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Tinè M, Daverio M, Semenzato U, Cocconcelli E, Bernardinello N, Damin M, Saetta M, Spagnolo P, Balestro E. Pleural clinic: where thoracic ultrasound meets respiratory medicine. Front Med (Lausanne) 2023; 10:1289221. [PMID: 37886366 PMCID: PMC10598727 DOI: 10.3389/fmed.2023.1289221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Thoracic ultrasound (TUS) has become an essential procedure in respiratory medicine. Due to its intrinsic safety and versatility, it has been applied in patients affected by several respiratory diseases both in intensive care and outpatient settings. TUS can complement and often exceed stethoscope and radiological findings, especially in managing pleural diseases. We hereby aimed to describe the establishment, development, and optimization in a large, tertiary care hospital of a pleural clinic, which is dedicated to the evaluation and monitoring of patients with pleural diseases, including, among others, pleural effusion and/or thickening, pneumothorax and subpleural consolidation. The clinic was initially meant to follow outpatients undergoing medical thoracoscopy. In this scenario, TUS allowed rapid and regular assessment of these patients, promptly diagnosing recurrence of pleural effusion and other complications that could be appropriately managed. Over time, our clinic has rapidly expanded its initial indications thus becoming the place to handle more complex respiratory patients in collaboration with, among others, thoracic surgeons and oncologists. In this article, we critically describe the strengths and pitfalls of our "pleural clinic" and propose an organizational model that results from a synergy between respiratory physicians and other professionals. This model can inspire other healthcare professionals to develop a similar organization based on their local setting.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Elisabetta Balestro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Biondini D, Tinè M, Semenzato U, Daverio M, Scalvenzi F, Bazzan E, Turato G, Damin M, Spagnolo P. Clinical Applications of Endobronchial Ultrasound (EBUS) Scope: Challenges and Opportunities. Diagnostics (Basel) 2023; 13:2565. [PMID: 37568927 PMCID: PMC10417616 DOI: 10.3390/diagnostics13152565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Endobronchial Ultrasound (EBUS) has been widely used to stage lung tumors and to diagnose mediastinal diseases. In the last decade, this procedure has evolved in several technical aspects, with new tools available to optimize tissue sampling and to increase its diagnostic yield, like elastography, different types of needles and, most recently, miniforceps and cryobiopsy. Accordingly, the indications for the use of the EBUS scope into the airways to perform the Endobronchial Ultrasound-TransBronchial Needle Aspiration (EBUS-TBNA) has also extended beyond the endobronchial and thoracic boundaries to sample lesions from the liver, left adrenal gland and retroperitoneal lymph nodes via the gastroesophageal tract, performing the Endoscopic UltraSound with Bronchoscope-guided Fine Needle Aspiration (EUS-B-FNA). In this review, we summarize and critically discuss the main indication for the use of the EBUS scope, even the more uncommon, to underline its utility and versatility in clinical practice.
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Affiliation(s)
- Davide Biondini
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Mariaenrica Tinè
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Umberto Semenzato
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Matteo Daverio
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Francesca Scalvenzi
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Erica Bazzan
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Graziella Turato
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Marco Damin
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
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Bernardinello N, Cocconcelli E, Giraudo C, Daverio M, Castelli G, Petrarulo S, Bovo M, Fichera G, Cavinato S, Cattelan AM, Saetta M, Spagnolo P, Balestro E. Predictors of pulmonary sequelae after COVID-19 pneumonia: A 12-month follow-up study. Front Med (Lausanne) 2023; 10:1084002. [PMID: 36817777 PMCID: PMC9932038 DOI: 10.3389/fmed.2023.1084002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Since the beginning of the SARS-CoV-2 pandemic, over 550 million people have been infected worldwide. Despite these large numbers, the long-term pulmonary consequences of COVID-19 remain unclear. Aims The aim of this single-center observational cohort study was to identify and characterize pulmonary sequelae of COVID-19 at 12 months from hospitalization and to reveal possible predictors for the persistence of long-term lung consequences. Methods Based on the persistence or absence of radiological changes after 12 months from hospitalization, the whole population was categorized into NOT-RECOVERED (NOT-REC) and RECOVERED (REC) groups, respectively. Clinical and pulmonary function data tests and clinical data were also collected and compared in the two groups. In the NOT-REC group, high resolution computed tomography (HRCT) images were semiquantitatively scored analyzing ground-glass opacities (GGO), interstitial