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Scagnellato, L., A. Collesei, G. Cozzi, M. Lorenzin, A. Doria, G. Lapadula, and R. Ramonda. "AB0944 COMORBIDITIES IN THE SPONDYLOARTHRITIS GISEA COHORT: AN AVERAGE TREATMENT EFFECT ANALYSIS ON PATIENTS TREATED WITH BDMARDS." Annals of the Rheumatic Diseases 82, Suppl 1 (May 30, 2023): 1690.1–1690. http://dx.doi.org/10.1136/annrheumdis-2023-eular.2730.
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BackgroundThe treatment of Spondyloarthritis (SpA) has enormously improved thanks to bDMARDs, which are usually safe but they still require some caution because of their interference with the immune system homeostasis. ATE is a still evolving method designed to study the causal relationship between treatment and outcome.ObjectivesWe endeavoured to investigate the impact of TNF-inhibitors (TNFi), anti-interleukin17 or interleukin12/23 monoclonal antibodies (anti-IL) on comorbidities among SpA patients enrolled in the Italian GISEA Registry, using an average treatment effect (ATE) analysis.MethodsSpA patients from the GISEA Registry were divided into groups according to pharmacological exposure: no treatment (G0), TNFi (G1) and anti-IL (G2). In each group, the prevalence and incidence of infectious, cardiopulmonary, endocrinological, non-inflammatory gastrointestinal disease (NIGID), oncologic, renal and neurologic comorbidities were evaluated. Thus, each comorbidity was fitted for ATE and baseline features were evaluated for importance.ResultsThis multi-centre Italian GISEA study comprised 4458 SpA patients (G0=495 patients, G1=3113 patients, G2=815 patients). Cardiovascular disease was the most prevalent and incident comorbidity in all groups, with no significant difference between groups. ATE showed no increased risk of solid cancer in G1 and G2 (G1 vs. G0 = 0,42 95% CI 0,20-0,85; G2 vs. G0 = 0,26 95% CI 0,08-0,71), but significantly higher prevalence and incidence in G0 (14.07/1000 patient-years, p=0,0001). Conversely, a significantly higher risk of NIGID and fibromyalgia was found in G1 and G2 vs. G0 (NIGID: G1 vs. G0 =1.56 95% CI 1.06-2.33, G2 vs. G0 =1.91 95% CI 1.05-3.24; fibromyalgia: G1 vs. G0 1.69 95% CI 1.05-2.68, G2 vs. G0 2.13 95% CI 1.14-3.41). No treatment risk modification was observed concerning haematological malignancies, cardiovascular events and endocrinological comorbidities.ConclusionOverall, this study reveals that bDMARDs have only a slight interference of the occurrence of comorbidities in SpA patients, underlining the appropriateness of the use of bDMARDs in current clinical practice. Some caveats pertain to NIGID and fibromyalgia. Importantly, causality may yield more reliable and relevant clinical information, flattening the unbalance between observational data and clinical trials.Table 1.Prevalence and incidence of selected comorbidities in the GISEA Cohort and results of the Average Treatment Effect Analysis (ATE).Incidence of comorbidities (number of events; events/1000 patient-years)ComorbidityNo treatment (G0)N=494TNFi (G1)N =3113AntiIL (G2)N=815P value (ANOVA)Cardiovascular disease10 events; 16.90114 events; 28.8126 events; 26.440,0794Endocrinological disease7 events; 11.3560 events; 9.3015 events; 13.830,6678Fibromyalgia5 events; 6.72102 events; 13.4233 events; 25.190,0095Gastrointestinal (non IBD) disease8 events; 12.41110 events; 16.4833 events; 19.680,0408Haematologic malignancy0 events; 02 events; 0.260 events; 00,6498Solid cancer10 events; 14.0713 events; 1.715 events; 3.790,0001Average treatment effect (ATE) analysisOutcome (comorbidity)RR (CI 95%)TNFi vs. no treatment (G1 vs. G0)antiIL vs. no treatment (G2 vs. G0)antiIL vs. TNFi (G2 vs. G1)Cardiovascular1.41 (0.99-1.99)1.66 (1-2.97)1.16 (0.91-1.55)Endocrinologic1.27 (0.76-2.05)1.41 (0.68-2.72)1.09 (0.74-1.54)Fibromyalgia1.69 (1.05-2.68)2.13 (1.14-3.41)1.25 (0.95-1.51)GI (non IBD)1.56 (1.06-2.33)1.91 (1.05-3.24)1.21 (0.92-1.51)Haematologic malignancy0.78 (0.14-2.88)0.81 (0.04-4.67)0.78 (0.20-1.96)Solid cancer0.42 (0.20-0.85)0.26 (0.08-0.71)0.61 (0.33-0.96)Legend: G0= Group 0, no treatment= no biologic DMARD, G1= Group 1, TNFi= Tumour necrosis factor inhibitors, G2= Group 2, antiIL= anti-interleukin17 and anti-interleukin17/23 monoclonal antibodies, N= numerosity of the group, IBD= inflammatory bowel disease, RR= relative risk, CI 95%= confidence interval 95%. Significant results are in bold characters.AcknowledgementsRoberta Ramonda and Giovanni Lapadula are part of the GISEA Working Group, comprising the Centre of Centre of Bari, Milan (Presidio Ospedaliero Gaetano Pini), Brescia, Catania, Foggia, Rome (Policlinico Umberto I, Policlinico Gemelli and Policlinico Tor Vergata), Cagliari, Modena, Verona, Turin (Azienda Ospedaliero-Universitaria Città della Salute and Ospedale Mauriziano Umberto I), Siena, Pavia, Messina, Ferrara and Padova.Disclosure of InterestsNone Declared.
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Pucci, Resi, Andrea Cassoni, Daniele Di Carlo, Piero Bartolucci, Marco Della Monaca, Giorgio Barbera, Michele Di Cosola, Antonella Polimeni, and Valentino Valentini. "Odontogenic-Related Head and Neck Infections: From Abscess to Mediastinitis: Our Experience, Limits, and Perspectives—A 5-Year Survey." International Journal of Environmental Research and Public Health 20, no. 4 (February 16, 2023): 3469. http://dx.doi.org/10.3390/ijerph20043469.
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Background: Head and neck infections are commonly caused by affections with an odontogenic origin. Untreated or non-responsive to treatment odontogenic infections can cause severe consequences such as localized abscesses, deep neck infections (DNI), and mediastinitis, conditions where emergency procedures such as tracheostomy or cervicotomy could be needed. Methods: An epidemiological retrospective observational study was performed, and the objective of the investigation was to present a single-center 5-years retrospective analysis of all patients admitted to the emergency department of the hospital Policlinico Umberto I “Sapienza” with a diagnosis of odontogenic related head and neck infection, observing the epidemiological patterns, the management and the type of surgical procedure adopted to treat the affections. Results: Over a 5-year period, 376,940 patients entered the emergency room of Policlinico Umberto I, “Sapienza” University of Rome, for a total of 63,632 hospitalizations. A total of 6607 patients were registered with a diagnosis of odontogenic abscess (10.38%), 151 of the patients were hospitalized, 116 of them were surgically treated (76.8%), and 6 of them (3.9%) manifested critical conditions such as sepsis and mediastinitis. Conclusions: Even today, despite the improvement of dental health education, dental affections can certainly lead to acute conditions, necessitating immediate surgical intervention.
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Belsito, Angela, Dario Costa, Carmela Fiorito, Gustavo De Iorio, Amelia Casamassimi, Silverio Perrotta, and Claudio Napoli. "Erythrocyte genotyping for transfusion-dependent patients at the Azienda Universitaria Policlinico of Naples." Transfusion and Apheresis Science 52, no. 1 (February 2015): 72–77. http://dx.doi.org/10.1016/j.transci.2014.12.006.
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Sterpetti, Antonio V., Antonino Cavallaro, Giorgio DeToma, and Sergio Stipa. "Francesco Durante and the hospital “Policlinico Umberto I”: The idea of a multidisciplinary university hospital." Surgery 155, no. 6 (June 2014): 1090–92. http://dx.doi.org/10.1016/j.surg.2014.01.019.
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Aceti, Franca, Francesca Aveni, Nicoletta Giacchetti, Paola Motta, and Bianca Straniero Sergio. "La depressione post-partum: inquadramento del problema." TERAPIA FAMILIARE, no. 94 (February 2011): 189–202. http://dx.doi.org/10.3280/tf2010-094013.
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In questo articolo gli Autori presentano i risultati preliminari relativi a 20 pazienti con diagnosi di depressione post-partum. Di recente infatti, č stato avviato dalla UOS di Igiene Mentale delle Relazioni Affettive e del post-partum del Policlinico Umberto I di Roma, un progetto intervento sui disturbi dell'umore nel puerperio. I dati raccolti finora indicano la prevalenza di un disturbo di personalitŕ del cluster B e che la depressione post-partum si configura come una difficoltŕ nel processo di separazione-individuazione madre-bambino che appare isomorfa a una indifferenziazione dei partner dalla propria famiglia di origine. Sia a livello individuale materno che della coppia, l'evento nascita, in quanto riedizione di vissuti di antiche separazioni, viene sperimentata come fonte di angosce e di pericolo.
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Pesaresi, Cristiano, Giuseppe Migliara, Davide Pavia, and Corrado De Vito. "Emergency Department Overcrowding: A Retrospective Spatial Analysis and the Geocoding of Accesses. A Pilot Study in Rome." ISPRS International Journal of Geo-Information 9, no. 10 (September 30, 2020): 579. http://dx.doi.org/10.3390/ijgi9100579.
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The overcrowding of first aid facilities creates considerable hardship and problems which have repercussions on patients’ wellbeing, the time needed for a diagnosis, and on the quality of the assistance. The basic objective of this contribution, based on the data collected by the Hospital Policlinico Umberto I in Rome (Lazio region, Italy), is to carry out a territorial screening of the municipality using GIS applications and spatial analyses aimed at reducing—in terms of triage—code white (inappropriate) attendances, after having identified the areas of greatest provenance of improperly used emergency room access. Working in a GIS environment and using functions for geocoding, we have tested an experimental model aimed at giving a close-up geographical-sanitary look at the situation: recognizing the territorial sectors in Rome which contribute to amplifying the Policlinico Umberto I emergency room overcrowding; leading up to an improvement of the situation; promoting greater awareness and knowledge of the services available on the territory, a closer relationship between patient and regular doctor (general practitioner, GP) or Local Healthcare Unit and a more efficient functioning of the emergency room. In particular, we have elaborated a “source” map from which derive all the others and it is a dot map on which all the codes white have been geolocalized on a satellite image through geocoding. We have produced three sets made up of three digital cartographic elaborations each, constructed on the census sections, the census areas and the sub-municipal areas, according to data aggregation, for absolute and relative values, and using different templates. Finally, following the same methodology and steps, we elaborated another dot map about all the codes red to provide another kind of information and input for social utility. In the near future, this system could be tested on a platform that spatially analyzes the emergency department (ED) accesses in near-real-time in order to facilitate the identification of critical territorial issues and intervene in a shorter time to regulate the influx of patients to the ED.
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Brescini, Lucia, Filippo Della Martera, Gianluca Morroni, Sara Mazzanti, Maria Di Pietrantonio, Paolo Mantini, Bianca Candelaresi, et al. "Use of Dalbavancin in Skin, Bone and Joint Infections: A Real-Life Experience in an Italian Center." Antibiotics 10, no. 9 (September 19, 2021): 1129. http://dx.doi.org/10.3390/antibiotics10091129.
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Dalbavancin is a lipoglycopeptide approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI). The aim of the study was to evaluate the efficacy and safety in all patients who received at least one administration of dalbavancin. Methods: We carried out a retrospective study of the use of dalbavancin in 55 patients at the Azienda Ospedaliera Ospedali Riuniti Umberto I (Ancona, Italy) from February 2017 to May 2020 and compared “on label” and “off label” use of dalbavancin in ABSSSI and non-ABSSSI. Results: A total of 55 patients were included in the study. The median age was 61 years; 51% had ABSSSI; 24% had prosthetic joint infections, and 14% had osteomyelitis. A total of 53% received a single 1500 mg infusion of dalbavancin, and 18% received a second dose 14 days later; 24% of patients received further doses at 14-day intervals. In 91% of cases, patients achieved clinical objectives with dalbavancin: 96% of patients with ABSSSI and 69% of those with prosthetic joint infections. Conclusions: Dalbavancin was shown to have an excellent tolerability profile and to be a highly successful therapeutic approach even in those cases treated “off-label”.
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Lubrano Lavadera, Anna, Ludovica Iesu, and Anna Lisa Micci. "La rilevazione della IPV in diversi contesti clinici." MALTRATTAMENTO E ABUSO ALL'INFANZIA, no. 1 (May 2009): 43–61. http://dx.doi.org/10.3280/mal2009-001003.
