102,127 research outputs found
Use of antipsychotics in elderly patients with dementia: do atypical and conventional agents have a similar safety profile?
No full textPharmacological treatment of dementia addresses two main clinical features of the disease: cognitive deterioration with predominantly memory loss and behavioural and psychological symptoms (BPSD). While cholinesterase inhibitors are recommended in an attempt to delay memory loss and disability, what should be considered the most appropriate pharmacological treatment for BPSD has remained questionable. Antipsychotic medications, conventional and atypical agents, have been increasingly utilized in clinical practice but only a small number of clinical studies have investigated their relative cost-benefit ratio. This review focuses on the safety of atypical and conventional antipsychotics when used in patients with BPSD. Overall, atypical and conventional antipsychotics are associated with a similarly increased risk for all-cause mortality and cerebrovascular events. Relative to atypical agents users, patients being treated with conventional antipsychotics have an increased incidence of cardiac arrhythmias and extrapyramidal symptoms. Conversely, users of atypical antipsychotics are exposed to an increased risk of venous thromboembolism and aspiration pneumonia. Also, metabolic effects (i.e. increased risk of diabetes, weight gain) have consistently been documented in clinical studies with atypical antipsychotics, although this effect tends to be attenuated with advancing age and in elderly patients with dementia. Antipsychotics, both conventional and atypical, should be used with caution only when nonpharmacologic approaches have failed to adequately control BPSD. More effective interventions are necessary to improve postmarket drug safety in vulnerable populations
Cancer-Related Anemia and Frailty in Older Persons
No full textAnemia, defined by the World Health Organization as a hemoglobin concentration lower than 13 g/dL in men and 12 g/dL in women, is particularly prevalent at advanced age. Nevertheless, it is not a condition simply explained by the normal aging process. Anemia represents a potentially reversible condition associated with numerous adverse health-related events, including hospitalization, disability, and mortality in older persons. Low haemoglobin concentrations are particularly common among patients with cancer due to direct (e.g., micro- and macroscopic blood losses) and indirect causes (e.g., increased production of pro-inflammatory cytokines with consequent reduction of erythropoietin release and erythropoiesis). The impaired oxygen-carrying capacity caused by the presence of anemia may play a major role in multiple clinical manifestations of cancer, such as dyspnea, fatigue, exhaustion, dizziness and/or headache. In the present review, we discuss the importance of low hemoglobin concentrations and anemia as important determinants of the frailty syndrome, a condition commonly present among cancer patients. Treatment of cancer-related anemia may improve quality of life and health-related outcomes (including disability and mortality) in older patients with oncological conditions
Prospective payment system and hospitalization for pneumonia in Italy
No full textProspective payment system and hospitalization for pneumonia in Ital
Quench action and large deviations: Work statistics in the one-dimensional Bose gas
No full textWe study the statistics of large deviations of the intensive work done in an interaction quench of a one-dimensional Bose gas with a large number N of particles, system size L, and fixed density. We consider the case in which the system is initially prepared in the noninteracting ground state and a repulsive interaction is suddenly turned on. For large deviations of the work below its mean value, we show that the large-deviation principle holds by means of the quench action approach. Using the latter, we compute exactly the so-called rate function and study its properties analytically. In particular, we find that fluctuations close to the mean value of the work exhibit a marked non-Gaussian behavior, even though their probability is always exponentially suppressed below it as L increases. Deviations larger than the mean value exhibit an algebraic decay whose exponent cannot be determined directly by large-deviation theory. Exploiting the exact Bethe ansatz representation of the eigenstates of the Hamiltonian, we calculate this exponent for vanishing particle density. Our approach can be straightforwardly generalized to quantum quenches in other interacting integrable systems
Rationale for antioxidant supplementation in sarcopenia
No full textSarcopenia is an age-related clinical condition characterized by the progressive loss of motor units and wasting of muscle fibers resulting in decreased muscle function. The molecular mechanisms leading to sarcopenia are not completely identified, but the increased oxidative damage occurring in muscle cells during the course of aging represents one of the most accepted underlying pathways. In fact, skeletal muscle is a highly oxygenated tissue and the generation of reactive oxygen species is particularly enhanced in both contracting and at rest conditions. It has been suggested that oral antioxidant supplementation may contribute at reducing indices of oxidative stress both in animal and human models by reinforcing the natural endogenous defenses. Aim of the present paper is to discuss present evidence related to possible benefits of oral antioxidants in the prevention and treatment of sarcopenia
Nonmonotonic Effects of Migration in Subdivided Populations
No full textThe influence of migration on the stochastic dynamics of subdivided populations is still an open issue in various evolutionary models. Here, we develop a self-consistent mean-field-like method in order to determine the effects of migration on relevant nonequilibrium properties, such as the mean fixation time. If evolution strongly favors coexistence of species (e. g., balancing selection), the mean fixation time develops an unexpected minimum as a function of the migration rate. Our analysis hinges only on the presence of a separation of time scales between local and global dynamics, and therefore, it carries over to other nonequilibrium processes in physics, biology, ecology, and social sciences
Assessment and treatment of elderly patients with cancer
No full textIn the US, the total projected cancer incidence will increase by 45% yearly from 2010 to 2030. The majority of these neoplasms will affect the elderly. The National Institute on Aging has characterised the aging of our society as a "silver tsunami". Thus, the management of cancer in the older aged person represents a priority for health care delivery in the immediate future. Aging, age-related changes, frailty, prolongation of active life expectancy, prevention of Adverse Drugs Reactions (ADRs), Comprehensive Geriatric Assessment (CGA), and individualised treatment in the future will become the most widely used concepts in the management of cancer patients
The stress of aging
No full textAlthough the evolutionary theories of aging are quite well established, our knowledge about how we age isstill very limited. The abundance and heterogeneity of available mechanistic theories of aging implicitly suggestthat this phenomenon is overly complex and unlikely to be explained by a single pathway. Moreover, although aging remains a unique process, it is characterized by heterogeneous manifestations, not only determininginter-individual variations, but even intra-individual diversities. Such heterogeneity renders the innernature of the aging process of difficult evaluation in older persons due to the potential biases introduced bymultiple age-related social, biological, and clinical factors (and responsible for the evidence-based issue ingeriatrics). Moving from the difficulties in translating anti-aging preclinical interventions into clinical trials, an alternative approach is illustrated. We encourage moving to a holistic evaluation of aging by adopting specificand consequent modifications in the design and conduction of clinical research. Such approach is today commonlyapplied in the clinical setting where the complexity of older patients often requires multidimensional interventionsto adequately target the geriatric syndromes. Consistently, interventions targeting the aging processmay result ineffective if too focused on a single underlying causalmechanism and/or failing to capture the complexityof the phenomenon. In this context, frailty (a geriatric syndrome characterized by age-related declinesoccurring acrossmultiple physiologic systems) may indeed represent a clinically relevant threshold throughoutthe continuum of the aging process and a promising benchmark to test multidomain interventions againstage-related conditions
ABO blood groups and cancer of the pancreas
No full textFew investigations discussing an association between ABO blood groups and pancreatic cancer exist. We have selected a series of 224 patients with histologically-confirmed pancreatic cancer, and their ABO blood groups distribution was compared with two control groups: 7086 patients with various diseases (Group 1) and 7320 voluntary blood donors (Group 2). There was an increased number of pancreatic cancer among the patients with blood group B (relative risk 1.5 vs Group 1 p = 0.021; 1.7 vs Group 2 p = 0.0025) and a decreased number in patients with blood group O, when compared with the two control groups
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