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Musetti D, Cutolo CA, Bonetto M, Giacomini M, Maggi D, Viviani GL, Gandin I, Traverso CE, Nicolò M. Autonomous artificial intelligence versus teleophthalmology for diabetic retinopathy. Eur J Ophthalmol 2024:11206721241248856. [PMID: 38656241 DOI: 10.1177/11206721241248856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Purpose: To assess the role of artificial intelligence (AI) based automated software for detection of Diabetic Retinopathy (DR) compared with the evaluation of digital retinography by two double masked retina specialists. Methods: Two-hundred one patients (mean age 65 ± 13 years) with type 1 diabetes mellitus or type 2 diabetes mellitus were included. All patients were undergoing a retinography and spectral domain optical coherence tomography (SD-OCT, DRI 3D OCT-2000, Topcon) of the macula. The retinal photographs were graded using two validated AI DR screening software (Eye Art TM and IDx-DR) designed to identify more than mild DR. Results: Retinal images of 201 patients were graded. DR (more than mild DR) was detected by the ophthalmologists in 38 (18.9%) patients and by the AI-algorithms in 36 patients (with 30 eyes diagnosed by both algorithms). Ungradable patients by the AI software were 13 (6.5%) and 16 (8%) for the Eye Art and IDx-DR, respectively. Both AI software strategies showed a high sensitivity and specificity for detecting any more than mild DR without showing any statistically significant difference between them. Conclusions: The comparison between the diagnosis provided by artificial intelligence based automated software and the reference clinical diagnosis showed that they can work at a level of sensitivity that is similar to that achieved by experts.
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Affiliation(s)
- Donatella Musetti
- Clinica Oculistica DiNOGMI, Università di Genova, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Carlo Alberto Cutolo
- Clinica Oculistica DiNOGMI, Università di Genova, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | | | | | - Davide Maggi
- Clinica Diabetologica, Università di Genova, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Giorgio Luciano Viviani
- Clinica Diabetologica, Università di Genova, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Ilaria Gandin
- Sciences, Biostatistic Unit, University of Trieste, Italy
| | - Carlo Enrico Traverso
- Clinica Oculistica DiNOGMI, Università di Genova, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Massimo Nicolò
- Clinica Oculistica DiNOGMI, Università di Genova, Ospedale Policlinico San Martino IRCCS, Genova, Italy
- Fondazione per la Macula onlus, Genova, Italy
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Iobbi V, Parisi V, Lanteri AP, Maggi N, Giacomini M, Drava G, Minuto G, Minuto A, Tommasi ND, Bisio A. NMR Metabolite Profiling for the Characterization of Vessalico Garlic Ecotype and Bioactivity against Xanthomonas campestris pv. campestris. Plants (Basel) 2024; 13:1170. [PMID: 38732385 PMCID: PMC11085173 DOI: 10.3390/plants13091170] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/05/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
The Italian garlic ecotype "Vessalico" possesses distinct characteristics compared to its French parent cultivars Messidor and Messidrôme, used for sowing, as well as other ecotypes in neighboring regions. However, due to the lack of a standardized seed supply method and cultivation protocol among farmers in the Vessalico area, a need to identify garlic products that align with the Vessalico ecotype arises. In this study, an NMR-based approach followed by multivariate analysis to analyze the chemical composition of Vessalico garlic sourced from 17 different farms, along with its two French parent cultivars, was employed. Self-organizing maps allowed to identify a homogeneous subset of representative samples of the Vessalico ecotype. Through the OPLS-DA model, the most discriminant metabolites based on values of VIP (Variable Influence on Projections) were selected. Among them, S-allylcysteine emerged as a potential marker for distinguishing the Vessalico garlic from the French parent cultivars by NMR screening. Additionally, to promote sustainable agricultural practices, the potential of Vessalico garlic extracts and its main components as agrochemicals against Xanthomonas campestris pv. campestris, responsible for black rot disease, was explored. The crude extract exhibited a MIC of 125 μg/mL, and allicin demonstrated the highest activity among the tested compounds (MIC value of 31.25 μg/mL).
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Affiliation(s)
- Valeria Iobbi
- Department of Pharmacy, University of Genova, Viale Cembrano 4, 16148 Genova, Italy; (V.I.); (G.D.)
| | - Valentina Parisi
- Department of Pharmacy, University of Salerno, via Giovanni Paolo II 132, 84084 Salerno, Italy;
| | - Anna Paola Lanteri
- CERSAA Centro di Sperimentazione e Assistenza Agricola, Regione Rollo 98, 17031 Albenga, Italy; (A.P.L.); (G.M.); (A.M.)
| | - Norbert Maggi
- Department of Informatics, Bioengineering, Robotics and System Science, University of Genova, via Opera Pia 13, 16145 Genova, Italy; (N.M.); (M.G.)
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Science, University of Genova, via Opera Pia 13, 16145 Genova, Italy; (N.M.); (M.G.)
| | - Giuliana Drava
- Department of Pharmacy, University of Genova, Viale Cembrano 4, 16148 Genova, Italy; (V.I.); (G.D.)
| | - Giovanni Minuto
- CERSAA Centro di Sperimentazione e Assistenza Agricola, Regione Rollo 98, 17031 Albenga, Italy; (A.P.L.); (G.M.); (A.M.)
| | - Andrea Minuto
- CERSAA Centro di Sperimentazione e Assistenza Agricola, Regione Rollo 98, 17031 Albenga, Italy; (A.P.L.); (G.M.); (A.M.)
| | - Nunziatina De Tommasi
- Department of Pharmacy, University of Salerno, via Giovanni Paolo II 132, 84084 Salerno, Italy;
| | - Angela Bisio
- Department of Pharmacy, University of Genova, Viale Cembrano 4, 16148 Genova, Italy; (V.I.); (G.D.)
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Giacobbe DR, Marelli C, Guastavino S, Mora S, Rosso N, Signori A, Campi C, Giacomini M, Bassetti M. Explainable and Interpretable Machine Learning for Antimicrobial Stewardship: Opportunities and Challenges. Clin Ther 2024:S0149-2918(24)00065-1. [PMID: 38519371 DOI: 10.1016/j.clinthera.2024.02.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/24/2024]
Abstract
There is growing interest in exploiting the advances in artificial intelligence and machine learning (ML) for improving and monitoring antimicrobial prescriptions in line with antimicrobial stewardship principles. Against this background, the concepts of interpretability and explainability are becoming increasingly essential to understanding how ML algorithms could predict antimicrobial resistance or recommend specific therapeutic agents, to avoid unintended biases related to the "black box" nature of complex models. In this commentary, we review and discuss some relevant topics on the use of ML algorithms for antimicrobial stewardship interventions, highlighting opportunities and challenges, with particular attention paid to interpretability and explainability of employed models. As in other fields of medicine, the exponential growth of artificial intelligence and ML indicates the potential for improving the efficacy of antimicrobial stewardship interventions, at least in part by reducing time-consuming tasks for overwhelmed health care personnel. Improving our knowledge about how complex ML models work could help to achieve crucial advances in promoting the appropriate use of antimicrobials, as well as in preventing antimicrobial resistance selection and dissemination.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy; UO Clinica Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy.
| | - Cristina Marelli
- UO Clinica Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Sara Mora
- UO Information and Communication Technologies, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | - Nicola Rosso
- UO Information and Communication Technologies, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Cristina Campi
- Department of Mathematics, University of Genoa, Genoa, Italy; Life Science Computational Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy; UO Clinica Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
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Taramasso L, Dettori S, Ricci E, Lerta S, Mora S, Blanchi S, Giacomini M, Vena A, Bassetti M, Di Biagio A. Weight Gain in Overweight and Obese People with HIV-The OBHIV Cohort. J Clin Med 2024; 13:1211. [PMID: 38592054 PMCID: PMC10932370 DOI: 10.3390/jcm13051211] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND HIV and non-HIV-related factors have been related to weight gain (WG); however, their specific impact on people with HIV (PWH) who are overweight or obese remains unclear. METHODS This is a single-center observational study enrolling PWH with a BMI > 25 kg/m2. A generalized linear model was used to assess variables related to greater WG during 12 years of observation. RESULTS A total of 321 PWH were enrolled, 67% overweight and 33% obese, who gained an average of 0.2 ± 1.3 and 1.7 ± 1.5 kg/year, respectively (p < 0.0001). Years since HIV infection were the only variable significantly associated with WG (β -0.048, 95% CI -0.083; -0.013) during the study period, while type of ART did not influence the outcome. Narrowing the observation to the period of the SARS-CoV-2 pandemic, PWH with a longer duration of infection (β 0.075, 95% CI 0.033; 0.117) and a greater increase in triglycerides (β 0.005; 95% CI 0.000; 0.011) gained more weight, while higher BMI (β -0.256, 95% CI -0.352; -0.160), obesity (β -1.363, 95% CI -2.319; -0.408), diabetes mellitus (β -1.538, 95% CI -2.797; -0.278), and greater abdominal circumference (β -0.086, 95% CI -0.142; -0.030) resulted in protection. CONCLUSION Among overweight and obese PWH, the amount of WG was higher in the first years after diagnosis of HIV and decreased thereafter, despite aging, regardless of the type of ART.
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Affiliation(s)
- Lucia Taramasso
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
| | - Silvia Dettori
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| | - Elena Ricci
- Fondazione ASIA Onlus, Buccinasco, 20090 Milan, Italy;
| | - Sonia Lerta
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, 16126 Genoa, Italy; (S.M.); (M.G.)
| | - Sabrina Blanchi
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, 16126 Genoa, Italy; (S.M.); (M.G.)
| | - Antonio Vena
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| | - Matteo Bassetti
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
| | - Antonio Di Biagio
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, 16132 Genoa, Italy; (S.B.); (A.V.); (M.B.); (A.D.B.)
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa, 16126 Genoa, Italy; (S.D.); (S.L.)
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Iobbi V, Donadio G, Lanteri AP, Maggi N, Kirchmair J, Parisi V, Minuto G, Copetta A, Giacomini M, Bisio A, De Tommasi N, Drava G. Targeted metabolite profiling of Salvia rosmarinus Italian local ecotypes and cultivars and inhibitory activity against Pectobacterium carotovorum subsp. carotovorum. Front Plant Sci 2024; 15:1164859. [PMID: 38390298 PMCID: PMC10883066 DOI: 10.3389/fpls.2024.1164859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Abstract
Introduction The development of agriculture in terms of sustainability and low environmental impact is, at present, a great challenge, mainly in underdeveloped and marginal geographical areas. The Salvia rosmarinus "Eretto Liguria" ecotype is widespread in Liguria (Northwest Italy), and farmers commonly use it by for cuttings and for marketing. In the present study, this ecotype was characterized in comparison with other cultivars from the same geographical region and Campania (Southern Italy), with a view to application and registration processes for the designation of protected geographical indications. Moreover, the possibility of using the resulting biomass after removing cuttings or fronds as a source of extracts and pure compounds to be used as phytosanitary products in organic farming was evaluated. Specifically, the potential of rosemary extracts and pure compounds to prevent soft rot damage was then tested. Methods A targeted NMR metabolomic approach was employed, followed by multivariate analysis, to characterize the rosemary accessions. Bacterial soft rot assay and disk diffusion test were carried out to evaluate the activity of extracts and isolated compounds against Pectobacterium carotovorum subsp. carotovorum. Enzymatic assay was performed to measure the in vitro inhibition of the pectinase activity produced by the selected pathogen. Molecular docking simulations were used to explore the possible interaction of the selected compounds with the pectinase enzymes. Results and Discussion The targeted metabolomic analysis highlighted those different geographical locations can influence the composition and abundance of bioactive metabolites in rosemary extracts. At the same time, genetic factors are important when a single geographical area is considered. Self-organizing maps (SOMs) showed that the accessions of "Eretto Liguria" appeared well characterized when compared to the others and had a good content in specialized metabolites, particularly carnosic acid. Soft rotting Enterobacteriaceae belonging to the Pectobacterium genus represent a serious problem in potato culture. Even though rosemary methanolic extracts showed a low antibacterial activity against a strain of Pectobacterium carotovorum subsp. carotovorum in the disk diffusion test, they showed ability in reducing the soft rot damage induced by the bacterium on potato tissue. 7-O-methylrosmanol, carnosol and isorosmanol appeared to be the most active components. In silico studies indicated that these abietane diterpenoids may interact with P. carotovorum subsp. carotovorum pectate lyase 1 and endo-polygalacturonase, thus highlighting these rosemary components as starting points for the development of agents able to prevent soft rot progression.
