1
|
Deana C, Biasucci DG, Aspide R, Brasil S, Vergano M, Leonardis F, Rica E, Cammarota G, Dauri M, Vetrugno G, Longhini F, Maggiore SM, Rasulo F, Vetrugno L. Transcranial Doppler and Color-Coded Doppler Use for Brain Death Determination in Adult Patients: A Pictorial Essay. J Ultrasound Med 2024; 43:979-992. [PMID: 38279568 DOI: 10.1002/jum.16421] [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] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
Transcranial Doppler (TCD) is a repeatable, at-the-bedside, helpful tool for confirming cerebral circulatory arrest (CCA). Despite its variable accuracy, TCD is increasingly used during brain death determination, and it is considered among the optional ancillary tests in several countries. Among its limitations, the need for skilled operators with appropriate knowledge of typical CCA patterns and the lack of adequate acoustic bone windows for intracranial arteries assessment are critical. The purpose of this review is to describe how to evaluate cerebral circulatory arrest in the intensive care unit with TCD and transcranial duplex color-coded doppler (TCCD).
Collapse
Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Daniele G Biasucci
- Department of Clinical Science and Translational Medicine, "Tor Vergata" University, Rome, Italy
- Emergency Department, "Tor Vergata" University Hospital, Rome, Italy
- Catholic University of the Sacred Heart (UCSC), Rome, Italy
| | - Raffaele Aspide
- Anesthesia and Neurointensive Care Unit, Istituto delle Scienze Neurologiche IRCCS, Bologna, Italy
| | - Sergio Brasil
- Neurosurgical Division, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Francesca Leonardis
- Emergency Department, "Tor Vergata" University Hospital, Rome, Italy
- Department of Surgical Science, "Tor Vergata" University, Rome, Italy
| | - Ermal Rica
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Gianmaria Cammarota
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Mario Dauri
- Department of Clinical Science and Translational Medicine, "Tor Vergata" University, Rome, Italy
- Emergency Department, "Tor Vergata" University Hospital, Rome, Italy
| | - Giuseppe Vetrugno
- Catholic University of the Sacred Heart (UCSC), Rome, Italy
- Risk Management, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Salvatore Maurizio Maggiore
- Department of Innovative Technologies in Medicine & Dentistry, Section of Anesthesia and Intensive Care, "G. D'Annunzio" University, "SS. Annunziata" Hospital, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, "SS. Annunziata" Hospital, Chieti, Italy
| | - Frank Rasulo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, "SS. Annunziata" Hospital, Chieti, Italy
- Department of Medical, Oral and Biotechnological Science, "G. d'Annunzio" Chieti-Pescara University, Chieti, Italy
| |
Collapse
|
2
|
Cacciola R, Leonardis F, Gitto L, Favi E, Gruttadauria S, Clancy M, Veroux M, Angelico R, Pagano D, Mazzeo C, Cacciola I, Santoro D, Toti L, Tisone G, Cucinotta E. Health economics aspects of kidney transplantation in Sicily: a benchmark analysis on activity and estimated savings. Front Public Health 2023; 11:1222069. [PMID: 38162608 PMCID: PMC10757609 DOI: 10.3389/fpubh.2023.1222069] [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: 05/13/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Abstract
Background International and national registries consistently report substantial differences in kidney transplant (KT) activity despite demonstrable clinical and financial benefits. The study aims to estimate the financial resources gained by KT and produce a benchmark analysis that would inform adequate strategies for the growth of the service. Methods We analyzed the KT activity in our region between 2017 and 2019. The benchmark analysis was conducted with programs identified from national and international registries. The estimate of financial resources was obtained by applying the kidney transplant coefficient of value; subsequently, we compared the different activity levels and savings generated by the three KT programs. Findings The KT activity in the region progressively declined in the study years, producing a parallel reduction of the estimated savings. Such savings were substantially inferior when compared to those generated by benchmark programs (range €18-22 million less). Interpretation The factors influencing the reduced KT activity in the study period with the related "foregone savings" are multiple, as well as interdependent. Organ donation, access to the transplant waiting list, and KT from living donors appear to be the most prominent determinants of the observed different levels of activities. International experience suggests that a comprehensive strategy in the form of a "task force" may successfully address the critical areas of the service reversing the observed trend. The financial impact of a progressively reduced KT activity may be as critical as its clinical implications, jeopardizing the actual sustainability of services for patients with end-stage kidney disease.
Collapse
Affiliation(s)
- Roberto Cacciola
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Francesca Leonardis
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
- Intensive Care Unit, Organ and Tissue Procurement Policlinico Tor Vergata, Rome, Italy
| | - Lara Gitto
- Dipartimento di Economia, Università Degli Studi di Messina, Messina, Italy
| | - Evaldo Favi
- General Surgery and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, University of Istituto di Ricovero e Cura a Carattere Scientifico – Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center Italy, Palermo, Italy
- Department of Surgery and Surgical and Medical Specialties, University of Catania, Catania, Italy
| | - Marc Clancy
- Institute of Cardiovascular and Molecular Sciences, Glasgow University, Glasgow, United Kingdom
| | - Massimiliano Veroux
- General Surgery Unit, Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Roberta Angelico
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Duilio Pagano
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, University of Istituto di Ricovero e Cura a Carattere Scientifico – Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Carmelo Mazzeo
- Department of Human Pathology, Emergency Surgery Unit, Università Degli Studi di Messina, Messina, Italy
| | - Irene Cacciola
- Department of Clinical and Experimental Medicine, Medicine and Hepatology Unit, Università Degli Studi di Messina, Messina, Italy
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, Nephrology and Dialysis Unit, Università Degli Studi di Messina, Messina, Italy
| | - Luca Toti
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Giuseppe Tisone
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Eugenio Cucinotta
- General Surgery Unit, Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| |
Collapse
|
3
|
Leonardis F, Gitto L, Favi E, Oliva A, Angelico R, Mitterhofer A, Cacciola I, Santoro D, Manzia TM, Tisone G, Cacciola R. A Keynesian perspective on the health economics of kidney transplantation would strengthen the value of the whole organ donation and transplantation service. Front Public Health 2023; 11:1120210. [PMID: 37050945 PMCID: PMC10083402 DOI: 10.3389/fpubh.2023.1120210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/09/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023] Open
Abstract
BackgroundIn this study, the Keynesian principle “savings may be used as investments in resources” is applied to Kidney Transplantation (KT), contextualizing the whole Organs Donation and Transplantation (ODT) service as a unique healthcare entity. Our aim was to define the financial resources that may be acquired in the form of savings from the KT activity.MethodsWe analyzed registry and funding data for ODT in our region, between 2015 and 2019. Our hypotheses aimed to evaluate whether the savings would offset the Organ Donation (OD) costs, define the scope for growth, and estimate what savings could be generated by higher KT activity. To facilitate the evaluation of the resources produced by KT, we defined a coefficient generated from the combination of clinical outcomes, activity, and costs.ResultsThe ODT activity reached a peak in 2017, declining through 2018–2019. The savings matured in 2019 from the KT activity exceeded €15 million while the OD costs were less than €9 million. The regional KT activity was superior to the national average but inferior to international benchmarks. The estimated higher KT activity would produce savings between €16 and 20 million.ConclusionThe financial resources produced by KT contribute to defining a comprehensive perspective of ODT finance. The optimization of the funding process may lead to the financial self-sufficiency of the ODT service. The reproducible coefficient allows a reliable estimate of savings, subsequently enabling adequate investments and budgeting. Applying such a perspective jointly with reliable estimates would establish the basis for an in-hospital fee-for-value funding methodology for ODT.
