Sara Moneta - Academia.edu (original) (raw)
Papers by Sara Moneta
[Rationale for anesthesia in non-cardiac surgery on patients with heart transplant]
Minerva anestesiologica, 1992
The introduction of cyclosporine in the prevention of rejection, together with the improvement of... more The introduction of cyclosporine in the prevention of rejection, together with the improvement of surgical and anaesthetic techniques, produced a tangible increase in long term survival time and the life quality of heart-transplanted patients, so that, they have to undergo non-cardiac surgical operation, more and more frequently. The aim of this report is to analyse the essential physio-pathological, clinical, haemodynamic and pharmacological knowledge in order to perform a safe anaesthesia on the above mentioned patients. The Authors are basing this report on experience obtained in deep study of their own cases. In fact they have anaesthetized 190 patients during heart transplantation; later on, 27 of these patients have undergone subsequent major or minor non-cardiac surgical operations.
![Research paper thumbnail of [Acute hepatitis C infection: epidemiological and clinical aspects, and efficacy of interferon therapy]](https://attachments.academia-assets.com/118315995/thumbnails/1.jpg)
](PubMed, Jun 1, 2007
Acute hepatitis C virus infection becomes chronic in 50-80% of patients; in recent years a number... more Acute hepatitis C virus infection becomes chronic in 50-80% of patients; in recent years a number of studies on acute hepatitis C have shown that interferon treatment can solve more than 80% of cases. In this study we evaluated all cases of acute hepatitis C referred to our unit from 1998 to 2005 to study the epidemiological and clinical features and the efficacy of interferon therapy during the course of the disease. Forty-three patients (28 males, 15 females) were monitored: 22 were drug-addicts, 6 patients referred from recent surgery, in 3 cases a percutaneous exposure was described, 2 patients had had a colonoscopy, 4 were partners of subjects with chronic hepatitis C and in the remaining cases the transmission route was uncertain. All subjects were symptomatic, jaundice was evident in 20 out of 43 patients and in all cases hepatic protein synthesis was unaltered. Of the 21 patients who consented to interferon therapy, in 19 cases a sustained virological response was achieved while in 2 cases the follow-up period was too short for evaluation. Four of the 22 non-treated patients had a spontaneous resolution of the infection, in 13 cases the infection became chronic, and in 4 cases the follow-up was too short for an analysis. In our study all patients were young, in 58% of subjects a parenteral exposure was described and most patients were drug-addicts. All the treated patients obtained a sustained response, while in the majority of non-treated cases the infection became chronic.
Extrapulmonary Pneumocystis jirovecii Infection in an Immunocompromised Patient With Concomitant Cytomegalovirus Reactivation: A Case Report and Literature Review
Infectious Diseases in Clinical Practice
Pneumocystis jirovecii is commonly associated with a potentially fatal pneumonia in acquired immu... more Pneumocystis jirovecii is commonly associated with a potentially fatal pneumonia in acquired immune deficiency syndrome patients, but its spread outside lungs is uncommon and poses a diagnostic challenge. Clinical awareness is therefore needed to start promptly adequate therapy. In this review, we report the case of an acquired immune deficiency syndrome patient with rapidly progressive disseminated pneumocystosis and subsequently analyze 189 other cases of extrapulmonary pneumocystosis described in literature. The most common extrapulmonary sites of Pneumocystosis jirovecii infection were spleen, lymph nodes, liver, kidneys, and eyes; clinical manifestations, which may occur either with or without lung involvement, ranged from asymptomatic incidental findings to a multifaceted disease with multisystem involvement. Human immunodeficiency virus (HIV) infection was documented in the majority of cases (91.6%), and concurrent or subsequent immunodeficiency-related conditions other than ...