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- The studies, conducted on the phenomenon of the Intimate Partner Violence (IPV), report the necessity to use a multidimensional approach which foresees the analysis of the risk and protection factors implicated. The present study is focused on the analysis of the formalities in which the phenomenon of the violence is investigated in different clinical contexts (social services, orders of family leaving, expert legal consultation, Department Alcoholics of the Policlinico Umberto I°, spanish anti-violence centre). For the data collection has been used a Scheme of analysis of histories of violent couples, built ad hoc. The results underline notable discrepancies in the typology of gathered information in the cases of IPV in the different clinical contexts, probably associated to a different formation of the operators and to specific protocols to the objectives of the service. Such discrepancy has solicited the necessity to structure protocols of work that allow a complete and uniform collection of information in different contexts, with the purpose to deepen the understanding of the phenomenon of the IPV. Key words: intimate partner violence; multidimensional approach; protection and risk factors; clinical context.
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Minisola, Salvatore, Elisabetta Romagnoli, Liliana Scarnecchia, Rossana Rosso, Maria T. Pacitti, Antonella Scarda, and Gianfranco Mazzuoli. "Serum carboxy-terminal propeptide of human type I procollagen in patients with primary hyperparathyroidism: studies in basal conditions and after parathyroid surgery." European Journal of Endocrinology 130, no. 6 (June 1994): 587–91. http://dx.doi.org/10.1530/eje.0.1300587.
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Minisola S, Romagnoli E, Scarnecchia L, Rosso R, Pacitti MT, Scarda A, Mazzuoli G. Serum carboxyterminal propeptide of human type I procollagen in patients with primary hyperparathyroidism: studies in basal conditions and after parathyroid surgery. Eur I Endocrinol 1994;130:587–91. ISSN 0804-4643 This study was carried out in order to evaluate serum carboxy-terminal propeptide of human type I procollagen (PICP) in patients with primary hyperparathyroidism and to examine its changes following parathyroidectomy. Seventeen patients (four males and 13 famels, aged 53.8 ± 3.1 sem years) were studied in basal conditions; six patients also were investigated after successful parathyroid surgery. Mean serum PICP values of patients with primary hyperparathyroidism (194.5 ± 27 sem μg/l) were significantly higher (p < 0.001) with respect to those found in normal subjects. However, deviations from the norm (Z score values) were significantly less with respect to deviations of serum osteocalcin, alkaline phosphatase and urinary hydroxyproline/creatinine ratio. Following parathyroidectomy, it was possible to observe a discrepancy between markers of bone resorption and those of bone formation. The former tend to decrease, while the latter either do not show any significant change (serum alkaline phosphatase and serum osteocalcin) or increase (serum procollagen). The results of our investigation indicate that in basal conditions the assay of serum procollagen may be of clinical value but it would be better to use it in combination with other biomarkers of skeletal remodelling. The results obtained after parathyroidectomy are the opposite of those obtained following parathyroid hormone infusion and should be ascribed to the effect of acute hormone deficiency on collagen synthesis. The positive biochemical uncoupling following surgery might lend support to the rise of bone mineral density consistently reported in the first few months following parathyroidectomy. S Minisola, Istituto di II Clinical Medica, Policlinico Umberto I, Via del Policlinico 155, 00161 Rome, Italy
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Ferrara, Francesco, Roberta Pasquinucci, Maurizio Capuozzo, Giacomo Polito, Gabriele Bagaglini, Marcello Vaccaro, Adriana Coluccia, et al. "Comparison and Analysis of Antibiotic Consumption in Two Italian Hospital Settings in Relation to the Fight of Antimicrobial Resistance." Pharmaceuticals 17, no. 2 (January 30, 2024): 183. http://dx.doi.org/10.3390/ph17020183.
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Introduction: The emergence and spread of drug-resistant pathogens due to the improper use of antibiotics have become increasingly apparent in recent years. Objective: This retrospective comparative analysis aimed to assess and compare antibiotic prescription trends in Italy across two different regions based on geographic area and healthcare structure. One region represents a large hospital institution, while the other represents a populous local Italian health agency. The study also examined the impact of documented antibiotic stewardship programs and efforts to promote responsible antibiotic use at all levels, in alignment with international goals. Antibiotic consumption data were collected from the Umberto I Polyclinic Hospital and the ASL Napoli 3 South Local Health Agency. Methods: To compare consumption between regions, a standardized comparison using the Defined Daily Dose (DDD) was employed. The internal management system of each healthcare facility records all prescriptions and drug dispensations, and these data were extrapolated for this retrospective study. Results: A comparative assessment between the first half of 2022 and 2023 (January–June) highlighted a significant increase in beta-lactam antibiotic consumption, showing a twofold rise compared to the previous year’s term. Regarding prescription averages, there was a noticeable increase of +29.00% in hospitalizations and +28.00% in hospital discharges within the ASL Napoli 3 South. Conversely, at Policlinico Umberto I, there was a marginal increase of +1.60% in hospitalizations and a decrease of −7.40% in hospital discharges. Conclusions: The study offers valuable insights into expenditure patterns and antibiotic consumption, underscoring the need for enhanced prescribing practices and awareness campaigns to address the issue of antibiotic resistance. The findings stress the importance of implementing international guidelines to combat the growing threat of antibiotic resistance and ensure the effective management of infectious diseases.
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De Felice, Francesca, Marco de Vincentiis, Valentino Valentini, Daniela Musio, Silvia Mezi, Luigi Lo Mele, Marco Della Monaca, et al. "Management of salivary gland malignant tumor: the Policlinico Umberto I, “Sapienza” University of Rome Head and Neck Unit clinical recommendations." Critical Reviews in Oncology/Hematology 120 (December 2017): 93–97. http://dx.doi.org/10.1016/j.critrevonc.2017.10.010.
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Colaprico, Corrado, Eleonora Ricci, Andrea Bongiovanni, Valentin Imeshtari, Vanessa India Barletta, Maria Vittoria Manai, David Shaholli, Mattia Marte, Pasquale Serruto, and Giuseppe La Torre. "Flu Vaccination among Healthcare Professionals in Times of COVID-19: Knowledge, Attitudes, and Behavior." Vaccines 10, no. 8 (August 18, 2022): 1341. http://dx.doi.org/10.3390/vaccines10081341.
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The seasonal flu vaccine is the most important way to prevent influenza epidemics, so it is useful to increase the awareness of health professionals. The aim of our study is to evaluate knowledge, attitudes, and behavior about flu vaccination among healthcare professionals in times of COVID-19. Methods: A cross sectional study was carried out between November 2020 and April 2021. Participants were recruited in teaching hospital ‘Policlinico Umberto I’ of Rome. A survey of 24 questions about flu vaccination was administered, evaluating their knowledge, attitude, and practice about this topic. Results: 872 healthcare professionals were involved in the study (36.9% men, 63.1% women). More than 90% of the HCWs, especially physicians, recognize the importance of getting influenza vaccination: The main reasons for not getting vaccinated were fear of vaccine side effects (20.3%) and fear of the needle (6.4%). Nevertheless, 40.7% of the healthcare providers consider mandatory vaccination as unethical, especially if they work in low-intensity wards. Conclusion: a high percentage of healthcare workers agree with the importance of influenza vaccination and only a small percentage is still opposed. It is therefore important to continue to promote the influenza vaccination through communication and health education programs.
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Galli, Carlotta. "Odontogenic Abscesses during the Pandemic by SARS-CoV-2." Open Access Journal of Dental and Oral Surgery (OAJDOS) 3, no. 5 (December 5, 2022): 1–5. http://dx.doi.org/10.54026/oajdos/1047.
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Dental abscess are pathologies caused by infectious processes in the teeth and/or their surrounding tissues. They can lead to complications, or in some cases they can be lethal, in base of the anatomy of the area of the oral cavity in which they develop. Therefore, this is a recurrent reason why patients with an odontogenic abscess may need to go to the dental emergency room. In this study, the access data to the emergency room of the “Policlinico Umberto I” of patients with odontogenic abscesses were analyzed and were put into a relation with the epidemic by SARS-CoV-2. The periods of 2019 and 2020 have been taken into consideration and the pre- and post- lockdown periods were analyzed by comparing the data. Due to the restrictions imposed during the lockdown in Italy, we would have expected an increase in the number of accesses to the dental emergency room for odontogenic abscesses, but the results showed a decrease in the percentage of accesses for this pathology. Having regard to the results, an attempt to give a logical explanation to this decline in the numbers recorded at our Polyclinic has been made.
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Zaccheo, Fabrizio, Andrea Cicconetti, Guido Gori, and Giulia Petroni. "Evaluating a Methodical Approach to Lingual Nerve Protection during Third Molar Surgery Using a Standardized Step-by-Step Procedure: A Retrospective Analysis." Applied Sciences 14, no. 13 (July 3, 2024): 5835. http://dx.doi.org/10.3390/app14135835.
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The aim of this study was to assess the methodical protection of the lingual nerve via the use of a standardized step-by-step procedure in the surgical extraction of the lower third molar. A 5-year retrospective analysis of surgical third molar surgery conducted by third-year oral surgery specialty program students was performed in the oral surgery department of Policlinico Umberto I in Rome, from 2017 to 2022. All surgeries were carried out using a standardized step-by-step procedure to protect the lingual flap during the surgery. Every patient underwent a review on the initial postoperative day, and subsequently, one week after the surgery, coinciding with the removal of the sutures. During each postoperative visit, thorough examinations were conducted to assess any sensory nerve impairment of the inferior alveolar, lingual, or mylohyoid nerves. None of the cases reported postsurgical lingual nerve injury; there was zero incidence of lingual nerve paresthesia or dysesthesia. The systematic application of lingual flap protection proved to be an effective and reproducible approach for the surgical removal of lower third molars without raising the risk of lingual nerve sensory impairment, regardless of the operator’s experience.
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La Torre, Giuseppe, Vanessa India Barletta, Mattia Marte, Francesca Paludetti, Augusto Faticoni, Lavinia Camilla Barone, Ilaria Rocchi, et al. "Assessment of Anxiety, Depression, Work-Related Stress, and Burnout in Health Care Workers (HCWs) Affected by COVID-19: Results of a Case–Control Study in Italy." Journal of Clinical Medicine 11, no. 15 (July 29, 2022): 4434. http://dx.doi.org/10.3390/jcm11154434.
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This study aims to investigate whether HCWs infected with COVID-19 may experience potential psychological consequences and a higher incidence of depression, anxiety, work-related stress, and burnout compared to non-infected HCWs. A case–control study with 774 participants was conducted comparing COVID-19-infected HCWs (cases) and non-infected HCWs (controls) from the Occupational Medicine Unit at the Teaching Hospital Policlinico Umberto I, who were administered the same questionnaire including Hospital Anxiety and Depression Scale, Copenhagen Burnout Inventory and Karasek’s Job Content Questionnaire. No differences in the levels of burnout and decision latitude were found between the two groups. Cases showed higher level of anxiety and job demand compared to controls. In contrast, levels of depression in the case group were significantly lower compared to the control group. The results are indicating the need for workplace health promotion activities based on stress and burnout management and prevention. Multiple organizational and work-related interventions can lower the impact of mental health-related issues in the COVID-19 pandemics, including the improvement of workplace infrastructures, as well as the adoption of correct and shared anti-contagion measures, which must include regular personal protective equipment supply, and the adoption of training programs that deal with mental health-related issues.
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Del Fante, Zoe, Nicola Di Fazio, Adriano Papale, Paola Tomao, Fabio Del Duca, Paola Frati, and Vittorio Fineschi. "Evaluation of Physical Risk during Necropsy and Morgue Activities as Risk Management Strategy." International Journal of Environmental Research and Public Health 18, no. 16 (August 4, 2021): 8266. http://dx.doi.org/10.3390/ijerph18168266.
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Physical risk assessments allow us to understand work-related critical issues, thus representing a useful tool in risk management strategies. In particular, our study focuses on the identification of already known and emerging physical risks related to necropsy and morgue activities, as well as crime scene investigations. The aim of our study is, therefore, to identify objective elements in order to quantify exposure to such risk factors among healthcare professionals and working personnel. For the research of potentially at-risk activities, data from the Morgue of Policlinico Umberto I Hospital in Rome were used. The scientific literature has been reviewed in order to assess the risks associated with morgue activity. Measurements were performed on previously scheduled days, in collaboration with the activities of different research units. The identified areas of risk were: microclimate; exposure to noise and vibrations; postural and biomechanical aspects of necropsy activities. The obtained results make it possible to detect interindividual variability in exposure to many of the aforementioned risk factors. In particular, the assessment of microclimate did not show significant results. On the contrary, exposure to vibrations and biomechanical aspects of load handling have shown potential risk profiles. For this reason, both profiles have been identified as possible action targets for risk management strategies.
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Bossù, Maurizio, Mario Trottini, Denise Corridore, Gianni Di Giorgio, Gian Luca Sfasciotti, Gaspare Palaia, Livia Ottolenghi, Antonella Polimeni, and Stefano Di Carlo. "Oral Health Status of Children with Autism in Central Italy." Applied Sciences 10, no. 7 (March 26, 2020): 2247. http://dx.doi.org/10.3390/app10072247.