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Affiliation(s)
- Valeria Iobbi
- Department of Pharmacy, University of Genova, Genova, Italy
| | | | - Anna Paola Lanteri
- Plant Pathology Laboratory, Section Microbiology and Molecular Biology, Centro di Sperimentazione e Assistenza Agricola (CeRSAA), Albenga, Italy
| | - Norbert Maggi
- Department of Informatics, Bioengineering, Robotics and System Science, University of Genova, Genova, Italy
| | - Johannes Kirchmair
- Department of Pharmaceutical Sciences, Division of Pharmaceutical Chemistry, University of Vienna, Vienna, Austria
| | | | - Giovanni Minuto
- Plant Pathology Laboratory, Section Microbiology and Molecular Biology, Centro di Sperimentazione e Assistenza Agricola (CeRSAA), Albenga, Italy
| | - Andrea Copetta
- Research Centre For Vegetable and Ornamental Crops (CREA), Sanremo, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Science, University of Genova, Genova, Italy
| | - Angela Bisio
- Department of Pharmacy, University of Genova, Genova, Italy
| | | | - Giuliana Drava
- Department of Pharmacy, University of Genova, Genova, Italy
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Giacobbe DR, Di Maria E, Tagliafico AS, Bavastro M, Trombetta CS, Marelli C, Di Meco G, Cattardico G, Mora S, Signori A, Vena A, Mikulska M, Dentone C, Bruzzone B, Bignotti B, Orsi A, Robba C, Ball L, Brunetti I, Battaglini D, Di Biagio A, Sormani MP, Pelosi P, Giacomini M, Icardi G, Bassetti M. External validation of unsupervised COVID-19 clinical phenotypes and their prognostic impact. Ann Med 2023; 55:2195204. [PMID: 37052252 PMCID: PMC10116925 DOI: 10.1080/07853890.2023.2195204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Hospitalized patients with coronavirus disease 2019 (COVID-19) can be classified into different clinical phenotypes based on their demographic, clinical, radiology, and laboratory features. We aimed to validate in an external cohort of hospitalized COVID-19 patients the prognostic value of a previously described phenotyping system (FEN-COVID-19) and to assess the reproducibility of phenotypes development as a secondary analysis. METHODS Patients were classified in phenotypes A, B or C according to the severity of oxygenation impairment, inflammatory response, hemodynamic and laboratory tests according to the FEN-COVID-19 method. RESULTS Overall, 992 patients were included in the study, and 181 (18%), 757 (76%) and 54 (6%) of them were assigned to the FEN-COVID-19 phenotypes A, B, and C, respectively. An association with mortality was observed for phenotype C vs. A (hazard ratio [HR] 3.10, 95% confidence interval [CI] 1.81-5.30, p < 0.001) and for phenotype C vs. B (HR 2.20, 95% CI 1.50-3.23, p < 0.001). A non-statistically significant trend towards higher mortality was also observed for phenotype B vs. A (HR 1.41; 95% CI 0.92-2.15, p = 0.115). By means of cluster analysis, three different phenotypes were also identified in our cohort, with an overall similar gradient in terms of prognostic impact to that observed when patients were assigned to FEN-COVID-19 phenotypes. CONCLUSIONS The prognostic impact of FEN-COVID-19 phenotypes was confirmed in our external cohort, although with less difference in mortality between phenotypes A and B than in the original study.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emilio Di Maria
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- University Unit of Medical Genetics, Galliera Hospital, Genoa, Italy
| | - Alberto Stefano Tagliafico
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Martina Bavastro
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo Simone Trombetta
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Marelli
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gabriele Di Meco
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Greta Cattardico
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Dentone
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bianca Bignotti
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Andrea Orsi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Iole Brunetti
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Di Biagio
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Pia Sormani
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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7
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Russo C, Tagliafico L, Labate L, Ponzano M, Mirabella M, Portunato F, Bellezza C, Mora S, Arboscello E, Monacelli F, Nencioni A, Signori A, Bruzzone B, Giacomini M, Dentone C, Bassetti M. Effect of SARS-CoV-2 vaccination in a vulnerable COVID-19 cohort: a real-life experience in an Italian Hospital. J Chemother 2023; 35:730-736. [PMID: 37608747 DOI: 10.1080/1120009x.2023.2246716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 08/24/2023]
Abstract
Clinical trials demonstrated that SARS-CoV-2 vaccines reduce COVID-19-related mortality and morbidity. We describe the effect of vaccination on COVID-19-patients admitted at our hospital. Retrospective, single-center study conducted in Genoa, Italy, including patients ≥18years hospitalized for COVID-19 from May to December 2021. Demographical and clinical data were collected, vaccinated (group-A) and not-vaccinated (group-B) patients were compared. Impact of vaccination on mortality, ICU admission, and oxygen need was studied using Cox proportional hazards and logistic regression models after adjusting for propensity scores. Overall, 395 patients SARS-CoV-2 infected were included, of which 150 (38%) were vaccinated and 245 (62%) were not vaccinated. Patients in group-A were older, more disable, and with higher morbidity. Overall, 64 patients (16%) died within 30 days from admission, 34 in Group A (23%), and 30 in group B (12%). However, no statistically significant differences were observed (group-A versus group-B: HR 0.83, 95% CI 0.49-1.40, p = 0.483). On the other hand, vaccination was protective in terms of ICU admission (OR = 0.23, p = 0.046) and oxygen need (OR = 0.33, p = 0.008). Our study confirms that SARS-CoV-2 vaccination reduces morbidity among patients hospitalized for COVID-19. The still high mortality in our cohort of vaccinated individuals could be partially due to vulnerable conditions of our patients.
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Affiliation(s)
- Chiara Russo
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Tagliafico
- Department of Internal Medicine (DIMI), Geriatric Clinic, University of Genoa, Genoa, Italy
| | - Laura Labate
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Ponzano
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | | | - Carmen Bellezza
- Department of Emergency, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Mora
- Department of Informatics Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genova, Genoa, Italy
| | - Eleonora Arboscello
- Department of Emergency, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine (DIMI), Geriatric Clinic, University of Genoa, Genoa, Italy
| | - Alessio Nencioni
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine (DIMI), Geriatric Clinic, University of Genoa, Genoa, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genova, Genoa, Italy
| | | | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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8
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Giacobbe DR, Marelli C, Mora S, Guastavino S, Russo C, Brucci G, Limongelli A, Vena A, Mikulska M, Tayefi M, Peluso S, Signori A, Di Biagio A, Marchese A, Campi C, Giacomini M, Bassetti M. Early diagnosis of candidemia with explainable machine learning on automatically extracted laboratory and microbiological data: results of the AUTO-CAND project. Ann Med 2023; 55:2285454. [PMID: 38010342 PMCID: PMC10836245 DOI: 10.1080/07853890.2023.2285454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Candidemia is associated with a heavy burden of morbidity and mortality in hospitalized patients. The availability of blood culture results could require up to 48-72 h after blood draw; thus, early treatment decisions are made in the absence of a definite diagnosis. METHODS In this retrospective study, we assessed the performance of different supervised machine learning algorithms for the early differential diagnosis of candidemia and bacteremia in adult patients on a large dataset automatically extracted within the AUTO-CAND project. RESULTS Overall, 12,483 episodes of candidemia (1275; 10%) or bacteremia (11,208; 90%) were included in the analysis. A random forest classifier achieved the best diagnostic performance for candidemia, with sensitivity 0.98 and specificity 0.65 on the training set (true skill statistic [TSS] = 0.63) and sensitivity 0.74 and specificity 0.57 on the test set (TSS = 0.31). Then, the random classifier was trained in the subgroup of patients with available serum β-D-glucan (BDG) and procalcitonin (PCT) values by exploiting the feature ranking learned in the entire dataset. Although no statistically significant differences were observed from the performance measures obtained by employing BDG and PCT alone, the performance measures of the classifier that included the features selected in the entire dataset, plus BDG and PCT, were the highest in most cases. CONCLUSIONS Random forest classifiers trained on large datasets of automatically extracted data have the potential to improve current diagnostic algorithms for candidemia. However, further development through implementation of automatically extracted clinical features may be necessary to achieve crucial improvements.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Marelli
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | | | - Chiara Russo
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgia Brucci
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Limongelli
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maryam Tayefi
- Norwegian Centre for E-Health Research, Tromsø, Norway
| | - Stefano Peluso
- Department of Statistics and Quantitative Methods, University of Milan - Bicocca, Milan, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Marchese
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Microbiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Campi
- Department of Mathematics (DIMA), University of Genoa, Genoa, Italy
- Life Science Computational Laboratory (LISCOMP), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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9
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Blobel B, Ruotsalainen P, Oemig F, Giacomini M, Sottile PA, Endsleff F. Principles and Standards for Designing and Managing Integrable and Interoperable Transformed Health Ecosystems. J Pers Med 2023; 13:1579. [PMID: 38003894 PMCID: PMC10672117 DOI: 10.3390/jpm13111579] [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: 09/08/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
The advancement of sciences and technologies, economic challenges, increasing expectations, and consumerism result in a radical transformation of health and social care around the globe, characterized by foundational organizational, methodological, and technological paradigm changes. The transformation of the health and social care ecosystems aims at ubiquitously providing personalized, preventive, predictive, participative precision (5P) medicine, considering and understanding the individual's health status in a comprehensive context from the elementary particle up to society. For designing and implementing such advanced ecosystems, an understanding and correct representation of the structure, function, and relations of their components is inevitable, thereby including the perspectives, principles, and methodologies of all included disciplines. To guarantee consistent and conformant processes and outcomes, the specifications and principles must be based on international standards. A core standard for representing transformed health ecosystems and managing the integration and interoperability of systems, components, specifications, and artifacts is ISO 23903:2021, therefore playing a central role in this publication. Consequently, ISO/TC 215 and CEN/TC 251, both representing the international standardization on health informatics, declared the deployment of ISO 23903:2021 mandatory for all their projects and standards addressing more than one domain. The paper summarizes and concludes the first author's leading engagement in the evolution of pHealth in Europe and beyond over the last 15 years, discussing the concepts, principles, and standards for designing, implementing, and managing 5P medicine ecosystems. It not only introduces the theoretical foundations of the approach but also exemplifies its deployment in practical projects and solutions regarding interoperability and integration in multi-domain ecosystems. The presented approach enables comprehensive and consistent integration of and interoperability between domains, systems, related actors, specifications, standards, and solutions. That way, it should help overcome the problems and limitations of data-centric approaches, which still dominate projects and products nowadays, and replace them with knowledge-centric, comprehensive, and consistent ones.
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Affiliation(s)
- Bernd Blobel
- Medical Faculty, University of Regensburg, 93053 Regensburg, Germany
- Faculty European Campus Rottal-Inn, Deggendorf Institute of Technology, 94469 Deggendorf, Germany
- First Medical Faculty, Charles University Prague, 11000 Staré Mĕsto, Czech Republic
| | - Pekka Ruotsalainen
- Faculty of Information Technology and Communication Sciences, Tampere University, 33100 Tampere, Finland;
| | - Frank Oemig
- IT-Consulting in Healthcare, 45472 Mülheim, Germany;
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, 16145 Genoa, Italy;
| | | | - Frederik Endsleff
- IT Architecture, Centre for IT and Medical Technology (CIMT), The Capital Region of Denmark, 2100 Copenhagen, Denmark;
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Bregante B, Paoli G, Sanguineti V, Scillieri GS, Giacomini M. Comparison of Different Telemedicine Services to Pre-Evaluate Their Use in a New "Computational Hospital". Stud Health Technol Inform 2023; 309:165-169. [PMID: 37869832 DOI: 10.3233/shti230767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Future healthcare is transitioning toward a decentralization of patient care, in which personal care is increasingly moved at the patient home and surrounding areas, while hospitals concentrate primarily on procedures that cannot be performed elsewhere, such as surgeries or outpatient examinations. The healthcare system in the Liguria region (Italy) is currently developing a new Center for Computational and Technological Medicine (CMCT), which is intended to facilitate and support this transition. As a component of the strategic planning and design process, this study examines the development and organization of telemedicine services across a range of chosen Italian and European institutions that share similarities with CMCT in terms of scope and scale. We specifically focus on telemedicine services - how they are governed, their main fields of application. The analysis confirmed the growing importance of telemedicine as part of the new vision of medicine, in which the patient is at the center.
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Affiliation(s)
- Beatrice Bregante
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | | | - Vittorio Sanguineti
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Gaetano Stefano Scillieri
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
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11
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Cappello A, Mora S, Giacobbe DR, Bassetti M, Giacomini M. Defining a Preprocessing Pipeline for the MULTI-SITA Project and General Medical Italian Natural Language Data. Stud Health Technol Inform 2023; 309:48-52. [PMID: 37869804 DOI: 10.3233/shti230737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
The application of Natural Language Processing (NLP) to medical data has revolutionized different aspects of health care. The benefits obtained from the implementation of this technique spill over into several areas, including in the implementation of chatbots, which can provide medical assistance remotely. Every possible application of NLP depends on one first main step: the pre-processing of the corpus retrieved. The raw data must be prepared with the aim to be used efficiently for further analysis. Considerable progress has been made in this direction for the English language but for other languages, such as Italian, the state of the art is not equivalently advanced, especially for texts containing technical medical terms. The aim of this work is to identify and develop a preprocessing pipeline suitable for medical data written in Italian. The pipeline has been developed in Python environment, employing Enchant, ntlk modules and Hugging Face's BERT and BART-based models. Then, it has been tested on real conversations typed between patients and physicians regarding medical questions. The algorithm has been developed within the MULTI-SITA project of the Italian Society of Anti-Infective Therapy (SITA), but shows a flexible structure that can adapt to a large variety of data.
