Evidence-based, standard antibiotic therapy for ventilator-associated pneumonia (VAP) caused by c... more Evidence-based, standard antibiotic therapy for ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) is a relevant unmet clinical need in the intensive care unit (ICU). We aimed to evaluate the effectiveness of first-line therapy with old and novel CRAB active antibiotics in monomicrobial VAP caused by CRAB. A prospective, observational study was performed in a mixed non-COVID-19 ICU. The primary outcome measure was clinical failure upon first-line targeted therapy. Features independently influencing failure occurrence were also investigated via Cox proportional multivariable analysis. To account for the imbalance in antibiotic treatment allocation, a propensity score analysis with an inverse probability treatment weighting approach was adopted. Of the 90 enrolled patients, 34 (38%) experienced clinical failure. Compared to patients who experienced a clinical resolution of VAP, those who had clinical failure were of an older age (median...
In the original version of the article, the group was mentioned incorrectly. The correct name is ... more In the original version of the article, the group was mentioned incorrectly. The correct name is "CSS COVID-19 Group". Also, in the Table 4 the p for ICU access and CKD were 0.024 (instead of 0.24) and 0.006 (instead of 0.06). These have been corrected with this erratum. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
It is still debated whether prophylactic doses of low-molecular-weight heparin (LMWH) are always ... more It is still debated whether prophylactic doses of low-molecular-weight heparin (LMWH) are always effective in preventing Venous Thromboembolism (VTE) and mortality in COVID-19. Furthermore, there is paucity of data for those patients not requiring ventilation. We explored mortality and the safety/efficacy profile of LMWH in a cohort of Italian patients with COVID-19 who did not undergo ventilation. From the initial cohort of 422 patients, 264 were enrolled. Most (n = 156, 87.7%) received standard LMWH prophylaxis during hospitalization, with no significant difference between medical wards and Intensive Care Unit (ICU). Major or not major but clinically relevant hemorrhages were recorded in 13 (4.9%) patients: twelve in those taking prophylactic LMWH and one in a patient taking oral anticoagulants (p: n.s.). Thirty-nine patients (14.8%) with median age 75 years. were transfused. Hemoglobin (Hb) at admission was significantly lower in transfused patients and Hb at admission inversely correlated with the number of red blood cells units transfused (p < 0.001). In-hospital mortality occurred in 76 (28.8%) patients, 46 (24.3%) of whom admitted to medical wards. Furthermore, Hb levels at admittance were significantly lower in fatalities (g/dl 12.3; IQR 2.4 vs. 13.3; IQR 2.8; Mann-Whitney U-test; p = 0.001). After the exclusion of patients treated by LMWH intermediate or therapeutic doses (n = 32), the logistic regression showed that prophylaxis significantly and independently reduced mortality (OR 0.31, 95% CI 0.13-0.85). Present data show that COVID-19 patients who do not require ventilation benefit from prophylactic doses of LMWH.
There is paucity of data on the transfusion need and its impact on the overall mortality in patie... more There is paucity of data on the transfusion need and its impact on the overall mortality in patients with COVID-19. We explored mortality in hospitalized patients with COVID-19 who required transfusions. Information on clinical variables and in-hospital mortality were obtained from medical records of 422 patients admitted to medical wards or the Intensive Care Unit (ICU). In-hospital mortality occurred in 147 (34.8%) patients, 94 (63.9%) of whom were admitted to the ICU. The median fatalities age was 77 years (IQR 14). Overall, 100 patients (60 males) received transfusion during hospitalization. The overall mortality was significantly and independently associated with age, ICU admission, Chronic Kidney Disease (CKD), and the number of transfused Red Blood Cell (RBC) units. Specifically, CKD was associated with mortality in patients admitted to medical wards, whereas the number of transfused RBC units predicted mortality in those admitted to the ICU. Transfusion strongly interacted w...
Our study examines the effectiveness of an educational approach to migraine patients. A course in... more Our study examines the effectiveness of an educational approach to migraine patients. A course in migraine education was set up for 30 patients suffering from this disease; meetings were structured taking into consideration specific educational aims, with parameters evaluated before the course, at the end of the course and at a 3-month follow-up. The results, particularly the increase in the migraineurs' knowledge of their disease and the decrease in the use of symptomatic drugs, suggest the effectiveness of the course. Furthermore, our study suggests that there is a need to build educational processes into therapeutic protocols, as they enable patients to manage their chronic diseases more correctly.
