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Farolfi F, Cavazza S, Mangiagalli A, Cavanna L. A 98-Year-Old Male With Paroxysmal Atrial Fibrillation Treated for COVID-19 at Home. Cureus 2022; 14:e30653. [DOI: 10.7759/cureus.30653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 11/07/2022] Open
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Murtas R, Morici N, Cogliati C, Puoti M, Omazzi B, Bergamaschi W, Voza A, Rovere Querini P, Stefanini G, Manfredi MG, Zocchi MT, Mangiagalli A, Brambilla CV, Bosio M, Corradin M, Cortellaro F, Trivelli M, Savonitto S, Russo AG. Algorithm for Individual Prediction of COVID-19-Related Hospitalization Based on Symptoms: Development and Implementation Study. JMIR Public Health Surveill 2021; 7:e29504. [PMID: 34543227 PMCID: PMC8594734 DOI: 10.2196/29504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/23/2021] [Accepted: 09/14/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has placed a huge strain on the health care system globally. The metropolitan area of Milan, Italy, was one of the regions most impacted by the COVID-19 pandemic worldwide. Risk prediction models developed by combining administrative databases and basic clinical data are needed to stratify individual patient risk for public health purposes. OBJECTIVE This study aims to develop a stratification tool aimed at improving COVID-19 patient management and health care organization. METHODS A predictive algorithm was developed and applied to 36,834 patients with COVID-19 in Italy between March 8 and the October 9, 2020, in order to foresee their risk of hospitalization. Exposures considered were age, sex, comorbidities, and symptoms associated with COVID-19 (eg, vomiting, cough, fever, diarrhea, myalgia, asthenia, headache, anosmia, ageusia, and dyspnea). The outcome was hospitalizations and emergency department admissions for COVID-19. Discrimination and calibration of the model were also assessed. RESULTS The predictive model showed a good fit for predicting COVID-19 hospitalization (C-index 0.79) and a good overall prediction accuracy (Brier score 0.14). The model was well calibrated (intercept -0.0028, slope 0.9970). Based on these results, 118,804 patients diagnosed with COVID-19 from October 25 to December 11, 2020, were stratified into low, medium, and high risk for COVID-19 severity. Among the overall study population, 67,030 (56.42%) were classified as low-risk patients; 43,886 (36.94%), as medium-risk patients; and 7888 (6.64%), as high-risk patients. In all, 89.37% (106,179/118,804) of the overall study population was being assisted at home, 9% (10,695/118,804) was hospitalized, and 1.62% (1930/118,804) died. Among those assisted at home, most people (63,983/106,179, 60.26%) were classified as low risk, whereas only 3.63% (3858/106,179) were classified at high risk. According to ordinal logistic regression, the odds ratio (OR) of being hospitalized or dead was 5.0 (95% CI 4.6-5.4) among high-risk patients and 2.7 (95% CI 2.6-2.9) among medium-risk patients, as compared to low-risk patients. CONCLUSIONS A simple monitoring system, based on primary care data sets linked to COVID-19 testing results, hospital admissions data, and death records may assist in the proper planning and allocation of patients and resources during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Rossella Murtas
- Epidemiology Unit, Agency for the Protection of Health of the Metropolitan Area of Milan, Milan, Italy
| | - Nuccia Morici
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Chiara Cogliati
- ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Massimo Puoti
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Università degli Studi Milano Bicocca, School of Medicine, Milan, Italy
| | | | - Walter Bergamaschi
- Agency for the Protection of Health of the Metropolitan Area of Milan, Milan, Italy
| | | | | | | | - Maria Grazia Manfredi
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Milan, Italy.,Ordine dei Medici Chirurghi e degli Odontoiatri di Milano, Milan, Italy
| | - Maria Teresa Zocchi
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Milan, Italy.,Ordine dei Medici Chirurghi e degli Odontoiatri di Milano, Milan, Italy
| | - Andrea Mangiagalli
