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6. Dexamethasone measurement during low-dose suppression test for suspected hypercortisolism: threshold development with and validation

Author

Ceccato, F., Artusi, C., Barbot, M., Lizzul, L., Pinelli, S., Costantini, G., Niero, S., Antonelli, G., Plebani, M., and Scaroni, C.

Abstract

Background and aim: Dexamethasone Suppression Test (DST), recommended for Cushing’s Syndrome (CS) diagnosis, explores the pituitary feedback to glucocorticoids. Its diagnostic accuracy could be affected by dexamethasone bioavailability, and therefore, we have developed and validated a dexamethasone threshold after 1-mg DST. Materials and methods: We studied 200 subjects: 125 patients were considered retrospectively and 75 were enrolled prospectively as the validation cohort. Serum dexamethasone, Late Night Salivary Cortisol (LNSC), and Urinary Free Cortisol (UFC) were measured with LC–MS/MS. Normal LNSC and UFC levels were used to exclude CS. The lower 2.5th percentile of dexamethasone distribution in non-CS patients with cortisol ≤ 50 nmol/L after 1-mg DST was used as threshold. Results: 16 patients were CS and 184 non-CS (108 adrenal incidentaloma and 76 excluded CS); 4.5 nmol/L resulted the calculated threshold. Cortisol after 1-mg DST confirmed high sensitivity (100% at 50 nmol/L cut-off) and moderate–low specificity (63%, increased to 91% at 138 nmol/L) to diagnose CS in the whole cohort of patients. We could reduce the number of false-positive results (from 10 to 6 and from 7 to 4 in AI and excluded CS) considering adequate dexamethasone levels. Dexamethasone levels were not affected by hypercortisolism, age, gender, smoke, weight, and creatinine. 6% of non-CS patients did not achieve adequate dexamethasone levels (40% of tests with serum cortisol > 138 nmol/L after 1-mg DST). Conclusions: We developed and validated the routine dexamethasone measurement during 1-mg DST: it is independent from patient’s clinical presentation, and it should be used to increase the specificity of serum cortisol levels.

Published
2024
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7. Telemedicine for management of patients with amyotrophic lateral sclerosis through COVID-19 tail

Author

Bombaci, A, Abbadessa, G, Trojsi, F, Leocani, L, Bonavita, S, Lavorgna, L, Tedeschi, G, Mancardi, G, Padovani, A, Clerico, M, Brigo, F, Lanzillo, R, Russo, A, Giometto, B, Straccia, G, Iodice, R, Bucello, S, Annovazzi, P, Moccia, M, Prosperini, L, Stromillo, M, Repice, A, Miele, G, Lerario, A, De Martino, A, Iodice, F, Di Lorenzo, F, Cuffaro, L, Romoli, M, Silvestro, M, Artusi, C, Bombaci A., Abbadessa G., Trojsi F., Leocani L., Bonavita S., Lavorgna L., Tedeschi G., Mancardi G., Padovani A., Clerico M., Brigo F., Lanzillo R., Russo A., Giometto B., Straccia G., Iodice R., Bucello S., Annovazzi P., Moccia M., Prosperini L., Stromillo M. L., Repice A. M., Miele G., Lerario A., De Martino A., Iodice F., Di Lorenzo F., Cuffaro L., Romoli M., Silvestro M., Artusi C. A., Bombaci, A, Abbadessa, G, Trojsi, F, Leocani, L, Bonavita, S, Lavorgna, L, Tedeschi, G, Mancardi, G, Padovani, A, Clerico, M, Brigo, F, Lanzillo, R, Russo, A, Giometto, B, Straccia, G, Iodice, R, Bucello, S, Annovazzi, P, Moccia, M, Prosperini, L, Stromillo, M, Repice, A, Miele, G, Lerario, A, De Martino, A, Iodice, F, Di Lorenzo, F, Cuffaro, L, Romoli, M, Silvestro, M, Artusi, C, Bombaci A., Abbadessa G., Trojsi F., Leocani L., Bonavita S., Lavorgna L., Tedeschi G., Mancardi G., Padovani A., Clerico M., Brigo F., Lanzillo R., Russo A., Giometto B., Straccia G., Iodice R., Bucello S., Annovazzi P., Moccia M., Prosperini L., Stromillo M. L., Repice A. M., Miele G., Lerario A., De Martino A., Iodice F., Di Lorenzo F., Cuffaro L., Romoli M., Silvestro M., and Artusi C. A.

