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Djuric O, Larosa E, Cassinadri M, Cilloni S, Bisaccia E, Pepe D, Bonvicini L, Vicentini M, Venturelli F, Giorgi Rossi P, Pezzotti P, Mateo Urdiales A, Bedeschi E. Effect of an enhanced public health contact tracing intervention on the secondary transmission of SARS-CoV-2 in educational settings: The four-way decomposition analysis. eLife 2024; 13:e85802. [PMID: 38416129 PMCID: PMC10901504 DOI: 10.7554/elife.85802] [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: 12/23/2022] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
Background The aim of our study was to test the hypothesis that the community contact tracing strategy of testing contacts in households immediately instead of at the end of quarantine had an impact on the transmission of SARS-CoV-2 in schools in Reggio Emilia Province. Methods We analysed surveillance data on notification of COVID-19 cases in schools between 1 September 2020 and 4 April 2021. We have applied a mediation analysis that allows for interaction between the intervention (before/after period) and the mediator. Results Median tracing delay decreased from 7 to 3.1 days and the percentage of the known infection source increased from 34-54.8% (incident rate ratio-IRR 1.61 1.40-1.86). Implementation of prompt contact tracing was associated with a 10% decrease in the number of secondary cases (excess relative risk -0.1 95% CI -0.35-0.15). Knowing the source of infection of the index case led to a decrease in secondary transmission (IRR 0.75 95% CI 0.63-0.91) while the decrease in tracing delay was associated with decreased risk of secondary cases (1/IRR 0.97 95% CI 0.94-1.01 per one day of delay). The direct effect of the intervention accounted for the 29% decrease in the number of secondary cases (excess relative risk -0.29 95%-0.61 to 0.03). Conclusions Prompt contact testing in the community reduces the time of contact tracing and increases the ability to identify the source of infection in school outbreaks. Although there are strong reasons for thinking it is a causal link, observed differences can be also due to differences in the force of infection and to other control measures put in place. Funding This project was carried out with the technical and financial support of the Italian Ministry of Health - CCM 2020 and Ricerca Corrente Annual Program 2023.
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Affiliation(s)
- Olivera Djuric
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
- Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), University of Modena and Reggio EmiliaModenaItaly
| | - Elisabetta Larosa
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Mariateresa Cassinadri
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Silvia Cilloni
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Eufemia Bisaccia
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Davide Pepe
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Francesco Venturelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di SanitàRomeItaly
| | | | - Emanuela Bedeschi
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly
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Molina Grané C, Mancuso P, Vicentini M, Venturelli F, Djuric O, Manica M, Guzzetta G, Marziano V, Zardini A, d'Andrea V, Trentini F, Bisaccia E, Larosa E, Cilloni S, Cassinadri MT, Pezzotti P, Ajelli M, Rossi PG, Merler S, Poletti P. SARS-CoV-2 transmission patterns in educational settings during the Alpha wave in Reggio-Emilia, Italy. Epidemics 2023; 44:100712. [PMID: 37567090 DOI: 10.1016/j.epidem.2023.100712] [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: 01/18/2023] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Different monitoring and control policies have been implemented in schools to minimize the spread of SARS-CoV-2. Transmission in schools has been hard to quantify due to the large proportion of asymptomatic carriers in young individuals. We applied a Bayesian approach to reconstruct the transmission chains between 284 SARS-CoV-2 infections ascertained during 87 school outbreak investigations conducted between March and April 2021 in Italy. Under the policy of reactive quarantines, we found that 42.5% (95%CrI: 29.5-54.3%) of infections among school attendees were caused by school contacts. The mean number of secondary cases infected at school by a positive individual during in-person education was estimated to be 0.33 (95%CrI: 0.23-0.43), with marked heterogeneity across individuals. Specifically, we estimated that only 26.0% (95%CrI: 17.6-34.1%) of students and school personnel who tested positive during in-person education caused at least one secondary infection at school. Positive individuals who attended school for at least 6 days before being isolated or quarantined infected on average 0.49 (95%CrI: 0.14-0.83) secondary cases. Our findings provide quantitative insights on the contribution of school transmission to the spread of SARS-CoV-2 in young individuals. Identifying positive cases within 5 days after exposure to their infector could reduce onward transmission at school by at least 30%.
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Affiliation(s)
- Carla Molina Grané
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy; Department of Mathematics, University of Trento, Trento, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Olivera Djuric
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Biomedical, Metabolic and Neural Sciences, Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Public Health Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Mattia Manica
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Giorgio Guzzetta
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | | | - Agnese Zardini
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Valeria d'Andrea
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Filippo Trentini
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy; Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Eufemia Bisaccia
- Public Health Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Larosa
- Public Health Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Cilloni
- Public Health Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Teresa Cassinadri
- Public Health Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Ajelli
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Merler
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Piero Poletti
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy.
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Venturelli F, Mancuso P, Vicentini M, Ottone M, Storchi C, Roncaglia F, Bisaccia E, Ferrarini C, Pezzotti P, Rossi PG. High temperature, COVID-19, and mortality excess in the 2022 summer: A cohort study on data from Italian surveillances. Sci Total Environ 2023; 887:164104. [PMID: 37178845 PMCID: PMC10174725 DOI: 10.1016/j.scitotenv.2023.164104] [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] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
We aimed to assess whether the effect of high temperature on mortality differed in COVID-19 survivors and naive. We used data from the summer mortality and COVID-19 surveillances. We found 3.8 % excess risk in 2022 summer, compared to 2015-2019, while 20 % in the last fortnight of July, the period with the highest temperature. The increase in mortality rates during the second fortnight of July was higher among naïve compared to COVID-19 survivors. The time series analysis confirmed the association between temperatures and mortality in naïve people, showing an 8 % excess (95%CI 2 to 13) for a one-degree increase of Thom Discomfort Index while in COVID-19 survivors the effect was almost null with -1 % (95%CI -9 to 9). Our results suggest that the high fatality rate of COVID-19 in fragile people has decreased the proportion of susceptible people who can be affected by the extremely high temperature.
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Affiliation(s)
| | - Pamela Mancuso
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Marta Ottone
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Storchi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Roncaglia
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eufemia Bisaccia
- Public Health Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Ferrarini
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Vicentini M, Venturelli F, Mancuso P, Bisaccia E, Zerbini A, Massari M, Cossarizza A, De Biasi S, Pezzotti P, Bedeschi E, Giorgi Rossi P. Risk of SARS-CoV-2 reinfection by vaccination status, predominant variant and time from prior infection: a cohort study, Reggio Emilia province, Italy, February 2020 to February 2022. Euro Surveill 2023; 28. [PMID: 36995374 PMCID: PMC10064646 DOI: 10.2807/1560-7917.es.2023.28.13.2200494] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
BackgroundUnderstanding the epidemiology of reinfections is crucial for SARS-CoV-2 control over a long period.AimTo evaluate the risk of SARS-CoV-2 reinfection by vaccination status, predominant variant and time after first infection.MethodsWe conducted a cohort study including all residents in the Reggio Emilia province on 31 December 2019, followed up until 28 February 2022 for SARS-CoV-2 first infection and reinfection after 90 days. Cox models were used to compare risk of first infection vs reinfection, adjusting for age, sex, vaccine doses and comorbidities.ResultsThe cohort included 538,516 residents, 121,154 with first SARS-CoV-2 infections and 3,739 reinfections, most in the Omicron BA.1 period. In the pre-Omicron period, three doses of vaccine reduced risk of reinfection by 89% (95% CI: 87-90), prior infection reduced risk by 90% (95% CI: 88-91), while two doses and infection reduced risk by 98% (95% CI: 96-99). In the Omicron BA.1 period, protection estimates were 53% (95% CI: 52-55), 9% (95% CI: 4-14) and 76% (95% CI: 74-77). Before Omicron, protection from reinfection remained above 80% for up to 15 months; with Omicron BA.1, protection decreased from 71% (95% CI: 65-76) at 5 months to 21% (95% CI: 10-30) at 22 months from the first infection. Omicron BA.1 reinfections showed 48% (95% CI: 10-57) lower risk of severe disease than first infections.ConclusionsNatural immunity acquired with previous variants showed low protection against Omicron BA.1. Combined vaccination and natural immunity seems to be more protective against reinfection than either alone. Vaccination of people with prior infection reduced the risk of severe disease.
