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Cozzi-Lepri A, Borghi V, Rotundo S, Mariani B, Ferrari A, Del Borgo C, Bai F, Colletti P, Miraglia P, Torti C, Cattelan AM, Cenderello G, Berruti M, Tascini C, Parruti G, Coladonato S, Gori A, Marchetti G, Lichtner M, Coppola L, Sorace C, D'Abramo A, Mazzotta V, Guaraldi G, Franceschini E, Meschiari M, Sarmati L, Antinori A, Nicastri E, Mussini C. Development and validation of a prediction score for failure to casirivimab/imdevimab in hospitalized patients with COVID-19 pneumonia. Front Med (Lausanne) 2024; 11:1293431. [PMID: 38529120 PMCID: PMC10961453 DOI: 10.3389/fmed.2024.1293431] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/19/2023] [Accepted: 02/19/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Casirivimab and imdevimab (CAS/IMV) are two non-competing, high-affinity human IgG1 anti-SARS-CoV-2 monoclonal antibodies, that showed a survival benefit in seronegative hospitalized patients with COVID-19. This study aimed to estimate the day-28 risk of mechanical ventilation (MV) and death in individuals hospitalized for severe COVID-19 pneumonia and receiving CAS/IMV. Additionally, it aimed to identify variables measured at the time of hospital admission that could predict these outcomes and derive a prediction algorithm. Methods This is a retrospective, observational cohort study conducted in 12 hospitals in Italy. Adult patients who were consecutively hospitalized from November 2021 to February 2022 receiving CAS/IMV were included. A multivariable logistic regression model was used to identify predictors of MV or death by day 28 from treatment initiation, and β-coefficients from the model were used to develop a risk score that was derived by means of leave-one-out internal cross-validation (CV), external CV, and calibration. Secondary outcome was mortality. Results A total of 480 hospitalized patients in the training set and 157 patients in the test set were included. By day 28, 36 participants (8%) underwent MV and 28 died (6%) for a total of 58 participants (12%) experiencing the composite primary endpoint. In multivariable analysis, four factors [age, PaO2/FiO2 ratio, lactate dehydrogenase (LDH), and platelets] were independently associated with the risk of MV/death and were used to generate the proposed risk score. The accuracy of the score in the area under the curve (AUC) was 0.80 and 0.77 in internal validation and test for the composite endpoint and 0.87 and 0.86 for death, respectively. The model also appeared to be well calibrated with the raw data. Conclusion The mortality risk reported in our study was lower than that previously reported. Although CAS/IMV is no longer used, our score might help in identifying which patients are not likely to benefit from monoclonal antibodies and may require alternative interventions.
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Affiliation(s)
- Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Vanni Borghi
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Salvatore Rotundo
- Unit of Infectious and Tropical Diseases, University Magna Græcia, Catanzaro, Italy
| | - Bianca Mariani
- Unità Organizzativa Complessa Malattie Infettive, Fondazione Istituto di Ricovero e Cura a Caratetre Scientifico, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Ferrari
- Unità Organizzativa Complessa Malattie Infettive, Azienda Ospedale Università, Padova, Italy
| | - Cosmo Del Borgo
- Unità Organizzativa Complessa Malattie Infettive, Ospedale SM Goretti, Latina, Italy
| | - Francesca Bai
- Clinica delle Malattie Infettive, Dipartimento di Scienze della Salute, ASST Santi Paolo e Carlo, University of Milano, Milan, Italy
| | - Pietro Colletti
- Unit of Infectious Diseases, Paolo Borsellino Hospital, ASP Trapani, Trapani, Italy
| | - Piermauro Miraglia
- Unit of Infectious Diseases, Paolo Borsellino Hospital, ASP Trapani, Trapani, Italy
| | - Carlo Torti
- Unit of Infectious and Tropical Diseases, University Magna Græcia, Catanzaro, Italy
| | - Anna Maria Cattelan
- Unità Organizzativa Complessa Malattie Infettive, Azienda Ospedale Università, Padova, Italy
| | | | - Marco Berruti
- SC Malattie Infettive Asl1 Imperiese, Imperia, Italy
| | - Carlo Tascini
- Clinic of Infectious Diseases, University of Udine, Udine, Italy
| | - Giustino Parruti
- Unit of Infectious Diseases, Hospital of Pescara, Pescara, Italy
| | | | - Andrea Gori
- Infectious Disease Unit, Ospedale L. Sacco, University of Milano, Milan, Italy
| | - Giulia Marchetti
- Clinica delle Malattie Infettive, Dipartimento di Scienze della Salute, ASST Santi Paolo e Carlo, University of Milano, Milan, Italy
| | - Miriam Lichtner
- Unità Organizzativa Complessa Malattie Infettive, Ospedale SM Goretti, Latina, Italy
| | - Luigi Coppola
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Chiara Sorace
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | | | | | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Erica Franceschini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Marianna Meschiari
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Loredana Sarmati
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Andrea Antinori
- Istituto Nazionale Malattie Infettive L. Spallanzani, Rome, Italy
| | | | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
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Papaioannu Borjesson R, Galli L, Lolatto R, Menzaghi B, Feasi M, Gulminetti R, Fornabaio C, Cattelan AM, Bonora S, Lagi F, Zazzi M, Castagna A, Spagnuolo V. Lower aids-related hospitalizations in women living with HIV multidrug resistance. AIDS 2024; 38:435-438. [PMID: 38300163 DOI: 10.1097/qad.0000000000003781] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
| | - Laura Galli
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan
| | - Riccardo Lolatto
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio
| | | | - Roberto Gulminetti
- Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Torino
| | - Filippo Lagi
- Infectious and Tropical diseases Unit, Azienda Ospedaliero Universitaria Careggi, Florence
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Antonella Castagna
- San Raffaele Vita-Salute University
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan
| | - Vincenzo Spagnuolo
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan
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Mazzitelli M, Scaglione V, Cattarin L, Franchin E, Stano P, Paci L, Coppi M, Rossolini GM, Mengato D, Calò L, Cattelan AM. Off-label oritavancin treatment outcome and molecular characterization of a vancomycin- and linezolid-resistant Enterococcus faecium causing liver abscesses. J Antimicrob Chemother 2024; 79:689-691. [PMID: 38225167 DOI: 10.1093/jac/dkad410] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Leda Cattarin
- Nephrology Unit, Padua University Hospital, Padua, Italy
| | - Elisa Franchin
- Microbiology and Virology Unit, Padua University Hospital, Padua, Italy
| | - Paola Stano
- Microbiology and Virology Unit, Padua University Hospital, Padua, Italy
| | - Lorenzo Paci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Coppi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniele Mengato
- Hospital Pharmacy Unit, Padua University Hospital, Padua, Italy
| | - Lorenzo Calò
- Nephrology Unit, Padua University Hospital, Padua, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
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Cosmo E, Frizziero L, Schiavon S, Cattelan AM, Leoni D, Capizzi A, Torresin T, Midena G, Armato Smaniotto Dai Roveri E, Parrozzani R, Midena E. The neurovascular retinal involvement in a large population of patients recovered from COVID-19: an OCT and OCT angiography study. Eye (Lond) 2024:10.1038/s41433-024-02991-9. [PMID: 38402287 DOI: 10.1038/s41433-024-02991-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND This study aimed to assess the neuronal and microvascular retinal and choroidal involvement in COVID-19 recovered patients using optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS This observational cross-sectional study recruited patients recovered from COVID-19 and a group of healthy controls for comparisons. OCT (peripapillary scan and macular map) and OCTA (macular map) were performed to obtain: the central subfield thickness (CST), the macular volume (MV), the peripapillary retinal nerve fibre layer (pRNFL) thickness, the vessel area density (VAD), vessel length fraction (VLF), vessel diameter index (VDI) and fractal dimension (FD) of the superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP), and the vessel density (VD), stromal density (SD) and vascular/stromal (V/S) ratio of the choriocapillaris (CC) and choroid (Ch). Data regarding disease severity, administered therapy and prior comorbidities were collected. RESULTS We recruited 676 eyes from 338 patients and 98 eyes from 49 healthy controls. VAD of all the three retinal plexuses, VLF and VDI of ICP and DCP and VD of CC were significantly reduced in patients versus controls. No differences were found in CST, MV and pRNFL. A multivariate analysis showed that oxygen therapy, previous cardio/cerebrovascular events and hypertension negatively influenced vascular parameters. CONCLUSION A microvascular retinal and choriocapillaris damage may be identified secondary to SARS-CoV-2 infection, even after recovery. OCTA may represent a reproducible and non-invasive tool to assess microangiopathy in these patients, with particular regard to those with previous cardio/cerebrovascular events, hypertension and those who received oxygen therapy.
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Affiliation(s)
- Eleonora Cosmo
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy
| | - Luisa Frizziero
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy
| | - Stefano Schiavon
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy
| | - Anna Maria Cattelan
- Unit of Infectious Disease, Department of Internal Medicine, University of Padova, 35128, Padova, Italy
| | - Davide Leoni
- Unit of Infectious Disease, Department of Internal Medicine, University of Padova, 35128, Padova, Italy
| | - Alfio Capizzi
- Department of Directional Hospital Management, University of Padova, 35128, Padova, Italy
| | - Tommaso Torresin
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy
| | | | | | - Raffaele Parrozzani
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy
| | - Edoardo Midena
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128, Padova, Italy.
- IRCCS-Fondazione Bietti, 00198, Rome, Italy.
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Clemente T, Galli L, Lolatto R, Gagliardini R, Lagi F, Ferrara M, Cattelan AM, Focà E, Di Biagio A, Cervo A, Calza L, Maggiolo F, Marchetti G, Cenderello G, Rusconi S, Zazzi M, Santoro MM, Spagnuolo V, Castagna A. Cohort profile: PRESTIGIO, an Italian prospective registry-based cohort of people with HIV-1 resistant to reverse transcriptase, protease and integrase inhibitors. BMJ Open 2024; 14:e080606. [PMID: 38341206 PMCID: PMC10862296 DOI: 10.1136/bmjopen-2023-080606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE The PRESTIGIO Registry was established in 2017 to collect clinical, virological and immunological monitoring data from people living with HIV (PLWH) with documented four-class drug resistance (4DR). Key research purposes include the evaluation of residual susceptibility to specific antiretrovirals and the validation of treatment and monitoring strategies in this population. PARTICIPANTS The PRESTIGIO Registry collects annual plasma and peripheral blood mononuclear cell samples and demographic, clinical, virological, treatment and laboratory data from PLWH followed at 39 Italian clinical centres and characterised by intermediate-to-high genotypic resistance to ≥1 nucleoside reverse transcriptase inhibitors, ≥1 non-nucleoside reverse transcriptase inhibitors, ≥1 protease inhibitors, plus either intermediate-to-high genotypic resistance to ≥1 integrase strand transfer inhibitors (INSTIs) or history of virological failure to an INSTI-containing regimen. To date, 229 people have been recorded in the cohort. Most of the data are collected from the date of the first evidence of 4DR (baseline), with some prebaseline information obtained retrospectively. Samples are collected from the date of enrollment in the registry. FINDINGS TO DATE The open-ended cohort has been used to assess (1) prognosis in terms of survival or development of AIDS-related or non-AIDS-related clinical events; (2) long-term efficacy and safety of different antiretroviral regimens and (3) virological and immunological factors predictive of clinical outcome and treatment efficacy, especially through analysis of plasma and cell samples. FUTURE PLANS The registry can provide new knowledge on how to implement an integrated approach to study PLWH with documented resistance to the four main antiretroviral classes, a population with a limited number of individuals characterised by a high degree of frailty and complexity in therapeutic management. Given the scheduled annual updates of PLWH data, the researchers who collaborate in the registry can send study proposals at any time to the steering committee of the registry, which evaluates every 3 months whether the research studies can be conducted on data and biosamples from the registry and whether they are aimed at a better understanding of a specific health condition, the emergence of comorbidities or the effect of potential treatments or experimental drugs that may have an impact on disease progression and quality of life. Finally, the research studies should aim to be inclusive, innovative and in touch with the communities and society as a whole. TRIAL REGISTRATION NUMBER NCT04098315.
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Affiliation(s)
- Tommaso Clemente
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Lolatto
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Gagliardini
- National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Rome, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Micol Ferrara
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Anna Maria Cattelan
- Infectious Diseases Unit, Department of Molecular Medicine, Padua University Hospital, Padua, Italy
| | - Emanuele Focà
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, Brescia, Italy
| | - Antonio Di Biagio
- Clinic of Infectious Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Adriana Cervo
- Infectious Diseases Unit, Policlinico di Modena, Università Degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Leonardo Calza
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S. Orsola Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - Franco Maggiolo
- Unit of HIV-related Diseases and Experimental Therapies, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Giulia Marchetti
- Clinic of Infectious Diseases, Department of Health Sciences, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | - Stefano Rusconi
- Infectious Diseases Unit, ASST Ovest Milanese, Legnano General Hospital, Legnano, Italy
- DIBIC, University of Milan, Milan, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | | | - Vincenzo Spagnuolo
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Cattelan AM, Mazzitelli M, Presa N, Cozzolino C, Sasset L, Leoni D, Bragato B, Scaglione V, Baldo V, Parisi SG. Changing Prevalence of AIDS and Non-AIDS-Defining Cancers in an Incident Cohort of People Living with HIV over 28 Years. Cancers (Basel) 2023; 16:70. [PMID: 38201498 PMCID: PMC10777974 DOI: 10.3390/cancers16010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The introduction and evolution of antiretrovirals has changed the panorama of comorbidities in people living with HIV (PLWH) by reducing the risk of AIDS-defining cancers (ADC). By contrast, due to ageing and persistent inflammation, the prevalence and incidence of non-AIDS-defining cancers have significantly increased. Therefore, we aimed at describing cancer epidemiology in our cohort over 28 years. METHODS We retrospectively included all PLWH in our clinic who ever developed cancers, considering features of ADC and NADC, from January 1996 to March 2023. Demographic, clinical characteristics, and survival were analyzed, comparing three observation periods (1996-2003, 2004-2013, and 2014-2023). RESULTS A total of 289 PLWH developed 308 cancers over the study period; 77.9% were male, the mean age was 49.6 years (SD 12.2), and 57.4% PLWH developed NADC and 41.5% ADC. Kaposi (21.8%) and non-Hodgkin lymphoma (20.1%) were the most frequent cancers. Age at the time of cancer diagnosis significantly increased over time (41.6 years in the first period vs. 54.4 years in the third period, p < 0.001). In the first period compared with the last, a simultaneous diagnosis of HIV infection and cancer occurred in a higher proportion of persons (42.7 vs. 15.3, p < 0.001). While viro-immunological control at cancer diagnosis significantly improved over time, the proportions of cancer progression/remission remained stable. Overall survival significantly increased, but this trend was not confirmed for ADC. CONCLUSIONS The probability of survival for ADC did not decrease as significantly as the number of ADC diagnoses over time. By contrast, NADC dramatically increased, in line with epidemiological studies and other literature data. The changing patterns of malignancies from ADC to NADC underline the need for public health interventions and the fostering of screening programs aimed at the prevention and early detection of NADC in PLWH.
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Affiliation(s)
- Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Nicolò Presa
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Claudia Cozzolino
- Department of Cardiothoracic and Vascular Sciences and Public Health, Padua University, 35122 Padua, Italy; (C.C.)
| | - Lolita Sasset
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Davide Leoni
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Beatrice Bragato
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy (N.P.); (L.S.); (D.L.); (B.B.); (V.S.)
| | - Vincenzo Baldo
- Department of Cardiothoracic and Vascular Sciences and Public Health, Padua University, 35122 Padua, Italy; (C.C.)
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Zuin M, Mazzitelli M, Rigatelli G, Bilato C, Cattelan AM. Risk of ischemic stroke in patients recovered from COVID-19 infection: A systematic review and meta-analysis. Eur Stroke J 2023; 8:915-922. [PMID: 37491810 PMCID: PMC10372514 DOI: 10.1177/23969873231190432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Data regarding the risk of ischemic stroke within 1 year after the post-acute phase of COVID-19 remain scant. We assess the risk of ischemic stroke in COVID-19 survivors after SARS-CoV-2 infection by performing a systematic review and meta-analysis of the available data. METHODS Following the PRISMA guidelines, we searched Medline and Scopus to locate all articles published up to February 11, 2023, reporting the risk of incident ischemic stroke in adult patients recovered from COVID-19 infection compared to non-infected patients (controls) defined as those who did not experience the infection over the same follow-up period. Ischemic stroke risk was evaluated using the Mantel-Haenszel random effects models with adjusted Hazard ratio (HR) as the effect measure with 95% confidence interval (CI) while heterogeneity was assessed using Higgins I2 statistic. RESULTS Overall, 23,559,428 patients (mean age 56, 1 year, 54.3% males), of whom 1,595,984 had COVID-19, were included. Over a mean follow-up of 9.2 months, ischemic stroke occurred in 4.40 [95% CI: 4.36-4.43] out of 1000 patients survived to COVID-19 compared to 3.25 [95% CI:3.21-3.29] out of 1000 controls. Recovered COVID-19 patients presented a higher risk of ischemic stroke ((HR: 2.06, 95% CI: 1.75-2.41, p < 0.0001, I2 = 63.7%) compared to people who did not have COVID-19. COVID-19 patients hospitalized at the time of the infection have a subsequent higher risk of stroke during the follow-up compared to those non-hospitalized. CONCLUSIONS Recovered COVID-19 patients have a higher risk of ischemic stroke compared to subjects from the general population within 9 months from the index infection.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Cardiology, West Vicenza Hospitals, Arzignano, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospitals, Arzignano, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
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Angioni R, Bonfanti M, Caporale N, Sánchez-Rodríguez R, Munari F, Savino A, Pasqualato S, Buratto D, Pagani I, Bertoldi N, Zanon C, Ferrari P, Ricciardelli E, Putaggio C, Ghezzi S, Elli F, Rotta L, Scardua A, Weber J, Cecatiello V, Iorio F, Zonta F, Cattelan AM, Vicenzi E, Vannini A, Molon B, Villa CE, Viola A, Testa G. RAGE engagement by SARS-CoV-2 enables monocyte infection and underlies COVID-19 severity. Cell Rep Med 2023; 4:101266. [PMID: 37944530 PMCID: PMC10694673 DOI: 10.1016/j.xcrm.2023.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 03/16/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023]
Abstract
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has fueled the COVID-19 pandemic with its enduring medical and socioeconomic challenges because of subsequent waves and long-term consequences of great concern. Here, we chart the molecular basis of COVID-19 pathogenesis by analyzing patients' immune responses at single-cell resolution across disease course and severity. This approach confirms cell subpopulation-specific dysregulation in COVID-19 across disease course and severity and identifies a severity-associated activation of the receptor for advanced glycation endproducts (RAGE) pathway in monocytes. In vitro THP1-based experiments indicate that monocytes bind the SARS-CoV-2 S1-receptor binding domain (RBD) via RAGE, pointing to RAGE-Spike interaction enabling monocyte infection. Thus, our results demonstrate that RAGE is a functional receptor of SARS-CoV-2 contributing to COVID-19 severity.
