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Ceasovschih A, Șorodoc V, Covantsev S, Balta A, Uzokov J, Kaiser SE, Almaghraby A, Lionte C, Stătescu C, Sascău RA, Onofrei V, Haliga RE, Stoica A, Bologa C, Ailoaei Ș, Şener YZ, Kounis NG, Șorodoc L. Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects. J Multidiscip Healthc 2024; 17:1695-1719. [PMID: 38659633 PMCID: PMC11041971 DOI: 10.2147/jmdh.s445549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.
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Affiliation(s)
- Alexandr Ceasovschih
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Victorița Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Serghei Covantsev
- Department of Research and Clinical Development, Botkin Hospital, Moscow, Russia
| | - Anastasia Balta
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Jamol Uzokov
- Department of Cardiology, Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | - Sergio E Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Abdallah Almaghraby
- Department of Cardiology, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah, United Arab Emirates
| | - Cătălina Lionte
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristian Stătescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Radu A Sascău
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Viviana Onofrei
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Raluca Ecaterina Haliga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Alexandra Stoica
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristina Bologa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Ștefan Ailoaei
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Yusuf Ziya Şener
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Nicholas G Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
| | - Laurențiu Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
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Roser LP, Samanapally H, Ali T, Xu Q, Han Y, Salunkhe V, Deepti F, McGuffin T, Huang EC, Furmanek S, Glynn A, Ramirez J, Jones CM, Mariyappa R, Hogue RJ, Williams AM, Huang JJ, Arnold FW, Clifford SP, Pahwa S, Kong M, Huang J. Different clinical characteristics and outcomes of adult hospitalized SARS-CoV-2 pneumonia patients complicated by cardiovascular events during the first, delta and omicron waves of COVID-19. Front Epidemiol 2024; 4:1342917. [PMID: 38699405 PMCID: PMC11064795 DOI: 10.3389/fepid.2024.1342917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/04/2024] [Indexed: 05/05/2024]
Abstract
Background The effects of SARS-CoV-2 have varied between significant waves of hospitalization. Research question Are cardiovascular complications different among the first, delta and omicron waves of hospitalized COVID-19 pneumonia patients? Study design and methods This was a multi-centre retrospective study of patients hospitalized with SARS-CoV-2 pneumonia: 632 were hospitalized during the first wave (March-July 2020), 1013 during the delta wave (September 2020-March 2021), and 323 during the omicron wave (January 2022-July 2022). Patients were stratified by wave and occurrence of cardiovascular events. Results Among all hospitalized patients with cardiovascular events, patients in the omicron wave were younger (62.4 ± 14 years) than patients in the first wave (67.4 ± 7.8 years) and the delta wave (66.9 ± 12.6 years) and had a higher proportion of non-Hispanic White people than in the first wave (78.6% vs. 61.7%). For COVID-19 patients who suffered from cardiovascular events, the omicron wave patients had significantly higher neutrophil/lymphocyte ratio, white blood cell and platelet counts when compared to the first wave. Omicron wave patients had significantly lower albumin and B-type natriuretic peptide levels (only 5.8% of the first wave and 14.6% of the delta wave) when compared to either the first wave or delta wave patients. In COVID-19 patients who suffered cardiovascular events during hospitalization, mortality rate in the omicron wave (26.8%) was significantly lower than the first wave (48.3%), time to mortality for non-survivors of COVID-19 patients who suffered cardiovascular events was significantly longer in the omicron wave (median 16 days) than in the first wave (median 10 days). Conclusions Younger and white patients were affected with cardiovascular complications more often by the omicron variant. Despite higher neutrophil/lymphocyte ratio and WBC counts, the omicron patients with cardiovascular events showed lower heart injuries, lower mortality and longer time to mortality for non-survivors when compared to the first and delta waves.