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Affiliation(s)
- Massimo Vicentini
- Epidemiology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Pamela Mancuso
- Epidemiology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Eufemia Bisaccia
- Public Health Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Zerbini
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
| | - Marco Massari
- Infectious Disease Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Cossarizza
- National Institute for Cardiovascular Research, Bologna, Italy
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Sara De Biasi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Patrizio Pezzotti
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Emanuela Bedeschi
- Public Health Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
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Djuric O, Larosa E, Cassinadri M, Cilloni S, Bisaccia E, Pepe D, Vicentini M, Venturelli F, Bonvicini L, Giorgi Rossi P, Pezzotti P, Mateo Urdiales A, Bedeschi E. Surveillance, contact tracing and characteristics of SARS-CoV-2 transmission in educational settings in Northern Italy, September 2020 to April 2021. PLoS One 2022; 17:e0275667. [PMID: 36215304 PMCID: PMC9550042 DOI: 10.1371/journal.pone.0275667] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The role of school contacts in the spread of the virus and the effectiveness of school closures in controlling the epidemic is still debated. We aimed to quantify the risk of transmission of SARS-CoV-2 in the school setting by type of school, characteristics of the index case and calendar period in the Province of Reggio Emilia (RE), Italy. The secondary aim was to estimate the speed of implementation of contact tracing. METHODS A population-based analysis of surveillance data on all COVID-19 cases occurring in RE, Italy, from 1 September 2020, to 4 April 2021, for which a school contact and/or exposure was suspected. An indicator of the delay in contact tracing was calculated as the time elapsed since the index case was determined to be positive and the date on which the swab test for classmates was scheduled (or most were scheduled). RESULTS Overall, 30,184 and 13,608 contacts among classmates and teachers/staff, respectively, were identified and were recommended for testing, and 43,214 (98.7%) underwent the test. Secondary transmission occurred in about 40% of the investigated classes, and the overall secondary case attack rate was 4%. This rate was slightly higher when the index case was a teacher but with almost no differences by type of school, and was stable during the study period. Speed of implementation of contact tracing increased during the study period, with the time from index case identification to testing of contacts being reduced from seven to three days. The ability to identify the possible source of infection in the index case also increased. CONCLUSIONS Despite the spread of the Alpha variant during the study period in RE, the secondary case attack rate remained stable from school reopening in September 2020 until the beginning of April 2021.
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Affiliation(s)
- Olivera Djuric
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Biomedical, Metabolic and Neural Sciences, Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Public Health Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Larosa
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mariateresa Cassinadri
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Cilloni
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eufemia Bisaccia
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Pepe
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Venturelli
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Emanuela Bedeschi
- Public Health Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Manica M, De Bellis A, Guzzetta G, Mancuso P, Vicentini M, Venturelli F, Zerbini A, Bisaccia E, Litvinova M, Menegale F, Molina Grané C, Poletti P, Marziano V, Zardini A, d'Andrea V, Trentini F, Bella A, Riccardo F, Pezzotti P, Ajelli M, Giorgi Rossi P, Merler S. Intrinsic generation time of the SARS-CoV-2 Omicron variant: An observational study of household transmission. Lancet Reg Health Eur 2022; 19:100446. [PMID: 35791373 PMCID: PMC9246701 DOI: 10.1016/j.lanepe.2022.100446] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Starting from the final months of 2021, the SARS-CoV-2 Omicron variant expanded globally, swiftly replacing Delta, the variant that was dominant at the time. Many uncertainties remain about the epidemiology of Omicron; here, we aim to estimate its generation time. METHODS We used a Bayesian approach to analyze 23,122 SARS-CoV-2 infected individuals clustered in 8903 households as determined from contact tracing operations in Reggio Emilia, Italy, throughout January 2022. We estimated the distribution of the intrinsic generation time (the time between the infection dates of an infector and its secondary cases in a fully susceptible population), realized household generation time, realized serial interval (time between symptom onset of an infector and its secondary cases), and contribution of pre-symptomatic transmission. FINDINGS We estimated a mean intrinsic generation time of 6.84 days (95% credible intervals, CrI, 5.72-8.60), and a mean realized household generation time of 3.59 days (95%CrI: 3.55-3.60). The household serial interval was 2.38 days (95%CrI 2.30-2.47) with about 51% (95%CrI 45-56%) of infections caused by symptomatic individuals being generated before symptom onset. INTERPRETATION These results indicate that the intrinsic generation time of the SARS-CoV-2 Omicron variant might not have shortened as compared to previous estimates on ancestral lineages, Alpha and Delta, in the same geographic setting. Like for previous lineages, pre-symptomatic transmission appears to play a key role for Omicron transmission. Estimates in this study may be useful to design quarantine, isolation and contact tracing protocols and to support surveillance (e.g., for the accurate computation of reproduction numbers). FUNDING The study was partially funded by EU grant 874850 MOOD.
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Affiliation(s)
- Mattia Manica
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
| | - Alfredo De Bellis
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
- Department of Mathematics, University of Trento, Trento, Italy
| | - Giorgio Guzzetta
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Venturelli
- Public Health Department, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Zerbini
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Italy
| | - Eufemia Bisaccia
- Public Health Department, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Litvinova
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Francesco Menegale
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
- Department of Mathematics, University of Trento, Trento, Italy
| | - Carla Molina Grané
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
- Department of Mathematics, University of Trento, Trento, Italy
| | - Piero Poletti
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
| | | | - Agnese Zardini
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
| | - Valeria d'Andrea
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
| | - Filippo Trentini
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Antonino Bella
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Riccardo
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Ajelli
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Merler
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
- Corresponding author at: Center for Health Emergencies, Fondazione Bruno Kessler, Via Sommarive 18, 38123, Povo (Trento), Italy.
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7
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Larosa E, Djuric O, Cassinadri M, Cilloni S, Bisaccia E, Vicentini M, Venturelli F, Giorgi Rossi P, Pezzotti P, Bedeschi E. Secondary transmission of COVID-19 in preschool and school settings in northern Italy after their reopening in September 2020: a population-based study. Euro Surveill 2020; 25:2001911. [PMID: 33303065 PMCID: PMC7730487 DOI: 10.2807/1560-7917.es.2020.25.49.2001911] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [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] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/10/2020] [Indexed: 12/29/2022] Open
Abstract
We report epidemiological investigations of transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 41 classes of 36 schools in Reggio Emilia province, northern Italy, from their reopening on 1 September to 15 October 2020. The overall secondary case attack rate was 3.2%, reaching 6.6% in middle and high schools. More timely isolation and testing of classmates could be effective in reducing virus transmission in this setting.