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Affiliation(s)
- Roberta Angioni
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy; Fondazione Istituto di Ricerca Pediatrica - Città Della Speranza, 35127 Padova, Italy
| | - Matteo Bonfanti
- Human Technopole, Viale Rita Levi-Montalcini 1, 20157 Milan, Italy
| | - Nicolò Caporale
- Human Technopole, Viale Rita Levi-Montalcini 1, 20157 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9, 20122 Milan, Italy; Department of Experimental Oncology, European Institute of Oncology IRCCS, Via Adamello 16, 20139 Milan, Italy
| | - Ricardo Sánchez-Rodríguez
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy; Fondazione Istituto di Ricerca Pediatrica - Città Della Speranza, 35127 Padova, Italy
| | - Fabio Munari
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy; Fondazione Istituto di Ricerca Pediatrica - Città Della Speranza, 35127 Padova, Italy
| | - Aurora Savino
- Human Technopole, Viale Rita Levi-Montalcini 1, 20157 Milan, Italy
| | | | - Damiano Buratto
- Institute of Quantitative Biology, College of Life Sciences, Zhejiang University, Hangzhou 310058, China; Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, Shanghai, China
| | - Isabel Pagani
- Viral Pathogenesis and Biosafety Unit, San Raffaele Scientific Institute, Via Olgettina 58, 20132 Milan, Italy
| | - Nicole Bertoldi
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy; Fondazione Istituto di Ricerca Pediatrica - Città Della Speranza, 35127 Padova, Italy
| | - Carlo Zanon
- Fondazione Istituto di Ricerca Pediatrica - Città Della Speranza, 35127 Padova, Italy
| | - Paolo Ferrari
- Human Technopole, Viale Rita Levi-Montalcini 1, 20157 Milan, Italy
| | | | - Cristina Putaggio
- Infectious Disease Unit, Padova University Hospital, 35128 Padova, Italy
| | - Silvia Ghezzi
- Viral Pathogenesis and Biosafety Unit, San Raffaele Scientific Institute, Via Olgettina 58, 20132 Milan, Italy
| | - Francesco Elli
- Human Technopole, Viale Rita Levi-Montalcini 1, 20157 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9, 20122 Milan, Italy
| | - Luca Rotta
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Via Adamello 16, 20139 Milan, Italy
| | | | - Janine Weber
- Human Technopole, Viale Rita Levi-Montalcini 1, 20157 Milan, Italy
| | | | - Francesco Iorio
- Human Technopole, Viale Rita Levi-Montalcini 1, 20157 Milan, Italy
| | - Francesco Zonta
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, Shanghai, China; Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, Suzhou 215123, China
| | | | - Elisa Vicenzi
- Viral Pathogenesis and Biosafety Unit, San Raffaele Scientific Institute, Via Olgettina 58, 20132 Milan, Italy
| | | | - Barbara Molon
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy; Fondazione Istituto di Ricerca Pediatrica - Città Della Speranza, 35127 Padova, Italy
| | - Carlo Emanuele Villa
- Human Technopole, Viale Rita Levi-Montalcini 1, 20157 Milan, Italy; Department of Experimental Oncology, European Institute of Oncology IRCCS, Via Adamello 16, 20139 Milan, Italy
| | - Antonella Viola
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy; Fondazione Istituto di Ricerca Pediatrica - Città Della Speranza, 35127 Padova, Italy.
| | - Giuseppe Testa
- Human Technopole, Viale Rita Levi-Montalcini 1, 20157 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9, 20122 Milan, Italy; Department of Experimental Oncology, European Institute of Oncology IRCCS, Via Adamello 16, 20139 Milan, Italy.
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9
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Poliseno M, Mazzitelli M, Narducci A, Ferrara SM, Resnati C, Gervasoni C, Cattelan AM, Lo Caputo S. Doravirine Plus Integrase Strand Transfer Inhibitors as a 2-Drug Treatment-Switch Strategy in People Living with HIV: The Real-Life DORINI Multicentric Cohort Study. J Acquir Immune Defic Syndr 2023; 94:235-243. [PMID: 37757865 DOI: 10.1097/qai.0000000000003248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/04/2023] [Accepted: 06/20/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Few data are available about the efficacy, durability, and tolerability of doravirine (DOR) + integrase strand inhibitors (INI) as a switching strategy among antiretroviral therapy (ART)-experienced people living with HIV (PLWH). SETTING Retrospective, multicenter cohort study investigating the durability, efficacy, and tolerability of 2 off-label drug associations of DOR + INI among ART-experienced PLWH. METHODS The study included PLWH who switched to DOR combined with either raltegravir (RAL) or dolutegravir (DTG) between June 1, 2020, and December 31, 2021, with at least 1 follow-up (FU) visit. Virologic, biometric, and metabolic parameters were evaluated at baseline (T0) and at 1-3 (T1), 6 (T2), and 12 (T3) months. Univariate and multivariate survival analyses assessed the 28-week probability of persistence on the regimens. Patient satisfaction was measured using the HIV Treatment Satisfaction Questionnaire. RESULTS Ninety-five PLWH were included, 52 in DOR + RAL and 43 in DOR + DTG. Six treatment discontinuations were reported during a mean of 37 (±17) weeks of FU (incidence of 2.7 × 1000 person-weeks FU). Only 2 were the result of virological failure without resistance mutations. DOR + DTG demonstrated significantly higher 28-week persistence than DOR + RAL (HR 1.90, 95% CI: 1.24-2.90, log-rank: P = 0.003). Weight, waist circumference, and fasting lipids reduced considerably at T3 vs T0. Overall, high satisfaction with the new treatment was reported, particularly in the DOR + RAL (68 (64-72)/72), compared with the DOR + DTG group (58 (50-65)/72, P < 0.001). CONCLUSIONS Our experience revealed few treatment discontinuations, improved metabolic parameters, and high patient satisfaction among ART-experienced PLWH switching to DOR combined with INI, irrespective of the specific INI used.
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Affiliation(s)
- Mariacristina Poliseno
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Arianna Narducci
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Sergio Maria Ferrara
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Chiara Resnati
- Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy; and
| | - Cristina Gervasoni
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Sergio Lo Caputo
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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10
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Bellato M, Cappellato M, Longhin F, Del Vecchio C, Brancaccio G, Cattelan AM, Brun P, Salaris C, Castagliuolo I, Di Camillo B. Uncover a microbiota signature of upper respiratory tract in patients with SARS-CoV-2 + . Sci Rep 2023; 13:16867. [PMID: 37803040 PMCID: PMC10558486 DOI: 10.1038/s41598-023-43040-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023] Open
Abstract
The outbreak of Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, forced us to face a pandemic with unprecedented social, economic, and public health consequences. Several nations have launched campaigns to immunize millions of people using various vaccines to prevent infections. Meanwhile, therapeutic approaches and discoveries continuously arise; however, identifying infected patients that are going to experience the more severe outcomes of COVID-19 is still a major need, to focus therapeutic efforts, reducing hospitalization and mitigating drug adverse effects. Microbial communities colonizing the respiratory tract exert significant effects on host immune responses, influencing the susceptibility to infectious agents. Through 16S rDNAseq we characterized the upper airways' microbiota of 192 subjects with nasopharyngeal swab positive for SARS-CoV-2. Patients were divided into groups based on the presence of symptoms, pneumonia severity, and need for oxygen therapy or intubation. Indeed, unlike most of the literature, our study focuses on identifying microbial signatures predictive of disease progression rather than on the probability of infection itself, for which a consensus is lacking. Diversity, differential abundance, and network analysis at different taxonomic levels were synergistically adopted, in a robust bioinformatic pipeline, highlighting novel possible taxa correlated with patients' disease progression to intubation.
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Affiliation(s)
- Massimo Bellato
- Department of Information Engineering, University of Padova, 35131, Padova, Italy
| | - Marco Cappellato
- Department of Information Engineering, University of Padova, 35131, Padova, Italy
| | - Francesca Longhin
- Department of Information Engineering, University of Padova, 35131, Padova, Italy
| | - Claudia Del Vecchio
- Department of Molecular Medicine, University of Padova, 35121, Padova, Italy
| | - Giuseppina Brancaccio
- Department of Molecular Medicine, University of Padova, 35121, Padova, Italy
- Infectious Diseases Unit, University Hospital Padova, 35128, Padova, Italy
| | - Anna Maria Cattelan
- Department of Molecular Medicine, University of Padova, 35121, Padova, Italy
- Infectious Diseases Unit, University Hospital Padova, 35128, Padova, Italy
| | - Paola Brun
- Department of Molecular Medicine, University of Padova, 35121, Padova, Italy
| | - Claudio Salaris
- Department of Molecular Medicine, University of Padova, 35121, Padova, Italy
| | - Ignazio Castagliuolo
- Department of Molecular Medicine, University of Padova, 35121, Padova, Italy
- Microbiology and Virology Unit, University Hospital Padova, 35121, Padova, Italy
| | - Barbara Di Camillo
- Department of Information Engineering, University of Padova, 35131, Padova, Italy.
- Department of Comparative Biomedicine and Food Science, University of Padova, 35020, Legnaro (PD), Italy.
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11
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Giacobbe DR, Marelli C, Cattardico G, Fanelli C, Signori A, Di Meco G, Di Pilato V, Mikulska M, Mazzitelli M, Cattelan AM, Pallotto C, Francisci D, Calabresi A, Lombardi A, Gori A, Del Bono V, Aldieri C, Losito AR, Raffaelli F, Cortegiani A, Milazzo M, Del Puente F, Pontali E, De Rosa FG, Corcione S, Mularoni A, Russelli G, Giacomini M, Badalucco Ciotta F, Oltolini C, Serino FS, Momesso E, Spinicci M, Graziani L, Torti C, Trecarichi EM, Merli M, D'Amico F, Marchese A, Vena A, Bassetti M. Mortality in KPC-producing Klebsiella pneumoniae bloodstream infections: a changing landscape. J Antimicrob Chemother 2023; 78:2505-2514. [PMID: 37606528 DOI: 10.1093/jac/dkad262] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVES To assess the impact of carbapenem resistance on mortality in Klebsiella pneumoniae bloodstream infection (BSI) in the era of novel β-lactam/β-lactamase inhibitor combinations. MATERIAL AND METHODS Retrospective study of patients with K. pneumoniae BSI between January and August 2020 in 16 centres (CARBANEW study within the MULTI-SITA project). RESULTS Overall, 426 patients were included: 107/426 (25%) had carbapenem-resistant K. pneumoniae (CR-Kp) BSI and 319/426 (75%) had carbapenem-susceptible K. pneumoniae (CS-Kp) BSI. Crude cumulative 30 day mortality was 33.8% and 20.7% in patients with, respectively, CR-Kp BSI and CS-Kp BSI (P = 0.027). Carbapenemase production or carbapenemase-encoding genes were detected in 84/98 tested CR-Kp isolates (85.7%), mainly KPC (78/84; 92.9%). Ceftazidime/avibactam was the most frequently used appropriate therapy for CR-Kp BSI (80/107; 74.7%). In multivariable analyses, variables showing an unfavourable association with mortality after correction for multiple testing were age-adjusted Charlson comorbidity index (HR 1.20; 95% CI 1.10-1.31, P < 0.001) and Pitt score (HR 1.33; 95% CI 1.15-1.55, P < 0.001), but not carbapenem resistance (HR 1.28, 95% CI 0.74-2.22, P = 0.410). In a propensity score-matched analysis, there was no difference in mortality between patients appropriately treated with ceftazidime/avibactam for CR-Kp BSI and patients appropriately treated with other agents (mainly meropenem monotherapy or piperacillin/tazobactam monotherapy) for CS-Kp BSI (HR 1.07; 95% CI 0.50-2.29, P = 0.866). CONCLUSIONS Our results suggest that the increased mortality in CR-Kp BSI compared with CS-Kp BSI is not (or no longer) dependent on the type of therapy in areas where ceftazidime/avibactam-susceptible KPC-producing isolates are the most prevalent type of CR-Kp.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Marelli
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Greta Cattardico
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Fanelli
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Medicine, Surgery and Pharmacy, Unit of Infectious Diseases, University of Sassari, Sassari, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Gabriele Di Meco
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Carlo Pallotto
- Department of Medicine and Surgery, Clinic of Infectious Diseases, 'Santa Maria della Misericordia' Hospital, University of Perugia, Perugia, Italy
| | - Daniela Francisci
- Department of Medicine and Surgery, Clinic of Infectious Diseases, 'Santa Maria della Misericordia' Hospital, University of Perugia, Perugia, Italy
| | - Alessandra Calabresi
- SOC Malattie Infettive, ASO 'SS Antonio e Biagio e C. Arrigo', Alessandria, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Andrea Gori
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Ospedale Luigi Sacco-Polo Universitario, Milan, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Chiara Aldieri
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Angela Raffaella Losito
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Raffaelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, University of Palermo, Palermo, Italy
- Department of Anesthesia Analgesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Marta Milazzo
- Department of Surgical, Oncological and Oral Science, University of Palermo, Palermo, Italy
| | | | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- Unit of Infectious Diseases, Cardinal Massaia, Asti, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Alessandra Mularoni
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Giovanna Russelli
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Flavia Badalucco Ciotta
- Clinic of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Oltolini
- Clinic of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Saverio Serino
- Azienda ULSS4 Veneto Orientale, UOS Malattie Infettive, UOC Medicina Generale, Ospedale di Portogruaro, Portogruaro, Italy
| | - Elena Momesso
- Azienda ULSS4 Veneto Orientale, UOC Anestesia e Rianimazione, Ospedale di San Donà di Piave, San Donà di Piave, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lucia Graziani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carlo Torti
- Department of Medical and Surgical Sciences, University 'Magna Graecia', Catanzaro, Italy
- Unit of Infectious and Tropical Diseases, 'Mater Domini' Teaching Hospital, Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, University 'Magna Graecia', Catanzaro, Italy
- Unit of Infectious and Tropical Diseases, 'Mater Domini' Teaching Hospital, Catanzaro, Italy
| | - Marco Merli
- Infectious Diseases Clinic, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Federico D'Amico
- Infectious Diseases Clinic, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Anna Marchese
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- UO Microbiologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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12
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Taramasso L, Andreoni M, Antinori A, Bandera A, Bonfanti P, Bonora S, Borderi M, Castagna A, Cattelan AM, Celesia BM, Cicalini S, Cingolani A, Cossarizza A, D'Arminio Monforte A, D'Ettorre G, Di Biagio A, Di Giambenedetto S, Di Perri G, Esposito V, Focà E, Gervasoni C, Gori A, Gianotti N, Guaraldi G, Gulminetti R, Lo Caputo S, Madeddu G, Maggi P, Marandola G, Marchetti GC, Mastroianni CM, Mussini C, Perno CF, Rizzardini G, Rusconi S, Santoro M, Sarmati L, Zazzi M, Maggiolo F. Pillars of long-term antiretroviral therapy success. Pharmacol Res 2023; 196:106898. [PMID: 37648103 DOI: 10.1016/j.phrs.2023.106898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Meeting the challenge of antiretroviral therapy (ART) whose efficacy can last a lifetime requires continuous updating of the virological, pharmacological, and quality of life outcomes to be pursued and a continuous review of literature data on the efficacy and tolerability of new drugs and therapeutic strategies. METHODS With the aim of identifying open questions and answers about the current controversies in modern ART, we adapted the Design Thinking methodology to the needs of the design phase of a scientific article, involving a team of experts in HIV care. RESULTS Five main pillars of treatment success were discussed: sustained virologic suppression over time; immunological recovery; pharmacological attributes; long-term tolerability and safety of ART; and people's satisfaction and quality of life. The definition of the outcomes to be achieved in each thematic area and the tools to achieve them were reviewed and discussed. CONCLUSIONS Long-term treatment success should be intended as a combination of HIV-RNA suppression, immune recovery, and high quality of life. To achieve this, the regimen should be well-tolerated, with high potency, genetic barrier, and forgiveness, and should be tailored by a person-centered perspective, based on individual needs, preferences, and therapeutic history.
