1,720,979 research outputs found
Cardiac visceral fat and cardiometabolic risk in the elderly
No full textAging is characterized by several changes in body mass composition with loss of muscle mass and increase in fat mass, particularly visceral fat. Visceral fat is represented mainly by abdominal and cardiac depots and it is directly related to chronic low-grade inflammation, insulin-resistance and metabolic syndrome. Unfavourable outcomes as cardiovascular death are also associated with the amount of visceral fat depots. In this scenario, the cardiac visceral fat seems to play an important role in increasing the cardiometabolic risk. This review aims to provide a literature revision about the role of cardiac visceral fat on cardiometabolic risk in elderly
Redox Homeostasis and Immune Alterations in Coronavirus Disease-19
No full textThe global Coronavirus Disease 2019 (COVID-19) pandemic is characterized by a wide variety of clinical features, from no or moderate symptoms to severe illness. COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that first affects the respiratory tract. Other than being limited to lungs, SARS-CoV-2 may lead to a multisystem disease that can even be durable (long COVID). The clinical spectrum of COVID-19 depends on variability in the immune regulation. Indeed, disease progression is consequent to failure in the immune regulation, characterized by an intensification of the pro-inflammatory response. Disturbance of systemic and organ-related redox balance may be a further mechanism underlying variability in COVID-19 severity. Other than being determinant for SARS-CoV-2 entry and fusion to the host cell, reactive species and redox signaling are deeply involved in the immune response. This review sums up the present knowledge on the role of redox balance in the regulation of susceptibility to SARS-CoV-2 infection and related immune response, debating the effectiveness of antioxidant compounds in the management of COVID-19
In-hospital use of antibiotics in internal medicine: A cross-sectional study before, during and after the COVID-19 pandemic in a COVID-19-free ward (Q1 WoS)
No full textDiagnostic reliability of the procalcitonin serum marker in septic frail patient
No full textAim: Aging is associated with increased inflammation, particularly in frailty. Indeed, such patient presents increased serum inflammatory markers, such as C-reactive protein and interleukin-6. Interleukin-6 is an important stimulating factor for the production of procalcitonin. The aim of this study is to evaluate the diagnostic reliability of serum PCT in the diagnosis of sepsis in frail elderly patients. Methods: Using Fried’s criteria for frailty, 140 older patients hospitalized for any cause were consecutively enrolled and divided in two groups: no-frail (60 patients) and frail (80 patients). Patients were further categorized on the basis of the presence/absence of sepsis. Interleukin-6, procalcitonin and inflammatory indices were sampled at hospital admission. Results: Septic patients from frail and no-frail groups showed higher values of interleukin-6 and procalcitonin. However, focusing on groups without sepsis, a statistically significant difference of interleukin-6 and procalcitonin values among frail and no-frail groups was seen at the post-hoc analysis. In frail group, procalcitonin cut-off of 0.5 ng/ml had a sensibility and specificity, respectively, of 100 and 22%. Through receiver operating characteristic curve (ROC) analysis, we found that procalcitonin serum value of 1.4 ng/ml had better sensibility and specificity (respectively, 93.8 and 84.4%, AUC 0.965). Conclusions: In our study, we confirm the diagnostic reliability of procalcitonin in frail elderly patients for the diagnosis of sepsis. We found that 1.4 ng/ml was the best cut-off in this population
Impact of Nutritional Status on Muscle Architecture in Elderly Patients Hospitalized in Internal Medicine Wards
No full textNutritional alterations are highly prevalent in older rather than adult hospitalized patients. In these subjects, a loss of physical performance is dependent on the impairment of muscle architecture. This study aimed to investigate the association between the nutritional status and muscle architecture in elderly patients hospitalized in internal medicine wards. 68 aged patients admitted in internal medicine wards were consecutively enrolled and stratified in three groups based on the Mini Nutritional Assessment (MNA) score: well-fed (WF), at risk of malnutrition (RM), and malnourished (M). Biochemical indices and anthropometric parameters were sampled at hospital admission. Furthermore, all patients were assessed at admission and after 7 days of hospitalization for muscle strength (hand-grip test), mass (bioimpedentiometry), and architecture (ultrasonography of vastus lateralis). At hospital admission, M patients showed lower percentage of fat free mass and muscle mass with respect to WF and RM. Furthermore, M group presented with lower muscle thickness and pennation angle, as compared to WF and RM. At admission, the MNA score was positively related to the pennation angle and muscle strength. Multivariate linear regression analysis showed that the nutritional status at admission was the only significant factor influencing pennation angle. Finally, during the first 7 days of hospitalization, a decrease of pennation angle occurred in all the groups studied. We conclude that malnutrition at admission is associated with impaired muscle architecture in elderly patients hospitalized in internal medicine wards. Moreover, muscle architecture is impacted by early hospitalization, irrespective of nutritional status
Reliability of serum procalcitonin concentration for the diagnosis of sepsis in elderly patient with chronic kidney disease
