Ospedale Sant Antonio

The ongoing digital transformation is reshaping organizational and care delivery models in cardiology, positioning telemedicine as a pivotal tool to address increasing clinical and demographic complexity. This ANMCO position paper presents a comprehensive and critical overview of telemedicine applications in cardiovascular care, with a focus on its role in strengthening hospital-community integration, its deployment within hospital-based healthcare systems, and the associated regulatory and operational frameworks. The analysis encompasses the management of chronic cardiovascular conditions, such as heart failure and atrial fibrillation, through telemonitoring, telecontrol, televisit, and teleconsultation. Additionally, it explores the use of digital technologies in post-myocardial infarction follow-up, oral anticoagulation management, preoperative assessment, and care for elderly patients. The position paper also highlights the challenges and opportunities linked to digital infrastructure, interoperability, data protection, and healthcare professional training.

Ventilator-associated pneumonia (VAP) remains a leading complication in mechanically ventilated patients, yet the contribution of the respiratory microbiota remains poorly understood. The PULMIVAP study is a multicenter, longitudinal cohort investigation of respiratory microbiota composition and host immune responses in critically ill adults intubated for non-pulmonary conditions. A total of 146 intubated adult patients were enrolled across eight Italian ICUs, forming matched groups of 73 with VAP and 73 without. Oropharyngeal swabs and endotracheal aspirates were collected at intubation and either at VAP diagnosis or at a matched point in controls for a total of 584 biological samples. Metataxonomic analyses revealed substantial temporal shifts in microbial communities across both upper and lower respiratory compartments, with a trend toward reduced microbial richness in patients who developed VAP. Several genera, such as Corynebacterium, were more abundant in no-VAP patients, whereas Escherichia-Shigella and Peptoniphilus were enriched in VAP samples. Cytokine-microbiota correlation analysis suggested a pro-inflammatory signature in VAP patients, with Citrobacter positively associated with IFN-γ and TNF-α, while several commensal genera were inversely correlated with inflammatory mediators. Additionally, taxa associated with VAP correlated with lower PaO2/FiO2 ratios, implicating them in disease severity. Consistently, several bacteria, such as Corynebacterium, appeared to be linked to better respiratory outcomes, suggesting protective or risk-associated microbial profiles. Overall, these findings highlight the complex interplay between microbial communities and mucosal immunity in the pathogenesis of VAP. The identification of condition-associated microbial and immunological signatures may inform future strategies for risk stratification and targeted prevention.IMPORTANCEVentilator-associated pneumonia (VAP) remains a major complication of mechanical ventilation, yet most microbiome studies have focused on late-stage infection or single airway compartments, limiting insight into early microbial dynamics associated with VAP risk. By longitudinally characterizing upper and lower airway microbiota before and during VAP development, this study provides new insights into microbial and immune patterns associated with susceptibility and disease severity in humans. These findings contribute to the current understanding of VAP pathogenesis by suggesting a role for early airway dysbiosis and local immune responses alongside clinical factors. Remarkably, the identification of taxa associated with risk or protection supports the potential for microbiota-informed monitoring and future risk stratification strategies during mechanical ventilation.CLINICAL TRIALSThis study is registered with ClinicalTrials.gov as NCT04849039.