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Affiliation(s)
- Alice Cappello
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
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12
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Giacobbe DR, Marelli C, Cattardico G, Fanelli C, Signori A, Di Meco G, Di Pilato V, Mikulska M, Mazzitelli M, Cattelan AM, Pallotto C, Francisci D, Calabresi A, Lombardi A, Gori A, Del Bono V, Aldieri C, Losito AR, Raffaelli F, Cortegiani A, Milazzo M, Del Puente F, Pontali E, De Rosa FG, Corcione S, Mularoni A, Russelli G, Giacomini M, Badalucco Ciotta F, Oltolini C, Serino FS, Momesso E, Spinicci M, Graziani L, Torti C, Trecarichi EM, Merli M, D'Amico F, Marchese A, Vena A, Bassetti M. Mortality in KPC-producing Klebsiella pneumoniae bloodstream infections: a changing landscape. J Antimicrob Chemother 2023; 78:2505-2514. [PMID: 37606528 DOI: 10.1093/jac/dkad262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVES To assess the impact of carbapenem resistance on mortality in Klebsiella pneumoniae bloodstream infection (BSI) in the era of novel β-lactam/β-lactamase inhibitor combinations. MATERIAL AND METHODS Retrospective study of patients with K. pneumoniae BSI between January and August 2020 in 16 centres (CARBANEW study within the MULTI-SITA project). RESULTS Overall, 426 patients were included: 107/426 (25%) had carbapenem-resistant K. pneumoniae (CR-Kp) BSI and 319/426 (75%) had carbapenem-susceptible K. pneumoniae (CS-Kp) BSI. Crude cumulative 30 day mortality was 33.8% and 20.7% in patients with, respectively, CR-Kp BSI and CS-Kp BSI (P = 0.027). Carbapenemase production or carbapenemase-encoding genes were detected in 84/98 tested CR-Kp isolates (85.7%), mainly KPC (78/84; 92.9%). Ceftazidime/avibactam was the most frequently used appropriate therapy for CR-Kp BSI (80/107; 74.7%). In multivariable analyses, variables showing an unfavourable association with mortality after correction for multiple testing were age-adjusted Charlson comorbidity index (HR 1.20; 95% CI 1.10-1.31, P < 0.001) and Pitt score (HR 1.33; 95% CI 1.15-1.55, P < 0.001), but not carbapenem resistance (HR 1.28, 95% CI 0.74-2.22, P = 0.410). In a propensity score-matched analysis, there was no difference in mortality between patients appropriately treated with ceftazidime/avibactam for CR-Kp BSI and patients appropriately treated with other agents (mainly meropenem monotherapy or piperacillin/tazobactam monotherapy) for CS-Kp BSI (HR 1.07; 95% CI 0.50-2.29, P = 0.866). CONCLUSIONS Our results suggest that the increased mortality in CR-Kp BSI compared with CS-Kp BSI is not (or no longer) dependent on the type of therapy in areas where ceftazidime/avibactam-susceptible KPC-producing isolates are the most prevalent type of CR-Kp.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Marelli
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Greta Cattardico
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Fanelli
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Medicine, Surgery and Pharmacy, Unit of Infectious Diseases, University of Sassari, Sassari, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Gabriele Di Meco
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Carlo Pallotto
- Department of Medicine and Surgery, Clinic of Infectious Diseases, 'Santa Maria della Misericordia' Hospital, University of Perugia, Perugia, Italy
| | - Daniela Francisci
- Department of Medicine and Surgery, Clinic of Infectious Diseases, 'Santa Maria della Misericordia' Hospital, University of Perugia, Perugia, Italy
| | - Alessandra Calabresi
- SOC Malattie Infettive, ASO 'SS Antonio e Biagio e C. Arrigo', Alessandria, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Andrea Gori
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Ospedale Luigi Sacco-Polo Universitario, Milan, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Chiara Aldieri
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Angela Raffaella Losito
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Raffaelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, University of Palermo, Palermo, Italy
- Department of Anesthesia Analgesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Marta Milazzo
- Department of Surgical, Oncological and Oral Science, University of Palermo, Palermo, Italy
| | | | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- Unit of Infectious Diseases, Cardinal Massaia, Asti, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Alessandra Mularoni
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Giovanna Russelli
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Flavia Badalucco Ciotta
- Clinic of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Oltolini
- Clinic of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Saverio Serino
- Azienda ULSS4 Veneto Orientale, UOS Malattie Infettive, UOC Medicina Generale, Ospedale di Portogruaro, Portogruaro, Italy
| | - Elena Momesso
- Azienda ULSS4 Veneto Orientale, UOC Anestesia e Rianimazione, Ospedale di San Donà di Piave, San Donà di Piave, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lucia Graziani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carlo Torti
- Department of Medical and Surgical Sciences, University 'Magna Graecia', Catanzaro, Italy
- Unit of Infectious and Tropical Diseases, 'Mater Domini' Teaching Hospital, Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, University 'Magna Graecia', Catanzaro, Italy
- Unit of Infectious and Tropical Diseases, 'Mater Domini' Teaching Hospital, Catanzaro, Italy
| | - Marco Merli
- Infectious Diseases Clinic, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Federico D'Amico
- Infectious Diseases Clinic, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Anna Marchese
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- UO Microbiologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Bartalucci C, Taramasso L, Nicolini LA, Magnasco L, Labate L, Vena A, Mora S, Giacomini M, Bassetti M, Di Biagio A. Barriers to HCV micro-elimination in a cohort of people living with HIV (PLWH). New Microbiol 2023; 46:246-251. [PMID: 37747468] [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] [Received: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 09/26/2023]
Abstract
To achieve the World Health Organization goal of hepatitis C virus (HCV) eradication, barriers to treatment should be investigated and overcome. The aim of this study was to identify those barriers and describe the strategies adopted to achieve HCV micro-elimination in a cohort of coinfected people living with HIV (PLWH-HCV). Adult PLWH-HCV followed at our hospital with detectable serum HCV-RNA in 2018 were enrolled. After a three-year follow-up, barriers to HCV treatment were investigated and strategies to overcome them were described. Of 492 PLWH-HCV seen in 2018, 29 (5.9%) had detectable serum HCV-RNA. Eight out of 29 (27.6%) were excluded because they were already under treatment, while 2 others were excluded because they moved to other outpatient clinics. Among the remaining 19 study participants, the most common barriers to treatment were poor adherence to therapies and follow-up visits (n=9, 47%), recent HCV diagnosis awaiting proper staging (n=3, 16%) and treatment hesitancy (n=2, 10%). During the following three years, direct-acting antivirals (DAAs) treatment was completed in 11/19 (58%) cases, with achievement of sustained virological response in 100% of cases. For the remaining cases, 2/19 (10.5%) were lost to follow-up, 2/19 (10.5%) died before treatment initiation and 4/19 (21.0%) are still awaiting treatment. Despite 3 years of effort, HCV micro-elimination has not been achieved at our center. We observed that poor adherence and treatment hesitancy were the main barriers to treatment. Strategies addressing these issues need to be implemented.
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Affiliation(s)
- Claudia Bartalucci
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health's Sciences, University of Genoa, Italy
| | | | | | | | - Laura Labate
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health's Sciences, University of Genoa, Italy
| | - Antonio Vena
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health's Sciences, University of Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Italy
| | - Matteo Bassetti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health's Sciences, University of Genoa, Italy
| | - Antonio Di Biagio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health's Sciences, University of Genoa, Italy
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14
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Giacobbe DR, Dettori S, Di Pilato V, Asperges E, Ball L, Berti E, Blennow O, Bruzzone B, Calvet L, Capra Marzani F, Casabella A, Choudaly S, Dartevel A, De Pascale G, Di Meco G, Fallon M, Galerneau LM, Gallego M, Giacomini M, González Sáez A, Hänsel L, Icardi G, Koehler P, Lagrou K, Lahmer T, Lewis White P, Magnasco L, Marchese A, Marelli C, Marín-Arriaza M, Martin-Loeches I, Mekontso-Dessap A, Mikulska M, Mularoni A, Nordlander A, Poissy J, Russelli G, Signori A, Tascini C, Vaconsin LM, Vargas J, Vena A, Wauters J, Pelosi P, Timsit JF, Bassetti M. Pneumocystis jirovecii pneumonia in intensive care units: a multicenter study by ESGCIP and EFISG. Crit Care 2023; 27:323. [PMID: 37620828 PMCID: PMC10464114 DOI: 10.1186/s13054-023-04608-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Pneumocystis jirovecii pneumonia (PJP) is an opportunistic, life-threatening disease commonly affecting immunocompromised patients. The distribution of predisposing diseases or conditions in critically ill patients admitted to intensive care unit (ICU) and subjected to diagnostic work-up for PJP has seldom been explored. MATERIALS AND METHODS The primary objective of the study was to describe the characteristics of ICU patients subjected to diagnostic workup for PJP. The secondary objectives were: (i) to assess demographic and clinical variables associated with PJP; (ii) to assess the performance of Pneumocystis PCR on respiratory specimens and serum BDG for the diagnosis of PJP; (iii) to describe 30-day and 90-day mortality in the study population. RESULTS Overall, 600 patients were included in the study, of whom 115 had presumptive/proven PJP (19.2%). Only 8.8% of ICU patients subjected to diagnostic workup for PJP had HIV infection, whereas hematological malignancy, solid tumor, inflammatory diseases, and solid organ transplants were present in 23.2%, 16.2%, 15.5%, and 10.0% of tested patients, respectively. In multivariable analysis, AIDS (odds ratio [OR] 3.31; 95% confidence interval [CI] 1.13-9.64, p = 0.029), non-Hodgkin lymphoma (OR 3.71; 95% CI 1.23-11.18, p = 0.020), vasculitis (OR 5.95; 95% CI 1.07-33.22, p = 0.042), metastatic solid tumor (OR 4.31; 95% CI 1.76-10.53, p = 0.001), and bilateral ground glass on CT scan (OR 2.19; 95% CI 1.01-4.78, p = 0.048) were associated with PJP, whereas an inverse association was observed for increasing lymphocyte cell count (OR 0.64; 95% CI 0.42-1.00, p = 0.049). For the diagnosis of PJP, higher positive predictive value (PPV) was observed when both respiratory Pneumocystis PCR and serum BDG were positive compared to individual assay positivity (72% for the combination vs. 63% for PCR and 39% for BDG). Cumulative 30-day mortality and 90-day mortality in patients with presumptive/proven PJP were 52% and 67%, respectively. CONCLUSION PJP in critically ill patients admitted to ICU is nowadays most encountered in non-HIV patients. Serum BDG when used in combination with respiratory Pneumocystis PCR could help improve the certainty of PJP diagnosis.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy.
| | - Silvia Dettori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy
| | - Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Erika Asperges
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Enora Berti
- Assistance Publique - Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Bianca Bruzzone
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Laure Calvet
- Service de Médecine Intensive Réanimation, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Federico Capra Marzani
- Servizio di Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Casabella
- Microbiology Unit, Laboratory Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Sofia Choudaly
- Inserm U1285, CHU Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale Et Fonctionnelle, University of Lille, 59000, Lille, France
| | - Anais Dartevel
- Medical Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Gennaro De Pascale
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele Di Meco
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy
| | - Melissa Fallon
- Public Health Wales Mycology Reference Laboratory, PHW Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, UK
| | | | - Miguel Gallego
- Respiratory Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Adolfo González Sáez
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Luise Hänsel
- Department I of Internal Medicine, Excellence Centre for Medical Mycology (ECMM), Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
- Medical Faculty and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Giancarlo Icardi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Philipp Koehler
- Department I of Internal Medicine, Excellence Centre for Medical Mycology (ECMM), Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
- Medical Faculty and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Tobias Lahmer
- Department of Internal Medicine II, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - P Lewis White
- Public Health Wales Mycology Reference Laboratory, PHW Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, UK
- Division of Infection and Immunity, Cardiff University Centre for Trials Research, Heath Park, Cardiff, UK
| | - Laura Magnasco
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy
| | - Anna Marchese
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- UO Microbiologia, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Cristina Marelli
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy
| | - Mercedes Marín-Arriaza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Leinster, Ireland
- Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, CIBERES, Barcelona, Spain
| | - Armand Mekontso-Dessap
- Assistance Publique - Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, IMRB, Creteil, Île-de-France, France
- INSERM, Creteil, Île-de-France, France
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy
| | - Alessandra Mularoni
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Anna Nordlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Julien Poissy
- Inserm U1285, CHU Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale Et Fonctionnelle, University of Lille, 59000, Lille, France
- Department of Intensive Care Medicine, Critical Care Center, CHU Lille, 59000, Lille, France
| | - Giovanna Russelli
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Carlo Tascini
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | | | - Joel Vargas
- Dipartimento di Scienze Dell'emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy
| | - Joost Wauters
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Jean-Francois Timsit
- Medical and Infectious Diseases ICU, APHP, Bichat Hospital, Paris, France
- INSERM, IAME, Université Paris Cité, Paris, France
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy
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Blobel B, Giacomini M. Selected Papers from the pHealth 2021 Conference, Genoa, Italy, 8-10 November 2021. J Pers Med 2023; 13:1213. [PMID: 37623464 PMCID: PMC10456097 DOI: 10.3390/jpm13081213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 07/29/2023] [Accepted: 07/29/2023] [Indexed: 08/26/2023] Open
Abstract
This Special Issue of the Journal of Personalized Medicine presents extended versions of selected contributions to pHealth 2021, the 18th International Conference on Wearable Micro and Nano Technologies for Personalized Health, held on 8-10 November 2021 in Genoa, Italy [...].
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Affiliation(s)
- Bernd Blobel
- Medical Faculty, University of Regensburg, 93053 Regensburg, Germany
- Faculty European Campus Rottal-Inn, Deggendorf Institute of Technology, 94469 Deggendorf, Germany
- First Medical Faculty, Charles University of Prague, Stare Mesto 110 00, Czech Republic
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16
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Boaglio A, Parra-Calderón CL, Martinez-García A, Escalona-Cuaresma MJ, Maggi N, Coviello D, Uva P, Giacomini M. From FAIR4Health Project to 1+MG Initiative: A Spain - Italy Collaboration. Stud Health Technol Inform 2023; 302:386-387. [PMID: 37203698 DOI: 10.3233/shti230153] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Results of two major projects funded by the European Union are taken into consideration: Fair4Health regarding the possibility of sharing clinical data in various environments applying FAIR principles and 1+Million Genome for the in-depth study of the human genome in Europe. Specifically, the Gaslini hospital plans to move on both areas joining the Hospital on FHIR initiative matured within the fair4health project and also collaborate with other Italian healthcare facilities through the implementation of a Proof of Concept (PoC) in the 1+MG. The aim of this short paper is to evaluate the applicability of some of the tools of the fair4health project to the Gaslini infrastructure to facilitate its participation in the PoC. One of the aims is also to prove the possibility of reuse the results of well-performed European funded projects to boost routine research in qualified healthcare facilities.