Abstract

Over the last months, due to coronavirus disease (COVID-19) pandemic, containment measures have led to important social restriction. Healthcare systems have faced a complete rearrangement of resources and spaces, with the creation of wards devoted to COVID-19 patients. In this context, patients affected by chronic neurological diseases, such as amyotrophic lateral sclerosis (ALS), are at risk to be lost at follow-up, leading to a higher risk of morbidity and mortality. Telemedicine may allow meet the needs of these patients. In this commentary, we briefly discuss the digital tools to remotely monitor and manage ALS patients. Focusing on detecting disease progression and preventing life-threatening conditions, we propose a toolset able to improve ALS management during this unprecedented situation.

Published
2021

9. Design of a study to investigate the mechanisms of obstructive sleep apnoea by means of drug-induced sleep endoscopy

Author

Bisogni, V, Maiolino, G, Ceolotto, G, Pengo, M, Marchese Ragona, R, Artusi, C, Brugnolo, L, Lerco, S, Borsetto, D, Gaudioso, P, Martini, A, Plebani, M, Rossi, G, Bisogni V., Maiolino G., Ceolotto G., Pengo M., Marchese Ragona R., Artusi C., Brugnolo L., Lerco S., Borsetto D., Gaudioso P., Martini A., Plebani M., Rossi G. P., Bisogni, V, Maiolino, G, Ceolotto, G, Pengo, M, Marchese Ragona, R, Artusi, C, Brugnolo, L, Lerco, S, Borsetto, D, Gaudioso, P, Martini, A, Plebani, M, Rossi, G, Bisogni V., Maiolino G., Ceolotto G., Pengo M., Marchese Ragona R., Artusi C., Brugnolo L., Lerco S., Borsetto D., Gaudioso P., Martini A., Plebani M., and Rossi G. P.

Abstract

Obstructive sleep apnoea (OSA) is an independent risk factor of hypertension and cardiovascular diseases. Recurrent episodes of upper airways collapse during sleep causing blood oxygen desaturation, hypercapnia, and micro-arousals, are known to activate the sympathetic nervous system (SNS). However, whether changes in the renin-angiotensin-aldosterone system and endothelial activation also occur remains contentious. Based on routine use of drug-induced sleep endoscopy (DISE) for the work-up of OSA patients in our centre, we designed a prospective study to investigate the haemodynamic and humoral changes occurring during the apnoeic episodes reproduced in vivo in the course of DISE. Specifically, plasma aldosterone concentration and renin activity, C-terminal fragment of proendothelin-1, as a marker of endothelial damage, and free plasma catecholamines, will be measured at fixed times during DISE. The activity of catechol-O-methyltransferase (COMT), a key catecholamine-inactivating enzyme that has been scantly investigated thus far owing to the lack of commercially available kits, will be also determined by a newly developed high performance liquid chromatography method, which is herein described. The aim of this study is to provide novel information on the haemodynamic, hormonal, and SNS changes, and also on COMT activity modification concomitantly occurring during apnoea, thus contributing substantively to the understanding of the pathophysiology of OSA.

Published
2019

10. Ventral tegmental area disconnection contributes two years early to correctly classify patients converted to alzheimer's disease: Implications for treatment

Author

Serra, L., D'Amelio, M., Esposito, S., Di Domenico, C., Koch, G., Marra, Camillo, Mercuri, N. B., Caltagirone, C., Artusi, C. A., Lopiano, L., Cercignani, M., Bozzali, M., Marra C. (ORCID:0000-0003-3994-4044), Serra, L., D'Amelio, M., Esposito, S., Di Domenico, C., Koch, G., Marra, Camillo, Mercuri, N. B., Caltagirone, C., Artusi, C. A., Lopiano, L., Cercignani, M., Bozzali, M., and Marra C. (ORCID:0000-0003-3994-4044)

Abstract

Background: Recent cross-sectional studies highlighted the loss of dopaminergic neurons in the ventral tegmental area (VTA) as an early pathophysiological event in Alzheimer's disease (AD). Objective: In this study, we longitudinally investigated by resting-state fMRI (rs-fMRI) a cohort of patients with mild cognitive impairment (MCI) due to AD to evaluate the impact of VTA disconnection in predicting the conversion to AD. Methods: A cohort of 35 patients with MCI due to AD were recruited and followed-up for 24 months. They underwent cognitive evaluation and rs-fMRI to assess VTA connectivity at baseline and at follow-up. Results: At 24-month follow-up, 16 out of 35 patients converted to AD. Although converters and non-converters to AD did not differ in demographic and behavioral characteristics at baseline, the first group showed a significant reduction of VTA-driven connectivity in the posterior cingulate and precentral cortex. This pattern of additional disconnection in MCI-Converters compared to non-converters remained substantially unchanged at 24-month follow-up. Conclusion: This study reinforces the hypothesis of an early contribution of dopaminergic dysfunction to AD evolution by targeting the default-mode network. These results have potential implications for AD staging and prognosis and support new opportunities for therapeutic interventions to slow down disease progression.