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Affiliation(s)
- Elisabetta Larosa
- Public Health Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Olivera Djuric
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Center for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy
| | - Mariateresa Cassinadri
- Public Health Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Cilloni
- Public Health Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eufemia Bisaccia
- Public Health Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Venturelli
- Public Health Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Emanuela Bedeschi
- Public Health Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Ragni P, Marino M, Formisano D, Bisaccia E, Scaltriti S, Bedeschi E, Grilli R. Association between Exposure to Influenza Vaccination and COVID-19 Diagnosis and Outcomes. Vaccines (Basel) 2020; 8:E675. [PMID: 33198368 PMCID: PMC7711765 DOI: 10.3390/vaccines8040675] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 10/16/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 01/01/2023] Open
Abstract
We explored whether influenza vaccination (IV) affects susceptibility to SARS-CoV-2 infection and clinical outcomes in COVID-19 patients in 17,608 residents of the Italian province of Reggio Emilia undergoing a SARS-CoV-2 test. Exposure to IV was ascertained and the strength of the association with SARS-CoV-2 positivity expressed with odds ratios (OR). Rates of hospitalisations and death in those found positive were assessed and hazard ratios (HR) were estimated. The prevalence of IV was 34.3% in the 4885 SARS-CoV-2 positive and 29.5% in the 12,723 negative subjects, but the adjusted OR indicated that vaccinated individuals had a lower probability of testing positive (OR = 0.89; 95% CI 0.80-0.99). Among the 4885 positive individuals, 1676 had received IV. After adjusting for confounding factors, there was no association between IV and hospitalisation (1.00; 95% CI 0.84-1.29) or death (HR = 1.14; 95% CI 0.95-1.37). However, for patients age ≥65 vaccinated close to the SARS-CoV-2 outbreak, HRs were 0.66 (95% CI: 0.44-0.98) and 0.70 (95% CI 0.50-1.00), for hospitalisation and death, respectively. In this study, IV was associated with a lower probability of COVID-19 diagnosis. In COVID-19 patients, overall, IV did not affect outcomes, although a protective effect was observed for the elderly receiving IV almost in parallel with the SARS-CoV-2 outbreak. These findings provide reassurance in planning IV campaigns and underscore the need for exploring further their impact on COVID-19.
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Affiliation(s)
- Pietro Ragni
- Unit of Clinical Governance, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia,42122 Reggio Emilia, Italy; (P.R.); (M.M.); (D.F.)
| | - Massimiliano Marino
- Unit of Clinical Governance, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia,42122 Reggio Emilia, Italy; (P.R.); (M.M.); (D.F.)
| | - Debora Formisano
- Unit of Clinical Governance, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia,42122 Reggio Emilia, Italy; (P.R.); (M.M.); (D.F.)
| | - Eufemia Bisaccia
- Department of Public Health, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (E.B.); (S.S.); (E.B.)
| | - Stefania Scaltriti
- Department of Public Health, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (E.B.); (S.S.); (E.B.)
| | - Emanuela Bedeschi
- Department of Public Health, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (E.B.); (S.S.); (E.B.)
| | - Roberto Grilli
- Unit of Clinical Governance, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia,42122 Reggio Emilia, Italy; (P.R.); (M.M.); (D.F.)
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Mancuso P, Venturelli F, Vicentini M, Perilli C, Larosa E, Bisaccia E, Bedeschi E, Zerbini A, Rossi PG. Temporal profile and determinants of viral shedding and of viral clearance confirmation on nasopharyngeal swabs from SARS-CoV-2-positive subjects: a population-based prospective cohort study in Reggio Emilia, Italy. BMJ Open 2020; 10:e040380. [PMID: 32878768 PMCID: PMC7477995 DOI: 10.1136/bmjopen-2020-040380] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/13/2020] [Accepted: 08/18/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives To determine the timing of viral clearance (first negative RT-PCR on nasopharyngeal swab) and the probability of viral clearance confirmation (two consecutive negative swabs) in COVID-19 patients and to identify related determinants. Design Population-based prospective cohort study on archive data. Setting Preventive services and hospital care in the Reggio Emilia province, northern Italy. Participants All 1162 subjects testing positive to RT-PCR on nasopharyngeal swabs and diagnosed with COVID-19 in the Reggio Emilia province with at least 30 days of follow-up by 22 April 2020. Main outcome measures Median times from diagnosis and from symptom onset to viral clearance with IQR assessed using the Kaplan–Meier estimator, stratified by included characteristics. The probability of viral clearance confirmation, stratified by time from diagnosis and putative determinants assessed using a multivariate logistic regression model. Results Viral clearance was achieved by 60.6% (704/1162) of patients, with a median time of 30 days from diagnosis (IQR 23–40) and 36 days from symptom onset (IQR 28–45). Of those negative and retested, 78.7% (436/554) had viral clearance confirmation, suggesting one in five false negative tests. The time from symptom onset to viral clearance slightly increased with age, from 35 (IQR 26–44) days under age 50 to 38 (IQR 28–44) in over age 80, and with disease severity, from 33 (IQR 25–41) days in non-hospitalised subjects to 38 (IQR 30–47) days in hospitalised patients. The probability of confirmed viral clearance reached 86.8% after 34 days from symptom onset and increased with time, even when adjusting for age and sex (OR 1.16 95% CI 1.06 to 1.26 per day from diagnosis). Conclusions Postponing follow-up testing of clinically recovered COVID-19 patients could increase the efficiency and performance of testing protocols. Understanding viral shedding duration also has implications for containment measures of paucisymptomatic subjects.
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Affiliation(s)
- Pamela Mancuso
- Epidemiology Unit, Azienda Unitá Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda Unitá Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, via Campi 287, 41125, Modena, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unitá Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Cinzia Perilli
- Public Health Service, Azienda Unitá Sanitaria Locale - IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Elisabetta Larosa
- Public Health Service, Azienda Unitá Sanitaria Locale - IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Eufemia Bisaccia
- Public Health Service, Azienda Unitá Sanitaria Locale - IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Emanuela Bedeschi
- Public Health Service, Azienda Unitá Sanitaria Locale - IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
| | - Alessandro Zerbini
- ClinicalImmunology, Allergy and Advanced Biotechnologies Unit, Azienda Unitá Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unitá Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy
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10
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Bisaccia E, Vonderheid E, Geskin L. Safety of a new, single, integrated, closed photopheresis system in patients with cutaneous T-cell lymphoma. Br J Dermatol 2009; 161:167-9. [DOI: 10.1111/j.1365-2133.2009.09081.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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11
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Bisaccia E, Lugo A, Johnson B, Scarborough D. The surgical correction of protuberant ears. Skin Therapy Lett 2005; 10:7-9. [PMID: 15986079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
While prominent ears are considered a sign of good fortune in the Far East, Western society looks upon prominent ears in a far less positive manner. Children with prominent ears are often the subjects of verbal and at times physical abuse by their peers, resulting in adverse psychological effects. Advances in otoplasty have made it possible not only to pin back the ears, but also to reshape them, reduce their size, or make them more symmetrical. For a dermatologic surgeon, an otoplasty may be an unfamiliar surgical procedure, however, the surgery itself does not significantly differ from ear wedges or cartilage removal procedures for skin cancer, procedures with which the dermatologic surgeon is quite familiar.
