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1. Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients

Author

Bellan, M, Patti, G, Hayden, E, Azzolina, D, Pirisi, M, Acquaviva, A, Aimaretti, G, Aluffi Valletti, P, Angilletta, R, Arioli, R, Avanzi, G, Avino, G, Balbo, P, Baldon, G, Baorda, F, Barbero, E, Baricich, A, Barini, M, Barone-Adesi, F, Battistini, S, Beltrame, M, Bertoli, M, Bertolin, S, Bertolotti, M, Betti, M, Bobbio, F, Boffano, P, Boglione, L, Borre, S, Brucoli, M, Calzaducca, E, Cammarata, E, Cantaluppi, V, Cantello, R, Capponi, A, Carriero, A, Casciaro, F, Castello, L, Ceruti, F, Chichino, G, Chirico, E, Cisari, C, Cittone, M, Colombo, C, Comi, C, Croce, E, Daffara, T, Danna, P, Della Corte, F, De Vecchi, S, Dianzani, U, Di Benedetto, D, Esposto, E, Faggiano, F, Falaschi, Z, Ferrante, D, Ferrero, A, Gagliardi, I, Gaidano, G, Galbiati, A, Gallo, S, Garavelli, P, Gardino, C, Garzaro, M, Gastaldello, M, Gavelli, F, Gennari, A, Giacomini, G, Giacone, I, Giai Via, V, Giolitti, F, Gironi, L, Gramaglia, C, Grisafi, L, Inserra, I, Invernizzi, M, Krengli, M, Labella, E, Landi, I, Landi, R, Leone, I, Lio, V, Lorenzini, L, Maconi, A, Malerba, M, Manfredi, G, Martelli, M, Marzari, L, Marzullo, P, Mennuni, M, Montabone, C, Morosini, U, Mussa, M, Nerici, I, Nuzzo, A, Olivieri, C, Padelli, S, Panella, M, Parisini, A, Pasche, A, Pau, A, Pedrinelli, A, Percivale, I, Re, R, Rigamonti, C, Rizzi, E, Rognoni, A, Roveta, A, Salamina, L, Santagostino, M, Saraceno, M, Savoia, P, Sciarra, M, Schimmenti, A, Scotti, L, Spinoni, E, Smirne, C, Tarantino, V, Tillio, P, Vaschetto, R, Vassia, V, Zagaria, D, Zavattaro, E, Zeppegno, P, Zottarelli, F, Sainaghi, P, Bellan M., Patti G., Hayden E., Azzolina D., Pirisi M., Acquaviva A., Aimaretti G., Aluffi Valletti P., Angilletta R., Arioli R., Avanzi G. C., Avino G., Balbo P. E., Baldon G., Baorda F., Barbero E., Baricich A., Barini M., Barone-Adesi F., Battistini S., Beltrame M., Bertoli M., Bertolin S., Bertolotti M., Betti M., Bobbio F., Boffano P., Boglione L., Borre S., Brucoli M., Calzaducca E., Cammarata E., Cantaluppi V., Cantello R., Capponi A., Carriero A., Casciaro F. G., Castello L. M., Ceruti F., Chichino G., Chirico E., Cisari C., Cittone M. G., Colombo C., Comi C., Croce E., Daffara T., Danna P., Della Corte F., De Vecchi S., Dianzani U., Di Benedetto D., Esposto E., Faggiano F., Falaschi Z., Ferrante D., Ferrero A., Gagliardi I., Gaidano G., Galbiati A., Gallo S., Garavelli P. L., Gardino C. A., Garzaro M., Gastaldello M. L., Gavelli F., Gennari A., Giacomini G. M., Giacone I., Giai Via V., Giolitti F., Gironi L. C., Gramaglia C., Grisafi L., Inserra I., Invernizzi M., Krengli M., Labella E., Landi I. C., Landi R., Leone I., Lio V., Lorenzini L., Maconi A., Malerba M., Manfredi G. F., Martelli M., Marzari L., Marzullo P., Mennuni M., Montabone C., Morosini U., Mussa M., Nerici I., Nuzzo A., Olivieri C., Padelli S. A., Panella M., Parisini A., Pasche A., Pau A., Pedrinelli A. R., Percivale I., Re R., Rigamonti C., Rizzi E., Rognoni A., Roveta A., Salamina L., Santagostino M., Saraceno M., Savoia P., Sciarra M., Schimmenti A., Scotti L., Spinoni E., Smirne C., Tarantino V., Tillio P. A., Vaschetto R., Vassia V., Zagaria D., Zavattaro E., Zeppegno P., Zottarelli F., Sainaghi P. P., Bellan, M, Patti, G, Hayden, E, Azzolina, D, Pirisi, M, Acquaviva, A, Aimaretti, G, Aluffi Valletti, P, Angilletta, R, Arioli, R, Avanzi, G, Avino, G, Balbo, P, Baldon, G, Baorda, F, Barbero, E, Baricich, A, Barini, M, Barone-Adesi, F, Battistini, S, Beltrame, M, Bertoli, M, Bertolin, S, Bertolotti, M, Betti, M, Bobbio, F, Boffano, P, Boglione, L, Borre, S, Brucoli, M, Calzaducca, E, Cammarata, E, Cantaluppi, V, Cantello, R, Capponi, A, Carriero, A, Casciaro, F, Castello, L, Ceruti, F, Chichino, G, Chirico, E, Cisari, C, Cittone, M, Colombo, C, Comi, C, Croce, E, Daffara, T, Danna, P, Della Corte, F, De Vecchi, S, Dianzani, U, Di Benedetto, D, Esposto, E, Faggiano, F, Falaschi, Z, Ferrante, D, Ferrero, A, Gagliardi, I, Gaidano, G, Galbiati, A, Gallo, S, Garavelli, P, Gardino, C, Garzaro, M, Gastaldello, M, Gavelli, F, Gennari, A, Giacomini, G, Giacone, I, Giai Via, V, Giolitti, F, Gironi, L, Gramaglia, C, Grisafi, L, Inserra, I, Invernizzi, M, Krengli, M, Labella, E, Landi, I, Landi, R, Leone, I, Lio, V, Lorenzini, L, Maconi, A, Malerba, M, Manfredi, G, Martelli, M, Marzari, L, Marzullo, P, Mennuni, M, Montabone, C, Morosini, U, Mussa, M, Nerici, I, Nuzzo, A, Olivieri, C, Padelli, S, Panella, M, Parisini, A, Pasche, A, Pau, A, Pedrinelli, A, Percivale, I, Re, R, Rigamonti, C, Rizzi, E, Rognoni, A, Roveta, A, Salamina, L, Santagostino, M, Saraceno, M, Savoia, P, Sciarra, M, Schimmenti, A, Scotti, L, Spinoni, E, Smirne, C, Tarantino, V, Tillio, P, Vaschetto, R, Vassia, V, Zagaria, D, Zavattaro, E, Zeppegno, P, Zottarelli, F, Sainaghi, P, Bellan M., Patti G., Hayden E., Azzolina D., Pirisi M., Acquaviva A., Aimaretti G., Aluffi Valletti P., Angilletta R., Arioli R., Avanzi G. C., Avino G., Balbo P. E., Baldon G., Baorda F., Barbero E., Baricich A., Barini M., Barone-Adesi F., Battistini S., Beltrame M., Bertoli M., Bertolin S., Bertolotti M., Betti M., Bobbio F., Boffano P., Boglione L., Borre S., Brucoli M., Calzaducca E., Cammarata E., Cantaluppi V., Cantello R., Capponi A., Carriero A., Casciaro F. G., Castello L. M., Ceruti F., Chichino G., Chirico E., Cisari C., Cittone M. G., Colombo C., Comi C., Croce E., Daffara T., Danna P., Della Corte F., De Vecchi S., Dianzani U., Di Benedetto D., Esposto E., Faggiano F., Falaschi Z., Ferrante D., Ferrero A., Gagliardi I., Gaidano G., Galbiati A., Gallo S., Garavelli P. L., Gardino C. A., Garzaro M., Gastaldello M. L., Gavelli F., Gennari A., Giacomini G. M., Giacone I., Giai Via V., Giolitti F., Gironi L. C., Gramaglia C., Grisafi L., Inserra I., Invernizzi M., Krengli M., Labella E., Landi I. C., Landi R., Leone I., Lio V., Lorenzini L., Maconi A., Malerba M., Manfredi G. F., Martelli M., Marzari L., Marzullo P., Mennuni M., Montabone C., Morosini U., Mussa M., Nerici I., Nuzzo A., Olivieri C., Padelli S. A., Panella M., Parisini A., Pasche A., Pau A., Pedrinelli A. R., Percivale I., Re R., Rigamonti C., Rizzi E., Rognoni A., Roveta A., Salamina L., Santagostino M., Saraceno M., Savoia P., Sciarra M., Schimmenti A., Scotti L., Spinoni E., Smirne C., Tarantino V., Tillio P. A., Vaschetto R., Vassia V., Zagaria D., Zavattaro E., Zeppegno P., Zottarelli F., and Sainaghi P. P.

