26 results on '"Biamonte, E."'
Search Results
2. Impact of age on postsurgical outcomes of nonfunctioning pituitary adenomas
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Biamonte, E., Betella, N., Milani, D., Lasio, G. B., Ariano, S., Radice, S., Lavezzi, E., Mazziotti, G., and Lania, A.
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- 2021
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3. Severe myocarditis due to influenza A(H1N1)pdm09 viral infection in a young woman successfully treated with intravenous zanamivir: A case report
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Mazzitelli, M., Garofalo, E., Bruni, A., Barreca, G. S., Quirino, A., Giancotti, A., Serapide, F., Indolfi, C., Matera, G., Navalesi, P., Trecarichi, E. M., Torti, C., Longhini, F., Peronace, C., Pisani, V., Costa, C., Greco, G., La Gamba, V., Scaglione, V., Biamonte, E., Brescia, V., De Leonardis, B., Karim, A., Cimino, G., La Torre, P., Gemelli, A., Tropea, F. A., Picicco, F., and Gallo, L.
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Drug ,intravenous zanamivir ,medicine.medical_specialty ,Oseltamivir ,Myocarditis ,viruses ,media_common.quotation_subject ,lcsh:Medicine ,Case Report ,Case Reports ,030204 cardiovascular system & hematology ,Viral infection ,Gastroenterology ,influenza A(H1N1)pdm09 virus ,Intestinal malabsorption ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Zanamivir ,Internal medicine ,myocarditis ,medicine ,In patient ,media_common ,lcsh:R5-920 ,business.industry ,lcsh:R ,food and beverages ,virus diseases ,Influenza a ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,medicine.disease ,respiratory tract diseases ,chemistry ,030220 oncology & carcinogenesis ,lcsh:Medicine (General) ,business ,medicine.drug - Abstract
In patients with influenza‐related myocarditis, prompt diagnosis and treatment are important. Intravenous zanamivir can be an alternative to oral oseltamivir, especially in severe cases and when drug intestinal malabsorption is suspected or proven.
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- 2019
4. Clinical outcomes of patients treated with intravenous zanamivir for severe influenza A(H1N1)pdm09 infection: A case report series
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Torti, C., Mazzitelli, M., Longhini, F., Garofalo, E., Bruni, A., Giancotti, A., Barreca, G. S., Quirino, A., Liberto, M. C., Serapide, F., Matera, G., Trecarichi, E. M., Navalesi, P., Pisani, V., Costa, C., Greco, G., Scaglione, V., Lionello, R., La Gamba, V., Biamonte, E., La Valle, O., Cimino, G., La Torre, P., Karim, A., and Gemelli, A.
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0301 basic medicine ,medicine.medical_specialty ,medicine.medical_treatment ,030106 microbiology ,Case Report ,Severe influenza ,Antiviral Agents ,law.invention ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,Influenza A Virus, H1N1 Subtype ,0302 clinical medicine ,Zanamivir ,Medical microbiology ,Randomized controlled trial ,law ,Internal medicine ,Influenza, Human ,ECMO ,ICU ,Influenza A(H1N1)pdm09 ,Humans ,medicine ,Extracorporeal membrane oxygenation ,Influenza A Virus ,lcsh:RC109-216 ,H1N1 Subtype ,030212 general & internal medicine ,Mechanical ventilation ,business.industry ,virus diseases ,Intensive care unit ,Influenza ,respiratory tract diseases ,Infectious Diseases ,Concomitant ,business ,medicine.drug ,Human - Abstract
Background Intravenous (IV) zanamivir could be a suitable alternative for the treatment of severe influenza A(H1N1)pdm09 infection in patients who are unable to take oral or inhaled medication, for example, those on mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, data on the clinical outcomes of such patients is limited. Case presentation We report the clinical outcomes of four patients who were admitted at the intensive care unit during the 2017–2018 influenza season with severe sepsis (SOFA score > 11) and acute respiratory distress syndrome requiring ECMO and mechanical ventilation. Two patients were immune-compromised. The A(H1N1)pdm09 genome was confirmed by polymerase chain reaction (PCR) on nasopharyngeal specimen swabs prior to administration of IV zanamivir at a dose of 600 mg twice daily. Weekly qualitative PCR analysis was done to monitor viral clearance, with zanamivir treatment being discontinued upon receipt of negative results. In addition, the patients were managed for concomitant multidrug-resistant bacterial infections, with infection resolution confirmed with blood cultures. The median time for zanamivir treatment was 10 days (IQR 10–17). The clinical outcome was favourable with all four patients surviving and improving clinically. All four patients achieved viral clearance of A(H1N1)pdm09 genome, and resolution of multidrug-resistant bacterial infections. Conclusions IV zanamivir could be a good therapeutic option in patients with severe influenza A(H1N1)pdm09 infection who are unable to take oral or aerosolised antiviral medication. We recommend prospective randomized control trials to support this hypothesis.
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- 2019
5. Pressure support ventilation + sigh in acute hypoxemic respiratory failure patients: study protocol for a pilot randomized controlled trial, the PROTECTION trial