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Affiliation(s)
- Lucia Taramasso
- IRCCS Ospedale Policlinico San Martino di Genova, Genova, Italy.
| | | | - Andrea Antinori
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Alessandra Bandera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Paolo Bonfanti
- Università degli Studi di Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori - Monza, Monza, Italy
| | - Stefano Bonora
- Ospedale Amedeo di Savoia, Università degli Studi di Torino, Torino, Italy
| | - Marco Borderi
- Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Stefania Cicalini
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani IRCCS, Roma, Italy
| | | | | | | | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases AOU Policlinico Umberto I Sapienza, Rome, Italy
| | - Antonio Di Biagio
- Department of Health Sciences, Clinic of Infectious Diseases, University of Genoa, Genoa, Italy
| | | | - Giovanni Di Perri
- Ospedale Amedeo di Savoia, Università degli Studi di Torino, Torino, Italy
| | - Vincenzo Esposito
- UOC di Malattie infettive e Medicina di Genere P.O. Cotugno-A.O. dei Colli, Napoli, Italy
| | - Emanuele Focà
- Università degli Studi di Brescia e ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Andrea Gori
- Università degli Studi di Milano, Milano, Italy; ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milano, Italy
| | | | - Giovanni Guaraldi
- Azienda Ospedaliero-Universitaria Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | | | - Giordano Madeddu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Paolo Maggi
- Università degli Studi della Campania Luigi Vanvitelli, AORN S. Anna e S. Sebastiano Caserta, Caserta, Italy
| | | | - Giulia Carla Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Cristina Mussini
- Azienda Ospedaliero-Universitaria Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | | | - Stefano Rusconi
- Ospedale Civile di Legnano ASST Ovest Milanese - Università degli Studi di Milano, Legnano, Italy
| | - Maria Santoro
- Università degli Studi di Roma "Tor Vergata", Roma, Italy
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13
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Mengato D, Mazzitelli M, Francavilla A, Bettio M, Sasset L, Presa N, Pivato L, Lo Menzo S, Trevenzoli M, Venturini F, Gregori D, Cattelan AM. Changing patterns and clinical outcomes of hospitalized patients with COVID-19 severe pneumonia treated with remdesivir according to vaccination status: results from a real-world retrospective study. Clin Exp Med 2023; 23:2749-2756. [PMID: 36961678 PMCID: PMC10037380 DOI: 10.1007/s10238-023-01036-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/01/2023] [Indexed: 03/25/2023]
Abstract
Since the beginning of Coronavirus Disease 2019 (COVID-19) pandemic, many drugs have been purposed for the treatment of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Remdesivir emerged as an encouraging antiviral drug for patients with documented severe COVID-19-related pneumonia. Although several studies about remdesivir effectiveness exist, no study investigated the effect of the combination of remdesivir with the vaccination status. The aim of this study was to assess whether the administration of remdesivir could show some differences in terms of clinical outcomes in patients vaccinated against SARS-CoV-2 versus those who were not. The primary outcome was the in-hospital mortality. The secondary outcomes were 30-days mortality, the need for ICU admission and for oxygen supplementation. This is a retrospective cohort study including all consecutive adult patients hospitalized for severe COVID-19 at the Padua University Hospital (Italy), between September 1st, 2020, and January 31st, 2022, and who received a 5-days course of remdesivir. A total of 708 patients were included, 467 (66%) were male, and the median age was 67 (IQR: 56-79) years. To better estimate the outcomes of interest, a propensity score weighted approach was implemented for vaccination status. A total of 605/708 patients (85.4%) did not complete the vaccination schedule. In-hospital mortality rate was 5.1% (n = 36), with no statistically significant difference between the unvaccinated (n=29, 4.8%) and vaccinated (n=7, 6.8%; p=0.4) patients. After propensity score matching, mortality between the two groups remained similar. However, both the need for ICU and oxygen supplementation were significantly lower in the vaccinated group. Our finding suggests that a complete vaccination course could have an impact in reducing the need for transfer in ICU and for high-flow therapy in moderate-to-severe COVID-19 patients treated with remdesivir.
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Affiliation(s)
- Daniele Mengato
- University of Padua, Padua, Italy.
- Padova University Hospital, Hospital Pharmacy Unit, Padua, Italy.
| | - Maria Mazzitelli
- Padova University Hospital, Infectious and Tropical Diseases Unit, Padua, Italy
| | - Andrea Francavilla
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Monica Bettio
- Padova University Hospital, Hospital Pharmacy Unit, Padua, Italy
| | - Lolita Sasset
- Padova University Hospital, Infectious and Tropical Diseases Unit, Padua, Italy
| | - Nicolò Presa
- Padova University Hospital, Infectious and Tropical Diseases Unit, Padua, Italy
| | - Lisa Pivato
- Padova University Hospital, Hospital Pharmacy Unit, Padua, Italy
| | - Sara Lo Menzo
- Padova University Hospital, Infectious and Tropical Diseases Unit, Padua, Italy
| | - Marco Trevenzoli
- Padova University Hospital, Infectious and Tropical Diseases Unit, Padua, Italy
| | | | - Dario Gregori
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Anna Maria Cattelan
- Padova University Hospital, Infectious and Tropical Diseases Unit, Padua, Italy
- Department of Molecular Medicine, University of Padua, Padua, Italy
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Mengato D, Mazzitelli M, Francavilla A, Bettio M, Sasset L, Presa N, Pivato L, Menzo SL, Trevenzoli M, Venturini F, Gregori D, Cattelan AM. Correction to: Changing patterns and clinical outcomes of hospitalized patients with COVID‑19 severe pneumonia treated with remdesivir according to vaccination status: results from a real‑world retrospective study. Clin Exp Med 2023; 23:2757. [PMID: 37289236 PMCID: PMC10248957 DOI: 10.1007/s10238-023-01088-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Daniele Mengato
- University of Padua, Padua, Italy.
- Hospital Pharmacy Unit, Padova University Hospital, Padua, Italy.
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy
| | - Andrea Francavilla
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Monica Bettio
- Hospital Pharmacy Unit, Padova University Hospital, Padua, Italy
| | - Lolita Sasset
- Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy
| | - Nicolò Presa
- Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy
| | - Lisa Pivato
- Hospital Pharmacy Unit, Padova University Hospital, Padua, Italy
| | - Sara Lo Menzo
- Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy
| | - Marco Trevenzoli
- Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy
| | | | - Dario Gregori
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy
- Department of Molecular Medicine, University of Padua, Padua, Italy
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15
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Raccagni AR, Leoni D, Ciccullo A, Verdenelli S, Cattelan AM, Di Giambenedetto S, Falcone M, Mileto D, Castagna A, Nozza S. Rapid improvement of severe Mpox lesions with oral tecovirimat. J Med Virol 2023; 95:e28825. [PMID: 37246746 DOI: 10.1002/jmv.28825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Affiliation(s)
| | - Davide Leoni
- Tropical and Infectious Diseases Unit, University Hospital of Padova, Padova, Italy
| | - Arturo Ciccullo
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Verdenelli
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Anna Maria Cattelan
- Tropical and Infectious Diseases Unit, University Hospital of Padova, Padova, Italy
| | | | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Davide Mileto
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, Ospedale Sacco, Milan, Italy
| | - Antonella Castagna
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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16
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Bai F, Mazzitelli M, Silvola S, Raumer F, Restelli U, Croce D, Marchetti G, Cattelan AM. Cost analysis of dalbavancin versus standard of care for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) in two Italian hospitals. JAC Antimicrob Resist 2023; 5:dlad044. [PMID: 37090914 PMCID: PMC10116602 DOI: 10.1093/jacamr/dlad044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/25/2023] [Indexed: 04/25/2023] Open
Abstract
Objectives Thanks to its long half-life, dalbavancin qualifies as an optimal drug for saving costs. We aimed to assess the cost and effectiveness of dalbavancin versus the standard of care (SoC). Patients and methods We conducted a multicentre retrospective study, including all hospitalized or outpatients diagnosed with ABSSSIs at Padua University Hospital, Padua and San Paolo Hospital, Milan (1 January 2016 to 31 July 2020). We compared patients according to antibiotic treatment (dalbavancin versus SoC), the number of lines of dalbavancin treatment, and monotherapy or combination (dalbavancin in association with other antibiotics). Primary endpoints were direct medical costs and length of hospital stay (LOS) associated with ABSSSI management; Student's t-test, chi-squared test and one-way ANOVA were used. Results One hundred and twenty-six of 228 (55.3%) patients received SoC, while 102/228 (44.7%) received dalbavancin. Twenty-seven of the 102 (26.5%) patients received dalbavancin as first-line treatment, 46 (45.1%) as second-line, and 29 (28.4%) as third- or higher-line treatment. Most patients received dalbavancin as monotherapy (62/102; 60.8%). Compared with SoC, dalbavancin was associated with a significant reduction of LOS (5 ± 7.47 days for dalbavancin, 9.2 ± 5.59 days for SoC; P < 0.00001) and with lower mean direct medical costs (3470 ± 2768€ for dalbavancin; 3493 ± 1901€ for SoC; P = 0.9401). LOS was also reduced for first-line dalbavancin, in comparison with second-, third- or higher-line groups, and for dalbavancin monotherapy versus combination therapy. Mean direct medical costs were significantly lower in first-line dalbavancin compared with higher lines, but no cost difference was observed between monotherapy and combination therapy. Conclusions Monotherapy with first-line dalbavancin was confirmed as a promising strategy for ABSSSIs in real-life settings, thanks to its property in reducing LOS and saving direct medical costs.
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Affiliation(s)
| | | | - Sofia Silvola
- Carlo Cattaneo—LIUC University, Castellanza, VA, Italy
- Department of Public Health Medicine, School of Health System & Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Umberto Restelli
- Carlo Cattaneo—LIUC University, Castellanza, VA, Italy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Davide Croce
- Carlo Cattaneo—LIUC University, Castellanza, VA, Italy
- Department of Public Health Medicine, School of Health System & Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit Department, Padua University Hospital, Padua, Italy
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17
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Mazzitelli M, Trunfio M, Sasset L, Scaglione V, Ferrari A, Mengato D, Gardin S, Bonadiman N, Calandrino L, Agostini E, Cattelan AM. Risk of hospitalization and sequelae in patients with COVID-19 treated with 3-day early remdesivir vs. controls in the vaccine and Omicron era: a real-life cohort study. J Med Virol 2023; 95:e28660. [PMID: 36905216 DOI: 10.1002/jmv.28660] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/18/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Recently, a benefit from administration of a 3-day course of early remdesivir (ER) in the outpatients' setting was reported. However, real-life data on its use is scarce. Therefore, we explored the ER clinical outcome in our outpatients' s cohort, compared to untreated controls. METHODS We included all patients who were prescribed ER from February to May 2022 and followed them up for three months and compared patients who received treatment with untreated controls. In the two groups the following outcomes were investigated: hospitalization and mortality rate, time of negativization and symptom's resolution, and post-acute COVID-19 syndrome prevalence. RESULTS Overall, 681 patients were analyzed, mostly females (53.6%), and with a median age of 66 years (IQR: 54-77), 316 (46.4%) patients received ER, and 365 (53.6%) did not receive antiviral treatment (control group). Overall, 8.5% patients eventually required oxygen support, 8.7% were hospitalized for COVID-19, and 1.5% died. SARS-CoV-2 immunization and ER (aOR 0.049 [0.015; 0.16], p<0.001) independently reduced hospitalization risk. ER was significantly associated with a shorter duration of SARS-CoV-2 positivity at nasopharyngeal swabs (aβ -8.15 [-9.21; -7.09], p<0.001) and of symptoms (aβ -5.11 [-5.82; -4.39], p<0.001), and with lower rate of COVID-19 sequelae compared to control group (aOR 0.18 [0.10;0.31], p<0.001). CONCLUSIONS Even in the SARS-CoV-2 vaccination and Omicron era, in patients at high risk of developing severe disease, ER demonstrated to have a good safety profile and to significantly reduce the risk of disease progression and COVID-19 sequelae compared to untreated controls. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy
| | - Mattia Trunfio
- Infectious Disease Unit, Department of Medical Sciences at Amedeo di Savoia Hospital, University of Torino, 10124, Torino, Italy
| | - Lolita Sasset
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy
| | - Anna Ferrari
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy
| | - Daniele Mengato
- Hospital Pharmacy Department, Padua University Hospital, 35128, Padua, Italy
| | - Samuele Gardin
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy
| | - Nicola Bonadiman
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy
| | - Lucrezia Calandrino
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy
| | - Elena Agostini
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy.,University of Padua, Padua, 35128, Italy
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18
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Brundu M, Marinello S, Scaglione V, Ferrari A, Franchin E, Mazzitelli M, Cattelan AM. The first case of monkeypox virus and acute HIV infection: Should we consider monkeypox a new possible sexually transmitted infection? J Dermatol 2023; 50:383-386. [PMID: 35996211 DOI: 10.1111/1346-8138.16556] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022]
Abstract
Since May 2022, a Monkeypox virus (MPXV) outbreak has been ongoing in several non-endemic countries. MPXV is usually transmitted after intimate contact, through body fluids, close contact from active lesions or through respiratory droplets. The recent outbreak occurrent in people with multiple recent sexual intercourse suggests the sexual route as the main way of transmission. However, there is no sufficient evidence to consider MPXV as a new sexually transmitted infection (STI), even though we believe that a link between MPXV and other STIs may exist with a possible facilitating action on their spreading. Herein, we illustrate the first case described during the current outbreak of a young man with both MPXV and acute HIV infection in a non-endemic country.
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Affiliation(s)
- Monica Brundu
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Serena Marinello
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Anna Ferrari
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Elisa Franchin
- Microbiology and Virology Unit, Padua University Hospital, Padua, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
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19
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Mazzitelli M, Trevenzoli M, Brundu M, Squarzoni G, Cattelan AM. COVID-19 and myotonic dystrophy: Case reports and systematic review. J Infect Dev Ctries 2023; 17:182-187. [PMID: 36897899 DOI: 10.3855/jidc.15653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/09/2021] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION Steinert's disease is a rare genetic disorder characterized by progressive myotonia and multi-organ damage. It is associated with respiratory and cardiological complications often leading patients to exitus. These conditions are also traditional risk factors for severe COVID-19. SARS-CoV-2 has affected people with chronic diseases, but the impact on people with Steinert's disease is poorly defined, with only a few reported and described. More data are needed to understand whether this genetic disease is a risk factor for more serious evolution or death in patients with COVID-19. METHODOLOGY The study describes two cases of patients with SD and COVID-19 and summarizes available evidence of the clinical outcome of COVID-19 in patients with Steinert's disease, by performing a systematic review of the literature (following PRISMA statements and performing PROSPERO registration). RESULTS Overall, 5 cases were retrieved from the literature review, with a median age of 47 years, of whom 4 had advanced SD and unfortunately died. By contrast, the 2 patients from our clinical practice and 1 from literature had a good clinical outcomes. Mortality ranged from 57% (all cases) to 80% (only literature review). CONCLUSIONS There is a high mortality rate in patients with both Steinert's disease and COVID-19. It highlights the importance of strengthening prevention strategies, especially vaccination. All SD with SARS-CoV-2 infection/COVID-19 patients should be identified early and treated to avoid complications. It is still unknown which treatment regimen is best to use in those patients. Studies on a greater number of patients are necessary to provide clinicians with further evidence.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua Hospital, Padua, Italy
| | - Marco Trevenzoli
- Infectious and Tropical Diseases Unit, Padua Hospital, Padua, Italy
| | - Monica Brundu
- Infectious and Tropical Diseases Unit, Padua Hospital, Padua, Italy
| | - Giulia Squarzoni
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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20
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Papavramidis T, Gentile I, Cattelan AM, Magnasco L, Viale P, Francisci D, Kofteridis DP, Tiseo G, Giamarellos-Bourboulis EJ, Lagi F, Pinna SM, D'Amico F, La Ferla L, Panagopoulos P, Gattuso G, Sipsas NV, Ruggieri A, Cattaneo A, Corio L, Comandini A, Mascagni P, Bassetti M. REDS study: Retrospective effectiveness study of dalbavancin and other standard of care of the same IV antibiotic class in patients with ABSSSI. Int J Antimicrob Agents 2023; 61:106746. [PMID: 36758778 DOI: 10.1016/j.ijantimicag.2023.106746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/24/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES Acute bacterial skin and skin-structure infections (ABSSSIs) are a common source of morbidity in both the community and hospital settings. The current standard of care (SoC) requires multiple-dose intravenous (IV) regimens, which are associated with high hospitalisation rates, concomitant event risks and costs. Dalbavancin is a lipoglycopeptide, long-acting antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA). Dalbavancin allows treatment of ABSSSIs with a single-shot IV administration or once weekly for 2 weeks, enabling clinicians to treat patients in an outpatient setting or to shorten the length of hospital stay. METHODS This multicentre, observational, retrospective study compared hospitalised patients who received dalbavancin and patients treated with the three most used IV antibiotics of the same or similar class: vancomycin, teicoplanin and daptomycin. The primary outcome was the time to discharge after starting the study antibiotics. RESULTS The primary endpoint, time to discharge from the study therapy start, was measured for both groups: the median number of days was 6.5 in the dalbavancin group vs. 11.0 days in the SoC group. Moreover, in subpopulations of patients receiving one or more concomitant antibiotics active for Gram-positives, MRSA and patients with the most prevalent comorbidity (i.e., diabetes), the advantage of dalbavancin in terms of length of stay was confirmed, with a halved time to discharge or more. Safety data on dalbavancin were consistent with data collected in clinical trials. No serious adverse drug reactions related to dalbavancin were reported and most of them were classified as skin and subcutaneous tissue disorders. One serious ADR was reported for daptomycin. CONCLUSIONS Although the analysis was only descriptive, it can be concluded that dalbavancin may enable a remarkable reduction in length of hospital stay, also confirming the clinical effectiveness and good safety profile demonstrated in clinical trials in a real-world setting.