Abstract

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk.

Published
2020

2. Simple parameters from complete blood count predict in-hospital mortality in covid-19

Author

Bellan, M., Azzolina, D., Hayden, E., Gaidano, G., Pirisi, M., Acquaviva, A., Aimaretti, G., Valletti, P. A., Angilletta, R., Arioli, R., Avanzi, G. C., Avino, G., Balbo, P. E., Baldon, G., Baorda, F., Barbero, E., Baricich, A., Barini, M., Barone-Adesi, F., Battistini, S., Beltrame, M., Bertoli, M., Bertolin, S., Bertolotti, M., Betti, M., Bobbio, F., Boffano, P., Boglione, L., Borre, S., Brucoli, M., Calzaducca, E., Cammarata, E., Cantaluppi, V., Cantello, R., Capponi, A., Carriero, A., Casciaro, G. F., Castello, L. M., Ceruti, F., Chichino, G., Chirico, E., Cisari, C., Cittone, M. G., Colombo, C., Comi, C., Croce, E., Daffara, T., Danna, P., Corte, F. D., de Vecchi, S., Dianzani, U., Benedetto, D. D., Esposto, E., Faggiano, F., Falaschi, Z., Ferrante, D., Ferrero, A., Gagliardi, I., Galbiati, A., Gallo, S., Garavelli, P. L., Gardino, C. A., Garzaro, M., Gastaldello, M. L., Gavelli, F., Gennari, A., Giacomini, G. M., Giacone, I., Via, V. G., Giolitti, F., Gironi, L. C., Gramaglia, C., Grisafi, L., Inserra, I., Invernizzi, M., Krengli, M., Labella, E., Landi, I. C., Landi, R., Leone, I., Lio, V., Lorenzini, L., Maconi, A., Malerba, M., Manfredi, G. F., Martelli, M., Marzari, L., Marzullo, P., Mennuni, M., Montabone, C., Morosini, U., Mussa, M., Nerici, I., Nuzzo, A., Olivieri, C., Padelli, S. A., Panella, M., Parisini, A., Pasche, A., Patrucco, F., Patti, G., Pau, A., Pedrinelli, A. R., Percivale, I., Ragazzoni, L., Re, R., Rigamonti, C., Rizzi, E., Rognoni, A., Roveta, A., Salamina, L., Santagostino, M., Saraceno, M., Savoia, P., Sciarra, M., Schimmenti, A., Scotti, L., Spinoni, E., Smirne, C., Tarantino, V., Tillio, P. A., Tonello, S., Vaschetto, R., Vassia, V., Zagaria, D., Zavattaro, E., Zeppegno, P., Zottarelli, F., Sainaghi, P. P., Aiosa, G., Airoldi, A., Barco, A., Bargiacchi, O., Bazzano, S., Berni, P., Bianchi, B., Bianco, S., Biffi, S., Binda, V., Bolgeo, T., Bolla, C., Bonato, V., Bonizzoni, G., Bragantini, A., Brustia, D., Bullara, V., Burlone, M., Brustia, F., Caccia, S., Calareso, A., Cammarota, G., Cancelliere, L., Carbone, R., Cassinari, A., Ceriani, E., Cena, T., Clivati, E., Collimedaglia, L., Colombatto, A., Cornella, C., Costanzo, M., Croce, A., de Benedittis, C., Delorenzi, S., Dionisio, R., Donato, P., Esposito, M., Fangazio, S., Feggi, A., Ferrillo, S., Foci, V., Fra, G. P., Gaggino, C., Gambaro, E., Gattoni, E., Gattoni, L., Giacchero, F., Gianfreda, R., Giubertoni, A., Grecu, L., Grossi, F., Guglielmetti, G., Guido, S., Iannantuoni, G., Ingrao, S., Jona, A., Lazzarich, E., Lissandrin, R., Maduli, E., Magne, F., Mantia, E., Marangon, D., Massara, M., Matino, E., Mauri, M. G., Menegatti, M., Moglia, R., Molinari, R., Morelli, S., Morlino, P., Naldi, P., Nebbiolo, C., Omodeo, P., Palmieri, D., Panero, A., Parodi, M., Pedrazzoli, R., Pelazza, C., Penpa, S., Perucca, R., Pirovano, A., Pittau, S., Pochetti, P., Poletti, F., Polla, B., Prandi, P., Prodam, F., Prosperini, P., Puma, A., Quaglia, M., Raie, A., Rapetti, R., Ravera, S., Re, A., Reale, M., Rossati, A., Rossi, M., Rossi, P., Rostagno, R., Salomoni, G., Sama, M. T., Sarchi, E., Sarcoli, M., Sarda, C., Sguazzotti, I., Soddu, D., Sola, D., Stobbione, P., Todoerti, M., Vallese, G. C., Varrasi, C., Veia, A., Vignazia, G. L., Zanotti, I., Zecca, E., Zichittella, D., Zisa, G., and Zoppis, E.

Subjects
Adult, Male, medicine.medical_specialty, Medicine (General), Multivariate analysis, Article Subject, Clinical Decision Rules, COVID-19, Prognosis, Blood Cell Count, Hospital Mortality, Severity of Illness Index, Clinical Biochemistry, Asymptomatic, Severity of Illness Index, NO, R5-920, Internal medicine, Clinical Decision Rules, Severity of illness, Genetics, 80 and over, Medicine, Humans, Hospital Mortality, Molecular Biology, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Biochemistry (medical), Complete blood count, COVID-19, Retrospective cohort study, Red blood cell distribution width, General Medicine, Odds ratio, Middle Aged, Prognosis, Female, Italy, Multivariate Analysis, Blood Cell Count, Cohort, medicine.symptom, business, Research Article
Abstract

Introduction. The clinical course of Coronavirus Disease 2019 (COVID-19) is highly heterogenous, ranging from asymptomatic to fatal forms. The identification of clinical and laboratory predictors of poor prognosis may assist clinicians in monitoring strategies and therapeutic decisions. Materials and Methods. In this study, we retrospectively assessed the prognostic value of a simple tool, the complete blood count, on a cohort of 664 patients ( F 260; 39%, median age 70 (56-81) years) hospitalized for COVID-19 in Northern Italy. We collected demographic data along with complete blood cell count; moreover, the outcome of the hospital in-stay was recorded. Results. At data cut-off, 221/664 patients (33.3%) had died and 453/664 (66.7%) had been discharged. Red cell distribution width (RDW) ( χ 2 10.4; p < 0.001 ), neutrophil-to-lymphocyte (NL) ratio ( χ 2 7.6; p = 0.006 ), and platelet count ( χ 2 5.39; p = 0.02 ), along with age ( χ 2 87.6; p < 0.001 ) and gender ( χ 2 17.3; p < 0.001 ), accurately predicted in-hospital mortality. Hemoglobin levels were not associated with mortality. We also identified the best cut-off for mortality prediction: a NL ratio > 4.68 was characterized by an odds ratio for in-hospital mortality OR = 3.40 (2.40-4.82), while the OR for a RDW > 13.7 % was 4.09 (2.87-5.83); a platelet count > 166,000 /μL was, conversely, protective (OR: 0.45 (0.32-0.63)). Conclusion. Our findings arise the opportunity of stratifying COVID-19 severity according to simple lab parameters, which may drive clinical decisions about monitoring and treatment.

Published
2021

3. Dal tribalismo urbano alla marginalità avanzata

Author

Scandurra, G, Rimoldi, L, Frassoldati, F, Colucci, M, Pizzo, B, Esposto, E, Valentinelli, A, Nani, M, Pozzi, G, Giubilaro, C, Picone, M, Cellamare, Pavoni, A, Tulumello, S., Scandurra, G, Rimoldi, L, Frassoldati, F, Colucci, M, Pizzo, B, Esposto, E, Valentinelli, A, Nani, M, Pozzi, G, Giubilaro, C, Picone, M, Cellamare, Pavoni, A, and Tulumello, S.

