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Cutrera R, Ciofi Degli Atti ML, Dotta A, D'Amore C, Ravà L, Perno CF, Villani A. Epidemiology of respiratory syncytial virus in a large pediatric hospital in Central Italy and development of a forecasting model to predict the seasonal peak. Ital J Pediatr 2024; 50:65. [PMID: 38589886 PMCID: PMC11003041 DOI: 10.1186/s13052-024-01624-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Respiratory Syncytial Virus (RSV) is responsible for the majority of acute lower respiratory infections in infants and can affect also older age groups. Restrictions linked to the emergence of the SARS-CoV-2 pandemic and their subsequent lifting caused a change in the dynamics of RSV circulation. It is therefore fundamental to monitor RSV seasonal trends and to be able to predict its seasonal peak to be prepared to the next RSV epidemics. METHODS We performed a retrospective descriptive study on laboratory-confirmed RSV infections from Bambino Gesù Children's Hospital in Rome from 1st January 2018 to 31st December 2022. Data on RSV-positive respiratory samples (n = 3,536) and RSV-confirmed hospitalizations (n = 1,895) on patients aged 0-18 years were analyzed. In addition to this, a SARIMA (Seasonal AutoRegressive Integrated Moving Average) forecasting model was developed to predict the next peak of RSV. RESULTS Findings show that, after the 2020 SARS-CoV-2 pandemic season, where RSV circulation was almost absent, RSV infections presented with an increased and anticipated peak compared to pre-pandemic seasons. While mostly targeting infants below 1 year of age, there was a proportional increase in RSV infections and hospitalizations in older age groups in the post-pandemic period. A forecasting model built using RSV weekly data from 2018 to 2022 predicted the RSV peaks of 2023, showing a reasonable level of accuracy (MAPE 33%). Additional analysis indicated that the peak of RSV cases is expected to be reached after 4-5 weeks from case doubling. CONCLUSION Our study provides epidemiological evidence on the dynamics of RSV circulation before and after the COVID-19 pandemic. Our findings highlight the potential of combining surveillance and forecasting to promote preparedness for the next RSV epidemics.
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Affiliation(s)
- Renato Cutrera
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marta Luisa Ciofi Degli Atti
- Epidemiology, Clinical Pathways and Clinical Risk Unit, Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carmen D'Amore
- Epidemiology, Clinical Pathways and Clinical Risk Unit, Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lucilla Ravà
- Epidemiology, Clinical Pathways and Clinical Risk Unit, Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlo Federico Perno
- Department of Diagnostic and Laboratory Medicine, Unit of Microbiology and Diagnostic Immunology, Multimodal Laboratory Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Hospital University Pediatric Clinical Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Systems Department, University of Rome Tor Vergata, Rome, Italy
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Butera G, Piccinelli E, Kolesnik A, Averin K, Seaman C, Castaldi B, Cuppini E, Fraisse A, Bautista-Rodriguez C, Hascoet S, D'Amore C, Baruteau AE, Blasco PB, Bianco L, Eicken A, Jones M, Kuo JA, Rajszys GB. Implantation of atrial flow regulator devices in patients with congenital heart disease and children with severe pulmonary hypertension or cardiomyopathy-an international multicenter case series. Front Cardiovasc Med 2024; 10:1332395. [PMID: 38288053 PMCID: PMC10822980 DOI: 10.3389/fcvm.2023.1332395] [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: 11/02/2023] [Accepted: 12/22/2023] [Indexed: 01/31/2024] Open
Abstract
Background The Occlutech Atrial Flow Regulator (AFR) is a self-expandable double-disc nitinol device with a central fenestration. Its use has been approved in the adult population with heart failure and described for pulmonary hypertension (PH). Only case reports and small series have been published about its use in the paediatric population and for congenital heart disease (CHD). Objectives The authors sought to investigate the feasibility, safety, and short-term follow-up of AFR implantation in patients with CHD or children with PH or cardiomyopathy. Methods This is a multicenter retrospective study involving 10 centers worldwide. Patients of any age with CHD or patients aged < 18 years with PH or cardiomyopathy needing AFR implantation were included. Results A total of 40 patients underwent AFR implantation. The median age of the population at the time of the procedure was 58.5 months (IQR: 31.5-142.5) and the median weight was 17 kg (IQR: 10-46). A total of 26 (65.0%) patients had CHD, nine (22.5%) children, a cardiomyopathy, and five (12.5%), a structurally normal heart. The implantation success rate was 100%. There were two early and one late device thrombosis. Two patients (5.0%) with dilated cardiomyopathy on extracorporeal membrane oxygenator (ECMO) died during the hospital stay. At a median follow-up of 330 days (IQR: 125-593), 37 (92.5%) patients were alive. At follow-up, 20 patients improved their New York Heart Association (NYHA) class, 12 patients did not change their NYHA class, and one patient with idiopathic PH worsened. Conclusions AFR implantation in patients with CHD and children with severe PH or cardiomyopathy is promising and seems to have beneficial effects at short-term follow-up.
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Affiliation(s)
- Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| | - Enrico Piccinelli
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Adam Kolesnik
- Cardiovascular Interventions Laboratory, The Children’s Memorial Health Institute, Varsavia, Poland
| | - Kostantin Averin
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Cameron Seaman
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Biagio Castaldi
- Pediatric Cardiology Department, Padova University, Padova, Italy
| | - Elena Cuppini
- Pediatric Cardiology Department, Padova University, Padova, Italy
| | - Alain Fraisse
- Pediatric Cardiology Department, Royal Brompton Hospital, London, United Kingdom
| | | | - Sebastien Hascoet
- Pediatric Cardiology Department, Royal Brompton Hospital, London, United Kingdom
| | - Carmen D'Amore
- Epidemiology, Clinical Pathways and Clinical Risk Unit, Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alban-Elouen Baruteau
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, Nantes, France
| | - Pedro Betrián Blasco
- Pediatric Interventional Cardiology Unit, Vall d'Hebron Hospital, Barcellona, Spain
| | - Lisa Bianco
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
- Pediatric Interventional Cardiology Unit, Vall d'Hebron Hospital, Barcellona, Spain
| | - Andreas Eicken
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, München, Germany
| | - Matthew Jones
- Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Evelina Children’s Hospital, London, United Kingdom
| | - James A. Kuo
- Division of Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, United States
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Premuselli R, D'Amore C, Barba M, Marasi A, Del Baldo G, DE Benedictis A, Piccirilli E, Colafati GS, Mastronuzzi A, Marras CE, Carai A. Operator perceived advantage of virtual surgical rehearsal in pediatric neurosurgical oncology: a preliminary experience. J Neurosurg Sci 2023:S0390-5616.23.06152-0. [PMID: 37930117 DOI: 10.23736/s0390-5616.23.06152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Roberto Premuselli
- Department of Pediatric Hematology and Oncology, and Cell and Gene Therapy, Bambino Gesù Children's Hospital, Rome, Italy
| | - Carmen D'Amore
- Epidemiology, Clinical Pathways and Clinical Risk Unit, Medical Direction Bambino Gesù Children's Hospital, Rome, Italy
| | - Matteo Barba
- Neurosurgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Giada Del Baldo
- Department of Pediatric Hematology and Oncology, and Cell and Gene Therapy, Bambino Gesù Children's Hospital, Rome, Italy
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Eleonora Piccirilli
- Oncological Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences (DNISC), G. D'Annunzio University, Chieti, Italy
| | - Giovanna S Colafati
- Oncological Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Angela Mastronuzzi
- Department of Pediatric Hematology and Oncology, and Cell and Gene Therapy, Bambino Gesù Children's Hospital, Rome, Italy
| | - Carlo E Marras
- Neurosurgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Bambino Gesù Children's Hospital, Rome, Italy -
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Agosta M, Bencardino D, Argentieri M, Pansani L, Sisto A, Ciofi Degli Atti ML, D'Amore C, Bagolan P, Iacobelli BD, Magnani M, Raponi M, Perno CF, Andreoni F, Bernaschi P. Clonal Spread of Hospital-Acquired NDM-1-Producing Klebsiella pneumoniae and Escherichia coli in an Italian Neonatal Surgery Unit: A Retrospective Study. Antibiotics (Basel) 2023; 12:antibiotics12040642. [PMID: 37107005 PMCID: PMC10135170 DOI: 10.3390/antibiotics12040642] [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: 02/24/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
This article reports a rapid and unexpected spread of colonization cases of NDM-1 carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in a neonatal surgical unit (NSU) at Bambino Gesù Children's Hospital in Rome, Italy. Between the 16th of November 2020 and the 18th of January 2021, a total of 20 NDM-1 carbapenemase-producing K. pneumoniae (n = 8) and E. coli (n = 12) were isolated from 17 out of 230 stool samples collected from neonates admitted in the aforementioned ward and time period by an active surveillance culture program routinely in place to monitor the prevalence of colonization/infection with multidrug-resistant Gram-negative microorganisms. All strains were characterized by antimicrobial susceptibility testing, detection of resistance determinants, PCR-based replicon typing (PBRT) and multilocus-sequence typing (MLST). All isolates were highly resistant to most of the tested antibiotics, and molecular characterization revealed that all of them harbored the blaNDM-1 gene. Overall, IncA/C was the most common Inc group (n = 20/20), followed by IncFIA (n = 17/20), IncFIIK (n = 14/20) and IncFII (n = 11/20). MLST analysis was performed on all 20 carbapenemase-producing Enterobacterales (CPE) strains, revealing three different Sequence Types (STs) among E. coli isolates, with the prevalence of ST131 (n = 10/12; 83%). Additionally, among the 8 K. pneumoniae strains we found 2 STs with the prevalence of ST37 (n = 7/8; 87.5%). Although patient results were positive for CPE colonization during their hospital stay, infection control interventions prevented their dissemination in the ward and no cases of infection were recorded in the same time period.
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Affiliation(s)
- Marilena Agosta
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00163 Rome, Italy
| | - Daniela Bencardino
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", 61032 Fano, Italy
| | - Marta Argentieri
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00163 Rome, Italy
| | - Laura Pansani
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00163 Rome, Italy
| | - Annamaria Sisto
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00163 Rome, Italy
| | | | - Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus-Newborn-Infant, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Barbara Daniela Iacobelli
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus-Newborn-Infant, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", 61032 Fano, Italy
| | - Massimiliano Raponi
- Health Directorate, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Carlo Federico Perno
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00163 Rome, Italy
| | - Francesca Andreoni
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", 61032 Fano, Italy
- Clinical Pathology Unit, Azienda Sanitaria Territoriale, 61029 Urbino, Italy
| | - Paola Bernaschi
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00163 Rome, Italy
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Ciofi degli Atti M, Rizzo C, D'Amore C, Ravà L, Reale A, Barbieri MA, Bernaschi P, Russo C, Villani A, Perno CF, Raponi M. Acute respiratory infection emergency access in a tertiary care children hospital in Italy, prior and after the SARS-CoV-2 emergence. Influenza Other Respir Viruses 2023; 17:e13102. [PMID: 36950039 PMCID: PMC10026100 DOI: 10.1111/irv.13102] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 03/24/2023] Open
Abstract
Background The COVID-19 pandemic has changed the epidemiology of acute respiratory infections (ARIs) in children. The aims of the present study were to describe the epidemiological trend of ARI emergency visits and virology results prior and after the SARS-CoV-2 emergence and to estimate the association of ARI emergency department (ED) visits with respiratory viruses. Methods This study was conducted at the Bambino Gesù Children's Hospital, a tertiary care children's hospital in the Lazio Region, Italy. The demographic and clinical information of children who accessed the ED and were diagnosed with ARI from January 1, 2018 to June 30, 2022 was retrospectively extracted from the electronic health records. The observed temporal trends in viruses diagnosed from respiratory samples were compared with the number of ARI ED visits over the same period through a multivariable linear regression model. Results During the study period, there were 72,959 ED admissions for ARIs and 33,355 respiratory samples resulted positive for viruses. Prior to the pandemic, respiratory syncytial virus (RSV) and influenza had a clear seasonal pattern, which was interrupted in 2020. In 2021-2022, RSV reached the highest peak observed during the study period, whereas influenza activity was minimal. The peaks of ARI ED visits corresponded to peaks of influenza, RSV, and rhinovirus in the 2018-2019 and 2019-2020 seasons, to SARS-CoV-2 and rhinovirus in 2020, and to RSV and parainfluenza in 2021-2022. Conclusions ARI resulting in ED visits should be included in the ARI disease burden measurement for a more accurate measure of the impact of preventive measures.
