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Barbanotti D, Tincati C, Tavelli A, Santoro A, Sala M, Bini T, De Bona A, d’Arminio Monforte A, Marchetti GC. HIV-Indicator Condition Guided Testing in a Hospital Setting. Life (Basel) 2023; 13:1014. [PMID: 37109543 PMCID: PMC10145962 DOI: 10.3390/life13041014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Late diagnosis is still a major issue in HIV infection management, leading to important consequences for both patients and community. In this perspective, HIV screening targeted on some clinical conditions (HIV indicator conditions-HIVICs) emerged as a useful strategy, also involving patients not considered at high behavioral risk. We organized an in-hospital HIVICs guided screening campaign named ICEBERG in Milan, Italy, between 2019 and 2021. Among the 520 subjects enrolled, mainly presenting with viral hepatitis or mononucleosis-like syndrome, 20 resulted HIV positive (3.8% prevalence). A significant proportion of them had multiple conditions and advanced immunosuppression, with 40% being AIDS-presenters. As adherence to the screening campaign was modest for non-ID specialists, educational interventions to raise clinicians' sensitivity are urgently needed. HIV-ICs guided testing was confirmed as a useful tool, but a combined approach with other screening strategies seems to be essential for early HIV diagnosis.
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Affiliation(s)
- Diletta Barbanotti
- Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy
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d’Arminio Monforte A, Tavelli A, De Benedittis S, Bai F, Tincati C, Gazzola L, Viganò O, Allegrini M, Mondatore D, Tesoro D, Barbanotti D, Mulé G, Castoldi R, De Bona A, Bini T, Chiumello D, Centanni S, Passarella S, Orfeo N, Marchetti G, Cozzi-Lepri A. Real World Estimate of Vaccination Protection in Individuals Hospitalized for COVID-19. Vaccines (Basel) 2022; 10:vaccines10040550. [PMID: 35455299 PMCID: PMC9031136 DOI: 10.3390/vaccines10040550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 12/17/2022] Open
Abstract
Whether vaccination confers a protective effect against progression after hospital admission for COVID-19 remains to be elucidated. Observational study including all the patients admitted to San Paolo Hospital in Milan for COVID-19 in 2021. Previous vaccination was categorized as: none, one dose, full vaccination (two or three doses >14 days before symptoms onset). Data were collected at hospital admission, including demographic and clinical variables, age-unadjusted Charlson Comorbidity index (CCI). The highest intensity of ventilation during hospitalization was registered. The endpoints were in-hospital death (primary) and mechanical ventilation/death (secondary). Survival analysis was conducted by means of Kaplan-Meier curves and Cox regression models. Effect measure modification by age was formally tested. We included 956 patients: 151 (16%) fully vaccinated (18 also third dose), 62 (7%) one dose vaccinated, 743 (78%) unvaccinated. People fully vaccinated were older and suffering from more comorbidities than unvaccinated. By 28 days, the risk of death was of 35.9% (95%CI: 30.1−41.7) in unvaccinated, 41.5% (24.5−58.5) in one dose and 28.4% (18.2−38.5) in fully vaccinated (p = 0.63). After controlling for age, ethnicity, CCI and month of admission, fully vaccinated participants showed a risk reduction of 50% for both in-hospital death, AHR 0.50 (95%CI: 0.30−0.84) and for mechanical ventilation or death, AHR 0.49 (95%CI: 0.35−0.69) compared to unvaccinated, regardless of age (interaction p > 0.56). Fully vaccinated individuals in whom vaccine failed to keep them out of hospital, appeared to be protected against critical disease or death when compared to non-vaccinated. These data support universal COVID-19 vaccination.
