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1. Lung ultrasound for the early diagnosis of COVID-19 pneumonia: an international multicenter study

Author

Volpicelli, G., Gargani, L., Perlini, S., Spinelli, S., Barbieri, G., Lanotte, A., Casasola, G. G., Nogue-Bou, R., Lamorte, A., Agricola, E., Villen, T., Deol, P. S., Nazerian, P., Corradi, F., Stefanone, V., Fraga, D. N., Navalesi, P., Ferre, R., Boero, E., Martinelli, G., Cristoni, L., Perani, C., Vetrugno, L., Mcdermott, C., Miralles-Aguiar, F., Secco, G., Zattera, C., Salinaro, F., Grignaschi, A., Boccatonda, A., Giostra, F., Infante, M. N., Covella, M., Ingallina, G., Burkert, J., Frumento, P., Forfori, F., Ghiadoni, L., Fraccalini, T., Vendrame, A., Basile, V., Cipriano, A., Frassi, F., Santini, M., Falcone, M., Menichetti, F., Barcella, B., Delorenzo, M., Resta, F., Vezzoni, G., Bonzano, M., Briganti, D. F., Cappa, G., Zunino, I., Demitry, L., Vignaroli, D., Dipietro, L. S. S., Bazzini, M., Capozza, V., Gonzalez, M. M., Gibal, R. V., Ibarz, R. P., Alfaro, L. M., Alfaro, C. M., Alins, M. G., Brown, A., Dunlop, H., Ralli, M. L., Persona, P., Russel, F. M., Pang, P. S., Rovida, S., Deana, C., Franchini, D., Gargani, Luna, Volpicelli, G., Gargani, L., Perlini, S., Spinelli, S., Barbieri, G., Lanotte, A., Casasola, G. G., Nogue-Bou, R., Lamorte, A., Agricola, E., Villen, T., Deol, P. S., Nazerian, P., Corradi, F., Stefanone, V., Fraga, D. N., Navalesi, P., Ferre, R., Boero, E., Martinelli, G., Cristoni, L., Perani, C., Vetrugno, L., Mcdermott, C., Miralles-Aguiar, F., Secco, G., Zattera, C., Salinaro, F., Grignaschi, A., Boccatonda, A., Giostra, F., Infante, M. N., Covella, M., Ingallina, G., Burkert, J., Frumento, P., Forfori, F., Ghiadoni, L., Fraccalini, T., Vendrame, A., Basile, V., Cipriano, A., Frassi, F., Santini, M., Falcone, M., Menichetti, F., Barcella, B., Delorenzo, M., Resta, F., Vezzoni, G., Bonzano, M., Briganti, D. F., Cappa, G., Zunino, I., Demitry, L., Vignaroli, D., Dipietro, L. S. S., Bazzini, M., Capozza, V., Gonzalez, M. M., Gibal, R. V., Ibarz, R. P., Alfaro, L. M., Alfaro, C. M., Alins, M. G., Brown, A., Dunlop, H., Ralli, M. L., Persona, P., Russel, F. M., Pang, P. S., Rovida, S., Deana, C., and Franchini, D.

Subjects
Adult, medicine.medical_specialty, Multivariate analysis, Letter, Coronavirus disease 2019 (COVID-19), Original, COVID-19, Interstitial pneumonia, Lung ultrasound, SARS-CoV-2, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, Internal medicine, medicine, Humans, Lung, Aged, Ultrasonography, business.industry, 030208 emergency & critical care medicine, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Pneumonia, Early Diagnosis, 030228 respiratory system, Respiratory failure, Observational study, business
Abstract

