Publications by authors named "Francesco Pugliese"

The role of Heart Rate Variability (HRV) indices in predicting the outcome of the weaning process remains a subject of debate. The aim of this study is to investigate HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation (IMV). The protocol of this systematic review was registered with PROSPERO (CRD42024485800).

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Background: COVID-19 vaccines reduced mortality, hospitalizations and ICUs admissions. Conversely, the impact of vaccination on Long COVID-19 syndrome is still unclear. This study compared the prevalence of post-acute sequelae at short and long-term follow-up among hospitalized unvaccinated and vaccinated COVID-19 survivors through a multidisciplinary approach.

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  • Low-grade endotoxemia, caused by lipopolysaccharide (LPS), is detected in COVID-19 patients, potentially promoting thrombosis through a pro-inflammatory and pro-coagulant state.
  • The study measured various biomarkers in 175 COVID-19 patients and 50 healthy controls, finding significantly elevated levels of markers like sNOX2-dp and D-dimer in COVID-19 patients, especially those with acute respiratory distress syndrome (ARDS).
  • Results suggest that factors like impaired gut barrier function, high NOX2 activation, and low albumin may lead to low-grade endotoxemia, increasing the risk of thrombotic events in COVID-19 patients.
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  • Umberto I Teaching Hospital in Rome set up a temporary ICU in March 2021 to manage critical COVID-19 patients and studied healthcare-associated infections (HAIs) among them across different COVID-19 variants.
  • Out of 355 patients admitted, 27.3% developed at least one HAI and the mortality rate was 49.6%, with older and more complex cases appearing over time, especially in the first year.
  • The research found that patients admitted during the later Omicron variants had lower chances of developing HAIs compared to those admitted during the Alpha variant, suggesting improvements in clinical management and infection control measures played a role in reducing HAI rates despite increasing patient severity.
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  • Invasive aspergillosis (IA) can cause severe respiratory issues, sometimes requiring ECMO, but there is limited existing data on its effectiveness in these cases.
  • This systematic review analyzed 32 patients with IA, finding that a majority of them had ARDS and that mortality was high at 78%, with numerous complications related to ECMO.
  • While ECMO may enhance survival for critically ill patients with IA, associated risks like superinfections and altered medication effects need cautious management.
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  • The study investigates long-term symptoms of COVID-19, focusing on both hospitalized and home-isolated patients to detail persistent issues related to long COVID.
  • Conducting a retrospective cohort study with 364 patients, researchers found that 82% experienced at least one symptom, primarily fatigue, and notable lung issues were detected in many patients.
  • The findings highlight significant long-term effects of COVID-19, stressing the need for comprehensive healthcare approaches and multidisciplinary teams to manage and improve patient outcomes.
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In this editorial, we explore the challenges of managing noncurative resections in early gastric cancer after endoscopic submucosal dissection (ESD), starting from the consideration recently made by Zhu . Specifically, we evaluate the management of eCura C1 lesions, where decisions regarding further interventions are pivotal yet contentious. Collaboration among endoscopists, surgeons, and pathologists is underscored to refine risk assessment and personalize therapeutic management.

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Background And Aim: In surgically altered anatomy (SAA), endoscopic retrograde cholangiopancreatography (ERCP) can be challenging, and it remains debatable the choice of the optimal endoscopic approach within this context. We aim to show our experience and evaluate the technical and clinical success of endoscopic treatment performed in the setting of adverse events (AE) after pancreaticoduodenectomy (PD).

Methods: This study was conducted on a retrospective cohort of patients presenting biliopancreatic complications after PD from 01/01/2012 to 31/12/2022.

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  • Early identification of high-risk elderly patients in the Emergency Department (ED) is essential for effective treatment and resource management, especially for those over 65 with acute medical conditions.
  • A study involving 953 patients found that a Neutrophil to Lymphocyte Ratio (NLR) greater than 8 is a significant predictor for 30-day mortality, with patients in this group exhibiting more severe symptoms and poorer vital signs.
  • The NLR was confirmed as an effective, low-cost tool for assessing mortality risk, but further validation in larger studies is necessary to strengthen these findings.
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Background: The efficacy and safety of dupilumab in atopic dermatitis (AD) have been defined in clinical trials but limited real-world evidence on long-term treatment outcomes is currently available to inform clinical decisions.

Objectives: To describe the long-term effectiveness and safety of dupilumab up to 48 months in patients with moderate-to-severe AD.

Methods: A multicentre, retrospective, dynamic cohort study was conducted to assess long-term effectiveness and safety of dupilumab in patients with moderate-to-severe AD in a real-world setting.

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: SARS-CoV-2 is the coronavirus responsible for the COVID-19 pandemic. Even though we are no longer in a pandemic situation, people are still getting infected, some of them need hospitalization and a few of them die. : We conducted a retrospective study including 445 patients who accessed the Emergency Section of Policlinico Umberto I, Rome, Italy, where they had routine blood exams.

