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Maddaloni E, Naciu AM, Mignogna C, Galiero R, Amendolara R, Fogolari M, Satta C, Serafini C, Angeletti S, Cavallo MG, Cossu E, Sasso FC, Buzzetti R, Pozzilli P. Saxagliptin/dapagliflozin is non-inferior to insulin glargine in terms of β-cell function in subjects with latent autoimmune diabetes in adults: A 12-month, randomized, comparator-controlled pilot study. Diabetes Obes Metab 2024; 26:1670-1677. [PMID: 38297915 DOI: 10.1111/dom.15469] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
AIM To compare the efficacy and safety of saxagliptin/dapagliflozin and insulin glargine in people with latent autoimmune diabetes in adults (LADA). METHODS In this phase 2b multicentre, open-label, comparator-controlled, parallel-group, non-inferiority study, we randomly assigned 33 people with LADA who had a fasting C-peptide concentration ≥0.2 nmol/L (0.6 ng/mL) to receive 1-year daily treatment with either the combination of saxagliptin (5 mg) plus dapagliflozin (10 mg) or insulin glargine (starting dose: 10 IU), both on top of metformin. The primary outcome was the 2-h mixed meal-stimulated C-peptide area under the curve (AUC), measured 12 months after randomization. Secondary outcomes were glycated haemoglobin (HbA1c) levels, change in body mass index (BMI), and hypoglycaemic events. RESULTS In the modified intention-to-treat analysis, the primary outcome was similar in participants assigned to saxagliptin/dapagliflozin or to insulin glargine (median C-peptide AUC: 152.0 ng*min/mL [95% confidence interval {CI} 68.2; 357.4] vs. 122.2 ng*min/mL [95% CI 84.3; 255.8]; p for noninferiority = 0.0087). Participants randomized to saxagliptin/dapagliflozin lost more weight than those randomized to insulin glargine (median BMI change at the end of the study: -0.4 kg/m2 [95% CI -1.6; -0.3] vs. +0.4 kg/m2 [95% CI -0.3; +1.1]; p = 0.0076). No differences in HbA1c or in the number of participants experiencing hypoglycaemic events were found. CONCLUSIONS Saxagliptin/dapagliflozin was non-inferior to glargine in terms of β-cell function in this 12-month, small, phase 2b study, enrolling people with LADA with still viable endogenous insulin production. Weight loss was greater with saxagliptin/dapagliflozin, with no differences in glycaemic control or hypoglycaemic risk.
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Affiliation(s)
- Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Anda M Naciu
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Rocco Amendolara
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, Campus Bio-Medico University of Rome, Rome, Italy
- Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Chiara Satta
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Chiara Serafini
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, Campus Bio-Medico University of Rome, Rome, Italy
- Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Efisio Cossu
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Pozzilli
- Diabetes, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Centre of Immunobiology, Blizard Institute, St. Bartholomew's and London School of Medicine, London, UK
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Ragusa A, Svelato A, Fogolari M, Ficarola F, Plotti F, De Luca C, D'Avino S, Davini F, De Cesaris M, Messina G, Bertolini A, Marci R, Angeletti S, Angioli R, Terranova C. The endogenous oxytocin after manipulative osteopathic treatment in full-term pregnant women. Eur Rev Med Pharmacol Sci 2024; 28:1155-1162. [PMID: 38375728 DOI: 10.26355/eurrev_202402_35354] [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: 02/21/2024]
Abstract
OBJECTIVE The aim of this study is to assess whether the touch of osteopathic manipulative treatment (OMT) can affect the endogenous production of oxytocin in full-term pregnant women and the assessment of well-being following the treatment. PATIENTS AND METHODS In this study have been enrolled 57 pregnant women at full-term pregnancy (37th-41st week) for evaluation of the concentration of salivary oxytocin 2 minutes before and 2 minutes after a single session of OMT by an osteopath lasting for 30 minutes. Pre-OMT and post-OMT saliva samples were collected with the use of Salivette® salivary swabs. 7 salivary swabs were excluded from the analysis. 50 samples were analyzed with an appropriate ELISA kit. RESULTS The mean OT salivary concentration pre-OMT was 89.98±16.39, and post-OMT was 100.60±19.13 tends to increase with p=0.0000051. In multivariate analysis, two subgroups show interesting data in the mean difference in OT salivary concentration post-OMT: women with painful contractions (p=0.06) and women under 35 years (p=0.09). CONCLUSIONS The results of this study demonstrate that the effectiveness of OMT-increasing endogenous oxytocin is statistically significant in full-term pregnant women. The sensation of well-being found in most women indicates that there has been a predominantly central rather than peripheral oxytocin release after OMT.
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Affiliation(s)
- A Ragusa
- Department of Gynecology and Obstetrics, Campus Bio-Medico University Hospital Foundation Rome, Italy.
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Spoto S, Basili S, Cangemi R, D’Avanzo G, Lupoi DM, Romiti GF, Argemi J, Yuste JR, Lucena F, Locorriere L, Masini F, Testorio G, Calarco R, Fogolari M, Francesconi M, Battifoglia G, Costantino S, Angeletti S. Mid-Regional Pro-Adrenomedullin Can Predict Organ Failure and Prognosis in Sepsis? Int J Mol Sci 2023; 24:17429. [PMID: 38139258 PMCID: PMC10743785 DOI: 10.3390/ijms242417429] [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: 09/18/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Sepsis causes immune dysregulation and endotheliitis, with an increase in mid-regional pro-adrenomedullin (MR-proADM). The aim of the study is to determine an MR-proADM value that, in addition to clinical diagnosis, can identify patients with localized infection or those with sepsis/septic shock, with specific organ damage or with the need for intensive care unit (ICU) transfer and prognosis. The secondary aim is to correlate the MR-proADM value with the length of stay (LOS). In total, 301 subjects with sepsis (124/301 with septic shock) and 126 with localized infection were retrospectively included. In sepsis, MR-proADM ≥ 3.39 ng/mL identified acute kidney injury (AKI); ≥2.99 ng/mL acute respiratory distress syndrome (ARDS); ≥2.28 ng/mL acute heart failure (AHF); ≥2.55 ng/mL Glascow Coma Scale (GCS) < 15; ≥3.38 multi-organ involvement; ≥3.33 need for ICU transfer; ≥2.0 Sequential Organ Failure Assessment (SOFA) score ≥ 2; and ≥3.15 ng/mL non-survivors. The multivariate analysis showed that MR-proADM ≥ 2 ng/mL correlates with AKI, anemia and SOFA score ≥ 2, and MR-proADM ≥ 3 ng/mL correlates with AKI, GCS < 15 and SOFA score ≥ 2. A correlation between mortality and AKI, GCS < 15, ICU transfer and cathecolamine administration was found. In localized infection, MR-proADM at admission ≥ 1.44 ng/mL identified patients with AKI; ≥1.0 ng/mL with AHF; and ≥1.44 ng/mL with anemia and SOFA score ≥ 2. In the multivariate analysis, MR-proADM ≥ 1.44 ng/mL correlated with AKI, anemia, SOFA score ≥ 2 and AHF. MR-proADM is a marker of oxidative stress due to an infection, reflecting severity proportionally to organ damage.
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Affiliation(s)
- Silvia Spoto
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (G.D.); (D.M.L.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza University, Viale dell’Università, 30, 00185 Rome, Italy; (S.B.); (R.C.); (G.F.R.)
| | - Roberto Cangemi
- Department of Translational and Precision Medicine, Sapienza University, Viale dell’Università, 30, 00185 Rome, Italy; (S.B.); (R.C.); (G.F.R.)
| | - Giorgio D’Avanzo
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (G.D.); (D.M.L.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Domenica Marika Lupoi
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (G.D.); (D.M.L.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Giulio Francesco Romiti
- Department of Translational and Precision Medicine, Sapienza University, Viale dell’Università, 30, 00185 Rome, Italy; (S.B.); (R.C.); (G.F.R.)
| | - Josepmaria Argemi
- Departamento de Medicina Interna, Clinica Universidad de Navarra, Avda. Pío XII, 36, 31008 Pamplona, Spain; (J.A.); (F.L.)
| | - José Ramón Yuste
- Division of Infectious Diseases, Faculty of Medicine, University of Navarra, Clinica Universidad de Navarra, Avda. Pío XII, 36, 31008 Pamplona, Spain;
- Department of Internal Medicine, Faculty of Medicine, University of Navarra, Clinica Universidad de Navarra, Avda. Pío XII, 36, 31008 Pamplona, Spain
| | - Felipe Lucena
- Departamento de Medicina Interna, Clinica Universidad de Navarra, Avda. Pío XII, 36, 31008 Pamplona, Spain; (J.A.); (F.L.)
| | - Luciana Locorriere
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (G.D.); (D.M.L.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Francesco Masini
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (G.D.); (D.M.L.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Giulia Testorio
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (G.D.); (D.M.L.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Rodolfo Calarco
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (G.D.); (D.M.L.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Marta Fogolari
- Unit of Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (M.F.); (M.F.); (S.A.)
- Research Unit of Clinical Laboratory Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Maria Francesconi
- Unit of Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (M.F.); (M.F.); (S.A.)
- Research Unit of Clinical Laboratory Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Giulia Battifoglia
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (G.D.); (D.M.L.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Sebastiano Costantino
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (G.D.); (D.M.L.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Silvia Angeletti
- Unit of Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (M.F.); (M.F.); (S.A.)
- Research Unit of Clinical Laboratory Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Spoto S, Argemi J, Di Costanzo R, Gavira Gomez JJ, Salterain Gonzales N, Basili S, Cangemi R, Abbate A, Locorriere L, Masini F, Testorio G, Calarco R, Battifoglia G, Mangiacapra F, Fogolari M, Costantino S, Angeletti S. Mid-Regional Pro-Adrenomedullin and N-Terminal Pro-B-Type Natriuretic Peptide Measurement: A Multimarker Approach to Diagnosis and Prognosis in Acute Heart Failure. J Pers Med 2023; 13:1155. [PMID: 37511766 PMCID: PMC10381388 DOI: 10.3390/jpm13071155] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Acute heart failure (AHF) is a major cause of hospitalization and mortality worldwide. Early and accurate diagnosis, as well as effective risk stratification, are essential for optimizing clinical management and improving patient outcomes. In this context, biomarkers have gained increasing interest in recent years as they can provide important diagnostic and prognostic information in patients with AHF. AIM AND METHODS The primary objective of the present study was to compare the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), mid-regional pro-adrenomedullin (MR-proADM), and C-reactive protein (CRP) between patients diagnosed with acute heart failure (AHF) and those without AHF and sepsis. Furthermore, the study aimed to assess the diagnostic and prognostic value of the use of a multimarker approach in AHF patients. To achieve these objectives, a total of 145 patients with AHF and 127 patients without AHF and sepsis, serving as the control group, were consecutively enrolled in the study. RESULTS Levels of MR-proADM (median: 2.07; (25th-75th percentiles: 1.40-3.02) vs. 1.11 (0.83-1.71) nmol/L, p < 0.0001), and NT-proBNP (5319 (1691-11,874) vs. 271 (89-931.5) pg/mL, p < 0.0001) were significantly higher in patients with AHF compared to controls, whereas CRP levels did not show significant differences. The mortality rate in the AHF group during in-hospital stay was 12%, and the rate of new re-admission for AHF within 30 days after discharge was 10%. During in-hospital follow-up, Cox regression analyses showed that levels of NT-proBNP > 10,132 pg/mL (hazard ratio (HR) 2.97; 95% confidence interval (CI): 1.13-7.82; p = 0.0284) and levels of MR-proADM > 2.8 nmol/L (HR: 8.57; CI: 2.42-30.28; p = 0.0009) predicted mortality. The combined use of MR-proADM and NT-proBNP provided significant additive predictive value for mortality and new re-admission for AHF at 30 days after discharge. A logistic regression analysis showed that the presence of NT-proBNP pg/mL > 12,973 pg mL and/or MR-proADM > 4.2 nmol/L predicted hospital re-admission within 30 days (OR: 3.23; CI: 1.05-9.91; p = 0.041). CONCLUSION The combined assay of MR-proADM and NT-proBNP could be helpful in accurately identifying AHF and in defining prognosis and re-admission for AHF. The complementary use of these biomarkers can provide a useful clinical evaluation of AHF while also orienting clinicians to the pathophysiology underlying heart damage and assisting them in tailoring therapy.