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Children with autism spectrum disorder (ASD) have significantly higher prevalence and caries severity compared to the average population. Knowledge about the oral health indices of children with this mental disorder is key to designing efficient plans of intervention. This paper reports the results of a study on the oral health status of children with ASD in central Italy. This is the first study of this type in Italy. The sample consists of 229 autistic children aged between 5 and 14 years, attending the Unit of Special Needs Policlinico Umberto I in Rome. Each patient received an intraoral examination to investigate decayed, missing, and filled teeth as well as periodontal status. Information on demographic attributes, dietary habits, medical history, and child’s cooperativeness at the first visit was also recorded. Of the participants, 79.26% presented signs of gingivitis and about 90% of them had plaque. Caries prevalence was 66.38%. The average of the total number of decayed, missing, and filled teeth in the permanent and primary dentition was 2.91. Among the factors considered, only dietary habits and the periodontal indices showed statistically significant association with caries prevalence and caries severity. Despite the selection bias, that prevents us to interpret the results presented as epidemiological evidence, our study suggests that children with ASD in central Italy represent a population at risk.
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Triaca, Viviana, Elena Fico, Pamela Rosso, Massimo Ralli, Alessandro Corsi, Cinzia Severini, Alvaro Crevenna, et al. "Pilot Investigation on p75ICD Expression in Laryngeal Squamous Cell Carcinoma." Cancers 14, no. 11 (May 25, 2022): 2622. http://dx.doi.org/10.3390/cancers14112622.
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We investigated the p75 Neurotrophin Receptor (p75NTR) expression and cleavage product p75NTR Intracellular Domain (p75ICD) as potential oncogenic and metastatic markers in human Laryngeal Squamous Cell Carcinoma (LSCC). p75NTR is highly expressed in Cancer Stem Cells (CSCs) of the laryngeal epithelia and it has been proposed as a marker for stemness, cell migration, and chemo-resistance in different squamous carcinomas. To investigate the clinical significance of p75NTR cleavage products in solid tumors, full-length and cleaved p75NTR expression was analyzed in laryngeal primary tumors from different-stage LSCC patients, diagnosed at the Policlinico Umberto I Hospital. Molecular and histological techniques were used to detect the expressions of p75NTR and p75ICD, and ATP Binding Cassette Subfamily G Member 2 (ABCG2), a CSC marker. We found regulated p75NTR cleavage during squamous epithelial tumor progression and tissue invasion. Our preliminary investigation suggests p75ICD expression and localization as possible features of tumorigenesis and metastaticity. Its co-localization with ABCG2 in squamous cells in the parenchyma invaded by the tumor formation allows us to hypothesize p75NTR and p75ICD roles in tumor invasion and CSC spreading in LSCC patients. These data might represent a starting point for a comprehensive analysis of p75NTR cleavage and of its clinical relevance as a potential molecular LSCC signature, possibly helping diagnosis, and improving prognosis and personalized therapy.
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Tenuta, Marta, Alain Gelibter, Carla Pandozzi, Grazia Sirgiovanni, Federica Campolo, Mary Anna Venneri, Salvatore Caponnetto, et al. "Impact of Sarcopenia and Inflammation on Patients with Advanced Non-Small Cell Lung Cancer (NCSCL) Treated with Immune Checkpoint Inhibitors (ICIs): A Prospective Study." Cancers 13, no. 24 (December 17, 2021): 6355. http://dx.doi.org/10.3390/cancers13246355.
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Background: Sarcopenia is a condition characterized by loss of skeletal muscle mass associated with worse clinical outcomes in cancer patients. Data on sarcopenia in patients undergoing immune checkpoint inhibitors (ICI) therapy are still limited. The aim of this prospective observational study was to investigate the relationship between sarcopenia, ICI treatment response and immunological profile, in patients with advanced non-small cell lung cancer (NSCLC). Methods: Forty-seven stage IV NSCLC patient candidates for starting ICI, were enrolled from the Policlinico Umberto I outpatient Oncology. Patients underwent baseline blood test, inflammatory markers, cytokine assessment and body composition with dual-energy X-ray absorptiometry (DXA). Sarcopenia was defined with appendicular skeletal muscle mass over height2 (ASM/heigh2). Results: Overall, 19/47 patients (40.4%) results were sarcopenic. Sarcopenic patients showed significantly shorter PFS than non-sarcopenic ones (20.3 weeks, 95% CI 7.5–33.1 vs. 61 weeks, 95% CI 22.5–99.4, p = 0.047). Specifically, they had an 8.1 times higher risk of progression disease (PD) than non-sarcopenic patients (OR 8.1, 95%, p = 0.011). Conclusions: Sarcopenic patients showed worse PFS and had a higher risk of PD compared to non-sarcopenic ones. Therefore, sarcopenia may reflect the increased metabolic activity of more aggressive tumors, which involves systemic inflammation and muscle wasting and could be considered a negative predictive factor for ICI response.
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Gratani, Loretta, Giacomo Puglielli, and Rosangela Catoni. "Relationship between Atmospheric CO<sub>2</sub> Concentration and Vegetation in a Hospital Area: The Policlinico Umberto I in Rome." American Journal of Plant Sciences 10, no. 08 (2019): 1313–24. http://dx.doi.org/10.4236/ajps.2019.108095.
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Terracina, Sergio, Antonio Pallaria, Marco Lucarelli, Antonio Angeloni, Annarita De Angelis, Flavio Maria Ceci, Brunella Caronti, et al. "Urine Dipstick Analysis on Automated Platforms: Is a Reliable Screening Tool for Proteinuria? An Experience from Umberto I Hospital in Rome." Biomedicines 11, no. 4 (April 13, 2023): 1174. http://dx.doi.org/10.3390/biomedicines11041174.
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Urinalysis is commonly used as a screening tool for kidney disease. In many cases, the dipstick urine assay includes the assessment of albumin/protein and creatinine; consequently, the value of their ratio is available on the urine section report. Identification of albuminuria/proteinuria at early stages is an important issue to prevent or at least delay the onset of chronic kidney disease (CKD), kidney failure, and the progression of cardiovascular damage linked to the kidney’s loss of function. Sensitive and specific diagnostic methods are required for the assessment of such an important biomarker: urine albumin, creatinine, and their ratio (ACR) measured with quantitative assays are considered the gold standard. Routine dipstick methods (more rapid and at a lower cost) are intended for wide population screening. The aim of our study was to verify the reliability of an automated urinalysis dipstick method by comparing the results with the quantitative test of creatinine and albumin performed on a clinical chemistry platform. The first-morning voids of 249 patients who arrived from different departments were analyzed in the Central Laboratory of the University Hospital Policlinico Umberto I in Rome. We found a good correlation between the two assays, even though we observed that the dipstick assessment tends to overestimate the ACR’s value, disclosing a higher number of false positives if compared to the reference method. As an important novelty in this study, we analyzed our data considering age (starting from pediatric to geriatric patients) and sex as variables for a sub-stratification of the participants. Our results show that positive values need to be confirmed with quantitative methods, especially in women and younger people, and that from samples that resulted as diluted at the dipstick assay, the ACR’s values can be obtained if they are reanalyzed with quantitative assays. Moreover, patients with microalbuminuria (ACR 30–300 mg/g) or severe albumin urinary excretion (ACR > 300 mg/g) should be reanalyzed using quantitative methods to obtain a more reliable calculation of the ACR.
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Sampirisi, Luigi, Luca D’Angelo, Mauro Palmieri, Alessandro Pesce, and Antonio Santoro. "Extradural Clinoidectomy in Clinoidal Meningiomas: Analysis of the Surgical Technique and Evaluation of the Clinical Outcome." Tomography 8, no. 5 (September 23, 2022): 2360–68. http://dx.doi.org/10.3390/tomography8050197.
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The surgical treatment of clinoidal meningiomas is currently still discussed in the literature. Different surgical approaches have been proposed and evaluated, in multiple studies, in order to improve the surgical outcomes. The aim of this study is to evaluate the advantages of extradural clinoidectomy in the context of tumor removal radicality for visual function improvement. A retrospective analysis was performed on 74 patients—of which 26 patients with clinoidal meningiomas were in group III, according to Al Mefty classification—who underwent surgery at the Policlinico Umberto I Hospital between 2000 and 2019. Further, extradural clinoidectomy was performed on 15 patients (Group A), and 11 patients underwent the pterional approach only (Group B). Additionally, visual impairment was present in all 26 patients before surgery. Next, visual function assessment was performed on all patients, both in presurgery and postsurgery. Radiological follow up was performed at 3 and 6 months, and then every 12 months. Gross Total Resection (GTR) was achieved in 13/15 (86.7%) patients who underwent clinoidectomy, and in 4/11 (36.4%) patients who did not undergo clinoidectomy. Visual function improvement was achieved in 12/15 (80%) patients who underwent clinoidectomy and in 4 of 11 (36.4%) who did not undergo clinoidectomy. According to our study, extradural clinoidectomy is the most suitable method for facilitating the gross total resection of clinoidal meningiomas. Our experience and data suggest that a higher rate of total resection and, subsequently, the best visual outcomes are achieved. Extradural drilling via the anterior clinoid process reveals a wider surgical corridor for meticulous tumor resection.
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De Angelis, Francesca, Stefania Basili, Fratto Giovanni, Pompiliu Dan Trifan, Stefano Di Carlo, and Licia Manzon. "Influence of the oral status on cardiovascular diseases in an older Italian population." International Journal of Immunopathology and Pharmacology 31 (January 1, 2018): 039463201775178. http://dx.doi.org/10.1177/0394632017751786.
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Oral diseases have been adversely associated with cardiovascular diseases (CVD), which are also the most frequent cause of death in older population. The aim of this study was to investigate the association among oral status indexes and CVD in patients aged more than 65 years attending in the Oral department of a public hospital Policlinico Umberto 1 of Rome. The study population consisted of 533 patients. Dental status was detected measuring the Decayed, Missing, and Filled Teeth (DMFT) and Community Periodontal Index (CPI) indexes. The chi-square test with a 95% confidence level was used to assess qualitative variables. Odds ratios (ORs) and stepwise logistic regression were used to calculate risk estimates; the independent variables: age, gender, DMFT, CPI index, Geriatric Oral Health Assessment Index (GOHAI) score, and tooth loss were included in the statistical model. P value <0.05 was considered a statistically significant cut-off. No differences were found between females and males for DMFT and CPI. GOHAI data were worst for females. Patients with CVD had less education and oral care ( P < 0.05), and higher CPI index and number of missing teeth ( P < 0.05). Data show that patients with more than 18 missing teeth have 2.5 times greater risk of CVD. CVDs are associated with type 2 diabetes mellitus, underweight, and obesity ( P < 0.05). From the findings of this study, it can be confirmed a significant link between CVD and oral health. A cooperation among geriatrician, cardiologist, and dentist is suitable to counteract the development of CVD and to early identify patients at risk of CVD.
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Marzuillo, Carolina, Maria De Giusti, Daniela Tufi, Alessandra Giordano, Angela Del Cimmuto, Serena Quattrucci, Carlo Mancini, and Paolo Villari. "Molecular Characterization ofStenotrophomonas maltophiliaIsolates from Cystic Fibrosis Patients and the Hospital Environment." Infection Control & Hospital Epidemiology 30, no. 8 (August 2009): 753–58. http://dx.doi.org/10.1086/598683.
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Objectives.To ascertain whether cystic fibrosis (CF) patients are colonized or infected with unique or multiple strains ofStenotrophomonas maltophilia; to understand whether some strains colonize or infect more than 1 patient, indicating clonal spread; and to explore the molecular heterogeneity of hospital water isolates and their correlation with clinical isolates.Setting.The regional CF center of Policlinico “Umberto I” of Rome, Italy.Methods.The study was carried out on a random sample ofS. maltophiliaisolates (n= 110) collected from CF patients (n= 50) during the period 2002–2005 and on 24 water isolates obtained during a monitoring program in the first 6 months of 2005. Home environmental samplings were not performed. All isolates, which were recovered from cultures of specimens obtained in both inpatient and outpatient settings, were genotyped with DNA macrorestriction analysis with the restriction enzymeXbaland pulsed-field gel electrophoresis.Results.One-third of the patients with repeated episodes ofS. maltophiliainfection or colonization hosted more than 1 strain. A potential transmission, defined as the isolation of the same strain in 2 or more patients, occurred 5 times, showing a frequency of potential transmission episodes slightly higher than previously reported. Water, taps, and sinks of the different rooms of the CF center tended to be persistently colonized with the same strain ofS. maltophilia, with no correlation between clinical and water-associated isolates.Conclusions.The study does not provide sufficient data to conclude definitively that isolation of colonized or infected CF patients and control of hospital water systems contamination would be beneficial infection control measures. Epidemiologic analytical studies that correlate the presence ofS. maltophiliawith clinical outcomes are strongly needed.
