1,721,038 research outputs found
Letter by Gronda et al Regarding Article, “Effect of Empagliflozin on Worsening Heart Failure Events in Patients With Heart Failure and Preserved Ejection Fraction: EMPEROR-Preserved Trial”
No full textN/
Association of serum uric acid with functional disability in older subjects: a population-based study
No full textBackground: The role of serum uric acid (SUA) in the development of adverse health outcomes in advanced age is still uncertain. Aims: The aim of the study was to assess the association of disability with SUA levels in older community-dwelling subjects. Methods: We assessed the association of disability with SUA in all 351 inhabitants of Tuscania (Italy) aged 75+. Functional ability was estimated using the instrumental activities of daily living (IADLs). Results: In logistic regression, increasing SUA levels were associated with disability (OR = 1.22; 95%CI = 1.01–1.48; P =.036), after adjusting. The association was independent of both gender and age (P for interaction > 0.050). SUA levels above 5.5 mg/dL best predicted disability. Conclusions: In older subjects, SUA levels are associated with disability; the cut off level above 5.5 mg/dL might be adopted in pharmacological trials aiming at reducing the incidence and progression of disability by reducing SUA, and for identifying subjects at increased risk of disability
Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both
Full text linkBackground and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16–2.61) and patients with dementia (HR 1.75, 95% CI 1.06–2.90) had a higher risk of death at one year. The Kaplan–Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population
Nota introduttiva - Titolo V - Libro II
No full textAn introduction to the definition of "public order" and to its meaning in the criminal code as well as in various laws, and an overview of some of the main issues arising in this title of the Italian Criminakl Code, first and foremost due to the difficulty to comply with the harm principle because of the blurred boundaries of this concept
Disability is associated with emergency room visits in the elderly: a population-based study
No full textEmergency room (ER) visits and hospitalizations of elderly subjects with chronic comorbidities, often disabled, are increasing
Long-term follow-up of patients after endoscopic sphincterotomy for choledocholithiasis, and risk factors for recurrence
No full textBackground and Study Aims: There have been growing concerns
about the long-term sequelae of endoscopic sphincterotomy
(ES). The aims of the study were to evaluate the long-term
clinical outcome of ES for choledocholithiasis and to identify the
predictors of recurrence.
Patients and Methods: A total of 529 patients (233 men, 296
women; mean age 63, range 9–88) who underwent successful
ES for choledocholithiasis were evaluated. Follow-up data were
obtained retrospectively. Statistical analyses were carried out
for 334 patients who had a follow-up of at least 5 years or had
recurrence.
Results: Immediate complications occurred in 37 patients (7 %).
Follow-up data were available in 458 patients (86.6 %), of whom
280 (61.1%) were asymptomatic,127 (27.7%) died from unrelated
causes without recurrence, and 51 (11.1%) had biliary symptoms
and/or choledocholithiasis recurrence. Most recurrences (65%)
occurred more than 2y ears following ES and were observed on
multiple occasions in 13 patients (2.8 %). A bile duct diameter of
22mm or greater was found to predict recurrence. Of 190 patients
with an intact gallbladder, 11 (5.8 %) developed acute
cholecystitis necessitating emergency cholecystectomy; all of
these had previously documented gallstones.
Conclusions: Endoscopic sphincterotomy for choledocholithiasis
is found to be safe at long-term follow-up. A dilated bile duct
(‡ 22 mm) is a marker for patients at increased risk of recurrence
of symptoms and/or choledocholithiasis
Position paper ANMCO: Strumenti di valutazione multidimensionale dell’anziano con cardiopatia cronica
No full textThe epidemiological transition has led to an increase in life expectancy and to a growing population of chronic patients, often with heart failure. These patients are frequently affected by comorbidities and frailty, which in turn increase the risk of disability and worsening quality of life, requiring an accurate multidimensional assessment (MDA). In this context, MDA is crucial for integrated and holistic management of elderly patients, considering not only the pathology but the patient in his complexity. MDA requires a multidisciplinary team to ensure a comprehensive and integrated assessment of the elderly patient. MDA tools assess various domains of health, using scales and validated tools to explore physical, functional, mental and socio-economic status. MDA is applied in two phases: an initial screening procedure and an in-depth analysis of individual problems for targeted interventions. MDA can be performed in various care settings, including outpatient clinics, hospitals, nursing homes, home care, and rehabilitation centers. Several studies show that MDA improves survival as well as functional and mental status, reducing hospitalization times and the frequency of institutionalization. This ANMCO position paper discusses MDA tools of older adults with chronic heart disease, highlighting the need for a holistic approach to address comorbidities and frailty in a growing population
Clinical effects of Helicobacter pylori outside the stomach
No full textThe discovery of Helicobacter pylori infection in the stomach could be considered as one of the most important events of modern gastroenterology. Understanding of the natural history of many disorders of the upper gastrointestinal tract, including chronic gastritis, peptic ulcer disease, gastric cancer and MALT lymphoma, was altered by this discovery. Interestingly, epidemiological studies have also revealed a correlation between H. pylori infection and some diseases localized outside the stomach, especially those characterized by persistent and low-grade systemic inflammation. Of note, H. pylori has an important role in iron deficiency anaemia, idiopathic thrombocytopenic purpura and vitamin B12 deficiency. Moreover, the association of this bacterial pathogen with many other diseases, including hepatobiliary, pancreatic, cardiovascular and neurodegenerative disorders is currently under investigation. In this Review, we summarize the results of the most important studies performed to date surrounding the association of H. pylori infection with extragastric diseases, as well as the strength of the evidence. We also provide information concerning bacterial-host interactions and the mechanisms implicated in the pathogenesis of each of these extragastric diseases
Italian Association of Hospital Cardiologists Position Paper 'Gender discrepancy: time to implement gender-based clinical management'
No full textIt has been well assessed that women have been widely under-represented in cardiovascular clinical trials. Moreover, a significant discrepancy in pharmacological and interventional strategies has been reported. Therefore, poor outcomes and more significant mortality have been shown in many diseases. Pharmacokinetic and pharmacodynamic differences in drug metabolism have also been described so that effectiveness could be different according to sex. However, awareness about the gender gap remains too scarce. Consequently, gender-specific guidelines are lacking, and the need for a sex-specific approach has become more evident in the last few years. This paper aims to evaluate different therapeutic approaches to managing the most common women’s diseases
Correlates of delayed referral for diagnosis of dementia in an outpatient population
No full textEarly diagnosis of dementia is critical, but there is usually a time lag between onset of symptoms and referral for neuropsychological testing and dementia diagnosis. We aimed to identify factors correlated with this delayed referral
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