Published
2021

18. The still under-investigated role of cognitive deficits in PML diagnosis

Author

Scarpazza, C, De Rossi, N, Moiola, L, Gerevini, S, Cosottini, M, Capra, R, Mattioli, F, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Bresciamorra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Clerico, M, Cordioli, C, D'Aleo, G, de Riz, M, Deotto, L, Durelli, L, Falcini, M, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Naldi, P, Pane, C, Perrone, P, Pizzorno, M, Pozzilli, C, Prosperini, L, Rezzonico, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza C., De Rossi N., Moiola L., Gerevini S., Cosottini M., Capra R., Mattioli F., Amato M. P., Artusi C. A., Bandini F., Barcella V., Bertolotto A., Bresciamorra V., Capobianco M., Cavaletti G., Cavalla P., Centonze D., Clerico M., Cordioli C., D'Aleo G., de Riz M., Deotto L., Durelli L., Falcini M., Ferrari E., Fusco M. L., Gasperini C., Ghezzi A., Grimaldi L., Guidotti M., Laroni A., Lugaresi A., Naldi P., Pane C., Perrone P., Pizzorno M., Pozzilli C., Prosperini L., Rezzonico M., Rovaris M., Salemi G., Salvetti M., Santuccio G., Scarpini E., Sessa E., Solaro C., Tabiadon G., Tortorella C., Trojano M., Valentino P., Scarpazza, C, De Rossi, N, Moiola, L, Gerevini, S, Cosottini, M, Capra, R, Mattioli, F, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Bresciamorra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Clerico, M, Cordioli, C, D'Aleo, G, de Riz, M, Deotto, L, Durelli, L, Falcini, M, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Naldi, P, Pane, C, Perrone, P, Pizzorno, M, Pozzilli, C, Prosperini, L, Rezzonico, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza C., De Rossi N., Moiola L., Gerevini S., Cosottini M., Capra R., Mattioli F., Amato M. P., Artusi C. A., Bandini F., Barcella V., Bertolotto A., Bresciamorra V., Capobianco M., Cavaletti G., Cavalla P., Centonze D., Clerico M., Cordioli C., D'Aleo G., de Riz M., Deotto L., Durelli L., Falcini M., Ferrari E., Fusco M. L., Gasperini C., Ghezzi A., Grimaldi L., Guidotti M., Laroni A., Lugaresi A., Naldi P., Pane C., Perrone P., Pizzorno M., Pozzilli C., Prosperini L., Rezzonico M., Rovaris M., Salemi G., Salvetti M., Santuccio G., Scarpini E., Sessa E., Solaro C., Tabiadon G., Tortorella C., Trojano M., and Valentino P.

Abstract

Background: Despite cognitive deficits frequently represent the first clinical manifestations of Progressive Multifocal Leukoencephalopathy (PML) in Natalizumab-treated MS patients, the importance of cognitive deficits in PML diagnosis is still under-investigated. The aim of the current study is to investigate the cognitive deficits at PML diagnosis in a group of Italian patients with PML. Methods: Thirty-four PML patients were included in the study. The demographic and clinical data, the lesion load and localization, and the longitudinal clinical course was compared between patients with (n = 13) and without (n = 15) cognitive deficit upon PML suspicion (the remaining six patients were asymptomatic). Clinical presentation of cognitive symptoms was described in detail. Result: After symptoms detection, the time to diagnosis resulted to be shorter for patients presenting with cognitive than for patients with non cognitive onset (p = 0.03). Within patients with cognitive onset, six patients were presenting with language and/or reading difficulties (46.15%); five patients with memory difficulties (38.4%); three patients with apraxia (23.1%); two patients with disorientation (15.3%); two patients with neglect (15.3%); one patients with object agnosia (7.7%), one patient with perseveration (7.7%) and one patient with dementia (7.7%). Frontal lesions were less frequent (p = 0.03), whereas temporal lesions were slightly more frequent (p = 0.06) in patients with cognitive deficits. The longitudinal PML course seemed to be more severe in cognitive than in non cognitive patients (F = 2.73, p = 0.03), but differences disappeared (F = 1.24, p = 0.29) when balancing for the incidence of immune reconstitution syndrome and for other treatments for PML (steroids, plasma exchange (PLEX) and other therapies (Mefloquine, Mirtazapine, Maraviroc). Conclusion: Cognitive deficits at PML onset manifest with symptoms which are absolutely rare in MS. Their appearance in MS patients should st