Abstract

Tra l’agosto del 1953 e il giugno del 1954 Arnold Leonard Epstein condusse un’indagine antropologica a Luanshya, città mineraria del Copperbelt (attuale Zambia), con l’intento di analizzare la formazione di alcune istituzioni giuridico-amministrative locali. Tra la fine degli anni Ottanta e i primi anni Duemila, Loïc Wacquant ha condotto una serie di ricerche teoriche ed empiriche volte a comprendere fenomeni riconducibili alla frammentazione sociale e alla povertà urbana tra Chicago e Parigi. I testi qui presentati sono frammenti dei frutti di queste inchieste etnografiche, i risultati delle quali, certamente lontani gli uni dagli altri, sono in grado, tuttavia, di mostrare un ipotetico percorso che l’antropologia ha intrapreso nel suo relazionarsi alle realtà urbane, mettendo in luce le continuità e le discontinuità da un punto di vista sia metodologico sia teorico sia del posizionamento del ricercatore nei confronti dei contesti indagati.

Published
2021

4. Alcune infezioni a trasmissione sessuale

Author

Grasso, Guido Maria, Ripabelli, Giancarlo, Sammarco, Michela Lucia, Esposto, E, Tantucci, L, Scaccia, F, Pompa, Mg, and D'Errico, Mm

Published
2011

10. La Consulta degli Specializzandi SItI presenta: 'È come te lo aspettavi?'

Author

Tantucci, L., Bartolini, R., Bentivegna, R., Brambilla, R., Cantù, A. P., Caputo, D., Cattogno, F., Chiesa, M., Corsi, R., Di Nola, A., Dinelli, F., Fanti, M., Farneti, F., Gianfagna, Francesco, Lazzari, C., Luciano, M., Mascellini, D., Matricoti, F., Mazzini, E., Molè, A., Montanari, K., Palombo, A., Pasqualetto, C., Pucci, D., Rini, F., Schieppati, S., Vigiani, N., Vitale, A., Busilacchi, G., and Esposto, E.

Subjects
Formazione professionale, Epidemiologia, Public Health
Published
2007

13. La Consulta degli Specializzandi SItI: quali aspettative?

Author

Torri, E., Schieppati, S., Bartolini, R., Bentivegna, R., Bulegato, L., Cattogno, F., Cecchini, M., Corsi, R., Di Benedetto, C., Di Legami, V., Di Nola, A., Esposto, E., Fanti, M., Franchi, S., Gallo, A., Gallo, E., Gianfagna, Francesco, Gregoretti, B., Lazzari, C., Luciano, M., Maccari, F., Marani Toro, P., Marano, E., Molè, A., Mazzini, E., Orizio, G., Pagani, G., Palla, S., Paudice, A., Pedote, P., Piras, G., Rini, F., Salemi, M., Segagli, L., Vigiani, N., Vitale, A., Zerman, T., and Tantucci, L.

Subjects
Formazione professionale, Public Health
Published
2007

16. Dal tribalismo urbano alla marginalità avanzata

Author

Rimoldi, L, Scandurra, G, Rimoldi, L, Frassoldati, F, Colucci, M, Pizzo, B, Esposto, E, Valentinelli, A, Nani, M, Pozzi, G, Giubilaro, C, Picone, M, Cellamare, Pavoni, A, and Tulumello, S.

Subjects
M-DEA/01 - DISCIPLINE DEMOETNOANTROPOLOGICHE, Antropologia, Studi Urbani, Marginalità, Tribalismo
Abstract

Tra l’agosto del 1953 e il giugno del 1954 Arnold Leonard Epstein condusse un’indagine antropologica a Luanshya, città mineraria del Copperbelt (attuale Zambia), con l’intento di analizzare la formazione di alcune istituzioni giuridico-amministrative locali. Tra la fine degli anni Ottanta e i primi anni Duemila, Loïc Wacquant ha condotto una serie di ricerche teoriche ed empiriche volte a comprendere fenomeni riconducibili alla frammentazione sociale e alla povertà urbana tra Chicago e Parigi. I testi qui presentati sono frammenti dei frutti di queste inchieste etnografiche, i risultati delle quali, certamente lontani gli uni dagli altri, sono in grado, tuttavia, di mostrare un ipotetico percorso che l’antropologia ha intrapreso nel suo relazionarsi alle realtà urbane, mettendo in luce le continuità e le discontinuità da un punto di vista sia metodologico sia teorico sia del posizionamento del ricercatore nei confronti dei contesti indagati.

Published
2021

17. Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients

Author

Lucio Boglione, Irene Cecilia Landi, Marinella Bertolotti, Alessandra Galbiati, Luca Lorenzini, Carlo Cisari, Luigia Salamina, Matteo Brucoli, Irene Giacone, Carlo Olivieri, Flavio Bobbio, Marta Betti, Maria Martelli, Paolo Amedeo Tillio, Vanessa Tarantino, Anita R. Pedrinelli, Mario Pirisi, Pietro Luigi Garavelli, Eleonora Croce, Alessandra Gennari, Francesca Zottarelli, Pietro Danna, Marco Invernizzi, Antonio Maconi, Francesca Giolitti, Sofia Battistini, Paolo Marzullo, Roberta Re, Domenico Zagaria, Francesco Gavelli, Federico Ceruti, Ilaria Leone, Greta Maria Giacomini, Leonardo Grisafi, Andrea Parisini, Stephanie Bertolin, Elia Esposto, Vincenzo Cantaluppi, Mattia Bellan, Giuseppe Patti, Emilio Chirico, Matteo Bertoli, Paolo Boffano, Paolo Aluffi Valletti, Alessandro Carriero, Cristoforo Comi, Umberto Dianzani, Eleonora Rizzi, Massimiliano Panella, Marco Sciarra, Edoardo Cammarata, Letizia Marzari, Elisa Zavattaro, Claudia Montabone, Gian Carlo Avanzi, Samuel Alberto Padelli, Massimiliano Garzaro, Pier Paolo Sainaghi, Francesco Barone-Adesi, Carlo Smirne, Gianluca Gaidano, Michela Barini, Francesco Giuseppe Casciaro, Ilaria Inserra, Laura Cristina Gironi, Ilaria Nerici, Clara Ada Gardino, Maria Luisa Gastaldello, Micol Giulia Cittone, Marco Mussa, Umberto Morosini, Andrea Capponi, Davide Di Benedetto, Fabrizio Faggiano, Crizia Colombo, Andrea Rognoni, Elisa Calzaducca, Alessio Paschè, Annalisa Roveta, Gianluca Aimaretti, Roberto Arioli, Giulia Baldon, Roberto Cantello, Ilaria Percivale, Piero Emilio Balbo, Emanuela Barbero, Silvio Borrè, Luigi Mario Castello, Patrizia Zeppegno, Ileana Gagliardi, Emanuela Labella, Alice Ferrero, Marco Krengli, Silvia Gallo, Andrea Schimmenti, Tommaso Daffara, Raffaella Landi, Paola Savoia, Giulia Francesca Manfredi, Valentina Giai Via, Michela Beltrame, Eyal Hayden, Enrico Guido Spinoni, Francesca Baorda, Cristina Rigamonti, Alessandro Nuzzo, Mario Malerba, Carla Gramaglia, Rosanna Vaschetto, Massimo Saraceno, Gianluca Avino, Marco G. Mennuni, Daniela Ferrante, Guido Chichino, Danila Azzolina, Alessio Baricich, Veronica Lio, Veronica Vassia, Alberto Pau, Roberto Angilletta, Simona De Vecchi, Antonio Acquaviva, Lorenza Scotti, Francesco Della Corte, Matteo Santagostino, Zeno Falaschi, Bellan, M, Patti, G, Hayden, E, Azzolina, D, Pirisi, M, Acquaviva, A, Aimaretti, G, Aluffi Valletti, P, Angilletta, R, Arioli, R, Avanzi, G, Avino, G, Balbo, P, Baldon, G, Baorda, F, Barbero, E, Baricich, A, Barini, M, Barone-Adesi, F, Battistini, S, Beltrame, M, Bertoli, M, Bertolin, S, Bertolotti, M, Betti, M, Bobbio, F, Boffano, P, Boglione, L, Borre, S, Brucoli, M, Calzaducca, E, Cammarata, E, Cantaluppi, V, Cantello, R, Capponi, A, Carriero, A, Casciaro, F, Castello, L, Ceruti, F, Chichino, G, Chirico, E, Cisari, C, Cittone, M, Colombo, C, Comi, C, Croce, E, Daffara, T, Danna, P, Della Corte, F, De Vecchi, S, Dianzani, U, Di Benedetto, D, Esposto, E, Faggiano, F, Falaschi, Z, Ferrante, D, Ferrero, A, Gagliardi, I, Gaidano, G, Galbiati, A, Gallo, S, Garavelli, P, Gardino, C, Garzaro, M, Gastaldello, M, Gavelli, F, Gennari, A, Giacomini, G, Giacone, I, Giai Via, V, Giolitti, F, Gironi, L, Gramaglia, C, Grisafi, L, Inserra, I, Invernizzi, M, Krengli, M, Labella, E, Landi, I, Landi, R, Leone, I, Lio, V, Lorenzini, L, Maconi, A, Malerba, M, Manfredi, G, Martelli, M, Marzari, L, Marzullo, P, Mennuni, M, Montabone, C, Morosini, U, Mussa, M, Nerici, I, Nuzzo, A, Olivieri, C, Padelli, S, Panella, M, Parisini, A, Pasche, A, Pau, A, Pedrinelli, A, Percivale, I, Re, R, Rigamonti, C, Rizzi, E, Rognoni, A, Roveta, A, Salamina, L, Santagostino, M, Saraceno, M, Savoia, P, Sciarra, M, Schimmenti, A, Scotti, L, Spinoni, E, Smirne, C, Tarantino, V, Tillio, P, Vaschetto, R, Vassia, V, Zagaria, D, Zavattaro, E, Zeppegno, P, Zottarelli, F, and Sainaghi, P