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Affiliation(s)
- E Bisaccia
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
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12
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Bisaccia E, Palangio M, Gonzalez J, Adler KR, Rowley SD, Goldberg SL. Treating refractory chronic graft-versus-host disease with extracorporeal photochemotherapy. Bone Marrow Transplant 2003; 31:291-4. [PMID: 12621465 DOI: 10.1038/sj.bmt.1703830] [Citation(s) in RCA: 22] [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] [Indexed: 11/09/2022]
Abstract
Extracorporeal photochemotherapy (ECP; photopheresis), an immunomodulatory therapy, has previously demonstrated promising results in treating chronic graft-versus-host disease (cGvHD). We treated six patients (ages 33-54 years) with long-standing refractory extensive-stage cGvHD. ECP was performed thrice weekly initially in all patients. Concomitant therapies included prednisone (n=6), tacrolimus (n=5), cyclosporin A (n=2), hydroxychloroquine (n=2), mycophenolate mofetil (n=1), and psoralen plus ultraviolet A radiation (n=1). After an average of 7.2 months (range, 2-13 months) of ECP, all patients experienced either improvement or stabilization in sclerodermatous skin changes, as well as partial improvements in liver enzyme levels. Skin softening occurred in four patients and was noted as early as 3-8 weeks into treatment. Two patients were able to taper steroid therapy, and two patients were able to taper ECP to twice weekly. ECP was well tolerated. Our results support those of previous studies, suggesting that ECP may be beneficial in patients with refractory cGvHD.
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Affiliation(s)
- E Bisaccia
- Department of Dermatology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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13
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Warmuth IP, Scarborough D, Bisaccia E. Dermatologic surgery into the next millennium, IV. Cutis 2001; 68:257-8. [PMID: 11710444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- I P Warmuth
- Advanced Dermatology, Laser and Cosmetic Center, Voorhees, New Jersey, USA
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14
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Warmuth IP, Scarborough D, Bisaccia E. Dermatologic surgery into the next millennium, Part III. Cutis 2001; 68:193-5. [PMID: 11579784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Face-lift procedures and blepharoplasties are performed as in-office surgeries. Either local sedation or conscious sedation is used, and the patient's vital signs are carefully monitored. To avoid complications, the patient is followed closely postoperatively. It is highly suggested that the patient receives a medical clearance prior to undergoing either of these procedures.
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Affiliation(s)
- I P Warmuth
- Division of Dermatology, Ohio State University Hospitals, Columbus, USA
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15
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Bisaccia E, Klainer AS, Gonzalez J, Schwartz J, Randazzo D, Antonucci LC, Shioleno CA, Eisen HJ, Banas JS. Feasibility of photopheresis to reduce the occurrence of restenosis after percutaneous transluminal coronary angioplasty: a clinical pilot study. Am Heart J 2001; 142:461-5. [PMID: 11526359 DOI: 10.1067/mhj.2001.117132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Photopheresis was evaluated as a means of preventing restenosis on the basis of immune modulation. METHODS This was a prospective, randomized, controlled clinical trial analyzing clinical restenosis at 6 months after percutaneous transluminal coronary angioplasty (PTCA). Seventy-eight patients with single-vessel angioplasty were randomly assigned to a control group of 41 patients and a treatment group of 37 patients. At 6 months, there were 72 evaluable patients: 39 control patients and 33 treated. Twenty-nine control patients received balloon PTCA only and 10 patients received stents. Twenty treated patients received PTCA only and 13 patients received stents. Baseline clinical characteristics of both groups were similar. The treatment group received photopheresis for a total of 5 treatments. Primary end points were death from any cause, myocardial infarction, ischemia, and repeat revascularization procedures. RESULTS By intention-to-treat analysis, clinical restenosis occurred in 27% of control patients versus 8% of treated patients (P =.040, relative risk = 0.30). CONCLUSIONS Photopheresis therapy in patients undergoing balloon PTCA with and without stent deployment has been shown to be effective in reducing restenosis. The use of photopheresis in such patients merits further investigation.
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Affiliation(s)
- E Bisaccia
- Morristown Memorial Hospital, Department of Cardiovascular Medicine, and Section of Photopheresis, Morristown, NJ, USA
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16
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Warmuth IP, Bader R, Scarborough D, Bisaccia E. Dermatologic surgery into the next millennium, part II. Cutis 2001; 68:99-101. [PMID: 11534924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
This is the second article in a 4-part series on dermatologic surgery. This section provides detailed information about filling agents and botulinus toxin A. The filling agents discussed here are frequently used in our office. It is emphasized that meticulous technique and patient selection predict a good cosmetic result. To select the right agent, patient safety must be a priority.
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Affiliation(s)
- I P Warmuth
- Affiliated Dermatology, Morristown, NJ 07960, USA
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17
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Abstract
BACKGROUND Facelifting has incorporated a wide range of new techniques and developments over the past few decades. Many techniques employ a more aggressive surgical approach that may be advocated for seeming advantage, yet upon closer review may be unwarranted for the average patient seeking facial rejuvenation. The Webster-type face and neck lift utilizes a minimally invasive approach to thoroughly resupport the face and neck substructure and skin. This approach affords the patient excellent results while limiting untoward complications. OBJECTIVE To evaluate the efficacy of the Webster-type face and neck lift. METHODS The Webster-type face and neck lift was utilized in 200 facelift patients. We reviewed these cases for aesthetic results and associated complications. RESULTS The great majority of patients have been uniformly pleased with the aesthetic restoration via the Webster-type lift. Postoperative courses have been routinely uneventful and major complications have been avoided. CONCLUSION The evolution of more invasive approaches to cervicofacial rhytidectomy has not been shown to produce consistently better or longer-lasting results. Many of these aggressive techniques have extended the operating time, heightened the potential morbidity of the operation, and prolonged the duration of convalescence. The Webster-type lift is a proven, modern approach that provides comparable and lasting results while limiting risk and avoiding serious complications.
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Affiliation(s)
- D Scarborough
- Department of Medicine, Division of Dermatology, Ohio State University Hospital Medical Center, Columbus, Ohio, USA
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18
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Bisaccia E, Gonzalez J, Palangio M, Schwartz J, Klainer AS. Extracorporeal photochemotherapy alone or with adjuvant therapy in the treatment of cutaneous T-cell lymphoma: a 9-year retrospective study at a single institution. J Am Acad Dermatol 2000; 43:263-71. [PMID: 10906649 DOI: 10.1067/mjd.2000.104852] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Extracorporeal photochemotherapy (ECP; photopheresis) is a treatment option for cutaneous T-cell lymphoma (CTCL). OBJECTIVE This study describes the outcomes obtained with ECP alone or with adjuvant therapy in treating CTCL. METHODS A 9-year retrospective study was performed at a single institution. RESULTS Among 69 patients, 37 were treated with 6 months or more of ECP alone over an average of 36.9 months. Of these patients, 68% (25/37) had stage T2, 5% (2/37) had stage T3, and 27% (10/37) had stage T4 CTCL. Complete response (no skin or systemic disease for 1 month or more) and partial response (50%-99% skin improvement for 1 month or more) were achieved by 14% (5/37) and 41% (15/37) of patients, respectively, giving an overall response rate of 54% (20/37). In recalcitrant patients, adjuvant therapy significantly increased the response rate from 31% (4/13) to 69% (9/13) (P = 0.004). ECP was well tolerated in the entire patient population. CONCLUSION Response rates in this study compared favorably with those in previous studies, underscoring the potential value of ECP in treating CTCL. To our knowledge, this investigation included the largest group of CTCL patients ever treated with ECP at a single institution.
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Affiliation(s)
- E Bisaccia
- Departments of Dermatology and Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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19
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Abstract
Scleromyxedema is a rare connective tissue disease of unknown cause characterized by a generalized papular eruption, dermal fibroblast proliferation, and monoclonal paraproteinemia. A paroxysmal triad consisting of high fever, seizures, and coma with a flu-like prodrome can rarely occur in patients with scleromyxedema and is termed "dermato-neuro syndrome." We describe a 41-year-old patient with scleromyxedema in whom the dermato-neuro syndrome developed.
