N. Mumoli, Francesca Zuretti, D. Mastroiacovo, F. Dentali, F. Cipollini
Sonography – similar to what happened almost two centuries ago with the introduction of stethoscopes – has completely changed patients’ clinical management in Internal Medicine. The availability of performant, sometimes even small-sized and cost-effective machines, has allowed doctors in Internal-Medicine units to perform bedside-ultrasound examinations alongside regular clinical ones. [...]
{"title":"A new series on diagnostic echographic cases and living brief reviews: a potentially useful tool for clinicians edited by FADOI","authors":"N. Mumoli, Francesca Zuretti, D. Mastroiacovo, F. Dentali, F. Cipollini","doi":"10.4081/itjm.2023.1625","DOIUrl":"https://doi.org/10.4081/itjm.2023.1625","url":null,"abstract":"Sonography – similar to what happened almost two centuries ago with the introduction of stethoscopes – has completely changed patients’ clinical management in Internal Medicine. The availability of performant, sometimes even small-sized and cost-effective machines, has allowed doctors in Internal-Medicine units to perform bedside-ultrasound examinations alongside regular clinical ones. [...]","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41251109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Coppola, G. Cardillo, M. Lugará, S. Tamburrini, F. Bizzarri, Gianmaria Chicone, F. Scotto di Uccio, Maria Flavia Coppola, M. Piccirillo, C. Liguori, C. D’Amore, A. Tuccillo, P. Madonna, G. Noschese, E. Pone, P. Di Micco
Background. Since the European Society of Cardiology (ESC) published guidelines to stratify the risk of pulmonary embolism (PE), the main goal of several physicians has been to find a biomarker able to identify patients with venous thromboembolism at high risk to die. Increased levels of pro-B-type natriuretic peptide (BNP) were suggested as useful biomarkers in the guidelines of ESC (i.e., 2014) to identify patients with PE at high risk of death, but its role was not confirmed in other guidelines. Lung Ultrasound Scan (LUS) has been suggested as a diagnostic and prognostic test to identify patients with a high risk of mortality for lung failure. The aim of this study is to evaluate the prognostic role of pro- BNP together with the LUS evaluation in patients with COVID-19 and PE in particular regarding mortality for pulmonary embolism and overall death. Patients and Methods. We retrospectively analyzed records from 178 patients with confirmed COVID-19, admitted to our ward (i.e., COVID Medicine Unit at Ospedale del Mare in the town of Napoli) between March 2020 and May 2021. For this study, we analyzed the LUS data of all 178 patients and the available data on the pro-BNP of 120 patients. For all selected patients, mortality for PE and overall deaths were recorded. Results. The Propensity Score Matching was used to minimize and erase confounding factors. Data showed that an association between serum levels of pro-BNP and pulmonary thrombotic events was neither present before nor after matching an association with adverse outcomes and was found for increased values of LUS. Discussion. During the first waves of the pandemic, patients with confirmed COVID-19 with severe lung failure frequently showed pulmonary embolism as a clinical acute complication inducing life-threatening evolution. Conclusions. An association between LUS score and severe PE and/or overall mortality in hospitalized patients with COVID-19 was found while a similar association was not confirmed for pro-BNP.