thickening (IT), consolidations (CO), linear and curvilinear band opacities, and bronchiectasis for each lung lobe. Logistic regression analyses served to detect the factors associated with 12-month radiological consequences. Results Out of the 421 patients followed after hospitalization for SARS-CoV-2 pneumonia, 347 met inclusion and exclusion criteria and were enrolled in the study. The NOT-REC patients (n = 24; 6.9%) were significantly older [67 (62-76) years vs. 63 (53-71) years; p = 0.02], more frequently current smokers [4 (17%) vs. 12 (4%); p = 0.02], and with more severe respiratory failure at the time of hospitalization [PaO2/FiO2 at admission: 201 (101-314) vs. 295 (223-343); p = 0.01] compared to REC group (n = 323; 93.1%). On multivariable analysis, being a current smoker resulted in an independent predictor for lung sequelae after 12 months from hospitalization [5.6 OR; 95% CI (1.41-22.12); p = 0.01]. Conclusion After 12 months from hospital admission, a limited number of patients displayed persistent pulmonary sequelae with minimal extension. Being a current smoker at the time of SARS-CoV-2 infection is an independent predictive factor to lung consequences, regardless of the disease severity.
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Affiliation(s)
- Nicol Bernardinello
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Elisabetta Cocconcelli
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Chiara Giraudo
- Department of Medicine, Institute of Radiology, University of Padova and Padova City Hospital, Padova, Italy
| | - Matteo Daverio
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Gioele Castelli
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Simone Petrarulo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Matteo Bovo
- School of Medicine and Surgery, University of Padova, Padova, Italy
| | - Giulia Fichera
- Pediatric Radiology Unit, University of Padova and Padova City Hospital, Padova, Italy
| | - Silvia Cavinato
- Division of Infectious and Tropical Diseases, University of Padova and Padova City Hospital, Padova, Italy
| | - Anna Maria Cattelan
- Division of Infectious and Tropical Diseases, University of Padova and Padova City Hospital, Padova, Italy
| | - Marina Saetta
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy,*Correspondence: Elisabetta Balestro,
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Daverio M, Tine' M, Spagnolo P. The milky way. Monaldi Arch Chest Dis 2021. [DOI: 10.4081/monaldi.2021.1856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mediastinal masses may present with signs and symptoms due to either compression of mediastinal structures or systemic effects of the underlying disease. The present case highlights the advantages of interventional pulmonology in the diagnosis of lymphoma as a cause of chylothorax and superior vena cava syndrome.
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Daverio M, Patrucco F, Gavelli F, Airoldi C, Sciortino G, Chiaramonte C, Rena O, Balbo PE, Boldorini RL. Comparative analysis of programmed death ligand 1 expression in paired cytologic and histologic specimens of non-small cell lung cancer. Cancer Cytopathol 2020; 128:580-588. [PMID: 32463583 DOI: 10.1002/cncy.22292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/03/2020] [Revised: 04/25/2020] [Accepted: 05/01/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND In advanced non-small cell lung cancer (NSCLC), cytologic specimens from transbronchial needle aspiration (TBNA) or transthoracic needle aspiration are often the only cancer tissue material available for the analysis of programmed death ligand 1 (PD-L1) expression. This study was aimed at assessing the concordance of PD-L1 expression in histologic and cytologic samples and at evaluating interobserver agreement on specimens in this setting. METHODS One hundred and thirty-eight specimens from 60 patients with NSCLC were analyzed. Histologic specimens were represented by endoscopic samples obtained with forceps (biopsies), whereas cytologic specimens were from TBNA and bronchial lavage (BL). PD-L1 expression was quantified with the immunohistochemistry (IHC)-based Ventana SP263 assay. For cytologic specimens, IHC was performed on cell block sections. Two independent pathologists who were blinded to the clinical data evaluated partial or complete membrane IHC staining. Concordance between 2 methods and between 2 pathologists was evaluated with normal and weighted Cohen's κ coefficients, overall agreement, and Bland-Altman plots. RESULTS PD-L1 expression was quantified in 138 specimens from 60 patients. Concordance between cytologic and histologic approaches was moderate (κ = 0.56; weighted κ = 0.55). Also, concordance in the biopsy-TBNA and biopsy-BL subgroups was moderate (κ = 0.43 and κ = 0.47, respectively), whereas interobserver agreement was substantial (weighted κ = 0.72). A Bland-Altman plot showed an underestimation in PD-L1 values from cytologic samples in comparison with histologic ones. CONCLUSIONS The results demonstrate that in the absence of available histologic specimens, PD-L1 positivity in cytologic samples could be a reliable data for the oncologist to consider immune checkpoint inhibitor therapy. However, a comparison of cytologic and histologic samples has shown an underestimation of PD-L1 values in cytologic samples.