Collapse
Affiliation(s)
- Francesca Leonardis
- UTV Intensive Care Unit, Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Lara Gitto
- Dipartimento di Economia, Università degli Studi di Messina, Messina, Italy
| | - Evaldo Favi
- General Surgery and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- *Correspondence: Evaldo Favi,
| | - Angelo Oliva
- Coordinamento Trapianti, Policlinico Tor Vergata, Rome, Italy
| | - Roberta Angelico
- Department of Surgical Sciences, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | | | - Irene Cacciola
- Department of Clinical and Experimental Medicine, Medicine and Hepatology Unit, University Hospital of Messina, Messina, Italy
| | - Domenico Santoro
- Dipartimento di Medicina Clinica e Sperimentale, UOC di Nefrologia e Dialisi, Università degli Studi di Messina, Messina, Italy
| | - Tommaso Maria Manzia
- Department of Surgical Sciences, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Tisone
- Department of Surgical Sciences, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Cacciola
- UTV Intensive Care Unit, Department of Surgical Sciences, Tor Vergata University, Rome, Italy
- Department of Surgical Sciences, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
4
|
Ciotti M, Nuccetelli M, Pieri M, Petrangeli CM, Giovannelli A, Cosio T, Rosa L, Valenti P, Leonardis F, Legramante JM, Bernardini S, Campione E, Minieri M. Evaluation of Hepcidin Level in COVID-19 Patients Admitted to the Intensive Care Unit. Diagnostics (Basel) 2022; 12:diagnostics12112665. [PMID: 36359509 PMCID: PMC9689230 DOI: 10.3390/diagnostics12112665] [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: 09/01/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) presents a clinical spectrum that ranges from a mild condition to critical illness. Patients with critical illness present respiratory failure, septic shock and/or multi-organ failure induced by the so called “cytokine storm”. Inflammatory cytokines affect iron metabolism, mainly inducing the synthesis of hepcidin, a hormone peptide not routinely measured. High levels of hepcidin have been associated with the severity of COVID-19. The aim of this study was to analyze, retrospectively, the levels of hepcidin in a group of COVID-19 patients admitted to the intensive care unit (ICU) of the Policlinico Tor Vergata of Rome, Italy. Thirty-eight patients from November 2020 to May 2021 were enrolled in the study. Based on the clinical outcome, the patients were assigned to two groups: survivors and non-survivors. Moreover, a series of routine laboratory parameters were monitored during the stay of the patients in the ICU and their levels correlated to the outcome. Statistical differences in the level of hepcidin, D-dimer, IL-6, LDH, NLR, neutrophils level, CRP, TNF-α and transferrin were observed between the groups. In particular, hepcidin values showed significantly different median concentrations (88 ng/mL vs. 146 ng/mL) between survivors and non-survivors. In addition, ROC curves analysis revealed sensitivity and specificity values of 74% and 76%, respectively, at a cut-off of 127 (ng/mL), indicating hepcidin as a good biomarker in predicting the severity and mortality of COVID-19 in ICU patients.
Collapse
Affiliation(s)
- Marco Ciotti
- Virology Unit, Polyclinic Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Correspondence:
| | - Marzia Nuccetelli
- Department of Laboratory Medicine, Polyclinic Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Massimo Pieri
- Department of Laboratory Medicine, Polyclinic Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Department of Experimental Medicine, University of Tor Vergata, 00133 Rome, Italy
| | | | - Alfredo Giovannelli
- Department of Laboratory Medicine, Polyclinic Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Terenzio Cosio
- Department of Experimental Medicine, University of Tor Vergata, 00133 Rome, Italy
- Dermatology Unit, Department of Systems Medicine, Polyclinic Tor Vergata, 00133 Rome, Italy
| | - Luigi Rosa
- Department of Public Health and Infectious Diseases, University of Rome “La Sapienza”, 00185 Rome, Italy
| | - Piera Valenti
- Department of Public Health and Infectious Diseases, University of Rome “La Sapienza”, 00185 Rome, Italy
| | - Francesca Leonardis
- Intensive Care Unit, Polyclinic Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | | | - Sergio Bernardini
- Department of Laboratory Medicine, Polyclinic Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Department of Experimental Medicine, University of Tor Vergata, 00133 Rome, Italy
- Emerging Technologies Division (ETD) of the International Federation Clinical Chemistry and Laboratory Medicine (IFCC), 20159 Milan, Italy
| | - Elena Campione
- Dermatology Unit, Department of Systems Medicine, Polyclinic Tor Vergata, 00133 Rome, Italy
| | - Marilena Minieri
- Department of Laboratory Medicine, Polyclinic Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Department of Experimental Medicine, University of Tor Vergata, 00133 Rome, Italy
| |
Collapse
|
5
|
zahran M, Leonardis F, Mohamed I, Favi E, Angelico R, Manzia T, Tisone G, Cacciola R. P6.09: Extended Criteria Donor, Cold Ischemia Time and Delayed Graft Functions; Common Ingredients for an Expensive Recipe. Transplantation 2022. [DOI: 10.1097/01.tp.0000888364.50653.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
Minieri M, Di Lecce VN, Lia MS, Maurici M, Leonardis F, Longo S, Colangeli L, Paganelli C, Levantesi S, Terrinoni A, Malagnino V, Brunetti DJ, Giovannelli A, Pieri M, Ciotti M, D’Agostini C, Gabriele M, Bernardini S, Legramante JM. Predictive Value of MR-proADM in the Risk Stratification and in the Adequate Care Setting of COVID-19 Patients Assessed at the Triage of the Emergency Department. Diagnostics (Basel) 2022; 12:diagnostics12081971. [PMID: 36010321 PMCID: PMC9406922 DOI: 10.3390/diagnostics12081971] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023] Open
Abstract
In the past two pandemic years, Emergency Departments (ED) have been overrun with COVID-19-suspicious patients. Some data on the role played by laboratory biomarkers in the early risk stratification of COVID-19 patients have been recently published. The aim of this study is to assess the potential role of the new biomarker mid-regional proadrenomedullin (MR-proADM) in stratifying the in-hospital mortality risk of COVID-19 patients at the triage. A further goal of the present study is to evaluate whether MR-proADM together with other biochemical markers could play a key role in assessing the correct care level of these patients. Data from 321 consecutive patients admitted to the triage of the ED with a COVID-19 infection were analyzed. Epidemiological; demographic; clinical; laboratory; and outcome data were assessed. All the biomarkers analyzed showed an important role in predicting mortality. In particular, an increase of MR-proADM level at ED admission was independently associated with a threefold higher risk of IMV. MR-proADM showed greater ROC curves and AUC when compared to other laboratory biomarkers for the primary endpoint such as in-hospital mortality, except for CRP. This study shows that MR-proADM seems to be particularly effective for early predicting mortality and the need of ventilation in COVID-19 patients admitted to the ED.