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Mauri, T, Foti, G, Fornari, C, Constantin, J, Guerin, C, Pelosi, P, Ranieri, M, Conti, S, Tubiolo, D, Rondelli, E, Lovisari, F, Fossali, T, Spadaro, S, Grieco, D, Navalesi, P, Calamai, I, Becher, T, Roca, O, Wang, Y, Knafelj, R, Cortegiani, A, Mancebo, J, Brochard, L, Pesenti, A, Grasselli, G, Spinelli, E, Abbruzzese, C, Rona, R, Bronco, A, Villa, S, Gianni, S, Papoff, A, Pinciroli, R, Colombo, R, Sproccati, C, Mandelli, P, Villa, F, Patroniti, N, Brunetti, I, Ball, L, Volta, C, Lazzeri, M, Maragoni, E, Eleuteri, D, Bello, G, Dell'Anna, A, Garofalo, E, Bruni, A, Biamonte, E, D'Andrea, R, Querci, L, Pierucci, E, Spina, R, Mori, I, Tomeo, F, Mercat, A, Beloncle, F, Jochmans, S, Mazerand, S, Baboi, L, Yonis, H, Jabaudon, M, Godet, T, Jovaisa, T, Barnes, T, Tariq, U, Weiler, N, Schädler, D, Frerichs, I, García-de-Acilu, M, Vidal, A, Rosas, E, Calvo, C, Zhou, J, Karagiannis, S, Zisopoulou, V, Staikos, I, Noc, M, Fister, M, Radsel, P, Gregoretti, C, Sabella, I, Raineri, S, Mauri, Tommaso, Foti, Giuseppe, Fornari, Carla, Constantin, Jean-Michel, Guerin, Claude, Pelosi, Paolo, Ranieri, Marco, Conti, Sara, Tubiolo, Daniela, RONDELLI, EGLE ROSALIA, Lovisari, Federica, Fossali, Tommaso, Spadaro, Savino, Grieco, Domenico Luca, Navalesi, Paolo, Calamai, Italo, Becher, Tobias, Roca, Oriol, Wang, Yu-Mei, Knafelj, Rihard, Cortegiani, Andrea, Mancebo, Jordi, Brochard, Laurent, Pesenti, Antonio, Volta, CA, dell'Anna, A, Calvo, CP, Zhou, JX, Raineri, SM, Mauri, T, Foti, G, Fornari, C, Constantin, J, Guerin, C, Pelosi, P, Ranieri, M, Conti, S, Tubiolo, D, Rondelli, E, Lovisari, F, Fossali, T, Spadaro, S, Grieco, D, Navalesi, P, Calamai, I, Becher, T, Roca, O, Wang, Y, Knafelj, R, Cortegiani, A, Mancebo, J, Brochard, L, Pesenti, A, Grasselli, G, Spinelli, E, Abbruzzese, C, Rona, R, Bronco, A, Villa, S, Gianni, S, Papoff, A, Pinciroli, R, Colombo, R, Sproccati, C, Mandelli, P, Villa, F, Patroniti, N, Brunetti, I, Ball, L, Volta, C, Lazzeri, M, Maragoni, E, Eleuteri, D, Bello, G, Dell'Anna, A, Garofalo, E, Bruni, A, Biamonte, E, D'Andrea, R, Querci, L, Pierucci, E, Spina, R, Mori, I, Tomeo, F, Mercat, A, Beloncle, F, Jochmans, S, Mazerand, S, Baboi, L, Yonis, H, Jabaudon, M, Godet, T, Jovaisa, T, Barnes, T, Tariq, U, Weiler, N, Schädler, D, Frerichs, I, García-de-Acilu, M, Vidal, A, Rosas, E, Calvo, C, Zhou, J, Karagiannis, S, Zisopoulou, V, Staikos, I, Noc, M, Fister, M, Radsel, P, Gregoretti, C, Sabella, I, Raineri, S, Mauri, Tommaso, Foti, Giuseppe, Fornari, Carla, Constantin, Jean-Michel, Guerin, Claude, Pelosi, Paolo, Ranieri, Marco, Conti, Sara, Tubiolo, Daniela, RONDELLI, EGLE ROSALIA, Lovisari, Federica, Fossali, Tommaso, Spadaro, Savino, Grieco, Domenico Luca, Navalesi, Paolo, Calamai, Italo, Becher, Tobias, Roca, Oriol, Wang, Yu-Mei, Knafelj, Rihard, Cortegiani, Andrea, Mancebo, Jordi, Brochard, Laurent, Pesenti, Antonio, Volta, CA, dell'Anna, A, Calvo, CP, Zhou, JX, and Raineri, SM
- Abstract
BACKGROUND: Adding cyclic short sustained inflations (sigh) to assisted ventilation yields optimizes lung recruitment, decreases heterogeneity and reduces inspiratory effort in patients with acute hypoxemic respiratory failure (AHRF). These findings suggest that adding sigh to pressure support ventilation (PSV) might decrease the risk of lung injury, shorten weaning and improve clinical outcomes. Thus, we conceived a pilot trial to test the feasibility of adding sigh to PSV (the PROTECTION study). METHODS: PROTECTION is an international randomized controlled trial that will be conducted in 23 intensive care units (ICUs). Patients with AHRF who have been intubated from 24 h to 7 days and undergoing PSV from 4 to 24 h will be enrolled. All patients will first undergo a 30-min sigh test by adding sigh to clinical PSV for 30 min to identify early oxygenation responders. Then, patients will be randomized to PSV or PSV + sigh until extubation, ICU discharge, death or day 28. Sigh will be delivered as a 3-s pressure control breath delivered once per minute at 30 cmH2O. Standardized protocols will guide ventilation settings, switch back to controlled ventilation, use of rescue treatments, performance of spontaneous breathing trial, extubation and reintubation. The primary endpoint of the study will be to verify the feasibility of PSV + sigh evaluated through reduction of failure to remain on assisted ventilation during the first 28 days in the PSV + sigh group versus standard PSV (15 vs. 22%). Failure will be defined by switch back to controlled ventilation for more than 24 h or use of rescue treatments or reintubation within 48 h from elective extubation. Setting the power to 80% and first-risk order to 5%, the computed size of the trial is 129 patients per arm. DISCUSSION: PROTECTION is a pilot randomized controlled trial testing the feasibility of adding sigh to PSV. If positive, it will provide physicians with an effective addition to standard PSV for lung protection, a
- Published
- 2018
6. COVID19 infection and vaccination and the risk of pituitary apoplexy: an entangled yarn.
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Ragni A, Biamonte E, Cavigiolo B, Mollero ELM, Bendotti G, Gabellieri E, Leporati P, and Gallo M
- Abstract
Purpose: Pituitary apoplexy (PA) has been increasingly reported in association with both infection from and vaccination for COVID19. Our aim was to analyse the available published cases and compare the clinical characteristics in the two groups (infection vs vaccination)., Methods: We systematically reviewed the published literature for all cases of PA associated with COVID19 infection or vaccination. We also presented two cases managed at our Centre., Results: Collectively, fortythree cases were analysed. Patients with PA after COVID19 vaccination (n = 7), compared with patients with PA after COVID19 infection (n = 36), were significantly younger (p = 0.009) and had a more abrupt onset of PA (p = 0.022), but showed a milder hormonal involvement (p = 0.008) and a lower rate of persistent hypopituitarism during follow-up (p = 0.001). Patients in the vaccination group did not have clinical risk factors for PA, although this difference did not reach statistical significance., Conclusions: PA associated with COVID19 is a rare but clinically significant entity, although pathophysiological details of this association are lacking. Given the significantly different clinical presentation, we could speculate that PA induced by COVID19 vaccination might represent a distinct clinical entity, with different pathophysiological mechanism, compared to PA from COVID19 infection., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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7. Retrospective ANalysis of multi-drug resistant Gram-nEgative bacteRia on veno-venous extracorporeal membrane oxygenation. The multicenter RANGER STUDY.
