Publications by authors named "Stefania Ianniello"

Spondylodiscitis is an infection of the intervertebral disc, the adjacent vertebral body, and/or contiguous structures due to the introduction of infectious agent, usually by the hematogenous route. Imaging is crucial in assessing bacterial and tubercular spondylodiscitis, as well as their associated complications. Magnetic resonance imaging in particular can clearly depict osteo-structural changes in the vertebral body and the associated disc, as well as any soft-tissue complications, such as paravertebral abscess and/or epidural abscess, improving disease characterization and helping to recognize the agent involved.

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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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  • 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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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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Objective: to evaluate the efficacy of US, both qualitatively and semi-quantitatively, in the selection of treatment for the Covid-19 patient, using patient triage as the gold standard.

Methods: Patients admitted to the Covid-19 clinic to be treated with monoclonal antibodies (mAb) or retroviral treatment and undergoing lung ultrasound (US) were selected from the radiological data set between December 2021 and May 2022 according to the following inclusion criteria: patients with proven Omicron variant and Delta Covid-19 infection; patients with known Covid-19 vaccination with at least two doses. Lung US (LUS) was performed by experienced radiologists.

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The overall probability of infection with RSV, influenza virus, or SARS-CoV-2 in the general population is assessed as high by the ECDC. A high level of respiratory virus circulation increases hospitalizations and places significant pressure on healthcare systems. Here we describe the case of a 52-year-old woman who recovered from pneumonia with a triple infection with SARS-CoV-2, RSV, and Influenza virus.

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Aim: To evaluate the role of lung ultrasound (LUS) in recognizing lung abnormalities in pregnant women affected by COVID-19 pneumonia.

Materials And Methods: An observational study analyzing LUS patterns in 60 consecutively enrolled pregnant women affected by COVID-19 infection was performed. LUS was performed by using a standardized protocol by Soldati et al.

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  • 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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Purpose: To analyze the vaccine effect by comparing five groups: unvaccinated patients with Alpha variant, unvaccinated patients with Delta variant, vaccinated patients with Delta variant, unvaccinated patients with Omicron variant, and vaccinated patients with Omicron variant, assessing the “gravity” of COVID-19 pulmonary involvement, based on CT findings in critically ill patients admitted to Intensive Care Unit (ICU). Methods: Patients were selected by ICU database considering the period from December 2021 to 23 March 2022, according to the following inclusion criteria: patients with proven Omicron variant COVID-19 infection with known COVID-19 vaccination with at least two doses and with chest Computed Tomography (CT) study during ICU hospitalization. Wee also evaluated the ICU database considering the period from March 2020 to December 2021, to select unvaccinated consecutive patients with Alpha variant, subjected to CT study, consecutive unvaccinated and vaccinated patients with Delta variant, subjected to CT study, and, consecutive unvaccinated patients with Omicron variant, subjected to CT study.

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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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Due to the increasing number of COVID-19-infected and vaccinated individuals, radiologists continue to see patients with COVID-19 pneumonitis and recall pneumonitis, which could result in additional workups and false-positive results. Moreover, cancer patients undergoing immunotherapy may show therapy-related pneumonitis during imaging management. This is otherwise known as immune checkpoint inhibitor-related pneumonitis.

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Pulmonary thromboembolism (PTE) has been associated with tuberculosis (TB), but the true incidence is unknown. The aim of our study was to retrospectively evaluate the PTE prevalence in TB patients hospitalized at the National Institute for Infectious Diseases L. Spallanzani during the January 2016-December 2021 period.

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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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Objective: To investigate two commercial software and their efficacy in the assessment of chest CT sequelae in patients affected by COVID-19 pneumonia, comparing the consistency of tools.

Materials And Methods: Included in the study group were 120 COVID-19 patients (56 women and 104 men; 61 years of median age; range: 21-93 years) who underwent chest CT examinations at discharge between 5 March 2020 and 15 March 2021 and again at a follow-up time (3 months; range 30-237 days). A qualitative assessment by expert radiologists in the infectious disease field (experience of at least 5 years) was performed, and a quantitative evaluation using thoracic VCAR software (GE Healthcare, Chicago, Illinois, United States) and a pneumonia module of ANKE ASG-340 CT workstation (HTS Med & Anke, Naples, Italy) was performed.