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Milan, Italy.,Ordine dei Medici Chirurghi e degli Odontoiatri di Milano, Milan, Italy
| | - Carla Vittoria Brambilla
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Milan, Italy.,Ordine dei Medici Chirurghi e degli Odontoiatri di Milano, Milan, Italy
| | - Marco Bosio
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | | | | | - Antonio Giampiero Russo
- Epidemiology Unit, Agency for the Protection of Health of the Metropolitan Area of Milan, Milan, Italy
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Sighinolfi M, Battaglia M, Bellardita L, Castiglioni S, Dal Moro F, De Giorgi U, De Monte A, Di Maio M, Gaboardi F, Gontero P, Jereczek B, Leonardi R, Lombardi E, Madonia M, Mangiagalli A, Marenghi C, Marrocco W, Masini C, Miano R, Polloni G, Prezioso D, Ruffini L, Sabbatini R, Schips L, Selli C, Valdagni R, Varca V, Veneziano P, Calcagnile T, Rocco B. Prostate cancer awareness among Italian adult males: a national web-based survey. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Morici N, Puoti M, Zocchi MT, Brambilla C, Mangiagalli A, Savonitto S. Home-based COVID 19 management: A consensus document from Italian general medical practitioners and hospital consultants in the Lombardy region (Italy). Eur J Intern Med 2021; 84:94-96. [PMID: 33293151 PMCID: PMC7709719 DOI: 10.1016/j.ejim.2020.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Nuccia Morici
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Massimo Puoti
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Teresa Zocchi
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Italy; Ordine dei Medici Chirurghi e degli Odontoiatri di Milano, Milan, Italy
| | - Carla Brambilla
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Italy
| | - Andrea Mangiagalli
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Italy
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Trotti R, Carratelli M, Bo P, Barbieri M, Mangiagalli A, Samuele A, Gabanti E, Blandini F. Pro-oxidant activity and methionine metabolism in chronic alcohol abusers: relationship to alcohol withdrawal and folate administration. Panminerva Med 2004; 46:161-4. [PMID: 15510084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
AIM The aim of this study was to investigate whether alcohol withdrawal and folate administration could play a role on redox balance and metionine metabolism in heavy drinkers. METHODS The derivatives of reactive oxygen metabolites (d-ROMs), homocysteine, total thiols, vitamin B12 and folate were evaluated in a selected group of 40 consecutive chronic alcohol abusers by comparison with 44 healthy moderate drinkers, as controls. RESULTS Before alcohol withdrawal, d-ROMs were significantly higher (p<0.0001) in heavy drinkers than in controls: 368.5 (254.8-718.6) U.CARR vs 245 (200.7-360) U.CARR, respectively, median with range. Plasma homocysteine were significantly higher in alcoholics than in moderate drinkers (p<0.0001): 18 (9.5-82.2) micromol/L vs 9.1 (4.9-19.6) micromol/L, respectively. Heavy drinkers also exhibited higher serum thiols than moderate drinkers (p<0.003): 605.8 (448.2-717.7) micromol/L vs 554.8 (508.3-658.4) micromol/L, respectively. The patients showed lower plasma folate than controls (p<0.0001): 4.1 (1.9-9.7) ng/mL vs 8.8 (5.0-8.4) ng/mL, respectively, but similar vitamin B12 levels: 487 (299-786) pg/mL 621 (243-894) pg/mL. A negative correlation between homocysteine and folate was observed before withdrawal in alcoholics (r=-0.4546, p<0.038). Both serum thiols (549.7 micromol/L, range 402.4-616.6 micromol/L) and homocysteinemia (6.6 micromol/L, range 2.9-18.5 micromol/L) were significantly decreased (p<0.0001 and p<0.022, respectively) after a week of alcohol withdrawal and folate administration. CONCLUSION Our findings show that both enhanced pro-oxidant activity and a derangement of methionine metabolism can be observed in heavy drinkers before alcohol withdrawal and folate administration. Furthermore, folate seems to be a strong determinant of both plasma homocysteine and thiol concentrations.
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Affiliation(s)
- R Trotti
- Laboratory of Clinical Biochemistry, Neurological Institute C. Mondino IRCCS, Pavia, Italy.