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Affiliation(s)
- J Gonzalez
- Section of Photopheresis and Department of Internal Medicine, Morristown Memorial Hospital, Morristown, NJ 07962-1956, USA
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20
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Abstract
BACKGROUND Dermatologic surgery has undergone increasing levels of sophistication over the past few decades. Commensurate with this demand, an established anesthesia technique called conscious sedation has been employed. OBJECTIVES Methods for performing office-based conscious sedation are described. Recommendations are made regarding prerequisites for conscious sedation in an office setting, patient selection, complications management, and postoperative discharge requirements. CONCLUSION The goals of anesthesia are to provide for patient safety and comfort, to increase patient acceptance of the procedure, and to enhance the surgeon's efficiency and satisfaction.
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Affiliation(s)
- G Abeles
- Wright State University and Kettering Anesthesia Associates, Dayton, Ohio, USA
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21
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Warmuth IP, Bader R, Scarborough D, Bisaccia E. Dermatologic surgery into the next millennium: Part I. Cutis 1999; 64:245-8. [PMID: 10544879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Dermatologic cosmetic surgery is a subspecialty of dermatology that has recently been developed. In this four-part series, we describe many of the procedures performed in our ambulatory surgery setting. We also highlight the significant changes in the techniques and treatment environments for these procedures over the past three decades. In part one, we focus on liposuction and face lift operations. Patients increasingly expect less invasive procedures, decreased "down time," and superior results. These expectations create a greater demand for the dermatologic surgeon. The trends and prospects for dermatologic cosmetic surgery in the next millennium are illustrated.
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Affiliation(s)
- I P Warmuth
- Division of Dermatology, Ohio State University Hospitals, Columbus, USA
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22
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Abstract
BACKGROUND Intravenous conscious sedation is currently being widely utilized for outpatient surgery including dermatologic surgery. Even though this type of anesthesia is typically administered by a trained, licensed anesthetist, it is important for dermatologists who either intend to or are currently utilizing this type of anesthesia to be familiar with some of the methods and agents that are commonly employed. OBJECTIVE Propofol and fentanyl are two anesthetic agents that are in prevalent use for skin and soft tissue surgery of brief or limited duration. With the goal of familiarizing dermatologic surgeons with this form of anesthesia, a study was conducted to evaluate the safety and effectiveness of the combination of propofol and fentanyl when used for conscious sedation in an outpatient dermatology center. METHODS Twenty patients, ages 25-65 years, who required conscious sedation were enrolled. Each patient received a standard dosage of fentanyl and propofol, as determined on a kilogram basis. Sedation time, total procedure time, recovery time, and total propofol dose, along with side effects, were determined. RESULTS The mean onset to sedation was 52.5 seconds, the mean procedure time was 40 minutes 37 seconds, and the mean interval to recovery was 3 minutes 43 seconds, with a mean total dose of propofol of 5.83 mg/kg. Minimal side effects occurred. CONCLUSION Propofol when used in conjunction with fentanyl appears to be a safe, quick, and effective method of providing conscious sedation.
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Affiliation(s)
- G Abeles
- Wright State University, Dayton, Ohio, USA
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23
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Bisaccia E, Sequeira M, Magidson J, Scarborough D. Surgical intervention for the aging face. Combination of mini-face-lifting and superficial carbon dioxide laser resurfacing. Dermatol Surg 1998; 24:821-6. [PMID: 9723045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients seeking facial rejuvenation often would benefit from a combination of face-lifting and laser resurfacing. Fear of skin slough has prevented the study of this issue. OBJECTIVE We report our experience utilizing a combination of simultaneous cervicofacial rhytidectomy and carbon dioxide (CO2) laser resurfacing, and summarize the results of a survey completed by each patient. METHODS Forty patients underwent the combination treatment. Patients were followed and asked to respond to a questionnaire 12 months postprocedure regarding their surgical experience. RESULTS Our survey revealed an overall degree of satisfaction. Reported complications included transient swelling, redness, pigmentary alteration, and numbness. One patient experienced minimal slough in a nonresurfaced site. CONCLUSIONS The control of depth of thermal damage with the CO2 UltraPulse laser allows for precision in its combined application along with face-lifting. In the area of the flap, one pass at low power settings is safe in our experience and results in an improved cosmetic result.
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Affiliation(s)
- E Bisaccia
- Department of Dermatology, Columbia University, College of Physicians & Surgeons, New York, New York 10032, USA
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Berger CL, Dong Z, Hanlon D, Bisaccia E, Edelson RL. A lymphocyte cell surface heat shock protein homologous to the endoplasmic reticulum chaperone, immunoglobulin heavy chain binding protein BIP. Int J Cancer 1997; 71:1077-85. [PMID: 9185714 DOI: 10.1002/(sici)1097-0215(19970611)71:6<1077::aid-ijc26>3.0.co;2-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BE2 is a cell surface monomeric 78-kDa protein (BE2-78) expressed on the malignant lymphocytes of cutaneous T-cell lymphoma and adult T-cell leukemia, on some lymphocytes from patients with acquired immunodeficiency syndrome and on Epstein-Barr virus-transformed B cells. BE2-78 positivity of cutaneous T-cell lymphoma tumor cells is a useful diagnostic and prognostic determinant in evaluating patients with that disorder. The BE2-78 protein was isolated from Epstein Barr virus-transformed B cells, purified by 1- and 2-dimensional electrophoresis and then sequenced. The sequence of 4 isolated peptide fragments was highly homologous with the 78-kDa heat shock protein, BiP, an endoplasmic reticulum chaperone. The similarity between BiP and BE2-78 was supported by the demonstration that BE2-78, like BiP, avidly binds to ATP. However, polyclonal and monoclonal reagents that recognize cytoplasmic 70- and 78-kDa heat shock proteins do not detect the BE2-78 antigen on the cell surface of cutaneous T-cell lymphoma or Epstein Barr virus-transformed lymphocytes, and peptide mapping demonstrates sequence divergence, suggesting that either they are distinct or conformationally different molecules. Our results indicate that BE2-78 is a cell surface heat shock protein. The possibility that malignant or transformed lymphocytes may express cell surface molecules with the capacity to bind a spectrum of exogenous or endogenous peptides has potential implications for tumor immunology.
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Affiliation(s)
- C L Berger
- Department of Dermatology, Yale University, School of Medicine, New Haven, CT 06510-8059, USA.
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Abstract
BACKGROUND Extracorporeal photochemotherapy (photopheresis), an immune-modulating therapy, has been demonstrated to elicit a therapeutic response in the treatment of several autoimmune disorders. We evaluated the use of photopheresis in the treatment of patients with progressive systemic sclerosis (PSS; scleroderma). METHODS Five patients with early-onset, diffuse PSS were treated with photopheresis on 2 successive days monthly for an average of 59 months (range 54-89 months). We initially reported the response this group of patients had to photopheresis treatment at an average of 11 months (range 6-21 months). RESULTS An improvement or stabilization was noted in most patients in skin thickening, joint mobility, pulmonary function studies, oral aperture, functional index, as well as symptoms including Raynaud's phenomenon, dyspnea, fatigue, dysphagia, arthralgias, and cutaneous ulcers. Renal function tests remained within normal range. A total of 296 monthly treatments were administered without significant toxicity. CONCLUSIONS This study suggests that extended use of extracorporeal photochemotherapy in the management of early-onset, diffuse PSS is well tolerated and may provide an increasingly beneficial clinical outcome.