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Affiliation(s)
- Silvia Spoto
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (R.D.C.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Josepmaria Argemi
- Departamento de Medicina Interna, Clinica Universidad de Navarra, Pamplona, 31008 Navarra, Spain;
| | - Roberta Di Costanzo
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (R.D.C.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Juan Josè Gavira Gomez
- Departamento de Cardiologìa, Clinica Universidad de Navarra, Pamplona, 31008 Navarra, Spain; (J.J.G.G.); (N.S.G.)
| | - Nahikari Salterain Gonzales
- Departamento de Cardiologìa, Clinica Universidad de Navarra, Pamplona, 31008 Navarra, Spain; (J.J.G.G.); (N.S.G.)
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy; (S.B.); (R.C.)
| | - Roberto Cangemi
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy; (S.B.); (R.C.)
| | - Antonio Abbate
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 23219, USA;
| | - Luciana Locorriere
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (R.D.C.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Francesco Masini
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (R.D.C.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Giulia Testorio
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (R.D.C.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Rodolfo Calarco
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (R.D.C.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Giulia Battifoglia
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (R.D.C.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Fabio Mangiacapra
- Unit of Cardiovascular Science, University Campus Bio-Medico, 00185 Rome, Italy;
| | - Marta Fogolari
- Unit of Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (M.F.); (S.A.)
| | - Sebastiano Costantino
- Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (R.D.C.); (L.L.); (F.M.); (G.T.); (R.C.); (G.B.); (S.C.)
| | - Silvia Angeletti
- Unit of Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (M.F.); (S.A.)
- Research Unit of Clinical Laboratory Science, Department of Medicine and Surgery, University Campus Bio-Medico di Roma, 00184 Rome, Italy
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Cupone IE, Roselli G, Marra F, Riva M, Angeletti S, Dugo L, Spoto S, Fogolari M, Giori AM. Orodispersible Film Based on Maltodextrin: A Convenient and Suitable Method for Iron Supplementation. Pharmaceutics 2023; 15:1575. [PMID: 37376024 DOI: 10.3390/pharmaceutics15061575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Orodispersible film (ODF) is an innovative dosage form used to administer drugs and nutrients, designed to disintegrate or dissolve in the oral cavity without needing water. One of the advantages of ODF is that it is suitable for administration in older people and children who have difficulty swallowing because of psychological or physiological deficiencies. This article describes the development of an ODF based on maltodextrin, which is easy to administer, has a pleasant taste, and is suitable for iron supplementation. An ODF containing 30 mg of iron as pyrophosphate and 400 µg of folic acid (iron ODF) was developed and manufactured on an industrial scale. The kinetic profile for serum iron and folic acid upon consumption of ODF compared with a Sucrosomial® iron capsule (known for its high bioavailability) was evaluated in a crossover clinical trial. The study was conducted in nine healthy women, and the serum iron profile (AUC0-8, Tmax, and Cmax) of both formulations was defined. Results showed that the rate and extent of elemental iron absorption with iron ODF was comparable to that obtained using the Sucrosomial® iron capsule. These data represent the first evidence of iron and folic acid absorption concerning the newly developed ODF. Iron ODF was proven to be a suitable product for oral iron supplementation.
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Affiliation(s)
| | | | - Fabio Marra
- Ibsa Farmaceutici Italia, Cassina de' Pecchi, 20051 Milan, Italy
| | | | - Silvia Angeletti
- Operative Research Unit of Clinical Laboratory, University of Rome Campus Bio-Medico, 00128 Rome, Italy
| | - Laura Dugo
- Department of Science and Technology for Sustainable Development and One Health, University Campus Bio-Medico of Rome, 00128 Rome, Italy
| | - Silvia Spoto
- Department of Diagnostic and Therapeutic Medicine, University Campus Bio-Medico of Rome, 00128 Rome, Italy
| | - Marta Fogolari
- Operative Research Unit of Clinical Laboratory, University of Rome Campus Bio-Medico, 00128 Rome, Italy
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D’Onofrio L, Fogolari M, Amendolara R, Siena A, De Fata R, Davini F, Coraggio L, Mignogna C, Moretti C, Maddaloni E, Angeletti S, Buzzetti R. Reduced early response to SARS-CoV2 vaccination in people with type 1 and type 2 diabetes, a 6 months follow-up study: The CoVaDiab study I. Diabetes Metab Res Rev 2023; 39:e3601. [PMID: 36533777 PMCID: PMC9877797 DOI: 10.1002/dmrr.3601] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Diabetes mellitus worsens the prognosis of SARS-CoV-2 infection, and vaccination has been the major tool for reducing the risk of hospitalisation, and mortality. The primary aim of this study was to evaluate the response to the SARS-CoV-2 vaccine in subjects with diabetes and controls. Differences between type 1 (T1D) and type 2 (T2D) diabetes and clinical determinants of vaccination response were also evaluated. METHODS 128 subjects with diabetes (60 with T1D and 62 with T2D) and 202 subjects acting as controls who completed a full vaccination cycle with two doses of mRNA vaccine were enroled. People with previous SARS-CoV-2 infection were excluded. Antibodies (Ab) directed against the spike protein of the SARS-CoV-2 were evaluated at one and 6 months after vaccination. RESULTS In the whole cohort, the Ab level was higher among women than in men (p = 0.011) and negatively correlated with age (rho = -0.155, p = 0.005). Subjects with diabetes showed decreased levels of Ab after one month compared to controls (1217[747-1887]BAU/mL vs. 1477[942-2556]BAU/mL, p = 0.002), even after correction for age and gender (p = 0.002). No difference was found between subjects with T1D and T2D. After 6 months, antibody levels significantly decreased in people with and without diabetes, with no differences between groups, although some subjects were lost at follow-up. In subjects with diabetes, only a significant correlation was found between Ab level and renal function (rho 0.190, p = 0.042). CONCLUSIONS Both T1D and T2D are associated with a reduced early response to vaccination. The serum concentration of Ab significantly reduced over time in both groups, highlighting the relevance of vaccination boosters independently of the presence of diabetes.
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Affiliation(s)
- Luca D’Onofrio
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Marta Fogolari
- Laboratory Unit of Fondazione Policlinico Universitario Campus Bio‐Medico di RomaRomeItaly
- Unit of Clinical Laboratory ScienceUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Rocco Amendolara
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Antonio Siena
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Riccardo De Fata
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Flavio Davini
- Laboratory Unit of Fondazione Policlinico Universitario Campus Bio‐Medico di RomaRomeItaly
- Unit of Clinical Laboratory ScienceUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Lucia Coraggio
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Carmen Mignogna
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Chiara Moretti
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Ernesto Maddaloni
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
| | - Silvia Angeletti
- Laboratory Unit of Fondazione Policlinico Universitario Campus Bio‐Medico di RomaRomeItaly
- Unit of Clinical Laboratory ScienceUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Raffaella Buzzetti
- Department of Experimental Medicine“Sapienza” University of RomeRomeItaly
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Fogolari M, Leoni BD, De Cesaris M, Italiano R, Davini F, Miccoli GA, Donati D, Clerico L, Stanziale A, Savini G, Petrosillo N, Ciccozzi M, Sommella L, Riva E, Fazii P, Angeletti S. Neutralizing Antibodies against SARS-CoV-2 Beta and Omicron Variants Inhibition Comparison after BNT162b2 mRNA Booster Doses with a New PETIA sVNT Assay. Diagnostics (Basel) 2023; 13:889. [PMID: 36900033 PMCID: PMC10000738 DOI: 10.3390/diagnostics13050889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Monitoring antibody response following SARS-CoV-2 vaccination is strategic, and neutralizing antibodies represent the gold standard. The neutralizing response to Beta and Omicron VOCs was evaluated versus the gold standard by a new commercial automated assay. METHODS Serum samples from 100 healthcare workers from the Fondazione Policlinico Universitario Campus Biomedico and the Pescara Hospital were collected. IgG levels were determined by chemiluminescent immunoassay (Abbott Laboratories, Wiesbaden, Germany) and serum neutralization assay as the gold standard. Moreover, a new commercial immunoassay, the PETIA test Nab (SGM, Rome, Italy), was used for neutralization evaluation. Statistical analysis was performed with R software, version 3.6.0. RESULTS Anti-SARS-CoV-2 IgG titers decayed during the first ninety days after the vaccine second dose. The following booster dose significantly (p < 0.001) increased IgG levels. A correlation between IgG expression and neutralizing activity modulation was found with a significant increase after the second and the third booster dose (p < 0.05. Compared to the Beta variant of the virus, the Omicron VOC was associated with a significantly larger quantity of IgG antibodies needed to achieve the same degree of neutralization. The best Nab test cutoff for high neutralization titer (≥1:80) was set for both Beta and Omicron variants. CONCLUSION This study correlates vaccine-induced IgG expression and neutralizing activity using a new PETIA assay, suggesting its usefulness for SARS-CoV2 infection management.
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Affiliation(s)
- Marta Fogolari
- Clinical Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Unit of Clinical Laboratory Science, Department of Medicine and Surgery, University Campus Bio-Medico, 00128 Rome, Italy
| | | | - Marina De Cesaris
- Clinical Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | | | - Flavio Davini
- Clinical Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Unit of Clinical Laboratory Science, Department of Medicine and Surgery, University Campus Bio-Medico, 00128 Rome, Italy
| | - Ginevra Azzurra Miccoli
- Infection Prevention and Control Service, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Daniele Donati
- Infection Prevention and Control Service, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Luigi Clerico
- Clinical Microbiology and Virology, Spirito Santo Hospital, 65122 Pescara, Italy
| | - Andrea Stanziale
- Clinical Microbiology and Virology, Spirito Santo Hospital, 65122 Pescara, Italy
| | - Giovanni Savini
- Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise ‘G Caporale’, 64100 Teramo, Italy
| | - Nicola Petrosillo
- Infection Prevention and Control Service, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 00128 Rome, Italy
| | - Lorenzo Sommella
- Health Management, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Elisabetta Riva
- Clinical Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Unit of Virology, University Campus Bio-Medico of Rome, 00128 Rome, Italy
| | - Paolo Fazii
- Clinical Microbiology and Virology, Spirito Santo Hospital, 65122 Pescara, Italy
| | - Silvia Angeletti
- Clinical Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Unit of Clinical Laboratory Science, Department of Medicine and Surgery, University Campus Bio-Medico, 00128 Rome, Italy
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8
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Angeletti S, Legramante JM, Lia MS, D'Amico L, Fogolari M, Cella E, De Cesaris M, De Angelis F, Pieri M, Terrinoni A, Bernardini S, Minieri M. Assessment of the Stability of Midregional Proadrenomedullin in Different Biological Matrices. Lab Med 2023; 54:41-46. [PMID: 35713618 DOI: 10.1093/labmed/lmac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Midregional proadrenomedullin (MR-proADM) has been shown to play a key role in endothelial dysfunction, with increased levels helping to prevent early stages of organ dysfunction. Recent clinical evidence has demonstrated MR-proADM to be a helpful biomarker to identify disease severity in patients with sepsis as well as pneumonia. This biomarker is helpful at triage in emergency departments to assess risk level of patients. The aim of this study is to evaluate the stability of MR-proADM in different biological matrices. The results, obtained by Bland-Altman and scatter plot analyses, demonstrate that deviation of MR-proADM concentration in serum compared to EDTA plasma unequivocally shows that serum should not be used as a sample matrix. Instead, the excellent correlation of heparin plasma vs EDTA plasma samples shows that heparin plasma can be used without reservation in clinical routine and emergency samples.