背景自从欧洲心脏病学会（ESC）发布了对肺栓塞（PE）风险进行分层的指南以来，几位医生的主要目标是找到一种能够识别高死亡风险静脉血栓栓塞患者的生物标志物。在ESC指南（即2014年）中，B型钠尿肽原（BNP）水平的升高被认为是有用的生物标志物，用于识别PE患者的高死亡风险，但其作用在其他指南中未得到证实。肺部超声扫描（LUS）已被建议作为一种诊断和预后测试，以识别肺衰竭死亡率高的患者。本研究的目的是评估BNP原与LUS评估在新冠肺炎和PE患者中的预后作用，特别是在肺栓塞死亡率和总体死亡方面。患者和方法。我们回顾性分析了2020年3月至2021年5月期间入住我们病房（即那不勒斯镇Ospedale del Mare的COVID医学室）的178名确诊新冠肺炎患者的记录。在本研究中，我们分析了所有178名患者的LUS数据和120名患者的前BNP可用数据。对于所有选定的患者，记录PE的死亡率和总死亡人数。后果倾向评分匹配用于最小化和消除混杂因素。数据显示，血清前BNP水平与肺血栓形成事件之间的相关性在与不良结果匹配之前和之后都不存在，并且发现LUS值增加。讨论在第一波疫情期间，确诊患有严重肺衰竭的新冠肺炎患者经常表现出肺栓塞，这是一种导致危及生命的临床急性并发症。结论。在新冠肺炎住院患者中，发现LUS评分与严重PE和/或总体死亡率之间的相关性，而pro-BNP未证实类似的相关性。
{"title":"Lung ultrasound scan score can identify pulmonary embolism high risk in patients with COVID-19: a retrospective analysis from a single center","authors":"M. Coppola, G. Cardillo, M. Lugará, S. Tamburrini, F. Bizzarri, Gianmaria Chicone, F. Scotto di Uccio, Maria Flavia Coppola, M. Piccirillo, C. Liguori, C. D’Amore, A. Tuccillo, P. Madonna, G. Noschese, E. Pone, P. Di Micco","doi":"10.4081/itjm.2023.1617","DOIUrl":"https://doi.org/10.4081/itjm.2023.1617","url":null,"abstract":"Background. Since the European Society of Cardiology (ESC) published guidelines to stratify the risk of pulmonary embolism (PE), the main goal of several physicians has been to find a biomarker able to identify patients with venous thromboembolism at high risk to die. Increased levels of pro-B-type natriuretic peptide (BNP) were suggested as useful biomarkers in the guidelines of ESC (i.e., 2014) to identify patients with PE at high risk of death, but its role was not confirmed in other guidelines. Lung Ultrasound Scan (LUS) has been suggested as a diagnostic and prognostic test to identify patients with a high risk of mortality for lung failure. The aim of this study is to evaluate the prognostic role of pro- BNP together with the LUS evaluation in patients with COVID-19 and PE in particular regarding mortality for pulmonary embolism and overall death. Patients and Methods. We retrospectively analyzed records from 178 patients with confirmed COVID-19, admitted to our ward (i.e., COVID Medicine Unit at Ospedale del Mare in the town of Napoli) between March 2020 and May 2021. For this study, we analyzed the LUS data of all 178 patients and the available data on the pro-BNP of 120 patients. For all selected patients, mortality for PE and overall deaths were recorded. Results. The Propensity Score Matching was used to minimize and erase confounding factors. Data showed that an association between serum levels of pro-BNP and pulmonary thrombotic events was neither present before nor after matching an association with adverse outcomes and was found for increased values of LUS. Discussion. During the first waves of the pandemic, patients with confirmed COVID-19 with severe lung failure frequently showed pulmonary embolism as a clinical acute complication inducing life-threatening evolution. Conclusions. An association between LUS score and severe PE and/or overall mortality in hospitalized patients with COVID-19 was found while a similar association was not confirmed for pro-BNP.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49508858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Methicillin-resistant Staphylococcus Aureus (MRSA) bacteremia is a complex and lethal condition. We reported the clinical case of a 58-year-old woman who developed MRSA bacteremia after a 3-month hospitalization for trauma and sepsis. Delay in diagnosis of aortic and mitral endocarditis in the setting of new-onset regurgitations, as the application of suboptimal therapy with linezolid and vancomycin, led to widespread disease with embolic dissemination and development of septic infarctions. Clinicians must be aware of the necessity to consider as high risk of endocarditis new onset valvular regurgitations and of the evidence about the need for daptomycin in treating high-risk MRSA bacteremia.