Malaria: approccio diagnostico-terapeutico nei maggiori ospedali della Toscana
XVIII Congresso Nazionale SIMIT, 2019
La malaria è la più rilevante tra le malattie di importazione in Italia. Ad oggi, non esiste cons... more La malaria è la più rilevante tra le malattie di importazione in Italia. Ad oggi, non esiste consenso unanime sul miglior percorso di gestione diagnostico-terapeutica del paziente con malaria di importazione, lasciando spazio a diverse modalità operative. Questo studio si propone di valutare i differenti approcci diagnostico-terapeutici per malaria, attuati nei maggiori ospedali della Toscana, per evidenziare i principali elementi di discordanza, in relazione a esperienze, strumenti e criticità presenti nelle diverse realtà ospedaliere. A questo scopo sono stati somministrati attraverso una piattaforma online due questionari: uno riguardante i percorsi e gli strumenti diagnostici, indirizzato ai referenti dei laboratori, e l’altro relativo alla gestione clinico-terapeutica, indirizzato ai referenti clinici delle strutture di Malattie Infettive. Hanno partecipato alla survey tutti i laboratori di riferimento (n=10) e tutte le Unità di Malattie Infettive della Toscana (n=11). Riguardo ai percorsi e agli strumenti diagnostici, emerge come le tre principali metodiche – emoscopia, test immunocromatografici (ICT) e biologia molecolare – assumano ruoli differenti all’interno dei diversi algoritmi, in base alla diponibilità e agli orari di attività dei laboratori. La Loop-mediated isothermal AMPlification (LAMP), disponibile in 7/10 laboratori, è la tecnica molecolare più utilizzata, per lo più come test di screening, in alternativa o in sostituzione degli ICT. L’emoscopia viene più spesso utilizzata come test di conferma, ma in alcuni laboratori (3/10) non viene eseguita se il test di screening è negativo. E’ emerso inoltre che diversi laboratori non eseguono l’emoscopia sulla goccia spessa. Riguardo alle strategie terapeutiche per la cura della malaria, emerge grande variabilità nella soglia di parassitemia utilizzata per la definizione di malaria grave, nei criteri di dimissione e follow-up. Esiste invece buona concordanza sulle scelte terapeutiche di prima e seconda linea per la malaria da Plasmodium falciparum, sia grave che non complicata, anche se non sempre artesunato è presente nelle strutture e possono essere necessarie fino a 12-24 ore per ottenerlo. Ulteriori discrepanze si sono evidenziate nella posologia delle combinazioni a base di artemisinina e nella terapia delle forme non complicate da Plasmodium non-falciparum. Alla luce dei risultati, è auspicabile un confronto tra specialisti coinvolti nella gestione del paziente con malaria, finalizzato all’elaborazione di un algoritmo diagnostico-terapeutico condiviso
JAMA Network Open, 2021
IMPORTANCE Convalescent plasma (CP) has been generally unsuccessful in preventing worsening of re... more IMPORTANCE Convalescent plasma (CP) has been generally unsuccessful in preventing worsening of respiratory failure or death in hospitalized patients with COVID-19 pneumonia. OBJECTIVE To evaluate the efficacy of CP plus standard therapy (ST) vs ST alone in preventing worsening respiratory failure or death in patients with COVID-19 pneumonia. DESIGN, SETTING, AND PARTICIPANTS This prospective, open-label, randomized clinical trial enrolled (1:1 ratio) hospitalized patients with COVID-19 pneumonia to receive CP plus ST or ST alone between July 15 and December 8, 2020, at 27 clinical sites in Italy. Hospitalized adults with COVID-19 pneumonia and a partial pressure of oxygen-to-fraction of inspired oxygen (PaO 2 /FiO 2) ratio between 350 and 200 mm Hg were eligible. INTERVENTIONS Patients in the experimental group received intravenous high-titer CP (Ն1:160, by microneutralization test) plus ST. The volume of infused CP was 200 mL given from 1 to a maximum of 3 infusions. Patients in the control group received ST, represented by remdesivir, glucocorticoids, and low-molecular weight heparin, according to the Agenzia Italiana del Farmaco recommendations. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of worsening respiratory failure (PaO 2 /FiO 2 ratio <150 mm Hg) or death within 30 days from randomization. RESULTS Of the 487 randomized patients (241 to CP plus ST; 246 to ST alone), 312 (64.1%) were men; the median (IQR) age was 64 (54.0-74.0) years. The modified intention-to-treat population included 473 patients. The primary end point occurred in 59 of 231 patients (25.5%) treated with CP and ST and in 67 of 239 patients (28.0%) who received ST (odds ratio, 0.88; 95% CI, 0.59-1.33; P = .54). Adverse events occurred more frequently in the CP group (12 of 241 [5.0%]) compared with the control group (4 of 246 [1.6%]; P = .04). CONCLUSIONS AND RELEVANCE In patients with moderate to severe COVID-19 pneumonia, hightiter anti-SARS-CoV-2 CP did not reduce the progression to severe respiratory failure or death within 30 days. (continued) Key Points Question Is convalescent plasma useful in preventing worsening respiratory failure or death in patients with COVID-19 pneumonia? Findings In this randomized clinical trial of 487 patients with COVID-19 pneumonia and a partial pressure of arterial oxygen-to-fraction of inspired oxygen (PaO 2 /FiO 2) ratio between 350 and 200 mm Hg at enrollment, the rate of the primary clinical end point (need for mechanical ventilation, defined as PaO 2 /FiO 2 ratio <150 mm Hg, or death) was not significantly different between the convalescent plasma group and the control group. Meaning In this trial, convalescent plasma did not reduce the progression to severe respiratory failure or death within 30 days.