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Affiliation(s)
- Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Jacopo M Legramante
- Emergency Department, Tor Vergata University Hospital, Rome, Italy.,Department of Medical Systems, University of Tor Vergata, Rome, Italy
| | - Maria Stella Lia
- Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Loreta D'Amico
- Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Eleonora Cella
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Marina De Cesaris
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Fabio De Angelis
- Emergency Department, Tor Vergata University Hospital, Rome, Italy
| | - Massimo Pieri
- Department of Experimental Medicine, University of Tor Vergata, RomeItaly
| | | | - Sergio Bernardini
- Department of Experimental Medicine, University of Tor Vergata, RomeItaly.,Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Marilena Minieri
- Department of Experimental Medicine, University of Tor Vergata, RomeItaly.,Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy
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9
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Navarini L, Vomero M, Currado D, Berardicurti O, Biaggi A, Marino A, Bearzi P, Corberi E, Rigon A, Arcarese L, Leuti A, Fava M, Fogolari M, Mattei A, Ruscitti P, Di Cola I, Sambuco F, Travaglino F, Angeletti S, Ursini F, Mariani E, Cipriani P, Agrò FE, Iagnocco A, Antonelli Incalzi R, Maccarrone M, Giacomelli R. The specialized pro-resolving lipid mediator Protectin D1 affects macrophages differentiation and activity in Adult-onset Still's disease and COVID-19, two hyperinflammatory diseases sharing similar transcriptomic profiles. Front Immunol 2023; 14:1148268. [PMID: 37153620 PMCID: PMC10160453 DOI: 10.3389/fimmu.2023.1148268] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/31/2023] [Indexed: 05/10/2023] Open
Abstract
Introduction COVID-19 and autoinflammatory diseases, such as Adult-onset Still's Disease (AOSD), are characterized by hyperinflammation, in which it is observed massive production and uncontrolled secretion of pro-inflammatory cytokines. The specialized pro-resolving lipid mediators (SPMs) family is one the most important processes counteracting hyperinflammation inducing tissue repair and homeostasis restoration. Among SPMs, Protectin D1 (PD1) is able to exert antiviral features, at least in animal models. The aim of this study was to compare the transcriptome of peripheral blood mononuclear cells (PBMCs) from patients with AOSD and COVID-19 and to evaluate the role of PD1 on those diseases, especially in modulating macrophages polarization. Methods This study enrolled patients with AOSD, COVID-19, and healthy donors HDs, undergoing clinical assessment and blood sample collection. Next-generation deep sequencing was performed to identify differences in PBMCs transcripts profiles. Plasma levels of PD1 were assessed by commercial ELISA kits. Monocyte-derived macrophages were polarized into M1 and M2 phenotypes. We analyzed the effect of PD1 on macrophages differentiation. At 10 days, macrophages were analyzed for surface expression of subtypes markers by flow cytometry. Cytokines production was measured in supernatants by Bio-Plex Assays. Results In the transcriptomes from AOSD patients and COVID-19 patients, genes involved in inflammation, lipid catabolism, and monocytes activation were specifically dysregulated in AOSD and COVID-19 patients when compared to HDs. Patients affected by COVID-19, hospitalized in intensive care unit (ICU), showed higher levels of PD1 when compared to not-ICU hospitalized patients and HDs (ICU COVID-19 vs not-ICU COVID-19, p= 0.02; HDs vs ICU COVID-19, p= 0.0006). PD1 levels were increased in AOSD patients with SS ≥1 compared to patients with SS=0 (p=0.028) and HDs (p=0.048). In vitro treatment with PD1 of monocytes-derived macrophages from AOSD and COVID-19 patients induced a significant increase of M2 polarization vs control (p<0.05). Furthermore, a significant release of IL-10 and MIP-1β from M2 macrophages was observed when compared to controls (p<0.05). Discussion PD1 is able to induce pro-resolutory programs in both AOSD and COVID-19 increasing M2 polarization and inducing their activity. In particular, PD1-treated M2 macrophages from AOSD and COVID-19 patients increased the production of IL-10 and enhanced homeostatic restoration through MIP-1β production.
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Affiliation(s)
- Luca Navarini
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Bio-Medico”, School of Medicine, Rome, Italy
- *Correspondence: Luca Navarini,
| | - Marta Vomero
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Bio-Medico”, School of Medicine, Rome, Italy
| | - Damiano Currado
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Bio-Medico”, School of Medicine, Rome, Italy
| | - Onorina Berardicurti
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Bio-Medico”, School of Medicine, Rome, Italy
| | - Alice Biaggi
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Bio-Medico”, School of Medicine, Rome, Italy
| | - Annalisa Marino
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Bio-Medico”, School of Medicine, Rome, Italy
| | - Pietro Bearzi
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Bio-Medico”, School of Medicine, Rome, Italy
| | - Erika Corberi
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Bio-Medico”, School of Medicine, Rome, Italy
| | - Amelia Rigon
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Luisa Arcarese
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alessandro Leuti
- Neurochemistry of Lipids Unit, European Center for Brain Research, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marina Fava
- Neurochemistry of Lipids Unit, European Center for Brain Research, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marta Fogolari
- Operative Research Unit of Clinical Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Clinical Laboratory Science, Department of Medicine, University of Rome “Campus Biomedico”, Rome, Italy
| | - Alessia Mattei
- Operative Research Unit of Anaesthesia, Intensive Care and Pain Management, Fondazione Policiclinico Campus Biomedico, Rome, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Ilenia Di Cola
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Federica Sambuco
- Emergency Department, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Francesco Travaglino
- Emergency Department, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Silvia Angeletti
- Operative Research Unit of Clinical Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Clinical Laboratory Science, Department of Medicine, University of Rome “Campus Biomedico”, Rome, Italy
| | - Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Erminia Mariani
- Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paola Cipriani
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Felice Eugenio Agrò
- Operative Research Unit of Anaesthesia, Intensive Care and Pain Management, Fondazione Policiclinico Campus Biomedico, Rome, Italy
- Research Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre - AO Mauriziano Torino, Cattedra di Reumatologia - Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, University of Rome “Campus Biomedico”, Rome, Italy
- Internal Medicine, Fondazione Policlinico Campus Biomedico, Rome, Italy
| | - Mauro Maccarrone
- Neurochemistry of Lipids Unit, European Center for Brain Research, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Roberto Giacomelli
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome “Campus Bio-Medico”, School of Medicine, Rome, Italy
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10
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Fogolari M, Francesconi M, De Florio L, Giovanetti M, Veralli R, De Flora C, Maruotti A, Scarpa F, Spoto S, Sambuco F, Riva E, Ciccozzi M, Angeletti S. SARS-CoV-2 Variants in COVID-19 Disease: A Focus on Disease Severity and Vaccine Immunity in Patients Admitted to the Emergency Department. J Pers Med 2022; 12:jpm12122001. [PMID: 36556222 PMCID: PMC9783322 DOI: 10.3390/jpm12122001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
Tracking SARS-CoV-2 variants along with vaccinations are fundamental for severe COVID-19 disease prevention. A study was performed that focused on 43 patients with the SARS-CoV-2 infection who were admitted to the Emergency Department. RT-PCR-positive nasopharyngeal samples were sequenced using the MiSeq II system for variant detection. The main reason for Emergency Department admission was COVID-19 (67%), followed by other causes (33%); 51% patients were unvaccinated or vaccinated with a single dose and 49% had completed the vaccination course with two or three doses. Among the vaccinated group, 38% were admitted for COVID-19, versus 94.5% of the unvaccinated group. After admission, 50% of the vaccinated group and 36% of the unvaccinated group were discharged and allowed to go home, and 80% of the unvaccinated had no major comorbidities; 63% needed hospital admission and 5% required a stay in the Intensive Care Unit. Of these, 37% were vaccinated with 3 doses, 11% with two doses, 4% with a single dose, and 48% were unvaccinated. The 70% of the vaccinated patients who were admitted to hospital presented major comorbidities versus 38% of the unvaccinated group. Two unvaccinated patients that needed intensive care had relevant comorbidities and died. Genome sequencing showed the circulation of three omicron and two pure sub-lineages of omicron, including 22 BA.1, 12 BA.1.1, and 7 BA.2. Data showed the SARS-CoV-2 national and international migration patterns and how vaccination was useful for severe COVID-19 disease prevention.
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Affiliation(s)
- Marta Fogolari
- Operative Research Unit of Clinical Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Unit of Clinical Laboratory Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Maria Francesconi
- Operative Research Unit of Clinical Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Unit of Clinical Laboratory Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Lucia De Florio
- Operative Research Unit of Clinical Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Unit of Clinical Laboratory Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Marta Giovanetti
- Laboratório de Flavivírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil
- Department of Science and Technology for Humans and the Environment, University of Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Roberta Veralli
- Operative Research Unit of Clinical Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Unit of Virology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Cecilia De Flora
- Operative Research Unit of Clinical Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Unit of Clinical Laboratory Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Antonello Maruotti
- Dipartimento di Scienze Economiche, Politiche e delle Lingue Moderne—Libera Università Maria Ss Assunta, 00193 Roma, Italy
| | - Fabio Scarpa
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Silvia Spoto
- Diagnostic and Therapeutic Medicine Department, Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Federica Sambuco
- Emergency Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Elisabetta Riva
- Operative Research Unit of Clinical Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Unit of Virology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Massimo Ciccozzi
- Operative Research Unit of Clinical Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Unit of Medical Statistic and Molecular Epidemiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Silvia Angeletti
- Operative Research Unit of Clinical Laboratory, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Unit of Clinical Laboratory Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
- Correspondence: ; Tel.: +39-06-225414161
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11
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Spoto S, Mangiacapra F, D’Avanzo G, Lemme D, Bustos Guillén C, Abbate A, Markley JD, Sambuco F, Markley R, Fogolari M, Locorriere L, Lupoi DM, Battifoglia G, Costantino S, Ciccozzi M, Angeletti S. Synergistic effect of myocardial injury and mid-regional proAdrenomedullin elevation in determining clinical outcomes of SARS-CoV-2 patients. Front Med (Lausanne) 2022; 9:929408. [PMID: 36388948 PMCID: PMC9643355 DOI: 10.3389/fmed.2022.929408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 04/26/2022] [Accepted: 09/16/2022] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) is a systemic disease induced by SARS-CoV-2 causing myocardial injury. To date, there are few data on the correlation between mid-regional proAdrenomedullin (MR-proADM) and myocardial injury. The aim of this study was to evaluate whether the association of myocardial injury and elevated mid-regional proAdrenomedullin values could predict mortality of SARS-CoV-2 patients, to offer the best management to COVID-19 patients. MATERIALS AND METHODS All patients hospitalized for SARS-CoV-2 infection at the COVID-19 Center of the Campus Bio-Medico of Rome University were included between October 2020 and March 2021 and were retrospectively analyzed. Myocardial injury was defined as rising and/or fall of cardiac hs Troponin I values with at least one value above the 99th percentile of the upper reference limit (≥15.6 ng/L in women and ≥34.2 ng/L in men). The primary outcome was 30-day mortality. Secondary outcomes were the comparison of MR-proADM, CRP, ferritin, and PCT as diagnostic and prognostic biomarkers of myocardial injury. Additionally, we analyzed the development of ARDS, the need for ICU transfer, and length of stay (LOS). RESULTS A total of 161 patients were included in this study. Of these, 58 (36.0%) presented myocardial injury at admission. An MR-proADM value ≥ 1.19 nmol/L was defined as the optimal cut-off to identify patients with myocardial injury (sensitivity 81.0% and specificity 73.5%). A total of 121 patients (75.2%) developed ARDS, which was significantly more frequent among patients with myocardial injury (86.2 vs. 68.9%, p = 0.015). The overall 30-day mortality was 21%. Patients with myocardial injury presented significantly higher mortality compared to those without the same (46.6 vs. 6.8%, p < 0.001). When dividing the entire study population into four groups, based on the presence of myocardial injury and MR-proADM values, those patients with both myocardial injury and MR-proADM ≥ 1.19 nmol/L presented the highest mortality (53.2%, p < 0.001). The combination of myocardial injury and MR-proADM values ≥ 1.19 nmol/L was an independent predictor of death (OR = 7.82, 95% CI = 2.87-21.30; p < 0.001). CONCLUSION The study is focused on the correlation between myocardial injury and MR-proADM. Myocardial injury induced by SARS-CoV-2 is strongly associated with high MR-proADM values and mortality.