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Blandini F, Mangiagalli A, Cosentino M, Marino F, Samuele A, Rasini E, Fancellu R, Martignoni E, Riboldazzi G, Calandrella D, Frigo GM, Nappi G. Peripheral markers of apoptosis in Parkinson's disease: the effect of dopaminergic drugs. Ann N Y Acad Sci 2004; 1010:675-8. [PMID: 15033810 DOI: 10.1196/annals.1299.123] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this study, we measured the lymphocyte levels of proteins involved in apoptosis regulation, such as Bcl-2, the peripheral benzodiazepine receptor (PBR), caspase-3, and Cu/Zn superoxide dismutase (Cu/Zn SOD), in patients with Parkinson's disease (PD), either untreated or under therapy with dopaminergic agents (l-Dopa alone or l-dopa + dopamine agonists) and in healthy volunteers. All PD groups showed increased activity of caspase-3, compared to controls, particularly those under treatment only with l-Dopa. In this latter group, the increase in caspase-3 activity was also paralleled by an increase in the concentration of Cu/Zn SOD. In addition, patients taking l-Dopa + dopamine agonists showed marked decrease in Bcl-2 levels and increased PBR expression, which seems in keeping with the hypothesis that PBR may be functionally related to Bcl-2. In conclusion, we found clear modifications in the levels of proteins involved in the control of apoptosis in lymphocytes of PD patients. These changes were disease related but also modulated by the pharmacological treatment, which confirms the potential role of apoptosis in PD pathogenesis and the modulatory influence of dopaminergic agents.
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Blandini F, Cosentino M, Mangiagalli A, Marino F, Samuele A, Rasini E, Fancellu R, Tassorelli C, Pacchetti C, Martignoni E, Riboldazzi G, Calandrella D, Lecchini S, Frigo G, Nappi G. Modifications of apoptosis-related protein levels in lymphocytes of patients with Parkinson?s disease. The effect of dopaminergic treatment. J Neural Transm (Vienna) 2004; 111:1017-30. [PMID: 15254790 DOI: 10.1007/s00702-004-0123-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2003] [Accepted: 01/20/2004] [Indexed: 10/26/2022]
Abstract
In this study, we investigated whether changes in the regulatory mechanisms of apoptosis and oxidative stress may be detected, peripherally, in patients with Parkinson's disease (PD). For this purpose, we measured caspase-3 activity, Bcl-2 concentrations, peripheral benzodiazepine receptor (PBR) expression and Cu/Zn superoxide dismutase (SOD) concentrations in lymphocytes of untreated PD patients, patients treated only with L-Dopa or with L-Dopa and dopamine agonists and healthy volunteers. Caspase-3 activity was significantly increased in all PD patient groups. Patients treated with L-Dopa and dopamine agonists showed the lowest values of Bcl-2, coupled with the highest density of PBRs, while increased levels of Cu/Zn SOD were found in the group under monotherapy with L-Dopa. We also found, in PD patients, clear, negative correlations between Bcl-2 levels and both duration and severity of the disease. Our findings point to the existence of changes in the regulatory mechanisms of apoptosis in PD patients -- observable outside the central nervous system -- which seem to be modulated by the pharmacological treatment with dopaminergic agents.
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Affiliation(s)
- F Blandini
- Laboratory of Functional Neurochemistry, Neurological Institute C. Mondino, Pavia, Italy.
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Blandini F, Mangiagalli A, Martignoni E, Samuele A, Fancellu R, Tassorelli C, Cosentino M, Marino F, Rasini E, Calandrella D, Riboldazzi G, Colombo C, Frigo GM, Nappi G. Effects of dopaminergic stimulation on peripheral markers of apoptosis: relevance to Parkinson?s disease. Neurol Sci 2003; 24:157-8. [PMID: 14598064 DOI: 10.1007/s10072-003-0107-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We investigated the effects of dopaminergic stimulation on anti-apoptotic protein Bcl-2, pro-apoptotic enzyme caspase- 3, and anti-oxidant/anti-apoptotic enzyme Cu/Zn superoxide dismutase (SOD) in human lymphocytes exposed to dopamine (DA). The same determinations were also carried out in parkinsonian patients treated with L-dopa. Caspase-3 activity and Cu/Zn SOD levels tended to increase when lymphocytes were exposed to low or intermediate doses of DA, while a decrease was observed, particularly in caspase-3 activity, with the higher DA dose. Bcl-2 levels were unaffected. In patients, we observed a negative correlation between Cu/Zn SOD levels and daily intake of L-dopa, which also tended to be negatively correlated with caspase-3 activity, but not with Bcl- 2. Our results show that dopaminergic stimulation is associated with complex changes in regulatory proteins of apoptosis.
