18 results on '"Sbrana F"'
Search Results
2. MAGLIO study: epideMiological Analysis on invasive meninGococcaL disease in Italy: fOcus on hospitalization from 2015 to 2019.
- Author
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Tascini C, Iantomasi R, Sbrana F, Carrieri C, D'Angela D, Cocchio S, Polistena B, Spandonaro F, Montuori EA, and Baldo V
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- Humans, Infant, Adult, Hospitalization, Patient Discharge, Italy epidemiology, Incidence, Meningococcal Infections epidemiology, Meningococcal Infections therapy, Neisseria meningitidis
- Abstract
This study analyzed hospital admissions for invasive meningococcal disease (IMD) in epidemiological and economic terms in Italy from 2015 to 2019. The volume of acute admissions for meningococcal diagnosis was analyzed in the period from 2015 to 2019. IMD admissions were identified by ICD-9-CM diagnoses. Costs were assessed using current DRG tariffs. In 2019, a total of 237 admissions for meningococcal disease were recorded in Italy. The mean age of patients was 36.1 years. Lumbar puncture was reported in only 14% of hospital discharge forms. From 2015 to 2019, there was a mean annual reduction of - 1.2% nationally for IMD hospitalizations. For 2019, the total costs for acute inpatient admissions were €2,001,093. Considering annual incidence due to IMD, a significant decrease was noted in the age group from 0 to 1 year (p = 0.010) during 2015-2019. For all years, mortality associated with meningeal syndrome was lower compared to septic shock with or without meningitis. From 2015 to 2019, hospitalizations for IMD appear to be decreasing slightly in Italy, even if mortality remains high. Favorable trends in hospitalizations for IMD were seen in the 0-1-year age group, which may be attributable to increased vaccination. Costs of hospitalizations for IMD remain high., (© 2023. The Author(s).)
- Published
- 2023
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3. Daptomycin-based aminoglycoside-sparing therapy for streptococcal endocarditis: a retrospective multicenter study.
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Pallotto C, Sbrana F, Ripoli A, Lupia T, Corcione S, Paciosi F, Francisci D, Pasticci MB, Sozio E, Bertolino G, Carannante N, Rescigno C, Carozza A, Di Caprio G, Taddei E, Murri R, Fantoni M, Emdin M, Aimo A, De Rosa FG, and Tascini C
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- Adult, Aged, Aminoglycosides adverse effects, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents adverse effects, Daptomycin administration & dosage, Daptomycin adverse effects, Drug Therapy, Combination, Endocarditis, Bacterial mortality, Female, Gentamicins administration & dosage, Humans, Italy, Male, Middle Aged, Renal Insufficiency chemically induced, Retrospective Studies, Streptococcal Infections mortality, beta-Lactams administration & dosage, beta-Lactams adverse effects, Anti-Bacterial Agents therapeutic use, Daptomycin therapeutic use, Endocarditis, Bacterial drug therapy, Streptococcal Infections drug therapy, beta-Lactams therapeutic use
- Abstract
Streptococci still represent common etiologic agents of infective endocarditis (IE). Although renal failure is frequently reported as an aminoglycoside-associated adverse event, last international guidelines recommend a beta-lactam/gentamicin combination therapy. We retrospectively evaluated the use of daptomycin-based aminoglycoside-sparing combination therapy for the treatment of streptococcal IE in seven referral hospitals in Italy. Retrospective, multicenter, observational study. All patients with streptococcal IE admitted from 2016 to 2018 were enrolled. Mortality and incidence of acute kidney injury (AKI) were compared between Group A (standard of care, SoC) and Group B (daptomycin-based aminoglycoside-sparing combination therapy). Fifty-four patients were enrolled, 33 in Group A and 21 in Group B. Mortality was 2/33 (6%) in Group A and 0 in Group B ( p = 0.681); AKI incidence was 8/33 (24%) in Group A and 0 in Group B ( p = 0.04). Daptomycin-based aminoglycoside-sparing combination therapy appears to be promising for the treatment of streptococcal endocarditis because of similar efficacy compared with SoC and significantly reduced incidence of AKI.
