Antonio Romanelli - Academia.edu (original) (raw)

Papers by Antonio Romanelli

Objective: This study analyses the patients' factors can influence the attitude to follow or not ... more Objective: This study analyses the patients' factors can influence the attitude to follow or not the therapeutic weight-loss plan after national lockdown measures adopted from March 2020 to May 2020. Materials and Methods: Patients that visited a private nutritional center in March 2020 were included in this retrospective observational study. All relevant characteristics were noted. In May 2020, patients who did not attend the follow-up visit were labeled as "abandoned". Variation in Body Mass Index (BMI) was noted in the second visit. Univariate logistic regression was performed to test the influence on dependent variables (lost follow-up). Odds Ratio (OR) was calculated. According to BMI distribution, we performed a Student T-test (α= 0.05) or Wilcoxon test (α= 0.05) to test BMI variation in patients that attended the follow-up visit. A P-value< 0.05 was considered statistically significant. Results: Our population consisted of 77 patients, and 26 patients (33.8%, CI 95% 23.4-45.4%) were labelled as "abandoned". Age≥ 54 years old (OR= 8.9048, CI 95% :1.888-41.9822, P-value= 0.0057) and suffering from hypertension (OR= 4.8706, CI 95% :1.4284-16.6076, P-value= 0.0114) were factors associated with the abandon follow-up visits. Wilcoxon test for BMI variation resulted statistically significant (May BMI 29.5 kg/m 2 vs March BMI 29.4 kg/m 2 , P-value= 0.0094). Conclusion: Age and hypertension are related to the risk of abandoning healthcare services after ending the national lockdown. The losing follow-up phenomenon could worsen clinical conditions and reduce life expectancy. An increase in BMI during lockdown should be interpreted as a personal difficulty in complying with therapeutic prescriptions.

Typical radiological findings in patients with SARS-CoV-2 pneumonia consist of the presence of bi... more Typical radiological findings in patients with SARS-CoV-2 pneumonia consist of the presence of bilateral pulmonary opacities (both ground-glass attenuations and consolidations) with a peripheral or subpleural distribution, often involving the posterior regions of both lungs specifically. Although interstitial pneumonia represents the hallmark of COVID-19, the clinician should remember that sudden worsening gas exchange may have different aetiology. Pneumothorax and pneumomediastinum are well-known complications of invasive mechanical ventilation. However, since the beginning, the development of spontaneous pneumothorax and pneumomediastinum was reported in COVID-19 patients, without risk factors. The exact mechanism for the development of spontaneous pneumothorax and pneumomediastinum in COVID-19 patients is still unclear, and findings suggest that these clinical manifestations can be interpreted as an index of lung disease severity associated with complicated hospital courses, worst prognosis and increase in mortality rate. We report a case of a SARS-CoV-2 infected obese male patient, in quarantine and without risk factors, presenting to the emergency department for severe dyspnea due to COVID-19 pneumonia complicated by spontaneous pneumothorax and pneumomediastinum.

Background: During the COVID-19 pandemia, non-invasive mechanical ventilation (NIV) has been larg... more Background: During the COVID-19 pandemia, non-invasive mechanical ventilation (NIV) has been largely applied. Few data are available about predictors of NIV failure in critical COVID-19 patients admitted to ICU. The aim of this study is to analyze clinical and laboratory features able to predict non-invasive ventilation success in avoiding endotracheal intubation. Methods: A retrospective observational study was performed in our COVID-19 ICU during a 6-month period. Demographic, clinical, laboratory, imaging, and outcome data were extracted from electronic and paper medical records and anonymously collected. Results: Eighty-two severe COVID-19 patients were supported by NIV at ICU admission. The median PaO 2 /FiO 2 ratio was 125 [98.5-177.7]. NIV failed in 44 cases (53%). Patients who experienced NIV failure had a higher Charlson Comorbidity Index (median value 4) compared to those who were dismissed without endotracheal intubation (median 2, p < 0.0001). At Cox regression analysis, the Charlson Comorbidity Index represented a predictive factor related to NIV failure. PaO 2 /FiO 2 , CPK, INR, and AT III at ICU admission showed a significant relationship with the outcome, when single variables were adjusted for the Charlson Comorbidity Index. Conclusion: The Charlson Comorbidity Index may be helpful to stratify patients' risk of NIV failure in a severe COVID-19 population; even if this study, retrospective design does not allow definitive conclusions.