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Affiliation(s)
- Matteo Daverio
- Medical Department, Division of Respiratory Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Filippo Patrucco
- Medical Department, Division of Respiratory Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy.,Department of Translational Medicine, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Francesco Gavelli
- Department of Translational Medicine, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Giusy Sciortino
- Pathology Unit, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Claudia Chiaramonte
- Pathology Unit, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Ottavio Rena
- Thoracic Surgery Unit, Cardio-Thoracic and Vascular Department, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy.,Health Sciences Department, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Piero E Balbo
- Medical Department, Division of Respiratory Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Renzo L Boldorini
- Pathology Unit, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy.,Health Sciences Department, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
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Donà D, Barbieri E, Daverio M, Lundin R, Giaquinto C, Zaoutis T, Sharland M. Correction to: Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review. Antimicrob Resist Infect Control 2020; 9:59. [PMID: 32381059 PMCID: PMC7206826 DOI: 10.1186/s13756-020-00720-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- D Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, London, UK.,Fondazione Penta ONLUS, Padua, Italy
| | - E Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.
| | - M Daverio
- Pediatric intensive care unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - R Lundin
- Fondazione Penta ONLUS, Padua, Italy
| | - C Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,Fondazione Penta ONLUS, Padua, Italy
| | - T Zaoutis
- Fondazione Penta ONLUS, Padua, Italy.,Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Sharland
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, London, UK.,Fondazione Penta ONLUS, Padua, Italy
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Gavelli F, Patrucco F, Daverio M, De Vita N, Bellan M, Rena O, Balbo PE, Avanzi GC, Castello LM. Sequelae of traumatic rib fractures: management in the Emergency Department. ACTA ACUST UNITED AC 2020. [DOI: 10.23736/s0026-4954.19.01863-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Donà D, Barbieri E, Daverio M, Lundin R, Giaquinto C, Zaoutis T, Sharland M. Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review. Antimicrob Resist Infect Control 2020; 9:3. [PMID: 31911831 PMCID: PMC6942341 DOI: 10.1186/s13756-019-0659-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.
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Affiliation(s)
- D. Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
- Fondazione Penta ONLUS, Padua, Italy
| | - E. Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
| | - M. Daverio
- Pediatric intensive care unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - R. Lundin
- Fondazione Penta ONLUS, Padua, Italy
| | - C. Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
- Fondazione Penta ONLUS, Padua, Italy
| | - T. Zaoutis
- Fondazione Penta ONLUS, Padua, Italy
- Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - M. Sharland
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
- Fondazione Penta ONLUS, Padua, Italy
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Patrucco F, Daverio M, Gavelli F, Castello L, Boldorini R, Rena O, Casadio C, Balbo P. Cryobiopsy in the diagnosis of lung tumors: a single center experience. MINERVA BIOTECNOL 2019. [DOI: 10.23736/s1120-4826.19.02561-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Bergallo M, Ferrari L, Faolotto G, Balbo PE, Montanari P, Patrucco F, Gavelli F, Daverio M, Bellan M, Salmi L, Castello LM, Ravanini P. Interferon signature in immunosuppressed patients with lower respiratory tract infections: dosage on bronchoalveolar lavage. Minerva Med 2019; 111:245-253. [PMID: 31755671 DOI: 10.23736/s0026-4806.19.06334-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Interferon signature (IS) is the measure of transcripts belonging to pathways of interferon activation. Viral infections can interfere with the interferon pathway, in particular herpesvirus present in immunocompromised hosts. The aim of our study was to evaluate if herpesvirus infections in immunocompromised patients with lower respiratory tract infections (LRTI) could lead to IS alterations. METHODS We measured IS transcription of six genes on bronchoalveolar lavage of immunocompromised patients with LRTI (IFI27, IFI44, IFIT1, ISG15, RSAD2, SIGLEC1). Patients were divided in three groups based on Epstein-Barr virus (EBV) and other herpesviruses coinfections. RESULTS We included 56 patients, 10 without and 17 with only EBV reactivation (respectively N and E groups) and 29 with EBV and other herpesviruses (group C). IS was higher in group C (P=0.01) compared to other ones, but single gene expressions were different among groups: IFI27 was higher whereas IFIT1 and ISG15 were lower in group C (P<0.05). CONCLUSIONS The continuous stimulation of interferon cascade by herpesviruses enhances IS. The analysis of IS in immunocompromised population is possible by limiting the use of IFI27, IFIT1, ISG15 genes. Our preliminary results seem to indicate that IS is a useful biomarker of cellular response to herpesvirus infection in immunocompromised patients.
