Relationship between clinical variables and Patient-Reported Outcomes in patients with psoriatic disease

Background Psoriatic Arthritis (PsA) is a chronic inflammatory form of Arthritis associated with enthesitis, dactylitis, nail dystrophy, uveitis, and osteitis. PsA is strongly associated with comorbidities such as obesity, metabolic syndrome, and cardiovascular disease. As usual PsA patients are assessed either by rheumatologist or dermatologist but a multiprofessional assessment for those subjects is important to improve their disease control and their quality-of-life. The multidimensional assessment is a new model of care for PsA patients in which a multiprofessional team (rheumatologist, dermatologist, internal medicine physician, nutritionist and a phycologist) with a nurse as case manager, assess patients in the main domains of PsA from the admission to the follow-up. Different validated tools are used by the team to assess different patients’ dimension as patient-reported-outcomes. This study aimed to evaluate the association between and among clinical variables and Patient-Reported Outcomes in a realworld sample of PsA patients evaluated according the Multidimensional Assessment. Methods A cross-sectional study was conducted. Patients with PsA who signed the informed consent were enrolled at the PsA clinic at the ARNAS Civico in Palermo (Italy) from March 2018 to October 2020. Clinical, pharmacological, anthropometric, laboratory variables, and patientreported outcomes were evaluated, including: • Health Assessment Questionnaire (HAQ); • Facit-Fatigue (FACIT-F); • Psoriatic Arthritis Impact of Disease Questionnaire (PsAID); • Patient Health Questionnaire-9 (PHQ-9); • Disease Activity in PSoriatic Arthritis score (Dapsa); • Patient global assessment (PGA) STATA 14.1 was used to perform logistic analysis. Results According to CASPAR Criteria, 158 patients aged 55.2 (53.3 – 57.1) affected by Psoriatic Arthritis were included in the study. All the collected variables were evaluated ad a strong association was observed between functional disability measured by HAQ >2 and central obesity [OR (95% CI) 16.94 (2.22 - 129.48); p < 0.004]. Moreover, data analysis showed an association between high impact of disease on life (PsAID >4) and central obesity [OR (95% CI) 3.33 (1.56 - 7.13); p<0,002]. Models were adjusted for age, sex, years of illness, and biological treatment. Conclusion This study demonstrated a high association between functional disability studied subjectively using the HAQ, the impact of the disease on patients’ quality-of-life using the PsAID, and central obesity in patients affected by PsA. Data suggest that a multiprofessional evaluation for these patients is important to evaluate different aspect of the disease as the comorbidities. In particular, therapeutic goals should not be focused only on treatment but also on waist circumference reduction to reduce inflammation and improve patients’ functional ability and quality-of-life

Does Evidence Exist to Blunt Inflammatory Response by Nutraceutical Supplementation during COVID-19 Pandemic? An Overview of Systematic Reviews of Vitamin D, Vitamin C, Melatonin, and Zinc

More than one year has passed since the first cases of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome (SARS)-CoV-2 coronavirus were reported in Wuhan (China), rapidly evolving into a global pandemic. This infectious disease has become a major public health challenge in the world. Unfortunately, to date, no specific antivirals have been proven to be effective against COVID-19, and although a few vaccines are available, the mortality rate is not decreasing but is still increasing. One therapeutic strategy has been focused on infection prevention and control measures. In this regard, the use of nutraceutical supports may play a role against some aspect of the infection, particularly the inflammatory state and the immune system function of patients, thus representing a strategy to control the worst outcomes of this pandemic. For this reason, we performed an overview including meta-analyses and systematic reviews to assess the association among melatonin, vitamin C, vitamin D, zinc supplementation and inflammatory markers using three databases, namely, MEDLINE, PubMed Central and the Cochrane Library of Systematic Reviews. According to the evidence available, an intake of 50,000 IU/month of vitamin D showed efficacy in CRP. An amount of 1 to 2 g per day of vitamin C demonstrated efficacy both in CRP and endothelial function, and a dosage of melatonin ranging from 5 to 25 mg /day showed good evidence of efficacy in CRP, TNF and IL6. A dose of 50 mg/day of elemental zinc supplementation showed positive results in CRP. Based on the data reported in this review, the public health system could consider whether it is possible to supplement the current limited preventive measures through targeted nutraceutical large-scale administration

