Publications by authors named "Gianpiero DʼOffizi"

Background And Aims: Bulevirtide (BLV) 2 mg/day is EMA approved for treatment of compensated chronic hepatitis due to Delta virus (HDV) infection, however real-life data in large cohorts of patients with cirrhosis are lacking.

Methods: Consecutive HDV-infected patients with cirrhosis starting BLV 2 mg/day since September 2019 were included in a European retrospective multicenter real-life study (SAVE-D). Patient characteristics before and during BLV treatment were collected.

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Three years into the COVID-19 pandemic, mass vaccination campaigns have largely controlled the disease burden but have not prevented virus circulation. Unfortunately, many immunocompromised patients have failed to mount protective immune responses after repeated vaccinations, and liver transplant recipients are no exception. Across different solid organ transplant populations, the plasma levels of Torquetenovirus (TTV), an orphan and ubiquitous human virus under control of the immune system, have been shown to predict the antibody response after COVID-19 vaccinations.

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The hepatitis delta virus (HDV) exhibits high genetic and evolutionary variability and is classified into eight genotypes (HDV-1 to -8). HDV-1 is the most widespread genotype worldwide and includes several subtypes. It predominates mainly in Europe, the Middle East, North America, and Northern Africa, and is associated with both severe and mild forms of liver disease.

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Background: Italy has a high HCV prevalence, and despite the approval of a dedicated fund for 'Experimental screening' for 2 years, screening has not been fully implemented. We aimed to evaluate the long-term impact of the persisting delay in HCV elimination after the Coronavirus disease 2019 (COVID-19) pandemic in Italy.

Methods: We used a mathematical, probabilistic modelling approach evaluating three hypothetical 'Inefficient', 'Efficient experimental' and 'WHO Target' screening scenarios differing by treatment rates over time.

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Article Synopsis
  • COVID-19 can lead to acute respiratory distress syndrome, requiring ICU admission and invasive ventilation, which increases the risk of ventilator-associated pneumonia (VAP) in these patients.
  • A study of 284 ICU patients with COVID-19 found a 33% incidence of VAP, predominantly caused by Pseudomonas aeruginosa and Klebsiella spp., with significant antimicrobial resistance noted in these bacteria.
  • Key risk factors for developing VAP included receiving blood transfusions and certain therapies, with higher VAP rates linked to orotracheal intubation compared to tracheostomy, although patient positioning and specific admission ratios did not correlate significantly with VAP incidence.
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Objectives: We describe the preliminary results of bulevirtide compassionate use in patients with hepatitis B and delta virus (HBV/HDV)-related cirrhosis and clinically significant portal hypertension, including those living with HIV.

Methods: We conducted a prospective observational study of consecutive patients. Clinical evaluation, liver function tests, bile acid levels, HDV-RNA, HBV-DNA, hepatitis B surface antigen, and liver and spleen stiffness were assessed at baseline and after treatment months 1, 2, 3, 4, 6, 9, and 12.

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Despite the higher transmissibility of Omicron Variant of Concern (VOC), several reports have suggested lower risk for hospitalization and severe outcomes compared to previous variants of SARS-CoV-2. This study, enrolling all COVID-19 adults admitted to a reference hospital who underwent both the S-gene-target-failure test and VOC identification by Sanger sequencing, aimed to describe the evolving prevalence of Delta and Omicron variants and to compare the main in-hospital outcomes of severity, during a trimester (December 2021 to March 2022) of VOCs' cocirculation. Factors associated with clinical progression to noninvasive ventilation (NIV)/mechanical ventilation (MV)/death within 10 days and to MV/admission to intensive care unit (ICU)/death within 28 days, were investigated through multivariable logistic regressions.

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Coronavirus-disease-2019 (COVID-19) mRNA vaccination effectively reduces mortality and morbidity in cirrhotic patients, but the immunogenicity and safety of vaccination have been partially characterized. The study aimed to evaluate humoral response, predictive factors, and safety of mRNA-COVID-19 vaccination in cirrhotic patients compared to healthy subjects. A prospective, single-center, observational study enrolled consecutive cirrhotic patients who underwent mRNA-COVID-19 vaccination from April to May 2021.

