Azienda Ospedaliera G.Rummo

Purpose: Hip fractures in older adults require multidisciplinary care and are associated with high morbidity and mortality. The COVID-19 pandemic has particularly impacted this vulnerable population. This study evaluated the 30-day outcomes of elderly patients with hip fractures and SARS-CoV-2 infection treated in a single center.Methods: We conducted a retrospective cohort study including patients admitted between July 2020 and December 2022 with proximal femoral fractures. Demographic data, comorbidities, COVID-19 status, and postoperative outcomes were collected from electronic records. Patients were categorized into four groups according to COVID-19 status and surgical timing (≤48 h vs. >48 h). Mortality, complications, and hospital stay were analyzed.Results: A total of 185 patients (mean age 80 years) were included; 56 (30.3%) tested positive for COVID-19. COVID-19-positive patients had significantly higher comorbidity scores and required postoperative oxygen therapy more frequently. Thirty-day mortality was markedly higher among infected patients (OR 7.01; 95% CI 4.94-8.77; p<0.00001). They also showed increased in-hospital mortality, complications, and prolonged hospitalization.Conclusion: SARS-CoV-2 infection significantly worsened short-term outcomes in elderly patients with hip fractures. A coordinated multidisciplinary approach remains crucial to reduce mortality and improve survival in this fragile population.

Neurological disorders often result in a broad spectrum of disabilities that impact mobility, communication, cognition, and sensory processing, leading to significant limitations in independence and quality of life. Assistive technologies (ATs) offer tools to compensate for these impairments, support daily living, and improve quality of life. The World Health Organization encourages the adoption and diffusion of effective assistive technology (AT). This narrative review aims to explore the integration, benefits, and challenges of assistive technologies in individuals with neurological disabilities, focusing on their role across mobility, communication, cognitive, and sensory domains. A narrative approach was adopted by reviewing relevant studies published between 2014 and 2024. Literature was sourced from PubMed and Scopus using specific keyword combinations related to assistive technology and neurological disorders. Findings highlight the potential of ATs, ranging from traditional aids to intelligent systems like brain-computer interfaces and AI-driven devices, to enhance autonomy, communication, and quality of life. However, significant barriers remain, including usability issues, training requirements, accessibility disparities, limited user involvement in design, and a low diffusion of a health technology assessment approach. Future directions emphasize the need for multidimensional, user-centered solutions that integrate personalization through machine learning and artificial intelligence to ensure long-term adoption and efficacy. For instance, combining brain-computer interfaces (BCIs) with virtual reality (VR) using machine learning algorithms could help monitor cognitive load in real time. Similarly, ATs driven by artificial intelligence technology could be useful to dynamically respond to users' physiological and behavioral data to optimize support in daily tasks.

ABSTRACTManagement of persistent air‐leaks (PAL) in mechanically ventilated patients is challenging as most patients are refractory to standard treatments. Herein, we report the successful management of persistent air‐leaks in a case series of seven patients. Patients were mechanically ventilated and presented severe air‐leaks that persisted 17.5 ± 6.2 days after chest drainage insertion. Patients were deemed unfit for surgical resection while talc pleurodesis was unfeasible in five patients or performed without success in two. Valves treatment was performed at bedside in the Intensive Care Unit. Chest drainage was removed 5.5 ± 3.1 days after valve insertion, and all patients were weaned off the ventilator 8.8 ± 3.4 days later. All but one patient was discharged 26.8 ± 10.2 days following the procedure. One patient died at 35 days due to systemic sepsis not related to valves. Valves were readily removed in four patients at a mean of 149 ± 12.7 days after the implant. Our study confirmed the safe and effective use of EBV treatment for the management of PAL refractory to standard treatment in mechanically ventilated patients.

IntroductionSeveral studies have demonstrated that psoriasis severity is generally greater in male patients, but it is unclear whether this gender difference may affect short-term therapeutic response. Notably, no studies have specifically investigated bimekizumab, a humanized, full-length IgG1 monoclonal antibody that acts as a dual inhibitor of interleukin (IL)-17A and IL-17F.MethodsThis was a cross-sectional, observational, retrospective, multicenter analysis. A cohort of 318 patients with moderate to severe psoriasis, 229 male patients (median [IQR] age 35 [23–67] years) and 89 female patients (median [IQR] age 33 [20–68] years), were retrospectively evaluated for short-term response (16 weeks) to bimekizumab according to standard dosage (320 mg at weeks 0, 4, 8, 12, and 16, and every 8 weeks thereafter). Patients were assessed to evaluate whether gender differences in demographic and clinical characteristics can affect treatment response to standard dose of bimekizumab, during the first 16 weeks of treatment. Therapeutic outcomes were evaluated by analyzing Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores recorded in each patient at three consecutive time points: baseline (T0), after 4 weeks (T4), and after 16 weeks of treatment (T16).ResultsMale patients showed more severe disease at baseline, compared to female patients (p = 0.01). A significant reduction in disease severity was observed in both male and female patients after 16 weeks of treatment, but male patients showed a faster decrease in PASI score between baseline and week 4 of treatment compared to female patients (p < 0.001). Nevertheless, by week 16, difference in PASI response and DLQI reduction between genders became less pronounced.ConclusionAlthough male patients exhibit greater disease severity at baseline compared to female patients, this does not result in a differential response to bimekizumab over the short term. Both male and female patients had equal probability of achieving complete or near-complete disease remission within the first 4 weeks of treatment, and both maintain this response status through week 16. The therapeutic benefit of bimekizumab may be due to the rapid dual inhibition of IL-17A and IL-17F, which may lead to consistent and robust clinical response across genders, regardless of baseline disease severity. Our results suggest a “gender severity-invariant effect” of bimekizumab, highlighting the treatment as rapidly effective in both genders, despite initial differences in disease severity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-025-01435-w.