Pancreatite da cryptosporidium parvum in pazienti con grave deficit immunitario correlato ad infezione da HIV
Journal of Translational Medicine, 2021
Following publication of the original article [1] the authors identified that the collaborators o... more Following publication of the original article [1] the authors identified that the collaborators of the TOCIVID-19 investigators, Italy were only available in the supplementary file. The original article has been updated so that the collaborators are correctly acknowledged. For clarity, all collaborators are listed in this correction article.
C-C motive chemokine ligand 2 and thromboinflammation in COVID-19-associated pneumonia: A retrospective study
Thrombosis Research, 2021
Purpose A derangement of the coagulation process and thromboinflammatory events have emerged as p... more Purpose A derangement of the coagulation process and thromboinflammatory events have emerged as pathologic characteristics of severe COVID-19, characterized by severe respiratory failure. CC motive chemokine ligand 2 (CCL2), a chemokine originally described as a chemotactic agent for monocytes, is involved in inflammation, coagulation activation and neoangiogenesis. We investigated the association of CCL2 levels with coagulation derangement and respiratory impairment in patients with COVID-19. Methods We retrospectively evaluated 281 patients admitted to two hospitals in Italy with COVID-19. Among them, CCL2 values were compared in different groups (identified according to D-dimer levels and the lowest PaO2/FiO2 recorded during hospital stay, P/Fnadir) by Jonckheere-Terpstra tests; linear regression analysis was used to analyse the relationship between CCL2 and P/Fnadir. We performed Mann-Whitney test and Kaplan-Meier curves to investigate the role of CCL2 according to different clinical outcomes (survival and endotracheal intubation [ETI]). Results CCL2 levels were progressively higher in patients with increasing D-dimer levels and with worse gas exchange impairment; there was a statistically significant linear correlation between log CCL2 and log P/Fnadir. CCL2 levels were significantly higher in patients with unfavourable clinical outcomes; Kaplan-Meier curves for the composite outcome death and/or need for ETI showed a significantly worse prognosis for patients with higher (> median) CCL2 levels. Conclusions CCL2 correlates with both indices of activation of the coagulation cascade and respiratory impairment severity, which are likely closely related in COVID-19 pathology, thus suggesting that CCL2 could be involved in the thromboinflammatory events characterizing this disease.
BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in patho... more BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicentre, single-arm, hypothesis-driven phase 2 trial was planned to study the effect of Tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints). A cohort of patients consecutively enrolled after phase 2 was used as a validation dataset. A multivariable logistic regression was performed to generate hypotheses, while controlling for possible confounders.Resultsout of 301 patients in phase 2 intention-to-treat (ITT) analysis, 180 (59.8%) received tocilizumab. With 67 death events, lethality rates were 18.4% (97.5%CI: 13.6-24.0, P=0.52) and 22.4% (97.5%CI: 17.2-28.3, P<0.001) at 14 and 30 days. Lethality rates were lower in the validation dataset, including 920 patients. No signal of specific drug toxicity was reported. The multivariable logistic regression suggests tocilizumab might be...