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Affiliation(s)
- Marta Ciofi degli Atti
- Clinical Pathways and Epidemiology Unit, Medical DirectionBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Caterina Rizzo
- Department of Translational Research on New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
| | - Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, Medical DirectionBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Lucilla Ravà
- Clinical Pathways and Epidemiology Unit, Medical DirectionBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Antonino Reale
- Pediatric Emergency DepartmentBambino Gesù Children's Hospital, IRCCSRomeItaly
| | | | - Paola Bernaschi
- Microbiology and Diagnostic Immunology UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Cristina Russo
- Microbiology and Diagnostic Immunology UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Alberto Villani
- Pediatric Emergency DepartmentBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Carlo Federico Perno
- Microbiology and Diagnostic Immunology UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
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De Luca M, D'Amore C, Romani L, Tripiciano C, Clemente V, Mercadante S, Perrotta D, Nunziata J, Cecchetti C, Rossetti E, Bianchi R, Perno CF, Bernaschi P, Russo C, Lancella L, Raponi M, Ciofi degli Atti ML. Severe viral respiratory infections in the pre-COVID era: A 5-year experience in two pediatric intensive care units in Italy. Influenza Other Respir Viruses 2022; 17:e13038. [PMID: 36193621 PMCID: PMC9835419 DOI: 10.1111/irv.13038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/27/2022] [Accepted: 07/30/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Viral respiratory infections are one of the main causes of hospitalization in children. Even if mortality rate is low, 2% to 3% of the hospitalized children need mechanical ventilation. Risk factors for admission to the pediatric intensive care unit (PICU) are well known, while few studies have described risk factors for invasive ventilator support and prolonged hospitalization. METHODS A retrospective study including all patients aged between 2 and 18 months with a confirmed viral respiratory infection, requiring admission to PICU from September to March between 2015 and 2019, was conducted at Bambino Gesù Children's Hospital in Rome, Italy. RESULTS One hundred ninety patients were enrolled, with a median age of 2.7 months; 32.1% had at least one comorbidity, mainly prematurity. The most frequent isolated viruses were RSV-B, rhinovirus, and RSV-A; 38.4% needed mechanical ventilation. This subgroup of patients had lower median birth weight compared with patients not requiring mechanical ventilation (2800 g vs. 3180 g, p = 0.02); moreover, comorbidities were present in 43.8% of intubated patients and in 24.8% of patients treated with non-invasive ventilation (p = 0.006). Viral coinfection did not result to be a risk factor for mechanical support, while virus-bacteria coinfection was significantly associated with mechanical ventilation (p < 0.001). Similar risk factors were identified for prolonged hospitalization. CONCLUSIONS Early identification of patients who could have a sudden respiratory deterioration and need of mechanical ventilation is crucial to reduce complications due to orotracheal intubation and prolonged hospitalization in PICU. Further studies are needed to define high-risk group of patients and to design targeted interventions.
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Affiliation(s)
- Maia De Luca
- Academic Department of Pediatrics (DPUO), Infectious Disease Unit, Bambino Gesù Children's HospitalIRCCSRomeItaly
| | - Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's HospitalIRCCSRomeItaly
| | - Lorenza Romani
- Academic Department of Pediatrics (DPUO), Infectious Disease Unit, Bambino Gesù Children's HospitalIRCCSRomeItaly
| | | | - Vitangelo Clemente
- Pediatric Emergency Department, Bambino Gesù Children's HospitalIRCCSRomeItaly
| | | | - Daniela Perrotta
- Department of Anesthesia and Critical Care, Bambino Gesù Children's HospitalIRCCSRomeItaly
| | - Joseph Nunziata
- Pediatric Emergency Department Pediatric Intensive Care Unit, Bambino Gesù Children's HospitalIRCCSRomeItaly
| | - Corrado Cecchetti
- Pediatric Emergency Department Pediatric Intensive Care Unit, Bambino Gesù Children's HospitalIRCCSRomeItaly
| | - Emanuele Rossetti
- Pediatric Intensive Care Unit, Paediatric Emergency, Anaesthesia and Intensive Care Department, Bambino Gesù Children's HospitalIRCCSRomeItaly
| | - Roberto Bianchi
- Pediatric Intensive Care Unit, Paediatric Emergency, Anaesthesia and Intensive Care Department, Bambino Gesù Children's HospitalIRCCSRomeItaly
| | - Carlo Federico Perno
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children's HospitalIRCCSRomeItaly,Multimodal Medicine Research Area, Bambino Gesù Children's HospitalIstituto di Ricovero e Cura a Carattere Scientifico (IRCCS)RomeItaly
| | - Paola Bernaschi
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children's HospitalIRCCSRomeItaly
| | - Cristina Russo
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children's HospitalIRCCSRomeItaly
| | - Laura Lancella
- Academic Department of Pediatrics (DPUO), Infectious Disease Unit, Bambino Gesù Children's HospitalIRCCSRomeItaly
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D'Amore C, Zama B, Salotti R, Raponi M, Atti MCD. Improving knowledge on safe medication management of inpatient children and adolescents: a pre-post study. Patient Educ Couns 2022; 105:2234-2239. [PMID: 35246362 DOI: 10.1016/j.pec.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/03/2022] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The primary aim of this study was to assess the impact of an education intervention on knowledge regarding medication use in hospitalized children and adolescents. METHODS A pre-post multicentre study was conducted in pediatric wards of the hospitals in Lazio Region between July 2019-March 2021. An in-person education intervention was provided to hospitalized patients aged 6-15 years, able to understand spoken and written Italian language. Topics included: correct intake and management of medications at home. Prior and after the education intervention, we evaluated patient knowledge with a self-administered test. RESULTS One-hundred-and-four (n = 104) patients participated in the study. In the pre-education period, 79.8% of the patients answered correctly to at least 60% of the questions of the test; the lowest number of correct answers concerned medication intake (36.5%; 33.6%), food-drug interactions (44.2%), appropriate indication to use of antibiotics (36.5%) and antibiotic resistance (55.8%). After the education intervention, 100% of the patients completed the test correctly. CONCLUSION The education intervention increased knowledge on several areas of interest, in children of different age-groups and including patients with chronic diseases. PRACTICE IMPLICATIONS Children's education is essential to encourage gradual transfer of responsibility for medication use, in ways that respect parental responsibilities and the health status and capabilities of the child.
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Affiliation(s)
- Carmen D'Amore
- Clinical Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Benedetta Zama
- Clinical Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Farina E, D'Amore C, Lancella L, Boccuzzi E, Ciofi Degli Atti ML, Reale A, Rossi P, Villani A, Raponi M, Raucci U. Alert sign and symptoms for the early diagnosis of pulmonary tuberculosis: analysis of patients followed by a tertiary pediatric hospital. Ital J Pediatr 2022; 48:90. [PMID: 35698090 PMCID: PMC9195307 DOI: 10.1186/s13052-022-01288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intercepting earlier suspected TB (Tuberculosis) cases clinically is necessary to reduce TB incidence, so we described signs and symptoms of retrospective cases of pulmonary TB and tried to evaluate which could be early warning signs. Methods We conducted a retrospective descriptive study of pulmonary TB cases in children in years 2005–2017; in years 2018–2020 we conducted a cohort prospective study enrolling patients < 18 years accessed to Emergency Department (ED) with signs/symptoms suggestive of pulmonary TB. Results In the retrospective analysis, 226 patients with pulmonary TB were studied. The most frequently described items were contact history (53.5%) and having parents from countries at risk (60.2%). Cough was referred in 49.5% of patients at onset, fever in 46%; these symptoms were persistent (lasting ≥ 10 days) in about 20%. Lymphadenopathy is described in 15.9%. The prospective study enrolled 85 patients of whom 14 (16.5%) were confirmed to be TB patients and 71 (83.5%) were non-TB cases. Lymphadenopathy and contact history were the most correlated variables. Fever and cough lasting ≥ 10 days were less frequently described in TB cases compared to non-TB patients (p < 0.05). Conclusions In low TB endemic countries, pulmonary TB at onset is characterized by different symptoms, i.e. persistent fever and cough are less described, while more relevant are contact history and lymphadenopathy. It was not possible to create a score because signs/symptoms usually suggestive of pulmonary TB (considered in the questionnaire) were not significant risk factors in our reality, a low TB country. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01288-5.
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Affiliation(s)
- Elisa Farina
- Unit of Internal Medicine, Celio Military Hospital, Rome, Italy
| | - Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- Division of Immunology and Infectious Diseases, Department (DPUO), University-Hospital Pediatric, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Elena Boccuzzi
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Antonino Reale
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paolo Rossi
- Medical Direction, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Alberto Villani
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Umberto Raucci
- Department of Emergency and Clinical Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Briguori C, Donahue M, D'Amore C. Renal Insufficiency and the Impact of Contrast Agents. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kohns Vasconcelos M, Loens K, Sigfrid L, Iosifidis E, Epalza C, Donà D, Matheeussen V, Papachristou S, Roilides E, Gijon M, Rojo P, Minotti C, Da Dalt L, Islam S, Jarvis J, Syggelou A, Tsolia M, Nyirenda Nyang'wa M, Keers S, Renk H, Gemmel AL, D'Amore C, Ciofi Degli Atti M, Rodríguez-Tenreiro Sánchez C, Martinón-Torres F, Burokienė S, Goetghebuer T, Spoulou V, Riordan A, Calvo C, Gkentzi D, Hufnagel M, Openshaw PJ, de Jong MD, Koopmans M, Goossens H, Ieven M, Fraaij PLA, Giaquinto C, Bielicki JA, Horby P, Sharland M. Aetiology of acute respiratory infection in preschool children requiring hospitalisation in Europe-results from the PED-MERMAIDS multicentre case-control study. BMJ Open Respir Res 2021; 8:8/1/e000887. [PMID: 34326154 PMCID: PMC8323363 DOI: 10.1136/bmjresp-2021-000887] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/05/2021] [Indexed: 12/21/2022] Open
Abstract
Background Both pathogenic bacteria and viruses are frequently detected in the nasopharynx (NP) of children in the absence of acute respiratory infection (ARI) symptoms. The aim of this study was to estimate the aetiological fractions for ARI hospitalisation in children for respiratory syncytial virus (RSV) and influenza virus and to determine whether detection of specific respiratory pathogens on NP samples was associated with ARI hospitalisation. Methods 349 children up to 5 years of age hospitalised for ARI (following a symptom-based case definition) and 306 hospital controls were prospectively enrolled in 16 centres across seven European Union countries between 2016 and 2019. Admission day NP swabs were analysed by multiplex PCR for 25 targets. Results RSV was the leading single cause of ARI hospitalisations, with an overall population attributable fraction (PAF) of 33.4% and high seasonality as well as preponderance in younger children. Detection of RSV on NP swabs was strongly associated with ARI hospitalisation (OR adjusted for age and season: 20.6, 95% CI: 9.4 to 45.3). Detection of three other viral pathogens showed strong associations with ARI hospitalisation: influenza viruses had an adjusted OR of 6.1 (95% CI: 2.5 to 14.9), parainfluenza viruses (PIVs) an adjusted OR of 4.6 (95% CI: 1.8 to 11.3) and metapneumoviruses an adjusted OR of 4.5 (95% CI: 1.3 to 16.1). Influenza viruses had a PAF of 7.9%, PIVs of 6.5% and metapneumoviruses of 3.0%. In contrast, most other pathogens were found in similar proportions in cases and controls, including Streptococcus pneumoniae, which was weakly associated with case status, and endemic coronaviruses. Conclusion RSV is the predominant cause of ARI hospitalisations in young children in Europe and its detection, as well as detection of influenza virus, PIV or metapneumovirus, on NP swabs can establish aetiology with high probability. PAFs for RSV and influenza virus are highly seasonal and age dependent.