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Affiliation(s)
- J Schwartz
- Department of Internal Medicine and Dermatology, Morristown Memorial Hospital, NJ 07962-1956, USA
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Fujihara K, Goldman B, Oseroff AR, Glenister N, Jaffe ES, Bisaccia E, Pincus S, Greenberg SJ. HTLV-associated diseases: human retroviral infection and cutaneous T-cell lymphomas. Immunol Invest 1997; 26:231-42. [PMID: 9037626 DOI: 10.3109/08820139709048929] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
An array of neurologic, oncologic, and autoimmune disorders are associated with infection with the human pathogenic retroviruses human T-cell leukemia virus types I and II (HTLV-I, II), as well as the human immunodeficiency viruses (HIV). The cutaneous T-cell lymphomas, mycosis fungoides (MF) and its hematogenous variant Sezary Syndrome (SS), share similar clinical and pathological features to HTLV-I-associated adult T-cell leukemia (ATL) and speculation of a retroviral link to MF and SS, especially in areas non-endemic for ATL, has lead to an intensified search for HTLV- and HIV-like agents in these diseases. To further explore a potential role for human retroviruses in MF and SS, skin biopsy-derived or peripheral blood mononuclear cell-derived DNA from 17 patients (MF, n = 7; erythrodermic MF (EMF), n = 5; SS, n = 5) from the North Eastern United States were screened using gene amplification by PCR and a liquid hybridization detection assay. Previously published primers and probes for HTLV-I (LTR, gag, pol, env, and pX), and our own primers and probes for HTLV-I (gag, pol, and env), HTLV-II (pol and env) and HIV-I (gag and pol) were employed. Serum antibodies to HTLV-I were negative in all but one EMF patient. The single HTLV-I seropositive patient carrying a diagnosis of EMF generated positive amplified signals for all of the eight HTLV-I regions tested. Ultimately, this individual evolved to exhibit clinical manifestations indistinguishable from ATL. The other 16 patients were negative for all 12 HTLV and HIV retroviral regions. Our findings suggest that none of the known prototypic human retroviruses are associated with seronegative MF and SS. The uniformly positive results for HTLV-I in the seropositive patient suggests that this patient initially presented with a smoldering form of ATL and illustrates the difficulty that sometimes may be encountered in the differential diagnosis of MF, SS, and ATL based solely on clinical and histopathological criteria.
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Affiliation(s)
- K Fujihara
- Department of Neurology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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Schwartz J, Gonzalez J, Rosenberg R, Fujihara K, Cottrill CM, Klainer AS, Bisaccia E. Cutaneous T-cell lymphoma, tropical spastic paraparesis, cerebral vasculitis, and protein S deficiency in a patient with HTLV-I. South Med J 1996; 89:999-1000. [PMID: 8865796 DOI: 10.1097/00007611-199610000-00014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The clinical spectrum of retroviruses is expanding rapidly. Human T-cell lymphotropic virus type I (HTLV-I) was the first retrovirus to be described, and its role had been established in adult T-cell leukemia/lymphoma and tropical spastic paraparesis. We report the case of a 35-year-old woman with HTLV-I and the unusual combination of cutaneous T-cell lymphoma, tropical spastic paraparesis, cerebral vasculitis, and protein S deficiency. We discuss the relationship of all her diseases to HTLV-I.
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Affiliation(s)
- J Schwartz
- Department of Internal Medicine, Morristown Memorial Hospital, NJ 07960-1956, USA
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Gonzalez J, Berger C, Cottrill CM, Geller A, Schwartz J, Palangio M, Klainer AS, Bisaccia E. Cytolytic response to HIV in patients with HIV disease treated with extracorporeal photochemotherapy: preliminary study. Photochem Photobiol 1996; 63:558-61. [PMID: 8628744 DOI: 10.1111/j.1751-1097.1996.tb05655.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Extracorporeal photochemotherapy (photopheresis), an immunomodulatory therapy that targets circulating T helper lymphocytes, has been applied to the management of human immunodeficiency virus (HIV) disease. Any therapy that exerts its actions on CD4+ T cells has the potential of exacerbating HIV infection. Therefore, it was necessary to observe immune function during treatment. Because cytotoxic T lymphocytes (CTL) and natural-killer cells are thought to play an important role in the response against HIV infection, we examined the effect of photopheresis on HIV cytolytic activity. The study group consisted of seven patients with late-stage HIV disease who had not received any previous treatment for HIV infection. Patients were treated exclusively with photopheresis on two consecutive days each month for 14-32 months (average, 25 months). Peripheral lymphocytes, collected at various points during treatment, were used as effectors in a 51Cr release assay. Epstein-Barr virus (EBV)-transformed autologous B cell lines transfected with recombinant vaccinia vectors that expressed the HIV env (gp120, gp41) and gag (p24) proteins were used as target cells. All seven patients demonstrated relatively constant levels of cytolysis (>10% above controls) during treatment in the context of stable CD4+ T cell counts and a stable clinical status. These results suggest that extracorporeal photochemotherapy did not impair the cytolytic response to HIV infection and may have enhanced it in some patients.
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Affiliation(s)
- J Gonzalez
- Department of Internal Medicine, Morristown Memorial Hospital, NJ, USA
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Gonzalez J, Schwartz J, Gerstein G, Klainer AS, Bisaccia E. Case report: post-transfusion purpura. N J Med 1996; 93:101-2. [PMID: 8837841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Post-transfusion purpura (PTP) is a rare disorder characterized by the abrupt onset of severe thrombocytopenia following a blood transfusion. We describe a case of PTP in a patient treated with plasmapheresis, noting that this is an uncommon but treatable disease entity.
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Affiliation(s)
- J Gonzalez
- Morristown Memorial Hospital, NJ 07962-1956, USA
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Schwartz J, Gonzalez J, Cottrill CM, Magidson JG, Klainer A, Bisaccia E. Extracorporeal photochemotherapy in a patient with Ki-1-positive anaplastic large-cell lymphoma. Br J Dermatol 1996; 134:332-5. [PMID: 8746351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A 57-year-old man with Ki-1 anaplastic large-cell lymphoma treated with extracorporeal photochemotherapy is described.
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Affiliation(s)
- J Schwartz
- Department of Internal Medicine, Morristown Memorial Hospital, NJ, USA
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Anderson DR, Schwartz J, Cottrill CM, McClain SA, Ross JS, Magidson JG, Klainer A, Bisaccia E. Silicone granuloma in acral skin in a patient with silicone-gel breast implants and systemic sclerosis. Int J Dermatol 1996; 35:36-8. [PMID: 8838927 DOI: 10.1111/j.1365-4362.1996.tb01613.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 68-year-old white woman was referred to us by her rheumatologist for possible participation in a clinical study of photopheresis for scleroderma. In February 1993, she noticed edema of her distal phalanges, Raynaud's phenomenon in both hands, flu-like symptoms, fatigue, intermittent diarrhea, abdominal pain, tearing in both eyes, dyspnea on exertion, dysphagia, and odynophagia. Bilateral silicone-gel breast implants had been placed 12 years before; 2 months before her present evaluation, they were removed and found to be ruptured. Physical examination revealed edema, limited to the fingers and hands bilaterally, and slight induration of the skin on the dorsum of both hands and distal forearms. The remainder of the physical examination was normal. According to our study protocol, a skin biopsy specimen from the dorsum of the right hand was taken, but all other laboratory investigations were refused. Histopathologic examination revealed multiple clear spaces of varying sizes in the dermis and multinucleated macrophages containing small refractile particles, characteristic of silicone granuloma (Figs. 1 and 2); however, the specimen showed no evidence of scleroderma. X-ray energy dispersive analysis by scanning electron-microscopy confirmed the presence of elemental silicon in the small refractile particles. The patient did not receive any treatment after her diagnosis and shortly thereafter, she was lost to follow-up.