[Pancreatitis caused by Cryptosporidium parvum in patients with severe immunodeficiency related to HIV infection]
Annali italiani di medicina interna : organo ufficiale della Società italiana di medicina interna
Up to the present, pancreatic complications due to cryptosporidium parvum infection have been des... more Up to the present, pancreatic complications due to cryptosporidium parvum infection have been described only in a few patients with acquired immunodeficiency syndrome (AIDS). We report our experience with 3 subjects with AIDS who presented with acute or chronic pancreatitis related to cryptosporidiosis. All 3 patients had abdominal pain resistant to analgesics, increased serum amylase and abnormalities at both sonography and computed tomography. Endoscopic retrograde cholangiopancreotography revealed papillary stenosis in all patients; one patient also had stenosis of the Wirsung duct. Cryptosporidium was found in both bile and stool samples in all patients, while viral cultures were negative, even in the 2 patients who had cytomegalovirus retinitis. Endoscopic sphincterotomy temporally relieved abdominal pain in all patients, but did not prevent either acute or recurrent pancreatic inflammation. Several antibiotic therapeutic protocols were ineffective against the parasite.
Journal of Travel Medicine, 2014
This report focuses on epidemiological and clinical features of dengue fever (DF) in Tuscany (Ita... more This report focuses on epidemiological and clinical features of dengue fever (DF) in Tuscany (Italy) between 2006 and 2012. Sixty-one DF cases were diagnosed, 32 of which were in the period of Aedes albopictus activity. Some clinical (arthralgia/myalgia, nausea/vomiting, and skin rash), laboratory (leukopenia and thrombocytopenia), and epidemiological characteristics (travel in a continent other than Africa) significantly distinguished DF cases from other febrile illnesses. Our data stress the importance of increasing awareness on dengue in Italy among clinicians in order to reach an early diagnosis in returning travelers and to implement appropriate clinical and public health interventions.
Journal of Clinical Microbiology, 2008
The definitive diagnosis of extrapulmonary tuberculosis is made by a positive body fluid culture ... more The definitive diagnosis of extrapulmonary tuberculosis is made by a positive body fluid culture result. Conventional culture methods require centrifugation or filtration of body fluid (peritoneal, pleural, synovial, or pericardial fluid) in order to improve the sensitivity. The aim of the present study was to evaluate the feasibility of the direct inoculation, at the patient's bedside, of up to 5 ml of uncentrifuged fluid onto BacT/Alert MB culture bottles (bioMérieux, Durham, NC).
![Research paper thumbnail of [Acute hepatitis C infection: epidemiological and clinical aspects, and efficacy of interferon therapy]](https://attachments.academia-assets.com/118315981/thumbnails/1.jpg)
](Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2007
Acute hepatitis C virus infection becomes chronic in 50-80% of patients; in recent years a number... more Acute hepatitis C virus infection becomes chronic in 50-80% of patients; in recent years a number of studies on acute hepatitis C have shown that interferon treatment can solve more than 80% of cases. In this study we evaluated all cases of acute hepatitis C referred to our unit from 1998 to 2005 to study the epidemiological and clinical features and the efficacy of interferon therapy during the course of the disease. Forty-three patients (28 males, 15 females) were monitored: 22 were drug-addicts, 6 patients referred from recent surgery, in 3 cases a percutaneous exposure was described, 2 patients had had a colonoscopy, 4 were partners of subjects with chronic hepatitis C and in the remaining cases the transmission route was uncertain. All subjects were symptomatic, jaundice was evident in 20 out of 43 patients and in all cases hepatic protein synthesis was unaltered. Of the 21 patients who consented to interferon therapy, in 19 cases a sustained virological response was achieved w...
International Journal of Infectious Diseases, 2002
were positive for Klebsiella pneumoniae and p brasiliensis. The serologic test for R brasiliensis... more were positive for Klebsiella pneumoniae and p brasiliensis. The serologic test for R brasiliensis was negative. Under suspect of R carinii infection therapy whith Trimethoprim-sulfamethoxa zole plus Prednisone and Fluconazole was initially and after Imipenem and Amphotericin B was administered. During the next several days the patient condition improved. It is suggested that the determining factor for paracoccidioidomycosis in HIV-infected patients is the immune imbalance caused by the infection, documented by the low CD4 cell count. Although this clinical presentation suggested an acute infection for F! carinii, it is endemic microorganism can also be included in the diferential diagnosis. Most cases of paracoccidioidomycosis in patients with AIDS could be expected to occur in endemic areas for I? brasiliensis.
