Sarcoidosis is a chronic inflammatory disease of unknown etiology characterized by multi-organ involvement. Endorgan disease consists of granulomatous inflammation, which if left untreated or not resolved spontaneously, leads to permanent fibrosis and end-organ dysfunction. Cardiac involvement and fibrosis in sarcoidosis occur in 5-10% of cases and is becoming increasingly diagnosed. This is due to increased clinical awareness among clinicians and new diagnostic modalities, since magnetic resonance imaging and positron-emission tomography are emerging as "gold standard'' tools replacing endomyocardial biopsy. Despite this progress, isolated cardiac sarcoidosis is difficult to differentiate from other causes of arrhythmogenic cardiomyopathy. Cardiac fibrosis leads to congestive heart failure, arrhythmias and sudden cardiac death. Immunosuppressives (mostly corticosteroids) are used for the treatment of cardiac sarcoidosis. Implantable devices like a cardioverter-defibrillator may be warranted in order to prevent sudden cardiac death. In this article current trends in the pathophysiology, diagnosis and management of cardiac sarcoidosis will be reviewed focusing on published research and latest guidelines. Lastly, a management algorithm is proposed.

BackgroundData regarding the prognostic significance of pleural effusion (PE) are scarce.ObjectiveExplore the impact of PE on mortality among hospitalized patients.MethodsMulticenter prospective observational study. Patients that underwent computed tomography (thorax and/or abdomen) and in which PE was detected, were admitted to the study. PE was classified by size on CT, anatomical distribution, diagnosis, and Light's criteria. Charlson comorbidity index (CCI), APACHE II, and SOFA score were calculated. Mortality at 1 month and 1 year were recorded.ResultsFive hundred and eight subjects, mean age 78 years. Overall mortality was 22.6% at 1 month and 49.4% at 1 year. Bilateral effusions were associated with higher mortality than unilateral effusions at 1 month (32 vs. 13.3%, p = 0.005) and large effusions with higher mortality than small effusions at 1 year (66.6 vs. 43.3%, p < 0.01). On multivariate analysis age, CCI, APACHE II, SOFA score, and bilateral distribution were associated with short-term mortality, while long-term significant predictors were CCI, APACHE II, SOFA, and malignant etiology. Exudates (excluding MPE) exhibited a survival benefit at both 1 month and 1 year but due to the smaller sample, fluid characteristics were not included in the multivariate analysis.ConclusionsPleural effusion is a marker of advanced disease. Mortality is higher within the first month in patients with PEs related to organ failure, while patients with MPE have the worst long-term outcome. Independent predictors of mortality, apart from CCI, APACHE II, and SOFA scores, are age and bilateral distribution in the short-term, and malignancy in the long-term.

Purpose Tocilizumab is associated with positive outcomes in severe Covid-19. We wanted to describe the characteristics of non-responders to treatment. Methods Retrospective multi-center study in two respiratory departments, investigating adverse outcomes at 90 days from diagnosis in subjects treated with tocilizumab (8mg/kg intravenously single dose) for severe progressive covid-19. Results 121 subjects, 62% males, 9% fully vaccinated. 96 (79.4%) survived and 25 died (20.6%). Compared to survivors (S), non-survivors (NS) were older (median 57 versus 75 years of age), had more comorbidities (charlson comorbidity index 2 versus 5) and higher rates of intubation/mechanical ventilation (p < 0,05). On admission, NS had lower PO2/FiO2 ratio, higher blood ferritin and higher troponin and on clinical progression (day of tocilizumab treatment) had lower PO2/FiO2 ratio, decreased lymphocytes, increased neutrophil to lymphocyte ratio, increased ferritin and lactate dehydrogenase (LDH), disease located centrally on computed tomography scan and increased late c-reactive protein. Cox proportional hazards regression analysis identified age and LDH on deterioration as predictors of death; admission PO2/FiO2 ratio and LDH as predictors of intubation; PO2/FiO2 ratios, LDH and central lung disease on radiology as predictors of non-invasive ventilation (NIV) (a < 0,05). Log-rank test of mortality yielded the same results (p < 0,001). ROC analysis of above predictors in a separate validation cohort yielded significant results. Conclusion Older age and high serum LDH on deterioration are predictors of mortality in tocilizumab treated severe covid-19. Hypoxia levels, LDH and central pulmonary involvement radiologically are associated with intubation and NIV.

Amiodarone, a common anti-arrhythmic drug, is well known for its pulmonary toxicity [...]

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