Subjects
Male, COVID-19, Viral infection, Risk factors, lcsh:Medicine, Comorbidity, Sex Factor, 030204 cardiovascular system & hematology, 0302 clinical medicine, Retrospective Studie, Case fatality rate, Pandemic, Age Factor, 030212 general & internal medicine, lcsh:Science, clinical characteristics, Aged, 80 and over, Multidisciplinary, Reverse Transcriptase Polymerase Chain Reaction, Smoking, Age Factors, Middle Aged, Coronavirus disease, Natural history, Survival Rate, Italy, Cohort, Female, Human, medicine.medical_specialty, Article, NO, 03 medical and health sciences, Sex Factors, Internal medicine, medicine, Humans, Pandemics, Survival rate, Retrospective Studies, Aged, business.industry, SARS-CoV-2, Risk Factor, lcsh:R, Retrospective cohort study, Length of Stay, medicine.disease, Obesity, lcsh:Q, Coronavirus disease, clinical characteristics, business
Abstract

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk.

Published
2020

18. The economics of green transition strategies for cities: Can low carbon,energy efficient development approaches be adapted to demand side urban water efficiency?

Author

Corrado Topi, Edoardo Esposto, Valentino Marini Govigli, Topi C., Esposto E., and Marini Govigli V.

Subjects
Payback period, 020209 energy, Geography, Planning and Development, Green development, 02 engineering and technology, 010501 environmental sciences, Management, Monitoring, Policy and Law, 01 natural sciences, Robustness (computer science), 0202 electrical engineering, electronic engineering, information engineering, Economics, 0105 earth and related environmental sciences, Nexus, Green economy transition, Demand side, business.industry, Environmental resource management, Nexu, Environmental economics, Water efficiency, Demand-side water management, Italy, Sustainability, Urban resilience, business, Efficient energy use
Abstract

Cities are major contributors to global emissions, producers of waste and consumers of resources such as energy, water and food: implementing green development strategies is hence a core challenge of modern city-planning. The attention of research has been focusing on the development of energy efficient, low carbon strategies, yet city decision-makers need truly integrated approaches, as the one proposed by the water-energy-food Nexus. The purpose of our paper is to investigate whether it is possible to take one step in this direction by extending existing approaches to energy efficiency strategies to progressively include other priority resources, in particular water. To test this hypothesis we have taken a robust and well accepted methodology, the ELCC (Economics of Low Carbon development strategies for Cities) developed by SEI and CCCEP, and we have extended it to the case of demand side water efficiency strategies for cities. We have then applied the adapted ELCC framework to the case study of the domestic sector of the city of Bologna (Italy), identifying and prioritizing several efficiency measures. Measures were evaluated through their capital investment, annual values of savings, payback period and reduction in consumption, and then aggregated in different scenarios in order to highlight potential urban investments and to showcase a possible approach to the prioritization of demand side water efficiency measures. The results show that, with an upfront investment of € 17 million, a feasible subset of Bologna’s households could be equipped with five selected cost-effective measures, generating annual savings of € 10.2 million and reducing the total domestic water consumption of 34% by 2020 compared to the 2012 initial value. With additional € 28.5 million, households could be equipped with more costly appliances reaching an overall water reduction of 37% by 2020. Our findings confirm that it is possible to successfully extend current approaches to urban energy efficiency strategies to include demand side water efficiency, adding an important building block to the construction of an integrated Nexus-based approach to green development strategies at the city-level. We encourage further tests to confirm the robustness of the methodology.

Published
2016

22. Trichophyton erinacei infection in humans: a case report and a literature review.

Author

Cammarata E, Cristo ND, Airoldi C, Veronese F, Esposto E, Giacomazzi C, Coppo P, Zavattaro E, and Savoia P

Subjects
Adult, Animals, Female, Humans, Male, Hedgehogs microbiology, Terbinafine therapeutic use, Antifungal Agents therapeutic use, Tinea diagnosis, Tinea drug therapy, Tinea microbiology, Tinea transmission, Trichophyton isolation & purification, Zoonoses microbiology, Zoonoses drug therapy, Zoonoses diagnosis
Abstract

Background: Trichophyton (T.) erinacei is a rare but emerging zoonotic dermatophyte that is rarely isolated as a human pathogen, with only a few cases extensively described in the literature., Patients and Methods: We conducted a systematic search to identify eligible articles reporting demographics, clinical characteristics, and the therapeutic approach regarding T. erinacei infection in humans., Results: 168 patients affected by T. erinacei were reported in the international literature between inception and November 2023. Only 56 cases (32.1%) were fully described. The median age at diagnosis was 26 years, the female/male ratio was around 2:1. The main source of the disease was the hedgehog. The infection presented with a combination of erythema, scaly plaques, pustules, papules, vesicles, oedema, and erosion; the most common locations were the hands and the head. The most frequently conducted examination was fungal culture, but gene sequencing and mass spectrometry improved both speed and precision in the most recent diagnostic course. Topical clotrimazole and systemic terbinafine were the most chosen treatment., Conclusions: Trichophyton erinacei should be considered in patients with erythematous scaly patches and recent contact with hedgehogs. Terbinafine should be considered as a first-line effective treatment, griseofulvin and azoles could be considered valid alternatives., (© 2024 Deutsche Dermatologische Gesellschaft (DDG).)

Published
2024
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23. Mohs micrographic technique in high-risk basal cell carcinoma: a 3D prediction of safety margins.

Author

Cammarata E, Esposto E, Airoldi C, Giorgione R, Boggio P, and Savoia P

Subjects
Humans, Male, Female, Aged, Middle Aged, Aged, 80 and over, Adult, Mohs Surgery, Carcinoma, Basal Cell surgery, Carcinoma, Basal Cell pathology, Margins of Excision, Skin Neoplasms surgery, Skin Neoplasms pathology
Abstract

Objective: Compared with standard excision with a two-dimensional histological examination, Mohs micrographic surgery offers a lower recurrence rate and a greater extent of healthy tissue sparing for the treatment of high-risk basal cell carcinoma (BCC). The aims of this study were to first quantify the healthy tissue spared through the micrographic technique compared to traditional surgery for high-risk tumours. Then, to speculate, through the analysis of the distal micrographic resection margin, the adequate width of safety margins for standard excision., Method: A cohort of patients with high-risk BCC was treated with Mohs surgery. Safety margins, tumours residual final breach and hypothetical standard excision safety margins areas were recorded., Results: A total of 96 patients were included. A reduction of 27.96% (95% Confidence Interval (CI): 17.90-38.02) of healthy skin removed was observed using a micrographic method compared to the standard approach. Standard excision with a 6mm safety margin was associated with 86.46% (95% CI: 79.62-93.30) of complete excision. Greater margins were not associated with a statistically significant improvement of complete excision., Conclusion: Mohs surgery should be considered the gold standard operative treatment for high-risk BCC. However, if micrographic techniques are not feasible, the standard excision with a predetermined margin of 6 mm, should be considered as the best option.

Published
2024
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24. A prospective randomized controlled trial of Psychodermatology on the efficacy of Rilastil Difesa Sterile® cream in the hand eczema of healthcare workers during the COVID-19 pandemic.