- Published
- 2021
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4. CORonavirus-19 mild to moderate pneumonia Management with blood Ozonization in patients with Respiratory failure (CORMOR) multicentric prospective randomized clinical trial.
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Sozio E, De Monte A, Sermann G, Bassi F, Sacchet D, Sbrana F, Ripoli A, Curcio F, Fabris M, Marengo S, Italiani D, Luciana Boccalatte-Rosa D, and Tascini C
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- Aged, COVID-19 blood, COVID-19 mortality, COVID-19 physiopathology, Female, Hospital Mortality, Humans, Italy, Length of Stay, Lung virology, Male, Middle Aged, Ozone adverse effects, Ozone blood, Prospective Studies, Respiration, Artificial, Respiratory Insufficiency blood, Respiratory Insufficiency mortality, Respiratory Insufficiency physiopathology, Severity of Illness Index, Time Factors, Treatment Outcome, COVID-19 therapy, Lung physiopathology, Ozone administration & dosage, Respiratory Insufficiency therapy
- Abstract
Background: Following positive experience on the use of blood ozonation in SARS-CoV-2, the CORMOR randomized trial was designed to evaluate the adjuvant role of oxygen/ozone therapy in mild to moderate SARS-CoV-2 pneumonia., Methods: The trial (ClinicalTrial.gov NCT04388514) was conducted in four different Italian centers (April-October 2020). Patients were treated according to best available standard of care (SoC) therapy, with or without O3-autohemotherapy (O3-AHT)., Results: A total of 92 patients were enrolled: SoC + O3-AHT (48 patients) were compared to the SoC treatment (44 patients). The two groups differed in steroids therapy administration (72.7% in SoC arm vs. 50.0% in O3-AHT arm; p = 0.044). Steroid therapy was routinely started when it was subsequently deemed as effective for the treatment of COVID-19 disease. No significant differences in mortality rates, length of hospital stay, mechanical ventilation requirement and ICU admission were observed. Clinical improvement in patients with pneumonia was assessed according to a specifically designed score (decrease in SIMEU class, improvement in radiology imaging, improvement in PaO2/FiO2, reduction in LDH and requirement of oxygen therapy ≤ 5 days). Score assessment was performed on day-3 (T3) and day-7 (TEnd) of O3-AHT treatment. A significant increase in the score was reported at TEnd, in the O3-AHT treatment arm (0 [0-1] in the SoC arm vs. 2 [1-3] the O3-AHT arm; p = 0.018). No adverse events related O3-AHT treatment was observed., Conclusion: In mild-to-moderate pneumonia due to SARS-CoV-2, adjuvant oxygen/ozone therapy did not show any effect on mortality, or mechanical intubation but show a clinical improvement a day 7 from randomization in a composite clinical endpoint. Larger Randomized prospective studies alone or in combination with steroids are needed to confirm our results., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2021
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5. Blood ozonization in patients with mild to moderate COVID-19 pneumonia: a single centre experience.