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Objective: To assess the effectiveness of 3 novel lung ultrasound (LUS)-based parameters: Pneumonia Score and Lung Staging for pneumonia staging and COVID Index, indicating the probability of SARS-CoV-2 infection.

Methods: Adult patients admitted to the emergency department with symptoms potentially related to pneumonia, healthy volunteers and clinical cases from online accessible databases were evaluated. The patients underwent a clinical-epidemiological questionnaire and a LUS acquisition, following a 14-zone protocol.

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Background: critically ill patients with SARS-CoV-2 infection present a hypercoagulable condition. Anticoagulant therapy is currently recommended to reduce thrombotic risk, leading to potentially severe complications like spontaneous bleeding (SB). Percutaneous transcatheter arterial embolization (PTAE) can be life-saving in critical patients, in addition to medical therapy.

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A convalescent, non-severe, patient with COVID-19 was enrolled as a hyper-immune plasma voluntary donor by the Immuno-Hematology and Transfusion Unit of the Regina Elena National Cancer Institute in Rome, under the TSUNAMI national study criteria. During a nearly 6-month period (May-October 2020), the patient was closely monitored and underwent four hyperimmune plasma collections. Serum SARS-CoV-2 (anti-S + anti-N) IgG and IgM, anti-S1 IgA, and neutralizing titers (NTs) were measured.

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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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Background: The WHO advised that the impact of COVID-19 pandemic on TB services was estimated to be dramatic due to the disruption of TB services.

Methods: A retrospective data collection and evaluation was conducted to include all the patients hospitalized for TB at INMI from 9 March to 31 August 2020 (lockdown period and three months thereafter). For the purpose of the study, data from patients hospitalized in the same period of 2019 were also collected.

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Article Synopsis
  • Critically ill COVID-19 patients are at higher risk for developing a hypercoagulable state, leading to the recommendation for anticoagulation to prevent thrombosis, but this can result in complications like ilio-psoas haematomas (IPH).
  • A case series from a COVID hospital in Rome reported seven cases of IPH among 925 COVID-19 patients, indicating an incidence of 7.6 cases per 1000 hospitalizations, all with severe pneumonia and at least one comorbidity.
  • Awareness of the potential for IPH as a serious complication in COVID-19 patients on anticoagulation is crucial, with symptoms including lower limb hypoesthesia, pain during femoral rotation, and signs of hypov
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Ultrasound is the most disruptive innovation in intensive care life, above all in this time, with a high diagnostic value when applied appropriately. In recent years, point-of-care lung ultrasound has gained significant popularity as a diagnostic tool in the acutely dyspnoeic patients. In the era of Sars-CoV-2 outbreak, lung ultrasound seems to be strongly adapting to the follow-up for lung involvement of patients with ascertaining infections, till to be used, in our opinion emblematically, as a screening test in suspected patients at the emergency triage or at home medical visit.

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Background: Extended focused abdominal sonography for trauma (e-FAST) is part of the primary survey in patients with high-energy trauma. However, it does not identify patients with retroperitoneal haemorrhage associated with significant pelvic trauma. A traumatic diastasis of pubic symphysis, as well as an 'open book' (OB) pelvic injury, is a diagnostic clue to recognize unstable pelvis with higher risk of bleeding.

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  • Pneumothorax detection is crucial in emergency settings due to the risk of hemodynamic instability, with chest ultrasound (US) emerging as a more sensitive diagnostic tool compared to traditional radiography.
  • * The study analyzed data from 3320 trauma patients over six years, using extended focused assessment with sonography in trauma (E-FAST) to identify pneumothorax (PNX) cases, which were then compared to results from multidetector computed tomography (MDCT).
  • * E-FAST showed a high sensitivity of 93.6% and specificity of 99.8% in detecting PNX, indicating its effectiveness as a rapid assessment tool in trauma care.
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