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Affiliation(s)
- Silvia Spoto
- Department of Diagnostic and Therapeutic Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Fabio Mangiacapra
- Unit of Cardiovascular Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Giorgio D’Avanzo
- Department of Diagnostic and Therapeutic Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Daniela Lemme
- Department of Diagnostic and Therapeutic Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - César Bustos Guillén
- Division of Infectious Diseases, Department of Internal Medicine, Clinica Universidad de los Andes, Santiago Metropolitan, Chile
| | - Antonio Abbate
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - John Daniel Markley
- Division of Infectious Disease and Epidemiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
- Central Virginia, Veterans Administration Hospital, Richmond, VA, United States
| | - Federica Sambuco
- Department of Emergency, University Campus Bio-Medico of Rome, Rome, Italy
| | - Roshanak Markley
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
- Labotarory Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Luciana Locorriere
- Department of Diagnostic and Therapeutic Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Domenica Marika Lupoi
- Department of Diagnostic and Therapeutic Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Giulia Battifoglia
- Department of Diagnostic and Therapeutic Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Sebastiano Costantino
- Department of Diagnostic and Therapeutic Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
- Labotarory Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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12
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Spoto S, Daniel Markley J, Valeriani E, Abbate A, Argemi J, Markley R, Fogolari M, Locorriere L, Anguissola GB, Battifoglia G, Costantino S, Ciccozzi M, Bustos Guillén C, Angeletti S. Active Surveillance Cultures and Procalcitonin in Combination With Clinical Data to Guide Empirical Antimicrobial Therapy in Hospitalized Medical Patients With Sepsis. Front Microbiol 2022; 13:797932. [PMID: 35464939 PMCID: PMC9023116 DOI: 10.3389/fmicb.2022.797932] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/19/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The prevalence of colonization with multidrug-resistant organisms (MDRO) has increased over the last decade, reaching levels as high as 23% in certain patient populations. Active surveillance cultures (ASC) represent a valuable tool to identify patients colonized with MDRO to apply preventive measures, reduce transmission, and guide empiric antimicrobial therapy. There is a paucity of data evaluating the impact of admission ASCs to predict future infection. The aim of this study was to evaluate the concordance between ASCs results and the development of clinical infection by the same microorganism identified in the surveillance swab ("swab-related infection"), in hospitalized septic patients, and to evaluate the presence of specific risk factors associated with the development of a swab-related infection. Methods All adults admitted to the Diagnostic and Therapeutic Medicine Department of the University Hospital Campus Bio-Medico of Rome with a diagnosis of infection or any other medical reason with admission surveillance swabs (rectal or nasal) between January 2018 and February 2021 were included in the study. A retrospective chart review was conducted to identify patients that developed infections with concordant MDROs identified on ASC, and the risk factors for swab-related infection. Secondary outcomes were need of intensive care unit transfer, length of stay, sepsis or septic shock development, and all-cause mortality. Results A total of 528 patients were included in the study, of which 97 (18.3%) had a positive surveillance swab. Among patients with positive surveillance swabs, 18 (18.5%) developed an infection with the same microorganism recovered from the swab, 57 (58.8%) developed an infection with a different microorganism than that recovered from the surveillance swab, and 22 (22.7%) did not develop an infection during hospitalization. The number of colonized sites, an interventional procedure within the previous 3 months, a Systemic Inflammatory Response Syndrome (SIRS) score ≥ 2, and a quick Sequential Organ Failure Assessment (q-SOFA) score ≥ 2 were associated with a significantly higher risk of developing a swab-related infection. SIRS and q-SOFA scores ≥ 2 and procalcitonin ≥ 0.43 ng/ml help for identifying patients with a swab-related infection. Conclusion Patients with positive surveillance swabs were at increased risk for development of infections by the same MDRO identified in surveillance swabs (swab-related infection). This study is the first to show that the positivity of surveillance swabs, in combination with anamnestic data, PCT values, and SIRS or q-SOFA scores, serves as a valuable tool to help clinicians predict patients at higher risk for swab-related infection development and guide the administration of appropriate empiric antimicrobial therapy in septic patients.
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Affiliation(s)
- Silvia Spoto
- Diagnostic and Therapeutic Medicine Department, Campus Bio Medico University of Rome, Rome, Italy
| | - John Daniel Markley
- Division of Infectious Disease and Epidemiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States.,Central Virginia, Veterans Administration Hospital, Richmond, VA, United States
| | - Emanuele Valeriani
- Diagnostic and Therapeutic Medicine Department, Campus Bio Medico University of Rome, Rome, Italy
| | - Antonio Abbate
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Josepmaria Argemi
- Liver Unit Clinica Universidad de Navarra Hepatology Program, Center for Applied Medical Research (CIMA), IdiSNA, Universidad de Navarra, Pamplona, Spain
| | - Roshanak Markley
- Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, Campus Bio Medico University of Rome, Rome, Italy
| | - Luciana Locorriere
- Diagnostic and Therapeutic Medicine Department, Campus Bio Medico University of Rome, Rome, Italy
| | | | - Giulia Battifoglia
- Diagnostic and Therapeutic Medicine Department, Campus Bio Medico University of Rome, Rome, Italy
| | - Sebastiano Costantino
- Diagnostic and Therapeutic Medicine Department, Campus Bio Medico University of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, Campus Bio Medico University of Rome, Rome, Italy
| | - César Bustos Guillén
- Division of Infectious Diseases, Department of Internal Medicine, Clinica Universidad de los Andes, Santiago, Chile
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, Campus Bio Medico University of Rome, Rome, Italy
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13
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Angeletti S, Giovanetti M, Fogolari M, Cella E, De Florio L, Lintas C, Veralli R, Francesconi M, Caccuri F, De Cesaris M, De Flora C, Ceccarelli G, Spoto S, Caruso A, Pascarella S, Riva E, Ciccozzi M. SARS-CoV-2 AY.4.2 variant circulating in Italy: Genomic preliminary insight. J Med Virol 2021; 94:1689-1692. [PMID: 34766651 PMCID: PMC8661725 DOI: 10.1002/jmv.27451] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 01/06/2023]
Abstract
The appearance of emerging variants of SARS‐CoV‐2 carrying mutations into the spike protein has recently raised concern with respect to tracking their transmission and mitigating the impact in the evolving pandemic across countries. AY.4.2, a recently detected Delta variant sublineage, is considered a new variant under investigation (VUI) as it carries specific genetic signatures present in the spike protein, called Y145H and A222V. Here, using genomic epidemiology, we provide the first preliminary insight regarding the circulation of this emerging VUI in Italy. Genomic epidemiology suggests that multiple independent introductions have occurred trough time likely‐mediated by European countries. Virus migration generally followed patterns of national and international human mobility, illustrating how the easing of restriction measures might facilitate the spread of those emerging variants worldwide. Our data reveal how crucial appear to be the implementation of a widespread genomic monitoring to detect variants previously not yet identified across the country.
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Affiliation(s)
- Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marta Giovanetti
- Laboratório de Flavivírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Eleonora Cella
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA
| | - Lucia De Florio
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Carla Lintas
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Roberta Veralli
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Maria Francesconi
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Francesca Caccuri
- Department of Molecular and Translational Medicine, Section of Microbiology, University of Brescia, Brescia, Italy
| | - Marina De Cesaris
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Cecilia De Flora
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Università 'Sapienza', Rome, Italy
| | - Silvia Spoto
- Diagnostic and Therapeutic Medicine Division, University Campus Bio-Medico of Rome, Rome, Italy
| | - Arnaldo Caruso
- Department of Molecular and Translational Medicine, Section of Microbiology, University of Brescia, Brescia, Italy
| | - Stefano Pascarella
- Department of Biochemical Sciences "A. Rossi Fanelli", University of Rome "La Sapienza", Rome, Italy
| | - Elisabetta Riva
- Unit of Virology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
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14
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Spoto S, Lupoi DM, Valeriani E, Fogolari M, Locorriere L, Beretta Anguissola G, Battifoglia G, Caputo D, Coppola A, Costantino S, Ciccozzi M, Angeletti S. Diagnostic Accuracy and Prognostic Value of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Septic Patients outside the Intensive Care Unit. Medicina (Kaunas) 2021; 57:medicina57080811. [PMID: 34441017 PMCID: PMC8399559 DOI: 10.3390/medicina57080811] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 12/29/2022]
Abstract
Background and Objectives: The aim of this study was to evaluate the diagnostic accuracy and prognostic value of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios and to compare them with other biomarkers and clinical scores of sepsis outside the intensive care unit. Materials and methods: In this retrospective study, 251 patients with sepsis and 126 patients with infection other than sepsis were enrolled. NLR and PLR were calculated as the ratio between absolute values of neutrophils, lymphocytes, and platelets by complete blood counts performed on whole blood by Sysmex XE-9000 (Dasit, Italy) following the manufacturer’s instruction. Results: The best NLR value in diagnosis of sepsis was 7.97 with sensibility, specificity, AUC, PPV, and NPV of 64.26%, 80.16%, 0.74 (p < 0.001), 86.49%, and 53.18%, respectively. The diagnostic role of NLR significantly increases when PLR, C-reactive protein (PCR), procalcitonin (PCT), and mid-regional pro-adrenomedullin (MR-proADM) values, as well as systemic inflammatory re-sponse syndrome (SIRS), sequential organ failure assessment (SOFA), and quick-sequential organ failure assessment (qSOFA) scores, were added to the model. The best value of NLR in predicting 90-day mortality was 9.05 with sensibility, specificity, AUC, PPV, and NPV of 69.57%, 61.44%, 0.66 (p < 0.0001), 28.9%, and 89.9%, respectively. Sensibility, specificity, AUC, PPV, and NPV of NLR increase if PLR, PCR, PCT, MR-proADM, SIRS, qSOFA, and SOFA scores are added to NLR. Conclusions: NLR and PLR represent a widely useful and cheap tool in diagnosis and in predict-ing 90-day mortality in patients with sepsis.
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Affiliation(s)
- Silvia Spoto
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, 00128 Roma, Italy; (S.S.); (D.M.L.); (E.V.); (L.L.); (G.B.A.); (G.B.); (S.C.)
| | - Domenica Marika Lupoi
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, 00128 Roma, Italy; (S.S.); (D.M.L.); (E.V.); (L.L.); (G.B.A.); (G.B.); (S.C.)
| | - Emanuele Valeriani
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, 00128 Roma, Italy; (S.S.); (D.M.L.); (E.V.); (L.L.); (G.B.A.); (G.B.); (S.C.)
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, 00128 Roma, Italy;
- Correspondence: ; Tel.: +39-0622-541-1461
| | - Luciana Locorriere
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, 00128 Roma, Italy; (S.S.); (D.M.L.); (E.V.); (L.L.); (G.B.A.); (G.B.); (S.C.)
| | - Giuseppina Beretta Anguissola
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, 00128 Roma, Italy; (S.S.); (D.M.L.); (E.V.); (L.L.); (G.B.A.); (G.B.); (S.C.)
| | - Giulia Battifoglia
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, 00128 Roma, Italy; (S.S.); (D.M.L.); (E.V.); (L.L.); (G.B.A.); (G.B.); (S.C.)
| | - Damiano Caputo
- Department of Surgery, University Campus Bio-Medico of Rome, 00128 Roma, Italy; (D.C.); (A.C.)
| | - Alessandro Coppola
- Department of Surgery, University Campus Bio-Medico of Rome, 00128 Roma, Italy; (D.C.); (A.C.)
| | - Sebastiano Costantino
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, 00128 Roma, Italy; (S.S.); (D.M.L.); (E.V.); (L.L.); (G.B.A.); (G.B.); (S.C.)
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 00128 Roma, Italy;
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, 00128 Roma, Italy;
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15
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Angeletti S, Travaglino F, Spoto S, Pascarella MC, Mansi G, De Cesaris M, Sartea S, Giovanetti M, Fogolari M, Plescia D, Macera M, Incalzi RA, Ciccozzi M. COVID-19 sniffer dog experimental training: Which protocol and which implications for reliable sidentification? J Med Virol 2021; 93:5924-5930. [PMID: 34152634 PMCID: PMC8426906 DOI: 10.1002/jmv.27147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022]
Abstract
The introduction of trained sniffer dogs for COVID‐19 detection could be an opportunity, as previously described for other diseases. Dogs could be trained to detect volatile organic compounds (VOCs), the whiff of COVID‐19. Dogs involved in the study were three, one male and two females from different breeds, Black German Shepherd, German Shepherd, and Dutch Shepherd. The training was performed using sweat samples from SARS‐CoV2 positive patients and from SARS‐Cov2 free patients admitted at the University Hospital Campus Bio‐medico of Rome. Gauze with sweat was collected in a glass jar with a metal top and put in metal boxes used for dog training. The dog training protocol was performed in two phases: the olfactory conditioning and the olfactory discrimination research. The training planning was focused on the switch moment for the sniffer dog, the moment when the dog was able to identify VOCs specific for COVID‐19. At this time, the dog was able to identify VOCs specific for COVID‐19 with significant reliability, in terms of the number of correct versus incorrect (p < 0.0001) reporting. In conclusion, this protocol could provide a useful tool for sniffer dogs' training and their introduction in a mass screening context. It could be cheaper and faster than a conventional testing method.