[Rationale for anesthesia in non-cardiac surgery on patients with heart transplant]
Minerva anestesiologica, 1992
The introduction of cyclosporine in the prevention of rejection, together with the improvement of... more The introduction of cyclosporine in the prevention of rejection, together with the improvement of surgical and anaesthetic techniques, produced a tangible increase in long term survival time and the life quality of heart-transplanted patients, so that, they have to undergo non-cardiac surgical operation, more and more frequently. The aim of this report is to analyse the essential physio-pathological, clinical, haemodynamic and pharmacological knowledge in order to perform a safe anaesthesia on the above mentioned patients. The Authors are basing this report on experience obtained in deep study of their own cases. In fact they have anaesthetized 190 patients during heart transplantation; later on, 27 of these patients have undergone subsequent major or minor non-cardiac surgical operations.
PubMed, Jun 1, 2007
Acute hepatitis C virus infection becomes chronic in 50-80% of patients; in recent years a number... more Acute hepatitis C virus infection becomes chronic in 50-80% of patients; in recent years a number of studies on acute hepatitis C have shown that interferon treatment can solve more than 80% of cases. In this study we evaluated all cases of acute hepatitis C referred to our unit from 1998 to 2005 to study the epidemiological and clinical features and the efficacy of interferon therapy during the course of the disease. Forty-three patients (28 males, 15 females) were monitored: 22 were drug-addicts, 6 patients referred from recent surgery, in 3 cases a percutaneous exposure was described, 2 patients had had a colonoscopy, 4 were partners of subjects with chronic hepatitis C and in the remaining cases the transmission route was uncertain. All subjects were symptomatic, jaundice was evident in 20 out of 43 patients and in all cases hepatic protein synthesis was unaltered. Of the 21 patients who consented to interferon therapy, in 19 cases a sustained virological response was achieved while in 2 cases the follow-up period was too short for evaluation. Four of the 22 non-treated patients had a spontaneous resolution of the infection, in 13 cases the infection became chronic, and in 4 cases the follow-up was too short for an analysis. In our study all patients were young, in 58% of subjects a parenteral exposure was described and most patients were drug-addicts. All the treated patients obtained a sustained response, while in the majority of non-treated cases the infection became chronic.
Extrapulmonary Pneumocystis jirovecii Infection in an Immunocompromised Patient With Concomitant Cytomegalovirus Reactivation: A Case Report and Literature Review
Infectious Diseases in Clinical Practice
Pneumocystis jirovecii is commonly associated with a potentially fatal pneumonia in acquired immu... more Pneumocystis jirovecii is commonly associated with a potentially fatal pneumonia in acquired immune deficiency syndrome patients, but its spread outside lungs is uncommon and poses a diagnostic challenge. Clinical awareness is therefore needed to start promptly adequate therapy. In this review, we report the case of an acquired immune deficiency syndrome patient with rapidly progressive disseminated pneumocystosis and subsequently analyze 189 other cases of extrapulmonary pneumocystosis described in literature. The most common extrapulmonary sites of Pneumocystosis jirovecii infection were spleen, lymph nodes, liver, kidneys, and eyes; clinical manifestations, which may occur either with or without lung involvement, ranged from asymptomatic incidental findings to a multifaceted disease with multisystem involvement. Human immunodeficiency virus (HIV) infection was documented in the majority of cases (91.6%), and concurrent or subsequent immunodeficiency-related conditions other than ...