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Affiliation(s)
- F Blandini
- IRCCS C. Mondino, Via Palestro 3, Pavia, Italy
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Blandini F, Nappi G, Fancellu R, Mangiagalli A, Samuele A, Riboldazzi G, Calandrella D, Pacchetti C, Bono G, Martignoni E. Modifications of plasma and platelet levels of L-DOPA and its direct metabolites during treatment with tolcapone or entacapone in patients with Parkinson's disease. J Neural Transm (Vienna) 2003; 110:911-22. [PMID: 12898346 DOI: 10.1007/s00702-003-0004-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We compared--retrospectively--the effects of a 3-month therapy with catechol- O-methyltransferase (COMT) inhibitors tolcapone (100 mg, t.i.d.) and entacapone (200 mg, t.i.d.), on L-DOPA metabolism in two groups of parkinsonian patients with motor fluctuations. Plasma and platelets concentrations of L-DOPA and its direct metabolites, dopamine and 3- O-methyldopa (3-OMD), were measured before starting treatment, after two weeks and at the end of treatment. Patients treated with tolcapone showed significant increases in plasma and platelet L-DOPA levels and marked reduction of plasma and platelet 3-OMD levels, both at short- and long-term. Entacapone did not modify L-DOPA levels, while inducing a less marked reduction of plasma and platelet 3-OMD concentrations, with respect to tolcapone, at both time points. Both drugs were similarly effective in increasing plasma and platelet levels of dopamine. These results confirm the different profiles of activity of the two drugs, with tolcapone proving more effective on both the intra- and extra-cellular levels of L-DOPA and 3-OMD.
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Affiliation(s)
- F Blandini
- Laboratory of Functional Neurochemistry, Neurological Institute C. Mondino, Pavia, Italy.
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Blandini F, Fancellu R, Martignoni E, Mangiagalli A, Pacchetti C, Samuele A, Nappi G. Plasma homocysteine and l-dopa metabolism in patients with Parkinson disease. Clin Chem 2001; 47:1102-4. [PMID: 11375298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- F Blandini
- Laboratory of Functional Neurochemistry, Neurological Institute C. Mondino, Via Palestro, 3 27100 Pavia, Italy.
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Braga M, Cristallo M, De Franchis R, Mangiagalli A, Agape D, Primignani M, Di Carlo V. Correction of malnutrition and maldigestion with enzyme supplementation in patients with surgical suppression of exocrine pancreatic function. Surg Gynecol Obstet 1988; 167:485-92. [PMID: 3187872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We studied the occurrence and extent of malnutrition and maldigestion in 13 patients who underwent pancreatoduodenectomy (PD) and injection of Neoprene (polychloroprene) (NI) into the duct of Wirsung, which results in sclerosis of hte acinar pancreatic tissue, but spares the endocrine function. At discharge, patients under took an enzyme supplementation regimen with pancreatin (18, 00 United States Pharmacopoeia units of lipase per meal). Patients were rehospitalized 24.9 months after PD plus NI to undergo nutritional and metabolic evaluation (hospital control). Nutritional status was evaluated by measuring the serum albumin level, total iron binding capacity and total lymphocyte count. Digestive function was assessed by the D-xylose tolerance test and determination of fecal fat excretion. Patients were then discharged with pancrelipase, enteric-coated microspheres (ECM) supplementation (16,050 United States Pharmacopoeia units of lipase per meal). Malnutrition, defined as the occurrence of at least two abnormal nutritional parameters, was observed in six patients at hospital control. After six months on pancrelipase ECM, the nutritional status was re-evaluated in nine patients (three previously malnourished) who were all well nourished. The mean body weight was 84.7 per cent of usual body weight at discharge after PD plus NI and raised to 88.0 per cent at the hospital control (p less than 0.01) and to 93.7 per cent )p less than 0.05) after six months on pancrelipase ECM. At hospital control, results from the D-xylose test were normal in all patients, and steatorrhea dropped from 33.6 grams per day without enzyme supplementation to 15.3 grams per day with pancrelipase ECM (16,050 United States Pharmacopoeia units of lipase per meal). Steatorrhea was incompletely but satisfactorily corrected by pancrelipase ECM. On supplementation therapy with pancrelipase ECM, patients recover a good deal of the body weight and normalize the biochemical indices of malnutrition.
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Affiliation(s)
- M Braga
- Scientific Institute, San Raffaele Hospital, Milano, Italy
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