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Affiliation(s)
| | | | | | | | | | | | - Paolo Uva
- IRCCS Istituto Giannina Gaslini, Genoa, Italy
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17
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Murgia Y, Bonetto M, Gazzarata R, Brogonzoli L, Iardino R, Venturi A, Giacomini M. Standardization Proposal for the Transmission of Waiting List Data in Italy. Stud Health Technol Inform 2023; 302:846-850. [PMID: 37203515 DOI: 10.3233/shti230287] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Each Italian region is required to manage and disclose data relating to waiting times for healthcare services which are provided by both public and private hospitals and local health units accredited to the Sistema Sanitario Nazionale (SSN - in English, National Healthcare System). The current law governing data relating to waiting times and their sharing is the Piano Nazionale di Governo delle Liste di Attesa (PNGLA - in English National Government Plan for Waiting Lists). However, this plan does not propose a standard to monitor such data, but only provides a few guidelines that the Italian regions are required to follow. The lack of a specific technical standard for managing sharing of waiting list data and the lack of precise and binding information in the PNGLA make the management and transmission of such data problematic, reducing the interoperability necessary to have an effective and efficient monitoring of the phenomenon. The proposal for a new standard for the transmission of waiting list data derives from these shortcomings. This proposed standard promotes greater interoperability, is easy to create with an implementation guide, and has sufficient degrees of freedom to assist the document author.
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Affiliation(s)
- Ylenia Murgia
- Dep. Of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | | | | | | | | | - Alessandro Venturi
- Dep. of Political and Social Sciences, University of Pavia, Pavia, Italy
- I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Mauro Giacomini
- Dep. Of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
- Healthropy s.r.l., Savona, Italy
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18
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Di Meco G, Giacobbe DR, Mora S, Dettori S, Bassetti M, Giacomini M. Protocol of Validation Mechanisms Within the Design of an Electronic Case Report Form for the MULTI-SITA Project. Stud Health Technol Inform 2023; 302:380-381. [PMID: 37203695 DOI: 10.3233/shti230150] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
With the wide diffusion of web technology, dedicated electronic Case Report Forms (eCRFs) became the main tool for collecting patient data. The focus of this work is to thoroughly consider the data quality in every aspect of the design of the eCRF, with the result of having multiple steps of validation that should produce a diligent and multidisciplinary approach towards every step of data acquisition. This goal affects every aspect of the system design.
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Affiliation(s)
| | - Daniele Roberto Giacobbe
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Silvia Dettori
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
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Mora S, Giannini B, Di Biagio A, Cenderello G, Nicolini LA, Taramasso L, Dentone C, Bassetti M, Giacomini M. Ten Years of Medical Informatics and Standards Support for Clinical Research in an Infectious Diseases Network. Appl Clin Inform 2023; 14:16-27. [PMID: 36631000 PMCID: PMC9833953 DOI: 10.1055/s-0042-1760081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND It is 30 years since evidence-based medicine became a great support for individual clinical expertise in daily practice and scientific research. Electronic systems can be used to achieve the goal of collecting data from heterogeneous datasets and to support multicenter clinical trials. The Ligurian Infectious Diseases Network (LIDN) is a web-based platform for data collection and reuse originating from a regional effort and involving many professionals from different fields. OBJECTIVES The objective of this work is to present an integrated system of ad hoc interfaces and tools that we use to perform pseudonymous clinical data collection, both manually and automatically, to support clinical trials. METHODS The project comprehends different scenarios of data collection systems, according to the degree of information technology of the involved centers. To be compliant with national regulations, the last developed connection is based on the standard Clinical Document Architecture Release 2 by Health Level 7 guidelines, interoperability is supported by the involvement of a terminology service. RESULTS Since 2011, the LIDN platform has involved more than 8,000 patients from eight different hospitals, treated or under treatment for at least one infectious disease among human immunodeficiency virus (HIV), hepatitis C virus, severe acute respiratory syndrome coronavirus 2, and tuberculosis. Since 2013, systems for the automatic transfer of laboratory data have been updating patients' information for three centers, daily. Direct communication was set up between the LIDN architecture and three of the main national cohorts of HIV-infected patients. CONCLUSION The LIDN was originally developed to support clinicians involved in the project in the management of data from HIV-infected patients through a web-based tool that could be easily used in primary-care units. Then, the developed system grew modularly to respond to the specific needs that arose over a time span of more than 10 years.
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Affiliation(s)
- Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy,Address for correspondence Sara Mora, Eng Department of Informatics, Bioengineering, Robotics and System Engineering, (DIBRIS), University of GenoaItaly
| | - Barbara Giannini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy,Department of Infectious Disease, IRCCS AOU San Martino IST, (DISSAL), University of Genoa, Italy
| | | | - Laura Ambra Nicolini
- Infectious Diseases Unit, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Chiara Dentone
- Infectious Diseases Unit, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy,Department of Infectious Disease, IRCCS AOU San Martino IST, (DISSAL), University of Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
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Taramasso L, Labate L, Briano F, Brucci G, Mora S, Blanchi S, Giacomini M, Bassetti M, Di Biagio A. CD4+ T lymphocyte recovery in the modern antiretroviral therapy era: Toward a new threshold for defining immunological non-responders. Front Virol 2023. [DOI: 10.3389/fviro.2022.822153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IntroductionDespite the high level of efficacy of modern antiretroviral therapy (ART) in reducing HIV viremia and the control of viral replication, some people living with HIV (PLWH) do not recover their CD4+ T cell count.MethodsTo evaluate the frequency and predictive factors of discordant immune responses, we performed a retrospective cohort study of 324 antiretroviral-naïve PLWH who initiated first-line ART between 2008 and 2018 and maintained HIV RNA < 50 copies/ml during 36 months of follow-up. PLWH were defined as immunological non-responders (INRs) when CD4+ T cell count was < 20% compared with baseline (INR20%), or < 500 cells/mm3 (INR500) or < 200 cells/mm3 (INR200) at 36 months.ResultsThe prevalence of INR20%, INR500, and INR200 was 12.5%, 34.6%, and 1.5%, respectively. After adjustment for possible confounders, CD4 nadir showed a significant association with all INR definitions, with lower values predicting INR500 (aOR 0.98, 95% CI 0.98–0.99, p < 0.001) and INR200 (aOR 0.98, 95% CI 0.95–1.01, p = 0.096). Moreover, a higher baseline CD4/CD8 ratio was inversely related to the probability of being INR500 (OR 0.03, 95% CI 0.01–0.12, p < 0.001) and INR200 (OR 0.002, 95% CI 18–7–67.72, p = 0.255). By contrast, INR20% had a higher CD4 nadir and CD4/CD8 ratio than other INRs, suggesting the identification of an heterogenous population with such definition.DiscussionThe present study highlights how INR200 has become rare in the contemporary ART era, and about one-third of PLWH meet the criteria for INR500. Overcoming the threshold of 500 CD4/mm3 could be an appropriate definition of immune response, in contrast with the older definitions of INR200 and INR20%. Early diagnosis and rapid treatment initiation, before CD4 counts and the CD4/CD8 ratio begin to decline, are critical for achieving an optimal immune response.
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Russo C, Tagliafico L, Labate L, Ponzano M, Mirabella M, Portunato F, Bellezza C, Mora S, Arboscello E, Nencioni A, Giacomini M, Dentone C, Bassetti M. 1942. Effect of SARS-CoV-2 Vaccination in a Frailty COVID-19 Cohort: a Real Life Experience in a Northern Italy Hospital. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Clinical trial demonstrated that SARS-CoV-2 vaccines have the ability of reduce mortality and morbidity due to COVID-19.
The aim of this study is to describe the effect of vaccination in term of mortality, type of ventilation and ICU admission among patients hospitalized for COVID-19 from May to December 2021 in a Ligurian Hospital.
Methods
This is a retrospective, single-center study conducted in San Martino Hospital (Genoa, Italy), including patients ≥ 18 years hospitalized for COVID-19 in Infectious Disease and Emergency Units from 1st May to 31st December 2021. We collected demographical data, multimorbidity and disability score, vaccination time (“vaccinated” all patients hospitalized ≥ 14 days after first dose or ≥ 7 days after second/third dose), therapy for COVID-19, mortality at 7 and 30 days, ICU admission, ventilation type. Characteristics of vaccinated (group A) versus non vaccinated (group B) patients were compared using Chi-squared/Fisher's exact test for categorical variables and t-test /Kruskal-Wallis test for the continuous ones. Cox proportional hazards models for death at 30 days were performed as univariate analysis as well as adjusting for age, Cumulative Illness Rating Scale [CIRS], gender, Remdesivir, Monoclonal antibodies, Tocilizumab use.
Results
Overall, 405 patients SARS-CoV-2 infected were enrolled. Data about timing of vaccination were available for 360 patients (89%). We compared clinical characteristics and outcomes of group A (32%) versus group B (68%). In group A patients were older (p< 0.001) and frailer (higher CIRS score and lower Barthel index, p< 0.001) than in group B. Among patients requiring oxygen, 76 (31.5%) in group B vs 26 (22.41%) in group A needed high flow ventilation (p=0.036); 33 (13.52%) vs 3 (2.59%) respectively were admitted to ICU (Figure 1).
Mortality at 30 days after hospitalization was higher in group A at univariate analysis [HR(95%CI) 1.44(0.82; 2.53), p=0.208], lower at multivariate analysis [0.57(0.31; 1.02), p=0.059].
Conclusion
The results of this study confirm that SARS-CoV-2 vaccination reduces rate of admission to ICU and 30 days mortality among patients hospitalized for COVID-19. In our cohort mortality among vaccinated patients remains high and we hypothesized this is due to high frailty of evaluated population.
Disclosures
Chiara Dentone, CD, Angelini: Advisor/Consultant|Gilead: Advisor/Consultant|Menarini: Advisor/Consultant|Novartis: Advisor/Consultant Matteo Bassetti, PhD, Angelini: Advisor/Consultant|Astellas: Grant/Research Support|Bayer: Advisor/Consultant|Bayer: Honoraria|BioMe ́ rieux: Advisor/Consultant|BioMe ́ rieux: Honoraria|Cidara: Advisor/Consultant|Cidara: Honoraria|Cipla: Advisor/Consultant|Cipla: Honoraria|Gilead: Advisor/Consultant|Gilead: Honoraria|Menarini: Advisor/Consultant|Menarini: Honoraria|MSD: Advisor/Consultant|MSD: Honoraria|Nabriva: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Board Member|Pfizer: Grant/Research Support|Pfizer: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria|Tetraphase: Advisor/Consultant.
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Affiliation(s)
- Chiara Russo
- IRCCS Policlinic San Martino , Genoa, Liguria , Italy
| | | | - Laura Labate
- IRCCS Policlinic San Martino , Genoa, Liguria , Italy
| | | | | | | | | | - Sara Mora
- University of Genoa , Genoa, Liguria , Italy
| | | | | | | | - Chiara Dentone
- Policlinic IRCCS San Martino Hospital , Genoa, Liguria , Italy
| | - Matteo Bassetti
- Department of Health Science (DISSAL), Infectious Diseases Unit , Genova, Liguria , Italy
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22
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Blobel B, Ruotsalainen P, Giacomini M. Standards and Principles to Enable Interoperability and Integration of 5P Medicine Ecosystems. Stud Health Technol Inform 2022; 299:3-19. [PMID: 36325842 DOI: 10.3233/shti220958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Health and social care ecosystems are currently a matter of foundational organizational, methodological and technological paradigm changes towards personalized, preventive, predictive, participative precision (5P) medicine. For designing and implementing such advanced ecosystems, an understanding and correct representation of structure, function and relations of their components is inevitable. To guarantee consistent and conformant processes and outcomes, the specifications and principles must be internationally standardized. Summarizing the first author's Keynotes over the last 15 years of pHealth conferences, the paper discusses concepts, standards and principles of 5P medicine ecosystems including their design and implementation. Furthermore, a guidance to find and to deploy corresponding international standards in practical projects is provided.
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Affiliation(s)
- Bernd Blobel
- Medical Faculty, University of Regensburg, Germany
- eHealth Competence Center Bavaria, Deggendorf Institute of Technology, Germany
- First Medical Faculty, Charles University Prague, Czech Republic
| | - Pekka Ruotsalainen
- Faculty of Information Technology and Communication Sciences (ITC), Tampere University, Finland
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Italy
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23
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Mora S, Blobel B, Gazzarata R, Giacomini M. CTS2 OWL: Mapping OWL Ontologies to CTS2 Terminology Resources. Stud Health Technol Inform 2022; 299:44-52. [PMID: 36325845 DOI: 10.3233/shti220962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The advancement of healthcare towards P5 medicine requires communication and cooperation between all actors and institutions involved. Interoperability must go beyond integrating data from different sources and include the understanding of the meaning of the data in the context of concepts and contexts they represent for a specific use case. In other words, we have to advance from data sharing through sharing semantics up to sharing clinical and medical knowledge. According to the Good Modeling Best Practices, we have to start with describing the real-world business system by domain experts using Domain Ontologies before transforming it into an information and communication technology (ICT) system, thereafter specifying the informational components and then transforming the system into an implementable solution. Any representation style - in the system development process acc. to ISO 10746 called system view - is defined by a related ontology, to be distinguished from real-world domain ontologies representing the knowledge spaces of involved disciplines. The system enabling such representational transformation shall also support versioning as well as the management of historical evolutions. One of such systems is the Common Terminology Service Release 2 (CTS2), which is a standard that allows the complete management of terminological contents. The main objective of this work is to present the choices we made to transform an ontology, written in the standard Ontology Web Language (OWL), into the CTS2 objects. We tested our transformation approach with the Alzheimer's Disease Ontology. We managed to map all the elements of the considered ontology to CTS2 terminological resources, except for a subset of elements such as the equivalentClass derived from restrictions on other classes.