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Affiliation(s)
- Malte Kohns Vasconcelos
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK .,Institute for Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Katherine Loens
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Louise Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elias Iosifidis
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Veerle Matheeussen
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Savvas Papachristou
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Manuel Gijon
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Pablo Rojo
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Chiara Minotti
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Liviana Da Dalt
- Paediatric Emergency Department, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Samsul Islam
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
| | - Jessica Jarvis
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aggeliki Syggelou
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece
| | - Maria Tsolia
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece
| | - Maggie Nyirenda Nyang'wa
- Paediatric Department, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK
| | - Sophie Keers
- Paediatric Department, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK
| | - Hanna Renk
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Anna-Lena Gemmel
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Marta Ciofi Degli Atti
- Clinical Pathways and Epidemiology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Carmen Rodríguez-Tenreiro Sánchez
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Servizo Galego de Saude, Santiago de Compostela, Spain.,Genetics, Vaccines and Infectious Diseases Research Group, Instituto de Investigación Sanitaria de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Servizo Galego de Saude, Santiago de Compostela, Spain.,Genetics, Vaccines and Infectious Diseases Research Group, Instituto de Investigación Sanitaria de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Sigita Burokienė
- Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Tessa Goetghebuer
- Department of Paediatrics, St-Pierre Hospital Brussels, Brussels, Belgium
| | - Vana Spoulou
- 1st Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, Agia Sophia Children's Hospital of Athens, Athens, Greece
| | - Andrew Riordan
- Department of Paediatric Infectious Diseases, Alder Hey Children's Hospital, Liverpool, UK
| | - Cristina Calvo
- Paediatrics and Infectious Diseases Department, La Paz University Hospital, Madrid, Spain
| | - Despoina Gkentzi
- Department of Paediatrics, University General Hospital of Patras, Patras Medical School, Patras, Greece
| | - Markus Hufnagel
- Division of Paediatric Infectious Diseases and Rheumatology, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Peter J Openshaw
- National Heart and Lung Division, Faculty of Medicine, Imperial College London, London, UK
| | - Menno D de Jong
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marion Koopmans
- Department of Viroscience, ErasmusMC, Rotterdam, The Netherlands
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | | | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Julia A Bielicki
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,Department of Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michael Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
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11
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Briguori C, D'Amore C, De Micco F, Signore N, Esposito G, Visconti G, Airoldi F, Signoriello G, Focaccio A. Left Ventricular End-Diastolic Pressure Versus Urine Flow Rate-Guided Hydration in Preventing Contrast-Associated Acute Kidney Injury. JACC Cardiovasc Interv 2021; 13:2065-2074. [PMID: 32912462 DOI: 10.1016/j.jcin.2020.04.051] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/19/2020] [Accepted: 04/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study compared left ventricular end-diastolic pressure (LVEDP)-guided and urine flow rate (UFR)-guided hydration. BACKGROUND Tailored hydration regimens improve the prevention of contrast-associated acute kidney injury (CA-AKI). METHODS Between July 15, 2015, and June 6, 2019, patients at high risk for CA-AKI scheduled for coronary and peripheral procedures were randomized to 2 groups: 1) normal saline infusion rate adjusted according to the LVEDP (LVEDP-guided group); and 2) hydration controlled by the RenalGuard System in order to reach UFR ≥300 ml/h (UFR-guided group). The primary endpoint was the composite of CA-AKI (i.e., serum creatinine increase ≥25% or ≥0.5 mg/dl at 48 h) and acute pulmonary edema (PE). Major adverse events (all-cause death, renal failure requiring dialysis, PE, and sustained kidney injury) at 1 month were assessed. RESULTS The primary endpoint occurred in 20 of 351 (5.7%) patients in the UFR-guided group and in 36 of 351 (10.3%) patients in the LVEDP-guided group (relative risk [RR]: 0.560; 95% confidence interval [CI]: 0.390 to 0.790; p = 0.036). CA-AKI and PE rates in the UFR-guided group and LVEDP-guided group were 5.7% and 10.0% (RR: 0.570; 95% CI: 0.300 to 0.960; p = 0.048), and, respectively, 0.3% and 2.0% (RR: 0.070; 95% CI: 0.020 to 1.160; p = 0.069). Three patients in the UFR-guided group experienced complications related to the Foley catheter. Hypokalemia rate was 6.2% in the UFR-guided group and 2.3% in the LVEDP-guided group (p = 0.013). The 1-month major adverse events rate was 7.1% in the UFR-guided group and 12.0% in the LVEDP-guided group (p = 0.030). CONCLUSIONS The study demonstrates that UFR-guided hydration is superior to LVEDP-guided hydration to prevent the composite of CA-AKI and PE.
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Affiliation(s)
- Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy.
| | - Carmen D'Amore
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Francesca De Micco
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Nicola Signore
- Interventional Cardiology Unit, Policlinico di Bari, Bari, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Division of Cardiology, "Federico II" University of Naples, Naples, Italy
| | - Gabriella Visconti
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Flavio Airoldi
- Interventional Cardiology Unit, Istituto di Ricerca a Carattere Scientifico Multimedica MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Giuseppe Signoriello
- Department of Mental Health and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Amelia Focaccio
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
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12
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D'Amore C, Ciofi Degli Atti ML, Zotti C, Prato R, Guareschi G, Spiazzi R, Petitti G, Moro ML, Raponi M. Use of multiple metrics to assess antibiotic use in Italian children's hospitals. Sci Rep 2021; 11:3543. [PMID: 33574450 PMCID: PMC7878731 DOI: 10.1038/s41598-021-83026-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/25/2021] [Indexed: 11/12/2022] Open
Abstract
Quantification of antibiotic utilization is an essential component of antibiotic stewardship programs. In this multicentric study, we used different metrics to evaluate inpatient antibiotic use in children. The study objectives were to describe point prevalence of antibiotic use by indication and patient characteristics, to evaluate DOTs, LOTs and PDDs, and to compare PDDs to DDDs, which assume average maintenance dose per day in adults. All children hospitalized on the days of the study were included. Trained personnel collected demographic and clinical data from patients’ clinical records. We recorded information about antibiotics administered on the date of data collection, and in the previous 30 days of hospitalization. Of 810 patients, 380 (46.9%; CI 95%: 43.4–50.4) received one or more antibiotics; prevalence of use was 27.0% for prophylaxis (219/810), and 20.7% (168/810) for treatment. Overall, 587 drugs were issued to the 380 patients receiving antibiotics (1.5 antibiotic per patient). When considering treatments, DOT and LOT per 100 patient-days were 30.5 and 19.1, respectively, resulting in a DOT/LOT ratio of 1.6. PDDs increased with age and approached DDDs only in children aged ≥ 10 years; the ratio between PDDs estimated in children aged ≥ 10 years and in 0–11 month-old infants ranged from 2 for sulfamethoxazole and trimethoprim, to 25 for meropenem. Our results confirm that DOT, LOT and PDD are better alternatives to DDD in children.
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Affiliation(s)
- Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Carla Zotti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia, Ospedale "D'Avanzo" Policlinico Riuniti, Foggia, Italy
| | - Giuliano Guareschi
- Ospedale Infantile Regina Margherita - AOU Città Della Salute E Della Scienza Di Torino, Torino, Italy
| | - Raffaele Spiazzi
- Ospedale dei Bambini - ASST Degli Spedali Civili di Brescia, Brescia, Italy
| | - Gaetano Petitti
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari Ospedale Pediatrico "Giovanni XXIII", Bari, Italy
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13
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Abstract
Contrast-induced acute kidney injury (CI-AKI) is a common complication after intravascular injection of iodinated contrast media, and it is associated with a prolonged in-hospital stay and unfavorable outcome. CI-AKI occurs in 5% to 20% among hospitalized patients. Its diagnosis relies on the increase in serum creatinine levels, which is a late biomarker of kidney injury. Novel and early serum and urinary biomarkers have been identified to detect kidney damage before the expected serum creatinine increase.
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Affiliation(s)
- Carmen D'Amore
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Via Orazio 2, Naples 80121, Italy
| | - Silvia Nuzzo
- IRCCS, SDN, Via Gianturco 113, Naples 80143, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Via Orazio 2, Naples 80121, Italy.
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14
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Ciofi Degli Atti ML, D'Amore C, Gagliotti C, Zotti C, Ricchizzi E, Moro ML, Raponi M. Strategies to control antibiotic resistance: results from a survey in Italian children's hospitals. Ann Ig 2020; 31:3-12. [PMID: 30554234 DOI: 10.7416/ai.2019.2253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Antimicrobial stewardship programs and comprehensive infection control programs represent the main strategies to limit the emergence and transmission of multi-drug resistant bacteria in hospital settings. The purpose of this study was to describe strategies implemented in Italian children's hospitals for controlling antibiotic resistance. STUDY DESIGN Cross sectional multicenter study. METHODS Four tertiary care Italian children's hospitals were invited to participate in a survey aimed at collecting information on activities implemented as of December 2015 using a self-administered online questionnaire. The questionnaire was divided in three sections focalizing on: i) policies for prevention and control of hospital-acquired infection, ii) prevention and control of multi-drug resistant bacteria, and iii) antibiotic prescribing policies and Antimicrobial stewardship programs. Questionnaires were compiled between May and July 2016. RESULTS All hospitals had multidisciplinary infection control committee, procedures on hand hygiene, isolation measures, disinfection/sterilization, waste disposal and prevention on infections associated to invasive procedures. All sites screened patients for multi-drug resistant bacteria colonization in selected units, and adopted contact precautions for colonized patients. Screening during hospitalization, or in case of infections in the same ward were not universally implemented. All hospitals had policies on surgical prophylaxis, while policies on medical prophylaxis and treatment of bacterial infections varied among sites. Two sites recommended to review the appropriateness of antibiotic prescribing after 48-72 hours and one recommended de-escalation therapy. CONCLUSIONS This study highlighted several areas of improvement, such as actions for screening patients in case of occurrence of multi-drug resistant bacteria, antimicrobial stewardship programs and implementation of policies targeting antibiotic prescriptions for therapeutic purposes and medical prophylaxis.