Author

Veronese F, Esposto E, Airoldi C, Gramaglia C, Bestagini L, Zavattaro E, Zeppegno P, and Savoia P

Subjects
Humans, Emollients, Health Personnel, Treatment Outcome, COVID-19, Eczema drug therapy
Abstract

Hand eczema is one of the most frequent dermatological diseases, with an incidence increased during the COVID-19 pandemic. The impact on life quality is considerable, giving rise to the need for a psycho-dermatological approach. This is a Randomized Control Trial (RCT) evaluating, either by the dermatological or psychological point of view, the effectiveness of an emollient and rehydrating topical product (Rilastil Difesa Sterile® cream) versus a standard treatment (i.e. moisturizing basic cream) in a group of 51 healthcare workers suffering from hand eczema during the COVID-19 pandemic. The enrolled subjects were randomized into a treatment or a control arm, treated for 8 weeks, and monitored through a clinical score (HECSI) and questionnaires evaluating the impact of the pathology and treatment on quality of life (DLQI and QOLHEQ). A psychometric evaluation was performed using the SCL-90 R, OCI-R, and CPDI scales. Our data, despite not reaching the statistical significance, demonstrated that both the clinical and psychological scores decreased mostly in patients treated with Rilastil Difesa Sterile ® cream when compared to those treated with simple topical emollients. Moreover, we observed a high level of psychic suffering in dermatological patients and a parallel change in dermatological and psychological indicators, thus confirming their connection.

Published
2023
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25. Aquaporin 1, Aquaporin 8, and Aquaporin 9 Expressions in Malignant Melanoma: A Possible Correlation with Prognosis and Clinical Outcome.

Author

Camillo L, Esposto E, Gironi LC, Airoldi C, Alhamed SA, Boldorini RL, Zavattaro E, and Savoia P

Abstract

Aquaporins (AQPs) are small transmembrane proteins able to facilitate the passive transport of water and small molecules throughout cells. Several studies have demonstrated that modulation of AQPs' expression contributes to cancer development and progression. However, to date, very little is known about their involvement in malignant melanoma (MM) progression. In this retrospective observational study, we evaluated the correlation between AQP1, -8, and -9 expression and the clinical outcomes of 58 patients diagnosed with MM from 2014 to 2016, of which 14 were diagnosed as nodular melanoma (NM) and 44 as superficial spreading melanoma (SSM). In general, we found that AQPs were more highly expressed in SSM than NM, suggesting a potential correlation with prognosis. While analyzing the expression of each AQP, we discovered that AQP1 was associated with a specific body site and low mitotic index, AQP8 with a negative sentinel lymph node, and AQP9 with the Breslow thickness and lack of ulcerations. Together with the survival analysis performed in this study, our results suggest that the expression of AQP1, -8, and -9 could be correlated with a better prognosis for malignant melanoma.

Published
2023
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26. Defense style and psychopathology in oncological patients: a preliminary report.

Author

Ribolsi M, Esposto E, Cancelliere F, Albergo G, Di Lorenzo G, Di Lazzaro V, and Tonini G

Subjects
Female, Humans, Adolescent, Young Adult, Adult, Middle Aged, Medical Oncology, Anxiety etiology, Adaptation, Psychological, Mental Disorders, Neoplasms
Abstract

Introduction: Previous studies shows that 30-40% of oncological and hematological patients report symptoms of distress compatible with a psychiatric disorder. The use of various and mostly unconscious defense mechanisms is implemented to cope with increased suffering after a cancer diagnosis. In this preliminary report, we explored the presence of defense mechanisms and their associations with psychopathological dimensions in a sample of late-stage cancer patients without history of psychiatric disorders., Methods: We recruited 50 patients (28 females, 18-64 years old) with cancer diagnosis without prior history of any substance use disorder or psychiatric disorders. All participants were given the following self-report questionnaires: the Symptom Checklist 90 (SCL-90) and the 40-item version of the Defense Style Questionnaire (DSQ-40)., Results: In our study we demonstrated significant psychiatric distress in a third of our patients (defined as SCL-90 ≥2 points). A Pearson correlation analysis on all patients shows that psychotic defense styles were correlated with hostility, obsessive-compulsive, anxiety, somatization, interpersonal sensitivity, and psychoticism, while neurotic defense styles correlated with somatization., Discussion and Conclusion: Our results are in line with previous findings showing that one third of cancer patients suffers from a psychiatric disorder. Moreover, we found that somatization correlates with both psychotic and neurotic defense mechanism styles. This demonstrates the importance of assessing oncological patients coping mechanisms to achieve best possible treatment.

Published
2023
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27. Temporal correlation between the first melanoma and the first noncutaneous tumor in CKDN2A genotyped patients.

Author

Gironi LC, Esposto E, Zottarelli F, Giorgione R, Farinelli P, Zavattaro E, Cammarata E, Di Cristo N, Ogliara P, Camillo L, Giordano M, Mellone S, Pasini B, Ambrosi A, and Savoia P

Subjects
Humans, Genotype, Melanoma, Cutaneous Malignant, Cyclin-Dependent Kinase Inhibitor p16 genetics, Melanoma complications, Melanoma genetics, Melanoma pathology, Skin Neoplasms complications, Skin Neoplasms genetics, Skin Neoplasms pathology
Abstract

CDKN2A pathogenic variants are well known to be associated with cutaneous melanoma and noncutaneous tumors (NCTs). Herein, we investigated the temporal correlation between the first cutaneous melanoma and NCT both in CDKN2A mutation carriers (MUT) and in wild-type melanoma patients, a poorly explored issue to date. Two hundred forty-five cutaneous melanoma patients were genotyped for the CDKN2A gene and divided into 51 MUT and 189 wild-type; the remaining five variant carriers were excluded from the analyses. MUT developed a significantly higher number of cutaneous melanoma than wild-type, while 13.7% in both genotyped groups received a diagnosis of at least one malignant NCT, without statistically significant differences. The onset of the first cutaneous melanoma preceded that of the first malignant or benign NCT in both MUT and wild-type patients by an average of 4.5 and 3.02 years, respectively. Considering only malignant tumors, the diagnosis of melanoma preceded that of the first NCT on an average of 8 and 4.34 years, in MUT and wild-type patients respectively. We emphasize the relevance to adopt a global vision for the primary and secondary surveillance of patients affected by cutaneous melanoma, not only limited to high-risk for multiple primary skin cancers but also to NCT that may develop several years after the diagnosis of the first cutaneous melanoma., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2023
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28. Prevalence of Self-Reported Hand Eczema Signs among Healthcare Workers after the Third Wave of COVID-19 Pandemic: A Survey in a Northern Italy Hospital.

Author

Veronese F, Esposto E, Airoldi C, Gramaglia C, Zeppegno P, Zavattaro E, and Savoia P

Subjects
Humans, Pandemics prevention & control, Self Report, Prevalence, Cross-Sectional Studies, Health Personnel, Surveys and Questionnaires, Personnel, Hospital, Hospitals, COVID-19 epidemiology, Eczema epidemiology
Abstract

Background: Proper hand hygiene is one of the enhanced preventive measures immediately proposed to avoid the spreading of the severe acute respiratory syndrome coronavirus-2, also known as COVID-19. Objectives: The objective of this study was to estimate the prevalence of self-reported hand eczema signs and symptoms among healthcare workers in a Northern Italy University Hospital after the third wave of the COVID-19 pandemic. Materials and methods: A cross-sectional study was conducted in June 2021. The hospital workers were invited to complete an online questionnaire through a link sent via institutional e-mail to both health personnel and support staff. Results: Eight-hundred and sixty-three subjects completed the questionnaire; 51.1% of them self-reported suffering from at least one hand skin lesion. One-hundred thirty-seven responders declared that they changed their hand hygiene habits, and 88.9% of them carried out these modifications both in occupational and domestic environments. In detail, a change in terms of daily hand washing frequency is reported as follows: before the COVID-19 pandemic, only 27.8% and 10.1% of responders washed their hands 10-20 and 20+ times per day, respectively, while after the pandemic, the percentage increased to 37.8% and 45.8%, respectively. When comparing the health care workers with the administrative staff, we observed a statistically significative difference ( p = 0.0001) in the daily hand washing frequency among the two groups, with a higher value in health care personnel. Accordingly, a higher prevalence of hand eczema signs (52.8% versus 45.6%) was detected in the healthcare group. Conclusions: We underline the potential role of the pandemic in the spread of hand eczema as an occupational disease and the need to implement its prevention.

Published
2023
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30. COVID-19 first lockdown and outpatient hospital setting: a single center, real life study focusing on pattern changes in patients' ethnicities and treated dermatoses.