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Affiliation(s)
- D R Anderson
- Columbia University College of Physicians and Surgeons, New York, New York, USA
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Anderson DR, Schwartz J, Hunter NJ, Cottrill C, Bisaccia E, Klainer AS. Varicella hepatitis: a fatal case in a previously healthy, immunocompetent adult. Report of a case, autopsy, and review of the literature. Arch Intern Med 1994; 154:2101-6. [PMID: 8092915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Varicella, usually a benign infection of childhood, is known to be associated with more serious complications, especially in adults and immunocompromised patients. Of these, varicella pneumonitis is the most common. Primary varicella hepatitis has been described, though rarely, in immunocompromised patients. We present a case of a previously healthy human immunodeficiency virus-negative 26-year-old immigrant from El Salvador in whom primary varicella developed that rapidly progressed to fulminant hepatic failure, disseminated intravascular coagulation, and death. Autopsy revealed evidence of varicella in the liver, adrenal glands, and myometrium. To our knowledge, this is the first report of a fatal case of varicella hepatitis in a previously healthy, immunocompetent patient.
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Affiliation(s)
- D R Anderson
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
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Fujihara K, Du TL, Selkirk S, Ward P, Rickert M, Hohmann P, Bisaccia E, Greenberg SJ. A new human endogenous DNA sequence homologous to HTLV-I pol. Genomics 1994; 22:244-6. [PMID: 7959782 DOI: 10.1006/geno.1994.1375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- K Fujihara
- Department of Neurology, Roswell Park Cancer Institute, Buffalo, New York
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Klainer AS, Oud L, Randazzo J, Freiheiter J, Bisaccia E, Gerhard H. Herpes simplex virus involvement of the lower respiratory tract following surgery. Chest 1994; 106:8S-14S; discussion 34S-35S. [PMID: 8020332 DOI: 10.1378/chest.106.1_supplement.8s] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- A S Klainer
- Department of Internal Medicine, Morristown (NJ) Memorial Hospital
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Abstract
The art of hair transplantation has continued to develop, achieving surgical correction with an enhanced aesthetic outcome. We have used incisional harvesting with donor site closure and have found that incisional harvesting allows for much more latitude in choosing slit, strip, micro, mini, or the standard round or square punch technique.
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Affiliation(s)
- E Bisaccia
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York
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Randazzo JP, DiSpaltro FX, Cottrill C, Klainer AS, Steere AC, Bisaccia E. Successful treatment of a patient with chronic Lyme arthritis with extracorporeal photochemotherapy. J Am Acad Dermatol 1994; 30:908-10. [PMID: 8169273 DOI: 10.1016/s0190-9622(94)70111-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report the use of photopheresis in a patient with chronic Lyme arthritis with apparent resolution of the signs and symptoms. Further controlled trials will be required to determine whether there is a therapeutic role for photopheresis in this disease.
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Affiliation(s)
- J P Randazzo
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York
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Cottrill C, Geller A, diSpaltro FX, Weissglass B, Klainer AS, Bisaccia E. Control of polycythaemia vera with photochemotherapy in a patient with cutaneous T-cell lymphoma. Br J Haematol 1994; 86:225-6. [PMID: 8011539 DOI: 10.1111/j.1365-2141.1994.tb03286.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report the use of photochemotherapy in a patient with polycythaemia vera (PV) and cutaneous T-cell lymphoma (CTCL). The patient was diagnosed with PV and required monthly phlebotomy. Subsequently he was diagnosed with CTCL and was started on photochemotherapy. A clinical improvement in both conditions, with haematocrit stabilizing at a level of 50%, eliminated the need for further phlebotomy. It is conceiveable that photochemotherapy induced the clinical and laboratory improvement in PV by targeting the aberrant clonal haemopoietic cell, similar to the mechanism thought to be operative in CTCL, a clonal helper T cell malignancy.
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Affiliation(s)
- C Cottrill
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York
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Di Spaltro FX, Cottrill C, Cahill C, Degnan E, Mulford GJ, Scarborough D, Franks AJ, Klainer AS, Bisaccia E. Extracorporeal photochemotherapy in progressive systemic sclerosis. Int J Dermatol 1993; 32:417-21. [PMID: 8320022 DOI: 10.1111/j.1365-4362.1993.tb02811.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Extracorporeal photochemotherapy, an immune-modulating form of therapy, has been shown to be effective in the treatment of autoimmune diseases. We evaluated the effects of extracorporeal photochemotherapy in the treatment of patients with progressive systemic sclerosis (PSS). METHODS Nine patients with active progressive systemic sclerosis were treated with extracorporeal photochemotherapy on 2 successive days monthly. The duration of therapy ranged from 6 to 21 months. RESULTS A significant improvement was noted in the skin, musculoskeletal system, functional index, and symptoms including Raynaud's phenomenon, dyspnea, fatigue, dysphagia, and arthralgias, as well as improvement of cutaneous ulcers. Stabilization of the pulmonary function studies was also noted in the majority of patients over the course of therapy. No serious side effects were noted throughout the course of therapy in the 9 patients. CONCLUSIONS The results suggest that photopheresis may be beneficial in selected early cases of progressive systemic sclerosis.
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Affiliation(s)
- F X Di Spaltro
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
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Bisaccia E, Berger C, DiSpaltro FX, Klainer AS. Extracorporeal photopheresis in the treatment of AIDS-related complex: extended trial. J Acquir Immune Defic Syndr (1988) 1993; 6:386-92. [PMID: 8095983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The objective of this study was to further evaluate the relative safety of extracorporeal photopheresis in the treatment of patients with AIDS-related complex. Twenty patients with AIDS-related complex, three from the initial report and 17 additional patients, were enrolled. The patient population had various risk factors. There were nine homosexuals, five heterosexual consorts of human immunodeficiency virus (HIV)-positive patients, four reformed i.v. drug abusers, and two hemophilia patients. The patients received monthly treatment with extracorporeal photopheresis. In 16 of the 19 patients, this study provides evidence of clinical stability over a longer period. The relative stability of beta 2-microglobulin and neopterin levels demonstrates that photopheresis therapy does not have an untoward effect on the degree of activation of the immune system with respect to induction of HIV replication. Antibody titers to the major viral antigens, envelope glycoproteins (gp) 120 and 41, reverse transcriptase enzyme gp 66/31 and 55, and the core protein p24 remained stable throughout the course of therapy. A subjective improvement was noted in the majority of patients. The evaluation of T-cell subsets revealed that the photopheresis treatment did not have a detrimental effect on CD3 and CD8 cells. Some decreases were noted in the CD4 cell counts but the decline may be less than is normally seen at corresponding stages of HIV infection. Skin test responsivity improved in 11 patients, remained unchanged in seven patients, and declined in two. The preliminary results suggest that in HIV disease, extracorporeal photopheresis is safe and warrants a prospective controlled trial.
