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Dorma MPF, Giuliani G, Guerra F, Santelli F, Esposito A, De Pastena M, Turri G, Pedrazzani C, Kauffmann EF, Boggi U, Solaini L, Ercolani G, Mastrangelo L, Jovine E, Di Franco G, Morelli L, Mazzola M, Ferrari G, Langella S, Ferrero A, La Mendola R, Abu Hilal M, Depalma N, D'Ugo S, Spampinato MG, Frisini M, Brolese A, Palaia R, Belli A, Cillara N, Deserra A, Cannavera A, Sagnotta A, Mancini S, Pinotti E, Montuori M, Coppola A, Di Benedetto F, Coratti A. The pan - COVID - AGICT study. The impact of COVID-19 pandemic on surgically treated pancreatic cancer patients. A multicentric Italian study. Surg Oncol 2024; 54:102081. [PMID: 38729088 DOI: 10.1016/j.suronc.2024.102081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/28/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND In this article we aimed to perform a subgroup analysis using data from the COVID-AGICT study, to investigate the perioperative outcomes of patients undergoing surgery for pancreatic cancers (PC) during the COVID-19 pandemic. METHODS The primary endpoint of the study was to find out any difference in the tumoral stage of surgically treated PC patients between 2019 and 2020. Surgical and oncological outcomes of the entire cohort of patients were also appraised dividing the entire peri-pandemic period into six three-month timeframes to balance out the comparison between 2019 and 2020. RESULTS Overall, a total of 1815 patients were surgically treated during 2019 and 2020 in 14 Italian surgical Units. In 2020, the rate of patients treated with an advanced pathological stage was not different compared to 2019 (p = 0.846). During the pandemic, neoadjuvant chemotherapy (NCT) has dropped significantly (6.2% vs 21.4%, p < 0.001) and, for patients who didn't undergo NCT, the latency between diagnosis and surgery was shortened (49.58 ± 37 days vs 77.40 ± 83 days, p < 0.001). During 2020 there was a significant increase in minimally invasive procedures (p < 0.001). The rate of postoperative complication was the same in the two years but during 2020 there was an increase of the medical ones (19% vs 16.1%, p = 0.001). CONCLUSIONS The post-pandemic dramatic modifications in healthcare provision, in Italy, did not significantly impair the clinical history of PC patients receiving surgical resection. The present study is one of the largest reports available on the argument and may provide the basis for long-term analyses.
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Affiliation(s)
- Maria Pia Federica Dorma
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est, School of Robotic Surgery, Grosseto, Italy; Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
| | - Giuseppe Giuliani
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est, School of Robotic Surgery, Grosseto, Italy
| | - Francesco Guerra
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est, School of Robotic Surgery, Grosseto, Italy
| | - Francesco Santelli
- Department of Economics, Business, Mathematics and Statistics (DEAMS), University of Trieste, Trieste, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Matteo De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Giulia Turri
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University and Hospital Trust of Verona, 37134, Verona, Italy
| | - Corrado Pedrazzani
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University and Hospital Trust of Verona, 37134, Verona, Italy
| | | | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Leonardo Solaini
- Department of Medical and Surgical Sciences, University of Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences, University of Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Laura Mastrangelo
- Division of General and Emergency Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elio Jovine
- Division of General and Emergency Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | - Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Roberta La Mendola
- Hepato-Bilio-Pancreatic Minimally Invasive Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Mohamnad Abu Hilal
- Hepato-Bilio-Pancreatic Minimally Invasive Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Norma Depalma
- Department of General Surgery, "Vito Fazzi" Hospital, Piazza Muratore 1-73100, Lecce, Italy
| | - Stefano D'Ugo
- Department of General Surgery, "Vito Fazzi" Hospital, Piazza Muratore 1-73100, Lecce, Italy
| | | | - Marco Frisini
- APSS, Department of General Surgery & HPB Unit, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Alberto Brolese
- APSS, Department of General Surgery & HPB Unit, Largo Medaglie d'oro 9, 38122, Trento, Italy
| | - Raffaele Palaia
- Department of Abdominal Oncology, Division of Gastro-esophageal and Pancreatic Surgical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, 80131, Italy
| | - Andrea Belli
- Department of Abdominal Oncology, Division of Gastro-esophageal and Pancreatic Surgical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples, 80131, Italy
| | - Nicola Cillara
- UOC Chirurgia Generale PO Santissima Trinità ASL Cagliari, Cagliari, Italy
| | - Antonello Deserra
- UOC Chirurgia Generale PO Santissima Trinità ASL Cagliari, Cagliari, Italy
| | | | - Andrea Sagnotta
- General and Oncology Surgery - San Filippo Neri Hospital - ASL Roma 1, Italy
| | - Stefano Mancini
- General and Oncology Surgery - San Filippo Neri Hospital - ASL Roma 1, Italy
| | - Enrico Pinotti
- Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy
| | - Mauro Montuori
- Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy
| | | | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Coratti