Purpose To analyze the application of a lung ultrasound (LUS)-based diagnostic approach to patients suspected of COVID-19, combining the LUS likelihood of COVID-19 pneumonia with patient’s symptoms and clinical history. Methods This is an international multicenter observational study in 20 US and European hospitals. Patients suspected of COVID-19 were tested with reverse transcription-polymerase chain reaction (RT-PCR) swab test and had an LUS examination. We identified three clinical phenotypes based on pre-existing chronic diseases (mixed phenotype), and on the presence (severe phenotype) or absence (mild phenotype) of signs and/or symptoms of respiratory failure at presentation. We defined the LUS likelihood of COVID-19 pneumonia according to four different patterns: high (HighLUS), intermediate (IntLUS), alternative (AltLUS), and low (LowLUS) probability. The combination of patterns and phenotypes with RT-PCR results was described and analyzed. Results We studied 1462 patients, classified in mild (n = 400), severe (n = 727), and mixed (n = 335) phenotypes. HighLUS and IntLUS showed an overall sensitivity of 90.2% (95% CI 88.23–91.97%) in identifying patients with positive RT-PCR, with higher values in the mixed (94.7%) and severe phenotype (97.1%), and even higher in those patients with objective respiratory failure (99.3%). The HighLUS showed a specificity of 88.8% (CI 85.55–91.65%) that was higher in the mild phenotype (94.4%; CI 90.0–97.0%). At multivariate analysis, the HighLUS was a strong independent predictor of RT-PCR positivity (odds ratio 4.2, confidence interval 2.6–6.7, p

Published
2021

2. Emergency Department and Out-of-Hospital Emergency System (112—AREU 118) integrated response to Coronavirus Disease 2019 in a Northern Italy centre

Author

Perlini, S., Canevari, F., Cortesi, S., Sgromo, V., Brancaglione, A., Contri, E., Pettenazza, P., Salinaro, F., Speciale, F., Sechi, G., Mare, C., Cutti, S., Novelli, V., Marena, C., Muzzi, A., Bruno, R., Palo, A., Mondelli, M. U., Brunetti, E., Di Matteo, A., Seminari, E., Maiocchi, L., Zuccaro, V., Pagnucco, L., Mariani, B., Ludovisi, S., Lissandrin, R., Parisi, A., Sacchi, P., Patruno, S. F. A., Michelone, G., Gulminetti, R., Zanaboni, D., Novati, S., Maserati, R., Orsolini, P., Vecchia, M., Sciarra, M., Asperges, E., Colaneri, M., Di Filippo, A., Sambo, M., Biscarini, S., Lupi, M., Roda, S., Pieri, T. C., Gallazzi, I., Sachs, M., Valsecchi, P., Alfano, C., Bonzano, M., Briganti, F., Crescenzi, G., Falchi, A. G., Guarnone, R., Guglielmana, B., Maggi, E., Martino, I., di Marco, S. P., Quaglia, F., Sabena, A., Zunino, I., Furlan, N., Savioli, G., De Lorenzo, M., Secco, G., Dimitry, L., Cappa, G., Maisak, I., Chiodi, B., Sciarrini, M., Barcella, B., Resta, F., Moroni, L., Vezzoni, G., Scattaglia, L., Boscolo, E., Zattera, C., Fidel, T. M., Vincenzo, C., Bazzini, M., Lago, E., Bracchi, F., Sturniolo, G., Iotti, G., Mojoli, F., Belliato, M., Perotti, L., Mongodi, S., Tavazzi, G., Marseglia, G., Licari, A., Brambilla, I., Daniela, B., Antonella, B., Patrizia, C., Giulia, C., Giuditta, C., Marta, C., Rossana, D., Milena, F., Bianca, M., Roberta, M., Enza, M., Stefania, P., Maurizio, P., Elena, P., Antonio, P., Francesca, R., Antonella, S., Maurizio, Z., Guy, A., Laura, B., Ermanna, C., Giuliana, C., Luca, D., Gabriella, F., Gabriella, G., Alessia, G., Viviana, L., Claudia, L., Valentina, M., Simona, P., Marta, P., Alice, B., Giacomo, C., Irene, C., Alfonso, C., Raffella, D. M., Annapia, D. N., Alessandro, F., Guglielmo, F., Loretta, F., Federica, G., Alessandra, M., Novazzi, Federica, Giacomo, R., Beatrice, R., Maria, S. I., Monica, T., Edoardo, V. N., Cerino, A., Varchetta, S., Oliviero, B., Mantovani, S., Mele, D., Calvi, M., Tizzoni, M., Nicora, C., Triarico, A., Petronella, V., Lago, P., Rettani, M., Comandatore, F., Bissignandi, G., Gaiarsa, S., Bandi, C., Ferrari, A., and Pasi, F.