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Affiliation(s)
| | - C D'Amore
- Unit of Clinical Epidemiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - C Gagliotti
- Regional Health and Social Agency, Emilia-Romagna Region, Italy
| | - C Zotti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - E Ricchizzi
- Regional Health and Social Agency, Emilia-Romagna Region, Italy
| | - M L Moro
- Regional Health and Social Agency, Emilia-Romagna Region, Italy
| | - M Raponi
- Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy
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15
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Colaceci S, Zambri F, D'Amore C, De Angelis A, Rasi F, Pucciarelli G, Giusti A. Long-Term Effectiveness of an E-Learning Program in Improving Health Care Professionals' Attitudes and Practices on Breastfeeding: A 1-Year Follow-Up Study. Breastfeed Med 2020; 15:254-260. [PMID: 32043898 DOI: 10.1089/bfm.2019.0203] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 02/02/2023]
Abstract
Introduction: In-service continuing education offers a unique opportunity to improve knowledge, skills, attitudes, and practices regarding breastfeeding. It has been shown that an online approach to in-service education is effective at improving practices and attitudes toward breastfeeding among health care professionals (HCPs) in the short term. Aim: To evaluate the long-term effectiveness of an online national program on infant nutrition for HCPs. Materials and Methods: We carried out a follow-up study using data from three time points: T0 (pretraining), T1 (immediately post-training), and T2 (1 year after training). The differences between T0, T1, and T2 were tested using repeated-measures ANOVA. Statistical analysis was performed using SPSS version 22.0. Results: The final sample was comprised of 4,582 participants, mainly women (87.4%). At T2, we observed a worsening of attitudes and practices (APs) as compared with T1, though those APs almost never reached the low levels observed at T0. The greatest changes over time concerned the use of drugs during breastfeeding (T0: 3.00 ± 1.33 versus T1: 1.74 ± 1.03 versus T2: 2.64 ± 1.35) and dietary restriction (T0: 2.77 ± 1.35 versus T1: 1.76 ± 1.12 versus T2: 2.57 ± 1.35). The differences between the means of APs at T0, T1, and T2 were significant (p < 0.01). Conclusion: This e-learning program was effective in improving APs regarding the protection, promotion, and support of breastfeeding. The improvement, higher immediately after training, decreased over time. E-learning project managers should propose strategies to facilitate the retention of knowledge related to the main training objectives.
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Affiliation(s)
- Sofia Colaceci
- Saint Camillus International University of Rome and Medical Sciences (UniCamillus), Rome, Italy.,National Centre for Diseases Prevention and Health Promotion-National Institute of Health, Rome, Italy
| | - Francesca Zambri
- National Centre for Diseases Prevention and Health Promotion-National Institute of Health, Rome, Italy.,Department of Biomedicine and Prevention-University of Rome Tor Vergata, Rome, Italy
| | - Carmen D'Amore
- Unit of Clinical Epidemiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessia De Angelis
- National Institute for Infectious Diseases "Lazzaro Spallanzani," Rome, Italy
| | - Francesco Rasi
- Saint Camillus International University of Rome and Medical Sciences (UniCamillus), Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention-University of Rome Tor Vergata, Rome, Italy
| | - Angela Giusti
- National Centre for Diseases Prevention and Health Promotion-National Institute of Health, Rome, Italy
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16
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Moro ML, Ciofi Degli Atti M, D'Amore C, Diegoli G, Forni S, Gagliotti C, Gemmi F, Iannazzo S, Miraglia V, Pan A, Pantosti A, Pittalis S, Puro V, Ricchizzi E, Sarnelli B, Torti C, Zotti C. [Good practices for the surveillance and control of antimicrobial resistance]. Epidemiol Prev 2020; 43:185-193. [PMID: 31293138 DOI: 10.19191/ep19.2-3.p185.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Italy is one of the European Countries with the highest level of antimicrobial consumption, both in the community and in hospital settings, and with the highest prevalence of antimicrobial resistant microorganisms. In 2015, the Project "Good practices for the surveillance and control of antimicrobial resistance" was funded by the Italian National Centre for Disease Prevention and Control (CCM): the aim was to promote integrated actions at national level to control antimicrobial resistance, favouring the transfer of existing good practices. The principal objectives of the project were: to describe the Italian scenario of good practices based on literature review; to improve the capacity of surveillance, through achieving consensus on a core set of indicators, including paediatrics, and through the strengthening of the national surveillance system of antimicrobial resistance coordinated by the Italian National Institute of Health; to define tools useful for priority setting; to evaluate the efficacy of intervention programme aimed at promoting the appropriate use of antibiotics among children for upper respiratory tract infections in the community; to set up training programmes on the prudent use of antibiotics in veterinary medicine. Seven regions were enrolled in the project (Emilia-Romagna with the role of programme coordinator, Campania, Calabria, Lazio, Lombardy, Piedmont, Tuscany) and the Italian National Health Institute. The project allowed to document: the scarce spread of control practices at national level (out of 277 studies reviewed, only 6.1% of the cases were targeted to evaluating the effectiveness of intervention programmes); a significant variability among regions both in relation to antimicrobial consumption and antimicrobial resistance prevalence, with a worrying spread in some regions of several antimicrobial resistant organisms responsible for "critical" infections with great potential health impact; the effectiveness of an intervention aimed at promoting appropriate use of antibiotics in frequent infections for children in the community, such as pharingotonsillitis and acute otitis media (35% reduction of antimicrobial consumption between 2010 and 2017 in Emilia-Romagna; an inversion of the ratio amoxicillin/amoxicillin-clavulanate); the need for new indicators to monitor antimicrobial consumption in hospital paediatric wards and of a new national system for timely identification of new antimicrobial resistance profiles; a positive evaluation of the training programme for veterinary physicians. In conclusion, the project has contributed to identify the most critical areas for antimicrobial resistance control and to select appropriate solutions, potentially transferable to the national level.
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Affiliation(s)
| | | | | | - Giuseppe Diegoli
- Direzione generale cura della persona, salute e welfare della Regione Emilia-Romagna, Bologna
| | - Silvia Forni
- Agenzia regionale di sanità della Toscana, Firenze
| | | | | | - Stefania Iannazzo
- Ufficio V, Direzione generale della prevenzione, Ministero della salute, Roma
| | - Viviana Miraglia
- Direzione generale cura della persona, salute e welfare della Regione Emilia-Romagna, Bologna
| | - Angelo Pan
- Azienda ospedaliera "Istituti ospitalieri", Cremona
| | | | - Silvia Pittalis
- Istituto nazionale malattie infettive "Lazzaro Spallanzani", Roma
| | - Vincenzo Puro
- Istituto nazionale malattie infettive "Lazzaro Spallanzani", Roma
| | | | - Bruno Sarnelli
- Direzione generale tutela della salute e coordinamento del Sistema sanitario regionale della Regione Campania, Napoli
| | - Carlo Torti
- Azienda ospedaliero universitaria "Mater Domini", Catanzaro
| | - Carla Zotti
- Dipartimento di scienze della sanità pubblica e pediatriche, Università di Torino
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17
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Briguori C, D'Amore C, De Micco F, Signore N, Esposito G, Napolitano G, Focaccio A. Renal insufficiency following contrast media administration trial III: Urine flow rate‐guided versus left‐ventricular end‐diastolic pressure‐guided hydration in high‐risk patients for contrast‐induced acute kidney injury. Rationale and design. Catheter Cardiovasc Interv 2019; 95:895-903. [DOI: 10.1002/ccd.28386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/12/2019] [Accepted: 06/22/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Carlo Briguori
- Interventional Cardiology UnitMediterranea Cardiocentro Naples Italy
| | - Carmen D'Amore
- Interventional Cardiology UnitMediterranea Cardiocentro Naples Italy
| | | | - Nicola Signore
- Interventional Cardiology UnitPoliclinico di Bari Bari Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Division of Cardiology“Federico II” University of Naples Naples Italy
| | | | - Amelia Focaccio
- Interventional Cardiology UnitMediterranea Cardiocentro Naples Italy
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Ciofi Degli Atti ML, D'Amore C, Ceradini J, Paolini V, Ciliento G, Chessa G, Raponi M. Prevalence of antibiotic use in a tertiary care hospital in Italy, 2008-2016. Ital J Pediatr 2019; 45:63. [PMID: 31109362 PMCID: PMC6528368 DOI: 10.1186/s13052-019-0645-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/12/2019] [Indexed: 01/13/2023] Open
Abstract
Background Few data are available about temporal trends of antibiotic use in hospitalized children. The aim of the current study was to investigate the pattern and trends of antibiotic use over the years 2008–2016 in the largest children’s hospital in Italy. Methods Annual point prevalence surveys of antibiotic use were conducted by reviewing medical charts of 0–17 year-old children hospitalized for ≥48 h. Prevalence of antibiotic use was computed by year, type of ward and indication. Trends in prevalence over time were evaluated using the Cochrane-Armitage test. Possibile determinants of antibiotic use were assessed at univariate analysis and through a logistic regression model. Results Out of 3015 children, 1516 (50.3%) received antibiotics, 58.1% of which for medical/surgical prophylaxis. Prevalence of antibiotic use increased from 42.0% in 2008 to 56.2% in 2016 (p = 0.001). The prevalence of patients receiving antibiotics for medical prophylaxis increased from 6.1% in 2008 to 24.2% in 2016 (p < 0.001), whereas the prevalence of patients receiving antibiotics for surgical prophylaxis significantly decreased (from 13.7 to 11.8%; p = 0.04); no significant temporal trends were found in antibiotic use for treating infections. The administration of third-generation cephalosporins for surgical and medical prophylaxis significantly decreased over time, while the proportion of antibiotics prescribed to treat infections after microbiological investigations significantly increased. Year (ORadj: 1.8 in 2016 compared to 2008, p < 0.001), age (ORadj ≥1.5 in children ≥1 year, compared to infants ≤2 months, p < 0.001), length of stay (LOS) (ORadj: 1.4 in case of LOS between 8 and 30 days compared to LOS ≤ 7 days, p < 0.001), and type of ward (ORadj: ≥1.3 in intensive-care, surgical and medical-subspecialty units compared to medical units, p < 0.001) were significantly and independently associated with antibiotic use. Conclusions Comparing prevalence rates of antibiotic use among hospitals and over time should consider differences in patient characteristics, such as age, ward of hospitalization and length of stay. Over the years, we documented an improvement in the choice of antibiotics prescribed for medical and surgical prophylaxis. However, further efforts are needed to avoid antibiotic misuse for medical prophylaxis, and to reduce the empirical use of broad spectrum antibiotics. Electronic supplementary material The online version of this article (10.1186/s13052-019-0645-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Carmen D'Amore
- Unit of Clinical Epidemiology, Bambino Gesù Children's Hospital, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Jacopo Ceradini
- Medical Direction, Bambino Gesù Children's Hospital, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Valerio Paolini
- Medical Direction, Bambino Gesù Children's Hospital, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Gaetano Ciliento
- Medical Direction, Bambino Gesù Children's Hospital, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Giuseppe Chessa
- Medical Direction, Bambino Gesù Children's Hospital, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children's Hospital, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
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Briguori C, Quintavalle C, Donahue M, D'Alessio F, D'Amore C, Signoriello G, De Caterina R, Condorelli G. Predictors of strut coverage of drug eluting stent implantation in diabetic patients- Is only on-clopidogrel platelet reactivity enough? Reply. Int J Cardiol 2019; 283:95. [PMID: 30890251 DOI: 10.1016/j.ijcard.2019.02.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Carlo Briguori
- Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy.
| | - Cristina Quintavalle
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Naples, Italy; IEOS, CNR, Naples, Italy
| | - Michael Donahue
- Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | | | - Carmen D'Amore
- Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Giuseppe Signoriello
- Department of Mental Health and Preventive Medicine, Second University of Naples, Italy
| | | | - Gerolama Condorelli
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Naples, Italy; IEOS, CNR, Naples, Italy
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Briguori C, Focaccio A, D'Amore C, Selvetella L, Lonobile T. Elective Mechanical Circulatory Support in the Percutaneous Treatment of Patients With Combined Complex Coronary Artery Disease and Severe Aortic Valve Stenosis. J Invasive Cardiol 2019; 31:52-56. [PMID: 30819975] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES One of the procedural concerns during percutaneous treatment of patients with concomitant coronary artery disease (CAD) and aortic valve stenosis (AS) is the risk of hemodynamic instability. In the present study, we assessed the safety and effectiveness of elective hemodynamic support with the Impella 2.5 system (Abiomed, Inc) in patients undergoing combined high-risk percutaneous coronary intervention (PCI) and balloon aortic valvuloplasty (BAV), as a bridge to transcatheter aortic valve replacement. METHODS Ten patients suffering from acute coronary syndrome (ACS) and severe AS were included. In all patients, we first performed PCI with the hemodynamic support of the Impella 2.5 system, and then BAV. RESULTS The Impella catheter was successfully positioned in the left ventricle in all instances. All cases were successful, without any intraprocedural complications. All patients were discharged without any major clinical events. CONCLUSIONS These preliminary results suggest that elective use of the Impella 2.5 system is safe and effective when performing PCI and BAV in high-risk ACS patients suffering from concomitant severe CAD and AS.
