Peripheral T-lymphocytes express WNT7A and its restoration in leukemia-derived lymphoblasts inhibits cell proliferation

<p>Abstract</p> <p>Background</p> <p>WNT7a, a member of the Wnt ligand family implicated in several developmental processes, has also been reported to be dysregulated in some types of tumors; however, its function and implication in oncogenesis is poorly understood. Moreover, the expression of this gene and the role that it plays in the biology of blood cells remains unclear. In addition to determining the expression of the <it>WNT7A </it>gene in blood cells, in leukemia-derived cell lines, and in samples of patients with leukemia, the aim of this study was to seek the effect of this gene in proliferation.</p> <p>Methods</p> <p>We analyzed peripheral blood mononuclear cells, sorted CD3 and CD19 cells, four leukemia-derived cell lines, and blood samples from 14 patients with Acute lymphoblastic leukemia (ALL), and 19 clinically healthy subjects. Reverse transcription followed by quantitative Real-time Polymerase chain reaction (qRT-PCR) analysis were performed to determine relative <it>WNT7A </it>expression. Restoration of WNT7a was done employing a lentiviral system and by using a recombinant human protein. Cell proliferation was measured by addition of WST-1 to cell cultures.</p> <p>Results</p> <p>WNT7a is mainly produced by CD3 T-lymphocytes, its expression decreases upon activation, and it is severely reduced in leukemia-derived cell lines, as well as in the blood samples of patients with ALL when compared with healthy controls (<it>p </it>≤0.001). By restoring <it>WNT7A </it>expression in leukemia-derived cells, we were able to demonstrate that WNT7a inhibits cell growth. A similar effect was observed when a recombinant human WNT7a protein was used. Interestingly, restoration of <it>WNT7A </it>expression in Jurkat cells did not activate the canonical Wnt/β-catenin pathway.</p> <p>Conclusions</p> <p>To our knowledge, this is the first report evidencing quantitatively decreased <it>WNT7A </it>levels in leukemia-derived cells and that <it>WNT7A </it>restoration in T-lymphocytes inhibits cell proliferation. In addition, our results also support the possible function of <it>WNT7A </it>as a tumor suppressor gene as well as a therapeutic tool.</p

Investigating the decision thresholds for impact-based warnings in South East Asia

The move towards impact-based forecasting presents a challenge for forecasters, who must combine information not just on what the weather might be, but also on what the weather might do. Such forecasts require an integration of both likelihood and impact severity information to issue a particular weather warning. The current pre-registered study focusses on forecasters' and stakeholders’ thresholds for determining the level of impact-based warnings, set in an area of the world particularly susceptible to extreme weather events. Set in the context of one hazard (heavy rainfall or river flooding), forecasters and stakeholders from Indonesia, Malaysia and the Philippines provided hypothetical impact-based warnings for impacts of varying likelihood. Results indicated generally good alignment with the warnings implied by previously developed impact tables. In the one country where a comparison was possible (the Philippines), we did not find evidence to suggest that forecasters and stakeholders use different thresholds for issuing warnings. We suggest that warning thresholds should be subject to regular monitoring wherever in the world an impact-based approach is used

Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register

reserved361siAs a consequence of population aging, we have witnessed in internal medicine hospital wards a progressive shift from a population of in-patients relatively young and mainly affected by a single ailment to one of ever older and more and more complex patients with multiple chronic diseases, followed as out-patients by many different specialists with poor integration and inevitably treated with multiple medications. Polypharmacy (defined as the chronic intake of five or more drugs) is associated with increased risks of drug-drug interactions and related adverse effects, prescription and intake errors, poor compliance, re-hospitalization and mortality. With this background, the Italian Society of Internal Medicine chose to start in 2008 a prospective register called REPOSI (REgistro POliterapie SIMI, Società Italiana di Medicina Interna) in internal medicine and geriatric hospital wards. The country wide register is an ongoing observatory on multimorbidity and polypharmacy in the oldest old, with the goal to improve prescription appropriateness and, thus to avoid potentially inappropriate medications. The main findings of the register, that has accrued so far, 7005 older patients throughout a 10 year period, are summarized herewith, with special emphasis on the main patterns of poor prescription appropriateness and related risks of adverse events.mixedMannucci PM, Nobili A, Pasina L; Tettamanti M, Franchi C, Corrao S, Marengoni A, Salerno F, Cesari M, Perticone F, Licata G, Violi F, Corazza GR, Franchi C, Cortesi L, Tettamanti M, Cortesi L, Ardoino I, Prisco D, Silvestri E, Cenci C, Emmi G, Biolo G, Zanetti M, Guadagni M, Zaccari M, Vanoli M, Grignani G, Pulixi EA, Bernardi M, Bassi SL, Santi L, Zaccherini G, Mannarino E, Lupattelli G, Bianconi V, Paciullo F, Nuti R, Valenti R, Ruvio M, Cappelli S, Palazzuoli A, Olivieri O, Girelli D, Matteazzi T, Barbagallo M, Dominguez L, Cocita F, Beneduce V, Plances L, Zoli M, Lazzari I, Brunori M, Pasini FL, Capecchi PL, Palasciano G, Modeo ME, Di Gennaro C, Cappellini MD, Maira D, Di Stefano V, Fabio G, Seghezzi S, Mancarella M, Cesari M, Rossi PD, Damanti S, Clerici M, Conti F, Corazza GR, Miceli E, Lenti MV, Pisati M, Dominioni CC, Murialdo G, Marra A, Cattaneo F, Secchi MB, Ghelfi D, Anastasio L, Sofia L, Carbone M, Cipollone F, Guagnano MT, Angelucci E, Valeriani E, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Muscaritoli M, Molfino A, Petrillo E, Zuccalà G, D'Aurizio G, Romanelli G, Marengoni A, Zucchelli A, Picardi A, Gentilucci UV, Gallo P, Dell'Unto C, Annoni G, Corsi M, Bellelli G, Zazzetta S, Mazzola P, Szabo H, Bonfanti A, Arturi F, Succurro E, Rubino M, Serra MG, Bleve MA, Gasbarrone L, Sajeva MR, Brucato A, Ghidoni S, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Cosi E, Manfredini R, Fabbian F, Boari B, De Giorgi A, Tiseo R, Paolisso G, Rizzo MR, Borghi C, Strocchi E, De Sando V, Pareo I, Sabbà C, Vella FS, Suppressa P, Agosti P, Schilardi A, Loparco F, Fenoglio L, Bracco C, Giraudo AV, Fargion S, Periti G, Porzio M, Tiraboschi S, Peyvandi F, Rossio R, Ferrari B, Colombo G, Monzani V, Savojardo V, Folli C, Ceriani G, Salerno F, Pallini G, Dallegri