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Affiliation(s)
- Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Silvia Spoto
- Department of Diagnostic and Therapeutic Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Giorgia Mansi
- Department of Emergency, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marina De Cesaris
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Sartea
- Head of the Drive In Area, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marta Giovanetti
- Laboratório de Flavivírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Davide Plescia
- K9 Unit SecurityDogs, NGS Private Security Company, Rome, Italy
| | | | | | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
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16
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Angeletti S, Benvenuto D, Fogolari M, De Flora C, Ceccarelli G, Maida I, Bazzardi R, Spoto S, Pascarella S, Mugosa B, Ciccozzi M. The Bayesian reconstruction and the evolutionary history of Salivirus type 1 and type 2: the worldwide spreading. J Infect Dev Ctries 2021; 15:280-288. [PMID: 33690212 DOI: 10.3855/jidc.12141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/05/2019] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Salivirus (SalV) represents an emerging problem in public health especially during the recent years. In this study, the Bayesian evolutionary history and the spread of the virus through the different countries have been reported. METHODOLOGY a database of 81 sequences of SalV structural VP1 fragment were downloaded from GenBank, aligned and manually edited by Bioedit Software. ModelTest v. 3.7 software was used to estimate the simplest evolutionary model fitting the sequence dataset. A Maximum-Likelihood tree has been generated using MEGA-X to test the "clockliness" signal using TempEst 1.5.1. The Bayesian phylogenetic tree was built by BEAST. Homology modelling was performed by SWISS-Model and protein variability evaluated by ConSurf server. RESULTS the phylogenetic tree showed a clade of SalV A2 and three main clades of SalV A1, revealing several infections in humans in South Korea, India, Tunisia, China, Nigeria, Ethiopia and USA. The Bayesian maximum clade credibility tree and the time of the most common recent ancestor dated back the root of the tree to the year 1788 with the probable origin in USA. Selective pressure analysis revealed two positive selection sites, His at 100th and Leu at 116th positions that at the homology modelling resulted important to guarantee protein stability and variability. This could contribute to the development of new mutations modifying the clinical features of this evolving virus. CONCLUSIONS Bayesian phylogenetic and phylodynamic represented a useful tool to follow the transmission dynamic of SalV and to prevent new epidemics worldwide.
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Affiliation(s)
- Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy.
| | - Domenico Benvenuto
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy
| | - Cecilia De Flora
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome, "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Ivana Maida
- Department of Medical, Surgical and Experimental Sciences Infectious Diseases, University of Sassari, Italy
| | - Riccardo Bazzardi
- Controllo Microbiologico e Ispezione degli Alimenti, Istituto Zooprofilattico Sperimentale della Sardegna "G. Pegreffi", Sassari, Italy
| | - Silvia Spoto
- 7Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Stefano Pascarella
- Department of Biochemical Science "A. Rossi Fanelli", Sapienza University, Rome, Italy
| | - Boban Mugosa
- Institute of Public Health, Podgorica, Montenegro
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
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17
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Spoto S, Agrò FE, Sambuco F, Travaglino F, Valeriani E, Fogolari M, Mangiacapra F, Costantino S, Ciccozzi M, Angeletti S. High value of mid-regional proadrenomedullin in COVID-19: A marker of widespread endothelial damage, disease severity, and mortality. J Med Virol 2021; 93:2820-2827. [PMID: 33200824 PMCID: PMC7753433 DOI: 10.1002/jmv.26676] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 09/18/2020] [Revised: 10/14/2020] [Accepted: 11/13/2020] [Indexed: 01/06/2023]
Abstract
The widespread endothelial damage due to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) may lead to a disruption of the adrenomedullin (ADM) system responsible for vascular leakage, increased inflammatory status, and microvascular alteration with multi‐organs dysfunction. The aim of this study was to evaluate the role of mid‐regional proadrenomedullin (MR‐proADM) as a marker of SARS‐CoV2 related widespread endothelial damage, clinically identified by organs damage, disease severity and mortality. Patients with SARS‐CoV‐2 infection has been prospectively enrolled and demographic characteristic, clinical and laboratory data has been evaluated. In the overall population, 58% developed acute respiratory distress syndrome (ARDS), 23.3% of patients died, 6.5% acute cardiac injury, 1.4% of patients developed acute ischemic stroke, 21.2% acute kidney injury, 11.8% acute liver damage, and 5.4% septic shock. The best MR‐proADM cut‐off values for ARDS development and mortality prediction were 3.04 and 2 nmol/L, respectively. Patients presenting with MR‐proADM values ≥2 nmol/L showed a significantly higher mortality risk. In conclusion, MR‐proADM values ≥2 nmol/L identify those patients with high mortality risk related to a multiorgan dysfunction syndrome. These patients must be carefully evaluated and considered for an intensive therapeutic approach.
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Affiliation(s)
- Silvia Spoto
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Felice E Agrò
- Intensive Care and Pain Management, Department of Anesthesia, University Campus Bio-Medico of Rome, Rome, Italy
| | - Federica Sambuco
- Emergency Department, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Emanuele Valeriani
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Fabio Mangiacapra
- Unit of Cardiovascular Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Sebastiano Costantino
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
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18
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Spoto S, Nobile E, Carnà EPR, Fogolari M, Caputo D, De Florio L, Valeriani E, Benvenuto D, Costantino S, Ciccozzi M, Angeletti S. Best diagnostic accuracy of sepsis combining SIRS criteria or qSOFA score with Procalcitonin and Mid-Regional pro-Adrenomedullin outside ICU. Sci Rep 2020; 10:16605. [PMID: 33024218 PMCID: PMC7538435 DOI: 10.1038/s41598-020-73676-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 06/12/2020] [Accepted: 09/03/2020] [Indexed: 12/17/2022] Open
Abstract
Early diagnosis and treatment significantly reduce sepsis mortality. Currently, no gold standard has been yet established to diagnose sepsis outside the ICU. The aim of the study was to evaluate the diagnostic accuracy of sepsis defined by SIRS Criteria of 1991, Second Consensus Conference Criteria of 2001, modified Second Consensus Conference Criteria of 2001 (obtaining SIRS Criteria and SOFA score), Third Consensus Conference of 2016, in addition to the dosage of Procalcitonin (PCT) and MR-pro-Adrenomedullin (MR-proADM). In this prospective study, 209 consecutive patients with clinical diagnosis of sepsis were enrolled (May 2014-June 2018) outside intensive care unit (ICU) setting. A diagnostic protocol could include SIRS criteria or qSOFA score evaluation, rapid testing of PCT and MR-proADM, and SOFA score calculation for organ failure definition. Using this approach outside the ICU, a rapid diagnostic and prognostic evaluation could be achieved, also in the case of negative SIRS, qSOFA or SOFA scores with high post-test probability to reduce mortality and improve outcomes.
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Affiliation(s)
- Silvia Spoto
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Edoardo Nobile
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Emanuele Paolo Rafano Carnà
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Damiano Caputo
- Department of Surgery, University Campus Bio-Medico, Rome, Italy
| | - Lucia De Florio
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Emanuele Valeriani
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Domenico Benvenuto
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| | - Sebastiano Costantino
- Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
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19
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Cheung KCP, Fanti S, Mauro C, Wang G, Nair AS, Fu H, Angeletti S, Spoto S, Fogolari M, Romano F, Aksentijevic D, Liu W, Li B, Cheng L, Jiang L, Vuononvirta J, Poobalasingam TR, Smith DM, Ciccozzi M, Solito E, Marelli-Berg FM. Preservation of microvascular barrier function requires CD31 receptor-induced metabolic reprogramming. Nat Commun 2020; 11:3595. [PMID: 32681081 PMCID: PMC7367815 DOI: 10.1038/s41467-020-17329-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/09/2020] [Indexed: 12/19/2022] Open
Abstract
Endothelial barrier (EB) breaching is a frequent event during inflammation, and it is followed by the rapid recovery of microvascular integrity. The molecular mechanisms of EB recovery are poorly understood. Triggering of MHC molecules by migrating T-cells is a minimal signal capable of inducing endothelial contraction and transient microvascular leakage. Using this model, we show that EB recovery requires a CD31 receptor-induced, robust glycolytic response sustaining junction re-annealing. Mechanistically, this response involves src-homology phosphatase activation leading to Akt-mediated nuclear exclusion of FoxO1 and concomitant β-catenin translocation to the nucleus, collectively leading to cMyc transcription. CD31 signals also sustain mitochondrial respiration, however this pathway does not contribute to junction remodeling. We further show that pathologic microvascular leakage in CD31-deficient mice can be corrected by enhancing the glycolytic flux via pharmacological Akt or AMPK activation, thus providing a molecular platform for the therapeutic control of EB response.
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Affiliation(s)
- Kenneth C P Cheung
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- School of Life Sciences, Centre for Cell & Developmental Biology and Partner State Key Laboratory of Agrobiotechnology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Silvia Fanti
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Claudio Mauro
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Mindelson Way, Birmingham, B152WB, UK
| | - Guosu Wang
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Anitha S Nair
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Hongmei Fu
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Spoto
- Internal Medicine Department, University campus Bio-Medico of Rome, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Francesco Romano
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Dunja Aksentijevic
- School of Biological and Chemical Sciences, Queen Mary University of London, Mile End Road, London, E1 4NS, UK
| | - Weiwei Liu
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, People's Republic of China
| | - Baiying Li
- School of Life Sciences, Centre for Cell & Developmental Biology and Partner State Key Laboratory of Agrobiotechnology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lixin Cheng
- School of Life Sciences, Centre for Cell & Developmental Biology and Partner State Key Laboratory of Agrobiotechnology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Liwen Jiang
- School of Life Sciences, Centre for Cell & Developmental Biology and Partner State Key Laboratory of Agrobiotechnology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Juho Vuononvirta
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Thanushiyan R Poobalasingam
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - David M Smith
- AstraZeneca R&D, Cambridge Science Park, Milton Road, Cambridge, CB4 0WG, UK
| | - Massimo Ciccozzi
- Unit of Medical Statistic and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Egle Solito
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Universita degli studi di Napoli "Federico II", 80131, Naples, Italy
| | - Federica M Marelli-Berg
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
- Centre for inflammation and Therapeutic Innovation, Queen Mary University of London, Charterhouse Square, London, UK.
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Angeletti S, Ceccarelli G, Bazzardi R, Fogolari M, Vita S, Antonelli F, De Florio L, Khazrai YM, De Noia V, Lopalco M, Alagia D, Pedone C, Lauri G, Aronica R, Riva E, Demir AB, Abacioglu H, Ciccozzi M. Migrants rescued on the Mediterranean Sea route: nutritional, psychological status and infectious disease control. J Infect Dev Ctries 2020; 14:454-462. [PMID: 32525831 DOI: 10.3855/jidc.11918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/21/2020] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION North Africa has become a key migratory hub where a large number of migrants attempt the journey by sea from the Libyan coastline to the south of Europe. In this humanitarian disaster scenario, the Mediterranean route has been one of the most used by illegal boats. METHODOLOGY In this report, the state of physical and psychological health of a cluster of Eritrean migrants, escaped from Libya and rescued in the Mediterranean Sea after a shipwreck, was described by epidemiological, clinical and laboratory investigations. RESULTS Data suggest that despite the majority of the migrants being apparently in good health upon a syndromic surveillance approach, most of them suffered a decline in psychological status as well as severe malnutrition. The emergence of infectious diseases, related to poor living conditions during the journey, is not a rare event. CONCLUSION The present report highlights the risks of failures of the syndromic medical approach in the setting of the extremely challenging migration route and underlines migrant frailties consequent to a prolonged journey and long period of detention. These stressors, which can degrade the initial health condition of traveling migrants, can lead to a premature "exhausted migrant effect" that should be carefully investigated in order to avoid the early emergence of diseases related to frailty.
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Affiliation(s)
- Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy.
| | - Giancarlo Ceccarelli
- Migrant and Global Health Research Organization, Centro di ricerca sulla salute globale e delle popolazioni mobili (Mi-Hero) e Sanità di Frontiera Onlus.
| | - Riccardo Bazzardi
- Controllo Microbiologico e Ispezione degli Alimenti, Istituto Zooprofilattico Sperimentale della Sardegna "G. Pegreffi", Sassari, Italy.
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy.
| | - Serena Vita
- Migrant and Global Health Research Organization, Centro di ricerca sulla salute globale e delle popolazioni mobili (Mi-Hero) e Sanità di Frontiera Onlus.
| | - Francesca Antonelli
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy.
| | - Lucia De Florio
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy.
| | - Yeganeh Manon Khazrai
- Unit of Food Science and Human Nutrition, University Campus Bio-Medico of Rome, Italy.
| | - Vincenza De Noia
- ERC "Mondo Migliore", Cooperativa Sociale San Filippo Neri, Rocca di Papa, Italy.
| | - Maurizio Lopalco
- ERC "Mondo Migliore", Cooperativa Sociale San Filippo Neri, Rocca di Papa, Italy.
| | - Domenico Alagia
- ERC "Mondo Migliore", Cooperativa Sociale San Filippo Neri, Rocca di Papa, Italy.
| | - Claudio Pedone
- Unit of Geriatrics, University Campus Bio-Medico of Rome, Italy.
| | - Gaetano Lauri
- Unit of Gastroenterology, University Campus Bio-Medico of Rome, Italy.
| | - Rosario Aronica
- Faculty of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Italy.
| | - Elisabetta Riva
- Unit of Virology, University Campus Bio-Medico of Rome, Italy.
| | - Ayse Banu Demir
- Department of Medical Biology, İzmir University of Economics, Izmir, Turkey.
| | - Hakan Abacioglu
- Faculty of Medicine, İzmir University of Economics, Izmir, Turkey.