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Affiliation(s)
- Carlo Briguori
- Interventional Cardiology, Clinica Mediterranea, Via Orazio, 2, I-80121, Naples, Italy.
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21
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Marrone A, Capoluongo N, D'Amore C, Pisaturo M, Esposito M, Guastafierro S, Siniscalchi I, Macera M, Boemio A, Onorato L, Rinaldi L, Minichini C, Adinolfi LE, Sagnelli E, Mastrullo L, Coppola N. Eighteen-month lamivudine prophylaxis on preventing occult hepatitis B virus infection reactivation in patients with haematological malignancies receiving immunosuppression therapy. J Viral Hepat 2018; 25:198-204. [PMID: 29029365 DOI: 10.1111/jvh.12802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 08/31/2017] [Indexed: 12/11/2022]
Abstract
This study evaluated the long-term efficacy and safety of an 18-month lamivudine prophylaxis in 68 HBsAg-negative/anti-HBc-positive patients with oncohaematological disease. All 68 consecutive HBsAg-negative/anti-HBc-positive patients with an oncohaematological disease and naïve for chemotherapy observed from April 2008 to December 2012 at 2 Hematology Units in Naples were treated with lamivudine for 18 months after stopping chemotherapy and monitored for HBsAg at months 1 and 3 during chemotherapy and then every 3 months after its discontinuation. During follow-up, 13 (19.1%) of the 68 patients died of complications related to their oncohaematological disease, and 3 (4%) showed a virological HBV reactivation (retroconversion to HBsAg positivity) 1-7 months after the discontinuation of lamivudine prophylaxis (2 treated for chronic lymphocytic leukaemia and one for Waldenstrom's disease); of these, 2 showed a biochemical reactivation. Comparing the demographic and clinical characteristics of the 3 patients with a virological HBV reactivation to the 65 without, the former were older (median age and range: 67 years [75-78] vs. 61 [24-88]; P = .05) and were less frequently treated for B-cell non-Hodgkin lymphoma (B-NHL) (0 vs. 70.7%, P = .03). In conclusion, a 18 months of lamivudine prophylaxis was effective in preventing HBV reactivation in HBsAg-negative/anti-HBc-positive patients treated for B-NHL. However, in patients with chronic and severe immunodepression, such as those with chronic lymphocytic leukaemia and Waldenstrom's disease, prophylaxis should be continued for an indefinite period.
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Affiliation(s)
- A Marrone
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - N Capoluongo
- Department of Mental Health and Public Medicine, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - C D'Amore
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Pisaturo
- Department of Mental Health and Public Medicine, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - M Esposito
- Hematology Unit, Ascalesi Hospital, Naples, Italy
| | - S Guastafierro
- Hematology Unit, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - I Siniscalchi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Macera
- Department of Mental Health and Public Medicine, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - A Boemio
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - L Onorato
- Department of Mental Health and Public Medicine, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - L Rinaldi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Minichini
- Department of Mental Health and Public Medicine, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - L E Adinolfi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - E Sagnelli
- Department of Mental Health and Public Medicine, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - L Mastrullo
- Hematology Unit, Ascalesi Hospital, Naples, Italy
| | - N Coppola
- Department of Mental Health and Public Medicine, University of Campania, Luigi Vanvitelli, Naples, Italy
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Parisi V, Paolillo S, Rengo G, Formisano R, Petraglia L, Grieco F, D'Amore C, Dellegrottaglie S, Marciano C, Ferrara N, Leosco D, Filardi PP. Sleep-disordered breathing and epicardial adipose tissue in patients with heart failure. Nutr Metab Cardiovasc Dis 2018; 28:126-132. [PMID: 29198416 DOI: 10.1016/j.numecd.2017.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/11/2017] [Accepted: 09/28/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS Sleep-disordered breathing (SDB) is common in patients with heart failure (HF), contributes to the progression of cardiac disease, and is associated with adverse prognosis. Previous evidence indicates that epicardial adipose tissue (EAT) is independently associated with sleep apnea in obese individuals. We explored the relationship between SDB and EAT in HF patients. METHODS AND RESULTS EAT thickness was assessed by echocardiography in 66 patients with systolic HF undergoing nocturnal cardiorespiratory monitoring. A significantly higher EAT thickness was found in patients with SDB than in those without SDB (10.7 ± 2.8 mm vs. 8.3 ± 1.8 mm; p = 0.001). Among SDB patients, higher EAT thickness was found in both those with prevalent obstructive sleep apnea (OSA) and those with prevalent central sleep apnea (CSA). Of interest, EAT thickness was significantly higher in CSA than in OSA patients (11.9 ± 2.9 vs. 10.1 ± 2.5 p = 0.022). Circulating plasma norepinephrine levels were higher in CSA than in OSA patients (2.19 ± 1.25 vs. 1.22 ± 0.92 ng/ml, p = 0.019). According to the apnea-hypopnea index (AHI), patients were then stratified in three groups of SDB severity: Group 1, mild SDB; Group 2, moderate SDB; Group 3, severe SDB. EAT thickness progressively and significantly increased from Group 1 to Group 3 (ANOVA p < 0.001). At univariate analysis, only left ventricular ejection fraction and AHI significantly correlated with EAT (p = 0.019 and p < 0.0001, respectively). At multivariate analysis, AHI was the only independent predictor of EAT (β = 0.552, p < 0.001). CONCLUSIONS Our results suggest an association between the presence and severity of sleep apneas and cardiac visceral adiposity in HF patients.
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Affiliation(s)
- V Parisi
- Department of Translational Medical Sciences, Naples, Italy
| | - S Paolillo
- SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy
| | - G Rengo
- Department of Translational Medical Sciences, Naples, Italy
| | - R Formisano
- Department of Translational Medical Sciences, Naples, Italy
| | - L Petraglia
- Department of Translational Medical Sciences, Naples, Italy
| | - F Grieco
- Department of Translational Medical Sciences, Naples, Italy
| | - C D'Amore
- Department of Advanced Biomedical Science, Naples, Italy
| | | | - C Marciano
- Istituto Diagnostico Varelli, Naples, Italy
| | - N Ferrara
- Department of Translational Medical Sciences, Naples, Italy
| | - D Leosco
- Department of Translational Medical Sciences, Naples, Italy.
| | - P P Filardi
- Department of Advanced Biomedical Science, Naples, Italy
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Gargiulo P, Savarese G, D'Amore C, De Martino F, Lund LH, Marsico F, Dellegrottaglie S, Marciano C, Trimarco B, Perrone-Filardi P. Efficacy and safety of glucagon-like peptide-1 agonists on macrovascular and microvascular events in type 2 diabetes mellitus: A meta-analysis. Nutr Metab Cardiovasc Dis 2017; 27:1081-1088. [PMID: 29113708 DOI: 10.1016/j.numecd.2017.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 09/12/2017] [Accepted: 09/16/2017] [Indexed: 01/21/2023]
Abstract
AIMS Glucagon-like peptide-1 (GLP-1) agonists improve glycaemic control in type 2 diabetes mellitus (DM). Outcome trials investigating macro and microvascular effects of GLP-1 agonists reported conflicting results. The aim of this study was to assess, in a meta-analysis, the effects of GLP-1 agonists on mortality, major nonfatal cardiovascular (CV) events, renal and retinal events. DATA SYNTHESIS MEDLINE, Cochrane, ISI Web of Science, SCOPUS and ClinicalTrial.gov databases were searched for articles published until June 2017. Randomized trials enrolling more than 200 patients, comparing GLP-1 versus placebo or active treatments in patients with DM, and assessing outcomes among all-cause death, CV death, MI, stroke, HF, diabetic retinopathy and nephropathy were included. 77 randomized trials enrolling 60,434 patients were included. Compared to control, treatment with GLP-1 significantly reduced the risk of all-cause death (RR: 0.888; CI: 0.804-0.979; p = 0.018) and the risk of CV death (RR: 0.858; CI: 0.757-0.973; p = 0.017). GLP-1 agonists did not affect the risk of MI (RR: 0.917; CI: 0.830-1.014; p = 0.092) as well as the risk of stroke (RR: 0.882; CI: 0.759-1.023; p = 0.097), HF (RR: 0.967; CI: 0.803-1.165; p = 0.725), retinopathy (RR: 1.000; CI: 0.807-1.238; p = 0.997) and nephropathy (RR: 0.866; CI: 0.625-1.199; p = 0.385). CONCLUSIONS Treatment with GLP-1 agonists in DM patients is associated with a significant reduction of all cause and CV mortality.
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Affiliation(s)
- P Gargiulo
- IRCCS SDN, Institute of Nuclear and Diagnostic Sciences, Naples, Italy
| | - G Savarese
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C D'Amore
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - F De Martino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L H Lund
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - F Marsico
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - S Dellegrottaglie
- Division of Cardiology, Ospedale Accreditato Villa dei Fiori, Acerra, Naples, Italy; Mount Sinai Medical School, New York City, NY, USA
| | - C Marciano
- Istituto Diagnostico Varelli, Naples, Italy
| | - B Trimarco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - P Perrone-Filardi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
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D'Amore C, Marsico F, Parente A, Paolillo S, De Martino F, Gargiulo P, Ferrazzano F, De Roberto AM, La Mura L, Marciano C, Dellegrottaglie S, Trimarco B, Perrone Filardi P. Vitamin D deficiency and clinical outcome in patients with chronic heart failure: A review. Nutr Metab Cardiovasc Dis 2017; 27:837-849. [PMID: 28954706 DOI: 10.1016/j.numecd.2017.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 07/17/2017] [Accepted: 07/23/2017] [Indexed: 12/26/2022]
Abstract
AIM The aim of this review was to summarize evidence on the role of Vitamin D deficiency in heart failure (HF), from pathophysiological mechanisms to clinical effects of Vitamin D supplementation. DATA SYNTHESIS Chronic HF secondary to left ventricular (LV) systolic dysfunction is a growing health problem, still associated with poor clinical outcome. In recent years, experimental and epidemiological evidence focused on the role of Vitamin D in HF. Cross sectional studies demonstrated that prevalence of HF is increased in patients with Vitamin D deficiency or parathyroid hormone (PTH) plasma level increase, whereas longitudinal studies showed enhanced risk of developing new HF in patients with Vitamin D deficiency. In addition, in patients with established HF, low plasma levels of Vitamin D are associated with worsening clinical outcome. Yet, clinical studies did not definitively demonstrate a benefit of Vitamin D supplementation for preventing HF or ameliorating clinical outcome in patients with established HF. CONCLUSIONS Despite convincing experimental and epidemiological data, treatment with Vitamin D supplementation did not show clear evidence of benefit for preventing HF or influencing its clinical course. Ongoing clinical studies will hopefully shed lights on the effects of Vitamin D supplementation on clinical endpoints along the spectrum of HF.