{"title":"MRSA bacteremia and new-onset aortic and mitral regurgitation: a pernicious and tricky association","authors":"M. Cinquegrani, F. Cei, M. Pistoia, N. Mumoli","doi":"10.4081/itjm.2023.1618","DOIUrl":"https://doi.org/10.4081/itjm.2023.1618","url":null,"abstract":"Methicillin-resistant Staphylococcus Aureus (MRSA) bacteremia is a complex and lethal condition. We reported the clinical case of a 58-year-old woman who developed MRSA bacteremia after a 3-month hospitalization for trauma and sepsis. Delay in diagnosis of aortic and mitral endocarditis in the setting of new-onset regurgitations, as the application of suboptimal therapy with linezolid and vancomycin, led to widespread disease with embolic dissemination and development of septic infarctions. Clinicians must be aware of the necessity to consider as high risk of endocarditis new onset valvular regurgitations and of the evidence about the need for daptomycin in treating high-risk MRSA bacteremia.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70231360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mudathir Abdelshafea Abdelkareem Abakar, Ashwag Ali Hussein Ali, Eman Damra Ahmed Elhassan, Esra Ali Hamuda Altaher, Nosaiba Hussein Abdalbasit Musa, S. Kafi, Amira Eltom Fawzi Osman, H. Waggiallah
Cytokines have a crucial part in the pathogenesis, persistence of infection, and prognosis of hepatitis B virus (HBV) infection as HBV does not cause direct liver destruction; rather, disease-related complications and prognosis are more associated with immune system action, specifically cytokines such as TNF-α, IFN-γ, IL-6, IL-10, and other cytokines. This study sought to link TNF-, IFN-, IL-6, and IL-10 to various clinical manifestations of HBV infection. Ninety sera were taken from HBV-infected patients, 30 (33.3%) of whom had liver cirrhosis, 30 (33.3%) were HBV carriers, 19 (21.2%) were acute HBV patients, and 11 (12.2%) were recently HBV infected. ELISA was used to determine the serum levels of TNF-α, IFN-γ, IL-6, and IL-10. HBV-infected patients with liver cirrhosis had considerably higher mean serum levels of IFN-γ (P=0.005) and IL-10 (P=0.003), but TNF-α and IL-6 were significantly higher in recent HBV-infected patients (P values 0.034 and 0.004, respectively). There were substantial changes in mean serum levels of TNF-α, IFN-γ, IL-6, and IL-10 at different phases of HBV infection, implying a role for cytokines in HBV etiology, chronicity, and consequences.
{"title":"Association of TNF-α, IFN-γ, IL-6, and IL-10 with different clinical manifestations of hepatitis B infection","authors":"Mudathir Abdelshafea Abdelkareem Abakar, Ashwag Ali Hussein Ali, Eman Damra Ahmed Elhassan, Esra Ali Hamuda Altaher, Nosaiba Hussein Abdalbasit Musa, S. Kafi, Amira Eltom Fawzi Osman, H. Waggiallah","doi":"10.4081/itjm.2023.1627","DOIUrl":"https://doi.org/10.4081/itjm.2023.1627","url":null,"abstract":"Cytokines have a crucial part in the pathogenesis, persistence of infection, and prognosis of hepatitis B virus (HBV) infection as HBV does not cause direct liver destruction; rather, disease-related complications and prognosis are more associated with immune system action, specifically cytokines such as TNF-α, IFN-γ, IL-6, IL-10, and other cytokines. This study sought to link TNF-, IFN-, IL-6, and IL-10 to various clinical manifestations of HBV infection. Ninety sera were taken from HBV-infected patients, 30 (33.3%) of whom had liver cirrhosis, 30 (33.3%) were HBV carriers, 19 (21.2%) were acute HBV patients, and 11 (12.2%) were recently HBV infected. ELISA was used to determine the serum levels of TNF-α, IFN-γ, IL-6, and IL-10. HBV-infected patients with liver cirrhosis had considerably higher mean serum levels of IFN-γ (P=0.005) and IL-10 (P=0.003), but TNF-α and IL-6 were significantly higher in recent HBV-infected patients (P values 0.034 and 0.004, respectively). There were substantial changes in mean serum levels of TNF-α, IFN-γ, IL-6, and IL-10 at different phases of HBV infection, implying a role for cytokines in HBV etiology, chronicity, and consequences.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43597733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Palmiero, M. Maiello, F. Amati, M. Ciccone, T. Paul
