The Role of Multidimensional Prognostic Index to Identify Hospitalized Older Adults with COVID-19 Who Can Benefit from Remdesivir Treatment: An Observational, Prospective, Multicenter Study

Background: Data regarding the importance of multidimensional frailty to guide clinical decision making for remdesivir use in older patients with coronavirus disease 2019 (COVID-19) are largely unexplored. Objective: The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), a multidimensional frailty tool based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of remdesivir. Methods: This was a multicenter, prospective study of older adults hospitalized for COVID-19 in 10 European hospitals, followed-up for 90 days after hospital discharge. A standardized CGA was performed at hospital admission and the MPI was calculated, with a final score ranging between 0 (lowest mortality risk) and 1 (highest mortality risk). We assessed survival with Cox regression, and the impact of remdesivir on mortality (overall and in hospital) with propensity score analysis, stratified by MPI = 0.50. Results: Among 496 older adults hospitalized for COVID-19 (mean age 80 years, female 59.9%), 140 (28.2% of patients) were treated with remdesivir. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. Remdesivir treatment significantly reduced the risk of overall mortality (hazard ratio [HR] 0.54, 95% confidence interval CI 0.35–0.83 in the propensity score analysis) in the sample as whole. Stratifying the population, based on MPI score, the effect was observed only in less frail participants (HR 0.47, 95% CI 0.22–0.96 in propensity score analysis), but not in frailer subjects. In-hospital mortality was not influenced by remdesivir use. Conclusions: MPI could help to identify less frail older adults hospitalized for COVID-19 who could benefit more from remdesivir treatment in terms of long-term survival

La prevenzione del dolore e dell’emorragia post-operatoria nella PPH (Procedure for Prolapse and Hemorrhoids) e nella STARR (Stapled Trans-Anal Rectal Resection). Risultati su una serie di 261 pazienti

e intra- e post-operatorie precoci (entro la pima settimana) rappresentano la più frequente complicanza nella emorroidectomia con PPH (Procedure for Prolapse and Hemorrhoids) e nella resezione circonferenziale del prolasso rettale con STARR (Stapled Trans Anal Rectal Resection). Durante l’esecuzione di PPH e STARR abbiamo impiegato un gel emostatico a base di trombina (FloSeal®) per controllare il sanguinamento intra-operatorio e ridurre quello post-operatorio evitando l’apposizione di punti emostatici sulla linea di sutura. Riportiamo i primi risultati di uno studio retrospettivo su 197 pazienti sottoposti a PPH e 64 sottoposti a STARR. In 44 PPH (22,4%) ed in 27 STARR (42,2%) è stato utilizzato il gel emostatico. Non si sono verificati sanguinamenti post-operatori significativi nei pazienti trattati con FloSeal®, contro l’ 1,3% e il 2,7% di emorragie rispettivamente in PPH e STARR nei pazienti trattati senza gel emostatico. Il dolore post-operatorio è stato meno severo nei pazienti trattati con FloSeal®, senza tuttavia una differenza statisticamente significativa. I dati ottenuti devono essere considerati preliminari e da confermare in studi prospettici randomizzati condotti su più ampie casistiche

"On time surgical management of severe genitourinary and rectal prolapse treatment of a case presenting an associated large rectocele and enterocele

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