Author

Gironi LC, Esposto E, Giorgione R, Zavattaro E, Farinelli P, Giordano M, Mellone S, Buja A, Pigatto PD, Damiani G, and Savoia P

Subjects
Communicable Disease Control, Emergency Service, Hospital, Hospitals, Humans, Outpatients, Pandemics prevention & control, Retrospective Studies, SARS-CoV-2, COVID-19 epidemiology, Skin Diseases epidemiology
Abstract

Background: During the first Italian lockdown period, the imponent amount of hospital COVID-19 patients forced the healthcare system to re-organize visits but no information are available on outpatient ethnical patterns. Here we evaluated healthcare management changes on dermatological outpatient non-surgical settings visits during the SARS-CoV-2 pandemic., Methods: In this retrospective study we collected data of scheduled, performed and not-performed visits, together with patients' characteristics (i.e., age, gender) with a particular attention for ethnicities among the outpatients accessing during the first Italian lockdown (March 5-April 30, 2020). Then, we compared these data with the corresponding ones in 2019 (before COVID-19 pandemic)., Results: During the Italian lockdown the dermatological department registered a great decrement (-83.5%, P<0.001) in visits compared to the corresponding time period in 2019. Performed and scheduled visits to non-oncological stable patients together with emergency accesses to dermatology decreased. Non-Italian patients decreased accesses, especially the South East Asians (-70.4%) and North Africans (-90.0%)., Conclusions: Hospitals policy and mass media deeply condition the public opinion, and this aspect may explain a different access to the hospital among non-Italian patients. Telemedicine should be promoted especially among non-Italian communities in Italy to overgo patients' skepticism and incentivize prevention and early treatment in dermatological conditions.

Published
2022
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32. Facial dermatoses and use of protective mask during Covid-19 pandemic: A clinical and psychological evaluation in patients affected by moderate-severe atopic dermatitis under treatment with dupilumab.

Author

Vanessa M, Elia E, Federica V, Edoardo C, Chiara A, Francesca G, and Paola S

Subjects
Antibodies, Monoclonal, Humanized, Humans, Pandemics prevention & control, SARS-CoV-2, Severity of Illness Index, Treatment Outcome, COVID-19, Dermatitis, Atopic complications, Dermatitis, Atopic drug therapy, Dermatitis, Atopic epidemiology, Eczema complications, Facial Dermatoses complications
Abstract

During the SARS-COV-2 pandemic, using face masks became mandatory in many countries. Although evidence suggests that masks can exacerbate several inflammatory skin diseases, few studies focus on their real impact on eczema localized to the face in atopic dermatitis (AD) patients. The aim of this study is to evaluate facial eczema prevalence during pandemic and its psychological impact in AD patients pre-assessed for systemic treatment and/or in therapy with dupilumab. This study includes 71 patients affected by moderate-severe AD, treated with dupilumab at SCDU of Dermatology in Novara, Italy. We calculated the number of subjects with facial involvement in pre- and post-pandemic periods and the related localization trend. We evaluated, in the two groups, clinical and psychological indicators recorded at each visit and the score modifications during the observational period. No statistically significant differences were observed in facial eczema prevalence, between pre- and post-pandemic periods (p = 0.7618) and in facial eczema remission among the two groups (p = 0.1903). In post-pandemic period, psychological scores were significantly lower (DLQI and HADS respectively with p < 0.0001 and p = 0.0025) and the reduction in EASI score during observational period was significantly greater (p = 0.0001). Our analysis revealed a potential protective effect of masks on face eczema, suggesting that they could enhance dupilumab efficacy. Face masks, covering sensitive areas, can positively contribute to mental distress in patients with facial eczema, and being associated with a lower allergic diseases incidence may sustain dupilumab in reducing AD severity., (© 2022 The Authors. Dermatologic Therapy published by Wiley Periodicals LLC.)

Published
2022
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33. Nicotinamide Attenuates UV-Induced Stress Damage in Human Primary Keratinocytes from Cancerization Fields.

Author

Camillo L, Gironi LC, Zavattaro E, Esposto E, and Savoia P

Subjects
DNA Damage, Humans, Inflammation metabolism, Keratinocytes metabolism, Reactive Oxygen Species metabolism, Ultraviolet Rays adverse effects, Niacinamide pharmacology, Nitric Oxide metabolism
Abstract

UVB radiation directly damages DNA, increases ROS and nitric oxide (NO) release, and promotes inflammation leading to genomic instability and cell death. Nicotinamide (NAM) is the precursor of NAM adenine dinucleotide, essential for cell energy production and DNA damage repair. NAM protects HaCat cells from UV-induced impairment; however, little is known about its effects on human primary keratinocytes and those isolated from field cancerization (i.e., field cancerization human primary keratinocytes [FC-HPKs]). We examined the role of NAM against UV-induced oxidative stress damages in FC-HPKs, isolated from precancerous lesions and skin cancers, and in normal human epidermal keratinocytes. Cells were treated for 18, 24, and 48 hours with NAM (5, 25, and 50 μM, respectively) before UVB irradiation. FC-HPK showed four-fold higher basal ROS levels than normal human epidermal keratinocytes; NAM downregulated ROS production only in irradiated FC-HPKs, which showed a greater sensibility to UV rays. UV exposure increased OGG1, inducible nitric oxide synthase, and IL-1β expression, an effect counteracted by NAM pretreatment. Intracellular nitric oxide production and DNA damages were inhibited by NAM exposure before irradiation. Collectively, our findings indicate that pretreatment with 25 μM NAM 24 hours before UVB irradiation effectively prevents oxidative stress formation, DNA damage, and inflammation in both normal human epidermal keratinocytes and FC-HPKs., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Published
2022
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34. The impact of COVID-19 pandemics on dermatologic surgery: real-life data from the Italian Red-Zone.

Author

Gironi LC, Boggio P, Giorgione R, Esposto E, Tarantino V, Damiani G, and Savoia P

Subjects
Communicable Disease Control, Dermatologic Surgical Procedures, Humans, Italy epidemiology, Pandemics, Retrospective Studies, SARS-CoV-2, COVID-19 epidemiology
Abstract

Background: The COVID-19 pandemic is challenging healthcare systems worldwide. Dermatology had to re-prioritize visits, guarantee urgent care, and ensure continuity for chronic patients., Objectives: To evaluate the COVID-19 impact on dermatologic surgery outpatient management., Material and Methods: In this real-life retrospective observational study, we evaluated both major and minor outpatient surgeries (MaOS and MiOS) performance in 2020, before and during the first month of lockdown declaration, in a primary referral center in Northern Italy. During the lockdown, all lifesaving and cancer surgery, (approximately 80% of our usual activities), were continued. Data from 2020 were compared with the 2019 corresponding periods to assess the real-life impact of COVID-19 in dermatologic surgical activities., Results: From January 1st to April 3rd, 2020 we performed 769 interventions, compared to 908 over the corresponding 2019 period. After the lockdown, scheduled surgeries were reduced by 14.8%; overall performed ones displayed a reduction of 46.5% (51.6% MaOS, 44.2% MiOS). 52.9% and 12.5% procedures were canceled due to patients' renunciation and due to confirmed/suspected COVID-19, respectively., Conclusions: While reduced in number, dermatologic surgeries, similarly to other surgical specialties, remained operative to provide oncological and/or life-saving procedures.

Published
2022
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35. Simple Parameters from Complete Blood Count Predict In-Hospital Mortality in COVID-19.

Author

Bellan M, Azzolina D, Hayden E, Gaidano G, Pirisi M, Acquaviva A, Aimaretti G, Aluffi Valletti P, Angilletta R, Arioli R, Avanzi GC, Avino G, Balbo PE, Baldon G, Baorda F, Barbero E, Baricich A, Barini M, Barone-Adesi F, Battistini S, Beltrame M, Bertoli M, Bertolin S, Bertolotti M, Betti M, Bobbio F, Boffano P, Boglione L, Borrè S, Brucoli M, Calzaducca E, Cammarata E, Cantaluppi V, Cantello R, Capponi A, Carriero A, Casciaro GF, Castello LM, Ceruti F, Chichino G, Chirico E, Cisari C, Cittone MG, Colombo C, Comi C, Croce E, Daffara T, Danna P, Della Corte F, De Vecchi S, Dianzani U, Di Benedetto D, Esposto E, Faggiano F, Falaschi Z, Ferrante D, Ferrero A, Gagliardi I, Galbiati A, Gallo S, Garavelli PL, Gardino CA, Garzaro M, Gastaldello ML, Gavelli F, Gennari A, Giacomini GM, Giacone I, Giai Via V, Giolitti F, Gironi LC, Gramaglia C, Grisafi L, Inserra I, Invernizzi M, Krengli M, Labella E, Landi IC, Landi R, Leone I, Lio V, Lorenzini L, Maconi A, Malerba M, Manfredi GF, Martelli M, Marzari L, Marzullo P, Mennuni M, Montabone C, Morosini U, Mussa M, Nerici I, Nuzzo A, Olivieri C, Padelli SA, Panella M, Parisini A, Paschè A, Patrucco F, Patti G, Pau A, Pedrinelli AR, Percivale I, Ragazzoni L, Re R, Rigamonti C, Rizzi E, Rognoni A, Roveta A, Salamina L, Santagostino M, Saraceno M, Savoia P, Sciarra M, Schimmenti A, Scotti L, Spinoni E, Smirne C, Tarantino V, Tillio PA, Tonello S, Vaschetto R, Vassia V, Zagaria D, Zavattaro E, Zeppegno P, Zottarelli F, and Sainaghi PP