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Affiliation(s)
- Antonella d’Arminio Monforte
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
- Correspondence:
| | - Alessandro Tavelli
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Sara De Benedittis
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Francesca Bai
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Camilla Tincati
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Lidia Gazzola
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Ottavia Viganò
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Marina Allegrini
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Debora Mondatore
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Daniele Tesoro
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Diletta Barbanotti
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Giovanni Mulé
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Roberto Castoldi
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Anna De Bona
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Teresa Bini
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
| | - Davide Chiumello
- Intensive Care Unit ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy;
| | - Stefano Centanni
- Pneumology Unit ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy;
| | - Sabrina Passarella
- Medical Direction ASST Santi Paolo e Carlo, 20142 Milan, Italy; (S.P.); (N.O.)
| | - Nicola Orfeo
- Medical Direction ASST Santi Paolo e Carlo, 20142 Milan, Italy; (S.P.); (N.O.)
| | - Giulia Marchetti
- Unit of Infectious Diseases ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.T.); (S.D.B.); (F.B.); (C.T.); (L.G.); (O.V.); (M.A.); (D.M.); (D.T.); (D.B.); (G.M.); (R.C.); (A.D.B.); (T.B.); (G.M.)
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Bai F, Tomasoni D, Falcinella C, Barbanotti D, Castoldi R, Mulè G, Augello M, Mondatore D, Allegrini M, Cona A, Tesoro D, Tagliaferri G, Viganò O, Suardi E, Tincati C, Beringheli T, Varisco B, Battistini CL, Piscopo K, Vegni E, Tavelli A, Terzoni S, Marchetti G, Monforte AD. Female gender is associated with long COVID syndrome: a prospective cohort study. Clin Microbiol Infect 2021; 28:611.e9-611.e16. [PMID: 34763058 PMCID: PMC8575536 DOI: 10.1016/j.cmi.2021.11.002] [Citation(s) in RCA: 205] [Impact Index Per Article: 68.3] [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: 03/24/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
Abstract
Objective We explored the association between female gender and long COVID syndrome, defined as persistence of physical and/or psychological symptoms for more than 4 weeks after recovery from acute COVID-19 disease. The secondary aim was to identify predictors of long COVID syndrome by multivariable logistic regression analysis. Methods This was a single-centre prospective cohort study conducted at San Paolo Hospital in Milan, Italy. We enrolled adult patients who were evaluated at the post-COVID outpatient service of our Infectious Diseases Unit between 15 April 2020 and 15 December 2020. Participants were individuals who had clinically recovered from COVID-19 and in whom virological clearance had occurred. Previous infection by SARS-CoV-2 was microbiologically documented by positivity using a reverse-transcriptase polymerase chain reaction (RT-PCR) assay of nasopharyngeal swab. All enrolled patients underwent blood tests and a comprehensive medical examination at follow-up. Individuals were interviewed about resolved and persisting symptoms and were asked to fill in two questionnaires to allow assessment of the Hospital Anxiety and Depression symptoms (HADS) score and of the Impact of Event Scale–Revised (IES-R) score. Results A total of 377 patients were enrolled in the study. The median time from symtpom onset to virological clerance was 44 (37–53) days. A diagnosis of long COVID syndrome was made in 260/377 (69%) patients. The most common reported symptoms were fatigue (149/377, 39.5%), exertional dyspnoea (109/377, 28.9%), musculoskeletal pain (80/377, 21.2%) and “brain fog” (76/377, 20.2%). Anxiety symptoms were ascertained in 71/377 (18.8%) individuals, whereas 40/377 (10.6%) patients presented symptoms of depression. Post-traumatic stress disorder (defined by a pathological IES-R score) was diagnosed in one-third of patients (85/275, 31%). Female gender was independently associated with long COVID syndrome at multivariable analysis (AOR 3.3 vs. males, 95% CI 1.8–6.2, p < 0.0001). Advanced age (adjusted (A)OR 1.03 for 10 years older, 95% CI 1.01–1.05, p 0.01) and active smoking (AOR 0.19 for former smokers vs. active smokers, 95% CI 0.06–0.62, p 0.002) were also associated with a higher risk of long COVID, while no association was found between severity of disease and long COVID (AOR 0.67 for continuous positive airway pressure (CPAP)/non-invasive mechanical ventilation (NIMV)/orotracheal intubation (OTI) vs. no 02 therapy, 95% CI 0.29–1.55, p 0.85). Discussion Factors that were found to be associated with a higher risk of developing “long COVID” syndrome were female gender, older age and active smoking, but not severity of the acute disease. Individuals affected by SARS-CoV-2 infection with the aforementioned features should be early identified and involved in follow-up programmes.