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Article Synopsis
  • Weaker immune responses were observed in liver transplant recipients after receiving just two doses of anti-SARS-CoV2 vaccination, prompting a study on the effects of a third dose.
  • In a study involving 122 liver transplant recipients, significant improvements in both humoral (antibodies) and cell-mediated (T-cell activity) immune responses were noted after the third vaccine dose, with 86.4% of previously non-responding patients showing a positive response.
  • Factors such as shorter time since transplantation were linked to reduced immune responses, while the presence of mycophenolate mofetil did not negatively impact the response rates; 60% of patients maintained protective antibodies against the Omicron variant 12 weeks post-third dose
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In the recent 2022 monkeypox (Mpox) global outbreak, cases have been mostly documented among men who have sex with men. Proctitis was reported in almost 14% of cases. In this study, four Mpox-confirmed cases requiring hospitalizations for severe proctitis were characterized by clinical, virological, microbiological, endoscopic, and histological aspects.

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Aero-medical evacuation has been considered as a feasible and safe treatment option during COVID pandemic, particularly when the needs of affected patients exceed what local clinics and hospitals are supposed to provide. In this article, we analyzed the clinical course of 17 patients medically evacuated to the "L. Spallanzani" Institute in Rome, Italy from foreign countries, mainly Africa and Eastern Europe, who had COVID-19 pneumonia with, or without, coinfections such as malaria, HIV, tuberculosis and microbiologically confirmed sepsis syndrome.

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Most patients infected with SARS-CoV-2 display mild symptoms with good prognosis, while 20% of patients suffer from severe viral pneumonia and up to 5% may require intensive care unit (ICU) admission due to severe acute respiratory syndrome, which could be accompanied by multiorgan failure.Plasma proteomics provide valuable and unbiased information about disease progression and therapeutic candidates. Recent proteomic studies have identified molecular changes in plasma of COVID-19 patients that implied significant dysregulation of several aspects of the inflammatory response accompanied by a general metabolic suppression.

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Article Synopsis
  • The study explores the effectiveness of noninvasive ventilation (NIV) in adult patients with Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19, revealing a significant rate of NIV failure and mortality risks based on ARDS severity.
  • Out of 307 ARDS patients hospitalized, 224 received NIV, with 37.5% experiencing failure, particularly higher in moderate and severe cases compared to mild ARDS.
  • The research indicates that starting NIV in mild ARDS patients may enhance its effectiveness and decrease the risk of mortality, suggesting a potential benefit in early intervention for these patients.
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(1) Background: Although COVID-19 is largely a respiratory disease, it is actually a systemic disease that has a wide range of effects that are not yet fully known. The aim of this study was to determine the incidence, predictors and outcome of non-hepatic hyperammonemia (NHH) in COVID-19 in intensive care unit (ICU); (2) Methods: This is a 3-month prospective observational study in a third-level COVID-19 hospital. The authors collected demographic, clinical, severity score and outcome data.

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Article Synopsis
  • Current COVID-19 treatments are mainly limited to vaccines and monoclonal antibodies, highlighting a potential gap for effective prophylactic options.
  • Propolis, a substance produced by honeybees, shows promise as a treatment due to its immune-boosting and antiviral properties, particularly against coronaviruses, yet more research is needed to confirm its effectiveness.
  • In laboratory tests, a standardized extract of Eurasian poplar propolis displayed significant antiviral effects against SARS-CoV-2, reducing viral replication and protecting cell health, although it did not prevent the virus from entering cells.
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Background: There is conflicting evidence for how HIV influences COVID-19 infection. The aim of this study was to compare characteristics at presentation and the clinical outcomes of people living with HIV (PLWH) versus HIV-negative patients (non-PLWH) hospitalized with COVID-19. Methods: Primary endpoint: time until invasive ventilation/death.

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Introduction: Transplantation among HIV positive patients may be a valuable therapeutic intervention. This study involves an HIV D+/R+ kidney-liver transplantation, where PBMC-associated HIV quasispecies were analyzed in donor and transplant recipients (TR) prior to transplantation and thereafter, together with standard viral monitoring.