Malaria: approccio diagnostico-terapeutico nei maggiori ospedali della Toscana
XVIII Congresso Nazionale SIMIT, 2019
La malaria è la più rilevante tra le malattie di importazione in Italia. Ad oggi, non esiste cons... more La malaria è la più rilevante tra le malattie di importazione in Italia. Ad oggi, non esiste consenso unanime sul miglior percorso di gestione diagnostico-terapeutica del paziente con malaria di importazione, lasciando spazio a diverse modalità operative. Questo studio si propone di valutare i differenti approcci diagnostico-terapeutici per malaria, attuati nei maggiori ospedali della Toscana, per evidenziare i principali elementi di discordanza, in relazione a esperienze, strumenti e criticità presenti nelle diverse realtà ospedaliere. A questo scopo sono stati somministrati attraverso una piattaforma online due questionari: uno riguardante i percorsi e gli strumenti diagnostici, indirizzato ai referenti dei laboratori, e l’altro relativo alla gestione clinico-terapeutica, indirizzato ai referenti clinici delle strutture di Malattie Infettive. Hanno partecipato alla survey tutti i laboratori di riferimento (n=10) e tutte le Unità di Malattie Infettive della Toscana (n=11). Riguardo ai percorsi e agli strumenti diagnostici, emerge come le tre principali metodiche – emoscopia, test immunocromatografici (ICT) e biologia molecolare – assumano ruoli differenti all’interno dei diversi algoritmi, in base alla diponibilità e agli orari di attività dei laboratori. La Loop-mediated isothermal AMPlification (LAMP), disponibile in 7/10 laboratori, è la tecnica molecolare più utilizzata, per lo più come test di screening, in alternativa o in sostituzione degli ICT. L’emoscopia viene più spesso utilizzata come test di conferma, ma in alcuni laboratori (3/10) non viene eseguita se il test di screening è negativo. E’ emerso inoltre che diversi laboratori non eseguono l’emoscopia sulla goccia spessa. Riguardo alle strategie terapeutiche per la cura della malaria, emerge grande variabilità nella soglia di parassitemia utilizzata per la definizione di malaria grave, nei criteri di dimissione e follow-up. Esiste invece buona concordanza sulle scelte terapeutiche di prima e seconda linea per la malaria da Plasmodium falciparum, sia grave che non complicata, anche se non sempre artesunato è presente nelle strutture e possono essere necessarie fino a 12-24 ore per ottenerlo. Ulteriori discrepanze si sono evidenziate nella posologia delle combinazioni a base di artemisinina e nella terapia delle forme non complicate da Plasmodium non-falciparum. Alla luce dei risultati, è auspicabile un confronto tra specialisti coinvolti nella gestione del paziente con malaria, finalizzato all’elaborazione di un algoritmo diagnostico-terapeutico condiviso
JAMA Network Open, 2021
IMPORTANCE Convalescent plasma (CP) has been generally unsuccessful in preventing worsening of re... more IMPORTANCE Convalescent plasma (CP) has been generally unsuccessful in preventing worsening of respiratory failure or death in hospitalized patients with COVID-19 pneumonia. OBJECTIVE To evaluate the efficacy of CP plus standard therapy (ST) vs ST alone in preventing worsening respiratory failure or death in patients with COVID-19 pneumonia. DESIGN, SETTING, AND PARTICIPANTS This prospective, open-label, randomized clinical trial enrolled (1:1 ratio) hospitalized patients with COVID-19 pneumonia to receive CP plus ST or ST alone between July 15 and December 8, 2020, at 27 clinical sites in Italy. Hospitalized adults with COVID-19 pneumonia and a partial pressure of oxygen-to-fraction of inspired oxygen (PaO 2 /FiO 2) ratio between 350 and 200 mm Hg were eligible. INTERVENTIONS Patients in the experimental group received intravenous high-titer CP (Ն1:160, by microneutralization test) plus ST. The volume of infused CP was 200 mL given from 1 to a maximum of 3 infusions. Patients in the control group received ST, represented by remdesivir, glucocorticoids, and low-molecular weight heparin, according to the Agenzia Italiana del Farmaco recommendations. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of worsening respiratory failure (PaO 2 /FiO 2 ratio <150 mm Hg) or death within 30 days from randomization. RESULTS Of the 487 randomized patients (241 to CP plus ST; 246 to ST alone), 312 (64.1%) were men; the median (IQR) age was 64 (54.0-74.0) years. The modified intention-to-treat population included 473 patients. The primary end point occurred in 59 of 231 patients (25.5%) treated with CP and ST and in 67 of 239 patients (28.0%) who received ST (odds ratio, 0.88; 95% CI, 0.59-1.33; P = .54). Adverse events occurred more frequently in the CP group (12 of 241 [5.0%]) compared with the control group (4 of 246 [1.6%]; P = .04). CONCLUSIONS AND RELEVANCE In patients with moderate to severe COVID-19 pneumonia, hightiter anti-SARS-CoV-2 CP did not reduce the progression to severe respiratory failure or death within 30 days. (continued) Key Points Question Is convalescent plasma useful in preventing worsening respiratory failure or death in patients with COVID-19 pneumonia? Findings In this randomized clinical trial of 487 patients with COVID-19 pneumonia and a partial pressure of arterial oxygen-to-fraction of inspired oxygen (PaO 2 /FiO 2) ratio between 350 and 200 mm Hg at enrollment, the rate of the primary clinical end point (need for mechanical ventilation, defined as PaO 2 /FiO 2 ratio <150 mm Hg, or death) was not significantly different between the convalescent plasma group and the control group. Meaning In this trial, convalescent plasma did not reduce the progression to severe respiratory failure or death within 30 days.