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy.
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21
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Spoto S, Legramante JM, Minieri M, Fogolari M, Terrinoni A, Valeriani E, Sebastiano C, Bernardini S, Ciccozzi M, Angeletti PS. How biomarkers can improve pneumonia diagnosis and prognosis: procalcitonin and mid-regional-pro-adrenomedullin. Biomark Med 2020; 14:549-562. [DOI: 10.2217/bmm-2019-0414] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Aim: The diagnostic and prognostic role of procalcitonin (PCT) and mid-regional-pro-adrenomedullin (MR-proADM) were investigated in patients with pneumonia. Material & methods: A total of 168 and 77 patients with pneumonia enrolled in two different hospital settings, an internal medicine unit and an emergency unit were included in the study. PCT and MR-proADM plasma concentrations and pneumonia severity index score were measured. Median values were compared by Mann–Whitney’s test. Receiver operating characteristic analysis and rank correlation were used to define the diagnostic and prognostic accuracy. Results: PCT confirmed the diagnostic role at values 0.08–0.10 ng/ml and MR-proADM the prognostic role for severe pneumonia. Significant correlation (p < 0.0001) between MR-proADM and pneumonia severity index score indicated expression of pneumonia severity. Conclusion: This combination of biomarkers presents a high positive predictive value in pneumonia diagnosis and prognosis.
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Affiliation(s)
- Silvia Spoto
- Internal Medicine Department, University Campus Bio-Medico of Rome, Italy
| | - Jacopo M Legramante
- Emergency Department, Policlinico Tor Vergata, Roma, Italy
- Department of Medical Systems, Università di Tor Vergata, Roma, Italy
| | - Marilena Minieri
- Department of Experimental Medicine & Surgery, Università di Tor Vergata, Roma, Italy
- Department of Laboratory Medicine, Policlinico Tor Vergata, Roma, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy
| | - Alessandro Terrinoni
- Department of Experimental Medicine & Surgery, Università di Tor Vergata, Roma, Italy
| | - Emanuele Valeriani
- Department of Internal Medicine ‘SS.ma Annunziata' Hospital, Chieti, Italy
| | | | - Sergio Bernardini
- Department of Experimental Medicine & Surgery, Università di Tor Vergata, Roma, Italy
- Department of Laboratory Medicine, Policlinico Tor Vergata, Roma, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics & Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | - Prof S Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy
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22
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Spoto S, Costantino S, Fogolari M, Valeriani E, Ciccozzi M, Angeletti S. An algorithm of good clinical practice to reduce intra-hospital 90-day mortality and need for Intensive Care Unit transfer: a new approach for septic patient management. Ital J Med 2020. [DOI: 10.4081/itjm.2020.1215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sepsis accounts for 50% of intra-hospital mortality. Septic shock is diagnosed in 2% of patients with half of these needing for Intensive Care Unit (ICU) transfer. An algorithm was applied for mortality, need for intensive care transfer and length of stay decrease. The observational study was performed on 231 consecutive enrolled patients with sepsis or septic shock admitted to the University Campus Bio-Medico of Rome. The algorithm was based on good clinical practice application of antimicrobial stewardship. Data were compared with data from comparable population of National and European surveys. In the study group, the global mortality rate was 26.8% (3.9% was intra-hospital and 23% 90-d mortality), need of ICU transfer was registered in 21.6%, and the median length of stay was 15 days. Globally, intra-hospital and 90-day mortality, were significantly lower than at national level (26.8% vs 63.6%, P<0.0001; 3.9% vs 25%, P<0.0001 and 23% vs 37.5%, P=0.0092). Need for ICU transfer in patients with septic shock was significantly lower than in the English survey (31.9% by vs 80.8% P<0.0001). A significant decrease of intra-hospital, 90-d mortality and need of ICU transfer was achieved.
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23
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Spoto S, Fogolari M, De Florio L, Minieri M, Vicino G, Legramante J, Lia MS, Terrinoni A, Caputo D, Costantino S, Bernardini S, Ciccozzi M, Angeletti S. Procalcitonin and MR-proAdrenomedullin combination in the etiological diagnosis and prognosis of sepsis and septic shock. Microb Pathog 2019; 137:103763. [DOI: 10.1016/j.micpath.2019.103763] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
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Ciccozzi M, Cella E, Lai A, De Florio L, Antonelli F, Fogolari M, Di Matteo FM, Pizzicannella M, Colombo B, Dicuonzo G, Angeletti S. Phylogenetic Analysis of Multi-Drug Resistant Klebsiella pneumoniae Strains From Duodenoscope Biofilm: Microbiological Surveillance and Reprocessing Improvements for Infection Prevention. Front Public Health 2019; 7:219. [PMID: 31448253 PMCID: PMC6691149 DOI: 10.3389/fpubh.2019.00219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/07/2019] [Accepted: 07/22/2019] [Indexed: 11/21/2022] Open
Abstract
Duodenoscopes have been described as potential vehicles of patient-to-patient transmission of multi-drug resistant organisms. Carbapenem-resistant Enterobacteriaceae duodenoscope related infections have been described by the Center for Disease Control and the US Food and Drug Administration consequently to outbreaks occurring in the United States. These evidences suggested that improved microbiological surveillance and endoscope design optimization could represent valid tools to improve infection control. At this aim, in this study an example of duodenoscope microbiological surveillance and reprocessing improvement analyzing strains component of bacterial biofilm by phylogenetic analysis has been proposed. From September 2016 to December 2017, duodenoscope instruments were subjected to microbial surveillance by post-reprocessing cultures of liquid collected by internal channels of instruments after injection and aspiration cycles and membrane filtration. During surveillance seventeen Klebsiella pneumoniae, of which 10/17 (58.8%) MDR and KPC strains were collected from duodenoscope instruments plus one MDR Klebsiella pneumoniae strain from the rectal swab performed before ERCP procedure in an inpatient. The surveillance allowed evidencing potential failure of reprocessing procedure and performing consequent reprocessing improvements including the contaminated instruments quarantine until their negativity. Phylogenetic analysis of whole genome sequence of duodenoscope strains plus inpatients MDR strains, showed intermixing between duodenoscopes and inpatients, as evidenced by minimum spanning tree and time-scale Maximum Clade Credibility tree. In minimum spanning tree, three groups have been evidenced. Group I including Klebsiella pneumoniae strains, isolated from inpatients before microbiological surveillance adoption; group II including intermixed Klebsiella pneumoniae strains isolated from inpatients and Klebsiella pneumoniae strains isolated from duedonoscopes and group III including Klebsiella pneumoniae strains exclusively from duedonoscope instruments. In the Maximum Credibility Tree, a statistically supported cluster including two Klebsiella pneumoniae strains from duedonoscope instruments and one strains isolated from an inpatient was showed. From the first microbiologic surveillance performed on September 2016 and after the reprocessing improvement adoption, none MDR or susceptible Klebsiella pneumoniae strain was isolated in the following surveillance periods. In conclusion, these results should encourage hospital board to perform microbiological surveillance of duodenoscopes as well as of patients, by rectal swabs culture, and rapid molecular testing for antimicrobial resistance before any endoscopic invasive procedure.
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Affiliation(s)
- Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Eleonora Cella
- Department of Biomedical and Clinical Sciences "L. Sacco," University of Milan, Milan, Italy
| | - Alessia Lai
- Department of Biomedical and Clinical Sciences "L. Sacco," University of Milan, Milan, Italy
| | - Lucia De Florio
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Francesca Antonelli
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | | | | | | | - Giordano Dicuonzo
- Healthcare Associated Infection Control Committee, University Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
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25
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Ceccarelli G, Cella E, Vita S, Lai A, Ebranati E, Zehender G, Fogolari M, Antonelli F, Luca Guarino MP, Riva E, Angeletti S, Ciccozzi M. A case of hepatitis B virus infection in Eritrean Diciotti migrant: phylogenetic analysis and ‘mirror effect’. Future Virol 2019. [DOI: 10.2217/fvl-2019-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A case of hepatitis B virus (HBV) infection in an Eritrean migrant was described to provide an epidemiological approach based on phylogenetic analysis useful in developing countries with lacking information. Migrant, positive for HBsAg and HBeAg, carried HBV at high copy number. A sequence of HBV HBsAg region was used for phylogenetic relationships and genetic variability investigation. In the phylogenetic tree, the sequence corresponded to D2 HBV genotype and the cluster root dated 7 years ago. These data compared with the date of landing in Italy, suggest that he was infected at least 7 years before his arrival. This approach by ‘mirror effect’ allows the reconstruction of HBV epidemiology in the country of origin, analyzing the migrant population in the host country.
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Affiliation(s)
- Giancarlo Ceccarelli
- Migrant Health Research Organisation (Mi-HeRO) – Centro di Ricerca Sulla Salute delle Popolazioni Mobili e Globale, Italy
- Department of Public Health & Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
- Sanitary Bureau of Extraordinary Reception Center for ‘Mondo Migliore’ of Rocca di Papa, Rome, Italy; San Filippo Neri Coop. Soc. Onlus, Italy
| | - Eleonora Cella
- Unit of Medical Statistics & Molecular Epidemiology, University Campus Bio-medico of Rome, Italy
| | - Serena Vita
- Migrant Health Research Organisation (Mi-HeRO) – Centro di Ricerca Sulla Salute delle Popolazioni Mobili e Globale, Italy
- Infectious Diseases Unit, Ospedale S Maria Goretti, Latina, Italy
| | - Alessia Lai
- Department of Biomedical & Clinical ‘L Sacco’, University of Milan, Milan, Italy
| | - Erika Ebranati
- Department of Biomedical & Clinical ‘L Sacco’, University of Milan, Milan, Italy
| | | | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy
| | | | | | - Elisabetta Riva
- Unit of Virology, University Campus Bio-Medico of Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics & Molecular Epidemiology, University Campus Bio-medico of Rome, Italy
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26
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Benvenuto D, Cella E, Fogolari M, De Florio L, Borsetti A, Donati D, Garilli F, Spoto S, Ceccarelli G, Angeletti S, Ciccozzi M. The transmission dynamic of Madariaga Virus by bayesian phylogenetic analysis: Molecular surveillance of an emergent pathogen. Microb Pathog 2019; 132:80-86. [PMID: 31029717 DOI: 10.1016/j.micpath.2019.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/03/2019] [Revised: 03/06/2019] [Accepted: 04/24/2019] [Indexed: 11/16/2022]
Abstract
Madariaga Virus (MADV) is an emergent Alphavirus of the eastern equine encephalitis virus (EEEV) strain complex causing epizootic epidemics. In this study the genetic diversity and the transmission dynamics of Madariaga virus has been investigated by Bayesian phylogenetics and phylodynamic analysis. A database of 32 sequences of MADV group structural polyprotein were downloaded from GenBank, aligned manually edited by Bioedit Software. ModelTest v. 3.7 was used to select the simplest evolutionary model that adequately fitted the sequence data. Neighbor-joining tree was generated using MEGA7. The phylogenetic signal of the dataset was tested by the likelihood mapping analysis. The Bayesian phylogenetic tree was built using BEAST. Selective pressure analysis revealed one positive selection site. The phylogenetic trees showed two main clusters. In particular, Lineage II showed an epizootic infection in monkeys and Lineage III, including 2 main clusters (IIIa and IIIB), revealing an epizootic infection in humans in Haiti and an epizootic infection in humans in Venezuela during the 2016, respectively. The Bayesian maximum clade credibility tree and the time of the most common recent ancestor estimates, showed that the root of the tree dated back to the year 346 with the probable origin in Brazil. Gene flow analysis revealed viral exchanges between different neighbor countries of South America. In conclusion, Bayesian phylogenetic and phylodynamic represent useful tools to follow the transmission dynamic of emergent pathogens to prevent new epidemics spreading worldwide.
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Affiliation(s)
- Domenico Benvenuto
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | - Eleonora Cella
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy
| | - Lucia De Florio
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy
| | - Alessandra Borsetti
- National HIV/AIDS Research Center, Istituto Superiore di Sanità, Roma, Italy
| | - Daniele Donati
- School of Nursing, Faculty of Medicine, Department of Biomedicine and Prevention, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Francesco Garilli
- Faculty of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Spoto
- Internal Medicine Department, University Campus Bio-Medico of Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome, Sapienza, Policlinico "Umberto I", Rome, Italy; Migrant and Global Health Research Organisation, Centro di ricerca sulla salute globale e delle popolazioni mobili (Mi-Hero), Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy.