Subjects
Emergency Medical Services, Coronavirus disease 2019 (COVID-19), Pneumonia, Viral, Population, Disease, 030204 cardiovascular system & hematology, law.invention, Hospital, 03 medical and health sciences, Patient Admission, 0302 clinical medicine, law, Health care, Pandemic, Internal Medicine, medicine, Covid-19, Emergency department, Emergency medical system, Emergency medical system organization, SARS-CoV-2, COVID-19, Coronavirus Infections, Emergency Service, Hospital, Humans, Intensive Care Units, Italy, Pandemics, Viral, 030212 general & internal medicine, education, Emergency Service, education.field_of_study, business.industry, Outbreak, Pneumonia, medicine.disease, Intensive care unit, Im - Original, Emergency Medicine, Medical emergency, business
Abstract

Since December 2019, the world has been facing the life-threatening disease, named Coronavirus disease-19 (COVID-19), recognized as a pandemic by the World Health Organization. The response of the Emergency Medicine network, integrating "out-of-hospital" and "hospital" activation, is crucial whenever the health system has to face a medical emergency, being caused by natural or human-derived disasters as well as by a rapidly spreading epidemic outbreak. We here report the Pavia Emergency Medicine network response to the COVID-19 outbreak. The "out-of-hospital" response was analysed in terms of calls, rescues and missions, whereas the "hospital" response was detailed as number of admitted patients and subsequent hospitalisation or discharge. The data in the first 5 weeks of the Covid-19 outbreak (February 21-March 26, 2020) were compared with a reference time window referring to the previous 5 weeks (January 17-February 20, 2020) and with the corresponding historical average data from the previous 5 years (February 21-March 26). Since February 21, 2020, a sudden and sustained increase in the calls to the AREU 112 system was noted (+ 440%). After 5 weeks, the number of calls and missions was still higher as compared to both the reference pre-Covid-19 period (+ 48% and + 10%, respectively) and the historical control (+ 53% and + 22%, respectively). Owing to the overflow from the neighbouring hospitals, which rapidly became overwhelmed and had to temporarily close patient access, the population served by the Pavia system more than doubled (from 547.251 to 1.135.977 inhabitants, + 108%). To minimize the possibility of intra-hospital spreading of the infection, a separate "Emergency Department-Infective Disease" was created, which evaluated 1241 patients with suspected infection (38% of total ED admissions). Out of these 1241 patients, 58.0% (n = 720) were admitted in general wards (n = 629) or intensive care unit (n = 91). To allow this massive number of admissions, the hospital reshaped many general ward Units, which became Covid-19 Units (up to 270 beds) and increased the intensive care unit beds from 32 to 60. In the setting of a long-standing continuing emergency like the present Covid-19 outbreak, the integration, interaction and team work of the "out-of-hospital" and "in-hospital" systems have a pivotal role. The present study reports how the rapid and coordinated reorganization of both might help in facing such a disaster. AREU-112 and the Emergency Department should be ready to finely tune their usual cooperation to respond to a sudden and overwhelming increase in the healthcare needs brought about by a pandemia like the current one. This lesson should shape and reinforce the future.

Published
2020
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3. Severe acute respiratory syndrome coronavirus 2 RNA contamination of inanimate surfaces and virus viability in a health care emergency unit