Pancreatite da cryptosporidium parvum in pazienti con grave deficit immunitario correlato ad infezione da HIV
Journal of Translational Medicine, 2021
Following publication of the original article [1] the authors identified that the collaborators o... more Following publication of the original article [1] the authors identified that the collaborators of the TOCIVID-19 investigators, Italy were only available in the supplementary file. The original article has been updated so that the collaborators are correctly acknowledged. For clarity, all collaborators are listed in this correction article.
C-C motive chemokine ligand 2 and thromboinflammation in COVID-19-associated pneumonia: A retrospective study
Thrombosis Research, 2021
Purpose A derangement of the coagulation process and thromboinflammatory events have emerged as p... more Purpose A derangement of the coagulation process and thromboinflammatory events have emerged as pathologic characteristics of severe COVID-19, characterized by severe respiratory failure. CC motive chemokine ligand 2 (CCL2), a chemokine originally described as a chemotactic agent for monocytes, is involved in inflammation, coagulation activation and neoangiogenesis. We investigated the association of CCL2 levels with coagulation derangement and respiratory impairment in patients with COVID-19. Methods We retrospectively evaluated 281 patients admitted to two hospitals in Italy with COVID-19. Among them, CCL2 values were compared in different groups (identified according to D-dimer levels and the lowest PaO2/FiO2 recorded during hospital stay, P/Fnadir) by Jonckheere-Terpstra tests; linear regression analysis was used to analyse the relationship between CCL2 and P/Fnadir. We performed Mann-Whitney test and Kaplan-Meier curves to investigate the role of CCL2 according to different clinical outcomes (survival and endotracheal intubation [ETI]). Results CCL2 levels were progressively higher in patients with increasing D-dimer levels and with worse gas exchange impairment; there was a statistically significant linear correlation between log CCL2 and log P/Fnadir. CCL2 levels were significantly higher in patients with unfavourable clinical outcomes; Kaplan-Meier curves for the composite outcome death and/or need for ETI showed a significantly worse prognosis for patients with higher (> median) CCL2 levels. Conclusions CCL2 correlates with both indices of activation of the coagulation cascade and respiratory impairment severity, which are likely closely related in COVID-19 pathology, thus suggesting that CCL2 could be involved in the thromboinflammatory events characterizing this disease.
BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in patho... more BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicentre, single-arm, hypothesis-driven phase 2 trial was planned to study the effect of Tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints). A cohort of patients consecutively enrolled after phase 2 was used as a validation dataset. A multivariable logistic regression was performed to generate hypotheses, while controlling for possible confounders.Resultsout of 301 patients in phase 2 intention-to-treat (ITT) analysis, 180 (59.8%) received tocilizumab. With 67 death events, lethality rates were 18.4% (97.5%CI: 13.6-24.0, P=0.52) and 22.4% (97.5%CI: 17.2-28.3, P<0.001) at 14 and 30 days. Lethality rates were lower in the validation dataset, including 920 patients. No signal of specific drug toxicity was reported. The multivariable logistic regression suggests tocilizumab might be...