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Affiliation(s)
- Theodossis Papavramidis
- 1st Propaedeutic Department of Surgery, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II - Naples, Italy
| | - Anna Maria Cattelan
- Clinic of Infectious Diseases, Department of Internal Medicine, University Hospital of Padua, Padua, Italy
| | - Laura Magnasco
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Hospital Policlinico San Martino - IRCCS, Genoa, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, University Hospital "S. Maria della Misericordia", University of Perugia, Perugia, Italy
| | - Diamantis P Kofteridis
- University Hospital of Heraklion, Department of Internal Medicine, Heraklion, Crete, Greece
| | - Giusy Tiseo
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Pisana, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | | | - Federico D'Amico
- Clinic of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lucia La Ferla
- Infectious Diseases Unit, Cannizzaro Hospital, Catania, Italy
| | - Periklis Panagopoulos
- Department of Internal Medicine, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Gianni Gattuso
- Department of Infectious Diseases, Carlo Poma Hospital, Mantua, Italy
| | - Nikolaos V Sipsas
- Infectious Diseases Unit, Pathophysiology Department, Laikon General Hospital and National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Hospital Policlinico San Martino - IRCCS, Genoa, Italy
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21
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Bernardinello N, Cocconcelli E, Giraudo C, Daverio M, Castelli G, Petrarulo S, Bovo M, Fichera G, Cavinato S, Cattelan AM, Saetta M, Spagnolo P, Balestro E. Predictors of pulmonary sequelae after COVID-19 pneumonia: A 12-month follow-up study. Front Med (Lausanne) 2023; 10:1084002. [PMID: 36817777 PMCID: PMC9932038 DOI: 10.3389/fmed.2023.1084002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 10/29/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Since the beginning of the SARS-CoV-2 pandemic, over 550 million people have been infected worldwide. Despite these large numbers, the long-term pulmonary consequences of COVID-19 remain unclear. Aims The aim of this single-center observational cohort study was to identify and characterize pulmonary sequelae of COVID-19 at 12 months from hospitalization and to reveal possible predictors for the persistence of long-term lung consequences. Methods Based on the persistence or absence of radiological changes after 12 months from hospitalization, the whole population was categorized into NOT-RECOVERED (NOT-REC) and RECOVERED (REC) groups, respectively. Clinical and pulmonary function data tests and clinical data were also collected and compared in the two groups. In the NOT-REC group, high resolution computed tomography (HRCT) images were semiquantitatively scored analyzing ground-glass opacities (GGO), interstitial thickening (IT), consolidations (CO), linear and curvilinear band opacities, and bronchiectasis for each lung lobe. Logistic regression analyses served to detect the factors associated with 12-month radiological consequences. Results Out of the 421 patients followed after hospitalization for SARS-CoV-2 pneumonia, 347 met inclusion and exclusion criteria and were enrolled in the study. The NOT-REC patients (n = 24; 6.9%) were significantly older [67 (62-76) years vs. 63 (53-71) years; p = 0.02], more frequently current smokers [4 (17%) vs. 12 (4%); p = 0.02], and with more severe respiratory failure at the time of hospitalization [PaO2/FiO2 at admission: 201 (101-314) vs. 295 (223-343); p = 0.01] compared to REC group (n = 323; 93.1%). On multivariable analysis, being a current smoker resulted in an independent predictor for lung sequelae after 12 months from hospitalization [5.6 OR; 95% CI (1.41-22.12); p = 0.01]. Conclusion After 12 months from hospital admission, a limited number of patients displayed persistent pulmonary sequelae with minimal extension. Being a current smoker at the time of SARS-CoV-2 infection is an independent predictive factor to lung consequences, regardless of the disease severity.
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Affiliation(s)
- Nicol Bernardinello
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Elisabetta Cocconcelli
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Chiara Giraudo
- Department of Medicine, Institute of Radiology, University of Padova and Padova City Hospital, Padova, Italy
| | - Matteo Daverio
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Gioele Castelli
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Simone Petrarulo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Matteo Bovo
- School of Medicine and Surgery, University of Padova, Padova, Italy
| | - Giulia Fichera
- Pediatric Radiology Unit, University of Padova and Padova City Hospital, Padova, Italy
| | - Silvia Cavinato
- Division of Infectious and Tropical Diseases, University of Padova and Padova City Hospital, Padova, Italy
| | - Anna Maria Cattelan
- Division of Infectious and Tropical Diseases, University of Padova and Padova City Hospital, Padova, Italy
| | - Marina Saetta
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy,*Correspondence: Elisabetta Balestro,
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Mazzitelli M, Mengato D, Sasset L, Ferrari A, Gardin S, Scaglione V, Bonadiman N, Calandrino L, Cavinato S, Trivellato S, Venturini F, Cattelan AM. Molnupiravir and Nirmatrelvir/Ritonavir: Tolerability, Safety, and Adherence in a Retrospective Cohort Study. Viruses 2023; 15:v15020384. [PMID: 36851598 PMCID: PMC9962206 DOI: 10.3390/v15020384] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Molnupiravir (MOL) and nirmatrelvir/ritonavir (NIR) were recently approved for the early treatment of COVID-19, but real-life data on tolerability, safety, and adverse events (AEs) are still scarce. METHODS We conducted a retrospective cohort study including all patients who were prescribed MOL and NIR at the Infectious Diseases Unit of Padua University Hospital, between January and May 2022. Demographic, clinical, and safety variables were recorded. RESULTS We included 909 patients, 48.3% males and 95.2% vaccinated against SARS-CoV-2. The median age was 73 (IQR: 62-82) years. MOL and NIR were prescribed in 407 (44.8%) and 502 (55.2%) patients, respectively. Overall, 124/909 (13.6%) patients experienced any AEs following antivirals intake: 98/124 (79%) patients reporting adverse events presented grade 1 AEs, 23/124 (18.5%) grade 2 AEs and 3 (2.5%) grade 3 AEs. Treatment discontinuation was recorded in 4.8% of patients. AEs were significantly higher in women, in patients treated with NIR compared to MOL and in people who were not vaccinated. CONCLUSIONS In our real-life setting, AEs were higher than those reported by clinical trials, and were particularly associated with NIR use and with not being vaccinated. Further analyses are needed to better assess safety of oral antivirals and to define which patient's profile may benefit most from MOL and NIR.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-049-821-3751
| | - Daniele Mengato
- Hospital Pharmacy Department, Padua University Hospital, 35128 Padua, Italy
| | - Lolita Sasset
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Anna Ferrari
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Samuele Gardin
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Nicola Bonadiman
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Lucrezia Calandrino
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Silvia Cavinato
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Sabrina Trivellato
- Hospital Pharmacy Department, Padua University Hospital, 35128 Padua, Italy
| | | | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
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Aita A, Navaglia F, Moz S, Contran N, Barbaro F, Cattelan AM, Padoan A, Cosma C, Faggian D, Plebani M, Basso D. New insights into SARS-CoV-2 Lumipulse G salivary antigen testing: accuracy, safety and short TAT enhance surveillance. Clin Chem Lab Med 2023; 61:323-331. [PMID: 36282616 DOI: 10.1515/cclm-2022-0849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/26/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The rapid, accurate and safe detection of SARS-CoV-2 is the key to improving surveillance and infection containment. The aim of the present study was to ascertain whether, after heat/chemical inactivation, SARS-CoV-2 N antigen chemiluminescence (CLEIA) assay in saliva remains a valid alternative to molecular testing. METHODS In 2022, 139 COVID-19 inpatients and 467 healthcare workers were enrolled. In 606 self-collected saliva samples (Salivette), SARS-CoV-2 was detected by molecular (TaqPath rRT-PCR) and chemiluminescent Ag assays (Lumipulse G). The effect of sample pre-treatment (extraction solution-ES or heating) on antigen recovery was verified. RESULTS Salivary SARS-CoV-2 antigen assay was highly accurate (AUC=0.959, 95% CI: 0.943-0.974), with 90% sensitivity and 92% specificity. Of the 254 antigen positive samples, 29 were false positives. We demonstrated that heterophilic antibodies could be a cause of false positive results. A significant antigen concentration decrease was observed after ES treatment (p=0.0026), with misclassification of 43 samples. Heat had a minimal impact, after treatment the correct classification of cases was maintained. CONCLUSIONS CLEIA SARS-CoV-2 salivary antigen provides accurate, timely and high-throughput results that remain accurate also after heat inactivation, thus ensuring a safer work environment. This supports the use of salivary antigen detection by CLEIA in surveillance programs.
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Affiliation(s)
- Ada Aita
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Filippo Navaglia
- Laboratory Medicine Unit, University Hospital of Padova, Padova, Italy
| | - Stefania Moz
- Laboratory Medicine Unit, University Hospital of Padova, Padova, Italy
| | - Nicole Contran
- Laboratory Medicine Unit, University Hospital of Padova, Padova, Italy
| | - Francesco Barbaro
- Tropical and Infectious Diseases Unit, University Hospital of Padova, Padova, Italy
| | - Anna Maria Cattelan
- Tropical and Infectious Diseases Unit, University Hospital of Padova, Padova, Italy
| | - Andrea Padoan
- Department of Medicine - DIMED, University of Padova, Padova, Italy
- Laboratory Medicine Unit, University Hospital of Padova, Padova, Italy
| | - Chiara Cosma
- Laboratory Medicine Unit, University Hospital of Padova, Padova, Italy
| | - Diego Faggian
- Laboratory Medicine Unit, University Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Daniela Basso
- Department of Medicine - DIMED, University of Padova, Padova, Italy
- Laboratory Medicine Unit, University Hospital of Padova, Padova, Italy
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24
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Aita A, Battisti I, Contran N, Furlan S, Padoan A, Franchin C, Barbaro F, Cattelan AM, Zambon CF, Plebani M, Basso D, Arrigoni G. Salivary proteomic analysis in asymptomatic and symptomatic SARS-CoV-2 infection: Innate immunity, taste perception and FABP5 proteins make the difference. Clin Chim Acta 2022; 537:26-37. [PMID: 36228679 PMCID: PMC9549389 DOI: 10.1016/j.cca.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM SARS-CoV-2 infection spawns from an asymptomatic condition to a fatal disease. Age, comorbidities, and several blood biomarkers are associated with infection outcome. We searched for biomarkers by untargeted and targeted proteomic analysis of saliva, a source of viral particles and host proteins. METHODS Saliva samples from 19 asymptomatic and 16 symptomatic SARS-CoV-2 infected subjects, and 20 controls were analyzed by LC-MS/MS for untargeted peptidomic (flow through of 10 kDa filter) and proteomic (trypsin digestion of filter retained proteins) profiling. RESULTS Peptides from 53 salivary proteins were identified. ADF was detected only in controls, while IL1RA only in infected subjects. PRPs, DSC2, FABP5, his-1, IL1RA, PRH1, STATH, SMR3B, ANXA1, MUC7, ACTN4, IGKV1-33 and TGM3 were significantly different between asymptomatic and symptomatic subjects. Retained proteins were 117, being 11 highly different between asymptomatic and symptomatic (fold change ≥2 or ≤-2). After validation by LC-MS/MS-SRM (selected reaction monitoring analysis), the most significant discriminant proteins at PCA were IL1RA, CYSTB, S100A8, S100A9, CA6, and FABP5. CONCLUSIONS The differentially abundant proteins involved in innate immunity (S100 proteins), taste (CA6 and cystatins), and viral binding to the host (FABP5), appear to be of interest for use as potential biomarkers and drugs targets.
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Affiliation(s)
- Ada Aita
- Department of Medicine, University of Padova, Padova, Italy
| | - Ilaria Battisti
- Department of Agronomy, Food, Natural Resources, Animals and Environment, University of Padova, Padova, Italy,Proteomic Center of Padova University and Azienda Ospedaliera di Padova, Padova, Italy
| | - Nicole Contran
- Department of Medicine, University of Padova, Padova, Italy
| | - Serena Furlan
- Proteomic Center of Padova University and Azienda Ospedaliera di Padova, Padova, Italy
| | - Andrea Padoan
- Department of Medicine, University of Padova, Padova, Italy
| | - Cinzia Franchin
- Department of Agronomy, Food, Natural Resources, Animals and Environment, University of Padova, Padova, Italy,Proteomic Center of Padova University and Azienda Ospedaliera di Padova, Padova, Italy
| | - Francesco Barbaro
- Tropical and Infectious Diseases Unit, University Hospital of Padova, Padova, Italy
| | - Anna Maria Cattelan
- Tropical and Infectious Diseases Unit, University Hospital of Padova, Padova, Italy
| | | | - Mario Plebani
- Department of Medicine, University of Padova, Padova, Italy
| | - Daniela Basso
- Department of Medicine, University of Padova, Padova, Italy,Corresponding author at: Department of Medicine – DIMED, Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Giorgio Arrigoni
- Proteomic Center of Padova University and Azienda Ospedaliera di Padova, Padova, Italy,Department of Biomedical Sciences, University of Padova, Padova, Italy
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25
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Mazzitelli M, Sasset L, Leoni D, Barbaro F, Marinello S, Cattelan AM. HIV testing and linkage to care: are we missing some opportunities? AIDS 2022; 36:2085-2087. [PMID: 36305190 DOI: 10.1097/qad.0000000000003353] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
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26
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Guaraldi G, Milic J, Cesari M, Leibovici L, Mandreoli F, Missier P, Rozzini R, Cattelan AM, Motta F, Mussini C, Cossarizza A. The interplay of post-acute COVID-19 syndrome and aging: a biological, clinical and public health approach. Ageing Res Rev 2022; 81:101686. [PMID: 35820609 PMCID: PMC9270773 DOI: 10.1016/j.arr.2022.101686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/07/2022] [Indexed: 01/31/2023]
Abstract
The post-acute COVID-19 syndrome (PACS) is characterized by the persistence of fluctuating symptoms over three months from the onset of the possible or confirmed COVID-19 acute phase. Current data suggests that at least 10% of people with previously documented infection may develop PACS, and up to 50-80% of prevalence is reported among survivors after hospital discharge. This viewpoint will discuss various aspects of PACS, particularly in older adults, with a specific hypothesis to describe PACS as the expression of a modified aging trajectory induced by SARS CoV-2. This hypothesis will be argued from biological, clinical and public health view, addressing three main questions: (i) does SARS-CoV-2-induced alterations in aging trajectories play a role in PACS?; (ii) do people with PACS face immuno-metabolic derangements that lead to increased susceptibility to age-related diseases?; (iii) is it possible to restore the healthy aging trajectory followed by the individual before pre-COVID?. A particular focus will be given to the well-being of people with PACS that could be assessed by the intrinsic capacity model and support the definition of the healthy aging trajectory.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy,Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy,Correspondence to: Department of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124 Modena, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Federica Mandreoli
- Department of Physical, Computer and Mathematical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Missier
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Renzo Rozzini
- Geriatric Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | - Federico Motta
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy,Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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27
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Mazzitelli M, Gatti M, Scaglione V, Mengato D, Trevenzoli M, Sattin A, Pea F, Cattelan AM. Off-Label Use of Dalbavancin for Sequential Treatment of Spondylodiscitis by Methicillin-Resistant Staphylococcus aureus: A Retrospective Single-Centre Experience. Antibiotics (Basel) 2022; 11:antibiotics11101377. [PMID: 36290035 PMCID: PMC9598816 DOI: 10.3390/antibiotics11101377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/24/2022] [Accepted: 10/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Our aim was to describe the clinical outcome and safety of the sequential treatment with off-label dalbavancin in patients with spondylodiscitis that is caused by methicillin-resistant Staphylococcus aureus (MRSA). Methods: We retrospectively included all patients >18 years of age with spondylodiscitis that is caused by MRSA that was treated with dalbavancin from January 2018−January 2021, recording the instances of clinical cure/failure, adverse events, and the need to be re-hospitalized after the initiation of dalbavancin. In 2/15 patients, we performed therapeutic drug monitoring (TDM) for dalbavancin. Results: We included 15 patients, 53.3% of them were females, with a median age of 67.9 years (57.4−78.5); 100% patients reported back pain, while a fever was present only in 2/15 cases. The spondylodiscitis was localized in 86.6% cases at the lumbar level. A median of a 2-week in-hospital intravenous vancomycin was followed by dalbavancin with a median duration of 12 weeks (12−16). All patients reported a clinical cure, except for a woman who is still on a suppressive treatment. No patient needed to be re-hospitalized, access to emergency department, or experienced adverse events. The TDM for dalbavancin showed that more than 90% of the determinations were above the pharmacodynamic target against staphylococci. Conclusions: The results from our unique, even if it was small, cohort demonstrated that dalbavancin can be a safe/effective option as a sequential treatment in patients with serious infections requiring prolonged antibiotic therapy, such as spondylodiscitis.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Via Giustiniani, 35128 Padua, Italy
- Correspondence:
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
- SSD Clinical Pharmacology, IRCSS Azienda Ospedaliero-Universitaria Sant’Orsola di Bologna, 40138 Bologna, Italy
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, Via Giustiniani, 35128 Padua, Italy
| | - Daniele Mengato
- Pharmacy Unit, Padua University Hospital, 35100 Padua, Italy
| | - Marco Trevenzoli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Via Giustiniani, 35128 Padua, Italy
| | - Andrea Sattin
- Infectious and Tropical Diseases Unit, Padua University Hospital, Via Giustiniani, 35128 Padua, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
- SSD Clinical Pharmacology, IRCSS Azienda Ospedaliero-Universitaria Sant’Orsola di Bologna, 40138 Bologna, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Via Giustiniani, 35128 Padua, Italy
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28
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Del Vecchio C, Cracknell Daniels B, Brancaccio G, Brazzale AR, Lavezzo E, Ciavarella C, Onelia F, Franchin E, Manuto L, Bianca F, Cianci V, Cattelan AM, Dorigatti I, Toppo S, Crisanti A. Impact of antigen test target failure and testing strategies on the transmission of SARS-CoV-2 variants. Nat Commun 2022; 13:5870. [PMID: 36198689 PMCID: PMC9533294 DOI: 10.1038/s41467-022-33460-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/15/2022] [Indexed: 11/09/2022] Open
Abstract
Population testing remains central to COVID-19 control and surveillance, with countries increasingly using antigen tests rather than molecular tests. Here we describe a SARS-CoV-2 variant that escapes N antigen tests due to multiple disruptive amino-acid substitutions in the N protein. By fitting a multistrain compartmental model to genomic and epidemiological data, we show that widespread antigen testing in the Italian region of Veneto favored the undetected spread of the antigen-escape variant compared to the rest of Italy. We highlight novel limitations of widespread antigen testing in the absence of molecular testing for diagnostic or confirmatory purposes. Notably, we find that genomic surveillance systems which rely on antigen population testing to identify samples for sequencing will bias detection of escape antigen test variants. Together, these findings highlight the importance of retaining molecular testing for surveillance purposes, including in contexts where the use of antigen tests is widespread.