A 42-year-old man came to our headache unit in October 1995 complaining of recurrent attacks of h... more A 42-year-old man came to our headache unit in October 1995 complaining of recurrent attacks of headache, which had begun in February 1991. Chronic cluster headache was diagnosed, and he was given verapamil, 360 mg per day. The attacks ceased in the following months and verapamil was stopped in March 1996. In May 1997, a recurrence of the attacks required the readministration of verapamil, 360 mg per day. The attacks decreased (one to three per week), but after 2 months the patient reported a worsening in his condition due to the appearance of shorter attacks, which were diagnosed as chronic paroxysmal hemicrania. The administration of indomethacin, 225 mg per day, resulted in the disappearance of the short attacks. The concomitant occurrence of attacks of cluster headache and chronic paroxysmal hemicrania suggests the presence of shared factors in the pathophysiology of the two forms of headache. This hypothesis is supported by previous reports in the literature.
Background Our aim was to analyze mortality attributable to carbapenem-resistant (CR) Gram-negati... more Background Our aim was to analyze mortality attributable to carbapenem-resistant (CR) Gram-negative bacilli (GNB) in patients with bloodstream infections (BSIs). Methods Prospective multicentric study including patients with GNB-BSI from19 Italian hospitals (June 2018-January 2020). Patients were followed-up to 30 days. Primary outcomes were 30-day mortality and attributable mortality. Attributable mortality was calculated in the following groups: KPC-producing Enterobacterales, metallo-β-lactamases (MBL)-producing Enterobacterales, CR-Pseudomonas aeruginosa (CRPA), CR-Acinetobacter baumannii (CRAB). A multivariable analysis with hospital fixed-effect was built to identify factors associated with 30-day mortality. Adjusted OR (aOR) were reported. Attributable mortality was calculated according to the DRIVE-AB Consortium. Results Overall,1276 patients with monomicrobial GNB BSI were included: 723/1276 (56.7%) carbapenem-susceptible (CS)-GNB, 304/1276 (23.8%) KPC-, 77/1276 (6%) MBL-pr...
Additional file 8: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Table S2. The risk of bias assessment for each trial, according to the Cochrane domain-based eval... more Table S2. The risk of bias assessment for each trial, according to the Cochrane domain-based evaluation. (DOCX 17 kb)
Additional file 7: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Table S1. Data concerning RCTs morbidity/mortality risk definition, population and type of surger... more Table S1. Data concerning RCTs morbidity/mortality risk definition, population and type of surgery, tools and target used. (DOCX 23 kb)
Additional file 6: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Figure S5. Forest plot for postoperative acute kidney injury (AKI) (defined as the proportion of ... more Figure S5. Forest plot for postoperative acute kidney injury (AKI) (defined as the proportion of patients who developed postoperative worsening of renal function, whichever definition was used). Studies were divided according to the kind of surgery (i.e., major abdominal, vascular, cardiac, thoracic, orthopedic, trauma surgery). Size of squares for odds ratio reflects weight of trial in pooled analyses. Horizontal bars represent 95% confidence intervals. (EPS 1847 kb)
Additional file 4: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Figure S3. Trial sequential analysis of postoperative acute kidney injury, including only low ris... more Figure S3. Trial sequential analysis of postoperative acute kidney injury, including only low risk of bias trials. A diversity adjusted information size of 9668 patients was calculated using α = 0.05 (two-sided), β = 0.20 (power 95%), an anticipated relative risk reduction of 2%, and an event proportion of 9% in the control arm. The blue cumulative z curve was constructed using a random effects model. (TIFF 3072 kb)
Additional file 8: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Table S2. The risk of bias assessment for each trial, according to the Cochrane domain-based eval... more Table S2. The risk of bias assessment for each trial, according to the Cochrane domain-based evaluation. (DOCX 17 kb)
Additional file 3: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Figure S2. Trial sequential analysis of postoperative acute kidney injury, including all trials. ... more Figure S2. Trial sequential analysis of postoperative acute kidney injury, including all trials. A diversity adjusted information size of 9668 patients was calculated using α = 0.05 (two-sided), β = 0.20 (power 95%), an anticipated relative risk reduction of 2%, and an event proportion of 9% in the control arm. The blue cumulative z curve was constructed using a random effects model. (TIFF 3072 kb)
Additional file 7: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Table S1. Data concerning RCTs morbidity/mortality risk definition, population and type of surger... more Table S1. Data concerning RCTs morbidity/mortality risk definition, population and type of surgery, tools and target used. (DOCX 23 kb)
Additional file 6: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Figure S5. Forest plot for postoperative acute kidney injury (AKI) (defined as the proportion of ... more Figure S5. Forest plot for postoperative acute kidney injury (AKI) (defined as the proportion of patients who developed postoperative worsening of renal function, whichever definition was used). Studies were divided according to the kind of surgery (i.e., major abdominal, vascular, cardiac, thoracic, orthopedic, trauma surgery). Size of squares for odds ratio reflects weight of trial in pooled analyses. Horizontal bars represent 95% confidence intervals. (EPS 1847 kb)
Evidence-based, standard antibiotic therapy for ventilator-associated pneumonia (VAP) caused by c... more Evidence-based, standard antibiotic therapy for ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) is a relevant unmet clinical need in the intensive care unit (ICU). We aimed to evaluate the effectiveness of first-line therapy with old and novel CRAB active antibiotics in monomicrobial VAP caused by CRAB. A prospective, observational study was performed in a mixed non-COVID-19 ICU. The primary outcome measure was clinical failure upon first-line targeted therapy. Features independently influencing failure occurrence were also investigated via Cox proportional multivariable analysis. To account for the imbalance in antibiotic treatment allocation, a propensity score analysis with an inverse probability treatment weighting approach was adopted. Of the 90 enrolled patients, 34 (38%) experienced clinical failure. Compared to patients who experienced a clinical resolution of VAP, those who had clinical failure were of an older age (median...