Collapse
Affiliation(s)
- Marilena Minieri
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Laboratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-06-20902365
| | - Vito N. Di Lecce
- Emergency Department, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Maria Stella Lia
- Laboratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesca Leonardis
- Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
- Intensive Care Unit, Emergency Department, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Susanna Longo
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Luca Colangeli
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Carla Paganelli
- Emergency Department, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Stefania Levantesi
- Emergency Department, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Alessandro Terrinoni
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Laboratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Vincenzo Malagnino
- Infectious Disease Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Domenico J. Brunetti
- Anaesthesia and Intensive Care Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Alfredo Giovannelli
- Laboratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Massimo Pieri
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Laboratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Marco Ciotti
- Virology Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Cartesio D’Agostini
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Clinical Microbiology Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Mariachiara Gabriele
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Respiratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Laboratory Medicine Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Jacopo M. Legramante
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Infectious Disease Unit, Tor Vergata University Hospital, 00133 Rome, Italy
| |
Collapse
|
7
|
Favi E, Leonardis F, Manzia TM, Angelico R, Alalawi Y, Alfieri C, Cacciola R. "Salus Populi Suprema Lex": Considerations on the Initial Response of the United Kingdom to the SARS-CoV-2 Pandemic. Front Public Health 2021; 9:646285. [PMID: 34660502 PMCID: PMC8514989 DOI: 10.3389/fpubh.2021.646285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
In several countries worldwide, the initial response to coronavirus disease 2019 (COVID-19) has been heavily criticized by general public, media, and healthcare professionals, as well as being an acrimonious topic in the political debate. The present article elaborates on some aspects of the United Kingdom (UK) primary reaction to SARS-CoV-2 pandemic; specifically, from February to July 2020. The fact that the UK showed the highest mortality rate in Western Europe following the first wave of COVID-19 certainly has many contributing causes; each deserves an accurate analysis. We focused on three specific points that have been insofar not fully discussed in the UK and not very well known outside the British border: clinical governance, access to hospital care or intensive care unit, and implementation of non-pharmaceutical interventions. The considerations herein presented on these fundamental matters will likely contribute to a wider and positive discussion on public health, in the context of an unprecedented crisis.
Collapse
Affiliation(s)
- Evaldo Favi
- Department of General Surgery, Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca Leonardis
- Intensive Care Unit, Department of Surgical Sciences, Università di Tor Vergata, Rome, Italy
| | - Tommaso Maria Manzia
- HPB Surgery and Transplantation, Department of Surgical SciencesUniversità di Tor Vergata, Rome, Italy
| | - Roberta Angelico
- HPB Surgery and Transplantation, Department of Surgical SciencesUniversità di Tor Vergata, Rome, Italy
| | - Yousof Alalawi
- Department of Surgery, Kidney Transplantation, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Carlo Alfieri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Internal Medicine, Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Cacciola
- HPB Surgery and Transplantation, Department of Surgical SciencesUniversità di Tor Vergata, Rome, Italy.,Department of Surgery, Kidney Transplantation, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| |
Collapse
|
8
|
Natoli S, Carpenedo R, Chinè E, Vannicola F, Leonardis F, Dauri M. Should we be concerned when COVID-19-positive patients take opioids to control their pain? Insights from a pharmacological point of view. Eur Rev Med Pharmacol Sci 2021; 25:4854-4867. [PMID: 34337735 DOI: 10.26355/eurrev_202107_26399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this narrative review is to discuss the available information regarding the currently utilized COVID-19 therapies (and the evidence level supporting them) and opioids for chronic pain with a focus on warnings of potential interactions between these two therapeutic approaches. MATERIALS AND METHODS Papers were retrieved from a PubMed search, using different combinations of keywords [e.g., pain treatment AND COVID-19 AND drug-drug interaction (DDI)], without limitations in terms of publication date and language. RESULTS Remdesivir is an inhibitor of CYP3A4 and may increase the plasma concentration of CYP3A4 substrates (e.g., fentanyl). Dexamethasone is an inducer of CYP3A4 and glycoprotein P, thus coadministration with drugs metabolized by this isoform will lead to their increased clearance. Dexamethasone may cause hypokalemia, thus potentiating the risk of ventricular arrhythmias if it is given with opioids able to prolong the QT interval, such as oxycodone and methadone. Finally, the existing differences among opioids with regard to their impact on immune responses should also be taken into account with only tapentadol and hydromorphone appearing neutral on both cytokine production and immune parameters. CONCLUSIONS Clinicians should keep in mind the frequent DDIs with drugs extensively metabolized by the CYP450 system and prefer opioids undergoing a limited hepatic metabolism. Identification and management of DDIs and dissemination of the related knowledge should be a major goal in the delivery of chronic care to ensure optimized patient outcomes and facilitate updating recommendations for COVID-19 therapy in frail populations, namely comorbid, poly-medicated patients or individuals suffering from substance use disorder.