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Affiliation(s)
- Claudia Del Vecchio
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy
| | - Bethan Cracknell Daniels
- MRC Centre for Global Infectious Disease Analysis and Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Giuseppina Brancaccio
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy
| | | | - Enrico Lavezzo
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy
| | - Constanze Ciavarella
- MRC Centre for Global Infectious Disease Analysis and Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Francesco Onelia
- Microbiology and Virology Diagnostic Unit, Padua University Hospital, Via Giustiniani 2, Padua, 35128, Italy
| | - Elisa Franchin
- Microbiology and Virology Diagnostic Unit, Padua University Hospital, Via Giustiniani 2, Padua, 35128, Italy
| | - Laura Manuto
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy
| | - Federico Bianca
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy
| | - Vito Cianci
- ER Unit, Emergency-Urgency Department, Padua University Hospital, Via Giustiniani 2, Padua, 35128, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Via Giustiniani 2, Padua, 35128, Italy
| | - Ilaria Dorigatti
- MRC Centre for Global Infectious Disease Analysis and Jameel Institute, School of Public Health, Imperial College London, London, UK.
| | - Stefano Toppo
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy. .,CRIBI Biotech Center, University of Padua, V.le G. Colombo, 3, Padua, 35131, Italy.
| | - Andrea Crisanti
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy. .,Microbiology and Virology Diagnostic Unit, Padua University Hospital, Via Giustiniani 2, Padua, 35128, Italy. .,Department of Life Science, Imperial College London, South Kensington Campus, Imperial College Road, SW7 AZ, London, UK.
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29
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Mazzitelli M, Antoni MD, Castelli F, Ripamonti D, Zuglian G, Lapadula G, Fabbiani M, Ferraresi A, Putaggio C, Cattelan AM, Quiros-Roldan E. Real-life use of Doravirine in treatment-experienced people living with HIV: A multicenter Italian study. Medicine (Baltimore) 2022; 101:e29855. [PMID: 35905209 PMCID: PMC9333545 DOI: 10.1097/md.0000000000029855] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Use of doravirine (DOR), a new nonnucleoside reverse-transcriptase inhibitors recently approved for HIV treatment, is still unclear in clinical practice and real-life data are scarce. We retrospectively investigated the rationale for switching people with HIV to DOR-containing/-based regimens in a real-life cohort. Among 132 patients (68.9% males, median age 56 years), the main reasons to start DOR were prevention of toxicities (39.4%) and dyslipidemia (18.2%). DOR was combined with integrase inhibitors in 40.9% cases, and in 25.7% of patients, DOR was prescribed without availability of a genotypic resistance test. Twenty-four weeks after the switch to DOR-containing/-based regimens, no significant changes in CD4+ T-cell count, CD4/CD8 ratio, detectable HIV-RNA, serum creatinine levels, and body weight were detected. By contrast, a significant reduction in lipids (both cholesterol and triglycerides) was observed in 52 patients for whom a follow-up assessment was available (P = .008 and .01, respectively). Our data confirmed that switching to DOR-containing/-based regimens may have a favorable impact on lipid profile and a neutral impact on weight gain. However, more data are needed to support its use in patients who do not have a genotypic test available or have an extensive nonnucleoside reverse-transcriptase inhibitors-associated resistance, as well as its use in a dual regimen, especially in combination with second-generation integrase inhibitors.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Melania Degli Antoni
- Department of Infectious and Tropical Diseases, ASST Spedali Civili General Hospital and University of Brescia, Brescia, Italy
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, ASST Spedali Civili General Hospital and University of Brescia, Brescia, Italy
| | - Diego Ripamonti
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gianluca Zuglian
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Massimiliano Fabbiani
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Alice Ferraresi
- Division of Infectious Diseases, Cremona Hospital, Cremona, Italy
| | - Cristina Putaggio
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Eugenia Quiros-Roldan
- Department of Infectious and Tropical Diseases, ASST Spedali Civili General Hospital and University of Brescia, Brescia, Italy
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30
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Devita M, Di Rosa E, Iannizzi P, Bianconi S, Contin SA, Tiriolo S, Ghisi M, Schiavo R, Bernardinello N, Cocconcelli E, Balestro E, Cattelan AM, Leoni D, Volpe B, Mapelli D. Risk and Protective Factors of Psychological Distress in Patients Who Recovered From COVID-19: The Role of Cognitive Reserve. Front Psychol 2022; 13:852218. [PMID: 35719579 PMCID: PMC9204198 DOI: 10.3389/fpsyg.2022.852218] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/05/2022] [Indexed: 01/06/2023] Open
Abstract
Recent studies reported the development of psychological distress symptoms in patients who recovered from COVID-19. However, evidence is still scarce and new data are needed to define the exact risk and protective factors that can explain the variability in symptoms manifestation. In this study, we enrolled 257 patients who recovered from COVID-19 and we evaluated the levels of psychological distress through the Symptoms Checklist-90-R scale. Data concerning illness-related variables were collected from medical records, while the presence of subjective cognitive difficulties, both before and after the illness, as well as the level of the cognitive reserve (CR), were assessed over a clinical interview. Results revealed that being female and reporting the presence of subjective cognitive difficulties after COVID-19 were associated with higher levels of psychological distress. At the same time, being admitted to the hospital and having a high CR were protective factors. Adding new information to this emerging research field, our results highlight the importance of a complete psychological and cognitive assessment in patients with COVID-19.
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Affiliation(s)
- Maria Devita
- Department of General Psychology, University of Padua, Padua, Italy
| | - Elisa Di Rosa
- Department of General Psychology, University of Padua, Padua, Italy
| | - Pamela Iannizzi
- Unitá Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Sara Bianconi
- Unitá Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Sara Anastasia Contin
- Unitá Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Simona Tiriolo
- Unitá Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Marta Ghisi
- Department of General Psychology, University of Padua, Padua, Italy.,Unitá Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Rossana Schiavo
- Unitá Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Nicol Bernardinello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Elisabetta Cocconcelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Elisabetta Balestro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Davide Leoni
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Biancarosa Volpe
- Unitá Operativa Complessa (UOC) Hospital Psychology, Padua University Hospital, Padua, Italy
| | - Daniela Mapelli
- Department of General Psychology, University of Padua, Padua, Italy
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31
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Savoldi A, Morra M, De Nardo P, Cattelan AM, Mirandola M, Manfrin V, Scotton P, Giordani MT, Brollo L, Panese S, Lanzafame M, Scroccaro G, Berkell M, Lippi G, Konnova A, Smet M, Malhotra-Kumar S, Kumar-Singh S, Tacconelli E. Clinical efficacy of different monoclonal antibody regimens among non-hospitalised patients with mild to moderate COVID-19 at high risk for disease progression: a prospective cohort study. Eur J Clin Microbiol Infect Dis 2022; 41:1065-1076. [PMID: 35727429 PMCID: PMC9209841 DOI: 10.1007/s10096-022-04464-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Abstract
This study aimed to compare the clinical progression of COVID-19 in high-risk outpatients treated with the monoclonal antibodies (mAb) bamlanivimab, bamlanivimab-etesevimab and casirivimab-imdevimab. This is an observational, multi-centre, prospective study conducted from 18 March to 15 July 2021 in eight Italian tertiary-care hospitals including mild-to-moderate COVID-19 outpatients receiving bamlanivimab (700 mg), bamlanivimab-etesevimab (700–1400 mg) or casirivimab-imdevimab (1200–1200 mg). All patients were at high risk of COVID-19 progression according to Italian Medicines Agency definitions. In a patient subgroup, SARS-CoV-2 variant and anti-SARS-CoV-2 serology were analysed at baseline. Factors associated with 28-day all-cause hospitalisation were identified using multivariable multilevel logistic regression (MMLR) and summarised with adjusted odds ratio (aOR) and 95% confidence interval (CI). A total of 635 outpatients received mAb: 161 (25.4%) bamlanivimab, 396 (62.4%) bamlanivimab-etesevimab and 78 (12.2%) casirivimab-imdevimab. Ninety-five (15%) patients received full or partial SARS-CoV-2 vaccination. The B.1.1.7 (Alpha) variant was detected in 99% of patients. Baseline serology showed no significant differences among the three mAb regimen groups. Twenty-eight-day all-cause hospitalisation was 11.3%, with a significantly higher proportion (p 0.001) in the bamlanivimab group (18.6%), compared to the bamlanivimab-etesevimab (10.1%) and casirivimab-imdevimab (2.6%) groups. On MMLR, aORs for 28-day all-cause hospitalisation were significantly lower in patients receiving bamlanivimab-etesevimab (aOR 0.51, 95% CI 0.30–0.88 p 0.015) and casirivimab-imdevimab (aOR 0.14, 95% CI 0.03–0.61, p 0.009) compared to those receiving bamlanivimab. No patients with a history of vaccination were hospitalised. The study suggests differences in clinical outcomes among the first available mAb regimens for treating high-risk COVID-19 outpatients. Randomised trials are needed to compare efficacy of mAb combination regimens in high-risk populations and according to circulating variants.
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Affiliation(s)
- Alessia Savoldi
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Matteo Morra
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Pasquale De Nardo
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.
| | - Anna Maria Cattelan
- Infectious Disease Unit, Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Massimo Mirandola
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.,School of Health Sciences, University of Brighton, Brighton, UK
| | - Vinicio Manfrin
- Division of Infectious and Tropical Diseases, S. Bortolo Hospital, Viale Ferdinando Rodolfi 37, 36100, Vicenza, Italy
| | | | - Maria Teresa Giordani
- Infectious Diseases Unit, Alto Vicentino Santorso Hospital, Azienda ULSS 7via Garziere 42, Santorso, Vicenza, Italy
| | - Lucio Brollo
- Division of Internal Medicine and Cardiology, Infectious Diseases and COVID-19 Section, Jesolo Hospital Via Levantina, 104, 30016, Jesolo, Italy
| | - Sandro Panese
- Infectious Diseases Unit, Azienda ULSS 3 Serenissima, Ss. Giovanni E Paolo Hospital, Castello 6777, 30122, Venice, Italy
| | - Massimiliano Lanzafame
- Division of Infectious Diseases, Ospedale Santa Maria Della Misericordia Hospital, Viale Tre Martiri 140, Rovigo, Rovigo, Italy
| | | | - Matilda Berkell
- Lab of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.,Molecular Pathology Group, Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Angelina Konnova
- Molecular Pathology Group, Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mathias Smet
- Lab of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Surbhi Malhotra-Kumar
- Lab of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Samir Kumar-Singh
- Molecular Pathology Group, Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
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Midena E, Cosmo E, Cattelan AM, Briani C, Leoni D, Capizzi A, Tabacchi V, Parrozzani R, Midena G, Frizziero L. Small Fibre Peripheral Alterations Following COVID-19 Detected by Corneal Confocal Microscopy. J Pers Med 2022; 12:jpm12040563. [PMID: 35455679 PMCID: PMC9030195 DOI: 10.3390/jpm12040563] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/07/2022] Open
Abstract
A large spectrum of neurological manifestations has been associated with coronavirus disease 2019 (COVID-19), and recently, the involvement of small fibers has been suggested. This study aims to investigate the involvement of small peripheral nervous fibers in recovered COVID-19 patients using in-vivo corneal confocal microscopy (CCM). Patients recovered from COVID-19 and a control group of healthy subjects underwent in-vivo CCM. Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), corneal nerve fiber total branch density (CTBD), corneal nerve fiber area (CNFA), corneal nerve fiber width (CNFW), fiber tortuosity (FT), number of beadings (NBe), and dendritic cells (DC) density were quantified. We enrolled 302 eyes of 151 patients. CNBD and FT were significantly higher (p = 0.0131, p < 0.0001), whereas CNFW and NBe were significantly lower (p = 0.0056, p = 0.0045) in the COVID-19 group compared to controls. Only CNBD and FT resulted significantly correlated to antiviral drugs (increased) and corticosteroids (decreased). No significant relationship with disease severity parameters was found. COVID-19 may induce peripheral neuropathy in small fibers even months after recovery, regardless of systemic conditions and therapy, and CCM may be a useful tool to identify and monitor these morphological changes.
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Affiliation(s)
- Edoardo Midena
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (V.T.); (R.P.); (L.F.)
- IRCCS—Fondazione Bietti, 00198 Rome, Italy; (E.C.); (G.M.)
- Correspondence: ; Tel.: +39-049-821-2110
| | - Eleonora Cosmo
- IRCCS—Fondazione Bietti, 00198 Rome, Italy; (E.C.); (G.M.)
| | - Anna Maria Cattelan
- Unit of Infectious Disease, Department of Internal Medicine, University of Padova, 35128 Padova, Italy; (A.M.C.); (D.L.)
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy;
| | - Davide Leoni
- Unit of Infectious Disease, Department of Internal Medicine, University of Padova, 35128 Padova, Italy; (A.M.C.); (D.L.)
| | - Alfio Capizzi
- Department of Directional Hospital Management, University of Padova, 35128 Padova, Italy;
| | - Vanessa Tabacchi
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (V.T.); (R.P.); (L.F.)
| | - Raffaele Parrozzani
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (V.T.); (R.P.); (L.F.)
| | - Giulia Midena
- IRCCS—Fondazione Bietti, 00198 Rome, Italy; (E.C.); (G.M.)
| | - Luisa Frizziero
- Ophthalmology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy; (V.T.); (R.P.); (L.F.)
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De Silvestro G, Marson P, La Raja M, Cattelan AM, Guarnieri G, Monticelli J, Tiberio I, Vianello A, Gandini G, Gessoni G, Fiorin F, Sardella C, Astolfi L, Saia M. Outcome of SARS CoV-2 inpatients treated with convalescent plasma: One-year of data from the Veneto region (Italy) Registry. Eur J Intern Med 2022; 97:42-49. [PMID: 34980505 PMCID: PMC8710400 DOI: 10.1016/j.ejim.2021.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/19/2021] [Accepted: 12/20/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES AND BACKGROUND Convalescent plasma (CP) has been used worldwide to contrast SARS-CoV-2 infection. Since April 2020, it has also been used in the treatment of patients with COVID-19 in the Veneto region (Italy), along with all the other available drugs and therapeutic tools. Here we report data analysis and clinical results in 1,517 COVID-19 inpatients treated with CP containing high-titre neutralizing anti-SARS-CoV-2 antibodies (CCP). Mortality after 30 days of hospitalization has been considered primary outcome, by comparing patients treated with CCP vs all COVID-19 patients admitted to hospitals of the Veneto region in a one-year period (from April 2020 to April 2021). PATIENTS AND METHODS Adult inpatients with a severe form of COVID-19 have been enrolled, with at least one of the following inclusion criteria: 1) tachypnea with respiratory rate (RR) ≥ 30 breaths/min; 2) oxygen saturation (SpO2) ≤ 93% at rest and in room air; 3) partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ≤ 200 mmHg, 4) radiological picture and/or chest CT scan showing signs of interstitial disease and/or rapid progression of lung involvement. Patients received a maximum of three therapeutic fractions (TFs) of CCP with a neutralizing antibody titre of ≥ 1:160, administered over a period of 3-5 days. If TFs of CCP with titre ≥ 1:160 were unavailable, 2 with antibody titre of ≥ 1:80 have been administered. RESULTS Of the 1,517 patients treated with CCP, 209 deceased at the 30-day follow-up (14%). Death was significantly associated with an older age (p<0.001), a longer time of hospitalization before CCP infusion (p<0.001), a greater number of inclusion criteria (p<0.001) and associated comorbidities (p<0.001). Conditions significantly associated with an increased frequency of death were PaO2/FiO2 ≤ 200 (p<0.001) and tachypnea with RR>30 (p<0.05) at entry, concurrent arterial hypertension (p<0.001), cardiovascular disease (p<0.001), chronic kidney disease (p<0.001), dyslipidemia (p<0.05) and cancer (p<0.05). Moreover, factors leading to an unfavorable prognosis were a life-threatening disease (p<0.001), admission to Intensive Care Unit (p<0.001), high flow oxygen therapy or mechanical ventilation (p<0.05) and a chest X-ray showing consolidation area (p<0.001). By analyzing the regional report of hospitalized patients, a comparison of mortality by age group, with respect to our series of patients treated with CCP, has been made. Mortality was altogether lower in patients treated with CCP (14% v. 25%), especially in the group of the elderly patients (23% vs 40%,), with a strong significance (p<0.001). As regards the safety of CCP administration, 16 adverse events were recorded out of a total of 3,937 transfused TFs (0,4%). CONCLUSIONS To overcome the difficulties of setting up a randomized controlled study in an emergency period, a data collection from a large series of patients with severe COVID-19 admitted to CCP therapy with well-defined inclusion criteria has been implemented in the Veneto region. Our results have shown that in patients with severe COVID-19 early treatment with CCP might contribute to a favourable outcome, with a reduced mortality, in absence of relevant adverse events.