Published
2017

19. Early diagnosis of progressive multifocal leucoencephalopathy: Longitudinal lesion evolution

Author

Scarpazza, C, Signori, A, Prosperini, L, Sormani, M, Cosottini, M, Capra, R, Gerevini, S, Altieri, M, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Morra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Chiusole, M, Clerico, M, Cordioli, C, D'Aleo, G, De Luca, G, De Riz, M, De Rossi, N, Deotto, L, Durelli, L, Falcini, M, Ferrante, C, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Moiola, L, Naldi, P, Pane, C, Palmeri, B, Perrone, P, Pizzorno, M, Pozzilli, C, Rezzonico, M, Rottoli, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Stenta, G, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza, Cristina, Signori, Alessio, Prosperini, Luca, Sormani, Maria Pia, Cosottini, Mirco, Capra, Ruggero, Gerevini, Simonetta, Altieri, Marta, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Morra, Vincenzo Brescia, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Chiusole, Maurizia, Clerico, Marinella, Cordioli, Cinzia, D'Aleo, Giangaetano, De Luca, Giovanna, De Riz, Milena, De Rossi, Nicola, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrante, Claudio, Ferrari, Ernesta, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Moiola, Lucia, Naldi, Paola, Pane, Chiara, Palmeri, Barbara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Rezzonico, Monica, Rottoli, Maria Rosa, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Stenta, Gianola, Tabiadon, Giulietta, Tortorella, Carla, Trojano, Maria, Valentino, Paola, Rottoli, Maira Rosa, Scarpazza, C, Signori, A, Prosperini, L, Sormani, M, Cosottini, M, Capra, R, Gerevini, S, Altieri, M, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Morra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Chiusole, M, Clerico, M, Cordioli, C, D'Aleo, G, De Luca, G, De Riz, M, De Rossi, N, Deotto, L, Durelli, L, Falcini, M, Ferrante, C, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Moiola, L, Naldi, P, Pane, C, Palmeri, B, Perrone, P, Pizzorno, M, Pozzilli, C, Rezzonico, M, Rottoli, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Stenta, G, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza, Cristina, Signori, Alessio, Prosperini, Luca, Sormani, Maria Pia, Cosottini, Mirco, Capra, Ruggero, Gerevini, Simonetta, Altieri, Marta, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Morra, Vincenzo Brescia, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Chiusole, Maurizia, Clerico, Marinella, Cordioli, Cinzia, D'Aleo, Giangaetano, De Luca, Giovanna, De Riz, Milena, De Rossi, Nicola, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrante, Claudio, Ferrari, Ernesta, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Moiola, Lucia, Naldi, Paola, Pane, Chiara, Palmeri, Barbara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Rezzonico, Monica, Rottoli, Maria Rosa, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Stenta, Gianola, Tabiadon, Giulietta, Tortorella, Carla, Trojano, Maria, Valentino, Paola, and Rottoli, Maira Rosa

Abstract

Objective early diagnosis of natalizumab-related progressive multifocal leucoencephalopathy (NTZ-pML) in multiple sclerosis has been deemed a major priority by the regulatory agencies but has yet to become a reality. The current paper aims to: (1) investigate whether patients with NTZ-pML pass through a prolonged presymptomatic phase with MRI abnormalities, (2) estimate the longitudinal pML lesion volume increase during the presymptomatic phase and (3) estimate the presymptomatic phase length and its impact on therapy duration as a risk stratification parameter. Methods all Italian patients who developed NTZ-pML between 2009 and 2018 were included. The data of patients with available prediagnostic MRI were analysed (n=41). Detailed clinical and neuroradiological information was available for each participant. results (1) pML lesions were detectable in the presymptomatic phase in 32/41 (78%) patients; (ii) the lesion volume increased by 62.8 % for each month spent in the prediagnostic phase; (3) the prediagnostic phase length was 150.8±74.9 days; (4) pML MRI features were detectable before the 24th month of therapy in 31.7 % of patients in our cohort. Conclusions considering the latency of pML clinical manifestation, the presymptomatic phase length supports the usefulness of MRI surveillance every 3-4 months. early diagnosis could prompt a better outcome for patients due to the relationship between lesion volume and Jc virus infection. The insight from this study might also have an impact on risk stratification algorithms, as therapy duration as a parameter of stratification appears to need reassessment.