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Accinni, Tommaso, Marianna Frascarelli, Antonino Buzzanca, Luca Carlone, Francesco Ghezzi, Martina Fanella, Carolina Putotto, et al. "S51. ANALYSIS OF SOCIAL COGNITION AS A PREDICTIVE FACTOR OF PSYCHOSIS IN 22Q11 DELETION SYNDROME (DS). DATA FROM THE MULTICENTER STUDY OF THE ITALIAN NETWORK FOR RESEARCH ON PSYCHOSES." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S52. http://dx.doi.org/10.1093/schbul/sbaa031.117.
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Abstract Background 22q11DS is the most important genetic risk factor for schizophrenia: up to 28% of these subjects develop psychosis in adulthood. At present this syndrome represents the strongest biological model to investigate neurobiological underpinnings of schizophrenia. We expected Theory of Mind impairments in subjects at risk for psychosis (22q11DS) and more severe impairments in subjects with an established psychotic disorder. Furthermore we sought to investigate eventual correlations between social cognition and self-esteem levels, hypothesizing that both would be impaired in psychotic groups. Methods Data come from Italian Network for Research on Psychoses for the Schizophrenic (SCZ, N=260) and Control groups (HC, N=111). 22q11DS psychotic (22q11DS_SCZ, N=17) and non-psychotic patients (22q11DS, N=46) were enrolled at Policlinico Umberto I, in Rome. The Awareness and Social Inference Test (TASIT) and Self-Esteem Rating Scale (SERS) were administered. Results The three main TASIT variables, Emotion Recognition, Minimal Social Inference and Enriched Social Inference, showed no different scores between the three clinical groups, which were significantly lower respect to the control group. The SERS total score showed no significant differences between clinical groups but was for all three significantly lower than control group score. No significant correlation was observed between SERS and TASIT scores for clinical groups. Discussion Social Cognition impairments are present in 22q11DS at the same extent as in idiopathic schizophrenia, and thus they represent an endophenotype of psychosis. A low Self-Esteem, even though associated to psychosis, does not affect neurocognitive process, impaired on a neurobiological basis.
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La Torre, Giuseppe, Gianluca Paglione, Lavinia Camilla Barone, Vittoria Cammalleri, Augusto Faticoni, Mattia Marte, Roberta Noemi Pocino, et al. "Evaluation of the Factors Associated with Reinfections towards SARS-CoV-2 Using a Case Control Design." Journal of Clinical Medicine 12, no. 11 (June 5, 2023): 3861. http://dx.doi.org/10.3390/jcm12113861.
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Objective: The risk of reinfection with SARS-CoV-2 has been rapidly increased with the circulation of concerns about variants. So, the aim of our study was to evaluate the factors that increase the risk of this reinfection in healthcare workers compared to those who have never been positive and those who have had only one positivity. Methods: A case-control study was carried out at the Teaching Hospital Policlinico Umberto I in Rome, Sapienza University of Rome, in the period between 6 March 2020 and 3 June 2022. Cases are healthcare workers who have developed a reinfection with the SARS-CoV-2 virus, while controls were either healthcare workers who tested positive once or those who have never tested positive for SARS-CoV-2. Results: 134 cases and 267 controls were recruited. Female gender is associated with a higher odds of developing reinfection (OR: 2.42; 95% CI: 1.38–4.25). Moreover, moderate or high alcohol consumption is associated with higher odds of reinfection (OR: 1.49; 95% CI: 1.19–1.87). Diabetes is also associated with higher odds of reinfection (OR: 3.45; 95% CI: 1.41–8.46). Finally, subjects with increased red blood cell counts have higher odds of reinfection (OR: 1.69; 95% CI: 1.21–2.25). Conclusion: From the prevention point of view, these findings indicate that particular attention should be paid to subjects with diabetes mellitus, women and alcoholic drinkers. These results could also suggest that contact tracing represents a fundamental approach model against the SARS-CoV-2 pandemic, together with the health information of participants.
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Gholamalishahi, Shima, Seyed Ali Hosseini, Evaristo Ettorre, Alice Mannocci, Chidiebere Emmanuel Okechukwu, Mohamad Javad Keshavarz, and Giuseppe La Torre. "The Association between Levels of Physical Activity and Lifestyle, Life Expectancy, and Quality of Life in Patients with Alzheimer’s Disease." Journal of Clinical Medicine 12, no. 23 (November 26, 2023): 7327. http://dx.doi.org/10.3390/jcm12237327.
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Background: Engaging in physical activity could help improve the quality of life in patients with Alzheimer’s disease. The objective of this study was to determine the association between the levels of physical activity and lifestyle, life expectancy, and quality of life in patients with Alzheimer’s disease in Iran and Italy. Methods: A total of 165 participants from Iran and Italy were enrolled in this cross-sectional study. In Iran, 85 patients participated in the study. In Italy, we enrolled 80 patients at the Sapienza University teaching hospital, Policlinico Umberto 1 in Rome. The inclusion criteria in this study include patients over 60 years old, non-smokers, and non-users of antidepressants and hypnotics. Results: The results of Tukey’s post hoc test of the study conducted in Iran showed that the lifestyle of patients with moderate (p = 0.001) and low (p = 0.009) physical activity levels was significantly better than inactive patients. Life expectancy in patients with moderate physical activity levels was significantly higher than inactive patients (p = 0.011). The quality of life was significantly better in patients with moderate (p = 0.001) and low (p = 0.002) physical activity levels than inactive patients. On the other hand, the findings of Tukey’s post hoc test of the study in Italy showed that the quality of life in patients with low (p = 0.001) and moderate physical activity levels (p = 0.01) was significantly higher than inactive patients. Conclusions: A low to moderate level of physical activity could be associated with an improved lifestyle, life expectancy, and quality of life in patients with Alzheimer’s disease compared to inactivity.
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Rusi, Eqrem, Fiorenza Pennacchia, Wael Abu Ruqa, Maria Antonella Zingaropoli, Patrizia Pasculli, Giuseppina Talarico, Giuseppe Bruno, et al. "Blood Count and Renal Functionality Assessments in the Emergency Section Disclose Morbidity and Mortality in Omicron COVID-19 Patients: A Retrospective Study." Clinics and Practice 14, no. 3 (April 23, 2024): 685–702. http://dx.doi.org/10.3390/clinpract14030055.
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Background: SARS-CoV-2 is the coronavirus responsible for the COVID-19 pandemic. Even though we are no longer in a pandemic situation, people are still getting infected, some of them need hospitalization and a few of them die. Methods: We conducted a retrospective study including 445 patients who accessed the Emergency Section of Policlinico Umberto I, Rome, Italy, where they had routine blood exams. In this study, we focused on the complete blood count, serum creatinine and azotemia. The data were analyzed using ANOVA, Spearman correlation and ROC analyses. They were divided into four groups based on their clinical outcomes: (1) the emergency group (patients who had mild forms and were quickly discharged); (2) the hospital ward group (patients who were admitted to the emergency section and were then hospitalized in a COVID-19 ward); (3) the intensive care unit (ICU) group (patients who required intensive assistance after the admission in the emergency section); (4) the deceased group (patients who had a fatal outcome after admission to the emergency section). Results: We found significant changes for creatinine, azotemia, hematocrit, mean corpuscular hemoglobin concentration, basophils, monocytes, red blood cell distribution width, hemoglobin, hematocrit and red blood cell numbers using ANOVA according to their clinical outcomes, particularly for the deceased group. Also, we found linear correlations of clinical outcomes with eosinophils, hemoglobin, hematocrit, mean corpuscular hemoglobin concentration, lymphocyte, neutrophil, platelet and red blood cell number and red blood cell distribution width. Conclusions: This study discloses an early association between “classical” routine blood biomarkers and the severity of clinical outcomes in Omicron patients.
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Letizia, Claudio, Marco Centanni, Luigi Scuro, Gianluca Canettieri, Sabrina Cerci, Anita De Ciocchis, Cecilia D'Ambrosio, and Domenico Scavo. "High plasma levels of endothelin-1 in untreated Addison's disease." European Journal of Endocrinology 135, no. 6 (December 1996): 696–99. http://dx.doi.org/10.1530/eje.0.1350696.
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Letizia C, Centanni M, Scuro L, Canettieri G, Cerci S, De Ciocchis A, D'Ambrosio C, Scavo D. High plasma levels of endothelin 1 in untreated Addison's disease. Eur J Endocrinol 1996;135:696–9. ISSN 0804–4643 The aim of this study has been to investigate the plasma endothelin-1 (ET-1) levels in adult patients with proven Addison's disease (AD). Plasma ET-1 levels were measured in 29 subjects (17 males and 12 females, aged between 20 and 54 years): 15 of them were patients with AD and 14 were sex- and age-matched normal subjects, used as a control group. All patients with AD have been studied under basal conditions and nine of them also after 2 weeks on oral corticosteroid therapy (individual cortisol dosage ranging from 25 to 37.5 mg/day and 0.1 mg/day 9α-fluorohydrocortisone). Extracted plasma ET-1 was determined by a specific radioimmunoassay using rabbit endothelin antisera. Mean ET-1 values in the patients with AD were three times higher than in normal subjects (21.09 ± 4.38 pg/ml vs 6.72 ± 1.74 pg/ml; p < 0.0001). Plasma ET-1 levels assayed in the patients with AD after 2 weeks of corticosteroid therapy were significantly decreased (14.47 ± 3.7 pg/ml vs 22.8 ± 5.2 pg/ml; −37%; p < 0.001) compared to values in untreated patients. However, the plasma ET-1 values obtained following corticosteroid therapy were still significantly higher (p < 0.001) than those detected in the control subjects. These results clearly indicate that patients with untreated AD have increased circulating ET-1 levels that may be reduced by short-term corticosteroid therapy. Claudio Letizia, Policlinico Umberto I, II Clinica Medica, 00185 Roma, Italy
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Rossi, V., E. Viozzi, F. M. Nimbi, F. Tripodi, and M. G. Porpora. "Endometriosis and Infertility: Impact on Sexuality." Klinička psihologija 9, no. 1 (June 13, 2016): 65. http://dx.doi.org/10.21465/2016-kp-op-0042.
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Objective: Endometriosis is a condition that has a great impact on women’s life. One of the most important consequences of the disease is infertility that may exacerbate the psychological, relational and sexual consequences on patients. The aim of the present study was to examine quality of life, anxiety, sexual functioning and relationship satisfaction of women with endometriosis and infertility. Infertility is supposed to be associated with a worse clinical profile. Design and Method: Data were collected on 71 patients (39 women with endometriosis and 32 with endometriosis and infertility) aged between 20 and 50 (M=34.21, SD=8.38), recruited in the Gynecological and Obstetrics department of Policlinico Umberto I, Rome. Participants completed: a socio-demographic questionnaire, the World Health Organization Quality of Life (WHOQOL)-Bref for quality of life, the McCoy Female Sexuality Questionnaire (MFS-Q) for sexual and relationship satisfaction, the Female Sexual Functioning Index (FSFI) for sexual functioning and the Hamilton Anxiety Rating Scale (HAM-A) for anxiety symptoms. Results: Women without infertility obtained worse scores: sexual functioning (F(1,69)=10.97 p<.01), sexual (F(1,69)=17.44 p<.001) and relationship satisfaction (F(1,69)=10.18 p<.001) and quality of life (F(1,69)=13.56 p<.001). Conclusions: Contrary to our hypothesis, endometriosis, with or without fertility impairment, has an impact on patients’ relationship, sexuality and quality of life. Therefore, infertility is not the main factor that explains a negative clinical profile. The present study suggests the importance of psychosexual counseling during medical treatment of the disease, and the need of involving partners in the assessment and in the health care decision making.
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Carlone, Luca, Marianna Frascarelli, Antonino Buzzanca, Tommaso Accinni, Francesco Ghezzi, Martina Fanella, Carolina Putotto, et al. "T219. REAL LIFE FUNCTIONING IN 22Q11 DELETION SYNDROME (DS) IN COMPARISON TO SCHIZOPHRENIA SUBJECTS: STUDY ON PSYCHOSES VULNERABILITY FACTORS. DATA FROM THE MULTICENTER STUDY OF THE ITALIAN NETWORK FOR RESEARCH ON PSYCHOSES." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S316. http://dx.doi.org/10.1093/schbul/sbaa029.779.