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Boscolo A, Bruni A, Giani M, Garofalo E, Sella N, Pettenuzzo T, Bombino M, Palcani M, Rezoagli E, Pozzi M, Falcioni E, Pistollato E, Biamonte E, Murgolo F, D'Arrigo G, Gori M, Tripepi GL, Gottin L, Longhini F, Grasso S, Navalesi P, and Foti G
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- Humans, Female, Male, Retrospective Studies, Middle Aged, Adult, Italy epidemiology, Gram-Negative Bacterial Infections drug therapy, Gram-Negative Bacterial Infections mortality, Aged, Extracorporeal Membrane Oxygenation methods, Extracorporeal Membrane Oxygenation statistics & numerical data, Drug Resistance, Multiple, Bacterial, Gram-Negative Bacteria drug effects
- Abstract
Background: Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a rapidly expanding life-support technique worldwide. The most common indications are severe hypoxemia and/or hypercapnia, unresponsive to conventional treatments, primarily in cases of acute respiratory distress syndrome. Concerning potential contraindications, there is no mention of microbiological history, especially related to multi-drug resistant (MDR) bacteria isolated before V-V ECMO placement. Our study aims to investigate: (i) the prevalence and incidence of MDR Gram-negative (GN) bacteria in a cohort of V-V ECMOs; (ii) the risk of 1-year mortality, especially in the case of predetected MDR GN bacteria; and (iii) the impact of annual hospital V-V ECMO volume on the probability of acquiring MDR GN bacteria., Methods: All consecutive adults admitted to the Intensive Care Units of 5 Italian university-affiliated hospitals and requiring V-V ECMO were screened. Exclusion criteria were age < 18 years, pregnancy, veno-arterial or mixed ECMO-configuration, incomplete records, survival < 24 h after V-V ECMO. A standard protocol of microbiological surveillance was applied and MDR profiles were identified using in vitro susceptibility tests. Cox-proportional hazards models were applied for investigating mortality., Results: Two hundred and seventy-nine V-V ECMO patients (72% male) were enrolled. The overall MDR GN bacteria percentage was 50%: 21% (n.59) detected before and 29% (n.80) after V-V ECMO placement. The overall 1-year mortality was 42%, with a higher risk observed in predetected patients (aHR 2.14 [1.33-3.47], p value 0.002), while not in 'V-V ECMO-acquired MDR GN bacteria' group (aHR 1.51 [0.94-2.42], p value 0.090), as compared to 'non-MDR GN bacteria' group (reference). Same findings were found considering only infections. A larger annual hospital V-V ECMO volume was associated with a lower probability of acquiring MDR GN bacteria during V-V ECMO course (aOR 0.91 [0.86-0.97], p value 0.002)., Conclusions: 21% of MDR GN bacteria were detected before; while 29% after V-V ECMO connection. A history of MDR GN bacteria, isolated before V-V ECMO, was an independent risk factor for mortality. The annual hospital V-V ECMO volume affected the probability of acquiring MDR GN bacteria. Trial Registration ClinicalTrial.gov Registration Number NCTNCT06199141, date 12.26.2023., (© 2024. The Author(s).)
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- 2024
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8. Ultrasound mapping of soft tissue vascular anatomy proximal to the larynx: a prospective cohort study.
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De Cassai A, Iuzzolino M, De Pinto S, Zecchino G, Pettenuzzo T, Boscolo A, Biamonte E, Navalesi P, and Munari M
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- Humans, Male, Female, Prospective Studies, Middle Aged, Adult, Aged, Cohort Studies, Tracheostomy methods, Arteries anatomy & histology, Arteries diagnostic imaging, Neck blood supply, Neck diagnostic imaging, Veins diagnostic imaging, Veins anatomy & histology, Larynx diagnostic imaging, Larynx anatomy & histology, Ultrasonography methods
- Abstract
Background: Bleeding incidents during percutaneous dilatational tracheostomy are concerning, and most cases occur in patients with unrecognized and unanticipated anatomical variations in the vascular anatomy. However, the extent of this variation remains unclear. To address this knowledge gap, our study aimed to comprehensively map laryngeal vascular anatomy in a cohort of adult patients., Methods: Ultrasound assessments of the soft tissue in the neck were performed, spanning from the thyroid cartilage to the third tracheal ring and extending 2 cm laterally on both sidesperformed. We subdivided this area into 12 zones comprising four medial and eight lateral sections. A pre-planned form was used to document the presence of arteries or veins in each zone. The results are reported as odds ratios, 95% CIs, and corresponding P values., Results: Five-hundred patients were enrolled from August 14, 2023, to November 13, 2023, at the University Hospital of Padua. Arteries and veins were identified in all investigated zones (varying from a minimum of 1.0%-46.4%). The presence of invessels progressively increased from the cricothyroid membrane to the third tracheal ring and from the midline to the paramedian laryngeal area., Conclusions: Given the prevalence of arteries and veins, particularly in areas where tracheostomies are commonly performed, we strongly advocate for routine ultrasound assessments before such procedures are performed.
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- 2024
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9. Complications during Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19 and Non-COVID-19 Patients with Acute Respiratory Distress Syndrome.
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Bruni A, Battaglia C, Bosco V, Pelaia C, Neri G, Biamonte E, Manti F, Mollace A, Boscolo A, Morelli M, Navalesi P, Laganà D, Garofalo E, Longhini F, and Image Group
- Abstract
Background: Acute respiratory distress syndrome (ARDS) presents a significant challenge in critical care settings, characterized by compromised gas exchange, necessitating in the most severe cases interventions such as veno-venous extracorporeal membrane oxygenation (vv-ECMO) when conventional therapies fail. Critically ill ARDS patients on vv-ECMO may experience several complications. Limited data exist comparing complication rates between COVID-19 and non-COVID-19 ARDS patients undergoing vv-ECMO. This retrospective observational study aimed to assess and compare complications in these patient cohorts. Methods: We retrospectively analyzed the medical records of all patients receiving vv-ECMO for ARDS between March 2020 and March 2022. We recorded the baseline characteristics, the disease course and complication (barotrauma, bleeding, thrombosis) before and after ECMO cannulation, and clinical outcomes (mechanical ventilation and ECMO duration, intensive care unit, and hospital lengths of stay and mortalities). Data were compared between COVID-19 and non-COVID-19 patients. In addition, we compared survived and deceased patients. Results: Sixty-four patients were included. COVID-19 patients (n = 25) showed higher rates of pneumothorax (28% vs. 8%, p = 0.039) with subcutaneous emphysema (24% vs. 5%, p = 0.048) and longer non-invasive ventilation duration before vv-ECMO cannulation (2 [1; 4] vs. 0 [0; 1] days, p = <0.001), compared to non-COVID-19 patients (n = 39). However, complication rates and clinical outcomes post-vv-ECMO were similar between groups. Survival analysis revealed no significant differences in pre-vv-ECMO complications, but non-surviving patients had a trend toward higher complication rates and more pleural effusions post-vv-ECMO. Conclusions: COVID-19 patients on vv-ECMO exhibit higher pneumothorax rates with subcutaneous emphysema pre-cannulation; post-cannulation complications are comparable to non-COVID-19 patients.
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- 2024
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10. SARS-Cov-2 Infection: A New Risk Factor for Pituitary Apoplexy?