Methods: The donor was a 54 year of age HIV infected woman: kidney and liver recipients were two HIV infected men, aged 49 and 61.

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Article Synopsis
  • Asymptomatic individuals make up a significant portion (25-45%) of SARS-CoV-2 infections, particularly among those on mild immunosuppressive therapy, leading to potential extended virus spread.
  • A study involving 278 liver transplant recipients in Central Italy found that serology testing every four months effectively increased infection detection rates, revealing that 31 individuals had either past or active SARS-CoV-2 infections.
  • The research indicated that factors like gender and kidney function affected the likelihood of being asymptomatic, and the overall anti-SARS-CoV-2 seroprevalence among liver transplant recipients was similar to the general population in the region (11.2%).
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Article Synopsis
  • COVID-19 has led to increased cases of acute respiratory distress syndrome (ARDS), with a concurrent rise in pneumothorax (PNX) and pneumomediastinum (PNM), but the prevalence and risk factors for these conditions remain uncertain.
  • An observational study of COVID-19 patients with moderate-severe ARDS was conducted to analyze the incidence of barotrauma during the pandemic, focusing on three distinct waves and utilizing positive-pressure ventilation (PPV).
  • Results showed a barotrauma incidence of 7.2% in ARDS patients on PPV, with 40 patients developing PNX/PMN, while mortality rates in the barotrauma group were 47.2%, compared to 37
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Background: Several biomarkers have been identified to predict the outcome of COVID-19 severity, but few data are available regarding sex differences in their predictive role. Aim of this study was to identify sex-specific biomarkers of severity and progression of acute respiratory distress syndrome (ARDS) in COVID-19.

Methods: Plasma levels of sex hormones (testosterone and 17β-estradiol), sex-hormone dependent circulating molecules (ACE2 and Angiotensin1-7) and other known biomarkers for COVID-19 severity were measured in male and female COVID-19 patients at admission to hospital.

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Background: Previous reports highlighted the efficacy of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific monoclonal antibodies (mAbs) against coronavirus disease 2019.

Methods: We conducted a prospective study on the clinical outcome and antiviral effects of mAbs added to standard of care therapy in SARS-CoV-2-infected patients with primary antibody defects.

Results: Median time of SARS-CoV-2 quantitative polymerase chain reaction (qPCR) positivity was shorter in 8 patients treated with mAbs (22 days) than in 10 patients treated with standard of care therapy only (37 days, P=.

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Article Synopsis
  • * Results showed that liver transplant recipients had significantly lower immune response rates than healthy individuals for both antibody and immune cell responses.
  • * Factors such as being recently transplanted and taking specific immunosuppressive medications (like mycophenolate mofetil) were linked to this reduced response, although the production of antibodies and cytokines remained closely tied amongst the transplant recipients.
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Background: The benefits and timing of percutaneous dilatational tracheostomy (PDT) in Intensive Care Unit (ICU) COVID-19 patients are still controversial. PDT is considered a high-risk procedure for the transmission of SARS-CoV-2 to healthcare workers (HCWs). The present study analyzed the optimal timing of PDT, the clinical outcomes of patients undergoing PDT, and the safety of HCWs performing PDT.

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Approximately 71 million people worldwide are infected with the hepatitis C virus (HCV). Injectable drug use represents the most common route of transmission in Europe and other developed countries. We studied the molecular characteristics of the HCV infection among mono-infected people who used drugs (PWUD) in Italy.

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Article Synopsis
  • The study analyzed the effectiveness of hydroxychloroquine (HCQ) in treating COVID-19 by observing 4,396 patients hospitalized in Italy from February to May 2020, revealing mixed results from previous research.
  • Two patient clusters were identified: a younger, healthier group at lower risk of death and an older, sicker group at higher risk, highlighting differing impacts of HCQ on these populations.
  • HCQ appeared to significantly reduce mortality risk in the lower risk cluster, suggesting that it may be more beneficial for patients with fewer comorbidities, potentially clarifying debates around its efficacy in COVID-19 treatment.
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