1
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Tresoldi M, Zangrillo A, Belletti A, Ramirez GA, Bozzolo E, Guzzo F, Marinosci A, Fominskiy EV, DA Prat V, Marmiere M, Palumbo D, Del Prete L, D'Amico F, Bellino C, Morando D, Saracino M, Ortalda A, Castelli E, Rocchi M, Baiardo Redaelli M, Scotti R, DI Terlizzi G, Azzolini ML, Guaschino G, Avitabile E, Borghi G, Soddu D, Dagna L, Landoni G, DE Cobelli F. Two-year multidisciplinary follow-up of COVID-19 patients requiring invasive and noninvasive respiratory support. Minerva Med 2023; 114:773-784. [PMID: 37021472 DOI: 10.23736/s0026-4806.22.08397-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND COVID-19 patients frequently develop respiratory failure requiring mechanical ventilation. Data on long-term survival of patients who had severe COVID-19 are insufficient. We assessed and compared two-year survival, CT imaging, quality of life, and functional recovery of COVID-19 ARDS patients requiring respiratory support with invasive (IMV) versus noninvasive ventilation (NIV). METHODS Patients with COVID-19 pneumonia admitted up to May 28th, 2020, who required IMV or NIV, and survived to hospital discharge were enrolled. Patients were contacted two years after discharge to assess vital status, functional, psychological, and cognitive outcomes using validated scales. Patients with persistent respiratory symptoms or high burden of residual lung damage at previous CT scan received a two-year chest CT scan. RESULTS Out of 61 IMV survivors, 98% were alive at two-year follow-up, and 52 completed the questionnaire. Out of 82 survivors receiving NIV only, 94% were alive at two years, and 47 completed the questionnaire. We found no major differences between invasively and noninvasively ventilated patients, with overall acceptable functional recovery. Among the 99 patients completing the questionnaire, 23 have more than moderate exertional dyspnea. Chest CT scans showed that 4 patients (all received IMV) had fibrotic-like changes. CONCLUSIONS Patients who received mechanical ventilation due to COVID-19 and were discharged from hospital had a 96% survival rate at the two-year follow-up. There was no difference in overall recovery and quality of life between patients who did and did not require IMV, although respiratory morbidity remains high.
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Affiliation(s)
- Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Guzzo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Marinosci
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evgeny V Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valentina DA Prat
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marilena Marmiere
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lidia Del Prete
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo D'Amico
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Bellino
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Deodata Morando
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Saracino
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Castelli
- Cardiothoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Rocchi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Baiardo Redaelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaetano DI Terlizzi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria L Azzolini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy -
| | - Giulia Guaschino
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emma Avitabile
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Borghi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Soddu
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco DE Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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2
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Soddu D, Sola D, Bellan M, Boin E, Cittone MG, Zecca E, Matino E, Pedrazzoli R, Rizzi E, Pedrinelli AR, Tonello S, Vassia V, Landi R, Pirisi M, Sainaghi PP. Red cell distribution width is a potential predictor of early relapse in polymyalgia rheumatica. Reumatismo 2021; 73:117-121. [PMID: 34342213 DOI: 10.4081/reumatismo.2021.1395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/15/2021] [Indexed: 11/23/2022] Open
Abstract
Red blood cell distribution width (RDW) has been studied as a prognostic biomarker for different chronic inflammatory diseases. In this paper we aim to evaluate its potential role in the prediction of early relapse in patients affected by polymyalgia rheumatica (PMR). We revised retrospectively clinical records of patients who received a diagnosis of PMR, according to 2012 ACR/EULAR classification criteria, for whom baseline clinical and laboratory data were available. The baseline RDW variation coefficient was correlated to the risk of relapse, in the first 6 months of the disease. We identified 44 patients [females 15 (34.0%)/males 29 (66.0%); median age 80 (72-83)], 9 of whom had an early relapse. These patients showed a larger median RDW than patients who did not relapse [13.7 (13.5-14.9)% vs 13.5 (12.7-14.2)%; p=0.04). The two groups were comparable for all the other clinical and laboratory parameters considered. Interestingly, patients in the higher half of the RDW distribution showed a shorter relapse-free survival (p<0.03). In a stepwise logistic regression, RDW (p=0.01) predicted the risk of relapse at 6 months, while age, gender, CRP, ESR, Hb, MCV and prednisone dose did not fit the model. Our results show that RDW is an independent biomarker of early relapse, making this parameter a potentially promising predictive marker in PMR.