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Affiliation(s)
- Francesca Bai
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy.
| | - Daniele Tomasoni
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Camilla Falcinella
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Diletta Barbanotti
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Roberto Castoldi
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Giovanni Mulè
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Matteo Augello
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Debora Mondatore
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Marina Allegrini
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Andrea Cona
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Daniele Tesoro
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Gianmarco Tagliaferri
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Ottavia Viganò
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Elisa Suardi
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Camilla Tincati
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Tomaso Beringheli
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Benedetta Varisco
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Chiara Luridiana Battistini
- Unit of Clinical Psychology, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Kyrie Piscopo
- Unit of Clinical Psychology, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Elena Vegni
- Unit of Clinical Psychology, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Alessandro Tavelli
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | | | - Giulia Marchetti
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
| | - Antonella d'Arminio Monforte
- Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy
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D’Arminio Monforte A, Tavelli A, Bai F, Tomasoni D, Falcinella C, Castoldi R, Barbanotti D, Mulè G, Allegrini M, Suardi E, Tesoro D, Tagliaferri G, Mondatore D, Augello M, Cona A, Beringheli T, Gemignani N, Sala M, Varisco B, Molà F, Pettenuzzo S, Biasioli L, Copes A, Gazzola L, Viganò O, Tincati C, De Bona A, Bini T, Marchetti G. Declining Mortality Rate of Hospitalised Patients in the Second Wave of the COVID-19 Epidemics in Italy: Risk Factors and the Age-Specific Patterns. Life (Basel) 2021; 11:979. [PMID: 34575128 PMCID: PMC8464683 DOI: 10.3390/life11090979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mortality rate from COVID-19 in Italy is among the world's highest. We aimed to ascertain whether there was any reduction of in-hospital mortality in patients hospitalised for COVID-19 in the second-wave period (October 2020-January 2021) compared to the first one (February-May 2020); further, we verified whether there were clusters of hospitalised patients who particularly benefitted from reduced mortality rate. METHODS Data collected related to in-patients' demographics, clinical, laboratory, therapies and outcome. Primary end-point was time to in-hospital death. Factors associated were evaluated by uni- and multivariable analyses. A flow diagram was created to determine the rate of in-hospital death according to individual and disease characteristics. RESULTS A total of 1561 patients were included. The 14-day cumulative incidence of in-hospital death by competing risk regression was of 24.8% (95% CI: 21.3-28.5) and 15.9% (95% CI: 13.7-18.2) in the first and second wave. We observed that the highest relative reduction of death from first to second wave (more than 47%) occurred mainly in the clusters of patients younger than 70 years. CONCLUSIONS Progress in care and supporting therapies did affect population over 70 years to a lesser extent. Preventive and vaccination campaigns should focus on individuals whose risk of death from COVID-19 remains high.
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Affiliation(s)
- Antonella D’Arminio Monforte
- Institute of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, 20142 Milan, Italy; (A.T.); (F.B.); (D.T.); (C.F.); (R.C.); (D.B.); (G.M.); (M.A.); (E.S.); (D.T.); (G.T.); (D.M.); (M.A.); (A.C.); (T.B.); (N.G.); (M.S.); (B.V.); (F.M.); (S.P.); (L.B.); (A.C.); (L.G.); (O.V.); (C.T.); (A.D.B.); (T.B.); (G.M.)