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Ragni A, Bendotti G, Biamonte E, Cavigiolo B, Gabellieri E, Leporati P, Mollero ELM, and Gallo M
- Abstract
Background: Pituitary apoplexy (PA) can arise from haemorrhage or ischaemia of pituitary tissue and is characterized by abrupt onset of headache, visual impairment and hypopituitarism. COVID-19 may be associated with various degrees of vascular complications and, recently, its relationship with PA has been suggested. Cases Presentation Case 1: A 64-year-old male with type 2 diabetes, hypertension and coronary heart disease was admitted to the ER, after several days of asymptomatic COVID-19 infection, with symptoms of PA of a known non-functioning pituitary macroadenoma. The hormonal panel was consistent with anterior panhypopituitarism and the sellar MRI showed haemorrhagic changes of macroadenoma tissue. Transsphenoidal resection of the pituitary lesion was carried out seven days after admission. Although a volumetric reduction of the lesion was apparent during follow-up, some degree of visual symptoms endured. Case 2: An 18-year-old, otherwise healthy, female presented to the ER with symptoms of PA of a recently-diagnosed non-functioning pituitary macroadenoma, after ten days of asymptomatic COVID-19 infection. Central hypocortisolism and hypothyroidism were diagnosed and, after six days, the lesion was surgically resected. At two months follow-up, clinical symptoms had completely resolved, and the hormonal panel was normal., Conclusion: Alongside known risk factors (hypertension, anticoagulation, pregnancy, surgery, etc.), COVID-19 infection might represent an emerging predisposing factor for PA onset. The two cases hereby presented are both significant: the first confirms the role of "classic" vascular predisposing factors for PA, while the second demonstrates that PA might arise also in young patients without known risk factors., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)
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- 2024
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11. Assessment of cephalometric parameters and correlation with the severity of the obstructive sleep apnea syndrome.
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Garofalo E, Neri G, Perri LM, Lombardo N, Piazzetta G, Antonelli A, Biamonte E, Bosco V, Battaglia C, Pelaia C, Manti F, Pitino A, Tripepi G, Bruni A, Morelli M, Giudice A, and Longhini F
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- Adult, Female, Humans, Male, Middle Aged, Obesity complications, Obesity pathology, Obesity physiopathology, Pilot Projects, Cephalometry, Severity of Illness Index, Sleep Apnea, Obstructive pathology, Sleep Apnea, Obstructive physiopathology
- Abstract
Background: In individuals diagnosed with obstructive sleep apnea syndrome (OSAS), variations in craniofacial structure have been inconsistently documented, showing differing degrees of alteration between obese and nonobese patients. In addition, sleep disturbance has also been shown to induce disequilibrium in this population of patients. This pilot observational study aimed to assess craniofacial values in obese and nonobese subpopulations of patients with OSAS and their correlation and association with the severity of OSAS. We also assessed whether OSAS patients are characterized by an impaired equilibrium in relation to and associated with the severity of OSAS., Methods: We included all consecutive adult patients with OSAS. Through cephalometry, we assessed the upper (UPa-UPp) and lower (LPa-LPp) pharynx diameters, superior anterior facial height (Sor-ANS), anterior facial height (ANS-Me), anterior vertical dimension (Sor-Me), posterior facial height (S-Go) and craniovertebral angle (CVA). Furthermore, we analyzed postural equilibrium through a stabilometric examination., Results: Forty consecutive OSAS patients (45% female with a mean age of 56 ± 8.2 years) were included. The subgroup of nonobese patients had a reduced UPa-UPp (p = 0.02). Cephalometric measurements were correlated with the severity of OSAS in nonobese patients, whereas only Sor-ANS was correlated with the severity of OSAS in the obese subpopulation. In the overall population, altered craniofacial values are associated with severe OSAS. Although there are differences in equilibrium between obese and nonobese OSAS patients, the stabilometric measurements were not correlated or associated with OSAS severity., Conclusion: Altered craniofacial values and compromised equilibrium in OSAS patients are linked to OSAS severity. Therefore, the management of OSAS should be tailored not only to weight management but also to craniofacial and postural rehabilitation to enhance patient outcomes., (© 2024. The Author(s).)
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- 2024
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12. Benefits of secretion clearance with high frequency percussive ventilation in tracheostomized critically ill patients: a pilot study.
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Garofalo E, Rovida S, Cammarota G, Biamonte E, Troisi L, Cosenza L, Pelaia C, Navalesi P, Longhini F, and Bruni A
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- Humans, Pilot Projects, Respiration, Artificial methods, Lung, Critical Illness, High-Frequency Ventilation methods
- Abstract
Clearance of secretions remains a challenge in ventilated patients. Despite high-frequency percussive ventilation (HFPV) showing benefits in patients with cystic fibrosis and neuromuscular disorders, very little is known about its effects on other patient categories. Therefore, we designed a physiological pilot study investigating the effects on lung aeration and gas exchange of short HFPV cycles in tracheostomized patients undergoing mechanical ventilation. Electrical impedance tomography (EIT) was recorded at baseline (T0) by a belt wrapped around the patient's chest, followed by the HFPV cycle lasting 10 min. EIT data was collected again after the HFPV cycle (T1) as well as after 1 h (T2) and 3 h (T3) from T0. Variation from baseline of end-expiratory lung impedance (∆EELI), tidal variation (TIV) and global inhomogeneity index (GI) were computed. Arterial blood was also taken for gas analysis. HFPV cycle significantly improved the ∆EELI at T1, T2 and T3 when compared to baseline (p < 0.05 for all comparisons). The ratio between arterial partial pressure and inspired fraction of oxygen (PaO
2 /FiO2 ) also increased after the treatment (p < 0.001 for all comparison) whereas TIV (p = 0.132) and GI (p = 0.114) remained unchanged. Short cycles of HFPV superimposed to mechanical ventilation promoted alveolar recruitment, as suggested by improved ∆EELI, and improved oxygenation in tracheostomized patients with high load of secretion.Trial Registration Prospectively registered on www.clinicaltrials.gov (NCT05200507; dated 6th January 2022)., (© 2023. The Author(s).)- Published
- 2023
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13. Severe and mild-moderate SARS-CoV-2 vaccinated patients show different frequencies of IFNγ-releasing cells: An exploratory study.