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est, School of Robotic Surgery, Grosseto, Italy
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Giuliani G, Guerra F, Messinese S, Santelli F, Salvischiani L, Esposito S, Ferraro L, Esposito A, De Pastena M, Rega D, Delrio P, La Raja C, Spinelli A, Massaron S, De Nardi P, Kauffmann EF, Boggi U, Deidda S, Restivo A, Marano A, Borghi F, Piccoli M, Depalma N, D'Ugo S, Spampinato M, Cozzani F, Del Rio P, Marcellinaro R, Carlini M, De Rosa R, Scabini S, Maiello F, Polastri R, Turri G, Pedrazzani C, Zese M, Parini D, Casaril A, Moretto G, De Leo A, Catarci M, Trapani R, Zonta S, Marsanic P, Muratore A, Di Franco G, Morelli L, Coppola A, Caputo D, Andreuccetti J, Pignata G, Mastrangelo L, Jovine E, Mazzola M, Ferrari G, Mariani L, Ceccarelli G, Giuseppe R, Bolzon S, Grasso M, Testa S, Germani P, de Manzini N, Langella S, Ferrero A, Coletta D, Bianchi PP, Bengala C, Coratti A. The COVID - AGICT study: COVID-19 and advanced gastro-intestinal cancer surgical treatment. A multicentric Italian study on the SARS-CoV-2 pandemic impact on gastro-intestinal cancers surgical treatment during the 2020. Analysis of perioperative and short-term oncological outcomes. Surg Oncol 2023; 47:101907. [PMID: 36924550 PMCID: PMC9892255 DOI: 10.1016/j.suronc.2023.101907] [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: 08/30/2022] [Revised: 12/31/2022] [Accepted: 01/22/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND This Italian multicentric retrospective study aimed to investigate the possible changes in outcomes of patients undergoing surgery for gastrointestinal cancers during the COVID-19 pandemic. METHOD Our primary endpoint was to determine whether the pandemic scenario increased the rate of patients with colorectal, gastroesophageal, and pancreatic cancers resected at an advanced stage in 2020 compared to 2019. Considering different cancer staging systems, we divided tumors into early stages and advanced stages, using pathological outcomes. Furthermore, to assess the impact of the COVID-19 pandemic on surgical outcomes, perioperative data of both 2020 and 2019 were also examined. RESULTS Overall, a total of 8250 patients, 4370 (53%) and 3880 (47%) were surgically treated during 2019 and 2020 respectively, in 62 Italian surgical Units. In 2020, the rate of patients treated with an advanced pathological stage was not different compared to 2019 (P = 0.25). Nevertheless, the analysis of quarters revealed that in the second half of 2020 the rate of advanced cancer resected, tented to be higher compared with the same months of 2019 (P = 0.05). During the pandemic year 'Charlson Comorbidity Index score of cancer patients (5.38 ± 2.08 vs 5.28 ± 2.22, P = 0.036), neoadjuvant treatments (23.9% vs. 19.5%, P < 0.001), rate of urgent diagnosis (24.2% vs 20.3%, P < 0.001), colorectal cancer urgent resection (9.4% vs. 7.37, P < 0.001), and the rate of positive nodes on the total nodes resected per surgery increased significantly (7 vs 9% - 2.02 ± 4.21 vs 2.39 ± 5.23, P < 0.001). CONCLUSIONS Although the SARS-CoV-2 pandemic did not influence the pathological stage of colorectal, gastroesophageal, and pancreatic cancers at the time of surgery, our study revealed that the pandemic scenario negatively impacted on several perioperative and post-operative outcomes.
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Affiliation(s)
- Giuseppe Giuliani
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est. School of Robotic Surgery, Grosseto, Italy
| | - Francesco Guerra
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est. School of Robotic Surgery, Grosseto, Italy
| | | | - Francesco Santelli
- Department of Economics, Business, Mathematics and Statistics (DEAMS), University of Trieste, Trieste, Italy
| | - Lucia Salvischiani
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est. School of Robotic Surgery, Grosseto, Italy
| | - Sofia Esposito
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, AOU Modena, Italy
| | - Luca Ferraro
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, ASST Santi Paolo e Carlo, 20142 Milano, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Matteo De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Carlotta La Raja
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy; IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy; IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Simonetta Massaron
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Paola De Nardi
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | | | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Simona Deidda
- Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy
| | - Angelo Restivo
- Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy
| | - Alessandra Marano
- General and Specialist Surgery Department, Emergency General Surgery Unit, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Felice Borghi
- Oncological Surgery, Candiolo Cancer Institute-FPO-IRCCS, Candiolo, 10060, Torino, Italy
| | - Micaela Piccoli
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, AOU Modena, Italy
| | - Norma Depalma
- Department of General Surgery, "Vito Fazzi" Hospital, Piazza Muratore, 1-73100, Lecce, Italy
| | - Stefano D'Ugo
- Department of General Surgery, "Vito Fazzi" Hospital, Piazza Muratore, 1-73100, Lecce, Italy
| | - Marcello Spampinato
- Department of General Surgery, "Vito Fazzi" Hospital, Piazza Muratore, 1-73100, Lecce, Italy
| | | | - Paolo Del Rio
- General Surgery Unit, Parma University Hospital, Parma, Italy
| | - Rosa Marcellinaro
- Department of General Surgery, S. Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | - Massimo Carlini