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Bai F, Tavelli A, Mulè G, Falcinella C, Mondatore D, Tesoro D, Barbanotti D, Tomasoni D, Castoldi R, Augello M, Allegrini M, Tagliaferri G, Cona A, Cozzi-Lepri A, Marchetti G, d'Arminio Monforte A. A Quantitative Estimate of the Expected Shortening of the Median Isolation Period of Patients With COVID-19 After the Adoption of a Symptom-Based Strategy. Front Public Health 2021; 9:639347. [PMID: 34178914 PMCID: PMC8222664 DOI: 10.3389/fpubh.2021.639347] [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: 12/08/2020] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
A long period of isolation was observed in patients hospitalized for COVID-19 in Milan over March-September 2020 (45; IQR: 37–54 days). A significantly shorter period would have been observed by the application of May-WHO (22, IQR: 17–30 days, P < 0.001) and October-Italian (26, IQR: 21–34 days, P < 0.001) Guidelines. The adoption of the new symptom-based criteria is likely to lead to a significant reduction in the length of the isolation period with potential social, economic and psychological benefits, particularly in the younger population with mild/moderate disease and no comorbidities. In our opinion, the release from isolation after 21 days from symptoms onset, even without a PCR diagnostic test, in most cases seems the most adequate strategy that could balance precautions to prevent SARS CoV-2 transmission and unnecessary prolonged isolation or overuse of diagnostic testing.
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Affiliation(s)
- Francesca Bai
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Alessandro Tavelli
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giovanni Mulè
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Camilla Falcinella
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Debora Mondatore
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Daniele Tesoro
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Diletta Barbanotti
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Daniele Tomasoni
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Roberto Castoldi
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Matteo Augello
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Marina Allegrini
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Gianmarco Tagliaferri
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Andrea Cona
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Alessandro Cozzi-Lepri
- Research Department of Infection and Population Health, Institute for Global Health, Centre for Clinical Research, Epidemiology, Modelling and Evaluation, University College London, London, United Kingdom
| | - Giulia Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Antonella d'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
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Tomasoni D, Bai F, Castoldi R, Barbanotti D, Falcinella C, Mulè G, Mondatore D, Tavelli A, Vegni E, Marchetti G, d'Arminio Monforte A. Anxiety and depression symptoms after virological clearance of COVID-19: A cross-sectional study in Milan, Italy. J Med Virol 2020; 93:1175-1179. [PMID: 32841387 PMCID: PMC7461061 DOI: 10.1002/jmv.26459] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 12/31/2022]
Abstract
Prevalence of anxiety or depression was investigated in 105 coronavirus disease 2019 (COVID-19) patients at 1 to 3 months from virological clearance by hospital anxiety and depression scale (HADS-A/D). 30% of patients displayed pathological HADS-A/D, 52.4% showed persistent symptoms. Pathological patients with HADS-A/D more commonly reported symptom persistence, even after adjustment for age, gender, and disease severity. Psychological assessments should be encouraged in COVID-19 patients' follow-up.
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Affiliation(s)
- Daniele Tomasoni
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesca Bai
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Roberto Castoldi
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Diletta Barbanotti
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Camilla Falcinella
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Giovanni Mulè
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Debora Mondatore
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alessandro Tavelli
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Elena Vegni
- Unit of Clinical Psychology, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giulia Marchetti
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
| | - Antonella d'Arminio Monforte
- Department of Health Sciences, ASST Santi Paolo e Carlo, Clinic of Infectious Diseases, San Paolo Hospital, University of Milan, Milan, Italy
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d'Arminio Monforte A, Tavelli A, Bai F, Tomasoni D, Falcinella C, Castoldi R, Barbanotti D, Mulè G, Allegrini M, Tesoro D, Tagliaferri G, Mondatore D, Augello M, Cona A, Ancona G, Gazzola L, Iannotti N, Tincati C, Viganò O, De Bona A, Bini T, Cozzi-Lepri A, Marchetti G. The importance of patients' case-mix for the correct interpretation of the hospital fatality rate in COVID-19 disease. Int J Infect Dis 2020; 100:67-74. [PMID: 32950738 PMCID: PMC7497732 DOI: 10.1016/j.ijid.2020.09.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 07/30/2020] [Revised: 08/31/2020] [Accepted: 09/13/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE We aimed to document data on the epidemiology and factors associated with clinical course leading to death of patients hospitalised with COVID-19. METHODS Prospective observational cohort study on patients hospitalised with COVID-19 disease in February-24th/May-17th 2020 in Milan, Italy. Uni-multivariable Cox regression analyses were performed. Death's percentage by two-weeks' intervals according to age and disease severity was analysed. RESULTS A total of 174/539 (32.3%) patients died in hospital over 8228 person-day follow-up; the 14-day Kaplan-Meier probability of death was 29.5% (95%CI: 25.5-34.0). Older age, burden of comorbidities, COVID-19 disease severity, inflammatory markers at admission were independent predictors of increased risk, while several drug-combinations were predictors of reduced risk of in-hospital death. The highest fatality rate, 36.5%, occurred during the 2nd-3rd week of March, when 55.4% of patients presented with severe disease, while a second peak, by the end of April, was related to the admission of older patients (55% ≥80 years) with less severe disease, 30% coming from long-term care facilities. CONCLUSIONS The unusual fatality rate in our setting is likely to be related to age and the clinical conditions of our patients. These findings may be useful to better allocate resources of the national healthcare system, in case of re-intensification of COVID-19 epidemics.