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Affiliation(s)
- Lynn P. Roser
- School of Nursing, University of Louisville, Louisville, KY, United States
| | - Harideep Samanapally
- Division of Infectious Diseases, Centre of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY, United States
| | - T’shura Ali
- Division of Infectious Diseases, Centre of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY, United States
| | - Qian Xu
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, United States
| | - Yuchen Han
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, United States
| | - Vidyulata Salunkhe
- Division of Infectious Diseases, Centre of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY, United States
| | - Fnu Deepti
- Division of Infectious Diseases, Centre of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY, United States
| | - Trevor McGuffin
- School of Nursing, University of Louisville, Louisville, KY, United States
| | - Emma C. Huang
- Department of Anesthesiology, Duke University, Durham, NC, United States
| | - Stephen Furmanek
- Division of Infectious Diseases, Centre of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY, United States
| | - Alex Glynn
- Kornhauser Health Sciences Library, University of Louisville, Louisville, KY, United States
| | - Julio Ramirez
- Division of Infectious Diseases, Centre of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY, United States
| | - Christopher M. Jones
- Division of Transplantation, Department of Surgery, University of Louisville, Louisville, KY, United States
| | - Ramesh Mariyappa
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, United States
| | - Ryan J. Hogue
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, United States
| | - Alexander M. Williams
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, United States
| | - Justin J. Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, United States
| | - Forest W. Arnold
- Division of Infectious Diseases, Centre of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY, United States
| | - Sean P. Clifford
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, United States
| | - Siddharth Pahwa
- Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY, United States
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, United States
| | - Jiapeng Huang
- Division of Infectious Diseases, Centre of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY, United States
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, United States
- Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY, United States
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY, United States
- Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, United States
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Mazandarani M, Sharififar R, Lashkarbolouk N, Ghorbani S. Evaluation of cardiac diagnostic tests findings based on pro-BNP levels in COVID-19 pregnant patients. BMC Infect Dis 2023; 23:790. [PMID: 37957564 PMCID: PMC10644487 DOI: 10.1186/s12879-023-08764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Pro-b-type natriuretic peptide (Pro-BNP) is an inflammatory marker that indicates cardiac damage and inflammation. The elevation of this marker in COVID-19 patients can be used as a predictive factor in the prognosis of these patients. METHOD Our cross-sectional study investigated the evaluation of cardiac diagnostic test findings based on pro-BNP levels in pregnant COVID-19 patients in Sayyad Shirazi Hospital, Gorgan, Iran, in 2020-2022. A hundred and ten pregnant patients diagnosed with COVID-19 infection were evaluated for cardiac diagnostic tests (electrocardiogram (ECG) and echocardiography (Echo)) and pro-BNP levels. Data were analyzed using SPSS 25 software. Chi-square and Student's t-test will be used to test and compare the relationship between variables and compare them. A P-value less than 0.05 is considered statistically significant. The chi-square test was used to compare the ratio of qualitative variables among the groups if the presuppositions of chi-square distribution were established. Otherwise, Fisher's exact test was used. RESULT The mean age of participants were 31.06 ± 5.533 years and 49.1% of patients had pro-BNP levels above the cut-off value for predicting an adverse outcome of COVID-19. The mean ± standard deviation of pro-BNP levels in the low group was 46.125 ± 17.523 pg/mL and in the high group was 878.814 ± 1038.060 pg/mL. This study revealed that patients with higher pro-BNP plasma levels had a significant relation between, myocardial infarction (MI), pericardial effusion (PE), urgent Caesarean section (C/S), and mortality. In addition, no significant relation between gravid, trimester, vaccination, arrhythmia, heart block, and valves diseases with high pro-BNP levels was found. CONCLUSION The current research showed that pro-BNP levels can be used as a diagnostic and valuable prognostic tool in pregnant women to diagnose cardiac complications by using ECG and Echo.
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Affiliation(s)
- Mahdi Mazandarani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan University of Medical Sciences, Gorgan, Iran
| | - Rahmat Sharififar
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Narges Lashkarbolouk
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Golestan University of Medical Sciences, Gorgan, Iran.
| | - Somayeh Ghorbani
- Assistant Professor of Biostatistics, Golestan University of Medical Sciences, Gorgan, Iran
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Tereshchenko LG, Pourbemany J, Haq KT, Patel H, Hyde J, Quadri S, Ibrahim H, Tongpoon A, Pourbemany R, Khan A. An electrophysiological substrate of COVID-19. J Electrocardiol 2023; 79:61-65. [PMID: 36963283 PMCID: PMC10027233 DOI: 10.1016/j.jelectrocard.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/28/2023] [Accepted: 03/11/2023] [Indexed: 03/24/2023]
Abstract
SARS-CoV-2 infection is associated with an increased risk of late cardiovascular (CV) outcomes. However, more data is needed to describe the electrophysiologic (EP) manifestation of post-acute CV sequelae of COVID-19. We compared two cohorts of adult patients with SARS-CoV-2 polymerase chain reaction (PCR) test and an electrocardiogram (ECG) performed between March 1, 2020, and September 13, 2020, in a retrospective double-cohort study, "Cardiovascular Risk Stratification in Covid-19" (CaVaR-Co19; NCT04555187). Patients with positive PCR comprised a COVID-19(+) cohort (n = 41; 61% women; 80% symptomatic), whereas patients with negative tests formed the COVID-19(-) cohort (n = 155; 56% women). In longitudinal analysis, comparing 3 ECGs recorded before, during, and on average 40 days after index COVID-19 episode, after adjustment for demographic and socioeconomic characteristics, baseline CV risk factors and comorbidities, use of prescription medications (including QT-prolonging drugs) before and during index COVID-19 episode, and the longitudinal changes in RR' intervals, heart rhythm, and ventricular conduction type, only in the COVID-19(+) cohort QTc increased by +30.2(95% confidence interval [CI] 0.1-60.3) ms and the spatial ventricular gradient (SVG) elevation increased by +13.5(95%CI 1.2-25.9)°. In contrast, much smaller, statistically nonsignificant changes were observed in the COVID-19(-) cohort. In conclusion, post-acute CV sequelae of SARS-CoV-2 infection manifested on ECG by QTc prolongation and rotation of the SVG vector upward.