F, Ottonello L, Liberale L, Caserza L, Salam K, Liberato NL, Tognin T, Bianchi GB, Giaquinto S, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Spazzini E, Ferrandina C, Montrucchio G, Petitti P, Salmi R, Gaudenzi P, Violi F, Perri L, Landolfi R, Montalto M, Mirijello A, Guasti L, Castiglioni L, Maresca A, Squizzato A, Molaro M, Grossi A, Bertolotti M, Mussi C, Libbra MV, Dondi G, Pellegrini E, Carulli L, Perticone F, Colangelo L, Falbo T, Stanghellini V, De Giorgio R, Ruggeri E, Del Vecchio S, Salvi A, Leonardi R, Damiani G, Gabrielli A, Capeci W, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Afeltra A, Marigliano B, Pipita ME, Castellino P, Blanco J, Zanoli L, Pignataro S, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Cittadini A, Vigorito C, Arcopinto M, Salzano A, Bobbio E, Marra AM, Sirico D, Moreo G, Gasparini F, Prolo S, Pina G, Ballestrero A, Ferrando F, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Scattolin G, Martinelli S, Turrin M, Sechi L, Catena C, Colussi G, Passariello N, Rinaldi L, Berti F, Famularo G, Patrizia T, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Del Giacco S, Firinu D, Losa F, Paoletti G, Montalto G, Licata A, Malerba V, Antonino L, Basile G, Antonino C, Malatino L, Stancanelli B, Terranova V, Di Marca S, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Lauretani F, Ticinesi A, Minuz P, Fondrieschi L, Pirisi M, Fra GP, Sola D, Porta M, Riva P, Quadri R, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Tedeschi A, Trotta L, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Cattaneo M, Nieves RD, Alberto MM, Pedro AR, Vanessa LP, Lara T, Xavier CV, Francesc F, Jesus DM, Esperanza BT, Esther DCB, Maria SP, Romero M, Blanca PL, Cristina LG, Victoria VGM, Saez L, Bosco J, Susana SB, Marta AG, Concepcion GB, Antonio FM, Hernandez MG, Borrego MP, Raquel PC, Florencia PR, Beatriz GO, Sara CG, Alfonso GC, Marta PM, Garcia SC, Alberto RC, Antonio AA, Montserrat GG, Ángel BRM, Manuel MJ, Ignacio NV, Lucía AS, Alfonso L, David RB, Iria IV, Monica RP.Mannucci, Pm; Nobili, A; Pasina, L; Tettamanti, M; Franchi, C; Corrao, S; Marengoni, A; Salerno, F; Cesari, M; Perticone, F; Licata, G; Violi, F; Corazza, Gr; Franchi, C; Cortesi, L; Tettamanti, M; Cortesi, L; Ardoino, I; Prisco, D; Silvestri, E; Cenci, C; Emmi, G; Biolo, G; Zanetti, M; Guadagni, M; Zaccari, M; Vanoli, M; Grignani, G; Pulixi, Ea; Bernardi, M; Bassi, Sl; Santi, L; Zaccherini, G; Mannarino, E; Lupattelli, G; Bianconi, V; Paciullo, F; Nuti, R; Valenti, R; Ruvio, M; Cappelli, S; Palazzuoli, A; Olivieri, O; Girelli, D; Matteazzi, T; Barbagallo, M; Dominguez, L; Cocita, F; Beneduce, V; Plances, L; Zoli, M; Lazzari, I; Brunori, M; Pasini, Fl; Capecchi, Pl; Palasciano, G; Modeo, Me; Di Gennaro, C; Cappellini, Md; Maira, D; Di Stefano, V; Fabio, G; Seghezzi, S; Mancarella, M; Cesari, M; Rossi, Pd; Damanti, S; Clerici, M; Conti, F; Corazza, Gr; Miceli, E; Lenti, Mv; Pisati, M; Dominioni, Cc; Murialdo, G; Marra, A; Cattaneo, F; Secchi, Mb; Ghelfi, D; Anastasio, L; Sofia, L; Carbone, M; Cipollone, F; Guagnano, Mt; Angelucci, E; Valeriani, E; Mancuso, G; Calipari, D; Bartone, M; Delitala, G; Berria, M; Muscaritoli, M; Molfino, A; Petrillo, E; Zuccalà, G; D'Aurizio, G; Romanelli, G; Marengoni, A; Zucchelli, A; Picardi, A; Gentilucci, Uv; Gallo, P; Dell'Unto, C; Annoni, G; Corsi, M; Bellelli, G; Zazzetta, S; Mazzola, P; Szabo, H; Bonfanti, A; Arturi, F; Succurro, E; Rubino, M; Serra, Mg; Bleve, Ma; Gasbarrone, L; Sajeva, Mr; Brucato, A; Ghidoni, S; Fabris, F; Bertozzi, I; Bogoni, G; Rabuini, Mv; Cosi, E; Manfredini, R; Fabbian, F; Boari, B; De