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Affiliation(s)
- E Bisaccia
- Department of Medicine, Columbia University, College of Physicians & Surgeons, New York, New York
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41
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De Wilde A, DiSpaltro FX, Geller A, Szer IS, Klainer AS, Bisaccia E. Extracorporeal photochemotherapy as adjunctive treatment in juvenile dermatomyositis: a case report. Arch Dermatol 1992; 128:1656-7. [PMID: 1456768 DOI: 10.1001/archderm.128.12.1656] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
The potential for therapeutic intervention in 7 patients with AIDS-related complex (ARC) was evaluated through the use of photopheresis. The rationale for the study was based on: 1. the demonstration that psoralen and UVA could inactivate HIV/virus in vitro; 2. CD4 cells are the primary target population effected by HIV and photopheresis; and 3. reinfusion of inactivated virus and cell-associated virus might serve to engender an immune response. Preliminary results in 7 patients with ARC over 6 to 18 months revealed a virus-specific response with an elevation of HIV antibodies, while EBV and CMV titers remained unchanged. The immunologic results revealed an increase in the CD8 lymphocyte population, stable activation markers (B2 microglobulin neopterin), a decrease in p24 antigen titers and inability to culture HIV virus in 3 patients. All of these results were in the context of a stable or increasing CD4+ percent. Six patients did not reveal a generalized inhibition of other immune responses as demonstrated by recovery of DTH. In addition, the resolution of lymphadenopathy, night sweats, fever and weight loss, paralleled the immunologic response.
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Affiliation(s)
- E Bisaccia
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York 10032
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43
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Affiliation(s)
- M Nevin
- Department of Dermatology, Columbia University College of Physicians and Surgeons, New York, New York
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44
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Heck DE, Bisaccia E, Armus S, Laskin JD. Production of hydrogen peroxide by cutaneous T-cell lymphoma following photopheresis with psoralens and ultraviolet light. Cancer Chemother Pharmacol 1991; 28:344-50. [PMID: 1914077 DOI: 10.1007/bf00685687] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Treatment of peripheral blood mononuclear cells with 8-methoxypsoralen (8-MOP) and ultraviolet light, a procedure known as PUVA, has been found to be useful in the management of systemically disseminated cutaneous T-cell lymphoma (CTCL). In the present study we used a highly sensitive flow cytometric assay in conjunction with the hydroperoxide-sensitive dye 2',7'-dichlorofluorescein diacetate to measure intracellular hydrogen peroxide in normal lymphocytes and CTCL following PUVA treatment. Based on their laser light-scattering properties, lymphocytes were separated into three major subpopulations. We found that ultraviolet light alone caused an increase in the hydrogen peroxide content of each of the subpopulations, a response that was augmented when the cells were pretreated with 8-MOP (50 ng/ml). Cells from CTCL patients were more sensitive to the effects of 8-MOP than were normal lymphocytes. In both cell types, the production of hydrogen peroxide was found to be inhibitable by catalase. We noted an increase in hydrogen peroxide production following photopheresis; however, this was observed only 24 h after treatment. In addition, a further increase in hydrogen peroxide production was observed in lymphocytes isolated from peripheral blood that had been obtained from patients at 15 min after a second photopheresis treatment. Hydrogen peroxide is known to modulate the action of cytokines as well as the immunological responses of leukocytes. Our data suggest that the production of hydrogen peroxide by lymphocytes may be important in the action of PUVA in CTCL.
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Affiliation(s)
- D E Heck
- Department of Environmental and Community Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway 08854
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45
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Armus S, Keyes B, Cahill C, Berger C, Crater D, Scarborough D, Klainer A, Bisaccia E. Photopheresis for the treatment of cutaneous T cell lymphoma. J Am Acad Dermatol 1990; 23:898-902. [PMID: 2147701 DOI: 10.1016/0190-9622(90)70312-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We investigated the use of extracorporeal chemotherapy (photopheresis) in eight patients with cutaneous T cell lymphoma. Initially described by Edelson et al. for the treatment of erythrodermic cutaneous T cell lymphoma, we have expanded the treatment to include patients with extensive patch/plaque disease as well as tumor-stage disease. Four of five patients with erythrodermic stage disease had either a complete or a partial clinical remission with photopheresis alone. One patient with extensive patch/plaque disease continued to have a partial clinical remission of 7 months' duration with photopheresis alone. Of the two patients with tumor-stage disease, one remained without evidence of clinical disease at 10 months with photopheresis alone, whereas the second patient had a partial clinical remission of 5 months with a combination of local radiation therapy followed by monthly photopheresis. The skin biopsy specimen obtained from the patient with tumor-stage disease in complete clinical remission did not show cutaneous T cell lymphoma. We conclude that photopheresis is an effective modality alone or in combination with adjunctive therapy for erythroderma, extensive patch/plaque disease, and some tumor-stage disease.
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Affiliation(s)
- S Armus
- Morristown Memorial Hospital, Columbia University College of Physicians and Surgeons, NJ 07960
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Abstract
OBJECTIVE To determine side effects of extracorporeal photopheresis in the treatment of patients with the acquired immunodeficiency syndrome (AIDS)-related complex, and to gain early evidence of efficacy of the treatment. DESIGN Uncontrolled trial. SETTING Tertiary referral center. PATIENTS Five patients with AIDS-related complex: three homosexual men and one man and one woman with histories of intravenous drug abuse. One patient, a homosexual man, withdrew from therapy after 5 months but returned for monthly clinical and laboratory evaluations. INTERVENTION Monthly treatments with extracorporeal photopheresis. MEASUREMENTS AND MAIN RESULTS Symptoms resolved in four patients. Lymphadenopathy disappeared in all five. Four patients had delayed-hypersensitivity reactions to skin testing (as defined by the Walter Reed staging classification). All showed increases in p24 and gp120 antibody levels. The CD4-cell percentage increased in four patients and declined in one after 6 months of therapy, but the absolute CD4 count decreased in two patients. At 15 months, the CD4 percentage remained at or increased over the baseline value in three patients still in the study but decreased in one. Levels of Beta 2-microglobulin decreased or remained stable in four patients. All patients were culture positive for the human immunodeficiency virus (HIV) before treatment. One patient had a negative viral culture after 5 months of treatment with confirmation. Two other patients became HIV culture negative, one at 14 and one at 15 months: The former patient became positive at 15 months and the latter patient remained negative at 16 months. CONCLUSIONS The preliminary results suggest that extracorporeal photopheresis deserves further evaluation as therapy for AIDS-related complex.
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Affiliation(s)
- E Bisaccia
- Morristown Memorial Hospital, New Jersey
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47
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Abstract
Dermatologic surgeons are familiar with many surgical and nonsurgical techniques for the reduction of facial rhytids. Injectable collagen, silicone, and fibril are commonly employed as injectable filler materials. Properly done, fat transfer is another valuable tool for use in facial restoration. Fat transfer is an excellent technique for intervention in the aging process, and is easily managed as an office procedure. We will review the near-century-old history of fat grafting and outline the structural dynamics in the process of facial aging. Our experience from the last 50 fat transfer procedures performed will be reviewed with specific attention to patient selection, extraction and injection technique, complications, and overall results.
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48
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Abstract
A blepharoplasty procedure is described in which the actual dissection and removal of adipose tissue has been replaced simply with unipolar electrodesiccation.
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Affiliation(s)
- E Bisaccia
- Columbia University College of Physicians and Surgeons, New York, New York
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49
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Affiliation(s)
- D Scarborough
- Department of Medicine, Ohio State University College of Medicine, Columbus
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50
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Abstract
A useful and simple technique for fat transfer requiring bilateral pressure prior to injection for effective correction of cosmetic defects is described.
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Affiliation(s)
- E Bisaccia
- Columbia University College of Physicians and Surgeons, New York
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