Collapse
Affiliation(s)
- S Natoli
- Unit of Pain Therapy, Polyclinic of Tor Vergata, Rome, Italy.
| | | | | | | | | | | |
Collapse
|
9
|
Novelli A, Biancolella M, Borgiani P, Cocciadiferro D, Colona VL, D'Apice MR, Rogliani P, Zaffina S, Leonardis F, Campana A, Raponi M, Andreoni M, Grelli S, Novelli G. Analysis of ACE2 genetic variants in 131 Italian SARS-CoV-2-positive patients. Hum Genomics 2020; 14:29. [PMID: 32917283 PMCID: PMC7483483 DOI: 10.1186/s40246-020-00279-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [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: 06/24/2020] [Accepted: 08/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Coronaviruses (CoV) are a large family of viruses that are common in humans and many animal species. Animal coronaviruses rarely infect humans with the exceptions of the Middle East respiratory syndrome ( MERS-CoV ), the severe acute respiratory syndrome corona virus (SARS-CoV), and now SARS-CoV-2, which is the cause of the ongoing pandemic of coronavirus disease 2019 (COVID-19). Several studies suggested that genetic variants in the ACE2 gene may influence the host susceptibility or resistance to SARS-CoV-2 infection according to the functional role of ACE2 in human pathophysiology. However, many of these studies have been conducted in silico based on epidemiological and population data. We therefore investigated the occurrence of ACE2 variants in a cohort of 131 Italian unrelated individuals clinically diagnosed with COVID-19 and in an Italian control population, to evaluate a possible allelic association with COVID-19, by direct DNA analysis. METHODS As a pilot study, we analyzed, by whole-exome sequencing, genetic variants of ACE2 gene in 131 DNA samples of COVID-19 patients hospitalized at Tor Vergata University Hospital and at Bambino Gesù Children's Hospital, Rome. We used a large control group consisting of 1000 individuals (500 males and 500 females). RESULTS We identified three different germline variants: one intronic c.439+4G>A and two missense c.1888G>C p.(Asp630His) and c.2158A>G p.(Asn720Asp) in a total of 131 patients with a similar frequency in male and female. Thus far, only the c.1888G>C p.(Asp630His) variant shows a statistically different frequency compared to the ethnically matched populations. Therefore, further studies are needed in larger cohorts, since it was found only in one heterozygous COVID-19 patient. CONCLUSIONS Our results suggest that there is no strong evidence, in our cohort, of consistent association of ACE2 variants with COVID-19 severity. We might speculate that rare susceptibility/resistant alleles could be located in the non-coding regions of the ACE2 gene, known to play a role in regulation of the gene activity.
Collapse
Affiliation(s)
- Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michela Biancolella
- Department of Biology, Tor Vergata University of Rome, 00133, Rome, Italy.,Medical Genetics Laboratory, Tor Vergata Hospital, Rome, Italy
| | - Paola Borgiani
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133, Rome, Italy
| | - Dario Cocciadiferro
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Salvatore Zaffina
- Occupational Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Andrea Campana
- Department of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | | | - Massimo Andreoni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Infectious Diseases Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Sandro Grelli
- Department of Experimental Medicine and Biochemical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Novelli
- Medical Genetics Laboratory, Tor Vergata Hospital, Rome, Italy. .,Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133, Rome, Italy. .,Department of Experimental Medicine and Biochemical Sciences, University of Rome Tor Vergata, Rome, Italy. .,IRCCS Neuromed, Pozzilli (IS), Italy. .,Department of Pharmacology, School of Medicine, University of Nevada, Reno, NV, 89557, USA.
| |
Collapse
|
10
|
Novelli A, Andreani M, Biancolella M, Liberatoscioli L, Passarelli C, Colona VL, Rogliani P, Leonardis F, Campana A, Carsetti R, Andreoni M, Bernardini S, Novelli G, Locatelli F. HLA allele frequencies and susceptibility to COVID-19 in a group of 99 Italian patients. HLA 2020; 96:610-614. [PMID: 32827207 PMCID: PMC7461491 DOI: 10.1111/tan.14047] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [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: 07/15/2020] [Revised: 08/05/2020] [Accepted: 08/18/2020] [Indexed: 12/31/2022]
Abstract
With the aim to individuate alleles that may reflect a higher susceptibility to the disease, in the present study we analyzed the HLA allele frequency distribution in a group of 99 Italian patients affected by a severe or extremely severe form of COVID‐19. After the application of Bonferroni's correction for multiple tests, a significant association was found for HLA‐DRB1*15:01, ‐DQB1*06:02 and ‐B*27:07, after comparing the results to a reference group of 1017 Italian individuals, previously typed in our laboratory. The increased frequencies observed may contribute to identify potential markers of susceptibility to the disease, although controversial results on the role of single HLA alleles in COVID‐19 patients have been recently reported.
Collapse
Affiliation(s)
- Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Andreani
- Transplantation Immunogenetics Laboratory, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Michela Biancolella
- Department of Biology, Tor Vergata University of Rome, Rome, Italy.,Medical Genetics Laboratory, Tor Vergata Hospital, Rome, Italy
| | | | - Chiara Passarelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Andrea Campana
- Department of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Rita Carsetti
- Immunology Research Area B-cell development Unit Immunological Diagnosis Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Andreoni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Infectious Diseases Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine and Biochemical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Novelli
- Department of Experimental Medicine and Biochemical Sciences, University of Rome Tor Vergata, Rome, Italy.,Department of Pharmacology, School of Medicine, University of Nevada, Reno, Nevada, USA.,Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Franco Locatelli
- Department of Haematology and Oncology, Bambino Gesù Children's Hospital, IRCCS, Rome.,Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
11
|
Alwardat M, Pisani A, Etoom M, Carpenedo R, Chinè E, Dauri M, Leonardis F, Natoli S. Is transcranial direct current stimulation (tDCS) effective for chronic low back pain? A systematic review and meta-analysis. J Neural Transm (Vienna) 2020; 127:1257-1270. [DOI: 10.1007/s00702-020-02223-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022]
|
12
|
Marziali S, Di Giuliano F, Picchi E, Natoli S, Leonardis C, Leonardis F, Garaci F, Floris R. Non-convulsive status epilepticus in a patient with carbon-monoxide poisoning treated with hyperbaric oxygen therapy. Neuroradiol J 2016; 29:431-435. [PMID: 27549147 DOI: 10.1177/1971400916665379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/15/2022] Open
Abstract
The presentation of carbon monoxide poisoning is non-specific and highly variable. Hyperbaric oxygen therapy is used for the treatment of this condition. Various reports show the occurrence of self-limiting seizures after carbon monoxide poisoning and as a consequence of hyperbaric oxygen therapy. Contrary to the seizures, status epilepticus has been rarely observed in these conditions. The exact pathophysiology underlying seizures and status epilepticus associated with carbon monoxide poisoning and hyperbaric oxygen therapy is not really clear, and some elements appear to be common to both conditions. We describe a case of non-convulsive status epilepticus in a patient with carbon monoxide poisoning treated with hyperbaric oxygen therapy. The mechanism, MRI findings and implications are discussed.