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Affiliation(s)
- D Soddu
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - D Sola
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara; CAAD, Centre for Autoimmune and Allergic Diseases, Novara.
| | - M Bellan
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara; CAAD, Centre for Autoimmune and Allergic Diseases, Novara.
| | - E Boin
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara.
| | - M G Cittone
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara.
| | - E Zecca
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - E Matino
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - R Pedrazzoli
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara.
| | - E Rizzi
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - A R Pedrinelli
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - S Tonello
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara.
| | - V Vassia
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - R Landi
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - M Pirisi
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara; CAAD, Centre for Autoimmune and Allergic Diseases, Novara.
| | - P P Sainaghi
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara; CAAD, Centre for Autoimmune and Allergic Diseases, Novara.
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3
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Zavattaro E, Cammarata E, Tarantino V, Soddu D, Gironi LC, Savoia P. Successful treatment of a bullous vasculitis with intravenous immunoglobulins in a COVID-19 patient. Dermatol Ther 2021; 34:e14853. [PMID: 33547851 PMCID: PMC7995060 DOI: 10.1111/dth.14853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/01/2021] [Accepted: 01/31/2021] [Indexed: 01/22/2023]
Affiliation(s)
- Elisa Zavattaro
- Maggiore della Carità University Hospital, Novara, Italy.,Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Edoardo Cammarata
- Maggiore della Carità University Hospital, Novara, Italy.,Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - Vanessa Tarantino
- Maggiore della Carità University Hospital, Novara, Italy.,Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - Daniele Soddu
- Maggiore della Carità University Hospital, Novara, Italy.,Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Laura C Gironi
- Maggiore della Carità University Hospital, Novara, Italy
| | - Paola Savoia
- Maggiore della Carità University Hospital, Novara, Italy.,Department of Health Science, University of Eastern Piedmont, Novara, Italy
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4
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Bellan M, Soddu D, Balbo PE, Baricich A, Zeppegno P, Avanzi GC, Baldon G, Bartolomei G, Battaglia M, Battistini S, Binda V, Borg M, Cantaluppi V, Castello LM, Clivati E, Cisari C, Costanzo M, Croce A, Cuneo D, De Benedittis C, De Vecchi S, Feggi A, Gai M, Gambaro E, Gattoni E, Gramaglia C, Grisafi L, Guerriero C, Hayden E, Jona A, Invernizzi M, Lorenzini L, Loreti L, Martelli M, Marzullo P, Matino E, Panero A, Parachini E, Patrucco F, Patti G, Pirovano A, Prosperini P, Quaglino R, Rigamonti C, Sainaghi PP, Vecchi C, Zecca E, Pirisi M. Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge. JAMA Netw Open 2021; 4:e2036142. [PMID: 33502487 PMCID: PMC7841464 DOI: 10.1001/jamanetworkopen.2020.36142] [Citation(s) in RCA: 258] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Although plenty of data exist regarding clinical manifestations, course, case fatality rate, and risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19), long-term respiratory and functional sequelae in survivors of COVID-19 are unknown. OBJECTIVE To evaluate the prevalence of lung function anomalies, exercise function impairment, and psychological sequelae among patients hospitalized for COVID-19, 4 months after discharge. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study at an academic hospital in Northern Italy was conducted among a consecutive series of patients aged 18 years and older (or their caregivers) who had received a confirmed diagnosis of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection severe enough to require hospital admission from March 1 to June 29, 2020. SARS-CoV-2 infection was confirmed via reverse transcription-polymerase chain reaction testing, bronchial swab, serological testing, or suggestive computed tomography results. EXPOSURE Severe COVID-19 requiring hospitalization. MAIN OUTCOMES AND MEASURES The primary outcome of the study was to describe the proportion of patients with a diffusing lung capacity for carbon monoxide (Dlco) less than 80% of expected value. Secondary outcomes included proportion of patients with severe lung function impairment (defined as Dlco <60% expected value); proportion of patients with posttraumatic stress symptoms (measured using the Impact of Event Scale-Revised total score); proportion of patients with functional impairment (assessed using the Short Physical Performance Battery [SPPB] score and 2-minute walking test); and identification of factors associated with Dlco reduction and psychological or functional sequelae. RESULTS Among 767 patients hospitalized for severe COVID-19, 494 (64.4%) refused to participate, and 35 (4.6%) died during follow-up. A total of 238 patients (31.0%) (median [interquartile range] age, 61 [50-71] years; 142 [59.7%] men; median [interquartile range] comorbidities, 2 [1-3]) consented to participate to the study. Of these, 219 patients were able to complete both pulmonary function tests and Dlco measurement. Dlco was reduced to less than 80% of the estimated value in 113 patients (51.6%) and less than 60% in 34 patients (15.5%). The SPPB score was suggested limited mobility (score <11) in 53 patients (22.3%). Patients with SPPB scores within reference range underwent a 2-minute walk test, which was outside reference ranges of expected performance for age and sex in 75 patients (40.5%); thus, a total of 128 patients (53.8%) had functional impairment. Posttraumatic stress symptoms were reported in a total of 41 patients (17.2%). CONCLUSIONS AND RELEVANCE These findings suggest that at 4 months after discharge, respiratory, physical, and psychological sequelae were common among patients who had been hospitalized for COVID-19.