In the original version of the article, the group was mentioned incorrectly. The correct name is ... more In the original version of the article, the group was mentioned incorrectly. The correct name is "CSS COVID-19 Group". Also, in the Table 4 the p for ICU access and CKD were 0.024 (instead of 0.24) and 0.006 (instead of 0.06). These have been corrected with this erratum. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
It is still debated whether prophylactic doses of low-molecular-weight heparin (LMWH) are always ... more It is still debated whether prophylactic doses of low-molecular-weight heparin (LMWH) are always effective in preventing Venous Thromboembolism (VTE) and mortality in COVID-19. Furthermore, there is paucity of data for those patients not requiring ventilation. We explored mortality and the safety/efficacy profile of LMWH in a cohort of Italian patients with COVID-19 who did not undergo ventilation. From the initial cohort of 422 patients, 264 were enrolled. Most (n = 156, 87.7%) received standard LMWH prophylaxis during hospitalization, with no significant difference between medical wards and Intensive Care Unit (ICU). Major or not major but clinically relevant hemorrhages were recorded in 13 (4.9%) patients: twelve in those taking prophylactic LMWH and one in a patient taking oral anticoagulants (p: n.s.). Thirty-nine patients (14.8%) with median age 75 years. were transfused. Hemoglobin (Hb) at admission was significantly lower in transfused patients and Hb at admission inversely correlated with the number of red blood cells units transfused (p < 0.001). In-hospital mortality occurred in 76 (28.8%) patients, 46 (24.3%) of whom admitted to medical wards. Furthermore, Hb levels at admittance were significantly lower in fatalities (g/dl 12.3; IQR 2.4 vs. 13.3; IQR 2.8; Mann-Whitney U-test; p = 0.001). After the exclusion of patients treated by LMWH intermediate or therapeutic doses (n = 32), the logistic regression showed that prophylaxis significantly and independently reduced mortality (OR 0.31, 95% CI 0.13-0.85). Present data show that COVID-19 patients who do not require ventilation benefit from prophylactic doses of LMWH.
There is paucity of data on the transfusion need and its impact on the overall mortality in patie... more There is paucity of data on the transfusion need and its impact on the overall mortality in patients with COVID-19. We explored mortality in hospitalized patients with COVID-19 who required transfusions. Information on clinical variables and in-hospital mortality were obtained from medical records of 422 patients admitted to medical wards or the Intensive Care Unit (ICU). In-hospital mortality occurred in 147 (34.8%) patients, 94 (63.9%) of whom were admitted to the ICU. The median fatalities age was 77 years (IQR 14). Overall, 100 patients (60 males) received transfusion during hospitalization. The overall mortality was significantly and independently associated with age, ICU admission, Chronic Kidney Disease (CKD), and the number of transfused Red Blood Cell (RBC) units. Specifically, CKD was associated with mortality in patients admitted to medical wards, whereas the number of transfused RBC units predicted mortality in those admitted to the ICU. Transfusion strongly interacted w...
Our study examines the effectiveness of an educational approach to migraine patients. A course in... more Our study examines the effectiveness of an educational approach to migraine patients. A course in migraine education was set up for 30 patients suffering from this disease; meetings were structured taking into consideration specific educational aims, with parameters evaluated before the course, at the end of the course and at a 3-month follow-up. The results, particularly the increase in the migraineurs' knowledge of their disease and the decrease in the use of symptomatic drugs, suggest the effectiveness of the course. Furthermore, our study suggests that there is a need to build educational processes into therapeutic protocols, as they enable patients to manage their chronic diseases more correctly.
