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Article: Aggregometry and thromboelastography to identify the timing to trach a COVID-19 patient receiving both antiplatelet therapy and enoxaparin.

Tescione, Marco / Vadalà, Eugenio / Marano, Graziella / Bruni, Andrea / Garofalo, Eugenio / Lavalle, Ovidia / Longhini, Federico / Battaglia, Enzo / Polimeni, Nicola / Labate, Demetrio / Caracciolo, Sarah / Giordano, Francesco / Caracciolo, Massimo / Macheda, Sebastiano

Clinical case reports

2021 Volume 9, Issue 3, Page(s) 1049–1054

Abstract: In COVID-19 patients receiving enoxaparin and antiplatelets therapy, aggregometry and thromboelastography might be considered an adjunctive tool to identify the time to perform procedures at risk of bleeding, such as tracheostomy. ...

Abstract	In COVID-19 patients receiving enoxaparin and antiplatelets therapy, aggregometry and thromboelastography might be considered an adjunctive tool to identify the time to perform procedures at risk of bleeding, such as tracheostomy.
Language	English
Publishing date	2021-01-09
Publishing country	England
Document type	Case Reports
ZDB-ID	2740234-4
ISSN	2050-0904
ISSN	2050-0904
DOI	10.1002/ccr3.3442
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Platelet aggregometry for hip fracture surgery in patients treated with clopidogrel: a pilot study.

Tescione, Marco / Vadalà, Eugenio / Marano, Graziella / Battaglia, Enzo / Bruni, Andrea / Garofalo, Eugenio / Longhini, Federico / Rovida, Serena / Polimeni, Nicola / Squillaci, Rosalba / Lascala, Stefano / Franco, Gaetana / Labate, Demetrio / Caracciolo, Massimo / Macheda, Sebastiano

Journal of clinical monitoring and computing

2021 Volume 36, Issue 3, Page(s) 823–828

Abstract: Surgery for hip fractures should be performed within 48 h from patient's admission. However, several factors including chronic antiplatelet therapy could delay operation. Among the totality of patients taking clopidogrel, up to 30% are resistant to the ... ...

Abstract	Surgery for hip fractures should be performed within 48 h from patient's admission. However, several factors including chronic antiplatelet therapy could delay operation. Among the totality of patients taking clopidogrel, up to 30% are resistant to the drug and have a normal platelets reactivity. We propose thromboelastography (TEG) with an ADP Platelet Mapping assay kit to assess platelet aggregation, a safe tool that could help to avoid surgery delay in those patients treated with antiplatelet therapy. A patient's blood sample was collected for aggregometry. If MA-ADP and platelets aggregation (%) were within normal values, the patient was fit for immediate surgery with neuraxial anesthesia and ultrasound-guided nerve block. If one of the two parameters or both were deranged, a mortality risk assessment was estimated. In the low risk category, the patients waited till normalization of the parameters, whereas in the high-risk group a general anesthesia and peripheral antalgic block was carried out. Nine patients were enrolled. Four of them showed normal aggregometry and surgery was performed within 24 h from admission. Two patients were classified as high mortality risk and surgery was carried out under general anesthesia. Three patients awaited operation till normalization of parameters. No peri or post-operative complications were reported. An aggregometry-guided protocol can safely expedite hip fracture surgery in patients taking clopidogrel. Nonetheless, in presence of a normal platelets function, clinician can opt for a neuraxial instead of general anesthesia reducing the incidence of postoperative delirium and cognitive dysfunction.Trial registration: prospectively registered at clinicaltrials.gov (NCT04642209; date of registration: 23rd November 2020).
MeSH term(s)	Adenosine Diphosphate ; Blood Platelets/physiology ; Clopidogrel/therapeutic use ; Hip Fractures/surgery ; Humans ; Pilot Projects ; Platelet Aggregation Inhibitors/therapeutic use ; Ticlopidine/therapeutic use
Chemical Substances	Platelet Aggregation Inhibitors ; Adenosine Diphosphate (61D2G4IYVH) ; Clopidogrel (A74586SNO7) ; Ticlopidine (OM90ZUW7M1)
Language	English
Publishing date	2021-05-06
Publishing country	Netherlands
Document type	Journal Article ; Observational Study
ZDB-ID	1418733-4
ISSN	1573-2614 ; 1387-1307 ; 0748-1977
ISSN (online)	1573-2614
ISSN	1387-1307 ; 0748-1977
DOI	10.1007/s10877-021-00714-z
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Article: Can Adenosine Fight COVID-19 Acute Respiratory Distress Syndrome?