Author

Colaneri, M., Seminari, E., Novati, S., Asperges, E., Biscarini, S., Piralla, A., Percivalle, E., Cassaniti, I., Baldanti, F., Bruno, R., Mondelli, M. U., Brunetti, E., Di Matteo, A., Maiocchi, L., Zuccaro, V., Pagnucco, L., Ludovisi, S., Lissandrin, R., Parisi, A., Sacchi, P., Patruno, S. F. A., Michelone, G., Gulminetti, R., Zanaboni, D., Maserati, R., Orsolini, P., Vecchia, M., Di Filippo, A., Sambo, M., Lupi, M., Roda, S., Pieri, T. C., Gallazzi, I., Sachs, M., Valsecchi, P., Perlini, S., Alfano, C., Bonzano, M., Briganti, F., Crescenzi, G., Falchi, A. G., Guarnone, R., Guglielmana, B., Maggi, E., Martino, I., Pettenazza, P., di Marco, S. P., Quaglia, F., Sabena, A., Salinaro, F., Speciale, F., Zunino, I., de Lorenzo, M., Secco, G., Dimitry, L., Cappa, G., Maisak, I., Chiodi, B., Sciarrini, M., Barcella, B., Resta, F., Moroni, L., Vezzoni, G., Scattaglia, L., Boscolo, E., Zattera, C., Fidel, T. M., Vincenzo, C., Vignaroli, D., Bazzini, M., Iotti, G., Mojoli, F., Belliato, M., Perotti, L., Mongodi, S., Tavazzi, G., Marseglia, G., Licari, A., Brambilla, I., Barbarini, D., Bruno, A., Cambieri, P., Campanini, G., Cavanna, C., Comolli, G., Corbella, M., Daturi, R., Furione, M., Mariani, B., Marone, P., Monzillo, V., Paolucci, S., Parea, M., Rovida, F., Sarasini, A., Zavattoni, M., Adzasehoun, G., Ardizzone, M., Bellotti, L., Brunco, V., Cabano, E., Casali, G., Capella, L., Devitis, D., Dossena, L., Frisco, G., Garbagnoli, G., Gardellini, F., Girello, A., Guerrizio, A., Landini, V., Lucchelli, C., Maliardi, V., Piemontese, P., Pezzaia, S., Premoli, M., Rebuffa, C., Bagnarino, J., Bergami, F., Bonetti, A., Caneva, G., Corcione, A., Di Martino, R., Di Napoli, A., Ferrari, A., Ferrari, G., Fiorina, L., Gallone, A., Giardina, F., Girardi, A., Mercato, A., Novazzi, F., Ratano, G., Rossi, B., Saverimpilla, G., Sciabica, I. M., Tallarita, M., Nepita, E. V., Vitali, J., Cerino, A., Varchetta, S., Oliviero, B., Mantovani, S., Mele, D., Calvi, M., Tizzoni, M., Nicola, C., Triarico, A., Petronella, V., Marena, C., Muzzi, A., Lago, P., Comandatore, F., Biffignandi, G. B., Gaiarsa, S., Rettani, M., and Bandi, C.

Subjects
0301 basic medicine, Microbiology (medical), Environmental contamination, medicine.medical_treatment, 030106 microbiology, Microbiology, Coronavirus disease 2019, Severe acute respiratory syndrome coronavirus-2, Surfaces, Vero E6 cells, Animals, Betacoronavirus, Chlorocebus aethiops, Coronavirus Envelope Proteins, Equipment Contamination, Fomites, Humans, Intensive Care Units, Microbial Viability, RNA-Dependent RNA Polymerase, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2, Vero Cells, Viral Envelope Proteins, Viral Proteins, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, RNA polymerase, medicine, 030212 general & internal medicine, Continuous positive airway pressure, Respiratory system, Gene, Cytopathic effect, business.industry, RNA, General Medicine, Infectious Diseases, chemistry, Vero cell, business
Abstract

Objectives To detect possible severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA contamination of inanimate surfaces in areas at high risk of aerosol formation by patients with coronavirus disease 2019 (COVID-19). Methods Sampling was performed in the emergency unit and the sub-intensive care ward. SARS-CoV-2 RNA was extracted from swabbed surfaces and objects and subjected to real-time RT-PCR targeting RNA-dependent RNA polymerase and E genes. Virus isolation from positive samples was attempted in vitro on Vero E6 cells. Results Twenty-six samples were collected and only two were positive for low-level SARS-CoV-2 RNA, both collected on the external surface of continuous positive airway pressure helmets. All transport media were inoculated onto susceptible cells, but none induced a cytopathic effect on day 7 of culture. Conclusions Even though daily contact with inanimate surfaces and patient fomites in contaminated areas may be a medium of infection, our data obtained in real-life conditions suggest that it might be less extensive than hitherto recognized.