Collapse
Affiliation(s)
- Simone Marziali
- Neuroradiology COU, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Francesca Di Giuliano
- Neuroradiology COU, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Eliseo Picchi
- Neuroradiology COU, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Silvia Natoli
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | - Carlo Leonardis
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | - Francesca Leonardis
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | - Francesco Garaci
- Neuroradiology COU, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Roberto Floris
- Neuroradiology COU, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| |
Collapse
|
13
|
Liguori C, Placidi F, Leonardis F, Diomedi M, Mercuri NB, Marciani MG, Stanzione P, Sallustio F. Development of collateral veins as a favorable prognostic factor for complete recovery in cerebral venous thrombosis due to Tribulus terrestris. Int J Stroke 2015. [PMID: 26202717 DOI: 10.1111/ijs.12572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Claudio Liguori
- Neurophysiopathology Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Fabio Placidi
- Neurophysiopathology Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Francesca Leonardis
- Department of Clinical Sciences and Translational Medicine, Intensive Care Unit, University of Rome 'Tor Vergata', Rome, Italy
| | - Marina Diomedi
- Neurology Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy.,Stroke Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Nicola Biagio Mercuri
- Neurophysiopathology Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy.,Fondazione Santa Lucia, Rome, Italy
| | - Maria Grazia Marciani
- Neurology Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Paolo Stanzione
- Neurology Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy.,Stroke Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Fabrizio Sallustio
- Stroke Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| |
Collapse
|
14
|
Lazzari M, Sabato AF, Caldarulo C, Casali M, Gafforio P, Marcassa C, Leonardis F. Effectiveness and tolerability of low-dose oral oxycodone/naloxone added to anticonvulsant therapy for noncancer neuropathic pain: an observational analysis. Curr Med Res Opin 2014; 30:555-64. [PMID: 24251879 DOI: 10.1185/03007995.2013.866545] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Opioids may alleviate chronic neuropathic pain (NP), but are considered second/third-line analgesia due to their poor gastrointestinal (GI) tolerability. A fixed combination of prolonged-release oxycodone and naloxone (OXN) has been developed to overcome the GI effects. The aim of this analysis was to evaluate analgesic effectiveness and tolerability of low-dose OXN in patients with moderate-to-severe noncancer NP despite analgesia. METHODS This retrospective observation of consecutive adult patients, treated open-label for 8 weeks at a single Italian centre, evaluated effectiveness (pain intensity numerical rating scale [NRS], Patients' Global Impression of Change [PGIC], Douleur Neuropathique 4 inventory [DN4] and Chronic Pain Sleep Inventory [CPSI]), doses of daily OXN and adjuvant medication, rescue paracetamol use, bowel function index (BFI), laxative use, and safety. RESULTS Of 200 patients (mean age 65.9 years; 54% female) with NP included in the analysis; 97% completed 8 weeks' treatment. At the observation start, all patients were taking anticonvulsants and complained of constipation, and 60% were receiving opioids. Pain intensity and DN4 score decreased significantly by endpoint (NRS p < 0.0001; DN4 p < 0.0001) and need for rescue analgesics abated. Reduction in pain intensity throughout the observation was similar regardless of NP aetiology. According to PGIC, 87.8% of patients were much/extremely improved, CPSI (p < 0.0001) and BFI were significantly improved (p < 0.0001) and laxative use decreased. No differences were found between patients <65 years vs those ≥65 years. OXN was generally well tolerated. STUDY LIMITATIONS Study limitations including the retrospective observational design, the lack of a control group and the single-centre design may limit the generalizability of our findings. CONCLUSIONS Low-dose OXN (25.0 ± 12.5 mg/day) added to anticonvulsants was highly effective in controlling noncancer NP of varied aetiology, with reduced need for rescue analgesia and improved quality of sleep, and was well tolerated, with improved bowel function and reduced laxative use. The efficacy and tolerability of OXN demonstrated in this real-world setting suggest its utility in this difficult to manage patient population.
Collapse
Affiliation(s)
- M Lazzari
- Emergency Care, Critical Care Medicine, Pain Medicine and Anaesthesiology Department, Tor Vergata Polyclinic, University of Rome 'Tor Vergata' , Rome , Italy
| | | | | | | | | | | | | |
Collapse
|
15
|
Frisardi F, Stefanini M, Natoli S, Cama V, Loreni G, Di Giuliano F, Fiume D, Leonardis C, Dauri M, Sabato AF, Simonetti G, Leonardis F. Decompressive craniectomy may cause diagnostic challenges to assess brain death by computed tomography angiography. Minerva Anestesiol 2014; 80:113-118. [PMID: 23698543] [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: 06/02/2023]
Abstract
According to Italian legislation to diagnose brain death (BD) after the initial documentation of the clinical signs, repetition of clinical testing and confirmation of the loss of bioelectrical activity of the brain (EEG) is required. However, when EEG is unreliable it is necessary to demonstrate cerebral circulatory arrest (CCA). Accepted imaging techniques to demonstrate CCA include: cerebral angiography, cerebral scintigraphy, transcranial Doppler (TCD) and computed tomography angiography (CTA). This latter technique, due to its large availability, low invasivity and easy and fast acquisition is widely used over the country. Nevertheless its diagnostic reliability is affected by some limitations in patients with decompressive craniectomy. Here we report two cases of brain injury with clinical signs of BD and at the same time, opacification of intracranial arteries on CTA and a pattern consistent with flow arrest on the corresponding insonable arteries on TCD. The discrepancy between CTA and TCD results points out a methodology limitation that could be overcome by updating Italian legislation according to other European Countries legislation.
Collapse
Affiliation(s)
- F Frisardi
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, Tor Vergata University of Rome, Rome, Italy -
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Liguori C, Albanese M, Romigi A, Izzi F, Natoli S, Leonardis F, Leonardis C, Bianchi L, Marciani M, Placidi F. Unexpected total recovery in a patient with post-anoxic complete alpha coma predicted by recording of cortical SEPs. Clin Neurophysiol 2013; 124:2450-3. [DOI: 10.1016/j.clinph.2013.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 05/19/2013] [Accepted: 05/21/2013] [Indexed: 11/16/2022]
|
17
|
Baffari E, Fiume D, Caiazzo G, Sinistro A, Natoli S, Almerighi C, Calò-Carducci F, Leonardis F, Bergamini A. Upregulation of the inhibitory receptor ILT4 in monocytes from septic patients. Hum Immunol 2013; 74:1244-50. [PMID: 23911358 DOI: 10.1016/j.humimm.2013.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 11/19/2012] [Revised: 06/17/2013] [Accepted: 07/19/2013] [Indexed: 01/02/2023]
Abstract
Sepsis-induced immune dysfunction is a complex phenomenon that involves both innate and adaptive responses. Upregulation of the inhibitor receptor named immunoglobulin like transcript 4 (ILT4) is crucial to the tolerogenic function of monocytes. Here, ILT4 expression, endotoxin-induced IL-12 and IL-10 production and CD86 expression were investigated in circulating monocytes from 16 patients with severe sepsis and 16 age and sex matched controls. We found that monocytes from patients with severe sepsis express significantly higher levels of ILT4 than monocytes from controls. Upregulation of ILT4 expression appeared to be induced by soluble factors present in the serum of septic patients and directly correlated with the degree of organ dysfunction. ILT4(+) monocytes from septic patients also displayed an alteration in the cytokine response to endotoxin stimulation characterized by reduced IL-12 production and increased IL-10 production, and a reduced expression of the costimulatory molecule CD86. In conclusion, the increased ILT4 expression and IL-10 production and the decreased CD86 expression and IL-12 production indicate that during sepsis monocytes undergo substantial modulation of the surface and cytokine phenotype. These phenotypic changes may interfere with the antigen presenting cell activity of monocytes, which may contribute to the impairment of adaptive immune responses that takes place during sepsis.