Published
2019

21. Subthalamic Deep Brain Stimulation

Author

Artusi, C. A., Zibetti, M., Romagnolo, A., Rizzone, M. G., Merola, A., and Lopiano, L.

Abstract

This is the peer reviewed version of the following article: [Artusi, C.A., Zibetti, M., Romagnolo, A., Rizzone, M.G., Merola, A., and Lopiano, L. (2017). Subthalamic deep brain stimulation and trunk posture in Parkinson's disease. Acta Neurologica Scandinavica 137, 481–487.], which has been published in final form at https://doi.org/10.1111/ane.12889. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions: https://authorservices.wiley.com/author-resources/Journal-Authors/licensing/self-archiving.html#3. Deposited by shareyourpaper.org and openaccessbutton.org. We've taken reasonable steps to ensure this content doesn't violate copyright. However, if you think it does you can request a takedown by emailing help@openaccessbutton.org.

Published
2017

29. Subthalamic deep brain stimulation and trunk posture in Parkinson's disease.

Author

Artusi, C. A., Zibetti, M., Romagnolo, A., Rizzone, M. G., Merola, A., and Lopiano, L.

Subjects
*DEEP brain stimulation, *PARKINSON'S disease, *PISA syndrome, *TORSO physiology, *POSTURE
Abstract

Objectives: We sought to assess the efficacy of subthalamic nucleus deep brain stimulation (STN‐DBS) in Parkinson's disease (PD)‐associated trunk posture abnormalities retrospectively analyzing data from 101 patients reporting mild‐to‐severe trunk posture abnormalities of a cohort of 216 PD patients treated with STN‐DBS at our center. Methods: Abnormal trunk posture was rated on a scale of 0 (normal) to 4 (marked flexion with an extreme abnormality of posture) as per the grading score reported in the Unified Parkinson's Disease Rating Scale. The independent effect of STN‐DBS on trunk posture was assessed comparing Medication‐Off (presurgery) vs Stimulation‐On/Medication‐Off (post‐surgery). The combined effect of STN‐DBS plus levodopa was evaluated comparing Medication‐On (presurgery) vs Stimulation‐On/Medication‐On (post‐surgery). Analyses were conducted considering both the entire cohort of patients and the subgroup with camptocormia (CMC) and Pisa syndrome (PS). Results: The independent effect of STN‐DBS resulted in a 41.4% improvement in abnormal trunk posture severity (P < .001), with 78.2% of patients (n = 79) reporting an improvement of at least 1 point. The combined effect of STN‐DBS and levodopa resulted in a 30.9% improvement (P = .061), with 54.5% of patients (n = 55) reporting an improvement of at least 1 point. The subanalysis of patients with CMC (n = 23) and PS (n = 5) showed a 42.7% improvement in abnormal posture severity when considering the independent effect of STN‐DBS (P < .001) and 30.5% when considering the combined effect of STN‐DBS and levodopa (P < .001). Conclusions: STN‐DBS may have the potential for improving posture in patients with advanced PD. [ABSTRACT FROM AUTHOR]

Published
2018
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32. The dominant subthalamic nucleus: A gait analysis study

Author

Rizzone, Mario Giorgio, Carpinella, I., Artusi, C. A., Lanotte, Michele Maria Rosario, Lopiano, Leonardo, Marchisio, A., Merola, Aristide, Rabuffetti, M., Roccatagliata, D. V., Zibetti, M., and Ferrarin, M.