Atopic dermatitis (AD) is a common inflammatory skin disease that affects both children and adults. However, limited research has been conducted on gender differences in AD. This study aimed to assess gender differences in adult AD patients, focusing on demographic and clinical features, comorbidities and treatment approaches. In this multicentre, observational, cross-sectional study, we enrolled 686 adult patients with AD (357 males and 329 females). For each patient, we collected demographic data (age and sex), anthropometric measurements (weight, height, hip circumference, waist circumference and waist-to-hip ratio), clinical information (onset age, disease duration, severity, itching intensity, impact on quality of life) and noted comorbidities (metabolic, atopic and other). We recorded past and current topical and systemic treatments. We analysed all collected data using statistical techniques appropriate for both quantitative and qualitative variables. Multiple correspondence analysis (MCA) was employed to evaluate the relationships among all clinical characteristics of the patients. We found no differences in age at onset, disease duration, severity and quality of life impact between males and females. Males exhibited higher rates of hypertriglyceridaemia and hypertension. No significant gender differences were observed in atopic or other comorbidities. Treatment approaches were overlapping, except for greater methotrexate use in males. MCA revealed distinct patterns based on gender, disease severity, age of onset, treatment and quality of life. Adult males with AD had severe disease, extensive treatments and poorer quality of life, while adult females had milder disease, fewer treatments and moderate quality of life impact. Our study reveals that gender differences in adult AD patients are largely due to inherent population variations rather than disease-related disparities. However, it highlights potential undertreatment of females with moderate AD and quality of life impact, emphasizing the need for equitable AD treatment. JAK inhibitors may offer a solution for gender-based therapeutic parity.

In the ELOQUENT-3 trial, the combination of elotuzumab, pomalidomide and dexamethasone (EloPd) proved to have a superior clinical benefit over pomalidomide and dexamethasone with a manageable toxicity profile, leading to its approval for the treatment of patients with relapsed/refractory multiple myeloma (RRMM) who have received at least two prior therapies, including lenalidomide and a proteasome inhibitor. We report here a real-world experience of 200 cases of RRMM treated with EloPd in 35 Italian centers outside of clinical trials. In our dataset, the median number of prior lines of therapy was two, with 51% of cases undergoing autologous stem cell transplant and 73% having been exposed to daratumumab. After a median follow-up of 9 months, 126 patients had stopped EloPd, most of them (88.9%) because of disease progression. The overall response rate was 55.4%, a finding in line with the pivotal trial results. Regarding adverse events, the toxicity profile in our cohort was similar to that in the ELOQUENT-3 trial, with no significant differences between younger (<70 years) and older patients. The median progression-free survival was 7 months, which was shorter than that observed in ELOQUENT-3, probably because of the different clinical characteristics of the two cohorts. Interestingly, International Staging System stage III disease was associated with worse progression-free survival (hazard ratio=2.55). Finally, the median overall survival of our series was shorter than that observed in the ELOQUENT-3 trial (17.5 vs. 29.8 months). In conclusion, our real-world study confirms that EloPd is a safe and possible therapeutic choice for patients with RRMM who have received at least two prior therapies, including lenalidomide and a proteasome inhibitor.

Abstract Background Although inappropriate feeding has been suggested to play a role in the occurrence of BRUE, only anecdotal reports have been so far described. The main objective of our study was to objectively evaluate whether overfeeding may represent a risk factor for the occurrence of BRUE. Methods We enrolled 42 infants aged 0–6 months admitted for BRUE episodes and a same number of age- and sex-matched healthy infants, who served as controls. Data about feeding practices and auxological parameters of each enrolled infant were collected and analysed, along with clinical data about peri- and post-natal period. Main outcome measures were mean daily body weight gain, daily number of feedings and mean volume of feedings and average daily volume of feedings only for bottle-fed infants. Results The mean (± SD) daily body weight gain, the only available and reliable parameter to assess feeding adequacy in both breast- and formula fed infants, was 41 ± 15 grams in infants with BRUE vs 35 ± 11 grams in healthy infants (95% CI [0.21; 11.8], p = 0.042). Moreover, infants with BRUE were more likely than controls having received mixed breastfeeding, although this difference did not reach statistical significance (33% vs 17%, 95 CI [-0.04; 0.37], p = 0.131). Conclusions Overfeeding seems to be a risk factor for the occurrence of BRUE, either through milk inhalation and choking or through GER worsening. Detecting inappropriate feeding practices, and providing appropriate education to correct them, may help preventing the occurrence of BRUE produced by either scenarios.