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Affiliation(s)
- Antonella d'Arminio Monforte
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.
| | - Alessandro Tavelli
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Francesca Bai
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Daniele Tomasoni
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Camilla Falcinella
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Roberto Castoldi
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Diletta Barbanotti
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giovanni Mulè
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Marina Allegrini
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Daniele Tesoro
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Gianmarco Tagliaferri
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Debora Mondatore
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Matteo Augello
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Andrea Cona
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giuseppe Ancona
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Lidia Gazzola
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Nathalie Iannotti
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Camilla Tincati
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Ottavia Viganò
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Anna De Bona
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Teresa Bini
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Giulia Marchetti
- Clinic of Infectious Diseases, Department of Health Science, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
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Sagnelli C, Uberti-Foppa C, Hasson H, Bellini G, Minichini C, Salpietro S, Messina E, Barbanotti D, Merli M, Punzo F, Coppola N, Lazzarin A, Sagnelli E, Rossi F. In vivo evidence that the cannabinoid receptor 2-63 RR variant is associated with the acquisition and/or expansion of HIV infection. HIV Med 2018; 19:597-604. [PMID: 29932291 DOI: 10.1111/hiv.12638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of the study was to investigate whether the rs35761398 variants of the cannabinoid receptor 2 (CB2) gene may influence the acquisition of HIV infection and the clinical presentation of HIV/hepatitis C virus (HCV) coinfection. METHODS We compared 166 HIV/HCV-coinfected patients with 186 HCV-monoinfected patients, all with biopsy-proven chronic hepatitis (using the Ishak scoring system), naïve for anti-HCV treatment and tested for the CB2 rs35761398 polymorphism (using the TaqMan assay). RESULTS The HIV/HCV-coinfected patients were more frequently male (P < 0.002), were younger (P < 0.001), and had lower median BMI (P < 0.001) and HCV RNA (P < 0.05) and higher median aspartate aminotransferase (AST; P < 0.001), alanine aminotransferase (ALT; P < 0.001) and gamma glutamyl transferase (GGT; P < 0.001) levels than the HCV-monoinfected patients. The CB2 RR variant predominated in HIV/HCV-coinfected patients (45.8% vs. 31.2% in HCV-monoinfected patients; P < 0.001) and the CB2 QR variant in HCV-monoinfected patients (57.5% vs. 38.6% in HIV/HCV-coinfected patients; P < 0.00001), and the CB2 QQ variant was equally distributed. Focusing on patients with the CB2 QQ variant, the 26 HIV/HCV-coinfected patients, compared with the 21 HCV-monoinfected patients, showed less severe liver necroinflammation [lower histological activity index (HAI)] (P < 0.05). Of the patients with the CB2 RR variant, the 76 HIV/HCV-coinfected patients, compared with the 58 HCV-monoinfected patients, were more frequently male (P < 0.05), were younger (P < 0.001), and had a lower median body mass index (BMI; P < 0.001), a higher median AST level (P < 0.001), a higher mean HAI score (P < 0.05) and a higher rate of cases with severe steatosis (P = 0.05). In an analysis of variance (anova) of HCV/HIV-coinfected and HCV-monoinfected patient data, those with the CB2 RR variant (P = 0.003) and of male sex (P = 0.002) were more prevalent in the HCV/HIV-coinfected group. CONCLUSIONS There is the suggestion of a positive effect of the CB2 RR variant on HIV acquisition and/or spread, which is in accordance with previous in vitro observations.