- Department of General Surgery, S. Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | - Raffaele De Rosa
- Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Stefano Scabini
- Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Fabio Maiello
- Department of Surgery - General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Roberto Polastri
- Department of Surgery - General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Giulia Turri
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University and Hospital Trust of Verona, 37134, Verona, Italy
| | - Corrado Pedrazzani
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University and Hospital Trust of Verona, 37134, Verona, Italy
| | - Monica Zese
- Department of General and Urgent Surgery, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Dario Parini
- Department of General and Urgent Surgery, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Andrea Casaril
- Department of Surgery, "Pederzoli" Hospital, Peschiera del Garda, Verona, Italy
| | - Gianluigi Moretto
- Department of Surgery, "Pederzoli" Hospital, Peschiera del Garda, Verona, Italy
| | - Antonio De Leo
- General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Via dei Monti Tiburtini, 385, 00157, Rome, Italy
| | - Marco Catarci
- General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Via dei Monti Tiburtini, 385, 00157, Rome, Italy
| | - Renza Trapani
- Department of General Surgery, Ospedale San Biagio, ASL VCO, Domodossola, Italy
| | - Sandro Zonta
- Department of General Surgery, Ospedale San Biagio, ASL VCO, Domodossola, Italy
| | | | - Andrea Muratore
- Surgical Department, E. Agnelli Hospital, 10064, Pinerolo, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | | | - Damiano Caputo
- Research Unit of Generale Surgery, Department of Medicine and Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy; Operative Research Unit of General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | | | - Giusto Pignata
- Second General Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Laura Mastrangelo
- Division of General and Emergency Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elio Jovine
- Division of General and Emergency Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Lorenzo Mariani
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Italy
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Italy
| | - Rocco Giuseppe
- Hepatobiliary, Pancreatic and General Surgery Unit, Department of Surgery, Azienda Unità Sanitaria Locale Area Vasta Romagna, Santa Maria delle Croci - Ravenna Hospital, Ravenna, Italy
| | - Stefano Bolzon
- Hepatobiliary, Pancreatic and General Surgery Unit, Department of Surgery, Azienda Unità Sanitaria Locale Area Vasta Romagna, Santa Maria delle Croci - Ravenna Hospital, Ravenna, Italy
| | | | - Silvio Testa
- S.C. Chirurgia Generale, Ospedale S.Andrea, Vercelli, Italy
| | - Paola Germani
- Surgical Clinic Unit, University Hospital of Trieste, Trieste, Italy
| | - Nicolò de Manzini
- Surgical Clinic Unit, University Hospital of Trieste, Trieste, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Diego Coletta
- Department of Surgical Sciences, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, ASST Santi Paolo e Carlo, 20142 Milano, Italy
| | - Carmelo Bengala
- Medical Oncology Unit, Misericordia Hospital, Grosseto, Italy
| | - Andrea Coratti
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est. School of Robotic Surgery, Grosseto, Italy
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Tasso M, Bertolini N, Mostacciuolo E, Passavanti S, Luppino JME, Del Puente A, Peluso R, Santelli F, Scarpa R, Costa L, Caso F. Effectiveness and safety profile of tofacitinib and baricitinib in rheumatoid arthritis patients: results from a 24-month real-life prospective study in Southern-Italy. Reumatismo 2022; 74. [PMID: 36580064 DOI: 10.4081/reumatismo.2022.1511] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/17/2022] [Indexed: 12/30/2022] Open
Abstract
The primary objectives of the study were to evaluate the efficacy and safety of tofacitinib and baricitinib up to 24 months of follow-up in patients with rheumatoid arthritis (RA) treated in Southern Italy. Patients' data, activity index, and clinimetric scores were collected at baseline (T0), six (T6), twelve (T12), and twenty-four (T24) months following treatment initiation. At six, twelve, and twenty-four months, adverse events and treatment cessation were also recorded. Sixty-eight patients (mean age: 62.2±10.9 years; mean RA duration: 15±9.6 years) were enrolled over a period of 12 weeks. At baseline, twenty-four patients (35.3%) were treated with tofacitinib, and forty-four patients (64.7%) were treated with baricitinib. The baseline mean disease activity was moderate as measured by DAS28- ESR (5.0±1.0), DAS 28 CRP (4.69±0.94), and SDAI (26.87±10.73) score. Before beginning JAKinhibs therapy, thirty-two patients (61.8%) were taking bDMARDs, while the remaining thirty-six (38.2%) were bDMARDs-naïve. The 24-month retention rate for JAKinhibs was 91.1%. Six months after beginning treatment with JAKinhibs, a statistically significant improvement was observed in all evaluated activity indices and clinimetric scores. Improvement was confirmed during the 12- and 24-month follow-up evaluations. The positive correlation between baseline-T6 SDAI delta and discontinuation of JAKinhibs (p=0.02) suggests that RA worsening in the first six months may be a predictor of therapy withdrawal. Patients with RA responded favorably to tofacitinib and baricitinib in this prospective, real-world study from a single center in Southern Italy. Efficacy was observed despite an underlying persistent and treatment-resistant disease.