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Affiliation(s)
| | - Piero Marson
- Department of Transfusion Medicine, Padua University Hospital, Padova, Italy.
| | - Massimo La Raja
- Department of Transfusion Medicine, Padua University Hospital, Padova, Italy.
| | | | - Gabriella Guarnieri
- Respiratory Pathophysiology Division, Padua University Hospital, Padova, Italy.
| | | | - Ivo Tiberio
- Intensive Care Central Unit, Department of Medicine, Padua University Hospital, Padova, Italy.
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Padua University Hospital, Padova, Italy.
| | - Giorgio Gandini
- Transfusion Medicine Department, Verona University Hospital, Verona, Italy.
| | - Gianluca Gessoni
- Transfusion Medicine Department of Venezia, Ospedale dell'Angelo-Mestre Venezia, Italy.
| | - Francesco Fiorin
- Transfusion Medicine Department of Vicenza, Ospedale San Bortolo, Vicenza, Italy.
| | | | - Laura Astolfi
- Bioacustics Research Laboratory, Department of Neurosciences, Padua University, Padova, Italy.
| | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Veneto, Italy.
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Mazzitelli M, Sasset L, Leoni D, Putaggio C, Cattelan AM. Real life use of dolutegravir doravirine dual regimen in experienced elderly PLWH with multiple comorbidities and on polypharmacy: A retrospective analysis. Medicine (Baltimore) 2021; 100:e28488. [PMID: 34967394 PMCID: PMC8718210 DOI: 10.1097/md.0000000000028488] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/16/2021] [Indexed: 01/05/2023] Open
Abstract
By increasing life expectancy of people living with HIV, the most clinical challenge is managing both drug-to-drug interactions and comorbidities (especially metabolic). Doravirine (DOR), a new non-nucleoside reverse transcriptase inhibitor, recently approved for the treatment of HIV, could be a good companion of dolutegravir (DTG) in a dual regimen for experienced elderly patients with multimorbidity and polypharmacy.We herein report our preliminary experience in a small cohort of elderly patients (>50 years of age) with multimorbidity and on polypharmacy who were switched to DOR/DTG dual regimen and followed-up for 3 months. The study was conducted at the Infectious and Tropical Diseases Unit of Padua University Hospital, Italy.Eighteen patients were included, 72.2% males and 27.8% postmenopausal women, mean age was of 61.3 years (7.6), 50% experienced AIDS events. Switches to DOR and DTG were mainly due to high cardiovascular and metabolic risk (72.2%), and interactions among comedications (50%). Antiretrovirals that subjects were switched off were mostly boosted protease inhibitors 66.7%. We observed a viral suppression among all subjects. Interestingly, we observed a statistically significant reduction in body mass index, body weight and waist circumference, eGFR, and a significant increase in serum creatinine levels. No significant changes in CD4+ T cell count was observed from the baseline. Lipid and fasting glucose values did not change significantly.To the best of our knowledge this is the first experience reporting real-life outcome of switch to DTG + DOR in elderly with multimorbidity and on polypharmacy. From our very preliminary data the dual combination of DTG and DOR could be a good treatment strategy for these subjects. However, our findings need to be validated on a greater number of patients.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, University Hospital of Padua, Padua, Italy
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Lolita Sasset
- Infectious and Tropical Diseases Unit, University Hospital of Padua, Padua, Italy
| | - Davide Leoni
- Infectious and Tropical Diseases Unit, University Hospital of Padua, Padua, Italy
| | - Cristina Putaggio
- Infectious and Tropical Diseases Unit, University Hospital of Padua, Padua, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, University Hospital of Padua, Padua, Italy
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Focà E, Calcagno A, Calza S, Renzetti S, Chiesa A, Siano M, De Socio G, Piconi S, Orofino G, Madeddu G, Cattelan AM, Nozza S, Ferrara M, Milic J, Celesia BM, Castelli F, Guaraldi G. Durability of Integrase STrand Inhibitor (InSTI)-based regimen in geriatric people living with HIV in the GEPPO cohort. PLoS One 2021; 16:e0258533. [PMID: 34644336 PMCID: PMC8513889 DOI: 10.1371/journal.pone.0258533] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the durability of the first integrase inhibitor-based regimen in a HIV geriatric multicentric prospective cohort and to explore the reasons of regimen discontinuation. DESIGN This is an analysis conducted on the Geriatric Patients Living with HIV/AIDS (GEPPO) cohort, an Italian prospective observational multicentre cohort of people living with HIV with 65 years of age or more. METHODS The analysis was performed using R (version 4.0.2). The tests performed were two sided assuming a 5% significance level (Kruskal-Wallis test, Chi-squared test, log-rank test and a Cox Proportional Hazard model). The proportion of participants discontinuing the three regimens was displayed using cumulative curves. RESULTS Among 1531 patients enrolled between 2017 and 2019 in the GEPPO cohort, we included 822 participants in this analysis. At baseline, median age was 69.8, the immunovirological profile good, multimorbidity was present in 42.3% of participants, while 27.4% were on polypharmacy. Overall, 483, 243 and 96 participants received DTG, RAL and EVG/c respectively as first InSTI. At the end of the follow up 6.4%, 21.1% and 22.9% participants discontinued DTG, RAL and EVG/c respectively. Using a log-rank test, EVG showed a significantly lower durability than DTG (p<0.001) or RAL (p 0.05) or both, DTG and RAL (p<0.001). Among participants who discontinued their regimen we found 0 virological failure and 56.7% simplification/deprescription. CONCLUSIONS The three integrase inhibitors considered showed a good durability and no virological failures in geriatric patients such as those enrolled in the GEPPO cohort when used in a two or three drug regimen.
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Affiliation(s)
- Emanuele Focà
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- BDbiomed lab, University of Brescia, Brescia, Italy
| | - Stefano Renzetti
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- BDbiomed lab, University of Brescia, Brescia, Italy
| | - Annacarla Chiesa
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Matteo Siano
- 3rd Division of Infectious Diseases, University of Milano, L. Sacco Hospital, Milano, Italy
| | - Giuseppe De Socio
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy
| | - Stefania Piconi
- 1st Division of Infectious Diseases Unit, University of Milano, L. Sacco Hospital, Milano, Italy
| | - Giancarlo Orofino
- Unit of Infectious Diseases, ’Divisione A’, Amedeo di Savoia Hospital, ASLTO2, Torino, Italy
| | - Giordano Madeddu
- Unit of Infectious and Tropical Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Anna Maria Cattelan
- Unit of Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliero-Universitaria di Padova, Padova, Italy
| | - Silvia Nozza
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy
| | - Micol Ferrara
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Jovana Milic
- Department of Mother, Child and Adult Medicine and Surgical Science, Infectious Disease Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Benedetto Maurizio Celesia
- Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, University of Catania, ARNAS Garibaldi, Catania, Italy
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Giovanni Guaraldi
- Department of Mother, Child and Adult Medicine and Surgical Science, Infectious Disease Clinic, University of Modena and Reggio Emilia, Modena, Italy
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Bordin A, Mucignat-Caretta C, Gaudioso P, Pendolino AL, Leoni D, Scarpa B, Andrews PJ, Cattelan AM, Antonini A, Nicolai P, Marchese-Ragona R, Ottaviano G. Comparison of self-reported symptoms and psychophysical tests in coronavirus disease 2019 (COVID-19) subjects experiencing long-term olfactory dysfunction: a 6-month follow-up study. Int Forum Allergy Rhinol 2021; 11:1592-1595. [PMID: 34148294 PMCID: PMC8426864 DOI: 10.1002/alr.22828] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Anna Bordin
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | | | - Piergiorgio Gaudioso
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - Alfonso Luca Pendolino
- Department of Ear, Nose and Throat Royal National ENT & Eastman Dental Hospitals, London, UK.,Ear Institute, University College London, London, UK
| | - Davide Leoni
- Unit of Infectious Disease University Hospital of Padova, Padova, Italy
| | - Bruno Scarpa
- Department of Statistical Sciences, University of Padova, Padova, Italy.,Department of Mathematics "Tullio Levi-Civita,", University of Padova, Padova, Italy
| | - Peter J Andrews
- Department of Ear, Nose and Throat Royal National ENT & Eastman Dental Hospitals, London, UK.,Ear Institute, University College London, London, UK
| | | | - Angelo Antonini
- Department of Neurosciences, Neurology Section, University of Padova, Padova, Italy
| | - Piero Nicolai
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | | | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
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Giraudo C, Librizzi G, Fichera G, Motta R, Balestro E, Calabrese F, Carretta G, Cattelan AM, Navalesi P, Pelloso M, Plebani M, Rea F, Vettor R, Vianello A, Stramare R. Reduced muscle mass as predictor of intensive care unit hospitalization in COVID-19 patients. PLoS One 2021; 16:e0253433. [PMID: 34138945 PMCID: PMC8211180 DOI: 10.1371/journal.pone.0253433] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose To evaluate if reduced muscle mass, assessed with Computed Tomography (CT), is a predictor of intensive care unit (ICU) hospitalization in COVID-19 patients. Methods In this Institution Review Board approved study, we retrospectively evaluated COVID-19 patients treated in our tertiary center from March to November 2020 who underwent an unenhanced chest CT scan within three weeks from hospitalization.We recorded the mean Hounsfield Unit (Hu) value of the right paravertebral muscle at the level of the 12th thoracic vertebra, the hospitalization unit (ICU and COVID-19 wards), clinical symptoms, Barthel Index, and laboratory findings.Logistic regression analysis was applied to assess if muscle loss (Hu<30) is a predictor of ICU admission and outcome.Fisher’s exact and Student’s tests were applied to evaluate if differences between patients with and without muscle loss occurred (p<0.05). Results One-hundred-fifty patients matched the inclusion criteria (46 females; mean age±SD 61.3±15 years-old), 36 treated in ICU. Patients in ICU showed significantly lower Hu values (29±24 vs 39.4±12, p = 0.001). Muscle loss was a predictor of ICU admission (p = 0.004).Patients with muscle loss were significantly older (73.4±10 vs 56.4±14 years), had lower Barthel Index scores (54.4±33 vs 85.1±26), red blood-cell count (3.9±1 vs 4.6±1×1012L−1), and Hb levels (11.5±2 vs 13.2±2g/l) as well as higher white blood-cell count (9.4±7 vs 7.2±4×109L−1), C-reactive protein (71.5±71 vs 44±48U/L), and lactate dehydrogenase levels (335±163 vs 265.8±116U/L) (p<0.05, each). Conclusions Muscle loss seems to be a predictor of ICU hospitalization in COVID-19 patients and radiologists reporting chest CT at admission should note this finding in their reports.
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Affiliation(s)
- Chiara Giraudo
- Department of Medicine–DIMED, University of Padova, Padova, Italy
- * E-mail:
| | | | - Giulia Fichera
- Department of Medicine–DIMED, University of Padova, Padova, Italy
| | - Raffaella Motta
- Department of Medicine–DIMED, University of Padova, Padova, Italy
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Fiorella Calabrese
- Pathological Anatomy Section, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giovanni Carretta
- Unità Locale Socio Sanitaria–ULSS 3 Serenissima, Veneto Region, Italy
| | - Anna Maria Cattelan
- Division of Infectious and Tropical Diseases, Padova University Hospital, Padova, Italy
| | - Paolo Navalesi
- Anesthesiology and Intensive Care Unit, Department of Medicine–DIMED, University of Padova, Padova, Italy
| | - Michela Pelloso
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Roberto Vettor
- Internal Medicine, Department of Medicine—DIMED, University of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Roberto Stramare
- Department of Medicine–DIMED, University of Padova, Padova, Italy
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Lunardi F, Fortarezza F, Vedovelli L, Pezzuto F, Boscolo A, Rossato M, Vettor R, Cattelan AM, Del Vecchio C, Crisanti A, Navalesi P, Gregori D, Calabrese F. Lower Gene Expression of Angiotensin Converting Enzyme 2 Receptor in Lung Tissues of Smokers with COVID-19 Pneumonia. Biomolecules 2021; 11:796. [PMID: 34073591 PMCID: PMC8226817 DOI: 10.3390/biom11060796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
Angiotensin-converting enzyme 2 (ACE-2) is the main cell entry receptor for severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2), thus playing a critical role in causing Coronavirus disease 2019 (COVID-19). The role of smoking habit in the susceptibility to infection is still controversial. In this study we correlated lung ACE-2 gene expression with several clinical/pathological data to explore susceptibility to infection. This is a retrospective observational study on 29 consecutive COVID-19 autopsies. SARS-CoV-2 genome and ACE-2 mRNA expression were evaluated by real-time polymerase chain reaction in lung tissue samples and correlated with several data with focus on smoking habit. Smoking was less frequent in high than low ACE-2 expressors (p = 0.014). A Bayesian regression also including age, gender, hypertension, and virus quantity confirmed that smoking was the most probable risk factor associated with low ACE-2 expression in the model. A direct relation was found between viral quantity and ACE-2 expression (p = 0.028). Finally, high ACE-2 expressors more frequently showed a prevalent pattern of vascular injury than low expressors (p = 0.049). In conclusion, ACE-2 levels were decreased in the lung tissue of smokers with severe COVID-19 pneumonia. These results point out complex biological interactions between SARS-CoV-2 and ACE-2 particularly concerning the aspect of smoking habit and need larger prospective case series and translational studies.
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Affiliation(s)
- Francesca Lunardi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (F.L.); (F.F.); (L.V.); (F.P.); (D.G.)
| | - Francesco Fortarezza
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (F.L.); (F.F.); (L.V.); (F.P.); (D.G.)
| | - Luca Vedovelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (F.L.); (F.F.); (L.V.); (F.P.); (D.G.)
| | - Federica Pezzuto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (F.L.); (F.F.); (L.V.); (F.P.); (D.G.)
| | - Annalisa Boscolo
- Department of Medicine, University of Padova Medical School, 35128 Padova, Italy; (A.B.); (M.R.); (R.V.); (A.M.C.); (P.N.)
| | - Marco Rossato
- Department of Medicine, University of Padova Medical School, 35128 Padova, Italy; (A.B.); (M.R.); (R.V.); (A.M.C.); (P.N.)
| | - Roberto Vettor
- Department of Medicine, University of Padova Medical School, 35128 Padova, Italy; (A.B.); (M.R.); (R.V.); (A.M.C.); (P.N.)
| | - Anna Maria Cattelan
- Department of Medicine, University of Padova Medical School, 35128 Padova, Italy; (A.B.); (M.R.); (R.V.); (A.M.C.); (P.N.)
| | - Claudia Del Vecchio
- Department of Molecular Medicine, University of Padova Medical School, 35121 Padova, Italy; (C.D.V.); (A.C.)
| | - Andrea Crisanti
- Department of Molecular Medicine, University of Padova Medical School, 35121 Padova, Italy; (C.D.V.); (A.C.)
| | - Paolo Navalesi
- Department of Medicine, University of Padova Medical School, 35128 Padova, Italy; (A.B.); (M.R.); (R.V.); (A.M.C.); (P.N.)
| | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (F.L.); (F.F.); (L.V.); (F.P.); (D.G.)
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (F.L.); (F.F.); (L.V.); (F.P.); (D.G.)
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Basso M, Zago D, Scaggiante R, Cavinato S, Pozzetto I, Stagni C, Parisatto B, Cattelan AM, Battagin G, Sarmati L, Parisi SG. HIV tropism switch in archived DNA of HIV-HCV subjects successfully treated with direct-acting antivirals for HCV infection. Sci Rep 2021; 11:9274. [PMID: 33927306 PMCID: PMC8085114 DOI: 10.1038/s41598-021-88811-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/16/2021] [Indexed: 02/02/2023] Open
Abstract
We described short-term HIV tropism changes occurring in peripheral blood mononuclear cells and the correlations with HIV DNA value in HIV-HCV co-infected patients cured for HCV disease and with undetectable HIV viremia or residual viremia (RV). Plasma HIV RNA, cellular HIV DNA and tropism were evaluated pre-HCV treatment (baseline, BL) and at 12(T1) and 24(T2) weeks after HCV treatment start. V3 sequences were interpreted using Geno2pheno and classified as R5 only if all three sequences had an FPR ≥ 10% and as X4 when at least one replicate sequence had an FPR < 10%. Forty-nine patients (21 with X4 and 28 with R5 virus) were enrolled. Five X4 patients and 9 R5 subjects experienced at least one tropism change,11 with RV:1/5 patients with X4 infection at BL switched at T1 versus 8/9 in the R5 group (p = 0.022977) and the difference was confirmed in subjects with RV (p = 0.02);6/9 R5 patients switching at T1 confirmed the tropism change at T2. No significant differences in HIV DNA values between patients with RV starting with a R5 or X4 tropism and experienced tropism switch or not were found. Short-term tropism switch involved almost a third of patients, in all but three cases with HIV RV. Being R5 at BL is associated to a higher instability, expressed as number of tropism changes and confirmed switch at T2.