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Garofalo E, Biamonte F, Palmieri C, Battaglia AM, Sacco A, Biamonte E, Neri G, Antico GC, Mancuso S, Foti G, Torti C, Costanzo FS, Longhini F, and Bruni A
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- Humans, BNT162 Vaccine, Interferon-gamma, Antibodies, Viral, Immunoglobulin M, Immunoglobulin G, Vaccination, SARS-CoV-2, COVID-19
- Abstract
Background: Despite an apparent effective vaccination, some patients are admitted to the hospital after SARS-CoV-2 infection. The role of adaptive immunity in COVID-19 is growing; nonetheless, differences in the spike-specific immune responses between patients requiring or not hospitalization for SARS-CoV-2 infection remains to be evaluated. In this study, we aim to evaluate the spike-specific immune response in patients with mild-moderate or severeSARS-CoV-2 infection, after breakthrough infection following two doses of BNT162b2 mRNA vaccine., Methods: We included three cohorts of 15 cases which received the two BNT162b2 vaccine doses in previous 4 to 7 months: 1) patients with severe COVID-19; 2) patients with mild-moderate COVID-19 and 3) vaccinated individuals with a negative SARS-CoV-2 molecular pharyngeal swab (healthy subjects). Anti-S1 and anti-S2 specific SARS-CoV-2 IgM and IgG titers were measured through a chemiluminescence immunoassay technology. In addition, the frequencies of IFNγ-releasing cells were measured by ELISpot., Results: The spike-specific IFNγ-releasing cells were significantly lower in severe patients (8 [0; 26] s.f.c.×106), as compared to mild-moderate patients (135 [64; 159] s.f.c.×106; p<0.001) and healthy subjects (103 [50; 188] s.f.c.×106; p<0.001). The anti-Spike protein IgG levels were similar among the three cohorts of cases (p = 0.098). All cases had an IgM titer below the analytic sensitivity of the test. The Receiver Operating Curve analysis indicated the rate of spike-specific IFNγ-releasing cells can discriminate correctly severe COVID-19 and mild-moderate patients (AUC: 0.9289; 95%CI: 0.8376-1.000; p< 0.0001), with a diagnostic specificity of 100% for s.f.c. > 81.2 x 106., Conclusions: 2-doses vaccinated patients requiring hospitalization for severe COVID-19 show a cellular-mediated immune response lower than mild-moderate or healthy subjects, despite similar antibody titers., Competing Interests: There are no conflicts of interest related to the present work. Dr. Longhini contributed to the development of a new device not discussed in the present study (European Patent number 3320941 released on 5th August 2020) and he is designed as inventor. He also received speaking fees from Intersurgical, Draeger and Fisher & Paykel. The remaining authors have no conflict of interest to disclose., (Copyright: © 2023 Garofalo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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14. Characteristics of unvaccinated and vaccinated critically ill COVID-19 patients in calabria region (Italy): A retrospective study.
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Bruni A, Longhini F, Macheda S, Biamonte E, Pasqua P, Neri G, Guzzo ML, and Garofalo E
- Abstract
Introduction: After the rapid surge of a novel coronavirus (SARS-CoV-2) in 2020 anti-SARS-CoV-2 vaccines have been developed to prevent the development of critical forms of COVID-19 leading to Intensive Care Unit (ICU) admission. The possibility of ICU admission after the first-cycle vaccination has been already reported; however, no data have been published regarding vaccinated patients with a "booster" dose. This retrospective study describes the characteristics of critically ill patients after the implementation of the regional "booster" dose vaccination program in a southern region of Italy., Materials and Methods: We screened all medical records of critically ill COVID-19 patients in the period between January to April 2022. We collected the demographic characteristics, the presence of comorbidities, the vaccination status, the clinical course (arterial blood gases and type of respiratory support) and outcomes (rate of tracheostomy, ICU length of stay and mortality)., Results: A total of 272 patients were admitted to ICUs during the study period. 161 patients were unvaccinated, whereas 111 were vaccinated with the complete first-cycle or "booster" dose. The type of respiratory support was similar between groups. Vaccinated patients were characterized by a better oxygenation throughout the whole ICU length of stay. Fourteen unvaccinated and 3 vaccinated patients required tracheostomy ( p = 0.045). ICU length of stay was 12.2 (± 7.3) days in unvaccinated patients and 10.4 (± 6.7) days in vaccinated patients ( p = 0.036). ICU mortalities were 38.5 and 24.3% in unvaccinated and vaccinated patients, respectively ( p = 0.014)., Conclusion: Vaccinated patients have better clinical course and outcomes as compared to the unvaccinated population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor declared a past co-authorship with one of the author FL., (Copyright © 2022 Bruni, Longhini, Macheda, Biamonte, Pasqua, Neri, Guzzo, Garofalo and Calabria COVID-ICU Network authors.)
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- 2022
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15. Bivalirudin vs. Enoxaparin in Intubated COVID-19 Patients: A Pilot Multicenter Randomized Controlled Trial.
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Garofalo E, Cammarota G, Neri G, Macheda S, Biamonte E, Pasqua P, Guzzo ML, Longhini F, and Bruni A
- Abstract
(1) Background: In COVID-19 patients, the occurrence of thromboembolic complications contributes to disease progression and mortality. In patients at increased risk for thrombotic complications, therapeutic enoxaparin should be considered. However, critically ill COVID-19 patients could develop resistance to enoxaparin. Bivalirudin, a thrombin inhibitor, may be an alternative. This pilot multicenter randomized controlled trial aims to ascertain if bivalirudin may reduce the time spent under invasive mechanical ventilation, as compared to enoxaparin. (2) Methods: Intubated COVID-19 patients at risk for thrombo-embolic complications were randomized to receive therapeutic doses of enoxaparin or bivalirudin. We ascertained the time spent under invasive mechanical ventilation during the first 28 days from Intensive Care Unit (ICU) admission. A standardized weaning protocol was implemented in all centers. In addition, we assessed the occurrence of thromboembolic complications, the number of patients requiring percutaneous tracheostomy, the gas exchange, the reintubation rate, the ICU length of stay, the ICU and 28-days mortalities. (3) Results: We enrolled 58 consecutive patients. Bivalirudin did not reduce the time spent under invasive mechanical ventilation as compared to enoxaparin (12 [8; 13] vs. 13 [10; 15] days, respectively; p = 0.078). Thrombotic ( p = 0.056) and embolic ( p = 0.423) complications, need for tracheostomy ( p = 0.423) or reintubation ( p = 0.999), the ICU length of stay ( p = 0.076) and mortality ( p = 0.777) were also similar between treatments. Patients randomized to bivalirudin showed a higher oxygenation at day 7 and 15 after randomization, when compared to enoxaparin group. (4) Conclusions: In intubated COVID-19 patients at increased risk for thromboembolic complications, bivalirudin did not reduce the time spent under invasive mechanical ventilation, nor improved any other clinical outcomes.
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- 2022
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16. A Multicenter Cohort Study in Patients With Primary Empty Sella: Hormonal and Neuroradiological Features Over a Long Follow-Up.