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Affiliation(s)
- M Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - N Bertolini
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - E Mostacciuolo
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - S Passavanti
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - J M E Luppino
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - A Del Puente
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - R Peluso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - F Santelli
- Department of Political Science, University of Naples Federico II, Naples.
| | - R Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - L Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - F Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
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Carbone A, Santelli F, Bottino R, Attena E, Mazzone C, Parisi V, D'Andrea A, Golino P, Nigro G, Russo V. Prevalence and clinical predictors of inappropriate direct oral anticoagulant dosage in octagenarians with atrial fibrillation. Eur J Clin Pharmacol 2022; 78:879-886. [PMID: 35138442 PMCID: PMC9005392 DOI: 10.1007/s00228-022-03286-2] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/30/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE Older age is associated with inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting. METHODS Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). Of the AF patients aged ≥ 80 who received DOACs treatment, 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were, respectively, defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus. RESULTS A total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them, 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR = 3.15 (95% IC; 1.45-6.83); p < 0.001], coronary artery disease [OR = 3.60 (95% IC 1.45-9.10); p < 0.001] and body mass index [OR = 1.27 (1.14-1.41); p < 0.001]. Overdosage was independently associated with diabetes mellitus [OR = 18 (3.36-96); p < 0.001], with age [OR = 0.76 (95% IC; 0.61-0.96; p = 0.045], BMI [OR = 0.77 (95% IC; 0.62-0.97; p = 0.043] and with previous bleedings [OR = 6.40 (0.7; 1.43-28); p = 0.039]. There wasn't significant difference in thromboembolic, major bleeding events and mortality among different subgroups. Underdosage group showed a significatively lower survival compared with appropriate dose group (p < 0.001). CONCLUSION In our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors were associated with DOACs' overdosage (diabetes mellitus type II, previous bleeding) or underdosage (male gender, coronary artery disease, and higher body mass index). Octogenarians with inappropriate DOACs underdosage showed less survival.
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Affiliation(s)
- Andreina Carbone
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, P.Zzale Ettore Ruggeri, 80131, Naples, Italy
| | - Francesco Santelli
- Department of Political Sciences, University of Naples Federico II, Naples, Italy
| | - Roberta Bottino
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, P.Zzale Ettore Ruggeri, 80131, Naples, Italy
| | - Emilio Attena
- Department of Cardiology, Health Authority Naples 2 North, Naples, Italy
| | | | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore, Italy
| | - Paolo Golino
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, P.Zzale Ettore Ruggeri, 80131, Naples, Italy
| | - Gerardo Nigro
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, P.Zzale Ettore Ruggeri, 80131, Naples, Italy
| | - Vincenzo Russo
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, P.Zzale Ettore Ruggeri, 80131, Naples, Italy.
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5
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Santelli F, Ragozini G, Vitale MP. Assessing the effects of local contexts on the mobility choices of university students in Campania region in Italy. Genus 2022. [DOI: 10.1186/s41118-021-00144-4] [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: 11/10/2022] Open
Abstract
AbstractThe mobility of university students in Italy has been framed as a phenomenon linked to so-called intellectual migrations and as a subset of the historical and consolidated internal migration path explained in terms of South–North trajectory. This study describes the most important mobility trajectories of students across macro-areas and disciplinary fields, and then evaluates, using a multilevel logistic regression model, the factors that encouraged student cohort, who were enrolled in a degree program in the academic years 2014–2015, to move elsewhere from the Campania region. Beyond fixed and interaction effects related to the students’ personal characteristics, the model included possible random effects linked to the high schools attended by the students to capture the possible influence of the local context on migration choices.
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6
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Cesaro A, Gragnano F, Calabrò P, Moscarella E, Santelli F, Fimiani F, Patti G, Cavallari I, Antonucci E, Cirillo P, Pignatelli P, Palareti G, Pelliccia F, Bossone E, Pengo V, Gresele P, Marcucci R. Prevalence and clinical implications of eligibility criteria for prolonged dual antithrombotic therapy in patients with PEGASUS and COMPASS phenotypes: Insights from the START-ANTIPLATELET registry. Int J Cardiol 2021; 345:7-13. [PMID: 34695525 DOI: 10.1016/j.ijcard.2021.10.138] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/28/2022]
Abstract
AIM To analyze the prevalence and clinical implications of the eligibility criteria for prolonged dual antithrombotic therapy with ticagrelor 60 mg twice daily and/or rivaroxaban 2.5 mg twice daily in a contemporary real-world ACS registry. METHODS Patients from the START-ANTIPLATELET registry (NCT02219984) were stratified according to the eligibility criteria of the PEGASUS and COMPASS studies to investigate the proportion of patients eligible for prolonged dual antithrombotic therapy at discharge and after 1-year of DAPT. Net adverse clinical events (NACE), defined as all-cause death, myocardial infarction, stroke, and major bleeding, at 1 year were also evaluated and compared among groups. RESULTS 1844 were considered for the analysis at baseline. Out of 849 event-free patients continually receiving dual antiplatelet therapy for at least 1 year, 577 (68%) and 583 (68.7%) met at least one eligibility criterion for ticagrelor and rivaroxaban, respectively. In the PEGASUS-like patients, age was the most common criterion (71% of cases). The presence ≥2 cardiovascular risk factors was the most common eligibility criterion in the COMPASS-like patients (80.8%). At 1-year follow-up, 211 (11.4%) and 119 (6.5%) patients experienced NACE and MACE, respectively. The incidence of NACEs was higher in the PEGASUS-only group (15.4% vs. 8.4%; p = 0.008) and numerically higher in the COMPASS-only group (10.9% vs. 8.4%; p = 0.299). CONCLUSIONS In a contemporary real-world ACS cohort, approximately two-thirds of patients that complete 1-year DAPT met the eligibility criteria for ticagrelor 60 mg twice daily or rivaroxaban 2.5 mg twice daily, showing a higher risk of NACEs.