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Tascini C, Sermann G, Pagotto A, Sozio E, De Carlo C, Giacinta A, Sbrana F, Ripoli A, Castaldo N, Merelli M, Cadeo B, Macor C, and De Monte A
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- Aged, Case-Control Studies, Female, Humans, Italy, Male, Middle Aged, Phenotype, Pneumonia, Viral virology, SARS-CoV-2, COVID-19 blood, COVID-19 therapy, Ozone therapeutic use, Pneumonia, Viral blood, Pneumonia, Viral therapy
- Abstract
The emerging outbreak of the coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread worldwide. We prescribed some promising medication to our patients with mild to moderate pneumonia due to SARS-CoV-2, however such drugs as chloroquine, hydrossichloroquine, azithromycin, antivirals (lopinavir/ritonavir, darunavir/cobicistat) and immunomodulating agents (steroids, tocilizumab) were not confirmed as effective against SARS-CoV2. We, therefore, started to use auto-hemotherapy treated with an oxygen/ozone (O
2 /O3 ) gaseous mixture as adjuvant therapy. In Udine University Hospital (Italy) we performed a case-control study involving hospitalized adult patients with confirmed COVID-19 with mild to moderate pneumonia. Clinical presentations are based upon clinical phenotypes identified by the Italian Society of Emergency and Urgency Medicine (SIMEU-Società Italiana di Medicina di Emergenza-Urgenza) and patients that met criteria of phenotypes 2 to 4 were treated with best available therapy (BAT), with or without O3 -autohemotherapy. 60 patients were enrolled in the study: 30 patients treated with BAT and O2 /O3 mixture, as adjuvant therapy and 30 controls treated with BAT only. In the group treated with O3 -autohemotherapy plus BAT, patients were younger but with more severe clinical phenotypes. A decrease of SIMEU clinical phenotypes was observed (2.70 ± 0.67 vs. 2.35 ± 0.88, p = 0.002) in all patients during hospitalization but this clinical improvement was statistically significant only in O3 -treated patients (2.87 ± 0.78 vs. 2.27 ± 0.83, p < 0.001), differently to the control group (2.53 ± 0.51 vs. 2.43 ± 0.93, p = 0.522). No adverse events were observed associated with the application of O2 /O3 gaseous mixture. O2 /O3 therapy as adjuvant therapy could be useful in mild to moderate pneumonia due to SARS-CoV-2. Randomized prospective study is ongoing [Clinical Trials.gov ID: Z7C2CA5837].- Published
- 2021
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6. Approach to patients with COVID-19 disease: the procedure in Udine.
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Agostinis P, Bontempo G, Della Siega P, Gerussi V, Pagotto A, Barbano E, Mazzoran L, Calci M, Sponza M, Sbrana F, Fapranzi S, Baritussio A, and Tascini C
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- Humans, Italy, SARS-CoV-2, COVID-19
- Abstract
Coronavirus disease 2019 poses a serious threat to public health. The protocol developed at the Azienda Sanitaria Universitaria Friuli Centrale (Italy) is based on clinical data, laboratory tests, chest echography and HRCT. Several therapeutic options are considered, since patients vary in disease severity, evolution and co-morbidities and because so far there are no clear indications about therapeutic strategy based on randomized clinical trial. In this protocol chest echography has a central role in categorizing patient status, follow-up and decision-making.
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- 2021
7. A large Italian cohort on proprotein convertase subtilisin/kexin type 9 inhibitors.
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Sbrana F, Pino BD, Bigazzi F, Ripoli A, Volpi E, Fogliaro MP, Surdo GL, Pianelli M, Luciani R, Biagini S, and Sampietro T
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- Female, Humans, Italy, Male, Middle Aged, Retrospective Studies, Secondary Prevention, Subtilisins antagonists & inhibitors, Antibodies, Monoclonal, Humanized therapeutic use, Anticholesteremic Agents therapeutic use, Cardiovascular Diseases prevention & control, Ezetimibe therapeutic use, PCSK9 Inhibitors
- Published
- 2020
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8. Null receptor homozygous familial hypercholesterolaemia: Quoad valetudinem long life treatment.
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Sampietro T, Sbrana F, Bigazzi F, Ripoli A, and Dal Pino B
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- Anticholesteremic Agents therapeutic use, Blood Component Removal, Child, Humans, Italy, Male, Mutation, Quality of Life, Hyperlipoproteinemia Type II genetics, Hyperlipoproteinemia Type II therapy
- Published
- 2020
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9. Personalized machine learning approach to predict candidemia in medical wards.