Published
2020
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4. Clinical characteristics of coronavirus disease (COVID-19) early findings from a teaching hospital in Pavia, North Italy, 21 to 28 February 2020

Author

Colaneri, M., Sacchi, P., Zuccaro, V., Biscarini, S., Sachs, M., Roda, S., Pieri, T. C., Valsecchi, P., Piralla, A., Seminari, E., Matteo, A. D., Novati, S., Maiocchi, L., Pagnucco, L., Tirani, M., Baldanti, F., Mojoli, F., Perlini, S., Bruno, R., Mondelli, M. U., Brunetti, E., Mariani, B., Ludovisi, S., Lissandrin, R., Parisi, A., Patruno, S. F. A., Michelone, G., Gulminetti, R., Zanaboni, D., Maserati, R., Orsolini, P., Vecchia, M., Asperges, E., Filippo, A. D., Sambo, M., Lupi, M., Gallazzi, I., Alfano, C., Bonzano, M., Briganti, F., Crescenzi, G., Falchi, A. G., Guarnone, R., Guglielmana, B., Maggi, E., Martino, I., Pettenazza, P., di Marco, S. P., Quaglia, F., Sabena, A., Salinaro, F., Speciale, F., Zunino, I., de Lorenzo, M., Secco, G., Dimitry, L., Cappa, G., Maisak, I., Chiodi, B., Sciarrini, M., Barcella, B., Resta, F., Moroni, L., Vezzoni, G., Scattaglia, L., Boscolo, E., Zattera, C., Fidel, T. M., Vincenzo, C., Vignaroli, D., Bazzini, M., Iotti, G., Belliato, M., Perotti, L., Mongodi, S., Tavazzi, G., Marseglia, G., Licari, A., Brambilla, I., Daniela, B., Antonella, B., Patrizia, C., Giulia, C., Giuditta, C., Marta, C., Rossana, D., Milena, F., Bianca, M., Roberta, M., Enza, M., Stefania, P., Maurizio, P., Elena, P., Francesca, R., Antonella, S., Maurizio, Z., Marone, P., Guy, A., Laura, B., Ermanna, C., Giuliana, C., Luca, D., Gabriella, F., Gabriella, G., Alessia, G., Viviana, L., Claudia, L., Valentina, M., Simona, P., Marta, P., Alice, B., Giacomo, C., Irene, C., Alfonso, C., Raffella, D. M., Annapia, D. N., Alessandro, F., Guglielmo, F., Loretta, F., Federica, G., Alessandra, M., Novazzi, Federica, Giacomo, R., Beatrice, R., Maria, S. I., Monica, T., Edoardo, V. N., Calvi, M., Tizzoni, M., Nicora, C., Triarico, A., Petronella, V., Marena, C., Muzzi, A., Cutti, S., Novelli, V., Lago, P., Comandatore, F., Gaiarsa, S., Rettani, M., Bandi, C., and Ferrari, A.

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), LDH, Epidemiology, retrospective study, Severe disease, Disease, 030204 cardiovascular system & hematology, medicine.disease_cause, Teaching hospital, Betacoronavirus, 03 medical and health sciences, 0302 clinical medicine, Virology, Internal medicine, Pandemic, medicine, Humans, Viral, 030212 general & internal medicine, Pandemics, Coronavirus, severe disease, Reverse Transcriptase Polymerase Chain Reaction, business.industry, SARS-CoV-2, Teaching, Public Health, Environmental and Occupational Health, Outbreak, COVID-19, Retrospective cohort study, Pneumonia, Hospitals, Europe, Italy, Coronavirus Infections, Hospitals, Teaching, Pneumonia, Viral, business, Rapid Communication
Abstract

We describe clinical characteristics, treatments and outcomes of 44 Caucasian patients with coronavirus disease (COVID-19) at a single hospital in Pavia, Italy, from 21–28 February 2020, at the beginning of the outbreak in Europe. Seventeen patients developed severe disease, two died. After a median of 6 days, 14 patients were discharged from hospital. Predictors of lower odds of discharge were age > 65 years, antiviral treatment and for severe disease, lactate dehydrogenase > 300 mg/dL.