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Affiliation(s)
- Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", Caserta, Italy.
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Francesco Santelli
- Department of Political Science, "Federico II" University, Naples, Italy
| | - Fabio Fimiani
- Unit of Inherited and Rare Cardiovascular Diseases, A.O.R.N. Dei Colli "V. Monaldi", Naples, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Ilaria Cavallari
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy
| | | | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, School of Medicine, "Federico II" University, Naples, Italy
| | - Pasquale Pignatelli
- I Clinica Medica, Atherothrombosis Centre, Department of Clinical Internal, Anesthesiologic, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Pelliccia
- Department of Cardiovascular Sciences, University Sapienza of Rome, Rome, Italy
| | | | - Vittorio Pengo
- Department of Cardiothoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy
| | - Paolo Gresele
- Department of Medicine and Surgery, Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, Center for Atherothrombotic diseases, University of Florence, Florence, Italy
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7
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Carbone A, Santelli F, Bottino R, Attena E, Mazzone C, Parisi V, D'Andrea A, Golino P, Nigro G, Russo V. 244 Prevalence and clinical predictors of inappropriate direct oral anticoagulant dosage in octagenarians with atrial fibrillation. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab131.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Older age is associated with inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting.
Methods
Data for this study were sourced from the multicentre prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). AF patients aged ≥80 who received DOACs treatment 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were respectively defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus.
Results
A total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR = 3.15 (95% IC 1.45–6.83); P < 0.01], coronary artery disease [OR = 3.6 (95% IC 1.41–9.1); P< 0.01] and body mass index [OR = 1.27 (1.14–1.41); P < 0.01]. Overdosage was independently associated with diabetes mellitus [OR = 18 (3.36–96); P < 0.01], with age [OR = 0.76 (95% IC; 0.61–0.96); P < 0.05], BMI [OR = 0.77 (0.11; 0.62–0.97); P < 0.05] and with previous bleedings [OR = 6.4 (0.7; 1.43–28) P < 0.05]. There wasn’t significant difference in thromboembolic, major bleeding events and mortality among different subgroups. Underdosage group showed a significatively lower survival compared with appropriate dose group (P < 0.001).
Conclusion
In our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors increased the risk of DOACs’ overdosage (diabetes mellitus Type II) or underdosage (male gender, coronary artery disease and higher body mass index). Octogenarians with inappropriate DOACs underdosage showed less survival.
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Affiliation(s)
- Andreina Carbone
- Università Della Campania Luigi Vanvitelli, Dipartimento Di Cardiologia, Napoli
| | | | - Roberta Bottino
- Università Della Campania Luigi Vanvitelli, Dipartimento Di Cardiologia, Napoli
| | | | | | | | | | - Paolo Golino
- Università Della Campania Luigi Vanvitelli, Dipartimento Di Cardiologia, Napoli
| | - Gerardo Nigro
- Università Della Campania Luigi Vanvitelli, Dipartimento Di Cardiologia, Napoli
| | - Vincenzo Russo
- Università Della Campania Luigi Vanvitelli, Dipartimento Di Cardiologia, Napoli
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8
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Cesaro A, Gragnano F, Calabrò P, Moscarella E, Santelli F, Fimiani F, Patti G, Cavallari I, Antonucci E, Cirillo P, Pignatelli P, Palareti G, Pelliccia F, Bossone E, Pengo V, Gresele P, Marcucci R. 760 Prevalence of eligibility criteria for prolonged dual antithrombotic therapy in patients with PEGASUS and COMPASS phenotypes: insights from the start-antiplatelet registry. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
After 1 year of dual antiplatelet therapy (DAPT) for acute coronary syndrome (ACS), clinicians face the dilemma of choosing between prolonged DAPT with aspirin and ticagrelor 60 mg twice daily (PEGASUS strategy) or aspirin and rivaroxaban 2.5 mg twice daily (COMPASS strategy). In recent years, there has been a widespread discussion about the optimal duration of DAPT and the best combination of drugs. To analyse the prevalence and clinical implications of the eligibility criteria for prolonged dual antithrombotic therapy with ticagrelor 60 mg twice daily and/or rivaroxaban 2.5 mg twice daily in a contemporary real-world ACS registry.
Methods and results
Patients from the START-ANTIPLATELET registry (NCT02219984) were stratified according to the eligibility criteria of the PEGASUS and COMPASS studies to investigate the proportion of patients eligible for prolonged dual antithrombotic therapy at discharge and after 1-year of DAPT. Net adverse clinical events (NACE), defined as all-cause death, myocardial infarction, stroke, and major bleeding, at 1 year were also evaluated and compared among groups. 1844 were considered for the analysis at baseline. Out of 849 event-free patients continually receiving dual antiplatelet therapy for at least 1 year, 577 (68%) and 583 (68.7%) met at least one eligibility criterion for ticagrelor and rivaroxaban, respectively. In the PEGASUS-like patients, age was the most common criterion (71% of cases). The presence ≥2 cardiovascular risk factors was the most common eligibility criterion in the COMPASS-like patients (80.8%). At 1-year follow-up, 211 (11.4%) and 119 (6.5%) patients experienced NACE and MACE, respectively. The incidence of NACEs was higher in the PEGASUS-only group (15.4% vs. 8.4%; P = 0.008) and numerically higher in the COMPASS-only group (10.9% vs. 8.4%; P = 0.299).