Background: Accuracy and precision of non-invasive continuous haemoglobin concentration (SpHb) pr... more Background: Accuracy and precision of non-invasive continuous haemoglobin concentration (SpHb) provided by Masimo device in diabetic patients is poorly studied. This retrospective analysis aimed to provide data on SpHb accuracy and precision in diabetic patients. Results: The sample size population consisted of 14 patients, with 56 SpHb/Lab data pairs. Lab value showed a mean ± standard deviation (SD) of 13.2 ± 1.2 g/dL, whilst SpHb showed a mean ± SD of 11.8 ± 1.1 g/dL. Linear regression analysis between Lab/SpHb data pairs showed a r of 0.8960 (CI 95% 0.8281-0.9379, p value < 0.0001). SpHb underestimated the real Hb values provided by Lab. Bland-Altman analysis showed that SpHb accuracy was −1.37 g/dL (CI 95% −1.51 to −1.22 g/dL, p value < 0.0001), precision of 0.55 g/dL, lower LOA −2.45 g/dL (CI 95% −2.71 to −2.20 g/dL) and upper LOA −0.28 g/dL (CI 95% −0.53 to −0.02 g/dL). Conclusions: For the first time, we provided data on SpHb accuracy and precision in the diabetic population. SpHb showed a high correlation coefficient when compared with Lab values, but the wide LOA limits its accuracy.

Recently, the first case of HIV and SARS-CoV-2 infection was reported in the literature. With thi... more Recently, the first case of HIV and SARS-CoV-2 infection was reported in the literature. With this letter, we proposed a hypothesis that could explain the interaction between HIV infection and the clinical course of SARS-CoV-2 infection. Dear editor We read with real interest the article of Zhu et al. 1. Here, the authors reported the first case of HIV and SARS-CoV-2 infection, in a 61-years-old male. After detection of SARS-CoV-2 infection by a real-time reverse-transcriptase polymerase chain reaction, anti-HIV drug (lopinavir/ritonavir, 400/100 mg per dose, twice daily for 12 days), was started. The patient also received moxifloxacin (400 mg once daily for 7 days), γ-globulin (400 mg/kg once daily for 3 days), and methylprednisolone (0.8 mg/kg once daily for 3 days). Despite the patient's comorbidities such as type II diabetes and mild lymphopenia (lymphocyte count of 1.1 × 10 9 /L), that worsened during the acute phase of the disease (0.56 × 10 9 /L), the patient had a good outcome, and he was discharged at home. As noted by Joob et al. 2 , the patient did not receive antiviral therapy for HIV infection before. Presently, antiretroviral drugs are widely used for the treatment of HIV and SARS-CoV-2 infections 3. However, the clinical efficacy of lopinavir/ritonavir for the treatment of SARS-CoV-2 infection needs to be

Research Article sessed using a Bland-Altman analysis for comparison of SpHb and Lab values in T ... more Research Article sessed using a Bland-Altman analysis for comparison of SpHb and Lab values in T 0 and T 3 in the two groups. To compare SpHb accuracy in T 0 and T 3 , between the two groups, we performed Student t-test (α=0.05). We considered statistically significative a p-value <0.05. Despite the excellent correlation coefficients, in each group and for the times considered, SpHb underestimated the value of Hb concentration when compared with Lab (p-value <0.0001), with wide limits of agreement. The difference of bias between the two groups at T 0 and T 3 were not statistically significative, with a p-value, respectively, of 0.356 and 0.523. In conclusion, SpHb accuracy was not influenced by the total amount of colloids used for the fluid challenge. Further studies are needed.