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Carosi G, Brunetti A, Mangone A, Baldelli R, Tresoldi A, Del Sindaco G, Lavezzi E, Sala E, Mungari R, Fatti LM, Galazzi E, Ferrante E, Indirli R, Biamonte E, Arosio M, Cozzi R, Lania A, Mazziotti G, and Mantovani G
- Subjects
- Adult, Aged, Cohort Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Empty Sella Syndrome complications, Empty Sella Syndrome diagnostic imaging, Hypopituitarism diagnostic imaging
- Abstract
Objective: primary empty sella (PES) represents a frequent finding, but data on hormonal alterations are heterogeneous, and its natural history is still unclear. Our aim was to evaluate the pituitary function of patients with PES over a long follow-up., Design: multicenter retrospective cohort study enrolling patients referred between 1984-2020 to five Pituitary Units, with neuroradiological confirmed PES and a complete hormonal assessment., Methods: we analyzed hormonal (including basal and dynamic evaluations), clinical and neuroradiological data collected at diagnosis and at the last visit (at least 6 months of follow-up)., Results: we recruited 402 patients (females=63%, mean age=51.5 ± 16 years) with PES (partial, total, undefined in 66%, 13% and 21%, respectively). Hypopituitarism was present in 40.5% (hypogonadism=20.4%, hypoadrenalism=14.7%, growth hormone deficiency=14.7%, hypothyroidism=10.2%, diabetes insipidus=1.5%; multiple deficiencies=11.4%) and hypeprolactinemia in 6.5%. Interestingly, hormonal alterations were diagnosed in 29% of incidental PES. Hypopituitarism was associated with male sex ( p =0.02), suspected endocrinopathy ( p <0.001), traumatic brain injury ( p =0.003) and not with age, BMI, number of pregnancies and neuroradiological grade. A longitudinal assessment was possible in 166/402 (median follow-up=58 months). In 5/166 (3%), new deficiencies occurred, whereas 14/166 (8.4%) showed a hormonal recovery. A progression from partial to total PES, which was found in 6/98 patients assessed with a second imaging, was the only parameter significantly related to the hormonal deterioration ( p =0.006)., Conclusions: this is the largest cohort of patients with PES reported. Hypopituitarism is frequent (40%) but hormonal deterioration seems uncommon (3%). Patients need to be carefully evaluated at diagnosis, even if PES is incidentally discovered., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Carosi, Brunetti, Mangone, Baldelli, Tresoldi, Del Sindaco, Lavezzi, Sala, Mungari, Fatti, Galazzi, Ferrante, Indirli, Biamonte, Arosio, Cozzi, Lania, Mazziotti and Mantovani.)
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- 2022
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17. Current Practice of High Flow through Nasal Cannula in Exacerbated COPD Patients.
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Bruni A, Garofalo E, Procopio D, Corrado S, Caroleo A, Biamonte E, Pelaia C, and Longhini F
- Abstract
Acute Exacerbation of Chronic Obstructive Pulmonary Disease is a form of severe Acute Respiratory Failure (ARF) requiring Conventional Oxygen Therapy (COT) in the case of absence of acidosis or the application of Non-Invasive Ventilation (NIV) in case of respiratory acidosis. In the last decade, High Flow through Nasal Cannula (HFNC) has been increasingly used, mainly in patients with hypoxemic ARF. However, some studies were also published in AECOPD patients, and some evidence emerged. In this review, after describing the mechanism underlying potential clinical benefits, we analyzed the possible clinical application of HFNC to AECOPD patients. In the case of respiratory acidosis, the gold-standard treatment remains NIV, supported by strong evidence in favor. However, HFNC may be considered as an alternative to NIV if the latter fails for intolerance. HFNC should also be considered and preferred to COT at NIV breaks and weaning. Finally, HFNC should also be preferred to COT as first-line oxygen treatment in AECOPD patients without respiratory acidosis.
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- 2022
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18. The Analytical Reliability of the Oral Glucose Tolerance Test for the Diagnosis of Gestational Diabetes: An Observational, Retrospective Study in a Caucasian Population.
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Pintaudi B, Di Vieste G, D'Anna R, Chiereghin F, Biamonte E, Corrado F, and Di Benedetto A
- Abstract
The Oral Glucose Tolerance Test (OGTT) is currently the gold standard reference test for the diagnosis of gestational diabetes mellitus (GDM). Several critical issues related to analytical variables have challenged its reproducibility and accuracy. This study aimed to assess the analytical reliability of the OGTT for the diagnosis of GDM. A total of 1015 pregnant women underwent a 2 h 75 g OGTT between 24 and 28 weeks of gestation. As recommended by National Academy of Clinical Biochemistry, we considered the total maximum allowable error for glucose plasma measurement as <6.9%. Assuming the possibility of analytical errors within this range for each OGTT glucose plasma value, different scenarios of GDM occurrence were estimated. GDM prevalence with standard criteria was 12.2%, and no hypothetical scenarios have shown a comparable GDM prevalence. Considering all the three OGTT values estimated at the lowest or the highest allowed value according to total maximum allowable error, GDM prevalence significantly varied (4.5% and 25.3%, respectively). Our results indicate that the OGTT is not completely accurate for GDM diagnosis.
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- 2022
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19. Weight change and glycemic control in type 2 diabetes patients during COVID-19 pandemic: the lockdown effect.
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Biamonte E, Pegoraro F, Carrone F, Facchi I, Favacchio G, Lania AG, Mazziotti G, and Mirani M
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- Aged, Blood Glucose, Communicable Disease Control, Glycated Hemoglobin analysis, Glycemic Control, Humans, Italy, Male, Pandemics, Retrospective Studies, SARS-CoV-2, COVID-19, Diabetes Mellitus, Type 2 drug therapy, Diabetes Mellitus, Type 2 epidemiology
- Abstract
Purpose: The aim of this study was to evaluate the impact of the COVID-19 lockdown occurred in Italy from March 9th to May 18th, 2020 on anthropometric parameters and glycemic control in patients with type 2 diabetes mellitus (T2DM)., Methods: One hundred twenty-eight consecutive patients with T2DM (median age 70 years, 74 males) were retrospectively evaluated at the end of the lockdown period. Data on metabolic control were collected at different time: within three months before the lockdown (visit 0) and within the first six weeks after it (visit 1)., Results: During the lockdown, a significant increase in body weight (from 79.7 ± 18.7 kg to 81.4 ± 19.4 kg, p < 0.001), body mass index (BMI, from 29.5 ± 6 kg/m
2 to 30.1 ± 6.3 kg/m2 , p < 0.001), waist circumference (from 103.8 ± 13 cm to 105 ± 13.6 cm, p < 0.001), fasting plasma glucose (FPG; from 138.1 ± 29.4 mg/dL to 146.6 ± 36.4 mg/dL) and glycated hemoglobin (HbA1c; from 7 ± 0.8 to 7.3 ± 0.9%, p < 0.001) was observed. Weight gain was directly associated with HbA1c increase (β 0.085, C.I. 95% 0.05-0.121; p < 0.001) while insulin therapy resulted to be the only significant independent predictor of HbA1c worsening at the multivariate logistic regression analysis (OR 2.40, C.I. 1.06-5.45; p = 0.035)., Conclusions: The lockdown due to COVID-19 pandemic had a negative impact on body weight and glucose control in T2DM patients, in particular in those on insulin treatment. This finding provides a further rationale to optimize the diabetes management during eventually new period of home confinement.- Published
- 2021
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20. Vertebral Fractures Associated with Spinal Sagittal Imbalance and Quality of Life in Acromegaly: A Radiographic Study with EOS 2D/3D Technology.
