Antonino Mazzone

The ILAILL study: iloprost as adjuvant to surgery for acute ischemia of lower limbs: a randomized, placebo-controlled, double-blind study by the italian society for vascular and endovascular surgery.

Summary Background Data:High rate of complications has been reported following revascularization for acute limb ischemia (ALI). No adjuvant pharmacologic treatment, apart from anticoagulation and standard perioperative care, has been shown clinically effective. Objective:Aim of this study was to evaluate the effects of the prostacyclin analog iloprost as adjuvant to surgery for ALI. Methods:A total of 300 patients were randomly assigned to receive perioperative iloprost (intra-arterial, intraoperative bolus of 3000 ng, plus intravenous infusion of 0.5–2.0 ng/kg/min for 6 hours/day for 4–7 days following surgery), or placebo. The primary endpoint was the combined incidence of death and amputation at 3-month follow-up. Secondary endpoints were the incidence of each single major complication, total event rate, symptomatology, and tolerability. Results:The combined incidence of death and amputation was 19.9% in the placebo and 14.1% in the iloprost group (relative risk, 1.56; 95% confidence interval, 0.89–2.75, P = 0.12, Cox regression analysis). A statistically significant lower mortality (4.7%) was reported in patients receiving iloprost, compared with controls (10.6%; relative risk, 2.61; 95% confidence interval, 1.07–6.37, P = 0.03). The overall incidence of fatal plus major cardiovascular events was 33.1% and 22.8% in placebo and iloprost groups, respectively (relative risk, 1.61; 95% confidence interval, 1.04–2.49, P = 0.03). No serious adverse reactions occurred after iloprost administration, nor differences in the incidence of bleeding or hypotension between treatment groups. Conclusions:Although at lower levels than previously reported, our results confirm the severity of ALI. Iloprost as adjuvant to surgery significantly reduced mortality and overall major event rate. Further data are needed to support this finding, and to face a still open medical issue.

Evaluation of the threshold value for the Modified Early Warning Score (MEWS) in medical septic patients: a secondary analysis of an Italian multicentric prospective cohort (SNOOPII study).

Background Due to aging and resources limitation, septic patients are often admitted to medical wards (MWs). Early warning deterioration is a relevant issue in this setting. Unfortunately, a suitable prognostic score has not been identified, yet. Aim To explore the ability of Modified Early Warning Score (MEWS) to predict the in-hospital mortality in septic patients admitted to MWs. Design Secondary analysis of a multicentric prospective study. Methods Consecutive septic patients with positive blood culture admitted to 31 Italian MWs were included. Baseline characteristics, clinics, isolates, rate of transfer to ICU, MEWS was collected on admission according to the study protocol. The accuracy of MEWS in predicting the in-hospital mortality was assessed with the area under the receiver-operating characteristic curves. Sensitivity, specificity, positive and negative predictive value (PPV and NPV), likelihood ratio (LR) were calculated for different MEWS cut-offs and age/comorbidities subgroups. Results In total 526 patients were included in this analysis. Median MEWS was (range 0-11). In-hospital mortality was 14.8% and transfer to ICU 1.3%. Mortality progressively increased according to MEWS (3% in MEWS 0 vs. 27% in MEWS >5; Chi square for trend P < 0.05). The AUC of MEWS in predicting in-hospital mortality was 0.596 (95% CI, 0.524, 0.669). MEWS did not appear to have an adequate sensitivity, sensibility, PPV, NPV and LR both in the whole population and in the pre-specified subgroups. Conclusions Our findings do not seem to support the use of MEWS to predict the in-hospital mortality risk of sepsis in MWs.

Prulifloxacin vs Levofloxacin for Exacerbation of COPD after Failure of Other Antibiotics.

ABSTRACT The chronic course and evolution of chronic obstructive pulmonary disease (COPD) is often characterized by periods of exacerbation of symptoms, which have a negative impact on the quality of life of patients, as well as on the evolution of COPD, and represent a significant cause of medical intervention and hospitalization. Very few data are available on the efficacy of rescue antibiotics in patients with acute exacerbation of COPD (AECOPD) unresponsive to previous treatment. The aim of this study was to evaluate the efficacy of two fluoroquinolones in AECOPD previously treated without success. The FADOI-FLOR study is a randomized, single-blind, non-inferiority comparison between levofloxacin and prulifloxacin. Primary end-point was “therapeutic success” at Day 10 of treatment, defined as disappearance of signs/symptoms or decrease of at least three points of a global score of symptomatology (maximum score = 15). 258 patients were enrolled (128 levofloxacin and 130 prulifloxacin), in 25 centers. A very high proportion of patients in the two groups had therapeutic success at Day-10 (levofloxacin 93.0% vs prulifloxacin 96.7%, population intention-to-treat; 94.6% vs 99.1%, population per-protocol). Earlier therapeutic success (within 7 days) was achieved in 32.0% and 36.2% of patients receiving levofloxacin or prulifloxacin, respectively. At 3-month follow-up, re-exacerbations occurred in 17.8% of patients treated with levofloxacin and 14.2% of those receiving prulifloxacin (p = 0.44). In conclusion, fluoroquinolones are very effective in the treatment of AECOPD resistant to other antibiotics.

La Medicina Interna ospedaliera: tra complessità ed intensità assistenziale verso una medicina sostenibile

La Medicina Interna ospedaliera: tra complessita ed intensita assistenziale verso una medicina sostenibile M. Campanini La complessita dei pazienti ricoverati nei reparti ospedalieri di Medicina Interna: di che cosa stiamo parlando? R. Nardi, D. Borioni, F. Berti, A. Greco, G. Scanelli, P. Leandri, M. Reta, M. Mazzetti, A. Pasquale, G. Belmonte, M. Magnani, S. Frasson, C. Baldo, G. Gussoni, G. Vescovo, M. La Regina, M. Campanini, I. Iori, G. Mathieu, A. Mazzone, C. Nozzoli, A. Fontanella Strumenti di valutazione della complessita nel paziente internistico: un percorso ancora da tracciare S. Frasson, R. Nardi La stratificazione per severita dei pazienti ricoverati in Medicina Interna: un lavoro ancora incompiuto. Valutazione clinica e non strumenti surrogati G. Chesi, R. Nardi Nella Medicina Interna ospedaliera vogliamo un sistema sanitario pubblico sostenibile: considerazioni e proposte di FADOI per ridurre le spese inappropriate R. Nardi, D. Borioni, A. Pasquale, G. Chesi, F. Berti, L.M. Fabbri, I. Iori, G. Mathieu, A. Mazzone, M. Campanini, C. Nozzoli, A. Fontanella Il medico ed il suo paziente: fare giusto, non troppo ne troppo poco F. D’Amore Il decalogo ANIMO per un’assistenza Slow Medicine : le raccomandazioni generali degli infermieri di Medicina Interna per un’assistenza sobria, rispettosa e giusta G. Bordin, M. Bonfanti, F. Calabria, R. Cossu, C. Cozzi, T. Esposito, C. Ganzini, E. Gragnoli, R. Leotta, M. Lince, L. Lucci, G. Manfroni, M. Martini, G. Pentella, N. Postal, R. Rapetti, O. Teti, G. Zocchi, A. Zuccone, C. Gatta Come organizzare l’Area Medica per affrontare le nuove sfide della complessita clinica ed assistenziale I. Stefani, A. Mazzone I modelli organizzativi per l’assistenza territoriale primaria nel Servizio Sanitario Nazionale: evidenze ed intervento specialistico D. Croce, A. Mazzone La Medicina Interna ospedaliera: tra complessita ed intensita assistenziale verso una medicina sostenibile A. Fontanella