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Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Daniele Soddu
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | | | - Alessio Baricich
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Giulia Baldon
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Giuseppe Bartolomei
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Marco Battaglia
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Sofia Battistini
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Valeria Binda
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Margherita Borg
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Vincenzo Cantaluppi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Elisa Clivati
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Carlo Cisari
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Martina Costanzo
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Alessandro Croce
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Daria Cuneo
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Carla De Benedittis
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Simona De Vecchi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Alessandro Feggi
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Martina Gai
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gambaro
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gattoni
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Leonardo Grisafi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Chiara Guerriero
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Eyal Hayden
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Amalia Jona
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Marco Invernizzi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Luca Lorenzini
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Lucia Loreti
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Maria Martelli
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Paolo Marzullo
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Erica Matino
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Antonio Panero
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Elena Parachini
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Filippo Patrucco
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Alice Pirovano
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | | | - Riccardo Quaglino
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Cristina Rigamonti
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Camilla Vecchi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Erika Zecca
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
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5
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Bellan M, Gavelli F, Hayden E, Patrucco F, Soddu D, Pedrinelli AR, Cittone MG, Rizzi E, Casciaro GF, Vassia V, Landi R, Menegatti M, Gastaldello ML, Beltrame M, Labella E, Tonello S, Avanzi GC, Pirisi M, Castello LM, Sainaghi PP. Pattern of emergency department referral during the Covid-19 outbreak in Italy. Panminerva Med 2020; 63:478-481. [PMID: 32549532 DOI: 10.23736/s0031-0808.20.04000-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The coronavirus disease (COVID-19) outbreak is putting the European National Health Systems under pressure. Interestingly, Emergency Department (ED) referrals for reasons other than Covid-19 seem to have declined steeply. In the present paper, we aimed to verify how the Covid-19 outbreak changed ED referral pattern. METHODS We retrospectively reviewed the clinical records of patients referred to the ED of a University Hospital in Northern Italy from 1st March to 13th April 2020. We compared the following data with those belonging to the same period in 2019: number of EDs accesses, rate of hospital admission, frequencies of the most common causes of ED referral, priority codes of access. RESULTS The number of ED referrals during the Covid-19 outbreak was markedly reduced when compared to the same period in 2019 (3059 vs. 5691;-46.3%). Conversely, the rate of hospital admission raised from 16.9% to 35.4% (p<0.0001), with a shift toward higher priority codes of ED admission. In 2020, we observed both a reduction of the number of patients referred for both traumatic (513, 16.8% vs. 1544, 27.1%; χ2=118.7, p<0.0001) and non-traumatic (4147 vs. 2546) conditions. Among the latter, suspected Covid-19 accounted for 1101 (43.2%) accesses. CONCLUSIONS The Covid-19 pandemic completely changed the pattern of ED referral in Italy, with a marked reduction of the accesses to the hospitals. This could be related to a limited exposure to traumas and to a common fear of being infected during EDs in-stay. This may limit the misuse of EDs for non- urgent conditions, but may also delay proper referrals for urgent conditions.