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
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27
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Spoto S, Riva E, Fogolari M, Cella E, Costantino S, Angeletti S, Ciccozzi M. Diffuse maculopapular rash: A family cluster during the last Chikungunya virus epidemic in Italy. Clin Case Rep 2018; 6:2322-2325. [PMID: 30564322 PMCID: PMC6293132 DOI: 10.1002/ccr3.1831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/29/2018] [Accepted: 09/01/2018] [Indexed: 11/24/2022] Open
Abstract
A family cluster of father, mother, and daughter with Chikungunya virus (CHIKV) infection was diagnosed during last epidemic in Italy. In temperate area, during the summer season, clinicians should consider CHIKV infection in the differential diagnosis of patients with fever, maculopapular rash, polyarthralgia, and conjunctival erythema.
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Affiliation(s)
- Silvia Spoto
- Internal Medicine DepartmentUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Elisabetta Riva
- Unit of VirologyUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Marta Fogolari
- Unit of Clinical Laboratory ScienceUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Eleonora Cella
- Unit of Medical Statistics and Molecular EpidemiologyUniversity Campus Bio‐Medico of RomeRomeItaly
| | | | - Silvia Angeletti
- Unit of Clinical Laboratory ScienceUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular EpidemiologyUniversity Campus Bio‐Medico of RomeRomeItaly
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28
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Fogolari M, Mavian C, Angeletti S, Salemi M, Lampel KA, Maurelli AT. Distribution and characterization of Shiga toxin converting temperate phages carried by Shigella flexneri in Hispaniola. Infect Genet Evol 2018; 65:321-328. [PMID: 30075254 PMCID: PMC6260934 DOI: 10.1016/j.meegid.2018.07.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/22/2018] [Accepted: 07/29/2018] [Indexed: 01/29/2023]
Abstract
Shigella infections account for a considerable burden of acute diarrheal diseases worldwide and remain a major cause of childhood mortality in developing countries. Although, all four species of Shigella (S. dysenteriae, S. flexneri, S. boydii, and S. sonnei) cause bacillary dysentery, historically only S. dysenteriae type 1 has been recognized as carrying the genes for Shiga toxin (stx). Recent epidemiological data, however, have suggested that the emergence of stx carrying S. flexneri strains may have originated from bacteriophage-mediated inter-species horizontal gene transfer in one specific geographical area, Hispaniola. To test this hypothesis, we analyzed whole genome sequences of stx-encoding phages carried by S. flexneri strains isolated in Haiti and S. flexneri S. boydii and S. dysenteriae strains isolated from international travelers who likely acquired the infection in Haiti or the Dominican Republic. Phylogenetic analysis showed that phage sequences encoded in the Shigella strains from Hispaniola were bacteriophage φPOC-J13 and they were all closely related to a phage isolated from a USA isolate, E. coli 2009C-3133 serotype O119:H4. In addition, despite the low genetic heterogeneity of phages from different Shigella spp. circulating in the Caribbean island between 2001 and 2014, two distinct clusters emerged in Haiti and the Dominican Republic. Each cluster possibly originated from phages isolated from S. flexneri 2a, and within each cluster several instances of horizontal phage transfer from S. flexneri 2a to other species were detected. The implications of the emergence of stx-producing non-S. dysenteriae type 1 Shigella species, such as S. flexneri, spans not only the basic science behind horizontal phage spread, but also extends to medical treatment of patients infected with this pathogen.
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Affiliation(s)
- Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Carla Mavian
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marco Salemi
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA.
| | | | - Anthony T Maurelli
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA.
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29
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De Florio L, Riva E, Giona A, Dedej E, Fogolari M, Cella E, Spoto S, Lai A, Zehender G, Ciccozzi M, Angeletti S. MALDI-TOF MS Identification and Clustering Applied to Enterobacter Species in Nosocomial Setting. Front Microbiol 2018; 9:1885. [PMID: 30154783 PMCID: PMC6102349 DOI: 10.3389/fmicb.2018.01885] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 07/26/2018] [Indexed: 12/22/2022] Open
Abstract
Enterobacter microorganisms cause important bacterial infections in humans. Recently, carbapenem resistant isolates carrying the blaKPC gene were described and their clonal transmission in different nosocomial outbreaks reported. In this study, the relative numbers of Enterobacter species, their antimicrobial susceptibility along 3 years of observation and the identification ability of the two most common MALDI-TOF platforms were evaluated. A clustering analysis was performed to identify changes in the microbial population within the nosocomial environment. Enterobacter were identified using two platforms (MALDI-TOF Biotyper and VITEK MS). Antimicrobial susceptibility was tested by Vitek2 Compact and MIC50 and MIC90 was evaluated using GraphPad software. Clustering analysis was performed by MALDI-TOF and a dendrogram was built with both platforms and compared. The most frequent species isolated were Enterobacter cloacae and Enterobacter aerogenes with a gradual increase of Enterobacter asburiae in 2017. MALDI-TOF platforms showed a very good sensitivity and specificity except for E. asburiae identification that was reliable only by MALDI-TOF MS Biotyper. An increase of resistance for Enterobacter, confirmed by the isolation of extended spectrum beta-lactamase (ESBL) strains and the emergence of E. cloacae multidrug-resistant (MDR) and carbapenem resistant strains, was observed. A clonal route of transmission involving general surgery and geriatric wards was evidenced as previously described for Klebsiella pneumoniae MDR strains in the same nosocomial setting. These data represent an important source of information about the spreading of Enterobacter in the nosocomial environment.
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Affiliation(s)
- Lucia De Florio
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Elisabetta Riva
- Unit of Virology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Annalisa Giona
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Etleva Dedej
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Eleonora Cella
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Spoto
- Internal Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Alessia Lai
- "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gianguglielmo Zehender
- "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
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Ciccozzi M, Riva E, Vita S, Cella E, Fogolari M, Spoto S, Lopalco M, Ceccarelli G, Angeletti S. An acute febrile outbreak in a refugee community of an Italian asylum seeker center: lessons learned. Public Health 2018; 163:16-19. [PMID: 30031836 PMCID: PMC7111893 DOI: 10.1016/j.puhe.2018.05.026] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The management of infectious outbreaks in closed settings represents an important public health issue. An outbreak of acute febrile syndrome affecting 22 refugees resident at the Asylum Seekers Centre of Castelnuovo di Porto in Rome has been reported, and the preventive and control measures adopted have been described as an example of public health safety. METHODS Pharyngeal swab and whole-blood samples were collected from 22 cases observed and analyzed for standard bacterial cultures and respiratory and herpesviruses by qualitative CLART PneumoVir2 and Entherpex microarray. RESULTS A possible respiratory-transmitted etiology and a concomitant reactivation of multiple herpesviruses have been evidenced. The epidemiological investigation showed that the spread of the epidemic was promoted because patients were hosted in neighboring rooms or in the same room, facilitating the rapid spread of infectious disease. CONCLUSIONS The potential way of transmission was supposed, and preventive measures for infection control were adopted. The measures adopted are an example of best practice for outbreak management, and the microbiological surveillance is recommended for public health improvement.
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Affiliation(s)
- M Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | - E Riva
- Unit of Virology, University Campus Bio-Medico of Rome, Italy
| | - S Vita
- Migrant and Global Health Research Organisation, Centro di Ricerca Sulla Salute Globale e Delle Popolazioni Mobili (Mi-Hero), Italy
| | - E Cella
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | - M Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy
| | - S Spoto
- Internal Medicine Department, University Campus Bio-Medico of Rome, Italy
| | - M Lopalco
- Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Rome, Italy; Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - G Ceccarelli
- Migrant and Global Health Research Organisation, Centro di Ricerca Sulla Salute Globale e Delle Popolazioni Mobili (Mi-Hero), Italy; Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Rome, Italy; Auxilium Società Cooperativa Sociale, Senise (PZ), Italy; Department of Public Health and Infectious Diseases, University of Rome Sapienza, Italy
| | - S Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy.
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31
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Cella E, Riva E, Angeletti S, Fogolari M, Blasi A, Scolamacchia V, Spoto S, Bazzardi R, Lai A, Sagnelli C, Sagnelli E, Ciccozzi M. Genotype I hepatitis A virus introduction in Italy: Bayesian phylogenetic analysis to date different epidemics. J Med Virol 2018; 90:1493-1502. [PMID: 29738070 DOI: 10.1002/jmv.25220] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/03/2018] [Indexed: 01/05/2023]
Abstract
Despite a significant decrease in acute hepatitis A in the last 2 decades in Italy, outbreaks were observed occurring mostly in southern Italy. In this study, Bayesian phylogenetic analysis was used to analyze the origin of these epidemics. With this aim, 5 different data sets of hepatitis A virus sequences were built to perform genotyping by the neighbor-joining method to estimate the evolutionary rates by using a Bayesian Markov chain Monte Carlo approach and to investigate the demographic history by independent Markov chain Monte Carlo runs enforcing both a strict and relaxed clock. The estimated mean value of the evolutionary rate, representing Ia and Ib strains, was 1.21 × 10-3 and 2.0 × 10-3 substitutions/site/year, respectively. The Bayesian maximum clade credibility tree of hepatitis A virus (HAV) Ia and Ib strains showed that Italian sequences mostly formed separate clusters. The root of the time for the most recent common ancestor (tMRCA) for HAV Ia and Ib strains dated back to 1981 and to 1988, respectively, showing in both cases different epidemic entrances. Phylodynamic analysis showed that genotype Ia increased in 1997, when the Apulia epidemic started, then suffered a bottleneck, probably consequent to vaccination and to the herd immunity, followed by a new increase in virus population in the years 2013-2014 consequent to the epidemic caused by the ingestion of mixed frozen berries. A similar trend without an evident bottleneck was observed also in the case of genotype Ib. In conclusion, the Bayesian phylogenetic analysis represents a good tool to measure the effectiveness of the public health plans used for HAV control.
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Affiliation(s)
- Eleonora Cella
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Elisabetta Riva
- Unit of Virology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Aletheia Blasi
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Vittoria Scolamacchia
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Spoto
- Internal Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Riccardo Bazzardi
- Dipartimento di Igiene degli Alimenti, Istituto Zooprofilattico Sperimentale della Sardegna, Sassari, Italy
| | - Alessia Lai
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
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Cella E, Ciccozzi M, Fogolari M, Azarian T, Prosperi M, Dicuonzo G, Salemi M, Angeletti S. A66 Multi-drug-resistant Klebsiella pneumoniae strains circulating in hospital setting: Whole-genome sequencing and Bayesian phylogenetic analysis for outbreak investigations. Virus Evol 2018. [PMCID: PMC5905358 DOI: 10.1093/ve/vey010.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- E Cella
- Unit of Clinical Pathology and Microbiology, University Campus Bio-Medico of Rome, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - M Ciccozzi
- Unit of Clinical Pathology and Microbiology, University Campus Bio-Medico of Rome, Italy
- Department of Infectious Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - M Fogolari
- Unit of Clinical Pathology and Microbiology, University Campus Bio-Medico of Rome, Italy
| | - T Azarian
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard’s T.H. Chan School of Public Health, Boston, MA
| | - M Prosperi
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - G Dicuonzo
- Unit of Clinical Pathology and Microbiology, University Campus Bio-Medico of Rome, Italy
| | - M Salemi
- Department of Pathology, Immunology, and Laboratory Medicine, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - S Angeletti
- Unit of Clinical Pathology and Microbiology, University Campus Bio-Medico of Rome, Italy
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33
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Cancilleri F, Ciccozzi M, Fogolari M, Cella E, De Florio L, Berton A, Salvatore G, Dicuonzo G, Spoto S, Denaro V, Angeletti S. A case of methicillin-resistant Staphylococcus aureus wound infection: phylogenetic analysis to establish if nosocomial or community acquired. Clin Case Rep 2018; 6:871-874. [PMID: 29744076 PMCID: PMC5930232 DOI: 10.1002/ccr3.1442] [Citation(s) in RCA: 6] [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: 01/03/2018] [Revised: 01/28/2018] [Accepted: 01/31/2018] [Indexed: 12/16/2022] Open
Abstract
Methicillin‐resistant Staphylococcus aureus (MRSA) infection is rapidly increasing in both hospital and community settings. A 71‐year‐old man admitted at the Department of Orthopaedics and Trauma Surgery, University Campus Bio‐Medico of Rome, with MRSA wound infection consequent to orthopedic surgery was studied and the MRSA transmission evaluated by phylogenetic analysis.
