Preliminary studies on environmental pollutants in chamois and wild boar from Eastern Piedmont, Italy.

Organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) are synthetic chlorinated compounds classified as POPs whereas only the penta e tetra-brominated polybromodiphenyl ethers (PBDEs) are so defined by the Stockolm Convention (Stockholm Convention, 2005) in order to elimitate or restrict the use of POPs. Organophosphorus insecticides (OCPs) represent important environmental and food contamination sources, widely used in agriculture. Among polyciclic aromatic hydrocarbons (PAHs), benzo[a]pirene is classified by IARC in Group 1, as cancerogen  and Benzo[a]fluoranthene as a Group 2B, as possible cancerogen (IARC, 2012; IARC, 2010).  EFSA (European Food Safety Authority) has released a scientific opinion on the risks to public health related to the presence of brominated flame retardants in food (EFSA, 2011) and in 2014 European commission has asked Member States to monitor the presence of brominated flame retardants (BFRs) in food over the next two years (EC, 2014). Due to their heir n-octanol/water partition coefficient (log Kow), they accumulate in fat tissue, bioconcentrate and biomagnify in the animals at the higher trophic levels, possibly causing, through chronic exposure, endocrine disruption and cancer (Wania et al., 1995; Vallack et al., 1998). The aim of this study is to evaluate the presence of OCPs, PCBs, PBDEs and PAHs in chamois and wild boar from Eastern Piedmont, Italy. A total of 20 chamois and 20 wild boar muscle samples were collected during the hunting season 2017, from Verbania Cusio Ossola (VCO) (Fig 1). The chemical analysis for the detection of OCPs, PCBs, PBDEs, and PAHs   was performed by GC-MS/MS on muscle samples purified and extracted using a QuEChERS technique, validated according to SANTE 2017 (SANTE/11183/2017). These preliminary results show the ubiquitary presence of the studied contaminants. PCBs have been found more in chamois (45%) than in wild boar (35%). No PBDEs were detected in wild boar but in chamois were found with a prevalence of 35%  and  concentration 0.25-1.52 ng g-1. About OCPs, phorate and demeton were found in wild boar (55%-15%) and chamois (32%- 35%) with range concentrations 0.21-20.1 ng g-1. No PAHs were detected, expect antharacene for one samples in wild boar (0.53 ng g-1). Further studies are in progress in order to correlate environmental contamination and game animals

Metals in mussels from Italian mollusc culture plants

The beneficial effects on human health of seafood are well known. However, seafood is a major source of exposition for consumers of most of the contaminants due to human activities such as breeding, industries, mining and agriculture: the overall level in biota, therefore seafood and particularly molluscs, dramatically increased over this last two centuries. This study evaluates the presence of Lead, Mercury, Cadmium, Arsenic, Nickel and Chromium in mussels from the Italian mussel culture plants, and estimate the risk that Italian consumer undergoes eating these molluscs. Mussels where collected at the wholesale fish market of Milan, the most important wholesale Italian fish market. The molluscs belonged to the   37 FAO marine area (corresponding to Mediterranean Sea), particularly from FAO 37.2.1 Ligury, 37.2.2. North Adriatic, middle Adriatic, Puglia, 37.2.3 Lazio and Sardinia, and were collected from July 2016 to February 2017. (FIG1). Analyses were carried out through inductively coupled plasma-mass spectrometry (ICP-MS) according to the Environmental Protection Agency (EPA) 3050B method. The sample concentrations were below the Maximum Levels (ML) given by Commission Regulation (EC) No 1881/2006 for Cadmium, Lead and Mercury, except one sample from south Adriatic sea, that showed Mercury concentration of 0.528 mg kg-1. Arsenic, Nickel and Chromium ML are not stated by EU. Arsenic concentration ranged from 2.05 to 13.35 mg kg-1, with the highest values found in Italian molluscs, Nickel concentration ranged from 0.00 to 3.98 mg kg-1. Chromium was found only in 5 of 30 sample analysed with a maximum concentration of 0.590 g kg-1. The tolerable intakes recommended by EFSA and on EU maximum levels, indicate that Italian mussels do not pose a risk consumers

Comparative diagnostic accuracy of 18F-FDG PET/CT for breast cancer recurrence

In the last decades, in addition to conventional imaging techniques and magnetic resonance imaging (MRI), 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has been shown to be relevant in the detection and management of breast cancer recurrence in doubtful cases in selected groups of patients. While there are no conclusive data indicating that imaging tests, including FDG PET/CT, produce a survival benefit in asymptomatic patients, FDG PET/CT can be useful for identifying the site of relapse when traditional imaging methods are equivocal or conflicting and for identifying or confirming isolated loco-regional relapse or isolated metastatic lesions. The present narrative review deals with the potential role of FDG PET in these clinical settings by comparing its accuracy and impact with conventional imaging modalities such as CT, ultrasound, bone scan, 18F-sodium fluoride PET/CT (18F-NaF PET/CT) as well as MRI. Patient-focused perspectives in terms of patients\ue2\u80\u99 satisfaction and acceptability are also discussed

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background 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

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background 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

Legacy and Emerging Contaminants in Demersal Fish Species from Southern Norway and Implications for Food Safety

The present study aimed at measuring the levels of legacy and emerging contaminants in fillet samples from four demersal fish caught in two fishing sites from Southern Norway, in order to assess possible implications for food safety. Levels of organochlorine compounds (OCs), organophosphate pesticides (OPs), polychlorinated biphenyls (PCBs), polybromodiphenyl ethers (PBDE), per- and polyfluoroalkyl substances (PFASs), and polycyclic aromatic hydrocarbons (PAHs) were measured in fillet from Atlantic cod (Gadus morhua), European plaice (Pleuronectes platessa), lemon sole (Microstomus kitt), and European flounder (Platichthys flesus) specimens. A negligible contamination by all the investigated chemicals was noted in both the fishing sites, as very low levels of OCs, PCBs, and PFASs were noted in a limited number of individuals for each species. Considering the levels of contaminants measured in fillets of the four demersal fish species, negligible risk for human health for Norwegian consumers can be supposed.publishedVersio