Conclusions
In a contemporary real-world ACS cohort, approximately two-thirds of patients that complete 1-year DAPT met the eligibility criteria for ticagrelor 60 mg twice daily or rivaroxaban 2.5 mg twice daily, showing a higher risk of NACEs.
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Affiliation(s)
- Arturo Cesaro
- Naples—Division of Cardiology, Department of Translational Medical Sciences, AORN S. Anna E S. Sebastiano, University of Campania ‘L. Vanvitelli’, Caserta, Italy
| | - Felice Gragnano
- Naples—Division of Cardiology, Department of Translational Medical Sciences, AORN S. Anna E S. Sebastiano, University of Campania ‘L. Vanvitelli’, Caserta, Italy
| | - Paolo Calabrò
- Naples—Division of Cardiology, Department of Translational Medical Sciences, AORN S. Anna E S. Sebastiano, University of Campania ‘L. Vanvitelli’, Caserta, Italy
| | - Elisabetta Moscarella
- Naples—Division of Cardiology, Department of Translational Medical Sciences, AORN S. Anna E S. Sebastiano, University of Campania ‘L. Vanvitelli’, Caserta, Italy
| | - Francesco Santelli
- Department of Political Science, ‘Federico II’ University, Naples, Italy
| | - Fabio Fimiani
- Unit of Inherited and Rare Cardiovascular Disease, AORN dei Colli ‘V. Monaldi’, Naples, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Ilaria Cavallari
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy
| | | | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, School of Medicine, ‘Federico II’ University, Naples, Italy
| | - Pasquale Pignatelli
- I Clinica Medica, Atherothrombosis Centre, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Pelliccia
- Department of Cardiovascular Sciences, University Sapienza of Rome, Rome, Italy
| | | | - Vittorio Pengo
- Department of Cardiothoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy
| | - Paolo Gresele
- Department of Medicine and Surgery, Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, Center for Atherothrombotic Diseases, University of Florence, Florence, Italy
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9
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Carbone A, Santelli F, Bottino R, Attena E, Mazzone C, Parisi V, D'Andrea A, Golino P, Nigro G, Russo V. Prevalence and clinical predictors of inappropriate direct oral anticoagulant dosage in octagenarians with atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Older age was associated to inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting.
Methods and results
Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). AF patients aged ≥ 80 who received DOACs treatment 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were respectively defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus. A total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR=3,15 (95% IC 1.45–6.83); p<0,01], coronary artery disease [OR= 3,6 (95% IC 1.41–9.1); p<0,01] and body mass index [OR=1,27 (1.14–1.41); p<0,01]. Overdosage was independently associated with diabetes mellitus [OR= 18 (3.36–96); p<0,01]. There wasn't significant difference in thromboembolic, major bleeding events and mortality among different subgroups. Underdosage group showed a significatively lower survival compared with appropriate dose group (p<0,001).
Conclusion
In our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors increased the risk of DOACs' overdosage (diabetes mellitus type II) or underdosage (male gender, coronary artery disease and higher body mass index). Octogenarians with inappropriate DOACs underdosage resulted in less survival.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Carbone
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - F Santelli
- Federico II University of Naples, Naples, Italy
| | - R Bottino
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - E Attena
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - C Mazzone
- Cardiovascular Center, Trieste, Italy
| | - V Parisi
- Federico II University of Naples, Naples, Italy
| | - A D'Andrea
- Hospital Umberto I, Nocera Inferiore, Italy
| | - P Golino
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - G Nigro
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - V Russo
- university of Campania Luigi Vanvitelli, Naples, Italy
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10
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Russo V, Carbone A, Mottola FF, Mocerino R, Verde R, Attena E, Verde N, Di Micco P, Nunziata L, Santelli F, Nigro G, Severino S. Effect of Triple Combination Therapy With Lopinavir-Ritonavir, Azithromycin, and Hydroxychloroquine on QT Interval and Arrhythmic Risk in Hospitalized COVID-19 Patients. Front Pharmacol 2020; 11:582348. [PMID: 33132915 PMCID: PMC7578422 DOI: 10.3389/fphar.2020.582348] [Citation(s) in RCA: 13] [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: 07/11/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction No data are provided about the effect of triple combination therapy with Lopinavir/Ritonavir (LPN/RTN), hydroxychloroquine (HQ) and azithromycin (AZT) on corrected QT (QTc) interval and arrhythmic risk, in COVID-19 patients. This study aims to describe the incidence of extreme QTc interval prolongation among COVID-19 patients on this experimental treatment and to identify the clinical features associated with extreme QTc prolongation. Materials and Methods Data of 87 COVID-19 patients, treated with triple combination including LPN/RTN, HQ and AZT, were analyzed. QT interval was obtained by the tangent method and corrected for heart rate using Bazett’s formula. Extreme QTc interval prolongation was considered an absolute QTc interval ≥ 500 ms or an increase in QTc intervals of 60 ms or greater (ΔQTc ≥ 60 ms) compared with baseline. Results Hypertension (66.7%) and diabetes (25.3%) were the most prevalent cardiovascular comorbidities. Twenty patients (23%) showed extreme QTc interval prolongation; no clinical, electrocardiographic or pharmacological characteristics have been associated to extreme QTc prolongation, except the history of ischemic stroke (P= 0,007). One torsade de pointes (TdP) in patient with QTc extreme prolongation (QTc: 560 ms) after 5 days of therapy was recorded. Conclusions We observed a high incidence of extreme QTc interval prolongation among COVID-19 patients on triple combination therapy. Since the incidence of malignant arrhythmias seems to be not negligible, a careful electrocardiographic monitoring would be advisable.