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Affiliation(s)
- Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Italy
| | - Bernd Blobel
- Medical Faculty, University of Regensburg, Regensburg, Germany
| | | | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Italy
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24
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Marceglia S, Balestra G, Bottrighi A, Giacomini M, Veltri P, Sacchi L. Developing the Digital Healthcare Workforce in Italy: The SIBIM Experience. Stud Health Technol Inform 2022; 298:46-50. [PMID: 36073454 DOI: 10.3233/shti220905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The digital healthcare workforce is usually composed of two major types of professionals: the healthcare workers, who are the users of eHealth, and the health informatics developers, who are usually computer scientists, biomedical engineers, or other technical experts. Health informatics educators have the responsibility to develop the appropriate skills for both, acting within their specific curricula. Here we present the experience of the Italian Society of Biomedical Informatics (SIBIM) and show that, whereas the technical curricula are widely covered with a large range of topics, the eHealth education in medical curricula is often limited to simple bioengineering and informatics skills, thus suggesting that eHealth associations and organizations at the national level should focus their efforts towards increasing the level of eHealth contents in medical schools.
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Affiliation(s)
- Sara Marceglia
- SIBIM, Società Scientifica Italiana di Informatica Biomedica
- Università di Trieste, Trieste, Italy
| | - Gabriella Balestra
- SIBIM, Società Scientifica Italiana di Informatica Biomedica
- Politecnico di Torino, Torino, Italy
| | - Alessio Bottrighi
- SIBIM, Società Scientifica Italiana di Informatica Biomedica
- DISIT, Università del Piemonte Orientale, Alessandria, Italy
- AI@UPO, Università del Piemonte Orientale, Vercelli, Italy
| | - Mauro Giacomini
- SIBIM, Società Scientifica Italiana di Informatica Biomedica
- Università di Genova, Genova, Italy
| | - Pierangelo Veltri
- SIBIM, Società Scientifica Italiana di Informatica Biomedica
- Università Magna Graecia di Catanzaro, Catanzaro, Italy
| | - Lucia Sacchi
- SIBIM, Società Scientifica Italiana di Informatica Biomedica
- Università di Pavia, Pavia, Italy
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25
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Lovisolo L, Paoli G, Luciani MN, Scillieri GS, Giacomini M. Criteria for the Evaluation of Italian Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS): Comparison with European Standards and Certification Models. Stud Health Technol Inform 2022; 298:122-126. [PMID: 36073469 DOI: 10.3233/shti220920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The definition of the title "Istituto di Ricovero e Cura a Carattere Scientifico" (IRCCS) and how this title is given by the Italian Ministry of Health is presented. Specifically, the first assessment of a commission concerning the essential information for the accreditation process is introduced. Moreover, the two years review process that aims to collect last updated information of the IRCCS, to identify level of excellence and critical aspects, is also explained. The present Italian forms and international manuals like Joint Commission, OECI and HCERES were schematized using UML diagrams. The current IRCCS accreditation forms are presented with the suggested updates organized in some levels of structuring. We compared the Italian forms with the manuals required to obtain international certifications (Joint Commission and OECI) and we analyzed the criteria for the evaluation of research units in France (the HCERES standards). Although it is a preliminary study, the use of UML diagrams allows to schematize a new accreditation model, in line with European guidelines and the most important international certifications.
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26
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Dettori S, Russo C, Mora S, Giacomini M, Taramasso L, Dentone C, Vena A, Bassetti M, Di Biagio A. Prevalence of Viral Hepatitis in Unselected, Consecutively Enrolled Patients Hospitalised for SARS-CoV-2. J Community Health 2022; 47:800-805. [PMID: 35729474 PMCID: PMC9211782 DOI: 10.1007/s10900-022-01111-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 02/07/2023]
Abstract
Diagnosing people living with chronic viral hepatitis is challenging due to the absence of symptoms as long as liver decompensated cirrhosis come out. The aim of this retrospective study was to evaluate the prevalence of HBV and/or HCV infections in a non-selected population, hospitalised for SARS-CoV-2 infection in a tertiary care hospital in Northern Italy. During the study period 1,429 patients were admitted to hospital for SARS-CoV-2 infection, serologic tests for HBV and/or HCV were available for 382 (27%) patients and 3 were excluded due to their previous known serologic status. Among 379 patients, 235 (62%) were male, median age was 70 years (range 21–103), 360 (95%) were Caucasian. Among them, 372/379 (98%) were screened for HBsAg, 320/379 (84%) for HBcAb. HBsAg was positive in 2/372 (0.5%, 95% CI 0.0006–0.02) patients (only in one HBV-DNA was performed that was negative), while HBcAb was found positive in 55/320 (17%, 95% CI 0.13–0.22). Among 370/379 (98%) patients screened for HCV, 11/370 (3%, 95% CI 0.02–0.05) had positive HCV-Ab. Five out of 11 (45%) were tested for HCV-RNA that resulted positive in two patients (0.5%, 95% CI 0.0006–0.02). Considering this data, even though the screening was performed in only 27% of study population, a tailored screening in people with known risk factors for hepatitis might be preferable to universal screening in low prevalence areas. Also a prompt diagnostic workout should begin in case of clinical or laboratory suspicion of hepatitis and in those starting immunosuppressive treatments.
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Affiliation(s)
- Silvia Dettori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Chiara Russo
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. .,Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy. .,Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. .,IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
| | - Sara Mora
- Department of Informatics Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Chiara Dentone
- Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Antonio Di Biagio
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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Taramasso L, Lo Caputo S, Magnasco L, Briano F, Poliseno M, Bruno SR, Ferrara S, Pincino R, Sarteschi G, Beltramini S, Sasso E, Mora S, Giacomini M, Bassetti M, Di Biagio A. Long-Term Effectiveness of Rilpivirine-Based Single-Tablet Regimens in a Seven-Year, Two-Center Observational Cohort of People Living with HIV. AIDS Res Hum Retroviruses 2022; 38:472-479. [PMID: 35172617 DOI: 10.1089/aid.2021.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Data on the long-term durability of rilpivirine (RPV) are still scarce. A two-center retrospective study was performed, including all people living with HIV (PLWH) treated with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC)/RPV or tenofovir alafenamide (TAF)/FTC/RPV in the period January 2013-December 2019. Aims of the study were to assess the rate of discontinuation of the RPV single-tablet regimen (STR) and identify factors associated with the risk of discontinuation according to Cox's regression analysis. A total of 684 PLWH were enrolled. Mean duration of RPV-STR treatment was 192.5 (±99.5) weeks for 123 antiretroviral therapy (ART)-naïve participants (18%) and 173.3 (± 85.6) weeks for 561 ART-experienced study participants (82%). During the study period, the incidence of discontinuation was 7.7 per 100 person-years. The estimated proportions of discontinuation after 48 and 96 weeks were 5.6% and 13.4%, respectively. Causes of discontinuation were loss to follow-up (30%), side effects (15%), ART optimization (14%), virological failure (VF) (12%), death or transfer to another center (9%), low adherence (7%), drug interactions (6%), simplification to dual therapy (3%), and unknown (3%). No differences were observed in cumulative probability of discontinuation between ART-naïve and -experienced PLWH. Heterosexual (hazard ratio [HR] 3.0, 95% confidence interval [CI] 1.4-6.8) and mother-to-child (HR 5.3, 95% CI 1.8-15.3) transmission of HIV infection and history of previous VF (HR 1.7, 95% CI 1.2-2.5) were associated with higher risk of discontinuation. High RPV-STR effectiveness and durability were confirmed in our real-life population of PLWH. Given these data, RPV has the potential to be a drug for life in patients selected according to current guidelines.
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Affiliation(s)
- Lucia Taramasso
- Infectious Diseases Clinic, Department of Internal Medicine, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Sergio Lo Caputo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Laura Magnasco
- Infectious Diseases Clinic, Department of Internal Medicine, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Federica Briano
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | - Mariacristina Poliseno
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Serena Rita Bruno
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Sergio Ferrara
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Rachele Pincino
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | - Giovanni Sarteschi
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | | | - Elisabetta Sasso
- Pharmacy Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
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28
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Di Meco G, Mora S, Giacobbe DR, Dettori S, Karaiskos I, Bassetti M, Giacomini M. A Wide Database for a Multicenter Study on Pneumocystis jirovecii Pneumonia in Intensive Care Units. Stud Health Technol Inform 2022; 294:557-558. [PMID: 35612142 DOI: 10.3233/shti220521] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal infection that may affect patients with immunosuppression. In order to improve the diagnosis accuracy for PJP, facilitating the collection of data across Europe to reliably assess the performance of diagnostic tests for PJP is essential to improve the care of critically ill patients developing this severe condition. Such large data can be collected thanks to the contribution of several European hospitals in the compilation of a dedicated electronic Case Report Form (eCRF). The main focus of this work is to create an interface with high ergonomics both in the compilation and in the subsequent validation of the records.
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Affiliation(s)
- Gabriele Di Meco
- Department of Informatics, Bioengineering, Robotics and System Engineering
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy.,San Martino Polyclinic Hospital - IRCCS, Genoa, Italy.,ESGCIP (Critically III Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases)
| | - Silvia Dettori
- Department of Health Sciences, University of Genoa, Genoa, Italy.,San Martino Polyclinic Hospital - IRCCS, Genoa, Italy
| | - Ilias Karaiskos
- ESGCIP (Critically III Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases).,1st Department of Internal Medicine - Infectious Diseases, Hygeia General Hospital, Athens, Greece
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy.,San Martino Polyclinic Hospital - IRCCS, Genoa, Italy.,ESGCIP (Critically III Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases)
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering
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29
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Bonetto M, Maggi N, Fuschi D, Venturi A, Brogonzoli L, Iardino R, Giacomini M. Healthcare Insights: Evaluating the Access to the Italian Healthcare System. Stud Health Technol Inform 2022; 294:709-710. [PMID: 35612185 DOI: 10.3233/shti220564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The Italian health system is organised on a regional basis and services are provided by both public and private operators, affecting the planning of services, access to services by citizens and their health rights. The creation of an observatory monitoring the methods and times of access to healthcare services has been pursued. The preliminary phase of the project is presented, which will lead to the comparison of the data obtained from 2019, with an eye on the Covid-19 pandemic impact.
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Affiliation(s)
| | - Norbert Maggi
- Healthropy s.r.l., Savona, Italy
- Dep. of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Damiano Fuschi
- Dep. of Italian and International Public Law, University of Milan, Milan, Italy
| | - Alessandro Venturi
- Dep. of Political and Social Sciences, University of Pavia, Pavia, Italy
- I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | | | | | - Mauro Giacomini
- Dep. of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
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30
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Taramasso L, Bozzano F, Casabianca A, Orlandi C, Bovis F, Mora S, Giacomini M, Moretta L, Magnani M, Di Biagio A, De Maria A. Persistence of Unintegrated HIV DNA Associates With Ongoing NK Cell Activation and CD34+DNAM-1brightCXCR4+ Precursor Turnover in Vertically Infected Patients Despite Successful Antiretroviral Treatment. Front Immunol 2022; 13:847816. [PMID: 35558085 PMCID: PMC9088003 DOI: 10.3389/fimmu.2022.847816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
The quantification of proviral DNA is raising interest in view of clinical management and functional HIV eradication. Measures of all unintegrated HIV DNA (uDNA) forms in infected reservoir cells provides information on recent replication events that is not found from other proviral DNA assays. To evaluate its actual relevance in a cohort of perinatally-infected adult HIV patients (PHIV), we studied how peripheral blood mononuclear cell uDNA levels correlated with total HIV DNA (tDNA) and with overall replication or innate immune control parameters including NK cell activation/exhaustion and lymphoid turnover. Twenty-two PHIV were included, with successfully controlled HIV (HIV RNA <50 copies/mL) on combined antiretroviral therapy for mean of 8.7 ± 3.9 years. uDNA accounted for 16 [5.2-83.5] copies/µg and was strongly correlated with tDNA (ρ=0.700, p=0.001). Flow cytometric analysis of peripheral NK cells showed that CD69 expression was directly correlated uDNA (p=0.0412), but not with tDNA. Interestingly, CD56-CD16+NK cells which include newly described inflammatory precursors and terminally differentiated cells were directly correlated with uDNA levels (p<0.001), but not with tDNA, and an inverse association was observed between the proportion of NKG2D+ NK cells and uDNA (ρ=-0.548, p=0.015). In addition, CD34+DNAM-1brightCXCR4+ inflammatory precursor frequency correlated directly with uDNA levels (ρ=0.579, p=0.0075). The frequencies of CD56-CD16+ and CD34+DNAM-1brightCXCR4+ cells maintained association with uDNA levels in a multivariable analysis (p=0.045 and p=0.168, respectively). Thus, control of HIV-1 reservoir in aviremic patients on ART is an active process associated with continuous NK cell intervention and turnover, even after many years of treatment. Quantification of linear and circular uDNA provides relevant information on the requirement for ongoing innate immune control in addition to ART, on recent replication history and may help stratify patients for functional HIV eradication protocols with targeted options.
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Affiliation(s)
- Lucia Taramasso
- Infectious Diseases Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Federica Bozzano
- Infectious Diseases Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Anna Casabianca
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Chiara Orlandi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Francesca Bovis
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Lorenzo Moretta
- Immunology Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Andrea De Maria
- Infectious Diseases Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
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31
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Paleari L, Malini V, Paoli G, Scillieri S, Bighin C, Blobel B, Giacomini M. EU-Funded Telemedicine Projects – Assessment of, and Lessons Learned From, in the Light of the SARS-CoV-2 Pandemic. Front Med (Lausanne) 2022; 9:849998. [PMID: 35572981 PMCID: PMC9098161 DOI: 10.3389/fmed.2022.849998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
The SARS-CoV-2 health emergency has demonstrated the need for developing structured telemedicine systems to protect citizens from the spread of the virus. Thereby, their importance and the necessity to tailor their diffusion at large scale for providing services both at a distance and in time has been shown. For these reasons, the European Union advocates the digital transition of health systems for the next 5 years. The main aim of this work is to revisit the telemedicine research projects financed by European Community during the period 2000-2020 with particular respect to the results derived from their application. The analysis showed that some integration of tele-care and tele-health could be obtained with tele-monitoring systems and the implementation of Electronic Personal Record (EPR). Furthermore, telemedicine allows enhancing health care in critical environments, to protect health and life of the most vulnerable patients, and to encourage cross-border dialogue. The criteria of “from distance” and “timely delivered” are granted, but the effectiveness of the overall offered services highly depends on the availability and the quality of the input data. Unfortunately, this remains a relevant problem in the SARS-CoV-2 pandemic.