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Abstract Background 22q11DS is the most common microdeletion with an incidence of 1:4000 live births. It is considered a genetic biological model for psychosis vulnerability: 25–28% of 22q11DS adults is affected by a psychotic disorder. Few data are available regarding functioning in 22q11DS. Our aim was to test the hypothesis that functioning is similar in 22q11DS psychotic and non-psychotic patients, and idiopathic schizophrenic subjects. We expected also a correlation between negative symptoms and functioning. Methods Data come from Italian Network for Research on Psychoses for the Schizophrenic (SCZ, N=252) and Control groups (HC, N=110). 22q11DS psychotic (22q11DS_SCZ, N=21) and non-psychotic patients (22q11DS, N=23) were enrolled at Policlinico Umberto I, in Rome. The SLOF scale (Specific Levels of Functioning) and the Brief Negative Symptom Scale interview (BNSS) were employed. Results The Global Functioning was significantly different between all groups but not between 22q11DS groups and SCZ. The multivariate analysis of variance showed the higher effect size for the Interpersonal Functioning, in which differences resulted significant between all groups, except for the comparison between 22q11DS-SCZ and SCZ. Differences between groups in BNSS were significant except for the post-hoc 22q11DS-SCZ vs SCZ. Global and Interpersonal Functioning showed a significant negative correlation with BNSS scores in the three clinical groups. Discussion 22q11DS-SCZ showed a severe deficit in Interpersonal Functioning, similar to that of idiopathic schizophrenia. 22q11DS showed a deficit in Interpersonal Functioning respect to control group, but less severe than psychotic groups. Our data suggest a common impairment shared among the clinical groups, that may be the functional correlate of an underlying neurobiological mechanism.
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Crudele, Lucilla, Fabio Novielli, Stefano Petruzzelli, Stefano Battaglia, Antonio Francesco Maria Giuliano, Rosa Melodia, Chiara Maria Morano, et al. "Liver Fibrosis Indices Predict the Severity of SARS-CoV-2 Infection." Journal of Clinical Medicine 11, no. 18 (September 13, 2022): 5369. http://dx.doi.org/10.3390/jcm11185369.
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Discovering novel risk and prognostic factors for COVID-19 may help not only in reducing severity and mortality but also in creating targeted therapies considering patients’ individual features. Liver fibrosis is considered a complication in Non-alcoholic Fatty Liver Disease (NAFLD), it is a feature of steatohepatitis (NASH), and it has already been related to an increased risk for a wide range of diseases. Here, we aimed to define if any parameter assessing metabolic status has predictive power in identifying inpatients at risk for poorer prognosis and an increased mortality from COVID-19. This retrospective study was conducted at the Sub-Intensive Medicine Care Unit of the Presidio Maxi-Emergenze Fiera del Levante, Azienda Ospedaliero-Universitaria Policlinico di Bari, Italy. We evaluated 271 inpatients with moderate-to-severe SARS-CoV-2-related respiratory failure by comparing biochemical features and non-invasive liver fibrosis scores among discharged, transferred to Intensive Care Units (ICU) and non-survivor patients. Moreover, by performing ROC curves, we defined cut-off values to predict mortality and disease severity for each score. We found that non-invasive scores of liver fibrosis, obtained at day of admission, such as AAR (p < 0.001), FIB-4 and mFIB-4, FORNS, and AARPRI (p < 0.05) strongly predict not only in-hospital mortality but also the length of hospitalization and eventual admission to ICU. FIB-4 was the best score to identify non-survivor patients (sensitivity of 80% and specificity of 63%) and predict the need for ICU or mortality (71% of sensitivity and 65% of specificity), with a cut-off value of 1.94. Therefore, we present the predictive power and the cut-off values of several liver fibrosis scores here for disease severity and mortality in SARS-CoV-2 in-patients and we proposed the use of the present scores to identify ab initio the clinical therapeutic and diagnostic protocols for high-risk patients.
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Brunetti, Antonio, Nicola Altini, Domenico Buongiorno, Emilio Garolla, Fabio Corallo, Matteo Gravina, Vitoantonio Bevilacqua, and Berardino Prencipe. "A Machine Learning and Radiomics Approach in Lung Cancer for Predicting Histological Subtype." Applied Sciences 12, no. 12 (June 8, 2022): 5829. http://dx.doi.org/10.3390/app12125829.
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Lung cancer is one of the deadliest diseases worldwide. Computed Tomography (CT) images are a powerful tool for investigating the structure and texture of lung nodules. For a long time, trained radiologists have performed the grading and staging of cancer severity by relying on radiographic images. Recently, radiomics has been changing the traditional workflow for lung cancer staging by providing the technical and methodological means to analytically quantify lesions so that more accurate predictions could be performed while reducing the time required from each specialist to perform such tasks. In this work, we implemented a pipeline for identifying a radiomic signature composed of a reduced number of features to discriminate between adenocarcinomas and other cancer types. In addition, we also investigated the reproducibility of this radiomic study analysing the performances of the classification models on external validation data. In detail, we first considered two publicly available datasets, namely D1 and D2, composed of n = 262 and n = 89 samples, respectively. Ten significant features, according to univariate AUC evaluated on D1, were retained. Mann–Whitney U tests recognised three of these features to have a statistically different distribution, with a p-value < 0.05. Then, we collected n = 51 CT images from patients with lung nodules at the Azienda Ospedaliero—Universitaria “Policlinico Riuniti” in Foggia. Resident radiologists manually annotated the lung lesions in images to allow the subsequent analysis of the malignancy regions. We designed a pipeline for feature extraction from the Volumes of Interest in order to generate a third dataset, i.e., D3. Several experiments have been performed showing that the selected radiomic signature not only allowed the discrimination of lung adenocarcinoma from other cancer types independently from the input dataset used for training the models, but also allowed reaching good classification performances also on external validation data; in fact, the radiomic signature computed on D1 and evaluated on the local cohort allowed reaching an AUC of 0.70 (p<0.001) for the task of predicting the histological subtype.
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Graham, Neil Samuel Nyholm, Karl A. Zimmerman, Guido Bertolini, Sandra Magnoni, Mauro Oddo, Henrik Zetterberg, Federico Moro, et al. "Multicentre longitudinal study of fluid and neuroimaging BIOmarkers of AXonal injury after traumatic brain injury: the BIO-AX-TBI study protocol." BMJ Open 10, no. 11 (November 2020): e042093. http://dx.doi.org/10.1136/bmjopen-2020-042093.
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Introduction and aimsTraumatic brain injury (TBI) often results in persistent disability, due particularly to cognitive impairments. Outcomes remain difficult to predict but appear to relate to axonal injury. Several new approaches involving fluid and neuroimaging biomarkers show promise to sensitively quantify axonal injury. By assessing these longitudinally in a large cohort, we aim both to improve our understanding of the pathophysiology of TBI, and provide better tools to predict clinical outcome.Methods and analysisBIOmarkers of AXonal injury after TBI is a prospective longitudinal study of fluid and neuroimaging biomarkers of axonal injury after moderate-to-severe TBI, currently being conducted across multiple European centres. We will provide a detailed characterisation of axonal injury after TBI, using fluid (such as plasma/microdialysate neurofilament light) and neuroimaging biomarkers (including diffusion tensor MRI), which will then be related to detailed clinical, cognitive and functional outcome measures. We aim to recruit at least 250 patients, including 40 with cerebral microdialysis performed, with serial assessments performed twice in the first 10 days after injury, subacutely at 10 days to 6 weeks, at 6 and 12 months after injury.Ethics and disseminationThe relevant ethical approvals have been granted by the following ethics committees: in London, by the Camberwell St Giles Research Ethics Committee; in Policlinico (Milan), by the Comitato Etico Milano Area 2; in Niguarda (Milan), by the Comitato Etico Milano Area 3; in Careggi (Florence), by the Comitato Etico Regionale per la Sperimentazione Clinica della Regione Toscana, Sezione area vasta centro; in Trento, by the Trento Comitato Etico per le Sperimentazioni Cliniche, Azienda Provinciale per i Servizi Sanitari della Provincia autonoma di Trento; in Lausanne, by the Commission cantonale d’éthique de la recherche sur l’être humain; in Ljubljana, by the National Medical Ethics Committee at the Ministry of Health of the Republic of Slovenia. The study findings will be disseminated to patients, healthcare professionals, academics and policy-makers including through presentation at conferences and peer-reviewed publications. Data will be shared with approved researchers to provide further insights for patient benefit.Trial registration numberNCT03534154.
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Oliva, Alessandra, Emanuele Rando, Dania Al Ismail, Massimiliano De Angelis, Francesca Cancelli, Maria Claudia Miele, Raissa Aronica, et al. "Role of Serum E-Selectin as a Biomarker of Infection Severity in Coronavirus Disease 2019." Journal of Clinical Medicine 10, no. 17 (September 6, 2021): 4018. http://dx.doi.org/10.3390/jcm10174018.
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Introduction: E-selectin is a recognized marker of endothelial activation; however, its place in Coronavirus Disease 2019 (COVID-19) has not been fully explored. Aims of the study are to compare sE-selectin values among the Intensive Care Unit (ICU)-admitted and non-admitted, survived and non-survived patients and those with or without thrombosis. Methods: A single-center study of patients with COVID-19 hospitalized at Policlinico Umberto I (Rome) from March to May 2020 was performed. Simple and multiple logistic regression models were developed. Results: One hundred patients were included, with a median age (IQR) of 65 years (58–78). Twenty-nine (29%) were admitted to ICU, twenty-eight (28%) died and nineteen (19%) had a thrombotic event. The median value (IQR) of sE-selectin was 26.1 ng/mL (18.1–35). sE-selectin values did not differ between deceased and survivors (p = 0.06) and among patients with or without a thrombotic event (p = 0.22). Compared with patients who did not receive ICU treatments, patients requiring ICU care had higher levels of sE-selectin (36.6 vs. 24.1 ng/mL; p < 0.001). In the multiple logistic regression model, sE-selectin levels > 33 ng/mL, PaO2/FiO2 < 200 and PaO2/FiO2 200–300 were significantly associated with an increased risk of ICU admission. sE-selectin values significantly correlated with a neutrophil count (R = 0.32 (p = 0.001)) and the number of days from the symptoms onset to hospitalization (R = 0.28 (p = 0.004)). Conclusions: sE-selectin levels are predictive of ICU admission in COVID-19 patients. Since data on the relation between sE-selectin and COVID-19 are scarce, this study aims to contribute toward the comprehension of the pathogenic aspects of COVID-19 disease, giving a possible clinical marker able to predict its severity.
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Schiavi, Laura, Giulia Brindisi, Giovanna De Castro, Valentina De Vittori, Lorenzo Loffredo, Alberto Spalice, Marzia Duse, and Anna Maria Zicari. "Nasal reactivity evaluation in children with allergic rhinitis receiving grass pollen sublingual immunotherapy." Allergy and Asthma Proceedings 41, no. 5 (September 1, 2020): 357–62. http://dx.doi.org/10.2500/aap.2020.41.200063.
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Background: The European Academy of Allergy and Clinical Immunology guidelines, strongly recommended allergen immunotherapy (AIT) as an effective treatment to achieve long-term clinical benefits and to modify the natural history of allergic diseases. Sublingual immunotherapy (SLIT) offers the possibility of home administration, which improves patient comfort and compliance. Objective: The primary outcome of this study was to assess the change in nasal reactivity after grass-pollen AIT treatment. Methods: This was a monocentric, prospective, observational study conducted in Rome from September 2016 to June 2018, in the Pediatric Department of Policlinico Umberto I. We enrolled children, ages between 6 and 12 years, with persistent allergic rhinitis (AR), sensitized to grass pollen. At the first visit (V0, September 2016), one group received the first dose of oral immunotherapy for grass-pollen spray buccal and the other group continued only standard therapy. All the patients had nasal specific immunoglobulin I (IgE) assay (Phl p1, Phl p5), active anterior rhinomanometry with a nasal provocation test (NPT), and spirometry. The patients attended two follow-up visits, in May 2017 (V1) and May 2018 (V2), with the same examinations as at V0. Results: During the treatment, we observed, in the treated group, a significant increase in the mean nasal flow compared with untreated children (p < 0.001). In the AIT group, we found an improvement of nasal function and only 21.05% of all the children in the active group with a positive NPT result at V2. In the control group, we found, at V2, a worsening of nasal function, with 89.47% of the children with a positive NPT result. Furthermore, we found a significant reduction of nasal specific IgE levels at the end of the observation period in the treated group. Conclusion: Analysis of our data provided evidence for a clinical effect of SLIT in inducing clinical changes and allergen tolerance in children with AR.
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Tiseo, Giusy, Elena Cavarretta, Arianna Forniti, Cristina Nocella, Sebastiano Sciarretta, Ornella Spagnolello, Enrico Baldini, et al. "Interplay between Nox2 Activity and Platelet Activation in Patients with Sepsis and Septic Shock: A Prospective Study." Oxidative Medicine and Cellular Longevity 2020 (October 27, 2020): 1–6. http://dx.doi.org/10.1155/2020/4165358.