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Affiliation(s)
| | - F Marsico
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - A Parente
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - F De Martino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - F Ferrazzano
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - A M De Roberto
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - L La Mura
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - C Marciano
- Istituto Diagnostico Varelli, Naples, Italy
| | | | - B Trimarco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - P Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
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D'Amore C, Trotta F, Da Cas R, Zocchetti C, Cocci A, Traversa G. Antihypertensive drug use during pregnancy: a population based study. Ann Ist Super Sanita 2017; 51:236-43. [PMID: 26428049 DOI: 10.4415/ann_15_03_12] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE The study aimed at assessing if the European guideline on the use of antihypertensive drugs (AD) in pregnancy are followed in clinical practice. We also evaluated the association between the use of non-recommended drugs and individual characteristics. METHODS This study analyzed a cohort of 86 171 singleton deliveries occurring between 2009-2010 in the Lombardy region, Italy. Women with first prescription of AD during pregnancy were considered as incident users. Methyldopa, labetalol and nifedipine were considered as "recommended drugs"; all other AD were considered as "non-recommended". Odds Ratio and 95% confidence intervals were estimated. RESULTS Among the 1009 patients (1.2%) exposed to AD during pregnancy, 675 (66.9%) were incident users. Among the incident users, 31% received non-recommended drugs; this proportion decreased to 18% among women who started treatment in the third trimester. Women with at least four concomitant diseases had an elevated risk of receiving non-recommended drugs in pregnancy (OR 2.68; 95% CI 1.10-6.73). CONCLUSIONS Exposure to recommended antihypertensives increased during pregnancy. Nevertheless, a fraction of users that continued or began treatment with non-recommended medications was still present.
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Affiliation(s)
- Carmen D'Amore
- Reparto di Farmacoepidemiologia, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Francesco Trotta
- Ufficio di Farmacovigilanza, Agenzia Italiana del Farmaco, Rome, Italy
| | - Roberto Da Cas
- Reparto di Farmacoepidemiologia, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Carlo Zocchetti
- Unità di Programmazione Sanitaria, Direzione Generale Salute, Regione Lombardia, Milan, Italy
| | - Alfredo Cocci
- Centro Regionale di Farmacovigilanza, Regione Lombardia, Milan, Italy
| | - Giuseppe Traversa
- Reparto di Farmacoepidemiologia, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
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Abstract
Background The acceptability of switching between reference drugs and their biosimilars is often disputed. It is unclear whether this concern is specific to the use of biosimilars or is relevant to the practice of switching between any biological drugs. Objective The objective of this study was to quantify the occurrence of switching between different erythropoiesis-stimulating agents. Methods A retrospective drug utilization study was conducted in the Umbria region (Italy). The study population included all residents who received their first epoetin prescription between 1 July 2011 and 31 December 2014. The Umbria drug prescription database and the regional archive of residents were used to gather information. Switching was defined as any transition between different epoetins (different substances and/or different products of the same substance) in a series of two prescriptions. The probability of switching was described in relationship to the duration of treatment in a survival analysis. Results Overall, 3258 subjects received prescriptions of epoetins. Among the 2896 patients with at least two prescriptions, 354 (12.2 %) experienced one or more switches. The probability of switching depended on the duration of treatment: approximately 15 % of users switched within 12 months of observation and 25 % switched within 2 years. Switching was not limited to reference and biosimilar epoetins and it affected patent and off-patent epoetins equally. Conclusions Switching between different epoetins was related to the duration of use and most episodes of switching involved epoetins that have never been contrasted in a comparability exercise. The present level of switching may provide reassurance to physicians when taken together with other sources of comparative evidence. Electronic supplementary material The online version of this article (doi:10.1007/s40259-015-0155-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carmen D'Amore
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Mariangela Rossi
- Unit for Pharmaceutical Governance, General Directorate for Health, Umbria Region, Perugia, Italy
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy.
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27
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Savarese G, Perrone-Filardi P, D'Amore C, Vitale C, Trimarco B, Pani L, Rosano GMC. Cardiovascular effects of dipeptidyl peptidase-4 inhibitors in diabetic patients: A meta-analysis. Int J Cardiol 2014; 181:239-44. [PMID: 25528528 DOI: 10.1016/j.ijcard.2014.12.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [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: 11/03/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Dipeptidyl peptidase-4 inhibitors (DPP-4is) improve glucose control in patients with type 2 diabetes mellitus (DM); however, only few studies were properly designed to evaluate their cardiovascular (CV) effects. The purpose of this study was to assess the impact of DPP-4i treatment on CV morbidity and mortality. METHODS Randomized clinical trials enrolling more than 200 patients, comparing DPP-4 versus placebo or active treatments in patients with DM and reporting at least one event among all-cause and CV mortality, myocardial infarction (MI), stroke and new onset of heart failure (HF) were included in the analysis. RESULTS Ninety-four trials enrolling 85,224 patients (median follow-up=29weeks) were included in the analysis. Compared to control, treatment with DPP-4i did not affect all-cause and CV mortality, as well as stroke, in the short and long terms (< and >=29weeks, respectively). DPP-4i reduced the risk of MI in the short (RR: 0.584 [95% CI: 0.361 to 0.943]; p=0.028), but not in the long term. Additionally, long-term treatment with DPP-4 was associated with a 15.8% increased risk of HF (RR: 1.158 [CI: 1.011 to 1.326]; p=0.034). No heterogeneity among studies or publication bias was detected. CONCLUSIONS DPP4is do not affect all cause- and CV-mortality and stroke in diabetic patients; the reduction in MI observed with short-term treatment does not persist in the long term. Long-term use of DPP-4i in diabetic patients is associated with increased risk of HF.
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Affiliation(s)
- Gianluigi Savarese
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy; IRCCS San Raffaele Roma, Italy
| | | | - Carmen D'Amore
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Luca Pani
- Italian Medicines Agency (AIFA), Italy
| | - Giuseppe M C Rosano
- IRCCS San Raffaele Roma, Italy; Cardiovascular and Cell Sciences Research Institute, St George's University, London, UK.
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Savarese G, Rosano GM, Parente A, D'Amore C, Reiner MF, Camici GG, Trimarco B, Perrone-Filardi P. Reduction of C-reactive protein is not associated with reduced cardiovascular risk and mortality in patients treated with statins. A meta-analysis of 22 randomized trials. Int J Cardiol 2014; 177:152-60. [DOI: 10.1016/j.ijcard.2014.09.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/30/2014] [Accepted: 09/16/2014] [Indexed: 12/26/2022]
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Savarese G, Parente A, D'Amore C, Trimarco B, Perrone-Filardi P. REDUCTION OF C-REACTIVE PROTEIN IS ASSOCIATED WITH REDUCED RISK OF MYOCARDIAL INFARCTION: A META-ANALYSIS OF 16 RANDOMIZED TRIALS. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60250-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Savarese G, Musella F, D'Amore C, Vassallo E, Losco T, Cecere M, Petraglia L, Trimarco B, Perrone-Filardi P. CHANGES OF NATRIURETIC PEPTIDES PREDICT HOSPITAL ADMISSIONS IN PATIENTS WITH CHRONIC HEART FAILURE: A META-ANALYSIS. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60737-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Savarese G, Dei Cas A, Rosano G, D'Amore C, Musella F, Mosca S, Reiner MF, Marchioli R, Trimarco B, Perrone-Filardi P. Reduction of albumin urinary excretion is associated with reduced cardiovascular events in hypertensive and/or diabetic patients. A meta-regression analysis of 32 randomized trials. Int J Cardiol 2014; 172:403-10. [PMID: 24502877 DOI: 10.1016/j.ijcard.2014.01.065] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 10/16/2013] [Accepted: 01/18/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND The association between renal dysfunction and risk of cardiovascular (CV) events and mortality has been reported in several studies. However, it is unclear whether reduction in urinary albumin excretion (UAE) is associated with reduced risk of clinical events. Therefore, we sought to investigate, in a meta-regression analysis of randomized studies enrolling hypertensive and/or diabetic patients, whether changes in UAE are associated with changes in CV outcomes and all-cause mortality. METHODS MEDLINE, ISI Web of Science, Cochrane Database and Scopus were searched for randomized trials enrolling more than 200 diabetic and/or hypertensive patients, reporting UAE at baseline and at end of follow-up and CV events [CV death, myocardial infarction (MI), and stroke], as well all-cause mortality. RESULTS Thirty-two trials enrolling 80,812 participants were included in analyses. Meta-regression analysis showed that each 10% reduction of UAE was significantly associated with 13% reduction of MI (Regression Coefficient [RC]:0.0055; 95% Confidence Interval [CI]:0.0014 to 0.0095; p=0.010), with 29% reduction of stroke (RC:0.0124; CI:0.0030 to 0.0218; p=0.013) and with 14% reduction of the composite outcome (CV death, MI, stroke)(RC:0.0059; CI:0.0027 to 0.0090; p=0.001), whereas not significantly associated with all-cause (RC:0.0028; CI:-0.0047 to 0.0103; p=0.486) and CV mortality (RC:0.0028; CI:-0.0047 to 0.0103; p=0.447). Results were mostly confirmed by sensitivity analysis. No heterogeneity or publication bias was detected. CONCLUSIONS Reduction in UAE is associated with reduced risk of MI and stroke in diabetic and/or hypertensive patients. These findings suggest that UAE changes may represent a valuable intermediate end-point for CV risk evaluation in clinical practice.