Background. Chronic depression (CD) is common among postmenopausal women and is associated with an increased risk of cardiovascular disease (CVD). The diagnosis of CD is a challenging problem in clinical practice which is vastly underdiagnosed. CD detection in postmenopausal women with metabolic syndrome (MetS) or hypertension is necessary for CVD prevention. Our study aims to assess the prevalence of CD in postmenopausal women and the relationship between CD and MetS or hypertension. Results. The rate of CD was significantly higher among postmenopausal women with MetS compared with the control group [18% versus 8%; Odds ratio (OR) 2.2, P<0.007]. The CD rate was significantly higher among women with MetS and hypertension (21% versus 8%; OR 2.7, P<0.0000). The rate of CD was similar between women with MetS and women with hypertension, 18% versus 21%; OR 0.8, P<0.44) and between women with metabolic cardiomyopathy and hypertensive cardiomyopathy (10% versus 8%; OR 1.1, P<0.65). Conclusions. There is a relationship between MetS and CD, which is stronger when compared to women with hypertension. There is a need to improve the diagnosis of CD in postmenopausal women with MetS or hypertension as unrecognized and untreated CD is associated with a poor outcome.
{"title":"Association between metabolic syndrome, hypertension, and chronic depression: a postmenopausal women prevention study","authors":"P. Palmiero, M. Maiello, F. Amati, M. Ciccone, T. Paul","doi":"10.4081/itjm.2023.1624","DOIUrl":"https://doi.org/10.4081/itjm.2023.1624","url":null,"abstract":"Background. Chronic depression (CD) is common among postmenopausal women and is associated with an increased risk of cardiovascular disease (CVD). The diagnosis of CD is a challenging problem in clinical practice which is vastly underdiagnosed. CD detection in postmenopausal women with metabolic syndrome (MetS) or hypertension is necessary for CVD prevention. Our study aims to assess the prevalence of CD in postmenopausal women and the relationship between CD and MetS or hypertension. Results. The rate of CD was significantly higher among postmenopausal women with MetS compared with the control group [18% versus 8%; Odds ratio (OR) 2.2, P<0.007]. The CD rate was significantly higher among women with MetS and hypertension (21% versus 8%; OR 2.7, P<0.0000). The rate of CD was similar between women with MetS and women with hypertension, 18% versus 21%; OR 0.8, P<0.44) and between women with metabolic cardiomyopathy and hypertensive cardiomyopathy (10% versus 8%; OR 1.1, P<0.65). Conclusions. There is a relationship between MetS and CD, which is stronger when compared to women with hypertension. There is a need to improve the diagnosis of CD in postmenopausal women with MetS or hypertension as unrecognized and untreated CD is associated with a poor outcome.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48392540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Presciuttini, Dario Benazzi, Massimo Amato, M. Pagani
Patients hospitalized with COVID-19 pneumonia are at risk for thrombotic complications. At the same time, they need respiratory support, and they frequently require nursing in a prone position. From March to May 2020, 57 patients with acute respiratory distress syndrome were admitted to our departments. Our therapeutic protocol included anticoagulant treatment and prone positioning. We have treated three obese women affected by severe pneumonia and pectoral hematoma with post-hemorrhagic anemia. We have already described two of these cases in our previous publication; in this new article, we describe a third similar case and review clinical reports from 2020 to 2022 about hemorrhagic complications during COVID-19. Reports confirm that pectoral hematomas and bleeding in unusual sites are a complication of COVID-19. Pectoral hematomas are likely to be related to COVID-19 severity, heparin dosage, and traumatism due to cough and pronosupination.