Short-rib thoracic dysplasia 3 with or without polydactyly (OMIM # 613091) represents a clinical spectrum encompassing a heterogeneous group of skeletal dysplasias associated with homozygous or compound heterozygous mutations of DYNC2H1. We describe the case of a couple with two consecutive therapeutic abortions due to a diagnosis of short-rib thoracic dysplasia mutations. In the first pregnancy, the diagnosis has been made at 21 weeks. In the second one, an accurate and early ultrasound examination allowed a diagnosis at 12 weeks. DYNC2H1 mutations were confirmed in both cases. In this report, we underline the importance of an ultrasound evaluation at the end of the first trimester of pregnancy in the detection of early signs of skeletal dysplasias. An early prenatal diagnosis of a short-rib skeletal dysplasia, such as for other severe skeletal dysplasias, is critical to offer a couple the chance of a weighted, informed, and less traumatic decision about the continuation of the pregnancy.

The presence of co-morbidities is associated with a poor outcome in patients with COVID-19. The aim of the present study was to investigate the outcomes of patients with SARS-CoV-2 infection and chronic kidney disease (CKD) in order to assess its impact on mortality and severity of disease. We performed a multicenter, observational, 1:2 matched case-control study involving seventeen COVID-19 Units in southern Italy. All the adults hospitalized for SARS-CoV-2 infection and with pre-existing CKD were included (Cases). For each Case, two patients without CKD pair matched for gender, age (+5 years), and number of co-morbidities (excluding CKD) were enrolled (Controls). Of the 2,005 patients with SARS-CoV-2 infection followed during the study period, 146 patients with CKD and 292 patients without were enrolled in the case and control groups, respectively. Between the Case and Control groups, there were no statistically significant differences in the prevalence of moderate (17.1% vs 17.8%, p=0.27) or severe (18.8% and 13.7%, p=0.27) clinical presentation of COVID-19 or deaths (20.9% vs 28.1%, p=0.27). In the Case group, the patients dead during hospitalization were statistically higher in the 89 patients with CKD stage 4-5 compared to 45 patients with stages 1-3 CKD (30.3% vs 13.3%, p=0.03). Our data suggests that only CKD stage 4-5 on admission was associated with an increased risk of in-hospital death.

Introduction: Doxorubicin-mediated adverse cardiovascular events are among the leading causes of morbidity and mortality in breast cancer patients. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have recently been shown to be of therapeutic value in patients with type 2 diabetes, chronic kidney disease, and heart failure with reduced ejection fraction (HFrEF), conditions that commonly coexist and are interrelated pathophysiologically. Hypothesis: Dapagliflozin (an SGLT2i), administered during doxorubicin, could improve cardiac function in preclinical models Methods: Female C57Bl/6 mice were untreated (Sham, n=6) or treated for 10 days with doxorubicin i.p at 2.17 mg/kg (DOXO, n=6), DAPA at 12 mg/kg (DAPA, n=6) or doxorubicin combined to DAPA (DOXO-DAPA, n=6). Ejection fraction, radial and longitudinal strain were analyzed through transthoracic echocardiography (Vevo 2100). Cardiac tissue expression of NLRP3 inflammasome, Myd88, DAMPs (galectine 3 and calgranulinS100) , pAMPK, NF-kB, and 13 chemokines (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12, IL17-α, IL-18, IFN-γ, TNF-α, G-CSF, and GM-CSF) were quantified through ELISA and western blot methods. Results: DAPA improved significantly the EF and prevented the reduction of radial and longitudinal strain after 10 days of treatment with doxorubicin. A reduced expression of NLRP3, MyD88, DAMPs and NF-kB in cardiac tissues was seen in DOXO-DAPA group compared to DOXO mice (p&lt;0.001). Cardiac expression of IL-1β, IL-6, TNF-α, G-CSF and GM-CSF were significantly reduced after treatment with DAPA indicating anti-inflammatory properties. Expression of pAMPK was strongly enhanced in DAPA-DOXO compared to DOXO group. Levels of Calgranulin S100 and galectine-3 were strongly enhanced in DOXO group; on the other hand their expression were reduced by 47.7 and 52.3% in DAPA-DOXO group vs DOXO (p&lt;0.005). Hystology evaluation indicate reduction in hypertrophy, fibrosis and cardiac necrosis in DOXO-DAPA vs DOXO. Conclusions: DAPA is able to improve cardiac function and reduce biomarkers involved in heart failure and fibrosis. The overall picture of the study pushes the use of DAPA in prevention of cardiomyopathies induced by anthracyclines in cancer patients.