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Ripoli A, Sozio E, Sbrana F, Bertolino G, Pallotto C, Cardinali G, Meini S, Pieralli F, Azzini AM, Concia E, Viaggi B, and Tascini C
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- Aged, Aged, 80 and over, Early Diagnosis, Female, Hospitals, Humans, Italy, Male, Middle Aged, Algorithms, Candidemia diagnosis, Diagnostic Techniques and Procedures statistics & numerical data, Machine Learning
- Abstract
Purpose: Candidemia is a highly lethal infection; several scores have been developed to assist the diagnosis process and recently different models have been proposed. Aim of this work was to assess predictive performance of a Random Forest (RF) algorithm for early detection of candidemia in the internal medical wards (IMWs)., Methods: A set of 42 potential predictors was acquired in a sample of 295 patients (male: 142, age: 72 ± 15 years; candidemia: 157/295; bacteremia: 138/295). Using tenfold cross-validation, a RF algorithm was compared with a classic stepwise multivariable logistic regression model; discriminative performance was assessed by C-statistics, sensitivity and specificity, while calibration was evaluated by Hosmer-Lemeshow test., Results: The best tuned RF algorithm demonstrated excellent discrimination (C-statistics = 0.874 ± 0.003, sensitivity = 84.24% ± 0.67%, specificity = 91% ± 2.63%) and calibration (Hosmer-Lemeshow statistics = 12.779 ± 1.369, p = 0.120), markedly greater than the ones guaranteed by the classic stepwise logistic regression (C-statistics = 0.829 ± 0.011, sensitivity = 80.21% ± 1.67%, specificity = 84.81% ± 2.68%; Hosmer-Lemeshow statistics = 38.182 ± 15.983, p < 0.001). In addition, RF suggests a major role of in-hospital antibiotic treatment with microbioma highly impacting antimicrobials (MHIA) that are found as a fundamental risk of candidemia, further enhanced by TPN. When in-hospital MHIA therapy is not performed, PICC is the dominant risk factor for candidemia, again enhanced by TPN. When PICC is not used and MHIA therapy is not performed, the risk of candidemia is minimum, slightly increased by in-hospital antibiotic therapy., Conclusion: RF accurately estimates the risk of candidemia in patients admitted to IMWs. Machine learning technique might help to identify patients at high risk of candidemia, reduce the delay in empirical treatment and improve appropriateness in antifungal prescription.
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- 2020
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10. Procalcitonin, white blood cell count and C-reactive protein as predictors of S. aureus infection and mortality in infective endocarditis.
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Tascini C, Aimo A, Arzilli C, Sbrana F, Ripoli A, Ghiadoni L, Bertone C, Passino C, Attanasio V, Sozio E, Taddei E, Murri R, Fantoni M, Paciosi F, Francisci D, Pasticci MB, Pallotto C, Di Caprio G, Carozza A, Maffei S, and Emdin M
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- Aged, Biomarkers blood, Diagnostic Tests, Routine methods, Female, Hospital Mortality, Humans, Italy epidemiology, Male, Predictive Value of Tests, Prognosis, Risk Assessment, C-Reactive Protein analysis, Endocarditis, Bacterial blood, Endocarditis, Bacterial diagnosis, Endocarditis, Bacterial microbiology, Endocarditis, Bacterial mortality, Leukocyte Count methods, Procalcitonin blood, Staphylococcal Infections blood, Staphylococcal Infections diagnosis, Staphylococcus aureus isolation & purification
- Abstract
Background: Infective endocarditis (IE) is characterized by high rates of in-hospital death, and Staphylococcus aureus infection predicts a worse prognosis. We aimed to assess if admission inflammatory biomarkers (white blood cell - WBC - count, C-reactive protein - CRP, and procalcitonin) are informative on microbiological etiology and short-term outcomes., Methods: Data from 236 patients admitted for IE from January 2013 to June 2018 were retrieved from a multicenter registry., Results: Fifty-two patients (22%) were infected by S. aureus. WBC, CRP and procalcitonin had area under the curve (AUC) values for S. aureus infection of 0.595, 0.675, and 0.727, respectively. Adding procalcitonin to WBC improved discrimination over WBC alone (p = 0.045), and procalcitonin predicted S. aureus infection independently from the other inflammatory biomarkers and patient characteristics. Patients with WBC ≥ 12,800/mm