Falcone, Carmela / Caracciolo, Massimo / Correale, Pierpaolo / Macheda, Sebastiano / Vadalà, Eugenio Giuseppe / La Scala, Stefano / Tescione, Marco / Danieli, Roberta / Ferrarelli, Anna / Tarsitano, Maria Grazia / Romano, Lorenzo / De Lorenzo, Antonino

Journal of clinical medicine

2020 Volume 9, Issue 9

Abstract: Coronavirus disease 2019 (COVID-19) patients can develop interstitial pneumonia, which, in turn, can evolve into acute respiratory distress syndrome (ARDS). This is accompanied by an inflammatory cytokine storm. severe acute respiratory syndrome ... ...

Abstract	Coronavirus disease 2019 (COVID-19) patients can develop interstitial pneumonia, which, in turn, can evolve into acute respiratory distress syndrome (ARDS). This is accompanied by an inflammatory cytokine storm. severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has proteins capable of promoting the cytokine storm, especially in patients with comorbidities, including obesity. Since currently no resolutive therapy for ARDS has been found and given the scientific literature regarding the use of adenosine, its application has been hypothesized. Through its receptors, adenosine is able to inhibit the acute inflammatory process, increase the protection capacity of the epithelial barrier, and reduce the damage due to an overactivation of the immune system, such as that occurring in cytokine storms. These features are known in ischemia/reperfusion models and could also be exploited in acute lung injury with hypoxia. Considering these hypotheses, a COVID-19 patient with unresponsive respiratory failure was treated with adenosine for compassionate use. The results showed a rapid improvement of clinical conditions, with negativity of SARS-CoV2 detection.
Keywords	covid19
Language	English
Publishing date	2020-09-21
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm9093045
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Article ; Online: Case Report: Canakinumab for the Treatment of a Patient With COVID-19 Acute Respiratory Distress Syndrome.

Caracciolo, Massimo / Macheda, Sebastiano / Labate, Demetrio / Tescione, Marco / La Scala, Stefano / Vadalà, Eugenio / Squillaci, Rosalba / D'Aleo, Francesco / Morabito, Antonella / Garreffa, Cristina / Marciano, Maria Concetta / Oliva, Esther N

Frontiers in immunology

2020 Volume 11, Page(s) 1942

Abstract: Severe cases of COVID-19 present with serious lung inflammation, acute respiratory distress syndrome and multiorgan damage. SARS-CoV-2 infection is associated with high cytokine levels, including interleukin-6 and certain subsets of immune cells, in ... ...

Abstract	Severe cases of COVID-19 present with serious lung inflammation, acute respiratory distress syndrome and multiorgan damage. SARS-CoV-2 infection is associated with high cytokine levels, including interleukin-6 and certain subsets of immune cells, in particular, NK, distinguished according to the cell surface density of CD56. Cytokine levels are inversely correlated with lymphocyte count, therefore cytokine release syndrome may be an impediment to the adaptive immune response against SARS-CoV-2 infection. Canakinumab, a monoclonal antibody targeting IL-1β is under investigation for the treatment of severe SAR-CoV-2 infection. An 85 year old male presenting in our hospital with COVID-19, whose condition was complicated by acute respiratory distress syndrome and cardiac and renal failure (with oliguria) after 25 days of hospitalization, was intubated and received canakinumab for compassionate use. On the next day, diuresis recovered and conditions improved: high IL-6 levels and NK cells expressing CD56
MeSH term(s)	Aged, 80 and over ; Antibodies, Monoclonal, Humanized/administration & dosage ; Antibodies, Monoclonal, Humanized/pharmacology ; Antibodies, Monoclonal, Humanized/therapeutic use ; Betacoronavirus ; CD56 Antigen/metabolism ; Coronavirus Infections/drug therapy ; Coronavirus Infections/virology ; Fatal Outcome ; Humans ; Interleukin-1beta/antagonists & inhibitors ; Interleukin-6/blood ; Killer Cells, Natural/immunology ; Male ; Pandemics ; Pneumonia, Viral/drug therapy ; Pneumonia, Viral/virology ; Respiratory Distress Syndrome, Adult/drug therapy ; Respiratory Distress Syndrome, Adult/virology ; Severity of Illness Index
Chemical Substances	Antibodies, Monoclonal, Humanized ; CD56 Antigen ; IL1B protein, human ; IL6 protein, human ; Interleukin-1beta ; Interleukin-6 ; NCAM1 protein, human ; canakinumab (37CQ2C7X93)
Keywords	covid19
Language	English
Publishing date	2020-08-25
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2020.01942
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Article ; Online: Fat mass affects nutritional status of ICU COVID-19 patients.