{"title":"Hemorrhagic complications in COVID-19: three women with pectoral hematoma and a review","authors":"B. Presciuttini, Dario Benazzi, Massimo Amato, M. Pagani","doi":"10.4081/itjm.2023.1590","DOIUrl":"https://doi.org/10.4081/itjm.2023.1590","url":null,"abstract":"Patients hospitalized with COVID-19 pneumonia are at risk for thrombotic complications. At the same time, they need respiratory support, and they frequently require nursing in a prone position. From March to May 2020, 57 patients with acute respiratory distress syndrome were admitted to our departments. Our therapeutic protocol included anticoagulant treatment and prone positioning. We have treated three obese women affected by severe pneumonia and pectoral hematoma with post-hemorrhagic anemia. We have already described two of these cases in our previous publication; in this new article, we describe a third similar case and review clinical reports from 2020 to 2022 about hemorrhagic complications during COVID-19. Reports confirm that pectoral hematomas and bleeding in unusual sites are a complication of COVID-19. Pectoral hematomas are likely to be related to COVID-19 severity, heparin dosage, and traumatism due to cough and pronosupination.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44249933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction. Urotensin II (U II) is a kind of active peptide with a variety of biological effects, such as promoting cell proliferation and endocrine effects. The aim of this study is to investigate the effect of urotensin II on the proliferation and secretion of vascular endothelial growth factor (VEGF) in cultured rat dermal papilla cells (DPCs), and to explore its molecular mechanism. Materials and Methods. We used the DPCs isolated from the thoracic aortas of Wistar-Kyoto rats to run the CCK8 and ELISA assay, RC-PCR and Western blotting techniques to identify the effect of Urotensin II on the proliferation and secretion of VEGF in DPCs, data were analyzed by one-way ANOVA or t-test. Results. U II can increase the mRNA expression of proliferation markers Ki67 and PCNA. In addition, the Wnt/β-catenin pathway was activated by U II, but Wnt inhibitor DKK1 reversed the effect of U II. Conclusions. U II promoted the proliferation and secretion of VEGF in rat DPCs through activation of the Wnt-β-catenin signaling pathway.
{"title":"Urotensin II promotes the proliferation and secretion of vascular endothelial growth factor in rat dermal papilla cells by activating the Wnt-β-catenin signaling pathway","authors":"Congjuan Liao, Zhen Huang, Liuting Chen, Xiao-guang Fan, J. Peng, Xiaoqing Tan, Jian-Bin Yang, Xusheng Zhang","doi":"10.4081/itjm.2023.1607","DOIUrl":"https://doi.org/10.4081/itjm.2023.1607","url":null,"abstract":"Introduction. Urotensin II (U II) is a kind of active peptide with a variety of biological effects, such as promoting cell proliferation and endocrine effects. The aim of this study is to investigate the effect of urotensin II on the proliferation and secretion of vascular endothelial growth factor (VEGF) in cultured rat dermal papilla cells (DPCs), and to explore its molecular mechanism. Materials and Methods. We used the DPCs isolated from the thoracic aortas of Wistar-Kyoto rats to run the CCK8 and ELISA assay, RC-PCR and Western blotting techniques to identify the effect of Urotensin II on the proliferation and secretion of VEGF in DPCs, data were analyzed by one-way ANOVA or t-test. Results. U II can increase the mRNA expression of proliferation markers Ki67 and PCNA. In addition, the Wnt/β-catenin pathway was activated by U II, but Wnt inhibitor DKK1 reversed the effect of U II. Conclusions. U II promoted the proliferation and secretion of VEGF in rat DPCs through activation of the Wnt-β-catenin signaling pathway.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47163052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Fiorino, A. Carusi, Alessandro Zappi, Fabio Tateo, L. Peruzzo, Melissa Zanardi, Francesco Savelli, G. Di Marzio, Silvia Cesaretti, F. Dazzani, R. Francesconi, P. Leandri, G. Tortorici, Susanna Vicari, D. Melucci, F. Lari