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Cellini M, Biamonte E, Mazza M, Trenti N, Ragucci P, Milani D, Ferrante E, Rossini Z, Lavezzi E, Sala E, Mantovani G, Arosio M, Fornari M, Balzarini L, Lania AG, and Mazziotti G
- Subjects
- Acromegaly complications, Acromegaly pathology, Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Joint Diseases etiology, Joint Diseases pathology, Male, Middle Aged, Spinal Fractures etiology, Spinal Fractures pathology, Young Adult, Acromegaly diagnostic imaging, Imaging, Three-Dimensional, Joint Diseases diagnostic imaging, Quality of Life, Spinal Fractures diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Introduction: Acromegaly is commonly complicated by arthropathy and skeletal fragility with high risk of vertebral fractures (VFs)., Objective: This study aimed to assess whether VFs may be associated with sagittal spine deformities, arthropathy, impaired quality of life (QoL), pain, and disability., Methods: Thirty-eight patients with acromegaly (median age: 55 years, 20 males) and 38 matched control subjects were evaluated by a low-dose sagittal and coronal planes, X-ray imaging system (EOS®-2D/3D) for morphometric VFs, radiological signs of spine arthropathy, and spine deformities (Cobb thoracic index ≥40°, pelvic incidence minus lumbar lordosis ≥10°, pelvic tilt >20°, and sagittal vertical axis ≥4 cm) determining sagittal spine imbalance. Acromegalic patients were also evaluated by questionnaires for QoL (Acromegaly QoL Questionnaire [AcroQoL] and Short Form-36 [SF-36]) and pain and disability (Western Ontario and McMaster University [WOMAC])., Results: Acromegalic patients showed higher prevalence of thoracic hyperkyphosis (i.e., Cobb thoracic index ≥40°; p = 0.04) and pelvic tilt >20° (p = 0.02) than control subjects. VFs were found in 34.2% of acromegalic patients (p = 0.003 vs. control subjects), in relationship with higher prevalence of hyperkyphosis (p = 0.03), pelvic tilt >20° (p = 0.04), sagittal vertical axis ≥4 cm (p = 0.03), and moderate/severe subchondral degeneration (p = 0.01). Moreover, patients with VFs had lower AcroQoL general health (p = 0.007) and SF-36 general health (p = 0.002) scores and higher WOMAC pain (p = 0.003) and global (p = 0.009) scores than patients who did not fracture., Conclusions: In acromegaly, VFs may be associated with spine deformities and sagittal imbalance, spine arthropathy, impaired QoL, and disability., (© 2020 S. Karger AG, Basel.)
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- 2021
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21. Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy.
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Mirani M, Favacchio G, Carrone F, Betella N, Biamonte E, Morenghi E, Mazziotti G, and Lania AG
- Subjects
- Betacoronavirus, Blood Glucose, COVID-19, Humans, Italy epidemiology, Risk Factors, SARS-CoV-2, Sitagliptin Phosphate, Coronavirus, Coronavirus Infections, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 drug therapy, Diabetes Mellitus, Type 2 epidemiology, Dipeptidyl-Peptidase IV Inhibitors therapeutic use, Pandemics, Pneumonia, Viral
- Abstract
Objective: Diabetes may unfavorably influence the outcome of coronavirus disease 19 (COVID-19), but the determinants of this effect are still poorly understood. In this monocentric study, we aimed at evaluating the impact of type 2 diabetes, comorbidities, plasma glucose levels, and antidiabetes medications on the survival of COVID-19 patients., Research Design and Methods: This was a case series involving 387 COVID-19 patients admitted to a single center in the region of Lombardy, the epicenter of the severe acute respiratory syndrome coronavirus 2 pandemic in Italy, between 20 February and 9 April 2020. Medical history, pharmacological treatments, laboratory findings, and clinical outcomes of patients without diabetes and patients with type 2 diabetes were compared. Cox proportional hazards analysis was applied to investigate risk factors associated with mortality., Results: Our samples included 90 patients (23.3%) with type 2 diabetes, who displayed double the mortality rate of subjects without diabetes (42.3% vs. 21.7%, P < 0.001). In spite of this, after correction for age and sex, risk of mortality was significantly associated with a history of hypertension (adjusted hazard ratio [aHR] 1.84, 95% CI 1.15-2.95; P = 0.011), coronary artery disease (aHR 1.56, 95% CI 1.04-2.35; P = 0.031), chronic kidney disease (aHR 2.07, 95% CI 1.27-3.38; P = 0.003), stroke (aHR 2.09, 95% CI 1.23-3.55; P = 0.006), and cancer (aHR 1.57, 95% CI 1.08-2.42; P = 0.04) but not with type 2 diabetes ( P = 0.170). In patients with diabetes, elevated plasma glucose (aHR 1.22, 95% CI 1.04-1.44, per mmol/L; P = 0.015) and IL-6 levels at admission (aHR 2.47, 95% CI 1.28-4.78, per 1-SD increase; P = 0.007) as well as treatment with insulin (aHR 3.05, 95% CI 1.57-5.95; P = 0.001) and β-blockers (aHR 3.20, 95% CI 1.50-6.60; P = 0.001) were independently associated with increased mortality, whereas the use of dipeptidyl peptidase 4 inhibitors was significantly and independently associated with a lower risk of mortality (aHR 0.13, 95% CI 0.02-0.92; P = 0.042)., Conclusions: Plasma glucose levels at admission and antidiabetes drugs may influence the survival of COVID-19 patients affected by type 2 diabetes., (© 2020 by the American Diabetes Association.)
- Published
- 2020
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22. Suboptimal medication adherence may favor the progression of vertebral fractures in women with post-menopausal osteoporosis treated with denosumab.
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Betella N, Biamonte E, Matarazzo C, Piccini S, Olivetti R, Cellini M, Lania AG, and Mazziotti G
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- Aged, Aged, 80 and over, Bone Density, Drug Administration Schedule, Female, Humans, Lumbar Vertebrae injuries, Middle Aged, Osteoporotic Fractures prevention & control, Retrospective Studies, Spinal Fractures diagnostic imaging, Bone Density Conservation Agents administration & dosage, Bone Density Conservation Agents therapeutic use, Denosumab administration & dosage, Denosumab therapeutic use, Medication Adherence, Osteoporosis, Postmenopausal drug therapy, Spinal Fractures epidemiology
- Abstract
Background: Medication adherence is a determinant of therapeutic outcomes in osteoporotic patients treated with bisphosphonates. In this monocentric study, we evaluated whether the regular drug administration may influence the effectiveness of denosumab in preventing vertebral fractures (VFs) in real-world clinical practice., Methods: Two-hundred and four women (median age 75 years, range: 54-90 years) under treatment with denosumab for post-menopausal osteoporosis were longitudinally evaluated for incident radiological VFs and changes in lumbar spine bone mineral density (BMD) in relationship with medication adherence. All patients were persistent with denosumab treatment (i.e., maximum delay in administration of a single denosumab dose: 90 days). Patients were defined adherent to denosumab therapy when the drug was administered every 6 months ±28 days., Results: One-hundred-seventy-three patients (84.4%) were adherent to denosumab therapy, whereas the remaining 31 patients (15.6%) received in delay one or more denosumab doses (cumulative delay: 52 days, range 29-183 days). Fourteen patients (6.9%) experienced incident VFs during the follow-up (median duration: 30 months, range: 18-48 months), in relationship with non-adherence to denosumab therapy (hazard ratio 4.44; 95% CI: 1.01-19.47) and smaller increase in lumbar spine BMD (hazard ratio 0.85, 95% CI: 0.76-0.94)., Conclusions: In post-menopausal women at high risk of fractures, the small delay in the administration of denosumab (i.e., not uncommon in clinical practice) was associated with a significant increase in incidence of VFs. Preservation of standard dosing schedule appears to be an important determinant of denosumab effectiveness in the real-life clinical practice.
