes count was 1040 × 109 IQR (852-1335). The median CPR upon diagnosis was 2.7 mg/dl (1.26-8.7). In our sample, 21 patients had a previous history of hypertension, and 8 had Diabetes Mellitus. Thirty-eight have been treated with hydroxychloroquine, 37 with azithromycin and in 10 patients a five-day course of methylprednisolone was used.

Aims A decrease in carbohydrate antigen 125 (CA-125) predicts survival advantage in chronic heart failure (HF); the impact of its variation in acute HF is unknown. We studied the association of CA-125 decrease with prognosis in acute HF. Methods and resultsWe studied acute hospitalized HF patients. Predictors of admission and discharge CA-125 were determined by linear regression. Follow-up was 1 year; endpoint was all-cause death. The association of admission and discharge CA-125 with mortality was assessed using a Cox-regression analysis. A Cox-regression analysis was also used to assess the prognostic impact of CA-125 decrease during hospitalization. Analysis was stratified by length of hospital stay (LOS). We studied 363 patients, 51.5% male, mean age 75 ± 12 years, 51.5% ischaemic, 30.0% with preserved ejection fraction, and 57.3% with reduced ejection fraction; patients presented elevated comorbidity burden. Median LOS was 7 (5-11) days. In the subgroup of 262 patients with CA-125 measured both at admission and at discharge, we reported a significant increase in its levels: 56.0 (26.0-160.7) U/mL to 74.0 (32.3-195.0) U/mL. Independent predictors of admission CA-125 were higher BNP and lower creatinine. Predictors of discharge CA-125 were higher discharge BNP, lower discharge albumin, and younger age. Both admission and discharge CA-125 predicted mortality. During follow-up, 75 (31.8%) patients died. A decrease in CA-125 predicted a 68% reduction in the 1 year death risk only in patients with LOS > 10 days. Conclusions Our results suggest that an early re-evaluation (>10 days) with CA-125 measurement after an acute HF hospitalization may be of interest in patient management.

HighlightsDieulafoy lesion of the gallbladder is a very rare cause of hemobilia.Hemobilia should be considered as a cause of acute pancreatitis.Intraoperative cholangiogram is effective in flushing small biliary clots.

O surgimento do vírus da síndrome respiratória aguda grave – coronavírus 2, responsável pela doença COVID-19, conduziu a um rápido desenvolvimento de métodos moleculares e serológicos para o seu diagnóstico. Apesar de o teste molecular de amostras do trato respiratório ser o teste de diagnóstico standard, verifica-se um interesse crescente pelo uso de exames serológicos, mas existe, ainda, evidência limitada sobre os mesmos. Os autores apresentam dois casos clínicos em que traduzem algumas das vantagens da utilização do teste serológico como complementar no diagnóstico da infeção pelo vírus da síndrome respiratória aguda grave – coronavírus 2, nomeadamente nos casos ativos de COVID-19, que apresentam teste molecular inicial negativo.

Doente de 57 anos, professor, ex grande fumador de 40 UMA, adenocarcinoma pulmonar, dezembro de 2018, estadio IIIB (TTF1 +; expressão de PD-L1 negativa; NGS - tissue lung custum - sem qualquer mutação ou translocação ECOG1; terapêutica combinada, de quimioterapia/radioterapia, janeiro/19, progressão para estadio IV, 2 linhas sucessivas de quimioterapia (carboplatinum/pemetrexed) e imunoterapia (atezolizumab) com progressão em fevereiro/20.