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

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

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

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

Sulfonated Pentablock Copolymer (Nexar^TM) for Water Remediation and Other Applications

This review focuses on the use of a sulfonated pentablock copolymer commercialized as NexarTM in water purification applications. The properties and the use of sulfonated copolymers, in general, and of NexarTM, in particular, are described within a brief reference focusing on the problem of different water contaminants, purification technologies, and the use of nanomaterials and nanocomposites for water treatment. In addition to desalination and pervaporation processes, adsorption and photocatalytic processes are also considered here. The reported results confirm the possibility of using NexarTM as a matrix for embedded nanoparticles, exploiting their performance in adsorption and photocatalytic processes and preventing their dispersion in the environment. Furthermore, the reported antimicrobial and antibiofouling properties of NexarTM make it a promising material for achieving active coatings that are able to enhance commercial filter lifetime and performance. The coated filters show selective and efficient removal of cationic contaminants in filtration processes, which is not observed with a bare commercial filter. The UV surface treatment and/or the addition of nanostructures such as graphene oxide (GO) flakes confer NexarTM with coating additional functionalities and activity. Finally, other application fields of this polymer are reported, i.e., energy and/or gas separation, suggesting its possible use as an efficient and economical alternative to the more well-known Nafion polymer

Wet Environment Effects for Ethanol and Water Adsorption on Anatase TiO2 (101) Surfaces

Titanium dioxide exhibits superior photocatalytic properties, mainly occurring in liquid environments through molecular adsorptions and dissociations at the solid/liquid interface. The presence of these wet environments is often neglected when performing ab initio calculations for the interaction between the adsorbed molecules and the TiO 2 surface. In this study, we consider two solvents, that is, water and ethanol, and show that the proper inclusion of the wet environment in the methodological scheme is fundamental for obtaining reliable results. Our calculations are based on structure predictions at a density functional theory level for molecules interacting with the perfect and defective anatase (101) surface under both vacuum and wet conditions. A soft-sphere implicit solvation model is used to describe the polar character of the two solvents. As a result, we find that surface oxygen vacancies become energetically favorable with respect to subsurface vacancies at the solid/liquid interface. This aspect is confirmed by ab initio molecular dynamics simulations with explicit water molecules. Ethanol molecules are able to strongly passivate these vacancies, whereas water molecules only weakly interact with the (101) surface, allowing the coexistence of surface vacancy defects and adsorbed species. The infrared and photoluminescence spectra of anatase nanoparticles predominantly exposing (101) surfaces dispersed in water and ethanol support the predicted molecule-surface interactions, validating the whole computational paradigm. The combined analysis allows for a better interpretation of TiO 2 processes in wet environments based on improved computational models with implicit solvation features

Photo-Fenton Degradation of Methyl Orange with Dunino Halloysite as a Source of Iron

The Fenton reaction is one of the most important processes for water and soil remediation, although this process has some drawbacks such as the use of H2O2 in large amounts, the formation of sludge due to the use of iron salts, and the need for acid pH values. Here we present the use of a natural clay, modified by acid treatment, as a heterogeneous catalyst to replace soluble iron salts and to avoid the use of water peroxide, resulting in a considerable increase in the attractiveness of the process. Halloysite (HT) clay from the Dunino mine consists of alumina and silica layers with the presence of iron species acting as a source of Fe ions. The etching of alumina layers using hydrochloric acid induces the release of iron species (mainly ions) in the solution, giving rise to the photodegradation activity of organic contaminants in water (i.e., Methyl Orange, MO) under UV irradiation without the need for hydrogen peroxide and avoiding the formation of sludges. MO adsorption properties and MO photodegradation ability were investigated for untreated and acid treated samples, respectively, to achieve the optimal process conditions. MO was not adsorbed on the clay’s surface due to electrostatic repulsion, but a complete degradation was observed after three hours under UV irradiation. The kinetics of photodegradation and the values of the half-life time are presented as a measure of the degradation rate. The proposed process shows a new route for effective remediation of water containing biologically active organic substances dissolved in it

Investigation of ZnO-decorated CNTs for UV Light Detection Applications

Multi-walled carbon nanotubes (CNTs) decorated with zinc oxide nanoparticles (ZnO NPs) were prepared in isopropanol solution by a simple, room-temperature process and characterized from structural, morphological, electronic, and optical points of view. A strong interaction between ZnO and CNTs is fully confirmed by all the characterization techniques. ZnO-CNTs nanocomposites, with different weight ratios, were deposited as a dense layer between two electrodes, in order to investigate the electrical behaviour. In particular, the electrical response of the nanocomposite layers to UV light irradiation was recorded for a fixed voltage: As the device is exposed to the UV lamp, a sharp current drop takes place and then an increase is observed as the irradiation is stopped. The effect can be explained by adsorption and desorption phenomena taking place on the ZnO nanoparticle surface under irradiation and by charge transfer between ZnO and CNTs, thanks to the strong interaction between the two nanomaterials. The nanocomposite material shows good sensitivity and fast response to UV irradiation. Room temperature and low-cost processes used for the device preparation combined with room temperature and low voltage operational conditions make this methodology very promising for large scale UV detectors applications

AZO Nanoparticles-Decorated CNTs for UV Light Sensing: A Structural, Chemical, and Electro-Optical Investigation

Nanocomposites formed by aluminum-doped zinc oxide nanoparticles (AZO–NP) and multiwall carbon nanotubes (CNT) are proposed here as a promising material for UV light sensing applications, with the great advantage of operating in air, at room temperature, and at low voltage. Nanocomposite layers were prepared with different AZO:CNT weight ratios by a simple methodology at room temperature. They were characterized by means of UV–Vis spectroscopy, scanning and transmission electron microscopies (SEM and TEM), and X-ray photoelectron spectroscopy (XPS). The interaction between the two nanomaterials was demonstrated by comparing the properties of the nanocomposite with the ones shown by the AZO–NPs. Dense AZO–CNT nanocomposite layers were deposited between two metal electrodes on a SiO2/Si substrate, and the electrical properties were investigated in dark condition and under UV light irradiation. The electrical response to the UV light was a sudden current increase that reduced when the light was switched off. Several UV on/off cycles were performed, showing good repeatability and stability of the response. The mechanisms involved in the electrical response are discussed and compared to the ones previously reported for ZnO–CNT nanocomposites