The development and study of new drugs to treat the pandemic coronavirus disease 2019 (COVID-19),... more The development and study of new drugs to treat the pandemic coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), is a challenge for the global scientific community. Although scientific research for new targeted therapeutic strategies is the primary issue, in emergency conditions, the use of already known and studied old drugs represents a fascinating and possible therapeutic option. Evidence suggests that excessive activation of the immune system is responsible for the severe clinical complications of COVID-19. Consequently, using drugs to reduce the exaggerated inflammatory response is an attractive therapeutic choice. 1 Appelberg et al demonstrated that SARS-CoV-2 causes excessive activation of the mammalian target of rapamycin (mTOR) signaling pathway in an in vitro model. 2 Using the network-based drug repurposing model and based on data from other human coronavirus infections, the in silico studies reported mTOR as a highly effective molecule in COVID-19 progression. 3 Dysregulation of the mTOR pathway seems to enhance SARS-CoV-2 pathogenicity, which may result in severe COVID-19. The mTOR exerts a vital role in regulating inflammation within the immune system, and controls multiple effector T cell fates. The mTOR exists in two distinct complexes, defined as mTOR complex 1 (mTORC 1) and 2 (mTORC 2). The mTORC 1 mediates T-Helper 1 (TH 1) and T-Helper 17 (TH 17) differentiation at the time of viral antigenic presentation by dendritic cells (DCs); mTORC 2 mediates T-Helper 2 (TH 2) differentiation, while both complexes restrict differentiation of the regulatory T-cell (T reg). 4 Optimal mTOR activity is required for proper T cell differentiation and function. Over-activation of mTORC 1 destabilizes T reg and impairs their suppressive function with an increase in TH 17 response. Data reported in the literature suggest that in patients with severe COVID-19, TH 17 cells were increased, 5 while T reg count was below normal value. 6 SARS-CoV-2 infection can cause an

Many centres worldwide raised the concern that immunocompromised patients for solid organ transpl... more Many centres worldwide raised the concern that immunocompromised patients for solid organ transplantation may be at high risk of developing a severe respiratory disease by SARS-CoV-2 infection. Currently, there are no specific data on COVID-19 in patients with generalized immunosuppression and transplantation. In this narrative review, we reported the main data of COVID-19 in patients with solid organ transplantation presented in the literature. The aim is to elaborate a strategy for tailored management, from diagnosis to therapy. The management of adult patients with solid organ transplantation and COVID-19 is a challenge for the clinicians. There is a lack of data in the literature, but three key-points are crucial: in the "pandemic era," consider the symptomatic patient as positive for SARS-CoV-2 until proven otherwise; adjust/stop immunosuppressive agents; protect graft function with adequate route and dose administration of glucocorticoid and supportive measures. For pediatric patients, data are scarce. It is unclear if immunosuppression in patients with solid organ transplantation alters the predisposition to acquiring COVID-19 or if the disease implications are modified for better or for worse. Further studies are needed.

, a confirmed SARS-CoV-2 infected woman, 55-year-old, 65 kg, without previous comorbidities, requ... more , a confirmed SARS-CoV-2 infected woman, 55-year-old, 65 kg, without previous comorbidities, requiring mechanical ventilation with tracheal intubation, was admitted to the ICU at Monaldi Hospital (AORN Ospedale dei Colli, Naples).

During previous coronavirus epidemic infections, numerous clinical studies reported the efficacy ... more During previous coronavirus epidemic infections, numerous clinical studies reported the efficacy of glucocorticoids in the treatment of pneumonia, but to date, no consensus has been reached on their effectiveness. Glucocorticoids are nowadays preferred by physicians to treat and relief COVID-19 symptoms because of their ability to stop the cytokine storm and to prevent lung fibrosis. However, it is essential to validate the clinical use of drugs based on evidence derived by good-quality trials, and not only based on physiopathological findings or previous experiences. This narrative review aims to resemble the evidence about the clinical efficacy of the use of glucocorticoid for the treatment of patients with SARS-CoV-2 infection. Glucocorticoids For The Treatment Of Sars-Cov-2 Cao et al. (Cao, Tu et al. 2020), in their cohort of patients with COVID-19, reported a rate of acute respiratory distress

During open aortic aneurysm repair, continuous, non-invasive measurementof Haemoglobin concentrat... more During open aortic aneurysm repair, continuous, non-invasive measurementof Haemoglobin concentration (SpHb), provided by Radical 7 device (Masimo Corp, Irvine, CA, USA) may be advantageous for assessing acute anaemia and improve the ability of the anesthesiologist to decide when to initiate blood transfusion. A strategy to improve the device's accuracy is the in-vivo adjustment (AdHb) using a haemoglobin value provided by Blood Gas Analyser (BGA).