No full textBackground and aims. Sepsis is complicated by high mortality in hospitalized patients. Procalcitonin (PCT) is a validated tool in the diagnosis of sepsis in both adults and aged patients. Several studies demonstrated the reliability of PCT in adults with chronic kidney disease (CKD), but this has not been studied in the geriatric population. Thus, we aimed at evaluating the reliability of PCT in a group of elderly patients with CKD.Methods. 382 subjects (mean age, 78.9 years) were consecutively enrolled and stratified in two groups at the time of the admission based on the absence or presence of CKD, defined as estimated Glomerular Filtration Rate (e-GFR) less than 60 ml/min/1.73 m(2). These two groups were further divided according to the presence (SEPSIS/NO CKD, n = 41; SEPSIS/CKD, n = 45) or absence of sepsis (NO SEPSIS/NO CKD, n = 147; NO SEPSIS/ CKD, n = 149), and the serum PCT was analyzed.Results. PCT was highly sensitive and specific in patients presenting with sepsis and no CKD. The mean serum PCT concentration in the group SEPSIS/CKD was significantly higher than in NO SEPSIS/CKD (21.00 [ 5.83 to 97.00] ng/ml vs 0.90 [ 0.24 to 1.32] ng/ml, p < 0.001). However, the PCT threshold value was 1.7 ng/ml (sensitivity 91.1%, specificity 88.6%) as compared with the currently used threshold value of 0.5 ng/ml (sensitivity 93.3%, specificity 30.2% in our population study).Conclusions. Our study confirms the diagnostic reliability of PCT for the diagnosis of sepsis in elderly patients with CKD. Nevertheless, we suggest to apply a cut-off of 1.7 ng/ml in this population
Malnutrition in Hospitalized Old Patients: Screening and Diagnosis, Clinical Outcomes, and Management
No full textMalnutrition in hospitalized patients heavily affects several clinical outcomes. The prevalence of malnutrition increases with age, comorbidities, and intensity of care in up to 90% of old populations. However, malnutrition frequently remains underdiagnosed and undertreated in the hospital. Thus, an accurate screening to identify patients at risk of malnutrition or malnourishment is determinant to elaborate a personal nutritional intervention. Several definitions of malnutrition were proposed in the last years, affecting the real frequency of nutritional disorders and the timing of intervention. Diagnosis of malnutrition needs a complete nutritional assessment, which is often challenging to perform during a hospital stay. For this purpose, various screening tools were pro-posed, allowing patients to be stratified according to the risk of malnutrition. The present review aims to summarize the actual evidence in terms of diagnosis, association with clinical outcomes, and management of malnutrition in a hospital setting
Reliability of serum procalcitonin concentration for the diagnosis of sepsis in elderly patient with chronic kidney disease
No full textBackground and aims. Sepsis is complicated by high mortality in hospitalized patients. Procalcitonin (PCT) is a validated tool in the diagnosis of sepsis in both adults and aged patients. Several studies demonstrated the reliability of PCT in adults with chronic kidney disease (CKD), but this has not been studied in the geriatric population. Thus, we aimed at evaluating the reliability of PCT in a group of elderly patients with CKD. Methods. 382 subjects (mean age, 78.9 years) were consecutively enrolled and stratified in two groups at the time of the admission based on the absence or presence of CKD, defined as estimated Glomerular Filtration Rate (e-GFR) less than 60 ml/min/1.73 m2. These two groups were further divided according to the presence (SEPSIS/NO CKD, n = 41; SEPSIS/CKD, n = 45) or absence of sepsis (NO SEPSIS/NO CKD, n = 147; NO SEPSIS/ CKD, n = 149), and the serum PCT was analyzed. Results. PCT was highly sensitive and specific in patients presenting with sepsis and no CKD. The mean serum PCT concentration in the group SEPSIS/CKD was significantly higher than in NO SEPSIS/CKD (21.00 [5.83 to 97.00] ng/ml vs 0.90 [0.24 to 1.32] ng/ml, p < 0.001). However, the PCT threshold value was 1.7 ng/ml (sensitivity 91.1%, specificity 88.6%) as compared with the currently used threshold value of 0.5 ng/ml (sensitivity 93.3%, specificity 30.2% in our population study). Conclusions. Our study confirms the diagnostic reliability of PCT for the diagnosis of sepsis in elderly patients with CKD. Nevertheless, we suggest to apply a cut-off of 1.7 ng/ml in this population
Factors related to nurses’ burnout during the first wave of coronavirus disease-19 in a university hospital in italy
No full textSafety of healthcare workers in hospitals is a major concern during the COVID-19 pandemic. Being exposed for several working hours per day to infected patients, nurses dealing with COVID-19 face several issues that lead to physical/psychological breakdown. This study focused on burnout and its associated factors in nurses working in an Italian University Hospital during the first wave of COVID-19 pandemic. We designed a web-based cross-sectional study addressed to nurses working at the University Hospital in Foggia, Italy. The online questionnaire was organized in sections aimed at collecting demographic and occupational variables, including the Maslach Burnout Inventory (MBI) and the Oldenburg Burnout Inventory (OBI). Two hundred and ninety-three nurses agreed to participate. According to MBI, we reported moderate/high emotional exhaustion in 76.5%, depersonalization in 50.2%, and personal gratification in 54.6% of participants. COVID-19-related burnout measured by OBI resulted medium/high in 89.1% of participants. Among demographic and occupational factors, a multivariate regression analysis identified emotional support, consideration of leaving job, and workload as predictive of burnout in nurses. In conclusion, this study suggests that the improvement of employer and family support to nurses, as well as reduction of workload and job-related stress, would contribute to reducing burnout in nurses during COVID-19 pandemics
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