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Affiliation(s)
- Gianluigi Savarese
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Alessandra Dei Cas
- Department of Internal Medicine and Biomedical Sciences, University of Parma, Parma, Italy
| | - Giuseppe Rosano
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Rome, Italy
| | - Carmen D'Amore
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Francesca Musella
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Susanna Mosca
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Martin F Reiner
- Department of Internal Medicine, Cantonal Hospital of Baden, Switzerland
| | - Roberto Marchioli
- Laboratory of Clinical Epidemiology of Cardiovascular Disease, Consorzio Mario Negri Sud, Chieti, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Savarese G, Paolillo S, D'Amore C, Losco T, Musella F, Scala O, Rengo G, Leosco D, Trimarco B, Perrone Filardi P. Benefits of statins in elderly subjects without established cardiovascular disease. a meta-analysis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Savarese G, Gotto AM, Paolillo S, D'Amore C, Losco T, Musella F, Scala O, Marciano C, Ruggiero D, Marsico F, De Luca G, Trimarco B, Perrone-Filardi P. Benefits of statins in elderly subjects without established cardiovascular disease: a meta-analysis. J Am Coll Cardiol 2013; 62:2090-9. [PMID: 23954343 DOI: 10.1016/j.jacc.2013.07.069] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/03/2013] [Accepted: 07/13/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The purpose of this paper was to assess whether statins reduce all-cause mortality and cardiovascular (CV) events in elderly people without established CV disease. BACKGROUND Because of population aging, prevention of CV disease in the elderly is relevant. In elderly patients with previous CV events, the use of statins is recommended by guidelines, whereas the benefits of these drugs in elderly subjects without previous CV events are still debated. METHODS Randomized trials comparing statins versus placebo and reporting all-cause and CV mortality, myocardial infarction (MI), stroke, and new cancer onset in elderly subjects (age ≥ 65 years) without established CV disease were included. RESULTS Eight trials enrolling 24,674 subjects (42.7% females; mean age 73.0 ± 2.9 years; mean follow up 3.5 ± 1.5 years) were included in analyses. Statins, compared with placebo, significantly reduced the risk of MI by 39.4% (relative risk [RR]: 0.606 [95% confidence interval (CI): 0.434 to 0.847]; p = 0.003) and the risk of stroke by 23.8% (RR: 0.762 [95% CI: 0.626 to 0.926]; p = 0.006). In contrast, the risk of all-cause death (RR: 0.941 [95% CI: 0.856 to 1.035]; p = 0.210) and of CV death (RR: 0.907 [95% CI: 0.686 to 1.199]; p = 0.493) were not significantly reduced. New cancer onset did not differ between statin- and placebo-treated subjects (RR: 0.989 [95% CI: 0.851 to 1.151]; p = 0.890). CONCLUSIONS In elderly subjects at high CV risk without established CV disease, statins significantly reduce the incidence of MI and stroke, but do not significantly prolong survival in the short-term.
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Affiliation(s)
- Gianluigi Savarese
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Lo Iudice F, Galderisi M, D'Amore C, Savarese G, Marciano C, Casaretti L, Pellegrino AM, Fabiani I, La Mura L, Perrone Filardi P. Endothelial dysfunction as a link between renal and coronary microvascular dysfunction in type II diabetic patients with normal coronary arteries: a transthoracic echocardiographic doppler study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p379] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Savarese G, Ferri C, Trimarco B, Rosano G, Dellegrottaglie S, Losco T, Casaretti L, D'Amore C, Gambardella F, Prastaro M, Rengo G, Leosco D, Perrone-Filardi P. Changes in serum uric acid levels and cardiovascular events: a meta-analysis. Nutr Metab Cardiovasc Dis 2013; 23:707-714. [PMID: 23725772 DOI: 10.1016/j.numecd.2013.03.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/07/2013] [Accepted: 03/10/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The association between serum uric acid (SUA) levels and cardiovascular (CV) risk or all-cause death has been repeatedly reported. However, it has not been assessed whether reduction of SUA levels is associated with reduced CV risk. The aim of the current study was to evaluate the relationship between changes of SUA levels and CV events as well as all-cause death. METHODS AND RESULTS Randomised trials reporting SUA at baseline and at the end of follow-up and clinical end-points (all-cause death, myocardial infarction (MI), stroke, heart failure (HF) and CV death) were included in the study. Meta-regression analysis was performed to test the relationship between SUA changes and clinical end-points. Eleven trials enrolling 21,373 participants followed up for 2.02 ± 1.76 years and reporting 4533 events were included. In meta-regression analysis, no relationship between SUA changes from baseline to end of follow-up and the composite outcome including CV death, stroke, MI and HF was found (change in Tau(2) (t) = -0.64; p Tau (p) = 0.541). Similarly, no relationship was found between SUA changes and single components of the composite outcome (MI: t = -0.83; p = 0.493; stroke: t = 0.46; p = 0.667; HF: t = 2.44; p = 0.162; CV death: t = -0.54; p = 0.614) and all-cause death (t = -0.72; p = 0.496). Results were confirmed by sensitivity analysis. No heterogeneity among studies or publication bias was detected. CONCLUSIONS Changes in SUA levels observed during pharmacologic treatments do not predict the risk of all-cause death or CV events. As SUA levels are associated with increased CV risk, additional studies with direct xanthine-oxidase inhibitors are requested.
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Affiliation(s)
- G Savarese
- Department of Advanced Biomedical Sciences, Federico II University, Via Pansini 5, I-80131 Naples, Italy
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Gargiulo P, Dellegrottaglie S, Bruzzese D, Savarese G, Scala O, Ruggiero D, D'Amore C, Paolillo S, Agostoni P, Bossone E, Soricelli A, Cuocolo A, Trimarco B, Perrone Filardi P. The prognostic value of normal stress cardiac magnetic resonance in patients with known or suspected coronary artery disease: a meta-analysis. Circ Cardiovasc Imaging 2013; 6:574-82. [PMID: 23771988 DOI: 10.1161/circimaging.113.000035] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [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] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ischemia detection with stress cardiac magnetic resonance (CMR) is typically based on induction of either myocardial perfusion defect or wall motion abnormality. Single-center studies have shown the high value of stress CMR for risk stratification. The aim of this study was to define the prognostic value of stress CMR for prediction of adverse cardiac events in patients with known or suspected coronary artery disease. METHODS AND RESULTS Studies published between January 1985 and April 2012 were identified by database search. We included studies using stress CMR to evaluate subjects with known or suspected coronary artery disease and providing primary data on clinical outcomes of nonfatal myocardial infarction or cardiac death with a follow-up time ≥3 months. Total of 14 studies were finally included, recruiting 12 178 patients. The negative predictive value for nonfatal myocardial infarction and cardiac death of normal CMR was 98.12% (95% confidence interval, 97.26-98.83) during a weighted mean follow-up of 25.3 months, resulting in estimated event rate after a negative test equal to 1.88% (95% confidence interval, 1.17-2.74). The corresponding annualized event rate after a negative test was 1.03%. Comparable negative predictive values for major coronary events were obtained in studies considering the absence of inducible perfusion defect compared with those evaluating the absence of inducible wall motion abnormality (98.39% versus 97.31%, respectively; P=0.227 by meta-regression analysis). CONCLUSIONS Stress CMR has a high negative predictive value for adverse cardiac events, and the absence of inducible perfusion defect or wall motion abnormality shows a similar ability to identify low-risk patients with known or suspected coronary artery disease.
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Affiliation(s)
- Paola Gargiulo
- SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy
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Iudice FL, Galderisi M, Paolillo S, D'Amore C, Parente A, Savarese G, Marciano C, Fabiani I, Pellegrino AM, Casaretti L, Perrone-Filardi P. CORONARY MICROVASCULAR FUNCTION IS IMPAIRED IN HIGH-RISK PATIENTS WITH CHRONIC RENAL DYSFUNCTION AND NORMAL EPICARDIAL CORONARY ARTERIES: A TRANSTHORACIC ECHOCARDIOGRAPHIC DOPPLER STUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60959-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Savarese G, Dei Cas A, Trimarco B, Paolillo S, Musella F, Mosca S, D'Amore C, Galasso G, Rengo G, Leosco D, Marchioli R, Perrone-Filardi P. CHANGES OF ALBUMIN URINARY EXCRETION PREDICT CARDIOVASCULAR AND MORTALITY RISK: A META-REGRESSION ANALYSIS OF 32 RANDOMIZED TRIALS IN 80,812 PATIENTS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61366-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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De Rosa ML, Musella F, Ilardi F, D'Amore C, Luciano R, Maresca F. Effects of antihypertensive therapy on glucose, insulin metabolism, left ventricular diastolic dysfunction and renin system in overweight and obese hypertensives. J Renin Angiotensin Aldosterone Syst 2013; 15:196-204. [PMID: 23396551 DOI: 10.1177/1470320312474053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We attempted to test the hypothesis that the direct renin inhibitor aliskiren can improve diastolic dysfunction, glucose, and insulin metabolism (GIM) in overweight and obese hypertensive patients. METHODS AND RESULTS Seventy-eight hypertensive patients were divided into two groups: 38 treated with aliskiren for six months, and 40 treated without aliskiren but with only traditional anti-hypertensive therapy, as controls. Doppler mitral flow velocity patterns were assessed before and after aliskiren during a six-month period. GIM (three-hour intravenous glucose tolerance test) was measured after four to six weeks of washout and six months of treatment. The mitral E/A ratio increased from 0.65 ± 0.11 to 0.75 ± 0.19. None of the indexes changed in the control group. In the control group, GIM parameters, fasting glucose levels (5.3 ± 0.9 to 6.0 ± 1.5 mmol/l; p = 0.003), fasting insulin levels (121 ± 121 to 189 ± 228 pmol/l; p = 0.03), and most other relevant metabolic measures (p < 0.05 for all) significantly worsened. Aliskiren did not affect GIM. In the control group LVM/height was not affected (119 ± 12 to 120 ± 17 g/m; p = 0.8), whereas aliskiren significantly reduced LVM/height (120 ± 13 to 111 ± 19 g/m; p = 0.04). CONCLUSIONS Optimal target BP was achieved in the group as a whole and in both obese patient groups, while benefits to cardiac structure were of a smaller magnitude. In high-risk, overweight/obese patients with hypertension, traditional therapy provides significantly greater BP- versus aliskiren-lowering throughout the 24-hour dosing interval. Therefore in obese, hypertensive individuals, adequate and similar blood pressure control was achieved with aliskiren; however, the aliskiren group and not the control group was associated with a more favorable GIM profile and led to a significant regression of LVM; overall aliskiren-based treatment offers sustained control of PRA.
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Mencarelli A, Cipriani S, Renga B, D'Amore C, Palladino G, Distrutti E, Baldelli F, Fiorucci S. FXR activation improves myocardial fatty acid metabolism in a rodent model of obesity-driven cardiotoxicity. Nutr Metab Cardiovasc Dis 2013; 23:94-101. [PMID: 21924881 DOI: 10.1016/j.numecd.2011.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 06/16/2011] [Accepted: 06/20/2011] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS Obesity-driven lipotoxicity is a risk factors for cardiovascular disease. The Farnesoid X Receptor (FXR) is a bile acids sensor and member of the nuclear receptor superfamily. Activation of FXR lowers plasma triacylglycerols and glucose levels through a mechanism that involves both the repression of key regulatory genes in the liver and the modulation of insulin sensitivity in peripheral tissues. In the present study we have investigated whether administering obese (fa/fa) Zucker rats, a genetic model of obesity associated with dyslipidemia and insulin resistance, with an FXR ligand protects against lipid-induced cardiomyopathy. METHODS AND RESULTS FXR is expressed in neonatal cardiomyocytes and the treatment with FXR agonists, chenodeoxycholic acid (CDCA), and GW4064, increased the mRNA expression of FXR and its canonical target gene, the small heterodimer partner (SHP), as well as proliferator-activated receptor alpha PPARα, acyl-CoA oxidase (AOX) and pyruvate dehydrogenase kinase (PDK-4). Feeding obese fa/fa rats with CDCA, 12 weeks, reduced hyperinsulinemia and hyperlipidaemia. The histological-pathological analysis of hearts demonstrated that treatment with the FXR ligand reduced lipid heart content decreased the rate of apoptosis, fibrosis scores and restored heart insulin signalling. Chronic CDCA administration, in the heart, induced PPARα and PPARα-regulated genes involved in β-oxidation. CONCLUSION FXR agonism exerts beneficial effects in a genetic model of lipid-induced cardiomyopathy. The striking benefit of this therapy on cardiac function in this model warrants an effort to determine whether a counterpart of this activity translates in human settings.