Published
2020

5. Tocilizumab for treatment of severe covid-19 patients: Preliminary results from smatteo covid19 registry (smacore)

Author

Colaneri, M., Bogliolo, L., Valsecchi, P., Sacchi, P., Zuccaro, V., Brandolino, F., Montecucco, C., Mojoli, F., Giusti, E. M., Bruno, R., Mondelli, M. U., Brunetti, E., Di Matteo, A., Seminari, E., Maiocchi, L., Pagnucco, L., Ludovisi, S., Lissandrin, R., Parisi, A., Patruno, S. F. A., Michelone, G., Gulminetti, R., Zanaboni, D., Novati, S., Maserati, R., Orsolini, P., Vecchia, M., Asperges, E., Di Filippo, A., Sambo, M., Biscarini, S., Lupi, M., Roda, S., Chiara Pieri, T., Gallazzi, I., Sachs, M., Perlini, S., Alfano, C., Bonzano, M., Briganti, F., Crescenzi, G., Giulia Falchi, A., Guarnone, R., Guglielmana, B., Maggi, E., Martino, I., Pettenazza, P., Di Marco, S. P., Quaglia, F., Sabena, A., Salinaro, F., Speciale, F., Zunino, I., De Lorenzo, M., Secco, G., Dimitry, L., Cappa, G., Maisak, I., Chiodi, B., Sciarrini, M., Barcella, B., Resta, F., Moroni, L., Vezzoni, G., Scattaglia, L., Boscolo, E., Zattera, C., Fidel, T. M., Vincenzo, C., Vignaroli, D., Bazzini, M., Iotti, G., Maurelli, M., Mongodi, S., Tavazzi, G., Belliato, M., Perotti, L., Aliberti, A. R., Amatu, A., Anfossi, L., Arisi, E., Baldi, C., Bellini, L., Benzi, A., Bichisao, G., Bolongaro, A., Andrea, B., Federica, B., Giacomo, B., Luca, C., Emanuele, C., Valeria, C., Fabrizio, C., Maria, C., Maria Paola, D., Elisa Lucia, D., Federica, F., Fiorenza, F., Marta, F., Marinella, F., Maddalena Margherita, G., Simonetta, G., Marcella, I., Claudia, L. C., Giuseppe, M., Benedetta, M. M., Simonetta, M., Maria, M. P., Maria, M. A., Federica, M., Larissa, N. T., Silvano, N., Anita, O., Michele, P., Debora, P., Simona, P., Raffaella, P., Silvia, P., Marco, P., Emanuela, P., Roberta, P., Danila Katia, R., Gianluca, R., Filippo, R., Francesca, R., Roberto, R., Giuseppe, R., Emanuela, R., Cristina, R., Giuseppe, S. G., Fabio, S., Debora, S., Giulia, T., Federico, V., Silvia, Z., Alessandro, B., Corrado, B., Chiara, B., Andrea, C., Costanza, C., Julia, N., Valentino, D., Roberto, D., Adelaide, G. M., Filippo, G., Andrea, P., Cecilia, Q., Andrea, S., Francesco, T., Chiara, D., Francesco, E., Bruno, L., Elisa, M., Maria Chiara, R., Barbara, R., Mariangela, S., Monica, T., Federica, V., Roberto, V., Marseglia, G., Licari, A., Brambilla, I., Baldanti, F., Barbarini, D., Bruno, A., Campanini, G., Cavanna, C., Comolli, G., Corbella, M., Daturi, R., Furione, M., Mariani, B., Marone, P., Paolucci, S., Parea, M., Percivalle, E., Piralla, A., Rovida, F., Sarasini, A., Zavattoni, M., Piero, M., Cambieri, P., Monzillo, V., Ardizzone, M., Bellotti, L., Brunco, V., Cabano, E., Casali, G., Capella, L., Devitis, D., Dossena, L., Frisco, G., Garbagnoli, G., Gardellini, F., Girello, A., Guerrizio, A., Landini, V., Lucchelli, C., Maliardi, V., Piemontese, P., Pezzaia, S., Premoli, M., Rebuffa, C., Bagnarino, J., Bergami, F., Bonetti, A., Caneva, G., Cassaniti, I., Corcione, A., Di Martino, R., Di Napoli, A., Ferrari, A., Ferrari, G., Fiorina, L., Gallone, A., Giardina, F., Girardi, A., Mercato, A., Novazzi, F., Ratano, G., Rossi, B., Saverimpilla, G., Sciabica, I. M., Tallarita, M., Nepita, E. V., Vitali, J., Cerino, A., Varchetta, S., Oliviero, B., Mantovani, S., Mele, D., Calvi, M., Tizzoni, M., Nicora, C., Triarico, A., Petronella, V., Marena, C., Muzzi, A., Lago, P., Cutti, S., Novelli, V., Comandatore, F., Biffignandi, G. B., Gaiarsa, S., Rettani, M., and Bandi, C.