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Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy - .,CAAD, Centre for Autoimmune and Allergic Diseases, Novara, Italy - .,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy -
| | - Francesco Gavelli
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Eyal Hayden
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Filippo Patrucco
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy
| | - Daniele Soddu
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Anita R Pedrinelli
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Micol G Cittone
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Eleonora Rizzi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Giuseppe F Casciaro
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Veronica Vassia
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Raffaella Landi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Mirta Menegatti
- Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Maria L Gastaldello
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Michela Beltrame
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Emanuela Labella
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Stelvio Tonello
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy
| | - Gian C Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Luigi M Castello
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
| | - Pier P Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy.,CAAD, Centre for Autoimmune and Allergic Diseases, Novara, Italy.,Internal Medicine and Emergency Medicine Divisions, "AOU Maggiore della Carità", Novara, Italy
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6
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Bellan M, Soddu D, Zecca E, Croce A, Bonometti R, Pedrazzoli R, Sola D, Rigamonti C, Castello LM, Avanzi GC, Pirisi M, Sainaghi PP. Association between red cell distribution width and response to methotrexate in rheumatoid arthritis. Reumatismo 2020; 72:16-20. [PMID: 32292017 DOI: 10.4081/reumatismo.2020.1243] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/06/2019] [Indexed: 11/22/2022] Open
Abstract
Red cell distribution width (RDW) is an unconventional biomarker of inflammation. We aimed to explore its role as a predictor of treatment response in rheumatoid arthritis (RA). Eighty-two RA patients (55 females), median age [interquartile range] 63 years [52-69], were selected by scanning the medical records of a rheumatology clinic, to analyze the associations between baseline RDW, disease activity scores and inflammatory markers, as well as the relationship between RDW changes following methotrexate (MTX) and treatment response. The lower the median baseline RDW, the greater were the chances of a positive EULAR response at three months, 13.5% [13.0-14.4] being among those with good response, vs 14.0% [13.2-14.7] and 14.2% [13.5- 16.0] (p=0.009) among those with moderate and poor response, respectively. MTX treatment was followed by a significant RDW increase (p<0.0001). The increase of RDW was greater among patients with good EULAR response, becoming progressively smaller in cases with moderate and poor response (1.0% [0.4-1.4] vs. 0.7 [0.1-2.0] vs. 0.3 [-0.1-0.8]; p=0.03). RDW is a strong predictor of early response to MTX in RA. RDW significantly increases after MTX initiation in parallel to treatment response, suggesting a role as a marker of MTX effectiveness.
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Affiliation(s)
- M Bellan
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy; Division of Internal Medicine, Immunorheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital, Novara, Italy; IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara.
| | - D Soddu
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy; Division of Internal Medicine, Immunorheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital, Novara.
| | - E Zecca
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy; Division of Internal Medicine, Immunorheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital, Novara.
| | - A Croce
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy; Division of Internal Medicine, Immunorheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital, Novara.
| | - R Bonometti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy; Division of Internal Medicine, Immunorheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital, Novara.
| | - R Pedrazzoli
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara.
| | - D Sola
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy; Division of Internal Medicine, Immunorheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital, Novara, Italy; IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara.
| | - C Rigamonti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara.
| | - L M Castello
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara.
| | - G C Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara.
| | - M Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy; Division of Internal Medicine, Immunorheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital, Novara, Italy; IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara.
| | - P P Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy; Division of Internal Medicine, Immunorheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital, Novara, Italy; IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara.
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7
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Bellan M, Andreoli L, Nerviani A, Piantoni S, Avanzi GC, Soddu D, Hayden E, Pirisi M, Sainaghi PP. Is cholecalciferol a potential disease-modifying anti-rheumatic drug for the management of rheumatoid arthritis? Clin Exp Rheumatol 2020. [DOI: 10.55563/clinexprheumatol/tdf172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immuno-Rheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) “Maggiore della Carità” Hospital, Novara; and IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara, Italy.