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Affiliation(s)
- A Mencarelli
- Dipartimento di Medicina Clinica e Sperimentale, University of Perugia, Facoltà di Medicina e Chirurgia, Via Gerardo Dottori n° 1, S. Andrea delle Fratte, 06132 Perugia, Italy.
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Mallozzi C, D'Amore C, Camerini S, Macchia G, Crescenzi M, Petrucci TC, Di Stasi AMM. Phosphorylation and nitration of tyrosine residues affect functional properties of Synaptophysin and Dynamin I, two proteins involved in exo-endocytosis of synaptic vesicles. Biochimica et Biophysica Acta (BBA) - Molecular Cell Research 2013; 1833:110-21. [DOI: 10.1016/j.bbamcr.2012.10.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/08/2012] [Accepted: 10/21/2012] [Indexed: 12/14/2022]
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Savarese G, Musella F, D'Amore C, Losco T, Marciano C, Gargiulo P, Rengo G, Dellegrottaglie S, Bossone E, Leosco D, Perrone-Filardi P. Haemodynamics, exercise capacity and clinical events in pulmonary arterial hypertension. Eur Respir J 2012; 42:414-24. [PMID: 23100502 DOI: 10.1183/09031936.00123712] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to clarify whether changes in cardiopulmonary haemodynamics induced by pharmacological therapy correlate with exercise capacity and clinical events in patients with pulmonary arterial hypertension. 16 randomised trials including 2353 patients, followed up for 16.4±10.6 weeks, measuring cardiopulmonary haemodynamics by right heart catheterisation and reporting clinical events were included. Meta-analysis and meta-regression analysis were performed to assess the effects of treatments on clinical events and the relationship between haemodynamic changes (pulmonary artery pressure, pulmonary vascular resistance, cardiac index and right atrial pressure) and clinical events. Treatments significantly reduced all-cause death (OR 0.5, 95% CI 0.3-0.7; p<0.01), hospitalisation for pulmonary arterial hypertension (OR 0.4, 95% CI 0.2-0.7; p<0.01), initiation of rescue therapy (OR 0.3, 95% CI 0.2-0.6; p<0.01) and the composite outcome (OR 0.3, 95% CI 0.3-0.5; p<0.01). No relationship was found between changes of haemodynamic parameters and clinical events, whereas changes of cardiac index and pulmonary vascular resistance significantly correlated with changes in the 6-min walking distance (r = 0.64, p = 0.03; r = -0.55, p = 0.04, respectively). In patients with pulmonary arterial hypertension, improvements of cardiopulmonary haemodynamics observed in randomised clinical trials correlate with exercise capacity changes but do not predict clinical events in a short-term follow-up.
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Affiliation(s)
- Gianluigi Savarese
- Dept of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Gargiulo P, Marciano C, Savarese G, D'Amore C, Paolillo S, Esposito G, Santomauro M, Marsico F, Ruggiero D, Scala O, Marzano A, Cecere M, Casaretti L, Perrone Filardi P. Endothelial dysfunction in type 2 diabetic patients with normal coronary arteries: a digital reactive hyperemia study. Int J Cardiol 2011; 165:67-71. [PMID: 21851998 DOI: 10.1016/j.ijcard.2011.07.076] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 06/17/2011] [Accepted: 07/25/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND To assess endothelial function (EF) in type 2 diabetic patients with angiographically normal coronaries compared to diabetic patients with obstructive coronary artery disease (CAD) and to non-diabetic patients, with and without CAD. METHODS One hundred eighty-three patients undergoing coronary angiography were divided in: group 1 with diabetes mellitus (DM) and CAD (n = 58); group 2 with DM without CAD (n = 58); group 3 with CAD without DM (n = 31) and group 4 without CAD and DM (n = 36). EF was assessed by reactive hyperemia index (RHI) using a fingertip peripheral arterial tonometry and compared to values obtained in 20 healthy volunteers. RESULTS RHI was significantly lower in patients with DM compared to patients without DM (1.69 ± 0.38 vs 1.84 ± 0.44; p = 0.019). RHI was comparable among groups 1, 2 and 3, each value being significantly lower compared to group 4 (2 ± 0.44; p<0.001 vs group 1; p<0.005 vs group 2; p<0.002 vs group 3). At multivariate analysis DM and CAD were significant predictors of endothelial dysfunction (ED) (OR = 2.29; p = 0.012; OR = 2.76; p = 0.001, respectively), whereas diabetic patients (n = 116) CAD and glycated haemoglobin (HbA1c) were independent significant predictors of ED (OR = 3.05; p = 0.009; OR = 1.96; p = 0.004, respectively). Diabetic patients with ED (n = 67) had higher levels of HbA1c than diabetic patients with normal endothelial function (7.35 ± 0.97 vs 6.87 ± 0.90; p = 0.008) and RHI inversely correlated to HbA1c (p = 0.02; r = -0.210). CONCLUSIONS Diabetic patients with and without CAD show significantly impaired peripheral vascular function compared to non-diabetic patients without CAD. ED in diabetic patients without CAD is comparable to that of patients with CAD but without DM. HbA1c is a weak independent predictor of ED.
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Affiliation(s)
- Paola Gargiulo
- Department of Internal Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy
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Gargiulo P, Petretta M, Bruzzese D, Cuocolo A, Prastaro M, D'Amore C, Vassallo E, Savarese G, Marciano C, Paolillo S, Filardi PP. Myocardial perfusion scintigraphy and echocardiography for detecting coronary artery disease in hypertensive patients: a meta-analysis. Eur J Nucl Med Mol Imaging 2011; 38:2040-9. [PMID: 21814850 DOI: 10.1007/s00259-011-1891-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/18/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE This meta-analysis summarized the accuracy of stress myocardial perfusion scintigraphy (MPS) and stress echocardiography for the diagnosis of coronary artery disease (CAD) in patients with arterial hypertension. METHODS We searched for studies in which stress MPS or stress echocardiography were performed to detect CAD in hypertensive patients, with coronary angiography used as the reference test, published from January 1980 to December 2010. Studies performed in patients with known CAD, acute coronary syndrome and previous revascularization procedures were excluded. RESULTS Of 1,263 studies, 13 met the inclusion criteria. Pooled summary estimates showed that stress MPS had a sensitivity of 0.90 [95% confidence interval (CI) 0.82-0.95] and a specificity of 0.63 (95% CI 0.53-0.72). For stress MPS, the area under the curve (AUC) at the summary receiver-operating characteristic (SROC) graph was 0.83 (95% CI 0.80-0.86). At meta-regression analysis, the presence of positive stress electrocardiography as inclusion criterion was the only significant effect modifier (p < 0.01). Pooled summary estimates showed that stress echocardiography had a sensitivity of 0.77 (95% CI 0.69-0.83) and a specificity of 0.89 (95% CI 0.83-0.93). For stress echocardiography, the AUC at SROC was 0.91 (95% CI 0.88-0.93). At the meta-regression analysis no significant effect modifier was detected. CONCLUSION MPS has high sensitivity for detecting CAD in hypertensive patients, with specificity comparable to that reported in the general population, whereas stress echocardiography shows higher specificity but substantially reduced sensitivity compared to MPS.
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Affiliation(s)
- Paola Gargiulo
- Department of Internal Medicine, Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy
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Monda C, Scala O, Paolillo S, Savarese G, Cecere M, D'Amore C, Parente A, Musella F, Mosca S, Filardi PP. [Sleep apnea and heart failure: pathophysiology, diagnosis and therapy]. G Ital Cardiol (Rome) 2010; 11:815-822. [PMID: 21348318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Sleep apnea, defined as a pathologic pause in breathing during sleep >10 s, promotes the progression of chronic heart failure and may be a predictor of poor prognosis. It causes, in fact, several mechanical, hemodynamic, chemical and inflammatory changes that negatively compromise cardiovascular homeostasis of heart failure patients. Sleep apnea is recognized as sleep apnea syndrome when specific symptoms, such as sleepiness and headache during the daytime and snoring, are present and is diagnosed with an overnight test called polysomnography. There are two different forms of sleep apnea, central and obstructive. Breathing is interrupted by the loss of respiratory drive and the lack of respiratory effort in the central form, which affects about 40-60% of heart failure patients. In obstructive sleep apnea, breathing stops when throat muscles relax, despite respiratory effort. This form affects about 3% of the general population, while it is present in at least 30% of heart failure patients. The diagnosis of sleep disorders in heart failure becomes very important to help patients adopting lifestyle changes and starting specific therapies to improve quality of life and retard the progression of chronic heart failure.
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Affiliation(s)
- Cinzia Monda
- Dipartimento di Medicina Interna, Scienze Cardiovascolari ed Immunologiche, Università degli Studi Federico II, Napoli
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Perrone-Filardi P, Costanzo P, Dellegrottaglie S, Gargiulo P, Ruggiero D, Savarese G, Parente A, D'Amore C, Cuocolo A, Chiariello M. Prognostic role of myocardial single photon emission computed tomography in the elderly. J Nucl Cardiol 2010; 17:310-5. [PMID: 20033857 DOI: 10.1007/s12350-009-9182-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The increase in average life expectancy will move the burden of coronary artery disease (CAD) to older patients. Myocardial perfusion imaging by single photon emission computed tomography (SPECT) has been extensively validated for diagnosis and prognostic evaluation in large population series. Yet, its use is usually limited in elderly patients in whom, despite increased absolute cardiovascular risk, diagnostic and therapeutic work-up is often underperformed. American College of Cardiology/American Heart Association guidelines recommend exercise ECG testing as the initial noninvasive method for assessment of CAD in patients with a normal or near-normal resting ECG, regardless of age. However, a considerable proportion of elderly patients is unable to reach an adequate workload during the exercise test and the majority of those undergoing for standard exercise treadmill score are classified as intermediate risk. In elderly patients, SPECT imaging may provide valuable diagnostic and prognostic information for clinical management. In particular, normal or near normal SPECT identifies elderly patients at low risk of major adverse cardiac events at the short-term follow-up.
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Affiliation(s)
- Pasquale Perrone-Filardi
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Via S. Pansini 5, Naples, 80131, Italy.
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Parnetti L, Balducci C, Pierguidi L, De Carlo C, Peducci M, D'Amore C, Padiglioni C, Mastrocola S, Persichetti E, Paciotti S, Bellomo G, Tambasco N, Rossi A, Beccari T, Calabresi P. Cerebrospinal fluid β-glucocerebrosidase activity is reduced in Dementia with Lewy Bodies. Neurobiol Dis 2009; 34:484-6. [DOI: 10.1016/j.nbd.2009.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 03/07/2009] [Indexed: 01/18/2023] Open
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Preziosi P, D'Amore C, De Luca B, Bigioni R. [Occasional encounter of fetal malformations during echographic examination in pregnancy]. Minerva Ginecol 1983; 35:785-91. [PMID: 6672678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Danese V, D'Amore C, Bigioni R, De Ferrari A. [Plagiocephaly. A rare form of craniosynostosis]. Minerva Pediatr 1983; 35:267-70. [PMID: 6865871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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50
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D'Amore C, Federici PV, Medici D, Danese V. [Echotomography in polycystic renal disease]. Minerva Med 1983; 74:601-6. [PMID: 6835551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Sonography is a safe and suitable diagnostic tool; to date it appears to be the most valuable method for detecting renal cystic lesions. In particular ultrasound examination, if a wider district is screened, can demonstrate the coexistence of the cystic disease in different organs. The Authors report a case of renal polycyctic disease in which the sonographic examination was extended to the entire abdomen disclosing simultaneous involvement of the kidneys and the liver.
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