Subjects
Microbiology (medical), medicine.medical_specialty, Azithromycin, Off label therapy, Microbiology, Article, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Tocilizumab, Virology, Internal medicine, Propensity score matching, Medicine, 030212 general & internal medicine, COVID-19 pneumonia, Adverse effect, lcsh:QH301-705.5, 030203 arthritis & rheumatology, business.industry, Mortality rate, Hydroxychloroquine, medicine.disease, Pneumonia, chemistry, lcsh:Biology (General), Cohort, ICU, tocilizumab, off label therapy, propensity score matching, mortality rate, business, medicine.drug
Abstract

Objective: This study aimed to assess the role of Tocilizumab therapy (TCZ) in terms of ICU admission and mortality rate of critically ill patients with severe COVID-19 pneumonia. Design: Patients with COVID-19 pneumonia were prospectively enrolled in SMAtteo COvid19 REgistry (SMACORE). A retrospective analysis of patients treated with TCZ matched using propensity score to patients treated with Standard Of Care (SOC) was conducted. Setting: The study was conducted at IRCCS Policlinico San Matteo Hospital, Pavia, Italy, from March 14, 2020 to March 27, 2020. Participants: Patients with a confirmed diagnosis of COVID-19 hospitalized in our institution at the time of TCZ availability. Interventions: TCZ was administered to 21 patients. The first administration was 8 mg/kg (up to a maximum 800 mg per dose) of Tocilizumab intravenously, repeated after 12 h if no side effects were reported after the first dose. Main Outcomes and Measures: ICU admission and 7-day mortality rate. Secondary outcomes included clinical and laboratory data. Results: There were 112 patients evaluated (82 were male and 30 were female, with a median age of 63.55 years). Using propensity scores, the 21 patients who received TCZ were matched to 21 patients who received SOC (a combination of hydroxychloroquine, azithromycin and prophylactic dose of low weight heparin). No adverse event was detected following TCZ administration. This study found that treatment with TCZ did not significantly affect ICU admission (OR 0.11; 95% CI between 0.00 and 3.38; p = 0.22) or 7-day mortality rate (OR 0.78; 95% CI between 0.06 and 9.34; p = 0.84) when compared with SOC. Analysis of laboratory measures showed significant interactions between time and treatment regarding C-Reactive Protein (CRP), alanine aminotransferase (ALT), platelets and international normalized ratio (INR) levels. Variation in lymphocytes count was observed over time, irrespective of treatment. Conclusions: TCZ administration did not reduce ICU admission or mortality rate in a cohort of 21 patients. Additional data are needed to understand the effect(s) of TCZ in treating patients diagnosed with COVID-19.