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Affiliation(s)
- Laura Paleari
- Research, Innovation and HTA Unit, A.Li.Sa.- Liguria Health Authority, Genoa, Italy
| | - Virginia Malini
- Department of Informatics, Bioengineering, Robotics and System Engineering, Genoa University, Genoa, Italy
| | - Gabriella Paoli
- Research, Innovation and HTA Unit, A.Li.Sa.- Liguria Health Authority, Genoa, Italy
| | - Stefano Scillieri
- Department of Informatics, Bioengineering, Robotics and System Engineering, Genoa University, Genoa, Italy
| | - Claudia Bighin
- Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bernd Blobel
- Medical Faculty, University of Regensburg, Regensburg, Germany
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, Genoa University, Genoa, Italy
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32
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Gazzarata R, Maggi N, Magnoni LD, Monteverde ME, Ruggiero C, Giacomini M. Semantics Management for a Regional Health Information System in Italy by CTS2 and FHIR. Stud Health Technol Inform 2021; 287:119-123. [PMID: 34795094 DOI: 10.3233/shti210828] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An infrastructure for the management of semantics is being developed to support the regional health information exchange in Veneto - an Italian region which has about 5 million inhabitants. Terminology plays a key role in the management of the information fluxes of the Veneto region, in which the management of electronic health record is given great attention. An architecture for the management of the semantics of laboratory reports has been set up, adopting standards by HL7. The system has been initially developed according to the common terminology service release 2 (CTS2) standard and, in order to overcome complexities of CTS2 is being revised according to the Fast Healthcare Interoperability Resources (FHIR) standard, which has been subsequently introduced. Aspects of CST2 and of FHIR have been considered in order to retain most suitable aspects of both. This integration can be regarded as most worthwhile.
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Affiliation(s)
| | - Norbert Maggi
- Department of Informatics, Bioengineering, Robotics and Information Systems, University of Genoa, Genoa, Italy.,Laboratory of Human Genetics, IRCCS Giannina Gaslini, Genova, Italy
| | | | | | - Carmelina Ruggiero
- Healthropy S.r.l., Savona, Italy.,Department of Informatics, Bioengineering, Robotics and Information Systems, University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Healthropy S.r.l., Savona, Italy.,Department of Informatics, Bioengineering, Robotics and Information Systems, University of Genoa, Genoa, Italy
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Maggi N, Boaglio A, Ruggiero C, Fancellu R, Cocchiara F, Coviello D, Capanna D, Giacomini M. Interoperability Standards for Data Sharing as a Basis to Fill in a Tailored EHR for Undiagnosed Rare Diseases. Stud Health Technol Inform 2021; 287:114-118. [PMID: 34795093 DOI: 10.3233/shti210827] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Undiagnosed rare diseases include diseases with a well-characterised phenotype, diseases with unknown molecular causes or due to non-genetic factors, and pathological condition that cannot be named. Several initiatives have been launched for healthcare of patients with undiagnosed rare diseases. A project for development of medical records with special reference to the HL7 standards is being carried out in Genoa (Italy), taking into account regional and national regulations. The project is based on the integration of functionality related to patient diagnostics, taking into account omic sciences for disease prevention and risk assessment. Considering the evolution of standards, the use of FHIR is being considered in order to increase the elasticity of the system also in view of foreseeable adoption of this standard by the Italian healthcare system.
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Affiliation(s)
- Norbert Maggi
- Department of Informatics, Bioengineering, Robotics and Information Systems, University of Genoa, Genoa, Italy.,Laboratory of Human Genetics, IRCCS Giannina Gaslini, Genoa, Italy
| | - Ariam Boaglio
- Department of Informatics, Bioengineering, Robotics and Information Systems, University of Genoa, Genoa, Italy
| | - Carmelina Ruggiero
- Department of Informatics, Bioengineering, Robotics and Information Systems, University of Genoa, Genoa, Italy.,Healthropy S.r.l., Savona, Italy
| | - Roberto Fancellu
- Unit of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinical Centre for Orphan Diagnosis Patients, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Cocchiara
- Clinical Centre for Orphan Diagnosis Patients, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Unit of Endocrinology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and Information Systems, University of Genoa, Genoa, Italy.,Healthropy S.r.l., Savona, Italy
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34
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Bertora S, Scillieri S, Giacomini M, Paoli G, Paleari L. Molecular tests for SARS-CoV-2: data from Liguria Region (Italy). Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:1491-1494. [PMID: 34891567 DOI: 10.1109/embc46164.2021.9630057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The current Covid-19 pandemic makes necessary to identify people affected by SARS-CoV-2. To do this, the most reliable method is the use of the molecular test that is the gold standard to detect positive peoples.Here, we provide a comprehensive review on the diagnostic processes through molecular tests for SARS-CoV-2 infection. First, we have obtained information about the testing technologies in the Liguria region's hospitals to find and describe the most common technologies used and to calculate the molecular test's average cost. Second, we have evaluated the sensitivity, the specificity, the safety with respect to the data reported on scientific literature (Real Word Data VS Registrative Studies) and the organizational aspects of the molecular tests.Clinical Relevance- This study aims to provide support to the decision makers on clinical, economic, organizational, social and ethical issues related to the use of molecular test for SARS-CoV-2.
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35
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Giacobbe DR, Russo C, Martini V, Dettori S, Briano F, Mirabella M, Portunato F, Dentone C, Mora S, Giacomini M, Berruti M, Bassetti M. Use of Ceftaroline in Hospitalized Patients with and without COVID-19: A Descriptive Cross-Sectional Study. Antibiotics (Basel) 2021; 10:antibiotics10070763. [PMID: 34201722 PMCID: PMC8300614 DOI: 10.3390/antibiotics10070763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
A single-center cross-sectional study was conducted to describe the use of ceftaroline in a large teaching hospital in Northern Italy, during a period also including the first months of the coronavirus disease 2019 (COVID-19) pandemic. The primary objective was to describe the use of ceftaroline in terms of indications and characteristics of patients. A secondary objective was to describe the rate of favorable clinical response in patients with bloodstream infections (BSI) due to methicillin-resistant Staphylococcus aureus (MRSA-BSI) receiving ceftaroline. Overall, 200 patients were included in the study. Most of them had COVID-19 (83%, 165/200) and were hospitalized in medical wards (78%, 155/200). Included patients with COVID-19 pneumonia were given empirical ceftaroline in the suspicion of bacterial co-infection or superinfection. Among patients with MRSA-BSI, ceftaroline was used as a first-line therapy and salvage therapy in 25% (3/12) and 75% (9/12) of cases, respectively, and as a monotherapy or in combination with daptomycin in 58% (7/12) and 42% (5/12) of patients, respectively. A favorable response was registered in 67% (8/12) of patients. Improving etiological diagnosis of bacterial infections is essential to optimize the use of ceftaroline in COVID-19 patients. The use of ceftaroline for MRSA-BSI, either as a monotherapy or in combination with other anti-MRSA agents, showed promising rates of favorable response.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (C.R.); (S.D.); (F.B.); (M.B.); (M.B.)
- Clinica Malattie Infettive, San Martino Policlinico Hospital—IRCCS, 16132 Genoa, Italy; (M.M.); (F.P.); (C.D.)
- Correspondence:
| | - Chiara Russo
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (C.R.); (S.D.); (F.B.); (M.B.); (M.B.)
- Clinica Malattie Infettive, San Martino Policlinico Hospital—IRCCS, 16132 Genoa, Italy; (M.M.); (F.P.); (C.D.)
| | | | - Silvia Dettori
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (C.R.); (S.D.); (F.B.); (M.B.); (M.B.)
- Clinica Malattie Infettive, San Martino Policlinico Hospital—IRCCS, 16132 Genoa, Italy; (M.M.); (F.P.); (C.D.)
| | - Federica Briano
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (C.R.); (S.D.); (F.B.); (M.B.); (M.B.)
- Clinica Malattie Infettive, San Martino Policlinico Hospital—IRCCS, 16132 Genoa, Italy; (M.M.); (F.P.); (C.D.)
| | - Michele Mirabella
- Clinica Malattie Infettive, San Martino Policlinico Hospital—IRCCS, 16132 Genoa, Italy; (M.M.); (F.P.); (C.D.)
| | - Federica Portunato
- Clinica Malattie Infettive, San Martino Policlinico Hospital—IRCCS, 16132 Genoa, Italy; (M.M.); (F.P.); (C.D.)
| | - Chiara Dentone
- Clinica Malattie Infettive, San Martino Policlinico Hospital—IRCCS, 16132 Genoa, Italy; (M.M.); (F.P.); (C.D.)
| | - Sara Mora
- Department of Informatics Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, 16145 Genoa, Italy; (S.M.); (M.G.)
| | - Mauro Giacomini
- Department of Informatics Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, 16145 Genoa, Italy; (S.M.); (M.G.)
| | - Marco Berruti
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (C.R.); (S.D.); (F.B.); (M.B.); (M.B.)
- Clinica Malattie Infettive, San Martino Policlinico Hospital—IRCCS, 16132 Genoa, Italy; (M.M.); (F.P.); (C.D.)
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy; (C.R.); (S.D.); (F.B.); (M.B.); (M.B.)
- Clinica Malattie Infettive, San Martino Policlinico Hospital—IRCCS, 16132 Genoa, Italy; (M.M.); (F.P.); (C.D.)
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36
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Mora S, Giacobbe DR, Russo C, Diana E, Signori A, Carmisciano L, Bassetti M, Giacomini M. A Wide Database for Future Studies Aimed at Improving Early Recognition of Candidemia. Stud Health Technol Inform 2021; 281:1081-1082. [PMID: 34042847 DOI: 10.3233/shti210354] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Invasive candidiasis is associated with high morbidity and mortality in critically ill patients, i.e. patients admitted to Intensive Care Units (ICUs) or in surgical wards. There are no clinical signs or specific symptoms and even though early diagnosis risk scores and rapid tests are available, none of such strategies has an equally-optimal level of sensitivity and specificity. In the era of Electronic Health Records (EHRs), several clinical studies exploited Machine Learning (ML) models and large database of features to improve the diagnosis accuracy. The main aim of this work is to build a wide dataset which can be exploited to apply ML models to further improve the early recognition of candidemia at the bedside of patients with compatible signs and symptoms.
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Affiliation(s)
- Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy.,San Martino Polyclinic Hospital - IRCCS, Genoa, Italy
| | - Chiara Russo
- Department of Health Sciences, University of Genoa, Genoa, Italy.,San Martino Polyclinic Hospital - IRCCS, Genoa, Italy
| | - Elia Diana
- School of Medicine, University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Luca Carmisciano
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy.,San Martino Polyclinic Hospital - IRCCS, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering
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37
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Fenoglio D, Dentone C, Parodi A, Di Biagio A, Bozzano F, Vena A, Fabbi M, Ferrera F, Altosole T, Bruzzone B, Giacomini M, Pelosi P, De Maria A, Bassetti M, De Palma R, Filaci G. Characterization of T lymphocytes in severe COVID-19 patients. J Med Virol 2021; 93:5608-5613. [PMID: 33913544 PMCID: PMC8242373 DOI: 10.1002/jmv.27037] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022]
Abstract
In this observational study, 13 patients with severe COVID‐19 and 10 healthy controls were enrolled. The data concerning the analysis of circulating T cells show that, in severe COVID‐19 patients, the expansion of these cell compartments is prone to induce antibody response, inflammation (CCR4+ and CCR6+ TFH) and regulation (CD8+ Treg). This pathogenic mechanism could lead us to envision a possible new form of biological target therapy. In patients with severe COVID‐19 we found a relative expansion of T‐cell subsets (Th2‐ and Th17‐ oriented TFH and CD8+ Treg) with a relative reduction of Th1 cells, which are those associated with eradication of a viral infection. This pathogenic mechanism could lead us to envision a possible new form of biological target therapy.