Background and Objectives. A relatively small number of studies have investigated the characteristics, comorbidities and laboratory measures associated with prognosis in patients with COVID-19, admitted to Internal Medicine Units (IMU) in Italy. Therefore, we performed a retrospective multicentre study to identify baseline features, predisposing to severe disease and poor outcomes, in adult individuals with SARS-CoV-2 infection, hospitalized in 5 IMUs in the Emilia-Romagna region (Italy). Materials and Methods. We included 129 consecutive patients (male 75, median age 68 years) from 1st March 2020 to 31st October 2021. Patients’ baseline characteristics, comorbidities, laboratory measures, and outcomes were collected. Results. At admission, the factors significantly associated with a higher risk of in-hospital mortality included: age (median 68 vs. 83 years in survived vs. dead patients, P=0.000), diabetes [Odds Ratio (OR) 4.00, P=0.016], chronic obstructive pulmonary disease (OR 4.60, P=0.022), cancer (OR 5.81, P=0.021), acute- (OR 9.88, P=0.000) and chronic-renal failure (OR 6.76, P=0.004). During the study period, 16 individuals died (12.4%), all over 70 years old. In deceased vs. non-deceased patients were detected: i) more elevated white blood cells and neutrophils-counts and lower lymphocytes count; ii) higher levels of total/direct bilirubin, creatinine, C-reactive-protein, lactate-dehydrogenase, ferritin, but only a slight Interleukin-6 increase; iii) a trend of lower vitamin D values. Conclusions. We proposed a new I index, a modified form of the Age-Adjusted Charlson Comorbidity Index, by considering pO2/FiO2 ratio, to better characterize the severity of COVID-19. Furthermore, we critically discuss our results with the current assumption which considers COVID-19 as a pathological condition associated with cytokine storm.
{"title":"Characteristics, comorbidities and laboratory measures associated with disease severity and poor prognosis in young and elderly patients with COVID-19 admitted to medical wards in Emilia-Romagna region, Italy: a multicentre retrospective study","authors":"S. Fiorino, A. Carusi, Alessandro Zappi, Fabio Tateo, L. Peruzzo, Melissa Zanardi, Francesco Savelli, G. Di Marzio, Silvia Cesaretti, F. Dazzani, R. Francesconi, P. Leandri, G. Tortorici, Susanna Vicari, D. Melucci, F. Lari","doi":"10.4081/itjm.2023.1608","DOIUrl":"https://doi.org/10.4081/itjm.2023.1608","url":null,"abstract":"Background and Objectives. A relatively small number of studies have investigated the characteristics, comorbidities and laboratory measures associated with prognosis in patients with COVID-19, admitted to Internal Medicine Units (IMU) in Italy. Therefore, we performed a retrospective multicentre study to identify baseline features, predisposing to severe disease and poor outcomes, in adult individuals with SARS-CoV-2 infection, hospitalized in 5 IMUs in the Emilia-Romagna region (Italy). Materials and Methods. We included 129 consecutive patients (male 75, median age 68 years) from 1st March 2020 to 31st October 2021. Patients’ baseline characteristics, comorbidities, laboratory measures, and outcomes were collected. Results. At admission, the factors significantly associated with a higher risk of in-hospital mortality included: age (median 68 vs. 83 years in survived vs. dead patients, P=0.000), diabetes [Odds Ratio (OR) 4.00, P=0.016], chronic obstructive pulmonary disease (OR 4.60, P=0.022), cancer (OR 5.81, P=0.021), acute- (OR 9.88, P=0.000) and chronic-renal failure (OR 6.76, P=0.004). During the study period, 16 individuals died (12.4%), all over 70 years old. In deceased vs. non-deceased patients were detected: i) more elevated white blood cells and neutrophils-counts and lower lymphocytes count; ii) higher levels of total/direct bilirubin, creatinine, C-reactive-protein, lactate-dehydrogenase, ferritin, but only a slight Interleukin-6 increase; iii) a trend of lower vitamin D values. Conclusions. We proposed a new I index, a modified form of the Age-Adjusted Charlson Comorbidity Index, by considering pO2/FiO2 ratio, to better characterize the severity of COVID-19. Furthermore, we critically discuss our results with the current assumption which considers COVID-19 as a pathological condition associated with cytokine storm.