Collapse
Affiliation(s)
- Eleonora Baffari
- Dept. of Internal Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Fiume D, Caiazza G, Tsekeuli V, Sinistro A, Almerighi C, Calo'-Carducci F, Baffari E, Bergamini A, Natoli S, Leonardis F. Dysregulation of immune monocyte responses during sepsis. Crit Care 2011. [PMCID: PMC3066933 DOI: 10.1186/cc9679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
19
|
Gatti A, Dauri M, Leonardis F, Longo G, Marinangeli F, Mammucari M, Sabato AF. Transdermal Buprenorphine in Non-Oncological Moderate-to-Severe Chronic Pain. Clin Drug Investig 2010; 30 Suppl 2:31-8. [DOI: 10.2165/1158409-s0-000000000-00000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
20
|
Fontana C, Favaro M, Sarmati L, Natoli S, Altieri A, Bossa MC, Minelli S, Leonardis F, Favalli C. Emergence of KPC-producing Klebsiella pneumoniae in Italy. BMC Res Notes 2010; 3:40. [PMID: 20178590 PMCID: PMC2844393 DOI: 10.1186/1756-0500-3-40] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [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: 09/03/2009] [Accepted: 02/23/2010] [Indexed: 12/17/2022] Open
Abstract
Background The emergence of KPC-producing K. pneumoniae has now become a global concern. KPC beta-lactamases are plasmid-borne and, like extended spectrum beta lactamases (ESBLs), can accumulate and transfer resistance determinants to other classes of antibiotics. Therefore, infection control guidelines on early identification and control of the spread of organisms carrying these resistant determinants are needed. Findings Klebsiella pneumoniae carbapenemase (KPC) was detected in two isolates of carbapenem-resistant K. pneumoniae obtained from patients at an Italian teaching hospital. The first strain was isolated from a culture drawn from a central venous device (CVC) in a patient with Crohn's disease who was admitted to a gastroenterology ward. The second was isolated from a urine sample collected from an indwelling urinary catheter in an intensive care unit (ICU) patient with a subdural haematoma. The patients had not travelled abroad. Both isolates were resistant to all β-lactams and were susceptible to imipenem and meropenem but resistant to ertapenem. Isolates also showed resistance to other classes of non-β-lactam antibiotics, such as quinolones, aminoglycosides (with the exception for amikacin), trimethoprim-sulfamethoxazole (TMP-SMX) and nitrofurantoin. They were determined to contain the plasmid encoding the carbapenemase gene bla-KPC and were also positive in the Hodge test. Conclusions This is the second report of KPC-producing isolates in Italy, but the first concerning KPC type 2 gene, and it may have important implications for controlling the transmission of microorganisms resistant to antibiotics.
Collapse
Affiliation(s)
- Carla Fontana
- Department of Experimental Medicine and Biochemical Sciences, "Tor Vergata" University of Rome - Via Montpellier 1, Rome, 00133, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Turani F, Falco M, Natoli S, Leonardis F, Fede M, Berlot G, Pelichovskà M. Coupled plasma filtration and adsorption in septic shock: a multicentric experience. Crit Care 2010. [PMCID: PMC2934555 DOI: 10.1186/cc8644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
22
|
Natoli S, Fontana C, Favaro M, Bergamini A, Testore GP, Minelli S, Bossa MC, Casapulla M, Broglio G, Beltrame A, Cudillo L, Cerretti R, Leonardis F. Characterization of coagulase-negative staphylococcal isolates from blood with reduced susceptibility to glycopeptides and therapeutic options. BMC Infect Dis 2009; 9:83. [PMID: 19497104 PMCID: PMC2701436 DOI: 10.1186/1471-2334-9-83] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [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: 12/01/2008] [Accepted: 06/04/2009] [Indexed: 11/18/2022] Open
Abstract
Background Coagulase-negative staphylococci (CoNS) are a major cause of nosocomial blood stream infection, especially in critically ill and haematology patients. CoNS are usually multidrug-resistant and glycopeptide antibiotics have been to date considered the drugs of choice for treatment. The aim of this study was to characterize CoNS with reduced susceptibility to glycopeptides causing blood stream infection (BSI) in critically ill and haematology patients at the University Hospital Tor Vergata, Rome, Italy, in 2007. Methods Hospital microbiology records for transplant haematology and ICU were reviewed to identify CoNS with elevated MICs for glycopeptides, and isolates were matched to clinical records to determine whether the isolates caused a BSI. The isolates were tested for susceptibility to new drugs daptomicin and tigecycline and the genetic relationship was assessed using f-AFLP. Results Of a total of 17,418 blood cultures, 1,609 were positive for CoNS and of these, 87 (5.4%) displayed reduced susceptibility to glycopeptides. Clinical review revealed that in 13 cases (7 in haematology and 6 in ICU), CoNS with reduced susceptibility to glycopeptides were responsible for a BSI. Staphylococcus epidermidis was the causative organism in 11 instances and Staphylococcus haemolyticus in 2. The incidence of oxacillin resistance was high (77%), although all isolates remained susceptible to linezolid, daptomycin and tigecycline. Fingerprinting of CoNS identified one clonal relationship between two isolates. Conclusion Multi-resistant CoNS with reduced susceptibility to glycopeptides, although still relatively infrequent in our hospital, are emerging pathogens of clinical concern. Surveillance by antibiotyping with attention to multi-resistant profile, and warning to clinicians, is necessary.