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Affiliation(s)
- Daniela Fenoglio
- Department of Internal Medicine, Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,Biotherapy Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Dentone
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessia Parodi
- Biotherapy Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Di Biagio
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Federica Bozzano
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marina Fabbi
- Biotherapy Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Ferrera
- Department of Internal Medicine, Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Tiziana Altosole
- Department of Internal Medicine, Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Anesthesia and Intensive Care Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea De Maria
- Department of Internal Medicine, Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Raffaele De Palma
- Internal Medicine, Clinical Immunology and Translational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gilberto Filaci
- Department of Internal Medicine, Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,Biotherapy Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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38
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Jacomine JC, Giacomini M, Agulhari MA, Zabeu G, Honório H, Wang L. Performance of a Universal Bonding System Associated With 2% Digluconate Chlorhexidine in Carious and Eroded Dentin. Oper Dent 2021; 46:E1-E10. [PMID: 33882142 DOI: 10.2341/19-123-l] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2020] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE Carious and eroded dentin represent clinical challenges. The use of a universal bonding system, in a self-etching mode, associated with chlorhexidine (CHX) seems to not improve its longevity. This may be attributed to the competition for calcium between the bonding agent functional monomer and CHX. SUMMARY
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39
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Giacobbe DR, Signori A, Del Puente F, Mora S, Carmisciano L, Briano F, Vena A, Ball L, Robba C, Pelosi P, Giacomini M, Bassetti M. Early Detection of Sepsis With Machine Learning Techniques: A Brief Clinical Perspective. Front Med (Lausanne) 2021; 8:617486. [PMID: 33644097 PMCID: PMC7906970 DOI: 10.3389/fmed.2021.617486] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/19/2021] [Indexed: 12/15/2022] Open
Abstract
Sepsis is a major cause of death worldwide. Over the past years, prediction of clinically relevant events through machine learning models has gained particular attention. In the present perspective, we provide a brief, clinician-oriented vision on the following relevant aspects concerning the use of machine learning predictive models for the early detection of sepsis in the daily practice: (i) the controversy of sepsis definition and its influence on the development of prediction models; (ii) the choice and availability of input features; (iii) the measure of the model performance, the output, and their usefulness in the clinical practice. The increasing involvement of artificial intelligence and machine learning in health care cannot be disregarded, despite important pitfalls that should be always carefully taken into consideration. In the long run, a rigorous multidisciplinary approach to enrich our understanding in the application of machine learning techniques for the early recognition of sepsis may show potential to augment medical decision-making when facing this heterogeneous and complex syndrome.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Infectious Diseases Unit, San Martino Policlinico Hospital – IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Filippo Del Puente
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Sara Mora
- Department of Informatics Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Luca Carmisciano
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Federica Briano
- Infectious Diseases Unit, San Martino Policlinico Hospital – IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antonio Vena
- Infectious Diseases Unit, San Martino Policlinico Hospital – IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Lorenzo Ball
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital – IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Chiara Robba
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital – IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital – IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, San Martino Policlinico Hospital – IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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40
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D'Alessio A, Del Poggio P, Bracchi F, Cesana G, Sertori N, Di Mauro D, Fargnoli A, Motta M, Giussani C, Moro P, Vitale G, Giacomini M, Borra G. Low-dose ruxolitinib plus steroid in severe SARS-CoV-2 pneumonia. Leukemia 2021; 35:635-638. [PMID: 33173161 PMCID: PMC7654848 DOI: 10.1038/s41375-020-01087-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/31/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023]
Affiliation(s)
- A D'Alessio
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - P Del Poggio
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy.
| | - F Bracchi
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - G Cesana
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - N Sertori
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - D Di Mauro
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - A Fargnoli
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - M Motta
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - C Giussani
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - P Moro
- COVID Medical Department, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - G Vitale
- Intensive Care Unit, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - M Giacomini
- Intensive Care Unit, Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
| | - G Borra
- Policlinico S.Marco Gruppo San Donato University and Research Hospital, Zingonia, Bergamo, Italy
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41
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Vena A, Giacobbe DR, Di Biagio A, Mikulska M, Taramasso L, De Maria A, Ball L, Brunetti I, Loconte M, Patroniti NA, Robba C, Delfino E, Dentone C, Magnasco L, Nicolini L, Toscanini F, Bavastro M, Cerchiaro M, Barisione E, Giacomini M, Mora S, Baldi F, Balletto E, Berruti M, Briano F, Sepulcri C, Dettori S, Labate L, Mirabella M, Portunato F, Pincino R, Russo C, Tutino S, Pelosi P, Bassetti M. Clinical characteristics, management and in-hospital mortality of patients with coronavirus disease 2019 in Genoa, Italy. Clin Microbiol Infect 2020; 26:1537-1544. [PMID: 32810610 PMCID: PMC7428680 DOI: 10.1016/j.cmi.2020.07.049] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To describe clinical characteristics, management and outcome of individuals with coronavirus disease 2019 (COVID-19); and to evaluate risk factors for all-cause in-hospital mortality. METHODS This retrospective study from a University tertiary care hospital in northern Italy, included hospitalized adult patients with a diagnosis of COVID-19 between 25 February 2020 and 25 March 2020. RESULTS Overall, 317 individuals were enrolled. Their median age was 71 years and 67.2% were male (213/317). The most common underlying diseases were hypertension (149/317; 47.0%), cardiovascular disease (63/317; 19.9%) and diabetes (49/317; 15.5%). Common symptoms at the time of COVID-19 diagnosis included fever (285/317; 89.9%), shortness of breath (167/317; 52.7%) and dry cough (156/317; 49.2%). An 'atypical' presentation including at least one among mental confusion, diarrhoea or nausea and vomiting was observed in 53/317 patients (16.7%). Hypokalaemia occurred in 25.8% (78/302) and 18.5% (56/303) had acute kidney injury. During hospitalization, 111/317 patients (35.0%) received non-invasive respiratory support, 65/317 (20.5%) were admitted to the intensive care unit (ICU) and 60/317 (18.5%) required invasive mechanical ventilation. All-cause in-hospital mortality, assessed in 275 patients, was 43.6% (120/275). On multivariable analysis, age (per-year increase OR 1.07; 95% CI 1.04-1.10; p < 0.001), cardiovascular disease (OR 2.58; 95% CI 1.07-6.25; p 0.03), and C-reactive protein levels (per-point increase OR 1.009; 95% CI 1.004-1.014; p 0.001) were independent risk factors for all-cause in-hospital mortality. CONCLUSIONS COVID-19 mainly affected elderly patients with predisposing conditions and caused severe illness, frequently requiring non-invasive respiratory support or ICU admission. Despite supportive care, COVID-19 remains associated with a substantial risk of all-cause in-hospital mortality.
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Affiliation(s)
- Antonio Vena
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | | | - Antonio Di Biagio
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Andrea De Maria
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Iole Brunetti
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Maurizio Loconte
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Nicolò A Patroniti
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Chiara Robba
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Emanuele Delfino
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Chiara Dentone
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Laura Magnasco
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Laura Nicolini
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Federica Toscanini
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Martina Bavastro
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Matteo Cerchiaro
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Emanuela Barisione
- Interventional Pulmonology Unit, IRCCS San Martino Hospital, IST National Cancer Research Institute, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Federico Baldi
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Elisa Balletto
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Marco Berruti
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Federica Briano
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Chiara Sepulcri
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Silvia Dettori
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Laura Labate
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Michele Mirabella
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Federica Portunato
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Rachele Pincino
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Chiara Russo
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Stefania Tutino
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
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Sarteschi G, Di Biagio A, Focà E, Taramasso L, Bovis F, Celotti A, Mirabella M, Magnasco L, Mora S, Giacomini M, Bassetti M. Viremia copy-years and risk of estimated glomerular filtration rate reduction in adults living with perinatal HIV infection. PLoS One 2020; 15:e0240550. [PMID: 33057418 PMCID: PMC7561100 DOI: 10.1371/journal.pone.0240550] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
Among people with perinatal HIV infection (PHIV), non-communicable diseases, such as chronic kidney disease, are increasing. Both HIV replication and antiretroviral therapy are recognised causes of renal impairment. Objective of the study is to describe the impact of viremia copy-years (VCY) and antiretroviral therapy on trend of estimated glomerular filtration rate (eGFR) in a cohort of adults with perinatal HIV infection. We conducted a multicentre observational study in sixty adults living with PHIV across a 9-year period, from January 2010 to December 2018. The mean values of eGFR were analysed at the first (T0) and last year of observation (T1). VCY was defined as the area under HIV-RNA curve during the study period. We analysed data according to antiretroviral therapy: tenofovir disoproxil (TDF), non-nucleoside reverse transcriptase inhibitors (NNRTI), boosted protease inhibitors (PI/b), integrase inhibitors (INI). We observed a mean overall eGFR reduction from 126.6 mL/min (95%CI: 119.6–133.5) to 105.0 mL/min (95%CI: 99.55–110.6) (p<0.001). Older age, higher baseline eGFR, higher VCY and longer exposure to INI treatment were associated with eGFR reduction at univariate analysis. In the multivariate model, older age (p = 0.039), baseline eGFR (p<0.001) and VCY (p = 0.069), were retained. We also observed a longer exposure to PI/b and INI in patients with lower control on HIV-RNA, expressed as VCY>2 log10. Our study outlines a progressive eGFR reduction in young adults with PHIV, related to the lower control on HIV-RNA VCY and related to aging.
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Affiliation(s)
- Giovanni Sarteschi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- * E-mail: (GS); (ADB)
| | - Antonio Di Biagio
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- * E-mail: (GS); (ADB)
| | - Emanuele Focà
- Infectious and Tropical Diseases Department, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Lucia Taramasso
- Department of Pathophysiology and Transplantation, Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- MultidisciplinAry ResearCh in Health Science (MACH), Milan, Italy
| | - Francesca Bovis
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Anna Celotti
- Infectious and Tropical Diseases Department, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Michele Mirabella
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Laura Magnasco
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Sara Mora
- Department of Informatics Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino Hospital, Genoa, Italy
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Mikulska M, Nicolini LA, Signori A, Di Biagio A, Sepulcri C, Russo C, Dettori S, Berruti M, Sormani MP, Giacobbe DR, Vena A, De Maria A, Dentone C, Taramasso L, Mirabella M, Magnasco L, Mora S, Delfino E, Toscanini F, Balletto E, Alessandrini AI, Baldi F, Briano F, Camera M, Dodi F, Ferrazin A, Labate L, Mazzarello G, Pincino R, Portunato F, Tutino S, Barisione E, Bruzzone B, Orsi A, Schenone E, Rosseti N, Sasso E, Da Rin G, Pelosi P, Beltramini S, Giacomini M, Icardi G, Gratarola A, Bassetti M. Tocilizumab and steroid treatment in patients with COVID-19 pneumonia. PLoS One 2020; 15:e0237831. [PMID: 32817707 PMCID: PMC7440633 DOI: 10.1371/journal.pone.0237831] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/02/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) can lead to respiratory failure due to severe immune response. Treatment targeting this immune response might be beneficial but there is limited evidence on its efficacy. The aim of this study was to determine if early treatment of patients with COVID-19 pneumonia with tocilizumab and/or steroids was associated with better outcome. METHODS This observational single-center study included patients with COVID-19 pneumonia who were not intubated and received either standard of care (SOC, controls) or SOC plus early (within 3 days from hospital admission) anti-inflammatory treatment. SOC consisted of hydroxychloroquine 400mg bid plus, in those admitted before March 24th, also darunavir/ritonavir. Anti-inflammatory treatment consisted of either tocilizumab (8mg/kg intravenously or 162mg subcutaneously) or methylprednisolone 1 mg/kg for 5 days or both. Failure was defined as intubation or death, and the endpoints were failure-free survival (primary endpoint) and overall survival (secondary) at day 30. Difference between the groups was estimated as Hazard Ratio by a propensity score weighted Cox regression analysis (HROW). RESULTS Overall, 196 adults were included in the analyses. They were mainly male (67.4%), with comorbidities (78.1%) and severe COVID-19 pneumonia (83.7%). Median age was 67.9 years (range, 30-100) and median PaO2/FiO2 200 mmHg (IQR 133-289). Among them, 130 received early anti-inflammatory treatment with: tocilizumab (n = 29, 22.3%), methylprednisolone (n = 45, 34.6%), or both (n = 56, 43.1%). The adjusted failure-free survival among tocilizumab/methylprednisolone/SOC treated patients vs. SOC was 80.8% (95%CI, 72.8-86.7) vs. 64.1% (95%CI, 51.3-74.0), HROW 0.48, 95%CI, 0.23-0.99; p = 0.049. The overall survival among tocilizumab/methylprednisolone/SOC patients vs. SOC was 85.9% (95%CI, 80.7-92.6) vs. 71.9% (95%CI, 46-73), HROW 0.41, 95%CI: 0.19-0.89, p = 0.025. CONCLUSION Early adjunctive treatment with tocilizumab, methylprednisolone or both may improve outcomes in non-intubated patients with COVID-19 pneumonia.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- * E-mail:
| | - Laura Ambra Nicolini
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences, University of Genova, Genova, Italy
| | - Antonio Di Biagio
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Sepulcri
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Chiara Russo
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Silvia Dettori
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Marco Berruti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Maria Pia Sormani
- Section of Biostatistics, Department of Health Sciences, University of Genova, Genova, Italy
| | - Daniele Roberto Giacobbe
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea De Maria
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Dentone
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Taramasso
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Mirabella
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Magnasco
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Emanuele Delfino
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federica Toscanini
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Balletto
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Ida Alessandrini
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Baldi
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Federica Briano
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Marco Camera
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ferdinando Dodi
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Ferrazin
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Labate
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Giovanni Mazzarello
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rachele Pincino
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Federica Portunato
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Stefania Tutino
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Emanuela Barisione
- Interventional Pulmonology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Orsi
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Eva Schenone
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nirmala Rosseti
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisabetta Sasso
- Pharmacy Complex Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giorgio Da Rin
- Medicine Laboratory, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Genova, Italy
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Sabrina Beltramini
- Pharmacy Complex Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Giancarlo Icardi
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Angelo Gratarola
- Department of Emergency and Urgency, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Nicolini LA, Mikulska M, Signori A, Di Biagio A, Portunato F, Vena A, Giacomini M, Bassetti M. Reply to: "Antiviral Activity and Safety of Darunavir/Cobicistat for Treatment of COVID-19". Open Forum Infect Dis 2020; 7:ofaa321. [PMID: 32855991 PMCID: PMC7443101 DOI: 10.1093/ofid/ofaa321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/24/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Laura Ambra Nicolini
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Malgorzata Mikulska
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Federica Portunato
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Antonio Vena
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
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Mora S, Madan S, Gebel S, Giacomini M. Proposal of an Architecture for Terminology Management in a Research Project. Stud Health Technol Inform 2020; 270:1371-1372. [PMID: 32570664 DOI: 10.3233/shti200447] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Clinical and medical knowledge evolve and this causes changes in concepts and terms that describe them. The objective of this work is to formally present an ontology-based standard architecture that will be used in the scenario of neurodegeneration research to maintain terminologies and their relations updated and coherent over the time. The proposed structure is composed by three elements that will allow the user to do a list of operations on the terminology resources explicitly contemplated by the Common Terminology Service Release 2 (CTS2).