Published
2020

6. Detection of the SARS-CoV-2 in different biologic specimens from positive patients with COVID-19, in Northern Italy

Author

Novazzi, Federica, Cassaniti, Irene, Piralla, Antonio, Di Sabatino, Antonio, Bruno, Raffaele, Baldanti, Fausto, Mondelli, M, Brunetti, E, Di Matteo, A, Seminari, E, Maiocchi, L, Zuccaro, V, Pagnucco, L, Mariani, B, Ludovisi, S, Lissandrin, R, Parisi, A, Sacchi, P, Patruno, SFA, Michelone, G, Gulminetti, R, Zanaboni, D, Novati, S, Maserati, R, Orsolini, P, Vecchia, M, Sciarra, M, Asperges, E, Colaneri, M, Di Filippo, A, Sambo, M, Biscarini, S, Lupi, M, Roda, S, Pieri, TC, Gallazzi, I, Sachs, M, Valsecchi, P, Perlini, S, Alfano, C, Bonzano, M, Briganti, F, Crescenzi, G, Falchi, AG, Guarnone, R, Guglielmana, B, Maggi, E, Martino, I, Pettenazza, P, Pioli di Marco, S, Quaglia, F, Sabena, A, Salinaro, F, Speciale, F, Zunino, I, De Lorenzo, M, Secco, G, Dimitry, L, Cappa, G, Maisak, I, Chiodi, B, Sciarrini, M, Barcella, B, Resta, F, Moroni, L, Vezzoni, G, Scattaglia, L, Boscolo, E, Zattera, C, Tassi, MF, Capozza, V, Vignaroli, D, Bazzini, M, Iotti, G, Mojoli, F, Belliato, M, Perotti, L, Mongodi, S, Tavazzi, G, Marseglia, G, Licari, A, Brambilla, I, Barbarini, D, Bruno, A, Cambieri, P, Campanini, G, Cavanna, C, Comolli, G, Corbella, M, Daturi, R, Furione, M, Marone, P, Monzillo, E, Paolucci, S, Parea, M, Percivalle, E, Rovida, F, Sarasini, A, Zavattoni, M, Adzasehoun, G, Ardizzone, M, Bellotti, L, Brunco, V, Cabano, E, Casali, G, Capella, L, Devitis, D, Dossena, L, Frisco, G, Garbagnoli, G, Gardellini, F, Girello, A, Guerrizio, A, Landini, V, Lucchelli, C, Maliardi, V, Piemontese, P, Pezzaia, S, Premoli, M, Rebuffa, C, Zanello, C, Bagnarino, J, Bergami, F, Bonetti, A, Caneva, G, Corcione, A, Di Martino, R, Di Napoli, A, Ferrari, A, Ferrari, G, Fiorina, L, Gallone, A, Giardina, F, Girardi, A, Mercato, A, Ratano, G, Rossi, B, Saveriaempillai, G, Sciabica, IM, Tallarita, M, Vecchio Nepita, E, Vitali, J, Cerino, A, Varchetta, S, Oliviero, B, Mantovani, S, Mele, D, Calvi, M, Tizzoni, M, Nicora, C, Triarico, A, Petronella, V, Marena, C, Muzzi, A, Lago, P, Cutti, S, Novelli, V, Comandatore, F, Batisti Biffignandi, G, Gaiarsa, S, Rettani, M, and Bandi, C

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), education, Immunology, medicine.disease_cause, SARS‐CoV‐2, Covid‐19 in Children and Adolescents, 03 medical and health sciences, 2020 Update from The Italian Society of Pediatric Allergy and Immunology, 0302 clinical medicine, COVID‐19, Internal medicine, Epidemiology, transmission routes, medicine, Immunology and Allergy, 030212 general & internal medicine, Pediatrics, Perinatology, and Child Health, Coronavirus, swabs, specimen types, northern Italy, business.industry, SARS-CoV-2, COVID-19, medicine.disease, epidemiology, Northern italy, Pneumonia, 030228 respiratory system, Respiratory secretion, Nasal Swab, Pediatrics, Perinatology and Child Health, Supplement Article, business
Abstract

Coronavirus disease 2019 (COVID‐19) diagnosis is based on molecular detection of SARS‐CoV‐2 in respiratory samples such as nasal swab (NS) However, the evidence that NS in patients with pneumonia was sometimes negative raises the attention to collect other clinical specimens SARS‐CoV‐2 was shown in 10 3% rectal swabs (RS), 7 7% plasma, 1% urine, and 0% feces from 143 NS‐positive patients Potential infection by fluids different from respiratory secretion is possible but unlikely [ABSTRACT FROM AUTHOR] Copyright of Pediatric Allergy & Immunology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Published
2020

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