De Lorenzo, Antonino / Tarsitano, Maria Grazia / Falcone, Carmela / Di Renzo, Laura / Romano, Lorenzo / Macheda, Sebastiano / Ferrarelli, Anna / Labate, Demetrio / Tescione, Marco / Bilotta, Federico / Gualtieri, Paola

Journal of translational medicine

2020 Volume 18, Issue 1, Page(s) 299

Abstract: Background: Obesity and steatosis are associated with COVID-19 severe pneumonia. Elevated levels of pro-inflammatory cytokines and reduced immune response are typical of these patients. In particular, adipose tissue is the organ playing the crucial role. ...

Abstract	Background: Obesity and steatosis are associated with COVID-19 severe pneumonia. Elevated levels of pro-inflammatory cytokines and reduced immune response are typical of these patients. In particular, adipose tissue is the organ playing the crucial role. So, it is necessary to evaluate fat mass and not simpler body mass index (BMI), because BMI leaves a portion of the obese population unrecognized. The aim is to evaluate the relationship between Percentage of Fat Mass (FM%) and immune-inflammatory response, after 10 days in Intensive Care Unit (ICU). Methods: Prospective observational study of 22 adult patients, affected by COVID-19 pneumonia and admitted to the ICU and classified in two sets: (10) lean and (12) obese, according to FM% and age (De Lorenzo classification). Patients were analyzed at admission in ICU and at 10th day. Results: Obese have steatosis, impaired hepatic function, compromise immune response and higher inflammation. In addition, they have a reduced prognostic nutritional index (PNI), nutritional survival index for ICU patients. Conclusion: This is the first study evaluating FM% in COVID-19 patient. We underlined obese characteristic with likely poorly prognosis and an important misclassification of obesity. A not negligible number of patients with normal BMI could actually have an excess of adipose tissue and therefore have an unfavorable outcome such as an obese. Is fundamental personalized patients nutrition basing on disease phases.
MeSH term(s)	Adipose Tissue/pathology ; Adipose Tissue/physiopathology ; Adiposity ; Adult ; Betacoronavirus ; Body Mass Index ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/physiopathology ; Critical Care/methods ; Female ; Humans ; Inflammation ; Intensive Care Units ; Male ; Nutrition Assessment ; Nutritional Status ; Obesity/complications ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/physiopathology ; Prognosis ; Prospective Studies ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-08-03
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	2118570-0
ISSN	1479-5876 ; 1479-5876
ISSN (online)	1479-5876
ISSN	1479-5876
DOI	10.1186/s12967-020-02464-z
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Article ; Online: Efficacy and Effect of Inhaled Adenosine Treatment in Hospitalized COVID-19 Patients.

Frontiers in immunology

2021 Volume 12, Page(s) 613070

Abstract: Lack of specific antiviral treatment for COVID-19 has resulted in long hospitalizations and high mortality rate. By harnessing the regulatory effects of adenosine on inflammatory mediators, we have instituted a new therapeutic treatment with inhaled ... ...

Abstract	Lack of specific antiviral treatment for COVID-19 has resulted in long hospitalizations and high mortality rate. By harnessing the regulatory effects of adenosine on inflammatory mediators, we have instituted a new therapeutic treatment with inhaled adenosine in COVID-19 patients, with the aim of reducing inflammation, the onset of cytokine storm, and therefore to improve prognosis. The use of inhaled adenosine in COVID19 patients has allowed reduction of length of stay, on average 6 days. This result is strengthened by the decrease in SARS-CoV-2 positive days. In treated patients compared to control, a clear improvement in PaO
MeSH term(s)	Adenosine/pharmacology ; Adenosine/therapeutic use ; Adult ; Aged ; Anti-Bacterial Agents/administration & dosage ; Azithromycin/administration & dosage ; COVID-19/diagnostic imaging ; COVID-19/drug therapy ; COVID-19/physiopathology ; Case-Control Studies ; Cytochrome P-450 CYP3A Inhibitors/administration & dosage ; Cytokine Release Syndrome/physiopathology ; Enzyme Inhibitors/administration & dosage ; Female ; Heparin/administration & dosage ; Hospitalization ; Humans ; Hydroxychloroquine/administration & dosage ; Inflammation/drug therapy ; Lopinavir/administration & dosage ; Male ; Middle Aged ; Prognosis ; Tomography, X-Ray Computed
Chemical Substances	Anti-Bacterial Agents ; Cytochrome P-450 CYP3A Inhibitors ; Enzyme Inhibitors ; Lopinavir (2494G1JF75) ; Hydroxychloroquine (4QWG6N8QKH) ; Azithromycin (83905-01-5) ; Heparin (9005-49-6) ; Adenosine (K72T3FS567)
Language	English
Publishing date	2021-03-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2021.613070
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Article ; Online: Fat mass affects nutritional status of ICU COVID-19 patients

