All over the world, SARS-CoV-2 pneumonia is causing a significant short and medium-term morbidity and mortality, with reported persisting symptoms, radiological and lung alterations up to 6 months after symptoms onset. Nevertheless, the 1-year impact on affected patients is still poorly known. In this prospective observational study, 39 patients with SARS-CoV-2 pneumonia were recruited from a single COVID-19 hospital in Southern Switzerland. They underwent a 3-month and 1-year follow-ups. At 1 year, 38 patients underwent functional follow-up through lung function tests and six minutes walking test and submitted SF-12 and SGRQ questionnaires about health-related quality of life. At 1 year most of the patients showed a persistence of the radiological and functional abnormalities and a reduction of the health-related quality of life. Thirty patients (96.8%) still presented some residual abnormalities on CT scans (31 patients at 3 months), though with a general reduction of the lesional load in all lung lobes. Twenty patients (52.6%) had persisting lung function tests impairment, with an overall improvement of DLCO. As concerning the functional status, lowest SpO2 during 6MWT increased significantly. Finally, 19 patients (50%) reported a pathological St. George’s Respiratory Questionnaire, and respectively 12 (31.6%) and 11 (28.9%) patients a pathological Short Form Survey-12 in physical and mental components. At 1-year follow-up SARS-CoV-2 pneumonia survivors still present a substantial impairment in radiological and functional findings and in health-related quality of life, despite showing a progressive recovery.

Background: All over the world, SARS-CoV-2 pneumonia is causing a significant short-term morbidity and mortality, but the medium-term impact on lung function and quality of life of affected patients are still unknown. Methods: In this prospective observational study, 39 patients with SARS-CoV-2 pneumonia were recruited from a single COVID-19 hospital in Southern Switzerland. At three months patients underwent radiological and functional follow-up through CT scan, lung function tests, and 6 min walking test. Furthermore, quality of life was assessed through self-reported questionnaires. Results: Among 39 patients with SARS-CoV-2 pneumonia, 32 (82% of all participants) presented abnormalities in CT scan and 25 (64.1%) had lung function tests impairment at three months. Moreover, 31 patients (79.5%) reported a perception of poor health due to respiratory symptoms and all 39 patients showed an overall decreased quality of life. Conclusions: Medium-term follow up at three months of patients diagnosed with SARS-CoV-2 pneumonia shows the persistence of abnormalities in CT scans, a significant functional impairment assessed by lung function tests and a decreased quality of life in affected patients. Further studies evaluating the long-term impact are warranted to guarantee an appropriate follow-up to patients recovering from SARS-CoV-2 pneumonia.

Background: Validated risk prediction scores for incident heart failure (HF) in patients with atrial fibrillation are lacking. We aimed to externally validate the the HF prediction risk score derived from three large control randomized trials RE‐LY, AVERROES, and ACTIVE‐A (REACT‐HF) score and assess potential improvements by incorporating biomarkers. Methods: We included 2599 patients with atrial fibrillation without prior HF from the Swiss‐AF (Swiss Atrial Fibrillation) and BEAT‐AF (Basel Atrial Fibrillation) cohorts. We estimated the C statistics of the REACT‐HF score with Cox proportional hazards models and improved prediction by adding hs‐CRP (high‐sensitivity C‐reactive protein), NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), and high‐sensitivity troponin T. The primary outcome was incident HF hospitalization within 2 years. Secondary outcomes included cardiovascular death, a composite of incident HF hospitalization and cardiovascular death, and all‐cause death. Results: The mean age was 70.2±10.3 years, 29.1% were women, and 54.8% had paroxysmal atrial fibrillation. Across risk score quintiles, the incidence rates per 100 patient‐years increased for the primary outcome (0.27, 0.54, 1.00, 2.24, 5.49), cardiovascular death (0.00, 0.11, 0.10, 0.91, 2.01), the composite of cardiovascular death and first HF hospitalization (0.27, 0.65, 1.10, 3.09, 6.86), and all‐cause death (0.00, 0.65, 0.40, 1.56, 4.10). The estimated C statistic (95% CI) for the primary outcome was 0.76 (0.72–0.81). C statistics for the secondary outcomes were consistent. The biomarker‐enhanced model, including hs‐CRP and NT‐proBNP, improved the C statistic to 0.84 (0.80–0.87). Conclusions: In this external validation, the REACT‐HF risk score demonstrated good discrimination for predicting the first HF hospitalization within 2 years of follow‐up. The addition of NT‐proBNP and hs‐CRP further improved the score. The REACT‐HF score may help identify patients with atrial fibrillation at risk for HF, aiding in preventive therapy.

Background: Up to 50% of cases of Shiga-toxin-producingEscherichia colihemolytic uremic syndrome occur in adults, and the clinical presentation is variable. Microbiological analyses must be performed in all patients with thrombotic microangiopathy to identify Shiga-toxin-producingEscherichia coli, even in the absence of diarrhea.Case presentation: A 79-year-old Caucasian woman was admitted to hospital because of severe proctitis. In the following days, the patient’s level of consciousness declined, and she developed acute kidney injury, thrombocytopenia, and hemolytic anemia. Shiga-toxin-producingEscherichia coliwas found in fecal cultures, suggesting the diagnosis of hemolytic uremic syndrome. In the following days, her clinical conditions improved, but thrombocytopenia worsened, and the patient developed posterior tibial vein thrombosis. The discordant evolution of thrombocytopenia compared with other clinical and laboratory parameters prompted a new evaluation of its causes. Diagnosis of heparin-induced thrombocytopenia was confirmed by heparin-induced platelet aggregation assay and positive antibodies to platelet factor 4.Conclusions: A discordant evolution of platelet count in patients with thrombotic microangiopathy requires a systematic reevaluation of the thrombocytopenia.

Aims: Patients with atrial fibrillation (AF) are at a high risk of adverse cardiovascular outcomes. Little is known about the specific population of AF patients with implanted pacemaker (PM) and their prognosis. Therefore, we aimed to compare the risks of adverse outcomes in AF patients with and without PM. Methods and results: Data from two Swiss prospective, multicentre cohort studies (Swiss-AF, Beat-AF) (n = 3675) with yearly follow-ups (FUs) up to 8 years were analysed. The first main outcome was major adverse cardiovascular events (MACE), a composite of stroke or transient ischaemic attack, myocardial infarction, cardiovascular death, and systemic embolism. The second main outcome was hospitalization for heart failure (HF). Secondary outcomes were the individual components of MACE. We performed time-updated Cox regression analyses to investigate the association of PM and outcomes. Median age was 71.4 years, 28.8% female, 445 (12.1%) patients had a PM at baseline, and 238 additional patients (7.4%, 1.05%/year) received a PM over a median FU of 7 years. Patients with a PM had higher incidence rates for MACE and HF (5.97 and 5.08 per 100 patient-years, respectively), compared to patients without a PM (3.37 and 2.61 per 100 patient-years, respectively). After multivariable adjustment, we found no independent association of PM and MACE (aHR [95% CI] 1.12 [0.95–1.33; P = 0.183]) or HF (aHR [95% CI] 1.14 [0.94–1.37; P = 0.180]). We found consistent results for the individual components of MACE. Conclusion: Patients with AF and a PM experienced an increased rate of adverse cardiovascular outcomes. However, the PM itself was not independently associated with these outcomes.