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Background. Although preclinical studies highlighted the potential role of NADPH oxidase (NOX) in sepsis, only few studies evaluated the oxidative stress in patients with sepsis and septic shock. The objective of the study is to appraise the oxidative stress status and platelet function in patients with sepsis and septic shock compared to healthy controls. Methods and Results. Patients with sepsis or septic shock admitted to the hospital Policlinico Umberto I (Sapienza University, Rome) underwent a blood sample collection within 1 hour from admission. Platelet aggregation, serum thromboxane B2 (TxB2), soluble NOX2-derived peptides (sNox2-dp), and hydrogen peroxide breakdown activity (HBA) were measured and compared to those of healthy volunteers. Overall, 33 patients were enrolled; of these, 20 (60.6%) had sepsis and 13 (39.4%) septic shock. Compared to healthy controls ( n = 10 , age 67.8 ± 3.2 , male 50%), patients with sepsis and septic shock had higher platelet aggregation (49% (IQR 45-55), 60% (55.75-67.25), and 73% (IQR 69-80), respectively, p < 0.001 ), higher serum TxB2 (77.5 (56.5-86.25), 122.5 (114-131.5), and 210 (195-230) pmol/L, respectively, p < 0.001 ), higher sNox2-dp (10 (7.75-12), 19.5 (17.25-21), and 33 (29.5-39) pg/mL, respectively, p < 0.001 ), and lower HBA (75% (67.25-81.5), 50% (45-54.75), and 27% (21.5-32.5), respectively, p < 0.001 ). Although not statistically significant, a trend in higher levels of serum TxB2 and sNox2-dp in patients who died was observed. Conclusions. Patients with septic shock exhibit higher Nox2 activity and platelet activation than patients with sepsis. These insights joined to better knowledge of these mechanisms could guide the identification of future prognostic biomarkers and new therapeutic strategies in the scenario of septic shock.
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Micangeli, Ginevra, Roberto Paparella, Francesca Tarani, Michela Menghi, Giampiero Ferraguti, Francesco Carlomagno, Matteo Spaziani, et al. "Clinical Management and Therapy of Precocious Puberty in the Sapienza University Pediatrics Hospital of Rome, Italy." Children 10, no. 10 (October 10, 2023): 1672. http://dx.doi.org/10.3390/children10101672.
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Puberty identifies the transition from childhood to adulthood. Precocious puberty is the onset of signs of pubertal development before age eight in girls and before age nine in boys, it has an incidence of 1/5000–1/10,000 with an F:M ratio ranging from 3:1 to 20:1. Precocious puberty can be divided into central, also known as gonadotropin-dependent precocious puberty or true precocious puberty, and peripheral, also recognized as gonadotropin-independent precocious puberty or precocious pseudopuberty. Thus, the main aim of this narrative report is to describe the standard clinical management and therapy of precocious puberty according to the experience and expertise of pediatricians and pediatric endocrinologists at Policlinico Umberto I, Sapienza University of Rome, Italy. In the suspicion of early sexual maturation, it is important to collect information regarding the age of onset, the speed of maturation of secondary sexual features, exposure to exogenous sex steroids and the presence of neurological symptoms. The objective examination, in addition to the evaluation of secondary sexual characteristics, must also include the evaluation of auxological parameters. Initial laboratory investigations should include serum gonadotropin levels (LH and FSH) and serum levels of the sex steroids. Brain MRI should be performed as indicated by the 2009 Consensus Statement in all boys regardless of chronological age and in all girls with onset of pubertal signs before 6 years of age. The gold standard in the treatment of central precocious puberty is represented by GnRH analogs, whereas, as far as peripheral forms are concerned, the triggering cause must be identified and treated. At the moment there are no reliable data establishing the criteria for discontinuation of GnRH analog therapy. However, numerous pieces of evidence suggest that the therapy should be suspended at the physiological age at which puberty occurs.
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Piovano, Elisa, Luca Fuso, Cinzia Baima Poma, Annamaria Ferrero, Stefania Perotto, Elisa Tripodi, Eugenio Volpi, Valentina Zanfagnin, and Paolo Zola. "Complications After the Treatment of Endometrial Cancer: A Prospective Study Using the French-Italian Glossary." International Journal of Gynecologic Cancer 24, no. 3 (March 2014): 418–26. http://dx.doi.org/10.1097/igc.0000000000000094.
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IntroductionThe evaluation of treatment complications is crucial in modern oncology because they heavily influence the every day life of patients. Several authors confirmed the reproducibility of the French-Italian glossary to score the complications in patients with endometrial cancer after radiotherapy (RT), but the treatment of endometrial carcinoma is primarily surgical and chemotherapy is often used for high-risk disease.ObjectivesThis study aimed to analyze the incidence of complications in our patients treated for endometrial cancer and to verify whether the glossary is a suitable instrument in the description of complications after surgery, RT, and chemotherapy.MethodsThe data of patients affected by endometrial cancer treated in the Gynecology and Obstetrics Academic Department, Azienda Ospedaliera Mauriziano Umberto I in Turin from 2000 to 2009 (with surgery alone or integrated treatments) were prospectively collected, and complications were described using the glossary. Every patient included in the analyses had a minimum of 18 months follow-up.ResultsOf the 271 patients, 68 (25%) experienced at least 1 complication with 87 overall complications. Most of the complications were mild (63%) and were found in the urinary (30%) or cutaneous systems (30%). Forty-four (50%) complications appeared within 1 year after treatment, but 9 (10%) complications appeared after 60 months of follow-up. Patients who were submitted to both surgery and RT showed a trend of higher rate of at least 1 complication (19/58 [32.7%]) if compared with surgery alone (36/135 [26.6%]), even if the difference was not statistically significant (P = 0.09). The incidence of complications in patients treated or not with lymphadenectomy was not statistically different (P = 0.088), whereas patients treated with laparotomy had a higher rate of cutaneous complications if compared with the laparoscopic approach (P = 0.018). The glossary included all observed complications.ConclusionsOne every 4 women treated for endometrial cancer develops a complication. Clinicians should check for complications especially after integrated treatments maintaining surveillance even in the long term. The glossary is a comprehensive instrument to describe the complications of endometrial cancer, regardless of the type of treatment delivered.
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Papalia, R. "AB0875 HYBRID COOPERATIVE COMPLEXES OF SODIUM HYALURONATE + SODIUM CHONDROITIN NON-SULFATED (HA-SC) IN THE TREATMENT OF HIP OA: CLINICAL RESULTS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1743.2–1744. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4186.
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Background:Hip Osteoarthritis (OA) is a widespread disease characterized by pain and functional impairment, which, particularly in the elderly, may compromise overall health and quality of life. In the last decades, Intra-articular (I.a.) injections of hyaluronic acid (HA) gained more space among the conservative treatment of OA because of their beneficial effects and positive outcomes without relevant complications. (1,2). An innovative and patented formulation containing hybrid cooperative complexes of sodium hyaluronate 2.4% + sodium chondroitin non-sulfated 1.6% of biotechnological origin (HA-SC) has been recently developed for the I.a. treatment of hip OA and evaluated in a pilot study (3).Objectives:1) Primary aim: Evaluation of the safety of HA-SC in the treatment of symptomatic hip OA; 2) Secondary aim: Evaluation of the efficacy of HA-SC in terms of pain reduction (VAS) and function improvement (Lequesne) of the affected hip joint.Methods:This is a pilot, multicentric, open, prospective study. The following inclusion criteria were established: Patients (both genders) aged ≥ 40 years suffering for primary hip OA confirmed by X-Ray; Grade I-II-III according to K&L grading scale; Basal VAS pain at the target hip > 40 mm; Failure of at least two lines of conservative treatments. All patients underwent a single I.a. hip injection of a 3mL vial of HA-SC and followed-up for six months.Results:48 patients have been enrolled and completed the study. The treatment was generally well-tolerated, with only ten patients out of 48 (20.8%) reporting local effects mainly consisting of injection site pain and arthralgia localized in the treated area. All these patients completed the study. The treatment with HA-SC was associated with a statistically significant decrease of VAS scale from a basal value of 67.5 (mean) to 22.8 (mean, p<0.0001) at the end of the observation period at six months, with a statistically significant decrease at seven days of follow-up evaluation (29.3, mean, p<0.0001). The mean Lequesne’s Index total score after the single injection of HA-SC decreased from a baseline value of 10.4 (mean) to 5.1 (mean, p<0.0001) at six months. The decrease was marked and significant also at any of the other evaluated time point (p<0.0001).Conclusion:A single I.a. injection of the innovative formulation containing hybrid cooperative complexes of sodium hyaluronate + sodium chondroitin non-sulfated (HA-SC) showed to be well tolerated and safe in the treatment of symptomatic hip OA. A rapid and significant decrease in hip pain (VAS) and Lequesne’s Index was also observed starting immediately after the I.a. injection and lasting until the end of the follow-up period. However, conservative treatment of hip OA is still challenging. This new formulation could represent a promising, long-lasting, and effective I.a. treatment.References:[1]Papalia R. et al. J. Biol. Regul. Homeost. Agents 2017; 31 (4 Suppl. 2): 103-109.[2]Abate M. et al. Int. J. Immunopathol.Pharmacol. 2017; 30 (1): 89-93.[3]IBSA Data on file.Acknowledgments:The author thanks all the investigators of the study: Costantino Cosimo, UO Medicina Riabilitativa, Azienda Ospedaliero-Universitaria di Parma, Italy; Fortina Mattia, Unità di Ortopedia Universitaria, AOU Senese Policlinico Santa Maria alle Scotte, Italy; Sadile Francesco, II Ortopedia - Ortopedia Infantile, Università degli studi di Napoli Federico II, Italy; Salini Vincenzo, Clinica Ortopedica e Traumatologica, Ospedale SS Annunziata di Chieti, Italy; Voglino Nicola, UO Ortopedia e Traumatologia, Ospedale Alto Tevere Città di Castello Azienda USL Umbria 1, ItalyDisclosure of Interests:Rocco Papalia Speakers bureau: Speaker for IBSA
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Ceci, Flavio Maria, Marco Fiore, Francesca Gavaruzzi, Antonio Angeloni, Marco Lucarelli, Carolina Scagnolari, Enea Bonci, et al. "Early Routine Biomarkers of SARS-CoV-2 Morbidity and Mortality: Outcomes from an Emergency Section." Diagnostics 12, no. 1 (January 12, 2022): 176. http://dx.doi.org/10.3390/diagnostics12010176.
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Background. COVID-19 is a severe acute respiratory disease caused by SARS-CoV-2, a virus belonging to the Coronaviridae family. This disease has spread rapidly around the world and soon became an international public health emergency leading to an unpredicted pressure on the hospital emergency units. Early routine blood biomarkers could be key predicting factors of COVID-19 morbidity and mortality as suggested for C-reactive protein (CRP), IL-6, prothrombin and D-dimer. This study aims to identify other early routine blood biomarkers for COVID-19 severity prediction disclosed directly into the emergency section. Methods. Our research was conducted on 156 COVID-19 patients hospitalized at the Sapienza University Hospital “Policlinico Umberto I” of Rome, Italy, between March 2020 and April 2020 during the paroxysm’s initial phase of the pandemic. In this retrospective study, patients were divided into three groups according to their outcome: (1) emergency group (patients who entered the emergency room and were discharged shortly after because they did not show severe symptoms); (2) intensive care unit (ICU) group (patients who attended the ICU after admission to the emergency unit); (3) the deceased group (patients with a fatal outcome who attended the emergency and, afterward, the ICU units). Routine laboratory tests from medical records were collected when patients were admitted to the emergency unit. We focused on Aspartate transaminase (AST), Alanine transaminase (ALT), Lactate dehydrogenase (LDH), Creatine kinase (CK), Myoglobin (MGB), Ferritin, CRP, and D-dimer. Results. As expected, ANOVA data show an age morbidity increase in both ICU and deceased groups compared with the emergency group. A main effect of morbidity was revealed by ANOVA for all the analyzed parameters with an elevation between the emergency group and the deceased group. Furthermore, a significant increase in LDH, Ferritin, CRP, and D-dimer was also observed between the ICU group and the emergency group and between the deceased group and ICU group. Receiver operating characteristic (ROC) analyses confirmed and extended these findings. Conclusions. This study suggests that the contemporaneous presence of high levels of LDH, Ferritin, and as expected, CRP, and D-dimer could be considered as potential predictors of COVID-19 severity and death.
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Macrina, Francesco, Maria Cristina Acconcia, Luigi Tritapepe, Mizar D’abramo, Wael Saade, Alessandra Capelli, and Fabio Miraldi. "Hypothermia during Surgical Treatment of Type A Aortic Dissection: A 16 Years’ Experience." International Journal of Vascular Medicine 2020 (January 25, 2020): 1–7. http://dx.doi.org/10.1155/2020/3893261.