[Pancreatitis caused by Cryptosporidium parvum in patients with severe immunodeficiency related to HIV infection]
Annali italiani di medicina interna : organo ufficiale della Società italiana di medicina interna
Up to the present, pancreatic complications due to cryptosporidium parvum infection have been des... more Up to the present, pancreatic complications due to cryptosporidium parvum infection have been described only in a few patients with acquired immunodeficiency syndrome (AIDS). We report our experience with 3 subjects with AIDS who presented with acute or chronic pancreatitis related to cryptosporidiosis. All 3 patients had abdominal pain resistant to analgesics, increased serum amylase and abnormalities at both sonography and computed tomography. Endoscopic retrograde cholangiopancreotography revealed papillary stenosis in all patients; one patient also had stenosis of the Wirsung duct. Cryptosporidium was found in both bile and stool samples in all patients, while viral cultures were negative, even in the 2 patients who had cytomegalovirus retinitis. Endoscopic sphincterotomy temporally relieved abdominal pain in all patients, but did not prevent either acute or recurrent pancreatic inflammation. Several antibiotic therapeutic protocols were ineffective against the parasite.
Journal of Travel Medicine, 2014
This report focuses on epidemiological and clinical features of dengue fever (DF) in Tuscany (Ita... more This report focuses on epidemiological and clinical features of dengue fever (DF) in Tuscany (Italy) between 2006 and 2012. Sixty-one DF cases were diagnosed, 32 of which were in the period of Aedes albopictus activity. Some clinical (arthralgia/myalgia, nausea/vomiting, and skin rash), laboratory (leukopenia and thrombocytopenia), and epidemiological characteristics (travel in a continent other than Africa) significantly distinguished DF cases from other febrile illnesses. Our data stress the importance of increasing awareness on dengue in Italy among clinicians in order to reach an early diagnosis in returning travelers and to implement appropriate clinical and public health interventions.
Journal of Clinical Microbiology, 2008
The definitive diagnosis of extrapulmonary tuberculosis is made by a positive body fluid culture ... more The definitive diagnosis of extrapulmonary tuberculosis is made by a positive body fluid culture result. Conventional culture methods require centrifugation or filtration of body fluid (peritoneal, pleural, synovial, or pericardial fluid) in order to improve the sensitivity. The aim of the present study was to evaluate the feasibility of the direct inoculation, at the patient's bedside, of up to 5 ml of uncentrifuged fluid onto BacT/Alert MB culture bottles (bioMérieux, Durham, NC).
Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2007
Acute hepatitis C virus infection becomes chronic in 50-80% of patients; in recent years a number... more Acute hepatitis C virus infection becomes chronic in 50-80% of patients; in recent years a number of studies on acute hepatitis C have shown that interferon treatment can solve more than 80% of cases. In this study we evaluated all cases of acute hepatitis C referred to our unit from 1998 to 2005 to study the epidemiological and clinical features and the efficacy of interferon therapy during the course of the disease. Forty-three patients (28 males, 15 females) were monitored: 22 were drug-addicts, 6 patients referred from recent surgery, in 3 cases a percutaneous exposure was described, 2 patients had had a colonoscopy, 4 were partners of subjects with chronic hepatitis C and in the remaining cases the transmission route was uncertain. All subjects were symptomatic, jaundice was evident in 20 out of 43 patients and in all cases hepatic protein synthesis was unaltered. Of the 21 patients who consented to interferon therapy, in 19 cases a sustained virological response was achieved w...
International Journal of Infectious Diseases, 2002
were positive for Klebsiella pneumoniae and p brasiliensis. The serologic test for R brasiliensis... more were positive for Klebsiella pneumoniae and p brasiliensis. The serologic test for R brasiliensis was negative. Under suspect of R carinii infection therapy whith Trimethoprim-sulfamethoxa zole plus Prednisone and Fluconazole was initially and after Imipenem and Amphotericin B was administered. During the next several days the patient condition improved. It is suggested that the determining factor for paracoccidioidomycosis in HIV-infected patients is the immune imbalance caused by the infection, documented by the low CD4 cell count. Although this clinical presentation suggested an acute infection for F! carinii, it is endemic microorganism can also be included in the diferential diagnosis. Most cases of paracoccidioidomycosis in patients with AIDS could be expected to occur in endemic areas for I? brasiliensis.