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Affiliation(s)
- C Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - C Uberti-Foppa
- Department of Infectious Diseases, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - H Hasson
- Department of Infectious Diseases, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - G Bellini
- Department of Pediatrics, University of Campania Luigi Vanvitelli, Naples, Italy
| | - C Minichini
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - S Salpietro
- Department of Infectious Diseases, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - E Messina
- Department of Infectious Diseases, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - D Barbanotti
- Department of Infectious Diseases, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - M Merli
- Department of Infectious Diseases, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - F Punzo
- Department of Pediatrics, University of Campania Luigi Vanvitelli, Naples, Italy
| | - N Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - A Lazzarin
- Department of Infectious Diseases, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - E Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - F Rossi
- Department of Pediatrics, University of Campania Luigi Vanvitelli, Naples, Italy
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Sagnelli C, Uberti-Foppa C, Hasson H, Bellini G, Minichini C, Salpietro S, Messina E, Barbanotti D, Merli M, Punzo F, Coppola N, Lazzarin A, Sagnelli E, Rossi F. Cannabinoid receptor 2-63 RR variant is independently associated with severe necroinflammation in HIV/HCV coinfected patients. PLoS One 2017; 12:e0181890. [PMID: 28759568 PMCID: PMC5536321 DOI: 10.1371/journal.pone.0181890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/07/2017] [Indexed: 12/20/2022] Open
Abstract
Objective This is the first study to analyze the impact of the rs35761398 variant of the CNR2 gene leading to the substitution of GLN (Q) of codon 63 of the cannabinoid receptor 2 (CB2) with ARG (R) on the clinical presentation of chronic hepatitis in HIV/HCV coinfected patients. Methods Enrolled in this study were 166 consecutive HIV/HCV coinfected patients, naïve for HCV treatment. A pathologist unaware of the patients’ condition graded liver fibrosis, necroinflammation (Ishak) and steatosis. All patients were screened for the CB2 rs35761398 polymorphism. Results Of the 166 HIV/HCV coinfected patients, 72.9% were males, 42.5% were infected with HCV-genotype-3 and 60.2% had been intravenous drug users. The median age was 40.6 years and the immunological condition good (median CD4+ cells/mm3 = 507, IQR: 398.0–669.5). Thirty-five (21.1%) patients were naive for ART and 131(78.9%) were on ART. The CB2-RR variant was detected in 45.8% of patients, QR in 38.6% and QQ in 15.7%. Patients with CB2-RR showed a necroinflammation score (HAI) ≥9 more frequently than those with CB2-QQ or CB2-QR (32.9% vs. 11.5% and 14.1%, respectively, p≤0.001). In the multivariate analysis, the CB2-RR variant (p = 0.03) and liver fibrosis were both identified as independent predictors of the entity of liver necroinflammation (p = 0.0001). Conclusion This study shows interesting interplay between the CB2-RR variant and liver necroinflammation in chronic hepatitis patients with HIV/HCV coinfection, an observation of clinical value that coincides with the interest in the use of the CB2 agonists and antagonists in clinical practice emerging from the literature.
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Affiliation(s)
- Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Caterina Uberti-Foppa
- Department of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Hamid Hasson
- Department of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Bellini
- Department of Pediatrics, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Carmine Minichini
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefania Salpietro
- Department of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Emanuela Messina
- Department of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Diletta Barbanotti
- Department of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Merli
- Department of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Punzo
- Department of Pediatrics, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Adriano Lazzarin
- Department of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
- * E-mail: ,
| | - Francesca Rossi
- Department of Pediatrics, University of Campania Luigi Vanvitelli, Naples, Italy
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