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Affiliation(s)
- Francesco Cancilleri
- Department of Orthopaedic and Trauma Surgery University Campus Bio-Medico of Rome Via Alvaro del Portillo 200 00128 Rome Italy
| | - Massimo Ciccozzi
- Unit of Clinical Laboratory Science University Campus Bio-Medico of Rome Via Alvaro del Portillo 200 00128 Rome Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science University Campus Bio-Medico of Rome Via Alvaro del Portillo 200 00128 Rome Italy
| | - Eleonora Cella
- Unit of Clinical Laboratory Science University Campus Bio-Medico of Rome Via Alvaro del Portillo 200 00128 Rome Italy
| | - Lucia De Florio
- Unit of Clinical Laboratory Science University Campus Bio-Medico of Rome Via Alvaro del Portillo 200 00128 Rome Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery University Campus Bio-Medico of Rome Via Alvaro del Portillo 200 00128 Rome Italy
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery University Campus Bio-Medico of Rome Via Alvaro del Portillo 200 00128 Rome Italy
| | - Giordano Dicuonzo
- Infection control Committee University Campus Bio-Medico of Rome Via Alvaro del Portillo 200 00128 Rome Italy
| | - Silvia Spoto
- Internal Medicine Department University Campus Bio-Medico of Rome Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery University Campus Bio-Medico of Rome Via Alvaro del Portillo 200 00128 Rome Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science University Campus Bio-Medico of Rome Via Alvaro del Portillo 200 00128 Rome Italy
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34
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Spoto S, Valeriani E, Caputo D, Cella E, Fogolari M, Pesce E, Mulè MT, Cartillone M, Costantino S, Dicuonzo G, Coppola R, Ciccozzi M, Angeletti S. The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery: Advantage from daily measurement. Medicine (Baltimore) 2018; 97:e9496. [PMID: 29504973 PMCID: PMC5779742 DOI: 10.1097/md.0000000000009496] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Postsurgical infections represent an important cause of morbidity after abdominal surgery. The microbiological diagnosis is not achieved in at least 30% of culture with consequent worsening of patient outcome. In this study, procalcitonin measurement, during the first 3 days after abdominal surgery, has been evaluated for the early diagnosis of postsurgical infection.Ninety consecutive patients subjected to major abdominal surgery at the University Campus Bio-Medico of Rome, have been included. PCT concentrations were measured by time-resolved amplified cryptate emission (TRACE) assay at admission and at the first, second, and third day after surgery. PCT levels were compared using the Mann-Whitney test and by ANOVA test for variance analysis. Receiver operating characteristic (ROC) analysis was performed to define the diagnostic ability of PCT in case of postsurgical infections.PCT values resulted significantly different between patients developing or not developing postsurgical infections. PCT >1.0 ng/mL at first or second day after surgery and >0.5 ng/mL at third day resulted diagnostic for infectious complication, whereas a value <0.5 ng/mL at the fifth day after surgery was useful for early and safety discharge of patients.In conclusion, PCT daily measurement could represent a useful diagnostic tool improving health care in the postsurgical period following major abdominal surgery and should be recommended.
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Affiliation(s)
- Silvia Spoto
- Internal Medicine Department, University Campus Bio-Medico of Rome, Rome Internal Medicine Department, University G. D'Annunzio, Chieti Department of Surgery, University Campus Bio-Medico of Rome Department of Public Health and Infectious Diseases, Sapienza University of Rome Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
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35
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Ceccarelli G, Vita S, Riva E, Cella E, Lopalco M, Antonelli F, De Cesaris M, Fogolari M, Dicuonzo G, Ciccozzi M, Angeletti S. Susceptibility to measles in migrant population: implication for policy makers. J Travel Med 2018; 25:4711101. [PMID: 29232456 DOI: 10.1093/jtm/tax080] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/13/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite a large measles outbreak is taking place in WHO European region, currently no data are available on measles immunization coverage in the asylum seeker and migrants hosted in this area. METHODS Two hundred and fifty-six migrants upon their arrival in Italy on March, April and May 2016 were screened for measles virus IgG antibodies by chemiluminescence immunoassay (Liaison XL analyzer, Diasorin, Italy). The virus susceptibility in this cohort, the differences between the official country reported and the observed measles immunization coverage and the impact of current measles outbreak on the asylum seekers hosted in the largest Asylum Seeker centres of Italy, were evaluated. RESULTS The prevalence of subjects with positive result for measles IgG antibodies ranged between 79.9% and 100%. In Senegal, Mali, Nigeria, Pakistan and Bangladesh, the measles IgG seroprevalence observed was greater than the vaccinal coverage reported by WHO after I dose of vaccine. Based on data regarding the II dose coverage, the ASs population presented a seroprevalence greater to that expected. CONCLUSION On the basis of the results obtained, extraordinary screening and vaccination campaigns in the migrant population, especially in the course of large outbreaks, could represent a resource to reach an adequate measles immunization coverage and to control this infectious disease.
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Affiliation(s)
- Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Roma, Italy.,Migrant and Global Health Research Organisation, Centro di ricerca sulla salute globale e delle popolazioni mobili (Mi-Hero), Via del Pigneto 3, 00176 Roma, Italy.,Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Via della Circonvallazione della Protezione Civile 1, 00100 Rome, Italy.,Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - Serena Vita
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Roma, Italy.,Migrant and Global Health Research Organisation, Centro di ricerca sulla salute globale e delle popolazioni mobili (Mi-Hero), Via del Pigneto 3, 00176 Roma, Italy.,Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Via della Circonvallazione della Protezione Civile 1, 00100 Rome, Italy.,Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - Elisabetta Riva
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Eleonora Cella
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Roma, Italy.,Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Via della Circonvallazione della Protezione Civile 1, 00100 Rome, Italy.,Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - Maurizio Lopalco
- Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Via della Circonvallazione della Protezione Civile 1, 00100 Rome, Italy.,Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - Francesca Antonelli
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Marina De Cesaris
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Marta Fogolari
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Giordano Dicuonzo
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Massimo Ciccozzi
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Silvia Angeletti
- Clinical Laboratory Science Unit, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Roma, Italy
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Angeletti S, Ciccozzi M, Cella E, Giovanetti M, Milano T, Fogolari M, Garilli F, Alexiev I, Bazzardi R, Salemi M, Junior Alcantara L, Pascarella S. Mayaro virus infection, the next epidemic wave after Zika? Evolutionary and structural analysis. ASIAN PAC J TROP MED 2018. [DOI: 10.4103/1995-7645.228433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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37
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Cella E, Riva E, Salemi M, Spoto S, Vita S, Fogolari M, Angeletti S, Ciccozzi M. The new Chikungunya virus outbreak in Italy possibly originated from a single introduction from Asia. Pathog Glob Health 2017; 112:93-95. [PMID: 29182057 DOI: 10.1080/20477724.2017.1406565] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Eleonora Cella
- a Unit of Clinical of Laboratory Science , University Campus Bio-Medico of Rome , Rome , Italy.,b Public Health and Infectious Diseases , Sapienza University , Rome , Italy
| | - Elisabetta Riva
- c Unit of Virology , University Campus Bio-Medico of Rome , Rome , Italy
| | - Marco Salemi
- d Department of Pathology, Immunology and Laboratory Science, College of Medicine , University of Florida , Gainesville , FL , USA
| | - Silvia Spoto
- e Internal Medicine Department , University Campus Bio-Medico of Rome , Rome , Italy
| | - Serena Vita
- b Public Health and Infectious Diseases , Sapienza University , Rome , Italy
| | - Marta Fogolari
- a Unit of Clinical of Laboratory Science , University Campus Bio-Medico of Rome , Rome , Italy
| | - Silvia Angeletti
- a Unit of Clinical of Laboratory Science , University Campus Bio-Medico of Rome , Rome , Italy
| | - Massimo Ciccozzi
- a Unit of Clinical of Laboratory Science , University Campus Bio-Medico of Rome , Rome , Italy
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38
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Spoto S, Costantino S, Valeriani E, Fogolari M, Cella E, Dicuonzo G, Ciccozzi M, Angeletti S. Visceral leishmaniasis triggering an adult-onset Still's disease: a unique case. Clin Case Rep 2017; 5:2111-2116. [PMID: 29225867 PMCID: PMC5715570 DOI: 10.1002/ccr3.1266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/19/2017] [Revised: 09/26/2017] [Accepted: 10/01/2017] [Indexed: 01/04/2023] Open
Abstract
Adult‐onset Still's disease (AOSD) due to visceral leishmaniasis (VL) has not been previously reported. This case report analyzes a single episode of AOSD probably due to a visceral leishmaniasis successfully treated with pentamidine isethionate and prednisone.
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Affiliation(s)
- Silvia Spoto
- Internal Medicine Department University Hospital Campus Bio-Medico Rome Italy
| | | | - Emanuele Valeriani
- Internal Medicine Department University Hospital Campus Bio-Medico Rome Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science University Campus Bio-Medico of Rome Rome Italy
| | - Eleonora Cella
- Unit of Clinical Laboratory Science University Campus Bio-Medico of Rome Rome Italy.,Department of Public Health and Infectious Diseases "Sapienza", Policlinico Umberto I University of Rome Rome Italy
| | - Giordano Dicuonzo
- Unit of Clinical Laboratory Science University Campus Bio-Medico of Rome Rome Italy
| | - Massimo Ciccozzi
- Unit of Clinical Laboratory Science University Campus Bio-Medico of Rome Rome Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science University Campus Bio-Medico of Rome Rome Italy
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Angeletti S, Ottaviani R, Lanotte M, Pedicino L, De Cesaris M, Lo Presti A, Cella E, Fogolari M, Ciccozzi M, Dicuonzo G. WITHDRAWN: Procalcitonin and mid regional-pro-adrenomedullin promising markers for sepsis diagnosis and prognosis. Asian Pac J Trop Biomed 2016. [DOI: 10.1016/j.apjtb.2016.09.008] [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: 10/20/2022] Open
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40
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Angeletti S, Spoto S, Fogolari M, Cortigiani M, Fioravanti M, De Florio L, Curcio B, Cavalieri D, Costantino S, Dicuonzo G. Diagnostic and prognostic role of procalcitonin (PCT) and MR-pro-Adrenomedullin (MR-proADM) in bacterial infections. APMIS 2015; 123:740-8. [PMID: 26058482 DOI: 10.1111/apm.12406] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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: 10/13/2014] [Accepted: 04/20/2015] [Indexed: 01/08/2023]
Abstract
Rapid diagnosis of bacterial infections is crucial for adequate antibiotic treatment. Serum molecules such as Procalcitonin (PCT) have been used as biomarkers of infection. Recently, the mid-regional pro-Adrenomedullin (MR-proADM) has been evaluated in combination with PCT for sepsis diagnosis. The diagnostic role of PCT and MR-proADM both in sepsis and in localized infections together with their contribution to effective antibiotic therapy has been evaluated. One hundred and eighty-two patients with bacterial infection has been enrolled: PCT and MR-proADM were measured at admission (T = 0), at 12-24 h (T = 1) and in the third or fifth day of antibiotic therapy (T = 3-5). ROC curve (receiver operating characteristic) and post-test probability were calculated. MR-proADM increased with the severity of the infection. PCT resulted significantly higher in sepsis than localized infection. After antibiotic therapy, PCT significantly decreased in localized respiratory infections and in sepsis, while MR-proADM decreased significantly after antibiotic therapy only in patients with severe sepsis/septic shock. The threshold values of PCT and MR-proADM were >0.1 ng/mL and >0.8 nmol/L, respectively. The combined use of PCT and MR-proADM increased the post-test probability of the diagnosis of bacterial infections compared to PCT alone. In conclusion, PCT and MR-proADM combination improves the diagnosis of bacterial infection and contribute to prognosis and antibiotic therapy effectiveness.
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Affiliation(s)
- Silvia Angeletti
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Spoto
- Internal Medicine Department, University Hospital Campus Bio-Medico, Rome, Italy
| | - Marta Fogolari
- Internal Medicine Department, University Hospital Campus Bio-Medico, Rome, Italy
| | - Marco Cortigiani
- Internal Medicine Department, University Hospital Campus Bio-Medico, Rome, Italy
| | - Marta Fioravanti
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Rome, Italy
| | - Lucia De Florio
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Rome, Italy
| | - Brunella Curcio
- Internal Medicine Department, University Hospital Campus Bio-Medico, Rome, Italy
| | - Danilo Cavalieri
- Internal Medicine Department, University Hospital Campus Bio-Medico, Rome, Italy
| | | | - Giordano Dicuonzo
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Rome, Italy
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