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Affiliation(s)
- Monica Basso
- grid.5608.b0000 0004 1757 3470Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padua, Italy
| | - Daniela Zago
- grid.5608.b0000 0004 1757 3470Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padua, Italy
| | | | - Silvia Cavinato
- grid.411474.30000 0004 1760 2630Infectious Diseases Unit, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - Irene Pozzetto
- grid.5608.b0000 0004 1757 3470Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padua, Italy
| | - Camilla Stagni
- grid.5608.b0000 0004 1757 3470Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padua, Italy
| | - Beatrice Parisatto
- grid.5608.b0000 0004 1757 3470Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padua, Italy
| | - Anna Maria Cattelan
- grid.411474.30000 0004 1760 2630Infectious Diseases Unit, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | | | - Loredana Sarmati
- grid.6530.00000 0001 2300 0941Infectious Diseases Clinic, Università Tor Vergata, Rome, Italy
| | - Saverio Giuseppe Parisi
- grid.5608.b0000 0004 1757 3470Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padua, Italy
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Brancaccio G, Gussetti N, Sasset L, Alaibac M, Tarantello M, Salmaso R, Trevenzoli M, Cattelan AM. Cutaneous manifestations in a series of 417 patients with SARS-CoV-2 infection: epidemiological and clinical correlates of chilblain like lesions. Pathog Glob Health 2021; 115:483-486. [PMID: 33729097 DOI: 10.1080/20477724.2021.1901040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A variety of dermatological lesions have been described in COVID-19, although the prevalence and pathogenic relationship remain unclear particularly for chilblain-like lesions. Dermatological examination was performed in a prospective cohort of consecutive patients seen at the service for SARS-CoV-2 infection. Out of 417 patients with confirmed SARS-CoV-2 infection [median age 29.5 years (range 15-65); 62.5% males], dermatological lesions were detected in 7 (1.7%). Three patients had acral lesions; their age (range) was 15-29 years; all had a negative nasopharyngeal swab and developed IgG and/or IgM-specific antibodies; all presented none or mild symptoms. A fourth patient remained negative at repeated testing; mother, father and sister had a documented mild COVID-19. Non-acral lesions were observed in four older patients, with severe COVID-19. Chilblain-like lesions may be the sole manifestation of SARS-CoV-2 infection; their presence in asymptomatic school children and adolescents should be considered a potential signal of familial or community spread of the virus.
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Affiliation(s)
- G Brancaccio
- Unit of Infectious Diseases, University Hospital of Padua, Padua, Italy
| | - N Gussetti
- Unit of Infectious Diseases, University Hospital of Padua, Padua, Italy
| | - L Sasset
- Unit of Infectious Diseases, University Hospital of Padua, Padua, Italy
| | - M Alaibac
- Unit of Dermatology, University of Padua, Padua, Italy
| | - M Tarantello
- Unit of Dermatology, University of Padua, Padua, Italy
| | - R Salmaso
- Unit of Pathology, University of Padua, Padua, Italy
| | - M Trevenzoli
- Unit of Infectious Diseases, University Hospital of Padua, Padua, Italy
| | - A M Cattelan
- Unit of Infectious Diseases, University Hospital of Padua, Padua, Italy
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Mussini C, Cozzi-Lepri A, Menozzi M, Meschiari M, Franceschini E, Milic J, Brugioni L, Pietrangelo A, Girardis M, Cossarizza A, Tonelli R, Clini E, Massari M, Bartoletti M, Ferrari A, Cattelan AM, Zuccalà P, Lichtner M, Rossotti R, Girardi E, Nicastri E, Puoti M, Antinori A, Viale P, Guaraldi G. Development and validation of a prediction model for tocilizumab failure in hospitalized patients with SARS-CoV-2 infection. PLoS One 2021; 16:e0247275. [PMID: 33621264 PMCID: PMC7901750 DOI: 10.1371/journal.pone.0247275] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aim of this secondary analysis of the TESEO cohort is to identify, early in the course of treatment with tocilizumab, factors associated with the risk of progressing to mechanical ventilation and death and develop a risk score to estimate the risk of this outcome according to patients' profile. METHODS Patients with COVID-19 severe pneumonia receiving standard of care + tocilizumab who were alive and free from mechanical ventilation at day 6 after treatment initiation were included in this retrospective, multicenter cohort study. Multivariable logistic regression models were built to identify predictors of mechanical ventilation or death by day-28 from treatment initiation and β-coefficients were used to develop a risk score. Secondary outcome was mortality. Patients with the same inclusion criteria as the derivation cohort from 3 independent hospitals were used as validation cohort. RESULTS 266 patients treated with tocilizumab were included. By day 28 of hospital follow-up post treatment initiation, 40 (15%) underwent mechanical ventilation or died [26 (10%)]. At multivariable analysis, sex, day-4 PaO2/FiO2 ratio, platelets and CRP were independently associated with the risk of developing the study outcomes and were used to generate the proposed risk score. The accuracy of the score in AUC was 0.80 and 0.70 in internal validation and test for the composite endpoint and 0.92 and 0.69 for death, respectively. CONCLUSIONS Our score could assist clinicians in identifying, early after tocilizumab administration, patients who are likely to progress to mechanical ventilation or death, so that they could be selected for eventual rescue therapies.
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Affiliation(s)
- Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL Population Health Sciences, University College London, London, United Kingdom
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucio Brugioni
- Internal Medicine Department, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Antonello Pietrangelo
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Girardis
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Anaesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Enrico Clini
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Marco Massari
- Infectious Disease Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michele Bartoletti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Anna Ferrari
- Infectious Disease Unit, Azienda Ospedale, University of Padua, Padua, Italy
| | - Anna Maria Cattelan
- Infectious Disease Unit, Azienda Ospedale, University of Padua, Padua, Italy
| | - Paola Zuccalà
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Polo Pontino, Italy
| | - Miriam Lichtner
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Polo Pontino, Italy
| | | | - Enrico Girardi
- National Institute for Infectious Diseases L. Spallanzani (INMI), Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases L. Spallanzani (INMI), Rome, Italy
| | - Massimo Puoti
- National Institute for Infectious Diseases L. Spallanzani (INMI), Rome, Italy
- School of Medicine, Università degli studi di Milano Bicocca, Milano, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases L. Spallanzani (INMI), Rome, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Guaraldi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Basso D, Aita A, Padoan A, Cosma C, Navaglia F, Moz S, Contran N, Zambon CF, Maria Cattelan A, Plebani M. Salivary SARS-CoV-2 antigen rapid detection: A prospective cohort study. Clin Chim Acta 2021; 517:54-59. [PMID: 33626369 PMCID: PMC7897404 DOI: 10.1016/j.cca.2021.02.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 01/19/2023]
Abstract
Background and aim SARS-CoV-2 quick testing is relevant for the containment of new pandemic waves. Antigen testing in self-collected saliva might be useful. We compared salivary and naso-pharyngeal swab (NPS) SARS-CoV-2 antigen detection by a rapid chemiluminescent assay (CLEIA) and two different point-of-care (POC) immunochromatographic assays, with results of molecular testing. Methods 234 patients were prospectively enrolled. Paired self-collected saliva (Salivette) and NPS were obtained to perform rRT-PCR, chemiluminescent (Lumipulse G) and POC (NPS: Fujirebio and Abbott; saliva: Fujirebio) for SARS-CoV-2 antigen detection. Results The overall agreement between NPS and saliva rRT-PCR was 78.7%, reaching 91.7% at the first week from symptoms. SARS-CoV-2 CLEIA antigen was highly accurate in distinguishing positive and negative NPS (ROC-AUC = 0.939, 95%CI:0.903–0.977), with 81.6% sensitivity and 93.8% specificity. This assay on saliva reached the optimal value within 7 days from symptoms onset (Sensitivity: 72%; Specificity: 97%). Saliva POC antigen was limited in sensitivity (13%), performing better in NPS (Sensitivity: 48% and 66%; Specificity: 100% and 99% for Espline and Abbott respectively), depending on viral loads. Conclusions Self-collected saliva is a valid alternative to NPS for SARS-CoV-2 detection by molecular, but also by CLEIA antigen testing, which is therefore potentially useful for large scale screening.
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Affiliation(s)
- Daniela Basso
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padova, Padova, Italy.
| | - Ada Aita
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Andrea Padoan
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Chiara Cosma
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Filippo Navaglia
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Stefania Moz
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Nicole Contran
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Carlo-Federico Zambon
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Anna Maria Cattelan
- Tropical and Infectious Diseases Unit, University Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Medicine - DIMED, Laboratory Medicine, University Hospital of Padova, Padova, Italy
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Guarneri V, Bassan F, Zagonel V, Milella M, Zaninelli M, Cattelan AM, Vianello A, Gori S, Aprile G, Azzarello G, Chiari R, Favaretto A, Oliani C, Scola A, Pastorelli D, Mandarà M, Zustovich F, Bernardi D, Chiarion-Sileni V, Morandi P, Toso S, Di Liso E, Ziampiri S, Caccese M, Zampiva I, Puccetti O, Celestino M, Dieci MV, Conte P. Epidemiology and clinical course of severe acute respiratory syndrome coronavirus 2 infection in cancer patients in the Veneto Oncology Network: The Rete Oncologica Veneta covID19 study. Eur J Cancer 2021; 147:120-127. [PMID: 33647547 PMCID: PMC7857033 DOI: 10.1016/j.ejca.2021.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 11/03/2022]
Abstract
Introduction Coronavirus disease 2019 (COVID-19) pandemic started in Italy with clusters identified in Northern Italy. The Veneto Oncology Network (Rete Oncologica Veneta) licenced dedicated guidelines to ensure proper care minimising the risk of infection in patients with cancer. Rete Oncologica Veneta covID19 (ROVID) is a regional registry aimed at describing epidemiology and clinical course of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with cancer. Materials and methods Patients with cancer diagnosis and documented SARS-CoV-2 infection are eligible. Data on cancer diagnosis, comorbidities, anticancer treatments, as well as details on SARS-CoV-2 infection (hospitalisation, treatments, fate of the infection), have been recorded. Logistic regression analysis was applied to calculate the association between clinical/laboratory variables and death from any cause. Results One hundred seventy patients have been enrolled. The median age at time of the SARS-CoV infection was 70 years (25–92). The most common cancer type was breast cancer (n = 40). The majority of the patients had stage IV disease. Half of the patients had two or more comorbidities. The majority of the patients (78%) presented with COVID-19 symptoms. More than 77% of the patients were hospitalized and 6% were admitted to intensive care units. Overall, 104 patients have documented resolution of the infection. Fifty-seven patients (33%) have died. In 29 cases (17%), the cause of death was directly correlated to SARS-CoV-2 infection. Factors significantly correlated with the risk of death were the following: Eastern Cooperative Oncology Group performance status (PS), age, presence of two or more comorbidities, presence of dyspnoea, COVID-19 phenotype ≥ 3, hospitalisation, intensive care unit admission, neutrophil/lymphocyte ratio and thrombocytopenia. Conclusions The mortality rate reported in this confirms the frailty of this population. These data reinforce the need to protect patients with cancer from SARS-CoV-2 infection.
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Affiliation(s)
- Valentina Guarneri
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
| | - Franco Bassan
- Medical Oncology, AULSS 7 Pedemontana, Santorso Hospital and Bassano Hospital, Vicenza, Italy
| | | | - Michele Milella
- Section of Oncology, Department of Medicine, University and Hospital Trust, Verona, Italy
| | - Marta Zaninelli
- Medical Oncology, AULSS 9 Scaligera, Villafranca Hospital, Villafranca (VR), Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Division, University Hospital, Padova, Italy
| | - Andrea Vianello
- Department of Cardiological, Thoracic and Vascular Sciences, Respiratory Pathophysiology Unit, University of Padova, Italy
| | - Stefania Gori
- Medical Oncology, IRCCS Ospedale Don Calabria-Sacro Cuore di Negrar, Verona, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, AULSS 8 Berica, Vicenza, Italy
| | - Giuseppe Azzarello
- Department of Medical Oncology, AULSS 3 Serenissima, Mirano Hospital, Mirano, (VE), Italy
| | - Rita Chiari
- Medical Oncology, AULSS 6 Euganea, South Padova Hospital, Monselice, (PD), Italy
| | - Adolfo Favaretto
- Department of Medical Oncology, AULSS 2 Marca Trevigiana, Ca'Foncello Hospital, Treviso, Italy
| | - Cristina Oliani
- Medical Oncology, AULSS 5 Polesana, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Annamaria Scola
- Onco-hematology, AULSS 3 Serenissima, Chioggia Hospital, Chioggia, (VE), Italy
| | - Davide Pastorelli
- Department of Oncology, AULSS 1 Dolomiti, S. Maria Del Prato Hospital, Feltre, (BL), Italy
| | - Marta Mandarà
- Unit of Oncology, San Bonifacio Hospital-ULSS 9 Scaligera, Verona, Italy
| | - Fable Zustovich
- Clinical Oncology Department, AULSS 1 Dolomiti, San Martino Hospital, Belluno, Italy
| | | | | | - Paolo Morandi
- Medical Oncology Department, Ulss 3 Serenissima,Sant'Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Silvia Toso
- Medical Oncology, AULSS 5 Polesana, Adria Hospital, Adria, Italy
| | | | - Stamatia Ziampiri
- Medical Oncology, AULSS 7 Pedemontana, Santorso Hospital and Bassano Hospital, Vicenza, Italy
| | - Mario Caccese
- Medical Oncology 1, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Ilaria Zampiva
- Section of Oncology, Department of Medicine, University and Hospital Trust, Verona, Italy
| | - Oliviero Puccetti
- Medical Oncology, AULSS 7 Pedemontana, Santorso Hospital and Bassano Hospital, Vicenza, Italy
| | | | - Maria Vittoria Dieci
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
| | - PierFranco Conte
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
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Diaz G, Arribas JR, Arribas JR, Robinson PA, Cattelan AM, Tashima KT, Tsang OTY, Tsang OTY, Chen YS, Chen YS, SenGupta D, Vendrame E, Blair C, Chokkalingam A, Osinusi A, Brainard DM, Chin BS, Chin BS, Spinner C, Criner GJ, Criner GJ, Muñoz J, Lye DCB, Lye DCB, Gottlieb RL. 73. Geographical Disparities in Clinical Outcomes of Severe COVID-19 Patients Treated with Remdesivir. Open Forum Infect Dis 2020. [PMCID: PMC7778124 DOI: 10.1093/ofid/ofaa439.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Remdesivir (RDV), a RNA polymerase inhibitor with potent in vitro activity against SARS-CoV-2, is the only treatment with demonstrated efficacy in shortening the duration of COVID-19. Here we report regional differences in clinical outcomes of severe COVID-19 patients treated with RDV, as part of an open-label, randomized phase-3 trial establishing RDV treatment duration. Methods Hospitalized patients with oxygen saturation ≤94%, a positive SARS-CoV-2 PCR in the past 4 days and radiographic evidence of pneumonia were randomized 1:1 to receive 5d or 10d of intravenous RDV. We compared d14 clinical outcomes of patients from different geographical areas, as measured by mortality rates, change in clinical status from baseline (BL) on a 7-point ordinal scale and change in O2 requirements from BL. Based on previous analyses in compassionate use data showing region as an important predictor of outcome, Italy was examined separately from other regions. Results 397 patients were treated with RDV, of which 229 (58%) were in the US, 77 (19%) Italy, 61 (15% in Spain), 12 (3%) Republic of Korea, 9 (2%) Singapore, 4 (1%) Germany, 4 (1%) Hong Kong and 1 (< 1%) Taiwan. BL clinical status was worse in Italy compared to other regions (72% vs 17% requiring high-flow oxygen delivery or higher), and Italian patients were more likely to be male than patients from other regions (69% vs 63%). Overall results showed 5d RDV was as effective as 10d. Mortality at d14 was higher in Italy (18%) compared to all other countries except Italy (7%). Similarly, clinical improvement at d14, measured as ≥2-point increase in the ordinal scale, was lower in Italian patients (39%) compared to all other countries combined (64%). (Fig.1). Figure 1. Change from Baseline in Clinical Status (measured on a 7-point Ordinal Scale) at d14. ![]()
Conclusion Overall, our results demonstrate significant geographical differences in the clinical course of severe COVID-19 patients treated with RDV. We observed worse outcomes, such as increased mortality and lower rate of clinical improvement, in patients from Italy compared to other regions. Disclosures George Diaz, MD, NO DISCLOSURE DATA Jose Ramon Arribas, MD, Alexa (Advisor or Review Panel member, Speaker’s Bureau, Other Financial or Material Support, Personal fees)Gilead Sciences Inc. (Scientific Research Study Investigator, Advisor or Review Panel member, Speaker’s Bureau, Other Financial or Material Support, Personal fees)Janssen (Advisor or Review Panel member, Speaker’s Bureau, Other Financial or Material Support, Personal fees)Merck (Advisor or Review Panel member, Speaker’s Bureau, Other Financial or Material Support, Personal fees)Viiv Healthcare (Advisor or Review Panel member, Speaker’s Bureau, Other Financial or Material Support, Personal fees) Jose Ramon Arribas, MD, NO DISCLOSURE DATA Philip A. Robinson, MD, NO DISCLOSURE DATA Anna Maria Cattelan, MD, NO DISCLOSURE DATA Karen T. Tashima, MD, Bristol-Myers Squibb (Research Grant or Support)Gilead Sciences Inc. (Grant/Research Support, Scientific Research Study Investigator)GlaxoSmithKline (Research Grant or Support)Merck (Research Grant or Support)Tibotec (Research Grant or Support)Viiv Healthcare (Research Grant or Support) Owen Tak-Yin Tsang, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Owen Tak-Yin Tsang, MD, NO DISCLOSURE DATA Yao-Shen Chen, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Yao-Shen Chen, MD, NO DISCLOSURE DATA Devi SenGupta, MD, Gilead Sciences Inc. (Employee, Shareholder) Elena Vendrame, MD, NO DISCLOSURE DATA Christiana Blair, MS, Gilead Sciences (Employee, Shareholder) Anand Chokkalingam, PhD, Gilead Sciences (Employee) Anu Osinusi, MD, Gilead Sciences (Employee) Diana M. Brainard, MD, Gilead Sciences (Employee) Bum Sik Chin, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Bum Sik Chin, MD, NO DISCLOSURE DATA Christoph Spinner, MD, AbbVie (Advisor or Review Panel member, Other Financial or Material Support, Travel)Bristol-Myers Squibb (Grant/Research Support, Advisor or Review Panel member, Other Financial or Material Support, Travel)Gilead Sciences Inc. (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Other Financial or Material Support, Travel)Janssen (Grant/Research Support, Advisor or Review Panel member, Other Financial or Material Support, Travel)MSD (Grant/Research Support, Advisor or Review Panel member, Other Financial or Material Support, Travel)Viiv Healthcare (Grant/Research Support, Advisor or Review Panel member, Other Financial or Material Support, Travel) Gerard J. Criner, MD, Gilead Sciences Inc. (Scientific Research Study Investigator)Regeneron (Scientific Research Study Investigator) Gerard J. Criner, MD, NO DISCLOSURE DATA Jose Muñoz, MD, NO DISCLOSURE DATA David Chien Boon Lye, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) David Chien Boon Lye, MD, NO DISCLOSURE DATA Robert L. Gottlieb, MD, Gilead Sciences Inc. (Scientific Research Study Investigator)
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Affiliation(s)
- George Diaz
- Providence Regional Medical Center Everett, Everett, Washington
| | | | | | | | - Anna Maria Cattelan
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliera di Padova, Padova, Puglia, Italy
| | | | | | | | - Yao-Shen Chen
- Kaohsiung Veterans General Hospital, Kaohsiung, Kaohsiung
| | - Yao-Shen Chen
- Kaohsiung Veterans General Hospital, Kaohsiung, Kaohsiung
| | | | | | | | | | | | | | | | | | - Christoph Spinner
- Department of Medicine II, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany, Munich, Bayern, Germany
| | | | | | - Jose Muñoz
- Hospital Clinic de Barcelona, Barcelona, Andalucia, Spain
| | - David Chien Boon Lye
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Singapore, Not Applicable, Singapore
| | - David Chien Boon Lye
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Singapore, Not Applicable, Singapore
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Cattelan AM, Di Meco E, Trevenzoli M, Frater A, Ferrari A, Villano M, Gomiero F, Carretta G, Sasset L. Clinical characteristics and laboratory biomarkers changes in COVID-19 patients requiring or not intensive or sub-intensive care: a comparative study. BMC Infect Dis 2020; 20:934. [PMID: 33297986 PMCID: PMC7724444 DOI: 10.1186/s12879-020-05647-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Identifying risk factors for severe novel-coronavirus disease (COVID-19) is useful to ascertain which patients may benefit from advanced supportive care. The study offers a description of COVID-19 patients, admitted to a general ward for a non-critical clinical picture, with the aim to analyse the differences between those transferred to the intensive (ICU) and/or sub-intensive care (SICU) units and those who were not. METHODS This observational retrospective study includes all COVID-19 patients admitted to the Infectious Diseases Unit. Clinical, laboratory, radiological and treatment data were collected. The primary outcome was a composite of need of transfer to the ICU and/or SICU during the hospitalization. Patients who did not require to be transferred are defined as Group 1; patients who were transferred to the ICU and/or SICU are defined as Group 2. Demographic, clinical characteristics and laboratory findings at the 1st, 3rd and last measurements were compared between the two groups. RESULTS 303 were included. The median age was 62 years. 69 patients (22.8%) met the primary outcome and were defined as Group 2. The overall fatality rate was 6.8%. Group 2 patients were predominantly male (76.8% vs. 55.1%, p < 0.01), had a higher fatality rate (14.5% vs. 3.8%, p < 0,01), had more hypertension (72.4% vs. 44%, p < 0,01) and diabetes (31.9% vs. 21%, p = 0.04) and were more likely to present dry cough (49.3% vs. 25.2%, p < 0.01). Overall, chest X-ray at admission showed findings suggestive of pneumonia in 63.2%, and Group 2 were more likely to develop pathological findings during the hospitalization (72.7% vs. 17.2%, p = 0.01). At admission, Group 2 presented significantly higher neutrophil count, aspartate-transaminase and C-Reactive-Protein. At the 3rd measurement, Group 2 presented persistently higher neutrophil count, hepatic inflammation markers and C-Reactive-Protein. Group 1 presented a shorter duration from admission to negativization of follow-up swabs (20 vs. 35 days, p < 0.01). CONCLUSIONS The presence of comorbidities and the persistent observation of abnormal laboratory findings should be regarded as predisposing factors for clinical worsening.