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Affiliation(s)
- Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Italy
| | - Sumit Madan
- Fraunhofer Institute for Algorithms and Scientific Computing SCAI Department of Bioinformatics Schloss Birlinghoven, Sankt Augustin, Germany
| | - Stephan Gebel
- Fraunhofer Institute for Algorithms and Scientific Computing SCAI Department of Bioinformatics Schloss Birlinghoven, Sankt Augustin, Germany
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Italy
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Bisio A, Schito AM, Pedrelli F, Danton O, Reinhardt JK, Poli G, Tuccinardi T, Bürgi T, De Riccardis F, Giacomini M, Calzia D, Panfoli I, Schito GC, Hamburger M, De Tommasi N. Antibacterial and ATP Synthesis Modulating Compounds from Salvia tingitana. J Nat Prod 2020; 83:1027-1042. [PMID: 32182064 PMCID: PMC7997632 DOI: 10.1021/acs.jnatprod.9b01024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Indexed: 05/05/2023]
Abstract
A surface extract of the aerial parts of Salvia tingitana afforded a nor-sesterterpenoid (1) and eight new sesterterpenoids (2-̵9), along with five known sesterterpenoids, five labdane and one abietane diterpenoid, one sesquiterpenoid, and four flavonoids. The structures of the new compounds were established by 1D and 2D NMR spectroscopy, HRESIMS, and VCD data and Mosher's esters analysis. The antimicrobial activity of compounds was evaluated against 30 human pathogens including 27 clinical strains and three isolates of marine origin for their possible implications on human health. The methyl ester of salvileucolide (10), salvileucolide-6,23-lactone (11), sclareol (15), and manool (17) were the most active against Gram-positive bacteria. The compounds were also tested for the inhibition of ATP production in purified mammalian rod outer segments. Terpenoids 10, 11, 15, and 17 inhibited ATP production, while only 17 inhibited also ATP hydrolysis. Molecular modeling studies confirmed the capacity of 17 to interact with mammalian ATP synthase. A significant reduction of ATP production in the presence of 17 was observed in Enterococcus faecalis and E. faecium isolates.
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Affiliation(s)
- Angela Bisio
- Department
of Pharmacy, University of Genova, Viale Cembrano 4, 16148 Genova, Italy
| | - Anna M. Schito
- Department
of Integrated Surgical and Diagnostical Sciences, University of Genova, Largo Rosanna Benzi 8, 16145 Genova, Italy
| | - Francesca Pedrelli
- Department
of Pharmacy, University of Genova, Viale Cembrano 4, 16148 Genova, Italy
| | - Ombeline Danton
- Department
of Pharmaceutical Sciences, University of
Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Jakob K. Reinhardt
- Department
of Pharmaceutical Sciences, University of
Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Giulio Poli
- Department
of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Tiziano Tuccinardi
- Department
of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Thomas Bürgi
- Department
of Chemical Physics, University of Geneva, 30 Quai Ernest-Ansermet, 1211 Genève 4, Switzerland
| | - Francesco De Riccardis
- Department
of Chemistry and Biology, University of
Salerno, Via Giovanni Paolo II 132, 84084 Salerno, Italy
| | - Mauro Giacomini
- Department
of Informatics Bioengineering Robotics and System Engineering, University of Genova, Via all’Opera Pia, 13, 16145 Genova, Italy
| | - Daniela Calzia
- Department
of Pharmacy, University of Genova, Viale Cembrano 4, 16148 Genova, Italy
| | - Isabella Panfoli
- Department
of Pharmacy, University of Genova, Viale Cembrano 4, 16148 Genova, Italy
| | - Gian Carlo Schito
- Department
of Pharmacy, University of Genova, Viale Cembrano 4, 16148 Genova, Italy
| | - Matthias Hamburger
- Department
of Pharmaceutical Sciences, University of
Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Nunziatina De Tommasi
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Salerno, Italy
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Nicolò M, Musetti D, Marenco M, Cotti L, Bonetto M, Giacomini M, Traverso CE. Real-Life Management of Diabetic Macular Edema with Dexamethasone Intravitreal Implant: A Retrospective Analysis of Long-Term Clinical Outcomes. J Ophthalmol 2020; 2020:4860743. [PMID: 32351722 PMCID: PMC7171629 DOI: 10.1155/2020/4860743] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Inflammation plays a key role in the pathogenesis of diabetic macular edema (DME), and intravitreal corticosteroids are among the recommended therapies. The goal of this retrospective analysis was to describe outcomes with dexamethasone intravitreal implant (DEX implant) in real life. METHODS Medical digital records of DME patients treated with DEX implant and followed up for 3 years were analyzed. Treatment with DEX implant was started either as first-line therapy in pseudophakic patients and in patients with cardiovascular comorbidities or as second-line therapy in patients refractory to the inhibitor of the vascular endothelial growth factor (anti-VEGF) therapy. Analyzed outcomes included central macular thickness (CMT) and best-corrected visual acuity (BCVA). Mean number of implant injections per patient and mean duration of the interval between injections were also estimated. RESULTS Seventy-five patients (mean age 65.7 (±12.3) years; 53 phakic and 22 pseudophakic) with DME were included. Overall, 84 eyes were treated. Mean CMT improved from 380.1 (±100.3) µm at baseline to 306.8 (±77.0) µm at 36 months (p=0.0003). Mean BCVA improved for up to 6 months (p=0.08) and then started to decrease reaching values lower than baseline after 24 months. In pseudophakic patients, BCVA improvements were more pronounced and sustained up to 36 months (p=0.6). Over 36 months, each patient received on average 2.4 (±1.6) intravitreal injections of DEX implant. The time interval between consecutive injections was included between 180 and 240 days. No unexpected safety issues were reported. CONCLUSIONS With fewer than 3 injections per patient over a 3-year period, DEX implant was able to improve anatomic outcomes in DME patients. Only pseudophakic eyes showed also a long lasting functional benefit at 36 months.
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Affiliation(s)
- Massimo Nicolò
- Clinica Oculistica, DiNOGMI, Università di Genova, Ospedale Policlinico San Martino IRCCS, Genova, Italy
- Fondazione per La Macula Onlus, Genova, Italy
| | - Donatella Musetti
- Clinica Oculistica, DiNOGMI, Università di Genova, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Maria Marenco
- Clinica Oculistica, DiNOGMI, Università di Genova, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | | | - Monica Bonetto
- Clinica Oculistica, DiNOGMI, Università di Genova, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | | | - Carlo Enrico Traverso
- Clinica Oculistica, DiNOGMI, Università di Genova, Ospedale Policlinico San Martino IRCCS, Genova, Italy
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Nicolò M, Morlacchi A, Cappelli F, Ferro Desideri L, Colombo V, Musetti D, Musolino M, Saccheggiani M, Bonetto M, Giacomini M, Traverso C. Real-Life Data in the Treatment of Neovascular Age-Related Macular Degeneration: Results from the Imaculaweb Registry Evaluated in a Single Italian Medical Retina Center. Ophthalmologica 2020; 243:453-460. [DOI: 10.1159/000507711] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/01/2020] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> The aim of this study is to assess and compare the long-term clinical efficacy of anti-VEGF drugs using the Imaculaweb registry. <b><i>Methods:</i></b> In this observational study based on the Imaculaweb registry, outcome measures were the number of injections, the change in mean visual acuity (VA) and central macular thickness (CMT), and the time between diagnosis and the first injection. <b><i>Results:</i></b> In total, 126 eyes of 109 patients were included in the study. The mean VA was 49.4 ± 21.4, 54.1 ± 22.2, 51.6 ± 24.9, and 48.3 ± 25.7 letters at baseline and at the 1-, 2-, and 3-year follow-ups, respectively. Significant VA increases (<i>p</i> = 0.0002 for the first year and <i>p</i> = 0.045 for the second year) were documented at years 1 and 2 but not at year 3 (<i>p</i> = 0.8). The mean number of injections was 5.2, 2.6, and 2.3 at the 1-, 2-, and 3-year follow-ups, respectively. In the first year, 30% of the patients received at least 7 injections, while only 6.4% received <3 injections. CMT decreased significantly during the overall follow-up period, and intra- and subretinal fluid decreased (<i>p</i> < 0.0001). <b><i>Conclusion:</i></b> Imaculaweb turned out to be an effective tool to collect and share clinical data as well as to monitor patient outcome.
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Gazzarata R, Monteverde ME, Ruggiero C, Maggi N, Palmieri D, Parruti G, Giacomini M. Healthcare Associated Infections: An Interoperable Infrastructure for Multidrug Resistant Organism Surveillance. Int J Environ Res Public Health 2020; 17:E465. [PMID: 31936787 PMCID: PMC7013448 DOI: 10.3390/ijerph17020465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/25/2019] [Accepted: 12/30/2019] [Indexed: 01/26/2023]
Abstract
Prevention and surveillance of healthcare associated infections caused by multidrug resistant organisms (MDROs) has been given increasing attention in recent years and is nowadays a major priority for health care systems. The creation of automated regional, national and international surveillance networks plays a key role in this respect. A surveillance system has been designed for the Abruzzo region in Italy, focusing on the monitoring of the MDROs prevalence in patients, on the appropriateness of antibiotic prescription in hospitalized patients and on foreseeable interactions with other networks at national and international level. The system has been designed according to the Service Oriented Architecture (SOA) principles, and Healthcare Service Specification (HSSP) standards and Clinical Document Architecture Release 2 (CDAR2) have been adopted. A description is given with special reference to implementation state, specific design and implementation choices and next foreseeable steps. The first release will be delivered at the Complex Operating Unit of Infectious Diseases of the Local Health Authority of Pescara (Italy).
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Affiliation(s)
| | | | - Carmelina Ruggiero
- Healthropy S.r.l., 17100 Savona, Italy (C.R.); (N.M.); (M.G.)
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genova, 16145 Genoa, Italy
| | - Norbert Maggi
- Healthropy S.r.l., 17100 Savona, Italy (C.R.); (N.M.); (M.G.)
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genova, 16145 Genoa, Italy
| | - Dalia Palmieri
- Epidemiology Office, Azienda Unità Sanitaria Locale (AUSL) di Pescara, 65124 Pescara, Italy;
| | - Giustino Parruti
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, 65124 Pescara, Italy;
| | - Mauro Giacomini
- Healthropy S.r.l., 17100 Savona, Italy (C.R.); (N.M.); (M.G.)
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genova, 16145 Genoa, Italy
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Taramasso L, Di Biagio A, Riccardi N, Briano F, Di Filippo E, Comi L, Mora S, Giacomini M, Gori A, Maggiolo F. Lipid profile changings after switching from rilpivirine/tenofovir disoproxil fumarate/emtricitabine to rilpivirine/tenofovir alafenamide/emtricitabine: Different effects in patients with or without baseline hypercholesterolemia. PLoS One 2019; 14:e0223181. [PMID: 31603906 PMCID: PMC6788691 DOI: 10.1371/journal.pone.0223181] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022] Open
Abstract
Tenofovir alafenamide (TAF) has similar efficacy compared to tenofovir disoproxil fumarate (TDF), but a less favorable effect on lipids. Aim of this retrospective multicentre study was to evaluate the impact on lipids of switching from rilpivirine (RPV)/ emtricitabine (FTC)/TDF to RPV/FTC/TAF in a cohort of HIV-1 infected patients. Total cholesterol (TC), high density lipoproteins (HDL) and low density lipoproteins (LDL) were compared at the moment of the switch and at the first following evaluation, by using paired t-test. Overall, 573 patients were considered, 99% with HIV-RNA <50 copies/ml, with mean age of 49.7 (±0.4) years and median 13.4 (6.9-22.5) years of HIV infection. In the study population with available data (431/573, 75%), mean TC changed from 173 ±1.7 to 188 ±1.8 mg/dl; mean HDL from 46 ±0.7 to 51± 0.7 mg/dl; mean LDL from 111 ±1.5 to 120 ±1.8 mg/dl (p<0.0001 for all). Neither LDL/HDL nor TC/HDL ratio changed significantly, with LDL/HDL from 2.6 ±0.5 to 2.5 ±0.5 (p = 0.12) and TC/HDL from 4.0 ±0.6 to 3.9 ±0.6 (p = 0.11). In patients with baseline diagnosis of hypercholesterolemia (TC>200 mg/dl, N = 87), there was no significant change in TC (224 ±2.2 to 228 ±3.4 mg/dl, p = 0.286) or LDL (150±2.5 to 151±3.2 mg/dl, p = 0.751), while HDL increased from 51 ±1.6 to 55 ±1.7 mg/dl (p<0.0001) and both LDL/HDL and TC/HDL ratio decreased significantly, from 3.2±0.1 to 3.0 ±0.1 (p = 0.025) and from 4.7±0.1 to 4.4 ±0.1 (p = 0.004). In this real life study, a slight increase in lipids was found after switching from RPV/FTC/TDF to RPV/FTC/TAF, but these results were not confirmed in people with hypercholesterolemia, in which lipids did not change and LDL/HDL and TC/HDL ratio decreased.
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Affiliation(s)
- Lucia Taramasso
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
- * E-mail:
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Policlinico San Martino Hospital, Genoa, Italy
| | - Niccolò Riccardi
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
- Infectious Diseases Department, San Raffaele Scientific Institute, Milan, Italy
| | - Federica Briano
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Elisa Di Filippo
- Infectious Disease Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Comi
- Infectious Disease Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Mora
- Department of Informatics Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genova, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genova, Genoa, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Franco Maggiolo
- Infectious Disease Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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