3 , CRP ≥ 130 mg/L, and procalcitonin ≥ 1.7 ng/mL had an almost 20-fold higher risk of S. aureus infection than patients with all biomarkers < cut-offs. AUC values for in-hospital death were 0.702, 0.725 and 0.727 for the WBC, CRP, and procalcitonin, respectively. Among inflammatory biomarkers, WBC and procalcitonin independently predicted in-hospital death. Procalcitonin refined risk stratification when added to WBC, and to the combination of WBC and CRP. Patients with WBC ≥ 10,535/mm3 , CRP ≥ 85 mg/dL, and procalcitonin ≥ 0.4 ng/mL had a 27-fold higher risk of in-hospital death than patients with all biomarkers < cut-offs., Conclusions: Among patients with IE, high levels of inflammatory biomarkers on admission, particularly procalcitonin, are associated with a higher likelihood of S. aureus infection, and a higher risk of in-hospital mortality., (Copyright © 2019 Elsevier B.V. All rights reserved.)- Published
- 2020
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11. A prediction rule for early recognition of patients with candidemia in Internal Medicine: results from an Italian, multicentric, case-control study.
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Sozio E, Pieralli F, Azzini AM, Tintori G, Demma F, Furneri G, Sbrana F, Bertolino G, Fortunato S, Meini S, Bragantini D, Morettini A, Nozzoli C, Menichetti F, Concia E, and Tascini C
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- Aged, Aged, 80 and over, Candidemia drug therapy, Case-Control Studies, Cross Infection drug therapy, Early Diagnosis, Female, Humans, Italy epidemiology, Male, Middle Aged, Odds Ratio, Prognosis, Reproducibility of Results, Retrospective Studies, Risk Factors, Sensitivity and Specificity, Severity of Illness Index, Candidemia diagnosis, Candidemia epidemiology, Cross Infection diagnosis, Cross Infection epidemiology, Internal Medicine
- Abstract
Purpose: Increasing prevalence of candidemia in Internal Medicine wards (IMWs) has been reported in recent years, but risk factors for candida bloodstream infection in patients admitted to IMW may differ from those known in other settings. The aim of this study was to identify risk factors and define a prediction rule for the early recognition of the risk of candidemia in IMW inpatients., Methods: This was a multicentric, retrospective, observational case-control study on non-neutropenic patients with candidemia admitted to IMWs of four large Italian Hospitals. Each eligible patient with candidemia (case) was matched to a control with bacteremia. Stepwise logistic regression analyses were performed., Results: Overall, 300 patients (150 cases and 150 controls) were enrolled. The following factors were associated with an increased risk of candidemia and weighted to build a score: total parenteral nutrition (OR 2.45, p = 0.008; 1 point); central venous catheter (OR 2.19, p = 0.031; 1 point); peripherally inserted central catheter (OR 5.63, p < 0.0001; 3 points), antibiotic treatment prior (OR 2.06; p = 0.059; 1 point) and during hospitalization (OR2.38, p = 0.033; 1 point); neurological disability (OR 2.25, p = 0.01; 1 point); and previous hospitalization within 3 months (OR 1.56, p = 0.163; 1 point). At ROC curve analysis, a final score ≥ 4 showed 84% sensitivity, 76% specificity, and 80% accuracy in predicting the risk of candidemia., Conclusions: The proposed scoring system showed to be a simple and highly performing tool in distinguishing bloodstream infections due to Candida and bacteria in patients admitted to IMW. The proposed rule might help to reduce delay in empirical treatment and improve appropriateness in antifungal prescription in septic patients.
- Published
- 2018
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12. Impact of infectious diseases consultation as a part of an antifungal stewardship programme on candidemia outcome in an Italian tertiary-care, University hospital.