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Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Andreina Carbone
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Filiberto Fausto Mottola
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy
| | | | | | - Emilio Attena
- Italy Medicine Unit, Division of Cardiology, San Giuliano Hospital, Naples, Naples, Italy
| | - Nicoletta Verde
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy
| | - Pierpaolo Di Micco
- Department of Cardiology, Fatebenefratelli Hospital of Naples, Naples, Italy
| | | | - Francesco Santelli
- Department of Political Sciences, University of Naples Federico II, Naples, Italy
| | - Gerardo Nigro
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy
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11
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Carbone A, Lieu A, Mouhat B, Santelli F, Philip M, Bohbot Y, Tessonnier L, Peugnet F, D'Andrea A, Cammilleri S, Delpierre Q, Gouriet F, Camoin-Jau L, Gun M, Casalta JP, Riberi A, Collart F, Martel H, Arregle F, Guedj E, Raoult D, Drancourt M, Tribouilloy C, Habib G. Spondylodiscitis complicating infective endocarditis. Heart 2020; 106:1914-1918. [PMID: 32467102 DOI: 10.1136/heartjnl-2019-316492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The primary objective was to assess the characteristics and prognosis of pyogenic spondylodiscitis (PS) in patients with infective endocarditis (IE). The secondary objectives were to assess the factors associated with occurrence of PS. METHODS Prospective case-control bi-centre study of 1755 patients with definite IE with (n=150) or without (n=1605) PS. Clinical, microbiological and prognostic variables were recorded. RESULTS Patients with PS were older (mean age 69.7±18 vs 66.2±14; p=0.004) and had more arterial hypertension (48% vs 34.5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without PS. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L4-L5. Neurological symptoms were observed in 59% of patients. Enterococci and Streptococcus gallolyticus were more frequent (24% vs 12% and 24% vs 11%; p<0001, respectively) in the PS group. The diagnosis of PS was based on contrast-enhanced MRI in 92 patients, bone CT in 88 patients and 18F-FDG PET/CT in 56 patients. In-hospital (16% vs 13.5%, p=0.38) and 1-year (21% vs 22%, p=0.82) mortalities did not differ between patients with or without PS. CONCLUSIONS PS is a frequent complication of IE (8.5% of IE), is observed in older hypertensive patients with enterococcal or S. gallolyticus IE, and has a similar prognosis than other forms of IE. Since PS is associated with specific management, multimodality imaging including MRI, CT and PET/CT should be used for early diagnosis of this complication of endocarditis.
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Affiliation(s)
- Andreina Carbone
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Audrey Lieu
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
| | - Basile Mouhat
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | | | - Mary Philip
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Yohann Bohbot
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
| | | | - Fanny Peugnet
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
| | - Antonello D'Andrea
- Luigi Vanvitelli University-Naples, Monaldi Hospital, Naples, Italy.,Dipartimento di Scienze Cardio-Toraciche e Respiratorie, Università degli Studi della Campania "Luigi Vanvitelli, Naples, Italy
| | - Serge Cammilleri
- Department of Nuclear Medicine, La Timone Hospital, Marseille, France
| | - Quentin Delpierre
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
| | - Frédérique Gouriet
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095-IHU, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Laurence Camoin-Jau
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France.,Department of Hematology, La Timone Hospital, Marseille, France
| | - Mesut Gun
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
| | - Jean-Paul Casalta
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095-IHU, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Alberto Riberi
- Department of Cardiac surgery, La timone Hospital, Marseille, France
| | - Frederic Collart
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Hélène Martel
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Florent Arregle
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Eric Guedj
- Department of Nuclear Medicine, La Timone Hospital, Marseille, France
| | - Didier Raoult
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095-IHU, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Michel Drancourt
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095-IHU, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Christophe Tribouilloy
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Marseille, France .,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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12
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Carbone A, Mouhat B, Philip M, Gouriet F, Cammilleri S, Tessonnier L, Casalta J, Riberi A, Bohbot Y, Santelli F, Tribouilloy C, Habib G. Spondylitis: A frequent and severe complication of infective endocarditis. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Carbone A, Mouhat B, Lieu A, Santelli F, Bohbot Y, Tessonnier L, D'Andrea A, Cammilleri S, Gouriet F, Camoin L, Casalta JP, Riberi A, Philip M, Tribouilloy C, Habib G. P3666Spondylitis: a frequent and severe complication of infective endocarditis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Spondylodiscitis (SP) is a rare, but severe complication of infective endocarditis (IE). The incidence, clinical features and prognosis of SP in IE are unknown.