Collapse
Affiliation(s)
- Silvia Natoli
- Intensive Care Unit, Department of Surgery, Tor Vergata University of Rome, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Fontana C, Favaro M, Minelli S, Bossa MC, Testore GP, Leonardis F, Natoli S, Favalli C. Acinetobacter baumannii in intensive care unit: a novel system to study clonal relationship among the isolates. BMC Infect Dis 2008; 8:79. [PMID: 18538034 PMCID: PMC2443154 DOI: 10.1186/1471-2334-8-79] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [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: 09/03/2007] [Accepted: 06/08/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The nosocomial infections surveillance system must be strongly effective especially in highly critic areas, such as Intensive Care Units (ICU). These areas are frequently an epidemiological epicentre for transmission of multi-resistant pathogens, like Acinetobacter baumannii. As an epidemic outbreak occurs it is very important to confirm or exclude the genetic relationship among the isolates in a short time. There are several molecular typing systems used with this aim. The Repetitive sequence-based PCR (REP-PCR) has been recognized as an effective method and it was recently adapted to an automated format known as the DiversiLab system. METHODS In the present study we have evaluated the combination of a newly introduced software package for the control of hospital infection (VIGI@ct) with the DiversiLab system. In order to evaluate the reliability of the DiversiLab its results were also compared with those obtained using f-AFLP. RESULTS The combination of VIGI@ct and DiversiLab enabled an earlier identification of an A. baumannii epidemic cluster, through the confirmation of the genetic relationship among the isolates. This cluster regards 56 multi-drug-resistant A. baumannii isolates from several specimens collected from 13 different patients admitted to the ICU in a ten month period. The A. baumannii isolates were clonally related being their similarity included between 97 and 100%. The results of the DiversiLab were confirmed by f-AFLP analysis. CONCLUSION The early identification of the outbreak has led to the prompt application of operative procedures and precautions to avoid the spread of pathogen. To date, 6 months after the last A. baumannii isolate, no other related case has been identified.
Collapse
Affiliation(s)
- Carla Fontana
- Department of Experimental Medicine and Biochemical Sciences, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Fontana C, Favaro M, Pistoia ES, Minelli S, Bossa MC, Altieri A, Testore GP, Leonardis F, Natoli S, Favalli C. The combined use of VIGI@ct (bioMérieux) and fluorescent amplified length fragment polymorphisms in the investigation of potential outbreaks. J Hosp Infect 2007; 66:262-8. [PMID: 17544166 DOI: 10.1016/j.jhin.2007.04.004] [Citation(s) in RCA: 3] [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] [Received: 05/12/2006] [Accepted: 04/12/2007] [Indexed: 10/23/2022]
Abstract
Even with good surveillance programmes, hospital-acquired infections (HAIs) are not always recognized and this may lead to an outbreak. In order to reduce this risk, we propose a model for prompt detection of HAIs, based on the use of a real-time epidemiological information system called VIGI@ct (bioMèrieux, Las Balmas, France) and on the rapid confirmation or exclusion of the genetic relationship among pathogens using fluorescent amplified length fragment polymorphism (f-AFLP) microbial fingerprinting. We present the results of one year's experience with the system, which identified a total of 306 suspicious HAIs. Of these, 281 (92%) were 'confirmed' by clinical evidence, 16 (5%) were considered to be simple colonization and the latter nine (3%) were archived as 'not answered' because of the absence of the physician's cooperation. There were seven suspected outbreaks; of these, f-AFLP analysis confirmed the clonal relationship among the isolates in four cases: outbreak 1 (four isolates of Pseudomonas aeruginosa), outbreak 2 (three Escherichia coli isolates), outbreak 6 (two Candida parapsilosis isolates) and outbreak 7 (30 ESbetaL-producing Klebsiella pneumoniae subsp. pneumoniae). Based on our results, we conclude that the combination of VIGI@ct and f-AFLP is useful in the rapid assessment of an outbreak due to Gram-positive or Gram-negative bacteria and yeasts.
Collapse
Affiliation(s)
- C Fontana
- Department of Experimental Medicine and Biochemical Sciences, Tor Vergata University of Rome, Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Testore GP, Natoli S, Fontana C, Buonuomini AR, Leonardi L, Leonardis F. Linezolid as rescue drug: a clinical case of soft tissue infection caused by a Staphylococcus aureus strain resistant in vivo to teicoplanin. J Chemother 2006; 18:430-2. [PMID: 17024801 DOI: 10.1179/joc.2006.18.4.430] [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] [Indexed: 10/31/2022]
Abstract
The authors report and discuss a patient admitted to intensive care unit (ICU) for acute respiratory failure due to upper airway obstruction caused by face and neck soft tissue infection. An oxacillin-resistant Staphyloccoccus aureus was isolated from necrotic skin lesions and from skin biopsy. The strain was susceptible in vitro to teicoplanin, but it showed resistance in vivo, despite appropriate dosage. After 6 days of full dose therapy, since the clinical course worsened, teicoplanin was interrupted and linezolid was started. In 48 hours signs of infection regressed, and the patient was discharged from the ICU after 10 days of linezolid treatment. Linezolid resulted as a rescue drug for a life-threatening infection.
Collapse
Affiliation(s)
- G P Testore
- Department of Public Heath, Infectious Diseases, University of Rome Tor Vergata, Teaching Hospital of Tor Vergata, Rome, Italy.
| | | | | | | | | | | |
Collapse
|
26
|
Fontana C, Favaro M, Pistoia E, Bossa M, Altieri A, Leonardis F, Natoli S, Testore G, Favalli C. ACCERTAMENTO MOLECOLARE DELLA RELAZIONE CLONALE FRA ALCUNI ISOLATI DI ACINETOBACTER BAUMANNII. Microbiol Med 2006. [DOI: 10.4081/mm.2006.3288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
27
|
Natoli S, Ciotti M, Paba P, Testore GP, Palmieri G, Orlandi A, Sabato AF, Leonardis F. A novel mutation of varicella-zoster virus associated to fatal hepatitis. J Clin Virol 2006; 37:72-4. [PMID: 16876475 DOI: 10.1016/j.jcv.2006.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [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: 12/27/2005] [Revised: 05/05/2006] [Accepted: 06/13/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lethal varicella in immunocompetent hosts is rare and its pathogenesis is largely unknown. The discovery of glycoprotein E (gE) mutants showing attributes consistent with increased virulence in vitro and in animal models, provided a possible molecular mechanism underlying a more aggressive virus infection. However, these mutants have never been associated with unusually severe clinical cases. OBJECTIVES To varicella-zoster virus (VZV) mutations that correlate with increased virulence. RESULTS We report a case of fatal hepatitis caused by a VZV bearing a novel mutation on the 3B3 monoclonal antibody epitope of gE in an immunocompetent host. CONCLUSIONS This report describes a mutant VZV responsible for an aggressive clinical course in an immunocompetent host. Linking these severe clinical presentations of VZV infection to virus mutations might provide insights into the underlying pathogenic mechanisms.