Journal of Translational Medicine

2020 Volume 18, Issue 1

Keywords	General Biochemistry, Genetics and Molecular Biology ; General Medicine ; covid19
Language	English
Publisher	Springer Science and Business Media LLC
Publishing country	us
Document type	Article ; Online
ISSN	1479-5876
DOI	10.1186/s12967-020-02464-z
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Case Report

Caracciolo, Massimo / Macheda, Sebastiano / Labate, Demetrio / Tescione, Marco / La Scala, Stefano / Vadalà, Eugenio / Squillaci, Rosalba / D’Aleo, Francesco / Morabito, Antonella / Garreffa, Cristina / Marciano, Maria Concetta / Oliva, Esther N.

Frontiers in Immunology

Canakinumab for the Treatment of a Patient With COVID-19 Acute Respiratory Distress Syndrome

2020 Volume 11

Keywords	covid19
Publisher	Frontiers Media SA
Publishing country	ch
Document type	Article ; Online
ZDB-ID	2606827-8
ISSN	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2020.01942
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Fat mass affects nutritional status of ICU COVID-19 patients

J Transl Med

Abstract: BACKGROUND: Obesity and steatosis are associated with COVID-19 severe pneumonia. Elevated levels of pro-inflammatory cytokines and reduced immune response are typical of these patients. In particular, adipose tissue is the organ playing the crucial role. ...

Abstract	BACKGROUND: Obesity and steatosis are associated with COVID-19 severe pneumonia. Elevated levels of pro-inflammatory cytokines and reduced immune response are typical of these patients. In particular, adipose tissue is the organ playing the crucial role. So, it is necessary to evaluate fat mass and not simpler body mass index (BMI), because BMI leaves a portion of the obese population unrecognized. The aim is to evaluate the relationship between Percentage of Fat Mass (FM%) and immune-inflammatory response, after 10 days in Intensive Care Unit (ICU). METHODS: Prospective observational study of 22 adult patients, affected by COVID-19 pneumonia and admitted to the ICU and classified in two sets: (10) lean and (12) obese, according to FM% and age (De Lorenzo classification). Patients were analyzed at admission in ICU and at 10th day. RESULTS: Obese have steatosis, impaired hepatic function, compromise immune response and higher inflammation. In addition, they have a reduced prognostic nutritional index (PNI), nutritional survival index for ICU patients. CONCLUSION: This is the first study evaluating FM% in COVID-19 patient. We underlined obese characteristic with likely poorly prognosis and an important misclassification of obesity. A not negligible number of patients with normal BMI could actually have an excess of adipose tissue and therefore have an unfavorable outcome such as an obese. Is fundamental personalized patients nutrition basing on disease phases.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #691901
Database	COVID19

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Article: Case Report: Canakinumab for the Treatment of a Patient With COVID-19 Acute Respiratory Distress Syndrome

Caracciolo, Massimo / Macheda, Sebastiano / Labate, Demetrio / Tescione, Marco / La Scala, Stefano / Vadalà, Eugenio / Squillaci, Rosalba / D039, / Aleo, Francesco / Morabito, Antonella / Garreffa, Cristina / Marciano, Maria Concetta / Oliva, Esther N

Front Immunol

Abstract	Severe cases of COVID-19 present with serious lung inflammation, acute respiratory distress syndrome and multiorgan damage. SARS-CoV-2 infection is associated with high cytokine levels, including interleukin-6 and certain subsets of immune cells, in particular, NK, distinguished according to the cell surface density of CD56. Cytokine levels are inversely correlated with lymphocyte count, therefore cytokine release syndrome may be an impediment to the adaptive immune response against SARS-CoV-2 infection. Canakinumab, a monoclonal antibody targeting IL-1ß is under investigation for the treatment of severe SAR-CoV-2 infection. An 85 year old male presenting in our hospital with COVID-19, whose condition was complicated by acute respiratory distress syndrome and cardiac and renal failure (with oliguria) after 25 days of hospitalization, was intubated and received canakinumab for compassionate use. On the next day, diuresis recovered and conditions improved: high IL-6 levels and NK cells expressing CD56 bright (associated with cytokine relase) were significantly reduced giving rise to NK CD56 dim . Patient died on day 58 with pulmonary bacterial superinfection and persistent SARS-CoV-2 positivity. In conclusion, canakinumab rescued a high risk, very elderly patient, from multiorgan damage complicating COVID-19. It may represent an useful treatment in severe cases.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #800867
Database	COVID19

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