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Acute aortic dissection (AAD) is among the most challenging cases for surgical treatment and requires procedural expertise for its safe conduct. Aortic surgery has undergone several changes over the last years, especially concerning cerebral protection. The brilliant results obtained with the aid of selective anterograde cerebral perfusion led to a progressive increase of circulatory arrest temperature, with the rise of safe time along with a reduction of the extracorporeal circulation time and hypothermia-related side effects. However, there is still no definitive consensus concerning the optimal range of temperature to be used during circulatory arrest. Objectives. This is a retrospective observational study, and we examined 16-year trends in the presentation, diagnosis, hospital outcome and treatment of A AAD type. In our Cardiac Surgery Unit in Policlinico Umberto I of Rome, our analysis focused on patients, who received ACP during aortic surgery and we analyzed the differences between two distinct groups based on the lowest temperature reached during CPB conduction: Lower Temperature Group (LT) (T < 24°C) versus Higher Temperature Group (HT) (T ≥ 24°C) arrest circulation temperature. Methods. Data from 241 patients enrolled between August 2002 and March 2018 were analyzed. Patients were divided according to the lowest temperature reached into 2 groups: Lower Temperature group (LT) (94 patients) and Higher Temperature Group (HT) (147 patients). Results. Our results showed a significant reduction of in-hospital mortality and in-hospital results in patients with higher CPB temperature. The global incidence of complications was statistically reduced in HT group: we found a statistical significant reduction of intestinal ischemia, and a similar trend also for other complications analyzed, such as infections. Since the two groups were similar for type of surgical procedures, we considered these differences depending on the lower temperature value reached, according to the current literature. Conclusions. We found a significantly higher mortality in patients with lower temperature during CPB and a global reduction of complications and in particular a significant reduction of intestinal ischemia in patients with higher temperature during CPB. We found a similar trend in other fields of investigations, so we can conclude that circulatory arrest performed at temperature ≥24°C nasopharyngeal temperature associated with ACP is a safe strategy for aortic surgery for AAD.
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Musto, F., M. Ranalli, C. Giordano, E. Bianchi, S. Veraldi, S. Oliva, G. D'Arcangelo, and M. Aloi. "P623 Mucosal eosinophils as markers of post-induction vedolizumab response in paediatric Ulcerative Colitis." Journal of Crohn's and Colitis 17, Supplement_1 (January 30, 2023): i752—i753. http://dx.doi.org/10.1093/ecco-jcc/jjac190.0753.
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Abstract Background Vedolizumab (VDZ) is commonly used as an off-label therapy in children with ulcerative colitis (UC) but no predictive factors of response are available. Vedolizumab binds α4β7 integrin and blocks the migration of T-lymphocytes and other cells, including eosinophils, which are involved in the UC inflammatory process. The aim of our study was to explore the predictive value of pre-therapy mucosal eosinophil count on the response to vedolizumab induction therapy in a paediatric population with UC Methods This is a retrospective, monocentric study, including children with UC treated with VDZ in the Paediatric Gastroenterology Unit of Policlinico Umberto I Hospital – Sapienza University of Rome. Histopathological data were analyzed for eosinophil counts in high power fields (hpf) in the cecum, transverse colon, sigma, and rectum prior to VDZ treatment. Clinical remission and response were evaluated at week 14 based on the PUCAI score. Results Twenty-five UC patients treated with VDZ were enrolled. All patients had failed previous anti-TNF therapy. Median baseline eosinophil count was 21 eo/hpf (5-60) in the cecum, 20 eo/hpf (6-68) in transverse colon, 44 eo/hpf (12-77) in sigma and 31 eo/hpf (9-67) in rectum. Baseline median eosinophil mucosal count in sigma was significantly higher in patients in remission (51[30-82]/ vs. 19[8.5–46] eosinophils/hpf, P<0.05) and clinical response (46[23-79]/ vs. 14[6–45] eosinophils/hpf, P<0.05) at week 14, compared to non-responders. At univariate and multivariate analysis, the number of eosinophils in sigma was confirmed to predict clinical remission [OR=1.0 (95%CI:1.00-1.087), p: 0.03), also independently to concomitant steroid use [OR: 1.06 (95%CI: 1.00-1.122) p: 0.047). The ROC curve identified a risk threshold value for eosinophil count in sigma >23 eosinophils/hpf, with a sensitivity of 85.7% and specificity of 66.7% (Youden’s index 0.83) with an area under the curve (AUC) of 0.778 Conclusion Mucosal eosinophil abundance in sigma may predict remission to vedolizumab induction in paediatric UC. More studies are warranted to confirm these preliminary results and further investigate the role of mucosal eosinophils as a marker of therapeutic response and in the pathogenesis of UC
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Santinelli, Letizia, Alessandro Lazzaro, Francesca Sciarra, Luca Maddaloni, Federica Frasca, Matteo Fracella, Sonia Moretti, et al. "Cellular Immune Profiling of Lung and Blood Compartments in Patients with SARS-CoV-2 Infection." Pathogens 12, no. 3 (March 11, 2023): 442. http://dx.doi.org/10.3390/pathogens12030442.
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Background: SARS-CoV-2 related immunopathology may be the driving cause underlying severe COVID-19. Through an immunophenotyping analysis on paired bronchoalveolar lavage fluid (BALF) and blood samples collected from mechanically ventilated patients with COVID-19-associated Acute Respiratory Distress Syndrome (CARDS), this study aimed to evaluate the cellular immune responses in survivors and non-survivors of COVID-19. Methods: A total of 36 paired clinical samples of bronchoalveolar lavage fluid (BALF) mononuclear cells (BALF-MC) and peripheral blood mononuclear cells (PBMC) were collected from 18 SARS-CoV-2-infected subjects admitted to the intensive care unit (ICU) of the Policlinico Umberto I, Sapienza University Hospital in Rome (Italy) for severe interstitial pneumonia. The frequencies of monocytes (total, classical, intermediate and non-classical) and Natural Killer (NK) cell subsets (total, CD56bright and CD56dim), as well as CD4+ and CD8+ T cell subsets [naïve, central memory (TCM) and effector memory (TEM)], and those expressing CD38 and/or HLADR were evaluated by multiparametric flow cytometry. Results: Survivors with CARDS exhibited higher frequencies of classical monocytes in blood compared to non-survivors (p < 0.05), while no differences in the frequencies of the other monocytes, NK cell and T cell subsets were recorded between these two groups of patients (p > 0.05). The only exception was for peripheral naïve CD4+ T cells levels that were reduced in non-survivors (p = 0.04). An increase in the levels of CD56bright (p = 0.012) and a decrease in CD56dim (p = 0.002) NK cell frequencies was also observed in BALF-MC samples compared to PBMC in deceased COVID-19 patients. Total CD4+ and CD8+ T cell levels in the lung compartment were lower compared to blood (p = 0.002 and p < 0.01, respectively) among non-survivors. Moreover, CD38 and HLA-DR were differentially expressed by CD4+ and CD8+ T cell subsets in BALF-MC and in PBMC among SARS-CoV-2-infected patients who died from COVID-19 (p < 0.05). Conclusions: These results show that the immune cellular profile in blood and pulmonary compartments was similar in survivors and non-survivors of COVID-19. T lymphocyte levels were reduced, but resulted highly immune-activated in the lung compartment of patients who faced a fatal outcome.
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La Torre, Giuseppe, Mattia Marte, Carlo Maria Previte, Lavinia Camilla Barone, Filippo Picchioni, Marta Chiappetta, Augusto Faticoni, et al. "The Synergistic Effect of Time of Exposure, Distance and No Use of Personal Protective Equipment in the Determination of SARS-CoV-2 Infection: Results of a Contact Tracing Follow-Up Study in Healthcare Workers." International Journal of Environmental Research and Public Health 18, no. 18 (September 8, 2021): 9456. http://dx.doi.org/10.3390/ijerph18189456.
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The aim of this study is to assess the effect of contact time, contact distance and the use of personal protective equipment on the determination of SARS-CoV-2 infection in healthcare workers (HCWs). This study consists of an analysis of data gathered for safety reasons at the Sapienza Teaching Hospital Policlinico Umberto I in Rome through the surveillance system that was put into place after the worsening of the COVID-19 pandemic. The studied subjects consist of HCWs who were put under health surveillance, i.e., all employees who were in contact with subjects who were confirmed to have tested positive for SARS-CoV-2. The HCWs under surveillance were monitored for a period encompassing ten days after the date of contact, during which they undertook nasopharyngeal swab tests analysed through RT-PCR (RealStar® SARS-CoV-2 Altona Diagnostic–Germany). Descriptive and univariate analyses have been undertaken, considering the following as risk factors: (a) no personal protective equipment use (PPE); (b) Distance < 1 m between the positive and contact persons; (c) contact time > 15′. Finally, a Cox regression and an analysis of the level of synergism between factors, as specified by Rothman, were carried out. We analysed data from 1273 HCWs. Of these HCWs, 799 (62.8%) were females, with a sample average age of 47.8 years. Thirty-nine (3.1%) tested positive during surveillance. The overall incidence rate was 0.4 per 100 person-days. Time elapsed from the last exposure and a positive RT-PCR result ranged from 2 to 17 days (mean = 7, median = 6 days). In the univariate analysis, a distance <1 m and a contact time > 15′ proved to be risk factors for the SARS-CoV-2 infection, with a hazard ratio (HR) of 2.62 (95% CI: 1.11–6.19) and 3.59 (95% IC: 1.57–8.21), respectively. The synergism analysis found the highest synergism between the “no PPE use” x “Contact time”. The synergy index S remains strongly positive also in the analysis of the factors “no PPE use” x “Distance” and “Time of contact” x “Distance”. This study confirms the absolute need to implement safety protocols during the pandemic and to use the correct PPE within health facilities in order to prevent SARS-CoV-2 infection. The analysis shows that among the factors considered (contact time and distance, no use of PPE), there is a strong synergistic effect.
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Signore, Alberto, Marco Chianelli, Elisabetta Ferretti, Anna Toscano, Keith E. Britton, Domenico Andreani, Edwin AM Gale, and Paolo Pozzilli. "New approach for in vivo detection of insulitis in type I diabetes: activated lymphocyte targeting with 123I-labelled interleukin 2." European Journal of Endocrinology 131, no. 4 (October 1994): 431–37. http://dx.doi.org/10.1530/eje.0.1310431.
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Signore A, Chianelli M, Ferretti E, Toscano A, Britton KE, Andreani D, Gale EAM, Pozzilli P. New approach for in vivo detection of insulitis in type I diabetes: activated lymphocyte targeting with 123I-labelled interleukin 2. Eur J Endocrinol 1994;131:431–7. ISSN 0804–4643 Insulitis is considered the histopathological hallmark of type I (insulin-dependent) diabetes. In the nonobese diabetic (NOD) mouse, diabetes has never been observed in the absence of insulitis. The in vivo detection of insulitis could be of relevance for early prediction of diabetes. As approximately 15% of islet-infiltrating lymphocytes express interleukin 2 receptors, we have labelled recombinant interleukin 2 with 123I and used this radiopharmaceutical to detect insulitis by gamma camera imaging. We studied 71 prediabetic NOD and 27 normal Balb/c mice. Labelled α-lactalbumin was used as the control protein. In the first set of experiments we studied the tissue distribution of radiolabelled interleukin 2 in isolated organs from animals sacrificed at different time points. Higher radioactivity was detected in the pancreas of NOD mice injected with labelled interleukin 2, as compared to NOD mice receiving labelled α-lactalbumin (p < 0.003 at 20 min; p< 0.001 at 40 min; p< 0.0001 at 60 min) or Balb/c mice injected with labelled interleukin 2 (p< 0.05 at 40 min; p< 0.001 at 60 min). In another set of experiments, gamma camera images have been acquired after injection of 123I-labelled interleukin 2. Radioactivity in the pancreatic region of prediabetic NOD and Balb/c mice showed similar kinetics to those observed by single organ counting, with higher accumulation in the pancreatic region of NOD mice (p < 0.04 after 22–45 min in NOD mice vs Balb/c mice). Finally, a positive correlation was found between the radioactivity in the pancreas and the extent of lymphocytic infiltration (p < 0.01 for pancreas radioactivity counted in vitro and p< 0.004 for pancreas radioactivity counted in vivo by gamma camera). This study demonstrates that 123I-labelled interleukin 2 administered iv accumulates specifically in the inflamed pancreas of diabetes-prone NOD mice, suggesting its potential application in human insulin-dependent diabetes mellitus. A Signore, Servizio Speciale di Medicina Nucleare, II Clinica Medica, Policlinico Umberto I, 00161 Roma, Italy
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Conticini, E., M. D’alessandro, S. Grazzini, M. Fornaro, D. Sabella, G. Lopalco, F. Iannone, et al. "POS1218 RELAPSES OF IDIOPATHIC INFLAMMATORY MYOPATHIES AFTER VACCINATION AGAINST COVID19: A REAL-LIFE ITALIAN STUDY." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 939. http://dx.doi.org/10.1136/annrheumdis-2022-eular.1744.
