Association between treatment with colchicine and improved survival in a single-centre cohort of adult hospitalised patients with COVID-19 pneumonia and acute respiratory distress syndrome.

OBJECTIVES: The outbreak of COVID-19 posed the issue of urgently identifying treatment strategies. Colchicine was considered for this purpose based on well-recognised anti-inflammatory effects and potential antiviral properties. In the present study, colchicine was proposed to patients with COVID-19, and its effects compared with 'standard-of-care' (SoC). METHODS: In the public hospital of Esine, northern Italy, 140 consecutive inpatients, with virologically and radiographically confirmed COVID-19 admitted in the period 5-19 March 2020, were treated with 'SoC' (hydroxychloroquine and/or intravenous dexamethasone; and/or lopinavir/ritonavir). They were compared with 122 consecutive inpatients, admitted between 19 March and 5 April 2020, treated with colchicine (1 mg/day) and SoC (antiviral drugs were stopped before colchicine, due to potential interaction). RESULTS: Patients treated with colchicine had a better survival rate as compared with SoC at 21 days of follow-up (84.2% (SE=3.3%) vs 63.6% (SE=4.1%), p=0.001). Cox proportional hazards regression survival analysis showed that a lower risk of death was independently associated with colchicine treatment (HR=0.151 (95% CI 0.062 to 0.368), p<0.0001), whereas older age, worse PaO2/FiO2, and higher serum levels of ferritin at entry were associated with a higher risk. CONCLUSION: This proof-of-concept study may support the rationale of use of colchicine for the treatment of COVID-19. Efficacy and safety must be determined in controlled clinical trials.

Prevalence of frontotemporal lobar degeneration in an isolated population: the Vallecamonica study.

The study of neurodegenerative diseases, such as frontotemporal lobar degeneration (FTLD), in isolated populations represents a privileged point of view for identifying new causative genes and pathogenetic mechanisms. Vallecamonica is a valley located in the Brescia province (Northern Italy), which experienced isolation until the end of World War II. The aims of the present work were (1) to estimate the prevalence of FTLD in Vallecamonica, (2) to determine the monogenic FTLD forms, and (3) to identify FTLD cases with no evidence of known pathogenetic mutations and the related clinical features. Patients meeting current clinical criteria for FTLD were considered. Mutation analysis for microtubule associated protein tau (MAPT) and progranulin (PGRN) genes was performed, as well as serum PGRN dosage. On the census day, 42 FTLD patients were alive, resulting in an overall disease prevalence of 35 per 100 inhabitants. Thirty-one out of 42 patients underwent sequencing analysis. Five patients carried PGRN Thr272fs mutation and one patient MAPT P301L mutation. There were no differences in term of age at onset and gender between this group and mutation carriers, but the latter had greater family history for dementia (100%, P = 0.01). In Vallecamonica, we detected a higher prevalence of FTLD compared with that already reported in other populations. A founder effect or a genetic drift might be considered for an allelic enrichment. Ongoing study aims to identify the presence of a new genetic form in those FTLD patients without known pathogenetic mutations in this isolated population.

Influence of anatomical factors on the feasibility and safety of carotid stenting in a series of 154 consecutive procedures.

OBJECTIVE: The present study assessed the impact of unfavourable vascular anatomy on the feasibility and safety of carotid angioplasty and stenting (CAS). METHODS: Between 2000 and 2005, 154 CAS procedures (46% in symptomatics) were performed in 138 consecutive patients (mean age 72 +/- 7 years, 63% males), followed for a median period of 16 months by a neurologist performing clinical and duplex scan examination. The impact on outcome of tortuous supra-aortic vessels, tortuous internal carotid artery (ICA), calcified stenosis and contralateral ICA occlusion were assessed. RESULTS: The feasibility was 100%. The 1-month rate of death and disabling stroke was 2.6% (1.2% in the asymptomatic group and 4.2% in symptomatic group, P = 0.33). The 1-month rate of any stroke and death was 4.5%. During follow-up, a further seven events occurred (one ipsilateral major stroke, one ipsilateral minor stroke and five deaths). There was no difference in occurrence of any event during follow-up between asymptomatic and symptomatic group (8.4% versus 9.6%, P = 0.78). At least one unfavourable vascular anatomy condition was present in 48% of cases, two conditions in 16% and three in 3%. No statistically significant association was found between unfavourable vascular anatomy and outcome. Intra-stent restenosis was registered by duplex scan in five cases (3.2%); it was associated with occurrence of minor stroke during follow-up (P = 0.032). CONCLUSIONS: CAS as first choice procedure is feasible, safe and effective, despite hostile vascular anatomy may be encountered in some patients. Unfavourable anatomic conditions appear to have a scarce impact on outcome.