Subjects
Adult, Aged, Aged, 80 and over, COVID-19 diagnosis, Female, Humans, Italy epidemiology, Male, Middle Aged, Multivariate Analysis, Prognosis, Retrospective Studies, Blood Cell Count, COVID-19 blood, COVID-19 mortality, Clinical Decision Rules, Hospital Mortality, Severity of Illness Index
Abstract

Introduction: The clinical course of Coronavirus Disease 2019 (COVID-19) is highly heterogenous, ranging from asymptomatic to fatal forms. The identification of clinical and laboratory predictors of poor prognosis may assist clinicians in monitoring strategies and therapeutic decisions., Materials and Methods: In this study, we retrospectively assessed the prognostic value of a simple tool, the complete blood count, on a cohort of 664 patients ( F 260; 39%, median age 70 (56-81) years) hospitalized for COVID-19 in Northern Italy. We collected demographic data along with complete blood cell count; moreover, the outcome of the hospital in-stay was recorded., Results: At data cut-off, 221/664 patients (33.3%) had died and 453/664 (66.7%) had been discharged. Red cell distribution width (RDW) ( χ 2 10.4; p < 0.001), neutrophil-to-lymphocyte (NL) ratio ( χ 2 7.6; p = 0.006), and platelet count ( χ 2 5.39; p = 0.02), along with age ( χ 2 87.6; p < 0.001) and gender ( χ 2 17.3; p < 0.001), accurately predicted in-hospital mortality. Hemoglobin levels were not associated with mortality. We also identified the best cut-off for mortality prediction: a NL ratio > 4.68 was characterized by an odds ratio for in-hospital mortality (OR) = 3.40 (2.40-4.82), while the OR for a RDW > 13.7% was 4.09 (2.87-5.83); a platelet count > 166,000/ μ L was, conversely, protective (OR: 0.45 (0.32-0.63))., Conclusion: Our findings arise the opportunity of stratifying COVID-19 severity according to simple lab parameters, which may drive clinical decisions about monitoring and treatment., Competing Interests: The authors have no conflict of interest to declare., (Copyright © 2021 Mattia Bellan et al.)

Published
2021
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36. North Italy: Welcome to the Tropics!

Author

Veronese F, Graziola F, Farinelli P, Zavattaro E, Tarantino V, Esposto E, and Savoia P

Abstract

We describe a case of cutaneous Larva Migrans in an 8-year-old Caucasian girl. The lesion appeared ten days after a bath in the river in a valley in the north-east of Piedmont. The patient was successfully treated with Albendazole 400 mg daily for 5 days. Autochthonous cases are rare, particularly in northern Italy. Probably the high temperatures and the high degree of humidity favored by the climate changes to which Europe is subjected are favorable to the development of larvae. The diagnosis of cutaneous Larva Migrans should, therefore, be considered also in individuals who have not traveled in geographic areas at risk for the climate.

Published
2021
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37. Minced Skin Grafting: A Minimally Invasive and Low-Cost Procedure to Treat Pyoderma Gangrenosum.

Author

Cammarata E, Giorgione R, Esposto E, Mazzoletti V, Boggio P, and Savoia P

Subjects
Adult, Humans, Male, Pyoderma Gangrenosum pathology, Transplantation, Autologous methods, Wound Healing, Pyoderma Gangrenosum therapy, Skin Transplantation methods
Abstract

Abstract: Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that usually presents as a painful ulcer with erythematous and undermined borders and is often characterized by pathergy. Although this condition precludes a surgical approach, in cases resistant to treatment with immunosuppressive agents, skin grafts and amputation are considered last resorts. Both expose the patient to the risk of developing new lesions. A minimally invasive autologous graft, "minced micrografts," is a possible alternative to speed up the healing process, reducing the risk of pathergy.This procedure was implemented in a 28-year-old man with PG who was prescribed prednisone and dapsone and who had a large ulcer on the arm and armpit that had persisted for 4 months and was undergoing slow re-epithelialization. A sample of finely minced skin previously taken from the clavicular region suspended in a hydrogel was spread on the wound bed in a proportion of less than 1:6 with respect to the receiving site. Seven days later, initial signs of re-epithelialization appeared, and the wound healed in 3 months.In patients with PG, the minced micrograft method could facilitate ulcer healing by releasing cytokines, chemokines, and growth factors, thus promoting granulation tissue formation, neoangiogenesis. Because this method does not require special equipment or complex surgical techniques and is very low cost, it should be an integral part of the arsenal of procedures aimed at improving the quality of life of patients with PG., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2021
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38. Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients.

Author

Bellan M, Patti G, Hayden E, Azzolina D, Pirisi M, Acquaviva A, Aimaretti G, Aluffi Valletti P, Angilletta R, Arioli R, Avanzi GC, Avino G, Balbo PE, Baldon G, Baorda F, Barbero E, Baricich A, Barini M, Barone-Adesi F, Battistini S, Beltrame M, Bertoli M, Bertolin S, Bertolotti M, Betti M, Bobbio F, Boffano P, Boglione L, Borrè S, Brucoli M, Calzaducca E, Cammarata E, Cantaluppi V, Cantello R, Capponi A, Carriero A, Casciaro FG, Castello LM, Ceruti F, Chichino G, Chirico E, Cisari C, Cittone MG, Colombo C, Comi C, Croce E, Daffara T, Danna P, Della Corte F, De Vecchi S, Dianzani U, Di Benedetto D, Esposto E, Faggiano F, Falaschi Z, Ferrante D, Ferrero A, Gagliardi I, Gaidano G, Galbiati A, Gallo S, Garavelli PL, Gardino CA, Garzaro M, Gastaldello ML, Gavelli F, Gennari A, Giacomini GM, Giacone I, Giai Via V, Giolitti F, Gironi LC, Gramaglia C, Grisafi L, Inserra I, Invernizzi M, Krengli M, Labella E, Landi IC, Landi R, Leone I, Lio V, Lorenzini L, Maconi A, Malerba M, Manfredi GF, Martelli M, Marzari L, Marzullo P, Mennuni M, Montabone C, Morosini U, Mussa M, Nerici I, Nuzzo A, Olivieri C, Padelli SA, Panella M, Parisini A, Paschè A, Pau A, Pedrinelli AR, Percivale I, Re R, Rigamonti C, Rizzi E, Rognoni A, Roveta A, Salamina L, Santagostino M, Saraceno M, Savoia P, Sciarra M, Schimmenti A, Scotti L, Spinoni E, Smirne C, Tarantino V, Tillio PA, Vaschetto R, Vassia V, Zagaria D, Zavattaro E, Zeppegno P, Zottarelli F, and Sainaghi PP

Subjects
Age Factors, Aged, Aged, 80 and over, COVID-19 virology, Comorbidity, Female, Humans, Italy epidemiology, Length of Stay, Male, Middle Aged, Retrospective Studies, Reverse Transcriptase Polymerase Chain Reaction, Risk Factors, Sex Factors, Smoking, Survival Rate, COVID-19 epidemiology, COVID-19 mortality, Pandemics, SARS-CoV-2 genetics
Abstract

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO 2 /FiO 2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk.

Published
2020
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39. Safety margins for dermatofibrosarcoma protuberans: a comparison between wide local excision and Mohs Tubingen technique.