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BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination plays a crucial role as pivotal strategies to curb the coronavirus disease-19 (COVID-19) pandemic. Despite the mass-scale vaccination, literature data about the incidence of disease flares in IIM patients are still not reported as well as the immunological condition.ObjectivesThe present study aimed to describe the clinical status of patients affected by IIM after vaccination against COVID19 in order to assess the number of relapses or immune-mediated reactions in a cohort of Italian patients with such disease.MethodsWe included all patients affected by IIM and followed by Myositis Clinic, Rheumatology and Respiratory Diseases Units, Siena University Hospital, Bari University Hospital, Policlinico Umberto I, Sapienza University, Rome, and Policlinico Paolo Giaccone, Palermo. Inclusion criteria were a recent (<3 months) clinical and serological assessment before the survey and a definite diagnosis of dermatomyositis, polymyositis and anti-synthetase syndrome. All patients underwent a telephone survey in order to establish their clinical status and potential relapses after vaccination.ResultsA total of 119 IIM patients (median, IQR 58 (47-66) years; 32 males) were consecutively enrolled. Fifty had a diagnosis of DM, 39 had PM and 30 had ASS. The median months of disease duration was 79.62±83.98. According to number of organs involvement, forty-two had only one, 45 had two organs involvement, 20 had three, 11 had four and one had five. The majority of them received two doses of COVID-19 vaccine, except four patients who refused the vaccination: 94 (78.9%) Cominarty, 16 (13.4%) Moderna, 5 (0.04%) AZ. Seven (0.06%) patients had flare after vaccination, the majority of them were mild except one major with three organs involved and one life-threatening with systemic involvement. In order to understand or predict the effect of demographic and clinical features on the flare development after vaccination, a logistic regression analysis was performed. The goodness-of-fit statistics showed a Chi2 associated with the Log ratio (L.R.) of 0.045. From the probability associated with the Chi-square tests, the Type II analysis showed the variable that most influences the development of flare was the number of organs involved (p=0.047).Sixty-eight patients received the third dose of COVID-19 vaccination: 51 (75%) Cominarty and 17 (25%) Moderna. Only one (0.01%) patient (the same who had life-threatening flare with systemic involvement after two doses) had flare after third dose and eventually died.ConclusionVaccines against SARS-CoV2 have provided, both in registratory studies and in preliminary real-life evidence, an overall good efficacy and safety. Nevertheless, only scanty data are available for rheumatic patients in general and the ones affected by IIM in particular. To the best of our knowledge, ours represent the largest cohort of IIM patients in which immunogenicity of anti-SARS-CoV2 vaccine was assessed. In line with real-life data from other diseases, we found a non-statistically significant risk of relapse in our patients, which occurred seldom, usually mild and in patients with a more severe and aggressive course of disease.ParametersFlare after two doses (n=7)No-flare after two doses (n=108)P valueAge (years)55 (51-68)59 (47-67)NSGender (M/F)2/530/82NSDiagnosis (DM/PM/ASS)2/2/348/36/28NSAntibodiesJo1225PL7-3PL12-1Ku-2Mi217PM/Scl15Ro5217TIG1g-5MDA5-6SRP-1SAE-2cN1a--NPX-1SSA-12Ds-DNA-1ANA (only positivity)-3negative227Length of disease (months)50 (19-200)60 (24-108)NSNumber of organs involved:One0360.0004Two243Three319Four110Five10Type of vaccination:Cominarty688NSModerna115AZ05Disease activity (PhGA≥2/PhGA<2)3/427/81NSMDI3 (1-6.5)2 (1-4)NSCRP (mg/dL)0.1 (0.01-0.3)0.99 (0.3-2.9)0.0041ESR32 (14-39)15.5 (8-27.5)NSCPK111 (63-905)97.5 (63-158)NSTreatment at time of vaccination: GCs010NS Immunosuppressive319 Biologic12 Combination365 no-treatment-12Disclosure of InterestsNone declared
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Zaami, Simona, Rossella Melcarne, Renato Patrone, Giuseppe Gullo, Francesca Negro, Gabriele Napoletano, Marco Monti, et al. "Oncofertility and Reproductive Counseling in Patients with Breast Cancer: A Retrospective Study." Journal of Clinical Medicine 11, no. 5 (February 27, 2022): 1311. http://dx.doi.org/10.3390/jcm11051311.
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Introduction. Improving the prognosis of breast cancer patients is of utmost importance in terms of increasing survival rates. Modern medicine has therefore prioritized better quality of life for patients, even after the disease, through a better management of the potential long-term side effects induced by anticancer treatments. Fertility preservation and family planning are therefore crucial issues to be addressed in all cancer patients of reproductive age. Along those lines, a new branch of medicine with distinct multidisciplinary characteristics has developed over the years: oncofertility. Although both national and international guidelines value reproductive counseling as an essential aspect of the diagnostic-therapeutic pathway, part and parcel of the informed consent process, it is not included within the protocols adopted by the operating units for the care and management of neoplastic diseases. Objective. This study aimed to evaluate the activity of the Breast Unit of the Policlinico Umberto I Hospital, Rome, Italy, and the degree of compliance with guidelines. By knowing the strengths and weaknesses of such approaches, the standards of care offered to breast cancer patients can be improved. Materials and methods. A retrospective study based on a review of medical records was conducted between 2014 and 2021. Patients under 40 years of age diagnosed with non-metastatic malignancies were included who received chemotherapy treatment, namely neoadjuvant, adjuvant or adjuvant hormone therapy. Results. The data were extracted from the medical records of 51 patients who met the inclusion criteria, 41% of whom received reproductive counseling, and of these, 43% decided to undertake a path of fertility preservation. Factors such as the absence of children and young age reportedly favored both the interest in counseling proposals by the medical staff and the decision to undertake a path of fertility preservation. Conclusions. The study shows that there has been growing interest in the topic of oncofertility, especially in light of law 219/2017. Therefore, since 2018, multiple proposals for reproductive counseling have been set forth, but there was not an equally growing demand for fertility preservation practices, which can be explained by the invasive nature of such practices, the patients’ concern about their own state of health, and poor or inadequate information. Such impediments highlight the importance of standardized counseling and the need for a multidisciplinary medical team to support the patient in the decision-making process. The study also revealed a drop in the number of patients receiving counseling due to the COVID-19 pandemic, contrary to the positive trend that was recorded prior to the pandemic.
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Mancuso, S., S. Truglia, A. Capozzi, F. Pasquali, S. Recalchi, G. Riitano, F. R. Spinelli, et al. "POS1238 ANTIPHOSPHOLIPID ANTIBODIES AND COVID-19: TREND OVER TIME." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 902.1–902. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3199.
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Background:Since the beginning of the SARS-CoV-2 outbreak, antiphospholipid antibodies (aPL), a known thrombotic risk factor, have been studied in COVID-19 patients, in whom thromboembolic events have been associated with poor prognosis. To date, the pathogenetic role of aPL and the trend over time is still unknown.Objectives:Aim of the study was to investigate whether aPL positivity was correlated with thrombosis in COVID-19 patients and whether it was a transient or persistent.Methods:We included all consecutive COVID-19 patients hospitalized at Policlinico Umberto I, Sapienza University of Rome from April 1, 2020 to June 7, 2020. In these patients, serum levels of anti-cardiolipin (aCL) IgM, IgG, IgA, anti-β2glycoprotein I (aβ2GPI) IgM, IgG were measured by enzyme-linked immunosorbent assay (ELISA) and Lupus Anticoagulant (LA) was detected with coagulatory tests in patients not in treatment with anticoagulant drugs.Results:Five out of 73 (6.8%) patients resulted positive for aCL IgM, 3 of them also tested positive for aβ2GPI IgM. aCL IgA were tested positive in 14 out of 46 patients (30.4%). Overall 18 patients resulted positive for at least one test. Seven (9.6%) patients developed thrombotic events during hospitalization, 3 of them resulting positive for aPL (Table 1. below).Table 1.Clinical and demographic features of the 7 Covid-19 patients that presented thrombotic eventsFeaturesPatient 1Patient 2Patient 3Patient 4Patient 5Patient 6Patient 7Age - yr67788343707495SexfemalefemalefemalemalemalefemalemaleMedical HistoryMalignancy, HypertensionStrokeChronic obstructive pulmonary diseaseNo medical historyChronic obstructive pulmonary disease, HypertensionMalignancy,HypertensionInitial findingsSigns and symptomsDyspneaDyspneaDyspneaFever, ageusia/anosmia, chest painFever, coughDyspneaDyspneaHRCT chest: Bilateralground glass opacityyesyesyesyesyesyesyesBaseline laboratory valuesLymphocytecount, cells x 106/L2202102330158016806001390Lactatedehydrogenase, U/L223321199227226349199Ferritin mcg/L6143172133874622455197D-dimer mcg/L7301213291228268812981097PaO2:FIO2, mm Hg132120442534348493314Anticoagulant therapy at the time of the thrombotic eventTherapeutic dosageProphylactic dosageProphylactic dosageNot administeredTherapeutic dosageTherapeutic dosageTherapeutic dosageThrombotic eventsStrokePulmonary embolismPeripheral venous thrombosisMyocardial infarctionPulmonary embolismMyocardial infarction, peripheral arterial thrombosis, peripheral venous thrombosisPeripheral venous thrombosisAntiphospholipid antibodiesnegativeAnti-cardiolipin IgM low title, anti-β2glicoprotein I IgM low titlenegativenegativenegativeAnti-cardiolipin IgM low title, anti-β2glicoprotein I IgM low titleAnti-cardiolipin IgA low titleOutcomeExitusExitusSuicideDischargedDischargedDischargedExitusAntiphospholipid antibodies tested after at least 12 weeksNPNPNPNPNPNegativeNPWe observed that patients showing double positivity for aCL IgM and aβ2GPI IgM had a likelihood positive ratio of 6.3 for thrombotic events (p=0.012) and a likelihood positive ratio of 4.9 for increased D-dimer levels (p=0.027). aCL IgA, the most prevalent aPL in this cohort, was not associated with thrombosis. Of the 18 aPL positive patients, 5 died, 3 were lost to follow-up, and 10 were tested on a second occasion at least 12 weeks, two patients confirmed positivity without clinical signs suggestive of APS.Conclusion:These results suggest that double positivity for aCL and aβ2GPI IgM increases the risk of thrombosis in COVID-19 patients, unlike aCL IgA. APL positivity may be persistent and it is advisable to monitor it over time.Disclosure of Interests:None declared
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Musto, F., M. Distante, E. Dei Rossi, A. Calicchia, S. Veraldi, F. Mondi', F. Tarani, G. D'Arcangelo, and M. Aloi. "P556 Surgery in high-risk paediatric Crohn’s Disease treated with up-front anti-TNF agents and long-standing biologic therapy." Journal of Crohn's and Colitis 17, Supplement_1 (January 30, 2023): i686—i687. http://dx.doi.org/10.1093/ecco-jcc/jjac190.0686.
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Abstract Background High-risk (HR) Crohn’s Disease (CD) is associated with high surgical and progression rates. Therefore, recent ESPGHAN guidelines (GL) suggest starting an early anti-TNFα treatment to modify the natural history of the disease. The aim of our study was to evaluate the surgical rate in a population of HR-CD paediatric patients treated with up-front anti-TNFα agents and long-standing biologic therapy Methods This is a retrospective, observational, single-center study conducted at the Paediatric Gastroenterology, Hepatology, and Endoscopy Unit at Policlinico Umberto I Hospital – Sapienza University of Rome. We collected data from all patients diagnosed with CD under 18 years, with a minimum follow-up of 12 months. between June 2008 to July 2022. Patients were then stratified at the diagnosis into HR and LR, based on ESPGHAN GL criteria. Demographic, clinical, laboratory, endoscopic, and imaging data were collected at 6, 12, 24, 36, 48, and 60 months Results 130 patients were enrolled, 76 HR (58%) and 54 LR (42%) [median age 12.5 (IQR) yrs, female 45 (35%), medium follow-up 54±24 months]. The HR group included 39 patients (51%) with panenteric disease, 15 (20%) with a structuring behavior (B2), 3 (4%) with structuring/penetrating disease (B2-B3), and 26 (34%) with perianal involvement (p). Early anti-TNFα agents were started in 80% of patients <6 months from the diagnosis, while 15 (20%) started biological therapy between 6 and 12 months from the diagnosis. All patients continued biologic therapy throughout the study follow-up: 20 (26%) optimized anti-TNF, 25% switched biologic, 11% added an immunomodulator, and 4% combined 2 biological drugs. The surgical rate at 5 years was 29% (n=22) and 29% n=16) in HR and LR groups respectively (p-value 1,0). Eleven % (n=8) of HR patients needed surgical resection, while perianal surgery (seton drainage, fistulotomy, fistulectomy) was performed in 18% (n=14), with no significant difference with LR group [(intestinal resection 18% (10/55), perianal surgery 11% (6/55), p > 0.05]. Perianal disease resulted positively associated with surgical risk (p 0.002, OR 5.62 CI 1.84-17.15) while small bowel imaging at the diagnosis was a protective factor for surgery (p 0.017, OR 0.23 CI 0.07-0.77). No significant difference was found in the interval free from surgery between HR and LR, although HR children mainly needed surgery in the first 12 months after the diagnosis. Conclusion Our data suggest that paediatric patients with HR-CD treated with early anti-TNF agents and long-standing biologic therapy have a similar disease course and surgical risk to those with LR disease. At a 5-year follow-up, one-third of patients needed surgery, mainly in the first year after the diagnosis