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Affiliation(s)
- Anna Maria Cattelan
- Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy.
| | - Eugenia Di Meco
- Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Marco Trevenzoli
- Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Alessia Frater
- Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Anna Ferrari
- Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy
| | - Marco Villano
- Information Technology System Unit, Azienda Ospedale Università di Padova, Padova, Italy
| | - Federica Gomiero
- Information Technology System Unit, Azienda Ospedale Università di Padova, Padova, Italy
| | - Giovanni Carretta
- Department of Directional Hospital Management, Azienda Ospedale Università di Padova, Padova, Italy
| | - Lolita Sasset
- Infectious Diseases Unit, Azienda Ospedale Università di Padova, Via Nicolò Giustiniani 2, 35128, Padova, Italy
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Zatta M, Di Bella S, Giacobbe DR, Del Puente F, Merelli M, Azzini AM, Brugnaro P, Vedovelli C, Cattelan AM, Busetti M, Gatti G, Bassetti M, Luzzati R. Clinical Features and Mortality of Nosocomial Candidemia in Very Old Patients: A Multicentre Italian Study. Gerontology 2020; 66:532-541. [PMID: 33070136 DOI: 10.1159/000510638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Being elderly is a well-known risk factor for candidemia, but few data are available on the prognostic impact of candidemia in the very old (VO) subjects, as defined as people aged ≥75 years. OBJECTIVE The aim of this study was to assess risk factors for nosocomial candidemia in two groups of candidemia patients, consisting of VO patients (≥75 years) and adult and old (AO) patients (18-74 years). In addition, risk factors for death (30-day mortality) were analysed separately in the two groups. METHODS We included all consecutive candidemia episodes from January 2011 to December 2013 occurring in six referral hospitals in north-eastern Italy. RESULTS A total of 683 nosocomial candidemia episodes occurred. Of those, 293 (42.9%) episodes were in VO and 390 (57.1%) in AO patients. Hospitalization in medical wards, chronic renal failure, urinary catheter, and peripheral parenteral nutrition (PPN) were more common in VO than in AO patients. In the former patient group, adequate antifungal therapy (73.2%) and central venous catheter (CVC) removal (67.6%) occurred less frequently than in AO patients (82.5 and 80%, p < 0.002 and p < 0.004, respectively). Thirty-day mortality was higher in VO compared to AO patients (47.8 vs. 23.6%, p < 0.0001). In AO patients, independent risk factors for death were age (OR 1.04, 95% CI 1.00-1.09, p = 0.038), recent history of chemotherapy (OR 22.01, 95% CI 3.12-155.20, p = 0.002), and severity of sepsis (OR 40.68, 95% CI 7.42-223.10, p < 0.001); CVC removal was associated with higher probability of survival (OR 0.10, 95% CI 0.03-0.33, p < 0.001). In VO patients, independent risk factors for death were PPN (OR 3.5, 95% CI 1.17-10.47, p = 0.025) and hospitalization in medical wards (OR 2.58, 95% CI 1.02-6.53, p = 0.046), while CVC removal was associated with improved survival (OR 0.40, 95% CI 0.16-1.00, p = 0.050). CONCLUSION Thirty-day mortality was high among VO patients and was associated with inadequate management of candidemia, especially in medical wards.
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Affiliation(s)
- Marta Zatta
- Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy,
| | - Stefano Di Bella
- Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy
| | | | - Filippo Del Puente
- Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Maria Merelli
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | | | | | | | - Anna Maria Cattelan
- Infectious and Tropical Diseases Division, University Hospital, Padua, Italy
| | - Marina Busetti
- Laboratory for Microbiology, University Hospital, Trieste, Italy
| | - Giuseppe Gatti
- Division of Cardiac Surgery, University Hospital, Trieste, Italy
| | - Matteo Bassetti
- Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Roberto Luzzati
- Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy
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Fadini GP, Morieri ML, Boscari F, Fioretto P, Maran A, Busetto L, Bonora BM, Selmin E, Arcidiacono G, Pinelli S, Farnia F, Falaguasta D, Russo L, Voltan G, Mazzocut S, Costantini G, Ghirardini F, Tresso S, Cattelan AM, Vianello A, Avogaro A, Vettor R. Newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration. Diabetes Res Clin Pract 2020; 168:108374. [PMID: 32805345 PMCID: PMC7428425 DOI: 10.1016/j.diabres.2020.108374] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/28/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023]
Abstract
AIMS We investigated whether pre-existing diabetes, newly-diagnosed diabetes, and admission hyperglycemia were associated with COVID-19 severity independently from confounders. METHODS We retrospectively analyzed data on patients with COVID-19 hospitalized between February and April 2020 in an outbreak hospital in North-East Italy. Pre-existing diabetes was defined by self-reported history, electronic medical records, or ongoing medications. Newly-diagnosed diabetes was defined by HbA1c and fasting glucose. The primary outcome was a composite of ICU admission or death. RESULTS 413 subjects were included, 107 of whom (25.6%) had diabetes, including 21 newly-diagnosed. Patients with diabetes were older and had greater comorbidity burden. The primary outcome occurred in 37.4% of patients with diabetes compared to 20.3% in those without (RR 1.85; 95%C.I. 1.33-2.57; p < 0.001). The association was stronger for newly-diagnosed compared to pre-existing diabetes (RR 3.06 vs 1.55; p = 0.004). Higher glucose level at admission was associated with COVID-19 severity, with a stronger association among patients without as compared to those with pre-existing diabetes (interaction p < 0.001). Admission glucose was correlated with most clinical severity indexes and its association with adverse outcome was mostly mediated by a worse respiratory function. CONCLUSION Newly-diagnosed diabetes and admission hyperglycemia are powerful predictors of COVID-19 severity due to rapid respiratory deterioration.
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Affiliation(s)
| | | | | | | | | | - Luca Busetto
- Department of Medicine, University of Padova, Italy
| | | | - Elisa Selmin
- Department of Medicine, University of Padova, Italy
| | | | | | | | | | - Lucia Russo
- Department of Medicine, University of Padova, Italy
| | | | | | | | | | | | | | - Andrea Vianello
- Department of Cardiothoracic Vascular Sciences and Public Health, University of Padova, Italy
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Fadini GP, Morieri ML, Longato E, Bonora BM, Pinelli S, Selmin E, Voltan G, Falaguasta D, Tresso S, Costantini G, Sparacino G, Di Camillo B, Tramontan L, Cattelan AM, Vianello A, Fioretto P, Vettor R, Avogaro A. Exposure to dipeptidyl-peptidase-4 inhibitors and COVID-19 among people with type 2 diabetes: A case-control study. Diabetes Obes Metab 2020; 22:1946-1950. [PMID: 32463179 PMCID: PMC7283835 DOI: 10.1111/dom.14097] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 12/17/2022]
Abstract
Because other coronaviruses enter the cells by binding to dipeptidyl-peptidase-4 (DPP-4), it has been speculated that DPP-4 inhibitors (DPP-4is) may exert an activity against severe acute respiratory syndrome coronavirus 2. In the absence of clinical trial results, we analysed epidemiological data to support or discard such a hypothesis. We retrieved information on exposure to DPP-4is among patients with type 2 diabetes (T2D) hospitalized for COVID-19 at an outbreak hospital in Italy. As a reference, we retrieved information on exposure to DPP-4is among matched patients with T2D in the same region. Of 403 hospitalized COVID-19 patients, 85 had T2D. The rate of exposure to DPP-4is was similar between T2D patients with COVID-19 (10.6%) and 14 857 matched patients in the region (8.8%), or 793 matched patients in the local outpatient clinic (15.4%), 8284 matched patients hospitalized for other reasons (8.5%), and when comparing 71 patients hospitalized for COVID-19 pneumonia (11.3%) with 351 matched patients with pneumonia of another aetiology (10.3%). T2D patients with COVID-19 who were on DPP-4is had a similar disease outcome as those who were not. In summary, we found no evidence that DPP-4is might affect hospitalization for COVID-19.
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Affiliation(s)
| | | | - Enrico Longato
- Department of Information EngineeringUniversity of PadovaPadovaItaly
| | | | | | - Elisa Selmin
- Department of MedicineUniversity of PadovaPadovaItaly
| | | | | | - Silvia Tresso
- Department of MedicineUniversity of PadovaPadovaItaly
| | | | | | | | | | | | - Andrea Vianello
- Department of Cardiothoracic Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
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Morieri ML, Fadini GP, Boscari F, Fioretto P, Maran A, Busetto L, Crepaldi MC, Vedovato M, Bonora BM, Selmin E, Arcidiacono G, Pinelli S, Farnia F, Falaguasta D, Russo L, Voltan G, Mazzocut S, Costantini G, Ghirardini F, Tresso S, Cattelan AM, Vianello A, Vettor R, Avogaro A. Hyperglycemia, glucocorticoid therapy, and outcome of COVID-19. Diabetes Res Clin Pract 2020; 168:108449. [PMID: 32949651 PMCID: PMC7494492 DOI: 10.1016/j.diabres.2020.108449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022]
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Giraudo C, Cavaliere A, Fichera G, Weber M, Motta R, Pelloso M, Tosato F, Lupi A, Calabrese F, Carretta G, Cattelan AM, De Conti G, Cianci V, Navalesi P, Plebani M, Rea F, Vettor R, Vianello A, Stramare R. Validation of a composed COVID-19 chest radiography score: the CARE project. ERJ Open Res 2020; 6:00359-2020. [PMID: 33263058 PMCID: PMC7682711 DOI: 10.1183/23120541.00359-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to validate a composed coronavirus disease 2019 (COVID-19) chest radiography score (CARE) based on the extension of ground-glass opacity (GG) and consolidations (Co), separately assessed, and to investigate its prognostic performance. METHODS COVID-19-positive patients referring to our tertiary centre during the first month of the outbreak in our area and with a known outcome were retrospectively evaluated. Each lung was subdivided into three areas and a three-grade score assessing the extension of GG and Co was used. The CARE was derived from the sum of the subscores. A mixed-model ANOVA with post hoc Bonferroni correction was used to evaluate whether differences related to the referring unit (emergency room, COVID-19 wards and intensive care unit (ICU)) occurred. Logistic regression analyses were used to investigate the impact of CARE, patients' age and sex on the outcome. To evaluate the prognostic performance of CARE, receiver operating characteristic curves were computed for the entire stay and at admission only. RESULTS A total of 1203 chest radiographs of 175 patients (120 males; mean age 67.81±15.5 years old) were examined. On average, each patient underwent 6.8±10.3 radiographs. Patients in ICU as well as deceased patients showed higher CARE scores (p<0.05, each). Age, Co and CARE significantly influenced the outcome (p<0.05 each). The CARE demonstrated good accuracy (area under the curve (AUC)=0.736) using longitudinal data as well as at admission only (AUC=0.740). A CARE score of 17.5 during hospitalisation showed 75% sensitivity and 69.9% specificity. CONCLUSIONS The CARE was demonstrated to be a reliable tool to assess the severity of pulmonary involvement at chest radiography with a good prognostic performance.
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Affiliation(s)
- Chiara Giraudo
- Institute of Radiology, Dept of Medicine DIMED, University of Padova, Padua, Italy
| | - Annachiara Cavaliere
- Institute of Radiology, Dept of Medicine DIMED, University of Padova, Padua, Italy
| | - Giulia Fichera
- Institute of Radiology, Dept of Medicine DIMED, University of Padova, Padua, Italy
| | - Michael Weber
- Dept of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Raffaella Motta
- Institute of Radiology, Dept of Medicine DIMED, University of Padova, Padua, Italy
| | - Michela Pelloso
- Dept of Laboratory Medicine, DIMED, University of Padova, Padua, Italy
| | - Francesca Tosato
- Dept of Laboratory Medicine, DIMED, University of Padova, Padua, Italy
| | - Amalia Lupi
- Institute of Radiology, Dept of Medicine DIMED, University of Padova, Padua, Italy
| | - Fiorella Calabrese
- Pathological Anatomy Section, Dept of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Giovanni Carretta
- Dept of Directional Hospital Management, Padova University Hospital, Padua, Italy
| | - Anna Maria Cattelan
- Division of Infectious and Tropical Diseases, Padova University Hospital, Padua, Italy
| | | | - Vito Cianci
- Emergency Dept, Padova University Hospital, Padua, Italy
| | - Paolo Navalesi
- Anesthesiology and Intensive Care Unit, DIMED, University of Padova, Padua, Italy
| | - Mario Plebani
- Dept of Laboratory Medicine, DIMED, University of Padova, Padua, Italy
| | - Federico Rea
- Thoracic Surgery, Dept of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Roberto Vettor
- Internal Medicine, DIMED, University of Padova, Padua, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Dept of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Roberto Stramare
- Institute of Radiology, Dept of Medicine DIMED, University of Padova, Padua, Italy
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