Purpose
The primary objective of our study was to assess the incidence, epidemiology, clinical presentation, prognosis, and therapeutic implications of SP in patient with IE. The secondary objectives were to assess factors associated with occurrence of spondylitis and to assess the value of imaging techniques.
Methods
In a French bi-center prospective study of patients who presented in our endocarditis reference centers with a diagnosis of definite IE from 1990 to 2018 (n=1755), 150 (8.5%) presented with SP. Clinical, epidemiological, microbiological, and prognostic variables were prospectively recorded and compared between patients with (n=150) and without (n=1605) SP.
Results
Patients with SP were older (mean age 69.7±18 vs 66.2±14; p=0.004), had more arterial hypertension (48% vs 34,5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without SP. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L3-L4. Neurological symptoms were observed in 59% of patients. Enterococci et Gallolyticus streptococci were more frequent (24% vs 12% and 24% vs 11%; p<0,001, respectively) in the SP group. Observed sensitivities of full spine contrast-enhanced MRI and CT were 95% and 89%, respectively. PET/CT had a great power to differentiate infective to degenerative vertebral processes, and to find embolic foci with a sensitivity of 90%. Clinical outcome did not differ between patients with or without SP, including similar in-hospital mortality (16% vs 13,5%, p=0.38).
Conclusions
We describe the largest ever reported series of patients with spondylodiscitis complicating IE. Spondylodiscitis is a more frequent complication of IE than previously reported (8.5% of IE), is observed in older hypertensive patients with Enterococcal or Streptococcus gallolyticus IE and has a similar prognosis than other forms of IE. Since SP is associated with prolonged antibiotic therapy and may need specific surgical therapy, multimodality imaging including MRI, CT, and PET/CT should be used for early diagnosis of this IE complication.
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Affiliation(s)
- A Carbone
- La Timone Hospital, Marseille, France
| | - B Mouhat
- La Timone Hospital, Marseille, France
| | - A Lieu
- University Hospital of Amiens, Amiens, France
| | - F Santelli
- Vincenzo Monaldi Hospital, Naples, Italy
| | - Y Bohbot
- University Hospital of Amiens, Amiens, France
| | | | - A D'Andrea
- Vincenzo Monaldi Hospital, Naples, Italy
| | | | - F Gouriet
- La Timone Hospital, Marseille, France
| | - L Camoin
- La Timone Hospital, Marseille, France
| | | | - A Riberi
- La Timone Hospital, Marseille, France
| | - M Philip
- La Timone Hospital, Marseille, France
| | | | - G Habib
- La Timone Hospital, Marseille, France
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Giretti R, Caruselli M, Zannini R, de Vivo E, Piattellini G, Bechi P, Catani F, Amici M, Santelli F, Pagni R. Dislocation of central venous catheters in pediatric patients. J Vasc Access 2018; 7:132-5. [PMID: 17019666 DOI: 10.1177/112972980600700308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/15/2022] Open
Abstract
Children have limited venous access possibilities; therefore, when long-term therapy is necessary, it is better to place a catheter in a central vein. The Port catheter, totally implanted, is less exposed to the risk of infection and permits a normal life. However, there is the possibility of the displacement or fragmentation of the catheter that can be diagnosed initially only by clinical symptoms and later by a chest X-ray. We report a case of disconnection between the Port catheter and the reservoir resulting in catheter migration to the left pulmonary artery.
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Affiliation(s)
- R Giretti
- Anesthesia and Intensive Care Unit, Ospedali Riuniti di Ancona, Presidio Materno-Infantile G. Salesi, Ancona, Italy.
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15
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Caruselli M, Pieroni G, Franceschi A, Santelli F, Bechi P, Pagni R. Secondary migration of a central venous catheter: a rare complication. J Vasc Access 2006; 5:36-8. [PMID: 16596538 DOI: 10.1177/112972980400500108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Authors describe a case of spontaneous migration in the right jugular vein of a central venous catheter tip, properly positioned in the right atrium through the right subclavian vein two days before.
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Affiliation(s)
- M Caruselli
- Department of Anesthesia and Intensive Care, G. Salesi Children's and Mother's Hospital, Ancona, Italy.
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16
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Gentili M, Pagni R, Gentili S, Ferretti A, Santelli F, Avenali S, Amici M, Piattellini GM, Mora D, Sichini L, De Angelis C, Camilletti GF, Dani C. [Partial liquid ventilation (PLV) in the newborn and infants: initial experiences in Italy]. Pediatr Med Chir 1998; 20:315-6. [PMID: 10068978] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Partial liquid ventilation is a valid alternative ventilation strategy for the management of the respiratory distress in newborn and infant. Authors describe their first experiences in 11 children (7 newborns, 4 infants).
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Affiliation(s)
- M Gentili
- Azienda Ospedaliera G. Salesi Ancona, Dipartimento Materno-Infantile, Italia
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17
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Forni E, Torreggiani D, Crivelli G, Maestrelli A, Bertolo G, Santelli F. INFLUENCE OF OSMOSIS TIME ON THE QUALITY OF DEHYDROFROZEN KIWI FRUIT. ACTA ACUST UNITED AC 1990. [DOI: 10.17660/actahortic.1990.282.54] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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