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit and Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, Italy
| | - Alessandra Nerviani
- IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara, Italy; and Centre for Experimental Medicine and Rheumatology, Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, UK
| | - Silvia Piantoni
- Rheumatology and Clinical Immunology Unit and Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, and Emergency Medicine Department, “Maggiore della Carità” Hospital, Novara, Italy
| | - Daniele Soddu
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara; and Division of Internal Medicine, Immuno-Rheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) “Maggiore della Carità” Hospital, Novara, Italy
| | - Eyal Hayden
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara; and Division of Internal Medicine, Immuno-Rheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) “Maggiore della Carità” Hospital, Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immuno-Rheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) “Maggiore della Carità” Hospital, Novara; and IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immuno-Rheumatology Unit, CAAD (Center for Translational Research on Autoimmune and Allergic Disease) “Maggiore della Carità” Hospital, Novara; and IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara, Italy
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8
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Grassi D, Desideri G, Mai F, Martella L, De Feo M, Soddu D, Fellini E, Veneri M, Stamerra CA, Ferri C. Cocoa, glucose tolerance, and insulin signaling: cardiometabolic protection. J Agric Food Chem 2015; 63:9919-9926. [PMID: 26126077 DOI: 10.1021/acs.jafc.5b00913] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Experimental and clinical evidence reported that some polyphenol-rich natural products may offer opportunities for the prevention and treatment of type 2 diabetes, due to their biological properties. Natural products have been suggested to modulate carbohydrate metabolism by various mechanisms, such as restoring β-cell integrity and physiology and enhancing insulin-releasing activity and glucose uptake. Endothelium is fundamental in regulating arterial function, whereas insulin resistance plays a pivotal role in pathophysiological mechanisms of prediabetic and diabetic states. Glucose and insulin actions in the skeletal muscle are improved by insulin-dependent production of nitric oxide, favoring capillary recruitment, vasodilatation, and increased blood flow. Endothelial dysfunction, with decreased nitric oxide bioavailability, is a critical step in the development of atherosclerosis. Furthermore, insulin resistance has been described, at least in part, to negatively affect endothelial function. Consistent with this, conditions of insulin resistance are usually linked to endothelial dysfunction, and the exposure of the endothelial cells to cardiovascular risk factors such as hypertension, dyslipidemia, and hyperglycemia is associated with reduced nitric oxide bioavailability, resulting in impaired endothelial-dependent vasodilatation. Moreover, endothelial dysfunction has been described as an independent predictor of cardiovascular risk and events. Cocoa and cocoa flavonoids may positively affect the pathophysiological mechanisms involved in insulin resistance and endothelial dysfunction with possible benefits in the prevention of cardiometabolic diseases.
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Affiliation(s)
- Davide Grassi
- Department of Life, Health & Environmental Sciences, University of L'Aquila , Coppito, Italy
| | - Giovambattista Desideri
- Department of Life, Health & Environmental Sciences, University of L'Aquila , Coppito, Italy
| | - Francesca Mai
- Department of Life, Health & Environmental Sciences, University of L'Aquila , Coppito, Italy
| | - Letizia Martella
- Department of Life, Health & Environmental Sciences, University of L'Aquila , Coppito, Italy
| | - Martina De Feo
- Department of Life, Health & Environmental Sciences, University of L'Aquila , Coppito, Italy
| | - Daniele Soddu
- Department of Life, Health & Environmental Sciences, University of L'Aquila , Coppito, Italy
| | - Emanuela Fellini
- Department of Life, Health & Environmental Sciences, University of L'Aquila , Coppito, Italy
| | - Mariangela Veneri
- Department of Life, Health & Environmental Sciences, University of L'Aquila , Coppito, Italy
| | - Cosimo A Stamerra
- Department of Life, Health & Environmental Sciences, University of L'Aquila , Coppito, Italy
| | - Claudio Ferri
- Department of Life, Health & Environmental Sciences, University of L'Aquila , Coppito, Italy
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