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Menichetti F, Bertolino G, Sozio E, Carmignani C, Rosselli Del Turco E, Tagliaferri E, Sbrana F, Ripoli A, Barnini S, Desideri I, Dal Canto L, and Tascini C
- Subjects
- Aged, Antimicrobial Stewardship methods, Candida drug effects, Female, Fluconazole therapeutic use, Hospitals, University, Humans, Italy, Male, Referral and Consultation, Retrospective Studies, Antifungal Agents therapeutic use, Candidemia drug therapy, Communicable Diseases drug therapy
- Abstract
Candidemia is a major cause of in-hospital mortality. Antifungal stewardship programme (AFSP) providing infectious diseases consultation (IDC) might improve the outcome. We evaluate the impact on candidemia mortality of IDC as part of AFSP restricting the use of all antifungals with exception of fluconazole. We retrospectively reviewed the charts of patients with documented candidemia in our hospital during the period 2012-2014 evaluating the impact of several variables on 30-days in-hospital mortality. We reviewed data on 276 patients with documented candidemia: 200 (72%) were treated without IDC and 76 (28%) with IDC. In the group without IDC, 52 patients (26%) received no antifungal therapy. Antifungals used for treating candidemia were (no IDC/IDC): azoles (74%/42%); echinocandins (0%/46%); liposomal and lipidic complex amphotericin B (0%/12%). The 30-day in-hospital mortality was respectively (no IDC/IDC) 37% vs. 20% (p = 0.011). The multivariate analysis confirmed IDC as independent factor protecting from death (OR 0.511, 95% CI 0.251-0.994; p = 0.046), together with fungemia due to non-albicans Candida (OR 0.565, 95% CI 0.327-0.977; p = 0.042). Age >65 years was associated with a higher risk of death (OR 1.989, 95% CI 1.055-3.895; p = 0.038). The additional cost for the use of echinocandins driven by IDC in the study period was €207,000. IDC, as a part of a restrictive front-end antimicrobial stewardship programme (ASP), providing a timely right choice of antifungal therapy, increases the cost of antifungal drugs but might be a contributing protective factor from mortality due to candidemia. Efforts to increase the number of IDC in patients with candidemia seems to be warranted.
- Published
- 2018
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13. Independent risk factors for mortality in critically ill patients with candidemia on Italian Internal Medicine Wards.
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Sbrana F, Sozio E, Bassetti M, Ripoli A, Pieralli F, Azzini AM, Morettini A, Nozzoli C, Merelli M, Rizzardo S, Bertolino G, Carrara D, Scarparo C, Concia E, Menichetti F, and Tascini C
- Subjects
- Aged, Aged, 80 and over, Candida drug effects, Candida pathogenicity, Candidemia epidemiology, Chi-Square Distribution, Cohort Studies, Critical Illness epidemiology, Female, Humans, Internal Medicine statistics & numerical data, Internal Medicine trends, Italy epidemiology, Logistic Models, Male, Middle Aged, Multivariate Analysis, Retrospective Studies, Risk Factors, Statistics, Nonparametric, Candidemia mortality, Critical Illness therapy
- Abstract
Candida is an increasing cause of bloodstream infection and is associated with significant morbidity and mortality. The aim of our study is to analyze risk factors for short-term mortality in patients with bloodstream Candida spp. infections admitted to Internal Medicine Wards (IMWs). This was a retrospective case-control study between January 2012 and December 2014 from four University Hospitals in Italy, where patients with candidemia dying within 30 days from diagnosis were matched to control cases with candidemia who survived in the same period of time. Two-hundred and fifty cases of candidemia were registered during the 36 months of enrollment. Among these, 112 patients died (45%) within 30 days from the first blood culture's positivity for Candida spp. At multivariate analysis, septic shock [odds ratio (95% CI) = 2.919 (1.62-5.35), p < 0.001] and concomitant chronic kidney failure [odds ratio (95% CI) = 2.296 (1.07-5.12), p = 0.036] were independent predictors of mortality. Low-dose chronic steroid therapy was protective [odds ratio (95% CI) = 0.461 (0.25-0.83), p = 0.011).