(1) Background: Coronavirus disease 2019 (COVID-19) is associated with the development of Acute C... more (1) Background: Coronavirus disease 2019 (COVID-19) is associated with the development of Acute COVID-19 Cardiovascular Syndrome (ACovCS) in critically ill patients. In this case series, we evaluated the incidence of ACovCS by ultrasound in critically COVID-19 ill patients. (2) Methods: This case series included all patients with confirmed COVID-19 requiring admission to the ICU at Monaldi Hospital (AORN Ospedale dei Colli, Naples), between March 14th, 2020, and May 1st, 2020. On admission, in stable clinical conditions, an experienced and certified intensivist performed Point-Of-Care Cardiac Ultrasound (POC-CU). The exam was performed daily in every patient and repeated according to clinical evolution and intensivist's judgment during the length of stay. Ex-Novo ACovCS echocardiographic patterns were noted. (3) Results: POC-CU evaluation performed on 19 patients revealed that, on admission, five patients (26.3%) presented an echocardiographic pattern like cor pulmonale. During the length of stay, seven patients (36.8%) presented ex-Novo echocardiographic alterations, suggesting ACovCS. Pericardial effusion (26.3%), acute right impairment due to pulmonary embolism (5.3%) and acute left impairment by wall motion alteration (5.3%) were the most common findings. (4) Conclusions: Ex-Novo cardiac abnormalities shown by POC-CU were common in patients with severe COVID-19. Competence in POC-CU is essential in identifying ACovCS in COVID-ICU and clinical decision-making.

The treatment of COVID-19 represents a challenge for the worldwide scientific community and, nowa... more The treatment of COVID-19 represents a challenge for the worldwide scientific community and, nowadays, a definitive antiviral treatment does not exist. Remdesivir (RDV), initially developed for Ebola virus disease, showed in-vitro efficacy against SARS-CoV-2 and a positive feedback in the COVID-19 patient. Because of potentially fatal nature of the illness and the absence of other treatments, clinicians started to use RDV as "compassionate" drug for the treatment of COVID-19. We report our clinical experience with RDV administered as compassionate drug in COVID-19 patients admitted to ICU at Monaldi Hospital-Italy. Four male patients with confirmed SARS-CoV-2, requiring invasive mechanical ventilation, received RDV. They, previously treated with other antivirals, received a 200 mg loading dose, followed by 100 mg daily intravenously for up to 10 days. One patient experienced a torsade de pointes requiring cardiac resuscitation and one died due to acute pulmonary embolism. Three patients experienced both ALT and AST increase. Lymphocyte count increased in all patients soon after starting RDV. Nasopharyngeal swab SARS-CoV-2 RNA became negative in three of four patients after 3 days of therapy. In conclusion, RDV can reduce the viral load persistently in critically COVID-19 patients, but it is unclear if this effect can improve outcomes. The clinicians should be alerted about the development of serious adverse events related to RDV administration. In particular, strict monitoring of cardiac rhythm and liver function is crucial. Further well-designed clinical trials, evaluating RDV benefit-risk ratio for COVID-19 patients, are needed.

The optimisation of DO 2 , within the Goal-Direct Therapy Protocol (GDTP) in high-risk surgical p... more The optimisation of DO 2 , within the Goal-Direct Therapy Protocol (GDTP) in high-risk surgical patients, improves their outcome. Haemodynamic and haemoglobin monitoring become crucial to achieve optimal DO 2. Our study compared Hb as measured by three methods: Coulter Counter (standard laboratory method) and CO-Oximetry (Masimo rainbow SET Radical 7 Pulse CO-Oximetry (SpHb) and Blood Gas Analysis) to establish the utility of the Hb continuous intraoperative monitoring, within the GDTP, in high-risk bleeding surgery. We studied 72 patients undergoing open abdominal aortic aneurysm repair. We compared the accuracy and the trending ability in measuring the haemoglobin concentration between the three methods (Coulter Counter, BGA and Masimo). We collected three simultaneous haemoglobin measurements: after induction of anaesthesia, pre-and post-aortic cross-clamping and at the end of the surgery. SpHb showed an excellent r-value for all samples (0.952, CI-95% (0.939, 0.961), p-value < 0.0001) compared to laboratory measurements. The results of the linear regression between SpHb and laboratory, for each time considered, demonstrated that SpHb showed excellent r and R 2 value. All data were statistically significant, with a p-value <0.0001. A Bland-Altmann analysis for SpHb vs. laboratory showed a bias of −1.45 g/dL (CI-95% −1.51 and −1.39 g/dL, LOA from −2.42 to −0.48 g/dL) with a precision of 0.49 g/dL. Four-quadrant plot trend analyses showed a high concordance rate ≥90%. During elective high-risk surgery, Masimo Pulse CO-Oximetry is not enough sufficiently accurate to assess the current value of haemoglobin but may be useful for the trend value ensuring DO 2 within intraoperative GDTP.