Published
2012

47. Telemedicine for management of patients with amyotrophic lateral sclerosis through COVID-19 tail

Author

Bombaci, Alessandro, Abbadessa, Gianmarco, Trojsi, Francesca, Leocani, Letizia, Bonavita, Simona, Lavorgna, Luigi, Gioacchino Tedeschi, Giovanni Mancardi, Alessandro Padovani, Marinella Clerico, Francesco Brigo, Roberta Lanzillo, Antonio Russo, Bruno Giometto, Giulia Straccia, Rosa Iodice, Sebastiano Bucello, Pietro Annovazzi, Marcello Moccia, Luca Prosperini, Maria Laura Stromillo, Anna Maria Repice, Giuseppina Miele, Alberto Lerario, Antonio De Martino, Francesco Iodice, Francesco Di Lorenzo, Luca Cuffaro, Michele Romoli, Marcello Silvestro, Carlo Alberto Artusi, Bombaci, Alessandro, Abbadessa, Gianmarco, Trojsi, Francesca, Leocani, Letizia, Bonavita, Simona, Lavorgna, Luigi, Bombaci, A., Abbadessa, G., Trojsi, F., Leocani, L., Bonavita, S., Lavorgna, L., Tedeschi, G., Mancardi, G., Padovani, A., Clerico, M., Brigo, F., Lanzillo, R., Russo, A., Giometto, B., Straccia, G., Iodice, R., Bucello, S., Annovazzi, P., Moccia, M., Prosperini, L., Stromillo, M. L., Repice, A. M., Miele, G., Lerario, A., De Martino, A., Iodice, F., Di Lorenzo, F., Cuffaro, L., Romoli, M., Silvestro, M., Artusi, C. A., Bombaci, A, Abbadessa, G, Trojsi, F, Leocani, L, Bonavita, S, Lavorgna, L, Tedeschi, G, Mancardi, G, Padovani, A, Clerico, M, Brigo, F, Lanzillo, R, Russo, A, Giometto, B, Straccia, G, Iodice, R, Bucello, S, Annovazzi, P, Moccia, M, Prosperini, L, Stromillo, M, Repice, A, Miele, G, Lerario, A, De Martino, A, Iodice, F, Di Lorenzo, F, Cuffaro, L, Romoli, M, Silvestro, M, Artusi, C, Alessandro, Bombaci, Gianmarco, Abbadessa, Francesca, Trojsi, Letizia, Leocani, Simona, Bonavita, Luigi, Lavorgna, Tedeschi, Gioacchino, Mancardi, Giovanni, Padovani, Alessandro, Clerico, Marinella, Brigo, Francesco, Lanzillo, Roberta, Russo, Antonio, Giometto, Bruno, Straccia, Giulia, Iodice, Rosa, Bucello, Sebastiano, Annovazzi, Pietro, Moccia, Marcello, Prosperini, Luca, Laura Stromillo, Maria, Maria Repice, Anna, Miele, Giuseppina, Lerario, Alberto, De Martino, Antonio, Iodice, Francesco, Di Lorenzo, Francesco, Cuffaro, Luca, Romoli, Michele, Silvestro, Marcello, and Alberto Artusi, Carlo

Subjects
medicine.medical_specialty, Telemedicine, Neurology, Coronavirus disease 2019 (COVID-19), Clinical Neurology, Monitoring, Ambulatory, Context (language use), Disease, Review Article, Dermatology, Tele-health, Teleneurology, ALS patients, COVID-19, Remote monitoring, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Pandemic, medicine, Humans, 030212 general & internal medicine, Amyotrophic lateral sclerosis, Intensive care medicine, business.industry, Amyotrophic Lateral Sclerosis, General Medicine, medicine.disease, Psychiatry and Mental health, ALS patient, Neurology (clinical), Neurosurgery, business, 030217 neurology & neurosurgery
Abstract

Over the last months, due to coronavirus disease (COVID-19) pandemic, containment measures have led to important social restriction. Healthcare systems have faced a complete rearrangement of resources and spaces, with the creation of wards devoted to COVID-19 patients. In this context, patients affected by chronic neurological diseases, such as amyotrophic lateral sclerosis (ALS), are at risk to be lost at follow-up, leading to a higher risk of morbidity and mortality. Telemedicine may allow meet the needs of these patients. In this commentary, we briefly discuss the digital tools to remotely monitor and manage ALS patients. Focusing on detecting disease progression and preventing life-threatening conditions, we propose a toolset able to improve ALS management during this unprecedented situation.

Published
2020
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48. COVID-19 in systemic lupus erythematosus: Data from a survey on 417 patients

Author

Selene Nicolosi, Lorenzo Beretta, Carolina Artusi, Lorenza Maria Argolini, Giuseppe A. Ramirez, Maria Gerosa, Emanuel Della Torre, Chiara Bellocchi, Luca Moroni, Enrica Bozzolo, Roberto Caporali, Lorenzo Dagna, Ramirez, G. A., Gerosa, M., Beretta, L., Bellocchi, C., Argolini, L. M., Moroni, L., Della Torre, E., Artusi, C., Nicolosi, S., Caporali, R., Bozzolo, E. P., and Dagna, L.