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Affiliation(s)
- Massimiliano Bergallo
- Department of Public Health and Pediatric Sciences, University of Turin Medical School, Turin, Italy
| | - Linda Ferrari
- Laboratory Medicine Department, Laboratory of Molecular Virology, Maggiore della Carità Hospital, Novara, Italy
| | - Giulia Faolotto
- Laboratory Medicine Department, Laboratory of Molecular Virology, Maggiore della Carità Hospital, Novara, Italy
| | - Piero E Balbo
- Division of Respiratory Diseases, Medical Department, Maggiore della Carità Hospital, Novara, Italy
| | - Paola Montanari
- Department of Public Health and Pediatric Sciences, University of Turin Medical School, Turin, Italy
| | - Filippo Patrucco
- Division of Respiratory Diseases, Medical Department, Maggiore della Carità Hospital, Novara, Italy - .,Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Francesco Gavelli
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Matteo Daverio
- Division of Respiratory Diseases, Medical Department, Maggiore della Carità Hospital, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Center for Autoimmune and Allergic Diseases (CAAD), Novara, Italy.,Immunorheumatology Unit, Division of Internal Medicine, Medical Department, Maggiore della Carità Hospital, Novara, Italy
| | - Livia Salmi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Luigi M Castello
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Paolo Ravanini
- Laboratory Medicine Department, Laboratory of Molecular Virology, Maggiore della Carità Hospital, Novara, Italy
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Montemezzo J, Patrucco F, Gavelli F, Ferrari L, Faolotto G, Crobu MG, Castello LM, Daverio M, Balbo PE, Ravanini P. Evaluation of a new diagnostic method for quantification of EBV and HHV-6 viral load in bronchoalveolar lavage. MINERVA BIOTECNOL 2019. [DOI: 10.23736/s1120-4826.19.02557-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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12
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Patrucco F, Gavelli F, Ravanini P, Daverio M, Statti G, Castello LM, Andreoni S, Balbo PE. Use of an innovative and non-invasive device for virologic sampling of cough aerosols in patients with community and hospital acquired pneumonia: a pilot study. J Breath Res 2019; 13:021001. [PMID: 30523983 PMCID: PMC7106764 DOI: 10.1088/1752-7163/aaf010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aetiology of lower respiratory tract infections is challenging to investigate. Despite the wide array of diagnostic tools, invasive techniques, such as bronchoalveolar lavage (BAL), are often required to obtain adequate specimens. PneumoniaCheckTM is a new device that collects aerosol particles from cough, allowing microbiological analyses. Up to now it has been tested only for bacteria detection, but no study has investigated its usefulness for virus identification. METHODS In this pilot study we included 12 consecutive patients with pneumonia. After testing cough adequacy via a peak flow meter, a sampling with PneumoniaCheckTM was collected and a BAL was performed in each patient. Microbiological analyses for virus identification were performed on each sample and concordance between the two techniques was tested (sensitivity, specificity and positive/negative predictive values), taking BAL results as reference. RESULTS BAL was considered adequate in 10 patients. Among them, a viral pathogen was identified by PneumoniaCheckTM 6 times, each on different samples, whereas BAL allowed to detect the presence of a virus on 7 patients (14 positivities). Overall, the specificity for PneumoniaCheckTM to detect a virus was 100%, whereas the sensitivity was 66%. When considering only herpes viruses, PneumoniaCheckTM showed a lower sensitivity, detecting a virus in 1/4 of infected patients (25%). CONCLUSIONS In this pilot study PneumoniaCheckTM showed a good correlation with BAL for non-herpes virologic identification in pneumonia patients, providing excellent specificity. Further studies on larger population are needed to confirm these results and define its place in the panorama of rapid diagnostic tests for lower respiratory tract infections.