Giorgi, A; Tiseo, R; Paolisso, G; Rizzo, Mr; Borghi, C; Strocchi, E; De Sando, V; Pareo, I; Sabbà, C; Vella, Fs; Suppressa, P; Agosti, P; Schilardi, A; Loparco, F; Fenoglio, L; Bracco, C; Giraudo, Av; Fargion, S; Periti, G; Porzio, M; Tiraboschi, S; Peyvandi, F; Rossio, R; Ferrari, B; Colombo, G; Monzani, V; Savojardo, V; Folli, C; Ceriani, G; Salerno, F; Pallini, G; Dallegri, F; Ottonello, L; Liberale, L; Caserza, L; Salam, K; Liberato, Nl; Tognin, T; Bianchi, Gb; Giaquinto, S; Purrello, F; Di Pino, A; Piro, S; Rozzini, R; Falanga, L; Spazzini, E; Ferrandina, C; Montrucchio, G; Petitti, P; Salmi, R; Gaudenzi, P; Violi, F; Perri, L; Landolfi, R; Montalto, M; Mirijello, A; Guasti, L; Castiglioni, L; Maresca, A; Squizzato, A; Molaro, M; Grossi, A; Bertolotti, M; Mussi, C; Libbra, Mv; Dondi, G; Pellegrini, E; Carulli, L; Perticone, F; Colangelo, L; Falbo, T; Stanghellini, V; De Giorgio, R; Ruggeri, E; Del Vecchio, S; Salvi, A; Leonardi, R; Damiani, G; Gabrielli, A; Capeci, W; Mattioli, M; Martino, Gp; Biondi, L; Pettinari, P; Ghio, R; Col, Ad; Minisola, S; Colangelo, L; Afeltra, A; Marigliano, B; Pipita, Me; Castellino, P; Blanco, J; Zanoli, L; Pignataro, S; Saracco, V; Fogliati, M; Bussolino, C; Mete, F; Gino, M; Cittadini, A; Vigorito, C; Arcopinto, M; Salzano, A; Bobbio, E; Marra, Am; Sirico, D; Moreo, G; Gasparini, F; Prolo, S; Pina, G; Ballestrero, A; Ferrando, F; Berra, S; Dassi, S; Nava, Mc; Graziella, B; Baldassarre, S; Fragapani, S; Gruden, G; Galanti, G; Mascherini, G; Petri, C; Stefani, L; Girino, M; Piccinelli, V; Nasso, F; Gioffrè, V; Pasquale, M; Scattolin, G; Martinelli, S; Turrin, M; Sechi, L; Catena, C; Colussi, G; Passariello, N; Rinaldi, L; Berti, F; Famularo, G; Patrizia, T; Castello, R; Pasino, M; Ceda, Gp; Maggio, Mg; Morganti, S; Artoni, A; Del Giacco, S; Firinu, D; Losa, F; Paoletti, G; Montalto, G; Licata, A; Malerba, V; Antonino, L; Basile, G; Antonino, C; Malatino, L; Stancanelli, B; Terranova, V; Di Marca, S; Mecocci, P; Ruggiero, C; Boccardi, V; Meschi, T; Lauretani, F; Ticinesi, A; Minuz, P; Fondrieschi, L; Pirisi, M; Fra, Gp; Sola, D; Porta, M; Riva, P; Quadri, R; Scanzi, G; Mengoli, C; Provini, S; Ricevuti, L; Simeone, E; Scurti, R; Tolloso, F; Tarquini, R; Valoriani, A; Dolenti, S; Vannini, G; Tedeschi, A; Trotta, L; Volpi, R; Bocchi, P; Vignali, A; Harari, S; Lonati, C; Cattaneo, M; Nieves, Rd; Alberto, Mm; Pedro, Ar; Vanessa, Lp; Lara, T; Xavier, Cv; Francesc, F; Jesus, Dm; Esperanza, Bt; Esther, Dcb; Maria, Sp; Romero, M; Blanca, Pl; Cristina, Lg; Victoria, Vgm; Saez, L; Bosco, J; Susana, Sb; Marta, Ag; Concepcion, Gb; Antonio, Fm; Hernandez, Mg; Borrego, Mp; Raquel, Pc; Florencia, Pr; Beatriz, Go; Sara, Cg; Alfonso, Gc; Marta, Pm; Garcia, Sc; Alberto, Rc; Antonio, Aa; Montserrat, Gg; Ángel, Brm; Manuel, Mj; Ignacio, Nv; Lucía, As; Alfonso, L; David, Rb; Iria, Iv; Monica, Rp

Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register.

As a consequence of population aging, we have witnessed in internal medicine hospital wards a progressive shift from a population of in-patients relatively young and mainly affected by a single ailment to one of ever older and more and more complex patients with multiple chronic diseases, followed as out-patients by many different specialists with poor integration and inevitably treated with multiple medications. Polypharmacy (defined as the chronic intake of five or more drugs) is associated with increased risks of drug-drug interactions and related adverse effects, prescription and intake errors, poor compliance, re-hospitalization and mortality. With this background, the Italian Society of Internal Medicine chose to start in 2008 a prospective register called REPOSI (REgistro POliterapie SIMI, Società Italiana di Medicina Interna) in internal medicine and geriatric hospital wards. The country wide register is an ongoing observatory on multimorbidity and polypharmacy in the oldest old, with the goal to improve prescription appropriateness and, thus to avoid potentially inappropriate medications. The main findings of the register, that has accrued so far, 7005 older patients throughout a 10 year period, are summarized herewith, with special emphasis on the main patterns of poor prescription appropriateness and related risks of adverse events

Therapeutic Duplicates in a Cohort of Hospitalized Elderly Patients: Results from the REPOSI Study

Background: Explicit criteria for potentially inappropriate prescriptions in the elderly are recommended to avoid prescriptions of duplicate drug classes and to optimize monotherapy within a single drug class before a new agent is considered. Duplicate drug class prescription (or therapeutic duplicates) puts the patient at increased risk of adverse drug reactions with no additional therapeutic benefits. To our knowledge, the prevalence of elderly inpatients receiving therapeutic duplicates has never been studied. Objectives: Our objective was to assess the prevalence of therapeutic duplicates at admission, discharge, and 3-month follow-up of hospitalized elderly patients. Methods: This cross-sectional prospective study was conducted in 97 Italian internal medicine and geriatric wards. Therapeutic duplicates were defined as at least two drugs of the same therapeutic class prescribed simultaneously to a patient. A patient\u2019s drug therapy at admission relates to prescriptions from general practitioners, whereas prescriptions at discharge are those from hospital internists or geriatricians. Results: The study sample comprised 5821 admitted and 4983 discharged patients. In all, 143 therapeutic duplicates were found at admission and 170 at discharge. The prevalence of patients exposed to at least one therapeutic duplicate rose significantly from hospital admission (2.5 %) to discharge (3.4 %; p = 0.0032). Psychotropic drugs and drugs for peptic ulcer or gastroesophageal reflux disease were the most frequently involved. A total of 86.8 % of patients discharged with at least one therapeutic duplicate were still receiving them at 3-month follow-up. Conclusions: Hospitalization and drugs prescribed by internists and geriatricians are both factors associated with a small but definite increase in overall therapeutic duplicates in elderly patients admitted to internal medicine and geriatric wards. More attention should be paid to the indications for each drug prescribed, because therapeutic duplicates are not supported by evidence and increase both the risk of adverse drug reactions and costs. Identification of unnecessary therapeutic duplicates is essential for the optimization of polypharmacy

Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study

Background: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the \u2018Registro Politerapie SIMI\u2019 study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p&nbsp;=&nbsp;0.002), had a higher Short Blessed Test (SBT; p&nbsp;=&nbsp;0.022) and a lower Barthel Index (p&nbsp;=&nbsp;0.047). Polypharmacy (p&nbsp;=&nbsp;0.001), heart failure (p&nbsp;=&nbsp;0.005) and diabetes (p&nbsp;=&nbsp;0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p&nbsp;=&nbsp;0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94\u20131.00, p&nbsp;=&nbsp;0.037], diabetes (OR 0.48, 95% CI 0.26\u20130.87, p&nbsp;=&nbsp;0.016) and polypharmacy (OR 0.58, 95% CI 0.34\u20130.99, p&nbsp;=&nbsp;0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p&nbsp;=&nbsp;0.89; and 15.9 vs. 14.1%, p&nbsp;=&nbsp;0.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up