- Published
- 2018
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14. The role of biofilm forming on mortality in patients with candidemia: a study derived from real world data.
- Author
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Tascini C, Sozio E, Corte L, Sbrana F, Scarparo C, Ripoli A, Bertolino G, Merelli M, Tagliaferri E, Corcione A, Bassetti M, Cardinali G, and Menichetti F
- Subjects
- Aged, Aged, 80 and over, Antifungal Agents therapeutic use, Bayes Theorem, Candida isolation & purification, Candidemia diagnosis, Candidemia drug therapy, Female, Hospitals, University, Humans, Italy, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Risk Factors, Biofilms growth & development, Candida physiology, Candidemia microbiology, Candidemia mortality
- Abstract
Background: Evaluation of the role on patient mortality exerted by biofilm forming (BF) Candida strains, by using predictive clinical data., Methods: Eighty-nine strains isolated from Candida bloodstream infection, occurring in two Italian University Hospitals, were employed in this study. A random forest (RF) model was built with a procedure of iterative selection of the risk factors potentially able to predict the probability of death. The similarity between patient conditions and Bayesian clustering was calculated in order to evaluate the role of predictors in the stratification of the death risk., Results: Three different groups of patients with different probability of death were obtained with a RF approach: Group 1 (mortality in 33.3% of cases), Group 2 (death in 50% of cases), and Group 3 (mortality in 76.9% of cases). The comparison between these three groups showed that BF correlated well with increased mortality in patients, admitted for medical diagnosis, with high APACHE II score and treated with azoles. Early treatment within 24 h between candidemia diagnosis and the beginning of antifungal therapy was associated with the lowest of BF rate and mortality., Conclusions: BF by Candida spp. seems to be clinically associated with increased mortality especially in medical patients with higher Apache II score or treated with azoles.
- Published
- 2018
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15. Peripherally inserted central catheter as a predominant risk factor for candidemia in critically ill patients in Internal Medicine wards in Italy.
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Tascini C, Sozio E, Tintori G, Ripoli A, Sbrana F, Rosselli Del Turco E, Bertolino G, Fortunato S, Carmassi F, Cardinali G, and Menichetti F
- Subjects
- Aged, Aged, 80 and over, Antifungal Agents therapeutic use, Candidemia drug therapy, Candidemia epidemiology, Catheter-Related Infections drug therapy, Critical Illness, Hospital Mortality, Humans, Incidence, Internal Medicine, Italy, Middle Aged, Patients' Rooms, Risk Factors, Candidemia etiology, Catheter-Related Infections epidemiology, Catheterization, Central Venous adverse effects, Catheterization, Peripheral adverse effects
- Published
- 2015
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16. The incidence of cardiovascular events is largely reduced in patients with maximally tolerated drug therapy and lipoprotein apheresis. A single-center experience.