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46576543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Principi generali di antimicrobial stewardshipS. Tedeschi L’interpretazione dell’antibiogrammaE. Carretto La terapia antibiotica empirica della sepsiP. Bocchi, P.G. Giuri, M. Gianfreda, S. Detrenis Il trattamento delle infezioni delle vie urinarieB. Laface, C. Moressa, E. Palaghita, G. Palamà, B. Marchisio, P. Colagrande, M. Giusti Approccio clinico alle polmoniti battericheM. Galassi, S. Fiorino, F. Lari Le infezioni di cute e tessuti molliS. Spiezia, C. Santini Infezioni fungine in Medicina InternaA. Milia, L. Corbo, F. Pieralli
{"title":"Antimicrobial stewardship: un imperativo per il futuro","authors":"C. Santini, M. Giusti","doi":"10.4081/itjm.q.2023.2","DOIUrl":"https://doi.org/10.4081/itjm.q.2023.2","url":null,"abstract":"\u0000Principi generali di antimicrobial stewardshipS. Tedeschi\u0000L’interpretazione dell’antibiogrammaE. Carretto\u0000La terapia antibiotica empirica della sepsiP. Bocchi, P.G. Giuri, M. Gianfreda, S. Detrenis\u0000Il trattamento delle infezioni delle vie urinarieB. Laface, C. Moressa, E. Palaghita, G. Palamà, B. Marchisio, P. Colagrande, M. Giusti\u0000Approccio clinico alle polmoniti battericheM. Galassi, S. Fiorino, F. Lari\u0000Le infezioni di cute e tessuti molliS. Spiezia, C. Santini\u0000Infezioni fungine in Medicina InternaA. Milia, L. Corbo, F. Pieralli","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45665620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Pisanu, Daniela Lucchetti, Dario Lucchetti, Nicolò Contu, V. Saraceni
Narrative Medicine approach has increased in popularity in the medical context as an effective model to approach their patients’ experiences of illness with more understanding and compassion, offering fresh opportunities for empathic, respectful, and nourishing medical care. The goal of our work has been to study the overall experience of COVID-19 patients, putting the personal dimension at the center of the dialogue and the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Firstly, we considered their reaction to the consequences of the Lockdown, then we asked if they were fearful of potentially being infected, and finally, we asked about their illness and arrival at the hospital, having little to no information about their future. The interdisciplinary intersection between neuropsychology, micro-sociology of health, and physical and rehabilitative medicine has made it possible for us to report the following experience, providing new insights on the pre-existent doctorpatient relationship and the importance of hospitalization stories, for humane and effective medical practice.
{"title":"The experience of COVID-19 ward’s patients: a narrative medicine approach","authors":"P. Pisanu, Daniela Lucchetti, Dario Lucchetti, Nicolò Contu, V. Saraceni","doi":"10.4081/itjm.2023.1602","DOIUrl":"https://doi.org/10.4081/itjm.2023.1602","url":null,"abstract":"Narrative Medicine approach has increased in popularity in the medical context as an effective model to approach their patients’ experiences of illness with more understanding and compassion, offering fresh opportunities for empathic, respectful, and nourishing medical care. The goal of our work has been to study the overall experience of COVID-19 patients, putting the personal dimension at the center of the dialogue and the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Firstly, we considered their reaction to the consequences of the Lockdown, then we asked if they were fearful of potentially being infected, and finally, we asked about their illness and arrival at the hospital, having little to no information about their future. The interdisciplinary intersection between neuropsychology, micro-sociology of health, and physical and rehabilitative medicine has made it possible for us to report the following experience, providing new insights on the pre-existent doctorpatient relationship and the importance of hospitalization stories, for humane and effective medical practice.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47716189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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