Author

Cammarata E, Esposto E, Veronese F, Airoldi C, Zavattaro E, Boggio P, and Savoia P

Subjects
Adult, Aged, Dermatofibrosarcoma pathology, Female, Humans, Male, Middle Aged, Mohs Surgery adverse effects, Organ Sparing Treatments adverse effects, Retrospective Studies, Skin Neoplasms pathology, Tumor Burden, Dermatofibrosarcoma surgery, Margins of Excision, Mohs Surgery methods, Neoplasm Recurrence, Local etiology, Skin Neoplasms surgery
Abstract

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare, locally infiltrating, rarely metastasizing, soft tissue tumour. Due to its indistinct margins, local aggressive behaviour and high recurrence rate, the surgical approach is complex. Micrographic surgery and variants of this technique, e.g. Tubingen torte technique (TTT), should be considered as first-line treatment., Objectives: To confirm that TTT is a safe and tissue-sparing technique, relative to theoretical wide local excision (WLE), for the same lesions, as recommended by the guidelines in the literature., Materials and Methods: Seventeen patients with histologically confirmed DFSP, treated with TTT between September 2014 and February 2019, were retrospectively analysed. For each patient, the final TTT excision area was calculated and compared with the theoretical equivalent area based on WLE. The difference in area was calculated and presented as percentage difference of preserved healthy skin based on the two approaches., Results: In our patients, the mean preoperative lesion size was 4.55 ± 5.34 cm 2 . The mean final total excised area was 17.73 ± 11.75 cm 2 for TTT and 53.65 ± 15.57 cm 2 for WLE. The amount of preserved healthy tissue using the micrographic technique was significant; 69.15% (95% CI: 62.95-75.36) of healthy tissue was preserved using TTT. No recurrence or metastases were observed in any of the patients after a median follow-up period of 38.00 ± 21 months., Conclusion: In our experience, TTT remains a safe, effective and tissue-sparing treatment for DFSP patients, especially when it is essential to spare tissue and in challenging locations.

Published
2020
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40. Melanoma-prone families: new evidence of distinctive clinical and histological features of melanomas in CDKN2A mutation carriers.

Author

Gironi LC, Colombo E, Pasini B, Giorgione R, Farinelli P, Zottarelli F, Esposto E, Zavattaro E, Allara E, Ogliara P, Betti M, Dianzani I, and Savoia P

Subjects
Adult, Age Distribution, Case-Control Studies, DNA Mutational Analysis, Female, Genetic Predisposition to Disease, Heredity, Humans, Italy epidemiology, Male, Melanoma enzymology, Melanoma ethnology, Melanoma pathology, Middle Aged, Pedigree, Phenotype, Risk Factors, Sex Distribution, Skin Neoplasms enzymology, Skin Neoplasms ethnology, Skin Neoplasms pathology, White People genetics, Young Adult, Biomarkers, Tumor genetics, Cyclin-Dependent Kinase Inhibitor p16 genetics, Germ-Line Mutation, Heterozygote, Melanoma genetics, Skin Neoplasms genetics
Abstract

Germline mutations on the CDKN2A gene, the most important known genetic factors associated with cutaneous melanomas (CMs), predispose carriers to multiple primary CMs (MPMs) with higher frequency and younger onset compared to non-carriers. Most of the largest published studies concerning clinical and histological characteristics of CMs with CDKN2A mutation carriers did not specify if the described CMs are first or subsequent to the first, and they used sporadic CMs from non-genotyped patients as controls. We conducted a single-centre observational study to compare clinical and histological CM features of 32 unrelated carriers (MUT) of 5 germline CDKN2A mutations (one of which was never previously described) compared to 100 genotyped wild-type (WT) patients. We stratified the data based on time of diagnosis, anatomical site and histological subtype of CMs, demonstrating several significant unreported differences between the two groups. MUT developed a higher number of dysplastic nevi and MPMs. We proved for the first time that anatomical distribution of CMs in MUT was independent of gender, unlike WTs. MUTs developed in situ and superficial spreading melanomas (SSMs) more frequently, with significantly higher number of SSMs on the head/neck. In MUTs, Breslow thickness was significantly lower for all invasive CMs. When CMs were stratified on the basis of the time of occurrence, statistical significance was maintained only for SSMs subsequent to the first. In WTs, Clark level was significantly higher, and ulceration was more prevalent than in MUTs. Significant differences in ulceration were observed only in SSMs. In nodular CMs, we did not find differences in terms of Breslow thickness or ulceration between WTs and MUTs. In situ CMs developed 10 years earlier in MUTs with respect to WTs, whereas no significant differences were observed in invasive CMs. In contrast to those reported previously by other authors, we did not find a difference in skin phototype.

Published
2018
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41. Extended-spectrum beta-lactamases Klebsiella pneumoniae: multimodal infection control program in intensive care units.

Author

Prospero E, Barbadoro P, Esposto E, Manso E, Martini E, Savini S, Scaccia F, Tantucci L, Pelaia P, and D'Errico MM

Subjects
Cross Infection microbiology, Cross Infection transmission, Drug Resistance, Multiple, Bacterial, Electrophoresis, Gel, Pulsed-Field, Hand Disinfection standards, Hospitals, Teaching, Humans, Infectious Disease Transmission, Professional-to-Patient statistics & numerical data, Intensive Care Units statistics & numerical data, Italy, Klebsiella Infections transmission, Klebsiella pneumoniae isolation & purification, Male, beta-Lactamases biosynthesis, Cross Infection prevention & control, Infection Control methods, Infectious Disease Transmission, Professional-to-Patient prevention & control, Intensive Care Units standards, Klebsiella Infections prevention & control, Klebsiella pneumoniae enzymology, beta-Lactamases metabolism
Abstract

Introduction: The aims of our study were to investigate a nosocomial spread of an extended-spectrum fl-lactamases-Klebsiella pneumoniae cluster at a University teaching hospital in Italy, to describe, and to monitor the implementation of a multimodal infection control program in two mixed ICUs., Methods: During the 1 October 2005-30 September 2006 period, 79 colonized patients have been identified. Isolates were genotyped by pulsed-field gel electrophoresis (PFGE). A mutimodal infection control program with monitoring of alcohol-based hand rub was performed in Intensive Care Units (ICU A and ICU B)., Results: The epidemiological investigation and PFGE showed a horizontal transmission of the same PFGE genotype, with the isolation of the outbreak strain on the hand of one healthcare operator. Alcohol based hand rub was adopted in ICUA on 18 March 2006, in addition to hand washing with plain or antiseptic soap. ICU B did not change its hand hygiene habits. Following the implementation of the program, the incidence density rate (IDR) in ICU A fell down from 4.50 to 1.68/1000 patient days., Discussion and Conclusions: Our findings confirm the important role of personnel in cross-transmission. Moreover the inbuilt control group involuntarily offered by the delaying of the intervention in ICU B has given the opportunity to verify the epidemiological association between the actual implementation of infection control practices and the outbreak control.

Published
2010

42. Surveillance of acute flaccid paralysis in the Marches region (Italy): 1997-2007.

Author

D'Errico MM, Barbadoro P, Bacelli S, Esposto E, Moroni V, Scaccia F, Tantucci L, and Prospero E

Subjects
Adolescent, Child, Child, Preschool, Female, Humans, Incidence, Infant, Infant, Newborn, Italy epidemiology, Male, National Health Programs, Paralysis virology, Poliomyelitis epidemiology, Poliomyelitis prevention & control, Poliovirus pathogenicity, Paralysis epidemiology, Paralysis etiology, Population Surveillance
Abstract

Background: The last case of poliomyelitis due to transmission of indigenous wild poliovirus occurred in Italy in 1982, however, it is important to guarantee a high quality surveillance as there is a risk of importation of cases from areas where polio is endemic. Stopping poliovirus transmission is pursued through a combination of high infant immunization coverage and surveillance for wild poliovirus through reporting and laboratory testing of all cases of acute flaccid paralysis (AFP) among children under fifteen years of age. The aim of this study was to describe and to evaluate 11 years of active surveillance in the Marches (Italy) in terms of: incidence, aetiology and clinical manifestation of AFP cases., Methods: The active Acute Flaccid Paralysis surveillance has been carried out in the Marches region since February 1997 by the Chair of Hygiene which established a regional hospital network. Active surveillance involves 15 hospital centres., Results: In the considered period, 0-15 years population varied between 187,051 in 1997 to 201,625 in 2007, so the number of AFP expected cases is 2 per year. From February 1997 to October 2007, 27 cases were found with rates of 1.0/100,000 in 1997; 2.0/100,000 in 1998; 1.0/100,000 in 1999; 0.5/100,000 in 2000; 2.5/100,000 in 2001; 1.0/100,000 in 2002; 0 in 2003; 0.5/100,000 in 2004; 1.5/100,000 in 2005; 2.0/100,000 in 2006; 1.5/100,000 in 2007. In 29.6% of cases two stool samples were collected in 14 days from the symptoms onset. The 60-days follow-up is available for 23 out of 27 cases reported. In 44.5% of cases the definite diagnosis was Guillain Barrè syndrome., Conclusion: In general, the surveillance activity is satisfactory even if in presence of some criticalities in biological samples collection. The continuation of surveillance, in addition to the maintenance of current levels of performance, will tend to a further and more detailed sensitization of all workers involved, in order to obtain spontaneous and prompt reporting, and to achieve the optimal standards recommended by the WHO both in the collection of biological samples and the availability of 60 days follow-up, with the goal of eradicating polio from all countries.

Published
2008
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