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- 2020
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23. Weaning off mechanical ventilation: much less an art, but not yet a science.
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Navalesi P, Bruni A, Garofalo E, Biamonte E, Longhini F, and Frigerio P
- Abstract
Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
- Published
- 2019
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24. Successful treatment with cefiderocol for compassionate use in a critically ill patient with XDR Acinetobacter baumannii and KPC-producing Klebsiella pneumoniae: a case report.
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Trecarichi EM, Quirino A, Scaglione V, Longhini F, Garofalo E, Bruni A, Biamonte E, Lionello R, Serapide F, Mazzitelli M, Marascio N, Matera G, Liberto MC, Navalesi P, and Torti C
- Subjects
- Acinetobacter Infections blood, Acinetobacter baumannii drug effects, Adult, Compassionate Use Trials, Critical Illness therapy, Humans, Influenza, Human complications, Influenza, Human microbiology, Klebsiella Infections blood, Klebsiella pneumoniae drug effects, Microbial Sensitivity Tests, Pneumonia complications, Pneumonia virology, Treatment Outcome, Cefiderocol, Acinetobacter Infections drug therapy, Anti-Bacterial Agents therapeutic use, Cephalosporins therapeutic use, Drug Resistance, Multiple, Bacterial, Klebsiella Infections drug therapy
- Published
- 2019
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25. Evaluation of a New Interface Combining High-Flow Nasal Cannula and CPAP.
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Garofalo E, Bruni A, Pelaia C, Cammarota G, Murabito P, Biamonte E, Abdalla K, Longhini F, and Navalesi P
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- Adult, Air Pressure, Diaphragm diagnostic imaging, Diaphragm physiology, Exhalation, Female, Humans, Inhalation, Male, Oxygen administration & dosage, Oxygen Inhalation Therapy methods, Patient Comfort, Pharynx, Respiratory Rate, Temperature, Ultrasonography, Young Adult, Cannula, Continuous Positive Airway Pressure instrumentation, Oxygen Inhalation Therapy instrumentation, Respiration
- Abstract
Background: This study assessed the effects of a new interface that combined CPAP 10 cm H
2 O by using a helmet with high-flow nasal cannula (HFNC) at varying flows in healthy volunteers. Outcome measures included pharyngeal pressures, diaphragm kinetics, breathing frequency, the temperature inside the helmet, and comfort., Methods: After baseline assessment during spontaneous breathing, HFNC was applied at flows of 30, 40, and 50 L/min. Successively, the volunteers underwent helmet CPAP at 10 cm H2 O and CPAP + HFNC at flows of 30, 40, and 50 L/min. We measured the variations of pharyngeal pressures at end-expiration and end-inspiration, referenced to spontaneous breathing for HFNC and to CPAP for CPAP + HFNC, diaphragm displacement and thickness at end-expiration and thickness at end-inspiration, breathing frequency, the temperature inside the helmet, the occurrence of the fog effect, and comfort., Results: Variations of pharyngeal pressures at end-inspiration changes were small overall and clinically unimportant. With the mouth closed, at increasing HFNC flow, variations of pharyngeal pressures at end-expiration increased during both HFNC (from 2.8 up to 7.7) and, to a lesser extent, CPAP + HFNC (from 2.7 up to 3.8) ( P < .001 for all comparisons). These variations were attenuated during open-mouth breathing. HFNC ≥ 40 L/min and CPAP + HFNC ≥ 40 L/min compared with spontaneous breathing and CPAP, respectively, increased diaphragm displacement ( P = .001), thickness at end-inspiration and thickness at end-expiration ( P < .003 for both). At all flows, breathing frequency was slightly, although significantly, lower with CPAP + HFNC than with HFNC alone ( P < .003). The temperature inside the helmet increased slightly and insignificantly at flows of ≤40 L/min with CPAP + HFNC compared with CPAP alone. The fog effect never occurred, whereas comfort was always rated as optimal, without differences between trials., Conclusions: CPAP + HFNC was well tolerated, with no adverse effects. Based on our findings, there was no need to vary the CPAP level when adding HFNC. At least in healthy subjects, CPAP + HFNC at 30 L/min seemed to be the best combination., (Copyright © 2019 by Daedalus Enterprises.)- Published
- 2019
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26. Medullary thyroid carcinoma treated with percutaneous ultrasound-guided radiofrequency ablation.
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Biamonte E, Solbiati L, Ierace T, Colombo P, Lavezzi E, Mazziotti G, and Lania A
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- Biopsy, Fine-Needle, Calcitonin blood, Female, Humans, Middle Aged, Neck diagnostic imaging, Thyroid Gland diagnostic imaging, Thyroid Nodule diagnostic imaging, Treatment Outcome, Ultrasonography, Interventional, Carcinoma, Medullary diagnostic imaging, Carcinoma, Medullary radiotherapy, Catheter Ablation methods, Thyroid Neoplasms diagnostic imaging, Thyroid Neoplasms radiotherapy
- Abstract
Purpose: Minimally invasive image-guided thermal ablation has been proposed as alternative to surgery for treatment of benign thyroid nodules and recurrent differentiated thyroid carcinoma. Here, we report for the first time the use of radiofrequency ablation (RFA) in a patient with non-metastatic medullary thyroid carcinoma (MTC) who did not undergo surgery due to high anesthesiological risk., Methods and Results: A 64-year-old woman was referred to our institution for a routine endocrinological visit. No thyroid-related symptoms were present. She had a history of metabolic, cardiovascular and neurological diseases. On clinical examination, a nodular lesion of about 10 mm was palpable in the right thyroid lobe; ultrasonography (US) confirmed the presence of a 13 mm thyroid nodule in the lower pole of the right lobe, that was hypoechoic and with regular margins. Serum calcitonin (Ctn) level was significantly high (647 pg/mL). Fine-needle aspiration (FNA) of the thyroid nodule was negative for malignant cells, but the marked increase of Ctn level in the FNA wash-out fluid confirmed the diagnostic suspicion of MTC. Since patient refused surgery due to high anesthesiological risk, percutaneous US-guided RFA in single session was performed. At 6-months follow-up the serum Ctn level decreased from the initial value of 647 pg/mL, reaching near-normal range (15 pg/mL), and neck ultrasound showed a complete necrosis of the tumour. Afterward, serum Ctn slowly increased to 49 pg/mL at 15-month follow-up. The US performed at 6 and 12 months of follow-up revealed fibrotic tissue in place of the thyroid nodule, without evidence of cervical lymph-node metastases., Conclusions: This clinical case suggests that RFA may be effective and safe for treatment of MTC when surgery cannot be performed.
- Published
- 2019
- Full Text
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