A 42-year-old man came to our headache unit in October 1995 complaining of recurrent attacks of h... more A 42-year-old man came to our headache unit in October 1995 complaining of recurrent attacks of headache, which had begun in February 1991. Chronic cluster headache was diagnosed, and he was given verapamil, 360 mg per day. The attacks ceased in the following months and verapamil was stopped in March 1996. In May 1997, a recurrence of the attacks required the readministration of verapamil, 360 mg per day. The attacks decreased (one to three per week), but after 2 months the patient reported a worsening in his condition due to the appearance of shorter attacks, which were diagnosed as chronic paroxysmal hemicrania. The administration of indomethacin, 225 mg per day, resulted in the disappearance of the short attacks. The concomitant occurrence of attacks of cluster headache and chronic paroxysmal hemicrania suggests the presence of shared factors in the pathophysiology of the two forms of headache. This hypothesis is supported by previous reports in the literature.
Background Our aim was to analyze mortality attributable to carbapenem-resistant (CR) Gram-negati... more Background Our aim was to analyze mortality attributable to carbapenem-resistant (CR) Gram-negative bacilli (GNB) in patients with bloodstream infections (BSIs). Methods Prospective multicentric study including patients with GNB-BSI from19 Italian hospitals (June 2018-January 2020). Patients were followed-up to 30 days. Primary outcomes were 30-day mortality and attributable mortality. Attributable mortality was calculated in the following groups: KPC-producing Enterobacterales, metallo-β-lactamases (MBL)-producing Enterobacterales, CR-Pseudomonas aeruginosa (CRPA), CR-Acinetobacter baumannii (CRAB). A multivariable analysis with hospital fixed-effect was built to identify factors associated with 30-day mortality. Adjusted OR (aOR) were reported. Attributable mortality was calculated according to the DRIVE-AB Consortium. Results Overall,1276 patients with monomicrobial GNB BSI were included: 723/1276 (56.7%) carbapenem-susceptible (CS)-GNB, 304/1276 (23.8%) KPC-, 77/1276 (6%) MBL-pr...
Additional file 8: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Table S2. The risk of bias assessment for each trial, according to the Cochrane domain-based eval... more Table S2. The risk of bias assessment for each trial, according to the Cochrane domain-based evaluation. (DOCX 17 kb)
Additional file 7: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Table S1. Data concerning RCTs morbidity/mortality risk definition, population and type of surger... more Table S1. Data concerning RCTs morbidity/mortality risk definition, population and type of surgery, tools and target used. (DOCX 23 kb)
Additional file 6: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Figure S5. Forest plot for postoperative acute kidney injury (AKI) (defined as the proportion of ... more Figure S5. Forest plot for postoperative acute kidney injury (AKI) (defined as the proportion of patients who developed postoperative worsening of renal function, whichever definition was used). Studies were divided according to the kind of surgery (i.e., major abdominal, vascular, cardiac, thoracic, orthopedic, trauma surgery). Size of squares for odds ratio reflects weight of trial in pooled analyses. Horizontal bars represent 95% confidence intervals. (EPS 1847 kb)
Additional file 4: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Figure S3. Trial sequential analysis of postoperative acute kidney injury, including only low ris... more Figure S3. Trial sequential analysis of postoperative acute kidney injury, including only low risk of bias trials. A diversity adjusted information size of 9668 patients was calculated using α = 0.05 (two-sided), β = 0.20 (power 95%), an anticipated relative risk reduction of 2%, and an event proportion of 9% in the control arm. The blue cumulative z curve was constructed using a random effects model. (TIFF 3072 kb)
Additional file 8: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Table S2. The risk of bias assessment for each trial, according to the Cochrane domain-based eval... more Table S2. The risk of bias assessment for each trial, according to the Cochrane domain-based evaluation. (DOCX 17 kb)
Additional file 3: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Figure S2. Trial sequential analysis of postoperative acute kidney injury, including all trials. ... more Figure S2. Trial sequential analysis of postoperative acute kidney injury, including all trials. A diversity adjusted information size of 9668 patients was calculated using α = 0.05 (two-sided), β = 0.20 (power 95%), an anticipated relative risk reduction of 2%, and an event proportion of 9% in the control arm. The blue cumulative z curve was constructed using a random effects model. (TIFF 3072 kb)
Additional file 7: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Table S1. Data concerning RCTs morbidity/mortality risk definition, population and type of surger... more Table S1. Data concerning RCTs morbidity/mortality risk definition, population and type of surgery, tools and target used. (DOCX 23 kb)
Additional file 6: of Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Figure S5. Forest plot for postoperative acute kidney injury (AKI) (defined as the proportion of ... more Figure S5. Forest plot for postoperative acute kidney injury (AKI) (defined as the proportion of patients who developed postoperative worsening of renal function, whichever definition was used). Studies were divided according to the kind of surgery (i.e., major abdominal, vascular, cardiac, thoracic, orthopedic, trauma surgery). Size of squares for odds ratio reflects weight of trial in pooled analyses. Horizontal bars represent 95% confidence intervals. (EPS 1847 kb)
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