Subjects
Male, Epidemiology, medicine.disease_cause, Autoimmunity, SLE, systemic lupus erythematosus, totCOVID-19, confirmed + presumptive COVID-19, COVID-19 Testing, 0302 clinical medicine, immune system diseases, Prednisone, Prevalence, Lupus Erythematosus, Systemic, 030212 general & internal medicine, skin and connective tissue diseases, Qualitative Research, education.field_of_study, Middle Aged, Web, NPSLE, neuropsychiatric SLE, Italy, Social Isolation, Antirheumatic Agents, pCOVID-19, presumptive COVID-19, Female, Viral disease, Symptom Assessment, medicine.symptom, Coronavirus Infections, cCOVID-19, COVID-19 confirmed by RT-PCR, noCOVID-19, patients without COVID-19, Hydroxychloroquine, medicine.drug, Adult, RT-PCR, reverse-transcriptase polymerase chain reaction, medicine.medical_specialty, Referral, Pneumonia, Viral, Population, Anosmia, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, Article, Betacoronavirus, 03 medical and health sciences, Systemic lupus erythematosus, Rheumatology, Internal medicine, medicine, Humans, education, Pandemics, 030203 arthritis & rheumatology, Clinical Laboratory Techniques, SARS-CoV-2, business.industry, COVID-19, HCQ, hydroxychloroquine, Coronavirus, Anesthesiology and Pain Medicine, Communicable Disease Control, Patient Compliance, COVID-19, coronavirus-related disease, business
Abstract

Highlights • Systemic lupus erythematosus (SLE) associates with infection susceptibility. • COVID-19 is a pandemic infectious disease with high morbidity and mortality. • The impact of COVID-19 in SLE is poorly characterised. • A web-based survey amongst patients with SLE suggest a moderate increase in morbidity due to COVID-19. • Hydroxychloroquine does not seem able to prevent COVID-19 in patients with SLE., Background Systemic lupus erythematosus (SLE) is a chronic disease characterised by autoimmunity and increased susceptibility to infections. COVID-19 is a systemic viral disease currently spreading as a pandemic. Little is known about the impact of COVID-19 in patients with SLE. Objective to acquire information on the impact of COVID-19 in SLE. Methods A 26-item anonymous questionnaire investigating demographics, SLE clinical features, COVID-19 diagnoses and changes in treatments and daily habits was administered to patients with SLE from three referral centres through www.surveymonkey.com over 10 days. Data from the survey were compared to those from published estimates about the general population. Results Four-hundred-seventeen patients responded to the survey. More than 60% of subjects complained of symptoms that are also associated to COVID-19. Fourteen COVID-19 diagnoses (five confirmed by polymerase chain reaction) were reported, in contrast to a 0.73% prevalence of confirmed cases in Lombardy. One hospitalisation was reported. Fever, anosmia, dry cough, a self-reported history of neuropsychiatric SLE and a recent contact with confirmed COVID-19 cases were more strongly associated with COVID-19, as were symptoms and lower compliance to behavioural preventive measures in patients’ contacts. No protective effect was seen in subjects on hydroxychloroquine. Conclusion COVID-19 morbidity might only moderately be increased in most patients with SLE, although limited information can be inferred on more severe cases. Hydroxychloroquine apparently seems not to confer protection to infection per se, although other beneficial roles cannot be excluded. Containment policies and behavioural preventive measures could have a major role in limiting the impact of COVID-19 in patients with SLE.

Published
2020
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49. Plasmatic Dimethylarginines in Dogs With Myxomatous Mitral Valve Disease

Author

Carlotta Valente, Carlo Guglielmini, Carlo Artusi, Barbara Contiero, Laura Brugnolo, Helen Poser, G. Romito, Marco Baron Toaldo, University of Zurich, Valente, Carlotta, Valente C., Guglielmini C., Baron Toaldo M., Romito G., Artusi C., Brugnolo L., Contiero B., and Poser H.

Subjects
medicine.medical_specialty, 10253 Department of Small Animals, Arginine, Heart disease, Urinalysis, Veterinary medicine, 3400 General Veterinary, canine, heart failure, arginine, Gastroenterology, chemistry.chemical_compound, medicine.artery, Internal medicine, SF600-1100, SDMA, medicine, Original Research, Aorta, Creatinine, medicine.diagnostic_test, 630 Agriculture, General Veterinary, business.industry, dimethylarginines, medicine.disease, ADMA, dimethylarginine, Blood pressure, chemistry, Heart failure, ADMA, canine, heart failure, SDMA, arginine, dimethylarginines, 570 Life sciences, biology, Veterinary Science, Asymmetric dimethylarginine, business
Abstract