Rosacea is a chronic inflammatory dermatosis that may involve the eye, causing surface and adnexal damage that can precede cutaneous signs. Detecting subclinical ocular changes is clinically important because early ocular surface dysfunction may be missed on routine examination yet progress to corneal complications, allowing earlier preventive management when identified. We prospectively evaluated subclinical ocular alterations in cutaneous rosacea using a combined, fully non-invasive high-tech imaging workflow-tear film interferometry, infrared meibography, and exploratory retinal optical coherence tomography angiography (OCT-A)-including patients without clinically evident ocular involvement. Sixteen patients with cutaneous rosacea (mean age 44.3 ± 11.2 years; 4 males, 12 females) were enrolled and divided into: Group 1-rosacea with clinically evident ocular involvement (n = 11); Group 2-rosacea without clinical ocular involvement (n = 5). Six age-matched healthy subjects served as controls (Group 3). All underwent LipiView II® interferometry and meibography to quantify lipid-layer thickness (LLT, nm) and meibomian gland (MG) loss score (1 = normal-4 = severe), plus retinal OCT-A (Optovue Inc., Fremont, CA, USA). ANOVA with post hoc Tukey test assessed inter-group differences. OCT-A showed no significant alterations in superficial or deep retinal plexuses across groups (p > 0.05). Conversely, LLT was significantly reduced in both rosacea groups vs. controls (OD: 45.5 ± 21.4 nm and 67.4 ± 10.1 nm vs. 92.7 ± 8.2 nm; OS: 40.4 ± 15.3 nm and 66.4 ± 10.1 nm vs. 96.0 ± 6.7 nm; p < 0.001). MG score was markedly higher (worse) in rosacea (OD: 3.63 ± 0.50 and 3.20 ± 0.83 vs. 1.83 ± 0.75; OS: 3.45 ± 0.68 and 3.40 ± 0.54 vs. 1.66 ± 0.81; p < 0.001). Ocular symptoms were reported by 85% of patients yet slit-lamp examination revealed surface alterations in 58% of asymptomatic cases. Tear film interferometry and meibography detect early ocular surface impairment in rosacea-even in the absence of clinical signs-while retinal microvasculature appears unaffected. Routine ophthalmologic screening of all rosacea patients could enable prompt treatment of subclinical dysfunction, potentially preventing corneal complications. Retinal OCTA metrics were not significantly different in this small pilot cohort, and these negative findings should be interpreted cautiously pending larger studies.

In Autoimmunology, interpretative comments can significantly improve the quality of information in laboratory reports. Laboratory autoimmunologists play an increasingly important role in supporting clinicians with the request and interpretation of tests, considering the growing complexity of autoimmune diagnostic and the increase in requests for autoimmune tests by non-specialist physicians. In 2024, the Study Group on Autoimmunology (GdS-AI) of the Italian Society of Clinical Pathology and Laboratory Medicine (SIPMeL) in collaboration with the Study Group of Extra-Analytical Quality (GdS-QuEA) developed a project with the aim to define interpretative comments for systemic autoimmune diseases and organ-specific autoimmune diseases. Based on the analysis of the comments used by GdS-AI laboratories in routine practice, the working group drafted a summary document including no. 47 interpretative comments (22 for systemic autoimmune diseases and 25 for organ-specific autoimmune diseases), representative of possible findings in autoimmune laboratory reports. The document is intended as a proposal of interpretative comments to support laboratory reporting. Furthermore, it defines the important role of the laboratory autoimmunologist in improving the informational quality of reports, while promoting harmonization and appropriateness of test ordering.

Dear Editor, Granuloma annulare is a chronic inflammatory skin disorder characterized by annular dermal papules and plaques. While localized forms often resolve spontaneously, generalized granuloma annulare tends to persist and frequently proves resistant to conventional therapies. The pathogenesis of the disease remains unclear, but increasing evidence suggests a dysregulated immune response involving T cells, macrophages, and cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, and interferon-gamma (IFN-γ). [...].