Disability, and not diabetes, is a strong predictor of mortality in oldest old patients hospitalized with pneumonia

Background: Pneumonia causes more deaths than any other infectious disease, especially in older patients with multiple chronic diseases. Recent studies identified a low functional status as prognostic factor for mortality in elderly patients with pneumonia while contrasting data are available about the role of diabetes. The aim of this study was to evaluate the in-hospital, 3-month and 1-year mortality in elderly subjects affected by pneumonia enrolled in the RePoSi register.Methods: We retrospectively analyzed the data collected on hospitalized elderly patients in the frame of the REPOSI project. We analyzed the socio-demographic, laboratory and clinical characteristics of subjects with pneumonia. Multivariate logistic analysis was used to explore the relationship between variables and mortality.Results: Among 4714 patients 284 had pneumonia. 52.8% were males and the mean age was 80 years old. 19.8% of these patients had a Barthel Index &lt;= 40 (p &lt; 0.0001), as well as 43.2% had a short blessed test &gt;= 10 (p &lt; 0.0117). In these subjects a significant CIRS for the evaluation of severity and comorbidity indexes (p &lt; 0.0001) were present. Although a higher fasting glucose level was identified in people with pneumonia, in the multivariate logistic analysis diabetes was not independently associated with in-hospital, 3-month and 1-year mortality, whereas patients with lower Barthel Index had a higher mortality risk (odds ratio being 9.45, 6.84, 19.55 in hospital, at 3 and 12 months).Conclusion: Elderly hospitalized patients affected by pneumonia with a clinically significant disability had a higher mortality risk while diabetes does not represent an important determinant of short and long-term outcome

Prevalence and Determinants of the Use of Lipid-Lowering Agents in a Population of Older Hospitalized Patients: the Findings from the REPOSI (REgistro POliterapie Società Italiana di Medicina Interna) Study.

BACKGROUND: Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. AIM: The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. METHODS: We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Società Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy. RESULTS: 2171 patients aged >65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (≥5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment. CONCLUSIONS: In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients' clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen

Prevalence and Determinants of the Use of Lipid-Lowering Agents in a Population of Older Hospitalized Patients: the Findings from the REPOSI (REgistro POliterapie Societ\ue0 Italiana di Medicina Interna) Study

Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited

Prevalence, characteristics and treatment of chronic pain in elderly patients hospitalized in internal medicine wards.

BACKGROUND: Chronic pain is a frequent characteristic of elderly people and represents an actual and still poorly debated topic. OBJECTIVE: We investigated pain prevalence and intensity, and its pharmacological therapy in elderly patients hospitalized in 101 internal medicine wards. METHODS: Taking advantage of the "REgistro POliterapie Società Italiana Medicina Interna" (REPOSI), we collected 2535 patients of whom almost a quarter was older than 85 years old. Among them, 582 patients were affected by pain (either chronic or acute) and 296 were diagnosed with chronic pain. RESULTS: Patients with pain showed worse cognitive status, higher depression and comorbidities, and a longer duration of hospital stay compared to those without pain (all p < .0366). Patients with chronic pain revealed lower level of independency in their daily life, worse cognitive status and higher level of depression compared to acute pain patients (all p < .0156). Moreover, most of them were not treated for pain at admission (73.4%) and half of them was not treated with any analgesic drug at discharge (50.5%). This difference affected also the reported levels of pain intensity. Patients who received analgesics at both admission and discharge remained stable (p = .172). Conversely, those not treated at admission who received an analgesic treatment during the hospital stay decreased their perceived pain (p < .0001). CONCLUSIONS: Our results show the need to focus more attention on the pharmacological treatment of chronic pain, especially in hospitalized elderly patients, in order to support them and facilitate their daily life after hospital discharge