Collapse
Affiliation(s)
- Silvia Natoli
- Istituto di Anestesia e Rianimazione, Università di Roma Tor Vergata, Policlinico di Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Turani F, Colella D, Leonardis F, Andreozzi G, Celeste G, Pilia G, Gianni G, Dauri P, Curatola D, Sabato A. Crit Care 2002; 6:P197. [DOI: 10.1186/cc1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
29
|
Pierantozzi M, Sabato AF, Leonardis F, Marciani MG, Cicardi C, Giacomini P, Bernardi G, Stanzione P. Curariform peripheral block of muscular tone selectively increases precentral N30 somatosensory evoked potentials component. A pharmacological study carried out on healthy subjects and parkinsonian syndromes. Exp Brain Res 2000; 133:368-76. [PMID: 10958527 DOI: 10.1007/s002210000387] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the present study we investigated whether the precentral component (N30) of short somatosensory evoked potentials (SEPs) to median nerve stimulation may be modified by peripheral neuromuscular blocking agent in patients affected by rigidity. We, therefore, recorded SEPs in nine Parkinson's disease (PD) patients and in seven psychotic patients affected by neuroleptic malignant syndrome (NMS), all showing severe rigidity. Each patient group was studied before and after the placebo, and before and after an atracurium besilate bolus of 0.05 mg/kg, in a single recording session. At the time of the test the PD patients had not taken any antiparkinsonian therapy for at least 48 h. The same recordings were also taken on nine neurologically normal subjects undergoing surgical procedures. Atracurium administration produced a remarkable amplitude increase of the major precentral component (N30) of SEPs. An atracurium-induced N30 amplitude increase was observed in both PD patients (from 2.41 to 4.07 microV) and NMS psychotic patients (from 2.03 to 3.97 microV), whereas there was a minor N30 amplitude increase in healthy subjects (from 3.53 to 4. 10 microV). The N30 latency was unaffected. Amplitude and latency of the major parietal SEPs component (N20) was unchanged in the three groups studied. Our results lead to the conclusion that a neuromuscular blocking agent is capable of increasing the N30 amplitude in patients affected by severe rigidity, exclusively reducing their muscular tone without interfering with the central dopaminergic system. Thus, a "peripheral gating" of sensory input to the supplementary motor area due to rigidity may play a relevant role in producing the N30 amplitude decrease described in patients affected by degenerative or pharmacologically induced parkinsonism. The reduction of rigidity could be the mechanism by which dopamine may increase the precentral N30 amplitude in parkinsonian syndromes.
Collapse
Affiliation(s)
- M Pierantozzi
- Clinica Neurologica Università di Roma Tor Vergata, Italy
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Agnifili A, Ibi I, Guadagni S, Verzaro R, Gianfelice F, Mancini E, De Bernardinis G, Silvi B, Leonardis F. [Perioperative pain and stress: a comparison between video laparoscopic cholecystectomy and "open" cholecystectomy]. G Chir 1993; 14:344-8. [PMID: 8286176] [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: 01/29/2023]
Abstract
Pain and endocrine-metabolic response to surgical stress, during surgery and in the early postoperative period, was compared in two groups of patients affected by gallstones and randomly assigned to Laparoscopic Cholecystectomy or Open Cholecystectomy. Pain was assessed by the VAS method also taking into account the need of analgesic administration in the postoperative period. The so called "stress hormones" (Prolactin (PRL), Cortisol (CORT), Human Growth Hormone (HGH)) and glycaemia were monitored during surgery and in the first postoperative 24 hours. The minimal invasive technique of laparoscopic cholecystectomy accounted for a very limited analgesic administration. In the intraoperative period laparoscopic cholecystectomy plasma hormone levels overlapped the open cholecystectomy ones, while in the postoperative period a constant increase in PRL and CORT levels was registered in the open cholecystectomy group demonstrating a prolonged stressful condition. The end results of this study show that laparoscopic cholecystectomy has major advantages than open cholecystectomy in the treatment of gallstones as far as pain and endocrine-metabolic response are concerned.
Collapse
Affiliation(s)
- A Agnifili
- Cattedra di Chirurgia Generale, Università degli Studi de L'Aquila
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Dauri M, Turani F, Andreozzi G, Celeste GF, Colella DF, Zupancich E, Leonardis F, Giovannini C, Sabato AF. [Monitoring of mixed venous oxygen saturation in multiorgan donors. Preliminary data]. Minerva Anestesiol 1991; 57:139-46. [PMID: 1806822] [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: 12/28/2022]
Affiliation(s)
- M Dauri
- Serv. Anestesia e Rianimazione, Osp. S. Eugenio
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Turani F, Dauri M, Ammirati F, Colella DF, Leonardis F, Dauri PF, Gatti, Borioni R, Zuppanchic E. [Mixed venous oxygen saturation: useful hemodynamic index in patients in critical cardiac status]. Minerva Anestesiol 1991; 57:49-54. [PMID: 1806834] [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: 12/28/2022]
Affiliation(s)
- F Turani
- Servizio di Anestesia e Rianimazione, Ospedale S. Eugenio, Roma
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Turani F, Dauri M, Colella DF, Celeste G, Leonardis F, Zuppancich E, Sabato AF. [Validity of indirect calorimetry in critical patients undergoing mechanical ventilation]. Minerva Anestesiol 1991; 57:880-9. [PMID: 1961534] [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: 12/29/2022]
Affiliation(s)
- F Turani
- Servizio di Anestesia e Rianimazione, Ospedale S. Eugenio di Roma
| | | | | | | | | | | | | |
Collapse
|
34
|
Colella DF, Zupancich E, Turani F, Leonardis F, Sernicola D, Falco M, Sabato AF. [Pre-anesthetic medication: usefulness of on line Sa02 in cardiovascular surgery with associated pulmonary pathology]. Minerva Anestesiol 1991; 57:786-7. [PMID: 1798580] [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: 12/28/2022]
Affiliation(s)
- D F Colella
- Catt. Anestesiologia e Rianimazione, II Università di Roma, Tor Vergata
| | | | | | | | | | | | | |
Collapse
|
35
|
Silvi MB, Turani F, Ciammitti B, Sabato AF, Colella DF, Leonardis F. [Autologous transfusion. The Italian experience]. Ann Fr Anesth Reanim 1989; 8:241-3. [PMID: 2782687 DOI: 10.1016/s0750-7658(89)80110-8] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- M B Silvi
- Cattedra di Anestesiologia e Rianimazione, II Università degli Studi di Roma, Italy
| | | | | | | | | | | |
Collapse
|