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In recent decades, an incredible evolution in antithrombotic therapies used for treating patients with atherosclerosis, atrial fibrillation, and venous thromboembolism has been observed, leading to the availability of increasingly safe drugs. Nonetheless, bleeding complications remain a significant concern, with considerable health, social, and economic implications. To improve the acute management of patients experiencing or at risk for major bleeding events, specific reversal agents for antithrombotic drugs have been recently developed.

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  • Endoscopic papillectomy (EP) is considered a safe method for removing ampullary lesions, but information on handling leftover or returning adenomas is limited.
  • In a study of 95 patients who underwent EP from 2011 to 2022, 28.4% showed residual adenomas, and 11.6% experienced recurrences, highlighting the need for ongoing monitoring.
  • Despite complications in 25% of patients, most recurrences were successfully managed endoscopically, suggesting EP is a viable long-term treatment for these tumors.
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Background:  Endoscopic full-thickness resection (EFTR) is an effective and safe technique for nonlifting colorectal lesions. Technical issues or failures with the full-thickness resection device (FTRD) system are reported, but there are no detailed data. The aim of our study was to quantify and classify FTRD technical failures.

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  • Endoscopic stenting, particularly using lumen-apposing metal stents (LAMS), is a key treatment for benign biliary strictures, which can recur or cause stent migration.
  • A study involving 70 patients showed a 100% technical success rate and an 85.7% clinical success rate for treating these strictures with bi-flanged LAMS over six years.
  • While 17.1% of patients experienced adverse events like stent migration, LAMS demonstrated effectiveness, especially in post-surgical cases, suggesting it is a safe option for managing short benign biliary strictures.
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Abdominal surgery is associated with high postoperative mortality and morbidity in cirrhotic patients. Despite improvements in surgical techniques, clinical management, and intensive care, the outcome could be influenced by the degree of portal hypertension, the severity of hepatopathy, or the type of surgery. Preoperative transjugular intrahepatic portosystemic shunt (TIPS) placement, in addition to medical therapy, plays an important role in managing the complications of portal hypertension such as ascites, hepatic encephalopathy, variceal bleeding or portal vein thrombosis.

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  • COVID-19 has been linked to increased cases of pneumothorax (PTX) and pneumomediastinum (PNM), leading to concerns about poor patient outcomes and factors affecting mortality.
  • This observational study, analyzing data from nearly 12,000 COVID-19 patients in central Italy, identified specific risk factors for 28-day mortality and need for intubation related to pulmonary barotrauma.
  • Key risk factors for higher mortality included elevated SOFA scores, use of vasopressors, hypercapnia, low PaO/FiO ratio, and existing cardiovascular disease, while variants of concern did not impact mortality rates.
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Ustekinumab is a monoclonal antibody targeting the p40 subunit of IL-12 and IL-23, approved for treating psoriasis, psoriatic arthritis, and inflammatory bowel disease. Despite a remarkable success in treating chronic inflammatory conditions and a generally favorable safety profile, its role in inducing rare adverse events, such as interstitial pneumonia and acute respiratory distress syndrome (ARDS), remains largely uncharted. We report a case of a 66-year-old male patient treated with Ustekinumab for severe psoriasis who, after almost two years of treatment, developed dyspnea, asthenia, and fever progressing to non-infectious pneumonia and ARDS leading to ICU admission.

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  • Medication poisoning is a leading method of self-harm, with long-term studies needed to assess its mental health impact, especially post-COVID-19.
  • From 2018 to 2022, 756 self-harm cases were reviewed, showing a dip in 2020, but cases returned to pre-pandemic levels by 2021, with an increase in single-medication poisonings, particularly among youth aged 12-21.
  • Acetaminophen was the most common medication involved, and the findings suggest that young people with psychiatric issues are increasingly vulnerable, prompting a call for better mental health support and counseling in at-risk populations.
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Background: Severe COVID-19 is associated with an excessive immunothrombotic response and thromboinflammatory complications. Vaccinations effectively reduce the risk of severe clinical outcomes in patients with COVID-19, but their impact on platelet activation and immunothrombosis during breakthrough infections is not known.

Objectives: To investigate how preemptive vaccinations modify the platelet-immune crosstalk during COVID-19 infections.

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  • * New reversal agents for these antithrombotic drugs have been developed to manage major bleeding events effectively, showing promise in initial studies.
  • * The consensus document by ANMCO/SIMEU details these reversal agents' characteristics and suggests practical guidelines for their use in patients experiencing or at risk of severe bleeding.
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  • The long-term effects and consequences of SARS-CoV-2 infection remain largely unclear and not fully researched.
  • Ongoing studies are needed to better understand the full scope of health impacts related to COVID-19.
  • There is still much to learn about how the virus affects individuals over time and the overall implications for public health.
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