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Affiliation(s)
- Filippo Patrucco
- Medical Department, Division of Respiratory Diseases, University of Piemonte Orientale, Maggiore della Carità Hospital, Novara, Italy
| | - Francesco Gavelli
- Department of Translational Medicine, Emergency Medicine Unit, University of Piemonte Orientale, Maggiore della Carità Hospital, Novara, Italy
| | - Paolo Ravanini
- Laboratory Medicine Department, Microbiology and Virology Unit, University of Piemonte Orientale, Maggiore della Carità Hospital, Novara, Italy
| | - Matteo Daverio
- Medical Department, Division of Respiratory Diseases, University of Piemonte Orientale, Maggiore della Carità Hospital, Novara, Italy
| | - Giulia Statti
- Department of Translational Medicine, Emergency Medicine Unit, University of Piemonte Orientale, Maggiore della Carità Hospital, Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, Emergency Medicine Unit, University of Piemonte Orientale, Maggiore della Carità Hospital, Novara, Italy
| | - Stefano Andreoni
- Laboratory Medicine Department, Microbiology and Virology Unit, University of Piemonte Orientale, Maggiore della Carità Hospital, Novara, Italy
| | - Piero Emilio Balbo
- Medical Department, Division of Respiratory Diseases, University of Piemonte Orientale, Maggiore della Carità Hospital, Novara, Italy
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Patrucco F, Gavelli F, Daverio M, Antonini C, Boldorini R, Casadio C, Balbo PE. Electromagnetic Navigation Bronchoscopy: Where Are We Now? Five Years of a Single-Center Experience. Lung 2018; 196:721-727. [PMID: 30209566 DOI: 10.1007/s00408-018-0161-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 04/26/2018] [Accepted: 09/06/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Electromagnetic navigation (ENB) is a guidance tool used in the diagnosis of solitary pulmonary nodules (SPNs) and masses. Its diagnostic yield is highly variable (38-71%) and a recent study has put in doubt the role of ENB in sampling SPNs in a real-life setting. The aim of this study is to describe the 5-year experience of our center with ENB, analyzing the population, possible confounding factors, and the diagnostic yield and accuracy of this technique. METHODS We conducted a retrospective observational study including all consecutive patients who underwent ENB for SPNs and masses from January 2011 to December 2015. RESULTS We included 113 patients; 79% had SPNs, 21% masses. The majority were localized in the upper and middle lobes (80%) and 61% presented a bronchus sign. 54% of the patients had a previous negative fluoroscopy-guided bronchoscopy. ENB achieved the diagnosis in 78 patients (69%) with 64 malignant and 14 were benign lesions. The diagnostic yield and accuracy of ENB were respectively 0.69 and 0.76. The only factor influencing the ability to reach a diagnosis was the presence of bronchus sign (p = 0.002). No procedural complications were reported. CONCLUSION ENB is a safe procedure with a similar diagnostic yield in the real-life and research setting. Bronchus sign is an important factor in determining the diagnostic yield. ENB efficacy can be maximized by expertise and by a careful selection of each case.
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Affiliation(s)
- Filippo Patrucco
- Department of Translational Medicine, Pneumology Unit U, University of Piemonte Orientale, Sant'Andrea Hospital, Vercelli, Italy. .,Division of Respiratory Medicine, Medical Department, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, C.so Mazzini 18, 28100, Novara, Italy.
| | - Francesco Gavelli
- Department of Translational Medicine, Emergency Medicine Unit, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Matteo Daverio
- Division of Respiratory Medicine, Medical Department, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, C.so Mazzini 18, 28100, Novara, Italy
| | - Cleto Antonini
- Department of Emergency Acceptance, Anaesthesia and Intensive Care, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Renzo Boldorini
- Department of Translational Medicine, Pathology Unit, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Caterina Casadio
- Surgical Department, Thoracic Surgery Unit, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Piero E Balbo
- Division of Respiratory Medicine, Medical Department, University of Piemonte Orientale, AOU Maggiore della Carità di Novara, C.so Mazzini 18, 28100, Novara, Italy
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