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Affiliation(s)
- Larisa G Tereshchenko
- Cleveland Clinic Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland, OH, USA.
| | - Jafar Pourbemany
- Cleveland Clinic Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland, OH, USA
| | - Kazi T Haq
- Children's National Hospital, Washington, DC, USA
| | - Hetal Patel
- Chicago Medical School at Rosalind Franklin University, North Chicago, IL, USA
| | - Jessica Hyde
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Suha Quadri
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Habiba Ibrahim
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Aaron Tongpoon
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Akram Khan
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
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Furmanek S, Salunkhe V, Pahwa S, Samanapally H, Nathala P, Xu Q, Ali T, Deepti F, Glynn A, McGuffin T, Titus D, Farah I, Jones CM, Ramirez JA, Clifford SP, Arnold FW, Kong M, Roser L, Huang J; Center of Excellence for Research in Infectious Diseases Coronavirus Study Group on behalf of the COVID-19 CardioVascular Research Group. Correlations of Before and After Event Echocardiographic Parameters with Troponin and BNP in Hospitalized COVID-19 Patients With Cardiovascular Events. J Cardiothorac Vasc Anesth 2022; 36:4553-5. [PMID: 36184474 DOI: 10.1053/j.jvca.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/24/2022] [Accepted: 08/28/2022] [Indexed: 01/11/2023]
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Scala I, Rizzo PA, Bellavia S, Brunetti V, Colò F, Broccolini A, Della Marca G, Calabresi P, Luigetti M, Frisullo G. Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review. J Clin Med 2022; 11:jcm11133883. [PMID: 35807167 PMCID: PMC9267913 DOI: 10.3390/jcm11133883] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023] Open
Abstract
Although autonomic dysfunction (AD) after the recovery from Coronavirus disease 2019 (COVID-19) has been thoroughly described, few data are available regarding the involvement of the autonomic nervous system (ANS) during the acute phase of SARS-CoV-2 infection. The primary aim of this review was to summarize current knowledge regarding the AD occurring during acute COVID-19. Secondarily, we aimed to clarify the prognostic value of ANS involvement and the role of autonomic parameters in predicting SARS-CoV-2 infection. According to the PRISMA guidelines, we performed a systematic review across Scopus and PubMed databases, resulting in 1585 records. The records check and the analysis of included reports’ references allowed us to include 22 articles. The studies were widely heterogeneous for study population, dysautonomia assessment, and COVID-19 severity. Heart rate variability was the tool most frequently chosen to analyze autonomic parameters, followed by automated pupillometry. Most studies found ANS involvement during acute COVID-19, and AD was often related to a worse outcome. Further studies are needed to clarify the role of autonomic parameters in predicting SARS-CoV-2 infection. The evidence emerging from this review suggests that a complex autonomic nervous system imbalance is a prominent feature of acute COVID-19, often leading to a poor prognosis.
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Affiliation(s)
- Irene Scala
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
| | - Pier Andrea Rizzo
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
| | - Simone Bellavia
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
| | - Valerio Brunetti
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
| | - Francesca Colò
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
| | - Aldobrando Broccolini
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
| | - Giacomo Della Marca
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
| | - Paolo Calabresi
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
| | - Marco Luigetti
- School of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy; (I.S.); (P.A.R.); (S.B.); (F.C.); (A.B.); (G.D.M.); (P.C.)
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
- Correspondence: ; Tel.: +39-06-30154435
| | - Giovanni Frisullo
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.B.); (G.F.)
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