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Sampietro T, Sbrana F, Bigazzi F, Ripoli A, Dal Pino B, Pasanisi EM, Petersen C, Coceani M, Luciani R, and Pianelli M
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- Aged, Biomarkers blood, Blood Component Removal adverse effects, Cardiovascular Diseases diagnosis, Cardiovascular Diseases epidemiology, Dextran Sulfate therapeutic use, Female, Heparin therapeutic use, Humans, Hyperlipoproteinemias blood, Hyperlipoproteinemias diagnosis, Hyperlipoproteinemias epidemiology, Hypolipidemic Agents adverse effects, Incidence, Italy epidemiology, Male, Middle Aged, Risk Factors, Time Factors, Treatment Outcome, Blood Component Removal methods, Cardiovascular Diseases prevention & control, Hyperlipoproteinemias therapy, Hypolipidemic Agents therapeutic use, Lipoproteins blood
- Abstract
Aim: Lipoprotein apheresis (LA) is the elective therapy for homozygous and other forms of familial hypercholesterolemia (FH) and familial combined hypercholesterolemia (FCH), resistant/intolerant to lipid lowering drugs, and hyperlipoproteinemia(a) for which drugs are not available. To assess the effect of LA on the incidence of adverse cardiac or vascular events (ACVE) at the time period of pre-initiation of apheresis and during the LA treatment., Methods: We collected data of 30 patients (mean age 62 ± 8 years, males 73%), with FH, or FCH and cardiovascular disease on maximally tolerated lipid lowering therapy and LA treatment (median 5 years, interquartile range 3-8 years). Associated hyperlipoproteinemia(a) was present in 16/30 subjects. The LA treatment was performed biweekly as clinically indicated by dextran-sulfate or heparin-induced LDL precipitation apheresis. The ACVE incidence, before and after treatment, was evaluated by statistical analyses., Results: The ACVE incidence occurred before and after the LA treatment inception, were 86 and 15 events respectively. Notably, 6/15 of ACVE were secondary to stent restenosis and 7/15 follow-up events occurred during the first 5 years. The AVCE rates/year were 0.58 and 0.13 respectively (p < 0.001)., Conclusions: Our data confirm long-term efficacy and positive impact of LA on morbidity in patients with FH and FCH and atherosclerotic disease at maximally tolerated lipid lowering therapy., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
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- 2015
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17. Syndromic craniosynostosis in a modern-age skeleton from Siena, Italy.
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Giuffra V, Sbrana F, Caramella D, Giustini D, Tixier B, and Fornaciari G
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- Adult, Archaeology, Female, Humans, Italy, Craniofacial Dysostosis diagnosis, Skull abnormalities
- Abstract
The skeleton of a female adult found in archaeological excavations carried out in Siena (central Italy) and dated back to the modern age showed a severe skull malformation due to the premature bilateral closure of the coronal suture, which determined a deformed brachycephalic skull. This craniosynostosis was associated with other malformations, such as shallow orbits, hypertelorism, mandibular prognathism, and consequent malocclusion, but there was absence of anomalies in the remaining bones of the extremities. These features did not seem to be related to an isolated condition but to a more complex genetic syndrome, suggesting a possible case of Crouzon syndrome. Besides representing a rare finding in archaeological material, the present case provides the opportunity to observe in an adult subject lesions typical of this congenital disorder, which is at present surgically corrected in infantile age.
- Published
- 2011
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18. Robotics in general surgery: personal experience in a large community hospital.
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Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, and Caravaglios G
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- Adolescent, Adult, Aged, Aged, 80 and over, Female, Hospitals, Community, Humans, Italy, Male, Middle Aged, Retrospective Studies, Minimally Invasive Surgical Procedures instrumentation, Outcome Assessment, Health Care, Robotics instrumentation
- Abstract
Hypothesis: Robotic technology is the most advanced development of minimally invasive surgery, but there are still some unresolved issues concerning its use in a clinical setting., Design: The study describes the clinical experience of the Department of General Surgery, Misericordia Hospital, Grosseto, Italy, in robot-assisted surgery using the da Vinci Surgical System., Results: Between October 2000 and November 2002, 193 patients underwent a minimally invasive robotic procedure (74 men and 119 women; mean age, 55.9 years [range, 16-91 years]). A total of 207 robotic surgical operations, including abdominal, thoracic and vascular procedures, were performed; 179 were single procedures, and 14 were double (2 operations on the same patient). There were 4 conversions to open surgery and 3 to conventional laparoscopy (conversion rate, 3.6%; 7 of 193 patients). The perioperative morbidity rate was 9.3% (18 of 193 patients), and 6 patients (3.1%) required a reoperation. The postoperative mortality rate was 1.5% (3 of 193 patients)., Conclusions: Our preliminary experience at a large community hospital suggests that robotic surgery is feasible in a clinical setting. Its daily use is safe and easily managed, and it expands the applications of minimally invasive surgery. However, the best indications still have to be defined, and the cost-benefit ratio must be evaluated. This report could serve as a basis for a future prospective, randomized trial.
- Published
- 2003
- Full Text
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