Plasmatic dimethylarginines, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are considered biomarkers of endothelial and renal dysfunction, respectively, in humans. We hypothesize that plasmatic concentration of dimethylarginines in dogs with myxomatous mitral valve disease (MMVD) is influenced by heart disease stage. Eighty-five client-owned dogs with MMVD, including 39, 19, and 27 dogs in ACVIM stages B1, B2, and C+D, respectively, and a control group of 11 clinically healthy dogs were enrolled. A prospective, multicentric, case-control study was performed. Each dog underwent a complete clinical examination, arterial blood pressure measurement, thoracic radiography, six-lead standard electrocardiogram, transthoracic echocardiography, CBC, biochemical profile, and urinalysis. Plasmatic concentration of dimethylarginines was determined through high-performance liquid chromatography coupled with tandem mass spectrometry. Median ADMA was significantly increased in dogs of group C+D (2.5 μmol/L [2.1–3.0]) compared to those of group B1 (1.8 μmol/L [1.6–2.3]; p < 0.001) and healthy dogs (1.9 μmol/L [1.7–2.3]; p = 0.02). Median SDMA was significantly increased in dogs of group C+D (0.7 μmol/L [0.5–0.9]) compared to those of groups B1 (0.4 μmol/L [0.3–0.5]; p < 0.001), B2 (0.4 μmol/L [0.3–0.6]; p < 0.01), and the control group (0.4 μmol/L [0.35–0.45]; p = 0.001). In the final multivariable analysis, ADMA and SDMA were significantly associated with left atrium to aorta ratio (p < 0.001), and creatinine (p < 0.001), respectively. Increased plasmatic concentrations of dimethylarginines suggest a possible role as biomarkers of disease severity in dogs with decompensated MMVD.

Published
2021

50. Digital work engagement among Italian neurologists

Author

Fabiana Colucci, Francesca Trojsi, Simona Bonavita, Letizia Leocani, Gioacchino Tedeschi, Maria Pia Sormani, Francesco Brigo, Marta Ponzano, Luigi Lavorgna, Marinella Clerico, Roberta Lanzillo, Gianmarco Abbadessa, Emanuele Spina, Luca Carmisciano, Maddalena Sparaco, Giovanni Cossu, Giuseppina Miele, Carla Tortorella, G. Servillo, Marco Bozzali, Carlo Alberto Artusi, Brigo, F., Ponzano, M., Sormani, M. P., Clerico, M., Abbadessa, G., Cossu, G., Trojsi, F., Colucci, F., Tortorella, C., Miele, G., Spina, E., Artusi, C. A., Carmisciano, L., Servillo, G., Bozzali, M., Sparaco, M., Leocani, L., Lanzillo, R., Tedeschi, G., Bonavita, S., Lavorgna, L., Brigo, Francesco, Ponzano, Marta, Sormani, Maria Pia, Clerico, Marinella, Abbadessa, Gianmarco, Cossu, Giovanni, Trojsi, Francesca, Colucci, Fabiana, Tortorella, Carla, Miele, Giuseppina, Spina, Emanuele, Artusi, Carlo Alberto, Carmisciano, Luca, Servillo, Giovanna, Bozzali, Marco, Sparaco, Maddalena, Leocani, Letizia, Lanzillo, Roberta, Tedeschi, Gioacchino, Bonavita, Simona, and Lavorgna, Luigi

Subjects
Digital work, The Role of Telemedicine in Chronic Disease, medicine.medical_specialty, Telemedicine, Medical education, Neurology, 020205 medical informatics, business.industry, Medicine (miscellaneous), 02 engineering and technology, RM1-950, Digital health, 03 medical and health sciences, 0302 clinical medicine, 0202 electrical engineering, electronic engineering, information engineering, medicine, Therapeutics. Pharmacology, business, 030217 neurology & neurosurgery, Original Research
Abstract

Background: Digital health, including telemedicine, is increasingly recommended for the management of chronic neurological disorders, and it has changed the roles of patients and clinicians. Methods: In this cross-sectional study we aimed to investigate the digital work engagement of Italian neurologists through a survey collected between September 2020 and January 2021. Questionnaires were anonymous and collected demographic characteristics, attitudes towards digital devices and social media, and details about the clinician–patient relationship. We used logistic-regression models to identify characteristics associated with the propensity to communicate with patients using social media. Results: Among the 553 neurologists who participated to the study, smartphones and computers were widely preferred compared with tablets; wearable devices were not common, although some neurologists desired them. A total of 48% of participants reported communicating with patients using social media but only a few were in favor of social friendship with patients; WhatsApp was the social media most popular for professional (86%) and personal (98%) purposes. Propensity to communicate with social media was significantly higher among those who were older ( p Conclusions: The preferred social media were those which were rapid and which safeguard privacy more effectively; neurologists made many efforts to disprove fake news circulating online, providing help to patients in various ways. This analysis can help direct future interventions for the management of chronic neurological disorders.

Published
2021

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