Abstract Background Janus kinase inhibitors (JAKi) are a class of oral therapies indicated for moderate-to-severe ulcerative colitis (UC), with three agents approved and broadly comparable efficacy and safety. Although no clear evidence shows that differences in target affinity influence response, switching to a second JAKi is sometimes attempted after failure or intolerance to the first. The main objective is to assess the effectiveness (defined as treatment persistence) and safety of a second JAKi after failure of the first one Methods This retrospective analysis is part of a 12-month, multicentre, ambispective observational study. We included patients who initiated a second JAKi less than 24 months prior to enrolment, following a first-line JAKi course. Demographics, disease features, and clinical, biochemical, and endoscopic data at baseline and at weeks 8, 26, and 52 were recorded in a REDCap database. Data are presented as frequencies and percentages. Treatment persistence was estimated with Kaplan–Meier survival analysis, and rates are reported both as observed and with non-responder imputation (NRI). Safety events were collected throughout follow-up. Recruitment for both retrospective and prospective phases is ongoing and will end in April 2026; this abstract presents preliminary. Results Data from 69 UC patients are currently available: median age 40 years (IQR 27–52); 30 (43.5%) females. Mean disease duration was 10.8±7.9 years. Disease extent: proctitis 3 (4.3%), left-sided colitis 29 (42.0%), extensive colitis 37 (53.7%). Eight patients (11.6%) were smokers, and 11.6% had other cardiovascular risk factors. Most patients (40, 57.9%) had prior exposure to ≥ 3 biologics or small molecules. Tofacitinib was the most common first JAKi (48, 69.6%) prescribed; among those who switched from tofacitinib, 9 (24.3%) moved to filgotinib and 28 (75.7%) to upadacitinib. Reasons for discontinuing the first JAKi were secondary loss of response in 42 patients (62%), primary non-response in 24 (34%), and intolerance in 3 patients (4%). At baseline, the mean Partial Mayo score was 5.1±2.3, and 20 (29%) were on systemic steroids. At week 26, treatment persistence was 87.0% (47/54) as observed and 68.1% (47/69) with NRI; at week 52 it was 85.1% (40/47) as observed and 58.0% (40/69) with NRI. Six patients experienced adverse drug reactions, none leading to discontinuation Conclusion Our preliminary findings suggest that switching from a first to a subsequent JAKi is effective and safe, including for patients with prior exposure to multiple biologic therapies. Further retrospective and prospective analyses will provide more precise estimates

Background and objectivesThe treatment of status epilepticus (SE) follows a stepwise approach, with benzodiazepines (BDZ) being the first-line therapy. This study analyzed real-word data on use of BDZ and non-BDZ antiseizure medications (ASMs) in SE treatment over 9-years to evaluate whether non-BDZ given as a first-line treatment affect 30-day mortality and other outcomes.MethodsWe included SE cases in patients aged ≥14 years who were prospectively registered at Baggiovara Civil Hospital (Modena, Italy) between September 1, 2013, and October 31, 2021. First-line treatment choices were dichotomized as: (i) i.v. BDZ; (ii) other ASMs. A multivariate model with logistic regression and an adjusted stepwise method for variables was used. Then, a propensity-score matched analysis was performed with clinical variables unevenly distributed between the two groups to evaluate the independent association between first-line therapy and 30-day mortality and secondary outcomes.ResultsSix hundred and thirty patients were included: 73.5% (463/630) received a BDZ as first-line therapy and 26.5% (167/630) were treated with non-BDZ. In the primary analyses of the whole cohort, 30-day mortality was 25.9 and 35.3% in patients receiving BDZ and non-BDZ, respectively (p = 0.027). However, multivariate analysis adjusted for potential confounders showed that non-BDZ treatment was not independently associated with increased 30-day mortality. Patients who received BDZ as a first-line treatment had less orotracheal intubation and anesthetics within 24 h of SE onset; less frequent progression to refractory and super-refractory status epilepticus; less admission to and shorter stay in intensive care units; shorter time to SE cessation. In the propensity cohort (140 patients, mainly non-convulsive SE; NCSE), 30-day mortality was 30.7% (43/140), with no difference between BDZ-treated patients (30%; 21/70) and those who received non-BDZ (31.4%; 22/70) (p = 1.000). No difference in secondary outcomes was found, except for a shorter time to SE cessation among BDZ-treated patients.ConclusionThe use of non-BDZ first-line treatment was found to be frequent, approaching 25%. Our propensity-score matching analysis shows that in some patients, mainly with NCSE, the overall prognosis of SE was not affected by first-line use of non-BDZ drugs. In these cases, SE prognosis might only be partially dependent on the first medications administered and could be more influenced by other biological variables.

Keiner.