MALNUTRITION IS ASSOCIATED WITH DEPRESSION IN LONG-TERM CARE POPULATION

Rationale: Frailty in elderly is a multifactorial syndrome and is associatet with an increased risk of poor health outcomes (falls, disability, hospital- ization and mortality), malnutrition and depression are the must impor- tant factors contributing to frailty. This study describes the application of multidimensional evaluation for the early identification of frailty in long- term care population.Methods: Clinical data from 100 long-term care inpatients (53 female and 47 male, mean age 69.6 years) were collected at the ARNAS Civico- DiCristina-Benfratelli, Palermo, Italy. Each inpatient had undergone a multidimensional assessment through a multiprofessional team. Nutri- tional state was assessed with the Malnutrition Universal Screening Tool (MUST) and Geriatric Nutritional Risk Index (GNRI), sarcopenia was esti- mated whit Skeletal Muscle Index (SMI). Also, nutritional and biochemical variables were under consideration (serum albumin, cholesterol, iron, and hemoglobin). Cognitive impairment was evaluated by the Short Blessed Test (SBT). Depression was analyzed using the Geriatric Depression Scale 5-items (GDS). Self-caring capacity was measured with Barthel Index (BI). Results: The prevalence of cognitive impairment and depression was 63% and 73,7% respectively. MUST showed 81,8% of patients at high risk of malnutrition. Sarcopenia was found in 77% of patients. BI showed that 57,6% of patients were not autonomous. The statistical analysis pointed out a significant association between male gender and severe sarcopenia (P&lt;0.001). GNRI was significantly association to depression (P&lt;0.001). Conclusion: The results of the study went towards an association between hight risk of malnutrition and risk of depression. Multidimensional assessment that includes assessment of nutritional state, sarcopenia, cognitive impairment and depression is a powerful instrument to evaluate the clinical complexity of long-term care units and potentially may improve the quality of care allowing the early identification of frail patients

The Importance of the Nurse’s Role in the Management of Complex Diabetic Outpatients: It is the Time to Manage Patient’s Multidimensions

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A novel flash glucose monitoring system in patients with diabetes mellitus type 1 and 2: which are the pieces of evidence for payer decision-makers?

A rigorous health technology assessment is necessary to evaluate a new technology. However, healthcare regulatory agencies have less restrictive rules about medical devices, despite some recent warnings about this relevant matter. The evaluation should have at least two key issues, which require attention. The first one is its effectiveness, and the second one is its economic sustainability. In this paper, we deal with a novel glucose-sensing technology as a case study to examine the matter in depth. An evidence-based point of view is used to highlight this important issue

The M.U.S.E. project: A nursing-centered MUltidimensional aSsessment of Elderly outpatient with comorbidities

Objective: Increasingly exacerbations of chronic diseases in frail elderly, causes reduction of patients' quality of life and lead to significant increases in resource utilization and cost to the health care system. A multidimensional and multidisciplinary assessment of an older person allows the identification of the level of stability or fragility of the patient, thereby determining a prognosis and a tailored therapeutic approach. Besides, the revaluation over time allows you to understand the evolution, the critical points of the natural history of the person, tailoring interventions to reduce the risk of disability, hospitalization, and death. The aim of our study is to implement a new approach named M.U.S.E. as improved multidimensional assessment of older outpatients. Methods: the model was developed by a financial support of the Italian Ministry of Health and has been recruiting patients over the age of 65 affected by chronic disease. According to the model, patients are assessed by a doctor and a specialist nurse. If they are affected by one or more of four main chronic diseases (COPD, Hypertension, Hearth Failure, and Diabetes), specific pathways are used to complete the assessment. Long-term outcomes have been investigating. Results and conclusion: the implementation of the M.U.S.E. model of multidimensional assessment seems to improve patients experiences and offer a complete evaluation of comorbidities and nutritional status other than physical and cognitive functionality. The project started in October 2016, and these are preliminary data. The project is in progress

Protective Effect of Vitamin D Supplementation on COVID-19-Related Intensive Care Hospitalization and Mortality: Definitive Evidence from Meta-Analysis and Trial Sequential Analysis

Background: The COVID-19 pandemic represents one of the world’s most important challenges for global public healthcare. Various studies have found an association between severe vitamin D deficiency and COVID-19-related outcomes. Vitamin D plays a crucial role in immune function and inflammation. Recent data have suggested a protective role of vitamin D in COVID-19-related health outcomes. The purpose of this meta-analysis and trial sequential analysis (TSA) was to better explain the strength of the association between the protective role of vitamin D supplementation and the risk of mortality and admission to intensive care units (ICUs) in patients with COVID-19. Methods: We searched four databases on 20 September 2022. Two reviewers screened the randomized clinical trials (RCTs) and assessed the risk of bias, independently and in duplicate. The pre-specified outcomes of interest were mortality and ICU admission. Results: We identified 78 bibliographic citations. After the reviewers’ screening, only five RCTs were found to be suitable for our analysis. We performed meta-analyses and then TSAs. Vitamin D administration results in a decreased risk of death and ICU admission (standardized mean difference (95% CI): 0.49 (0.34–0.72) and 0.28 (0.20–0.39), respectively). The TSA of the protective role of vitamin D and ICU admission showed that, since the pooling of the studies reached a definite sample size, the positive association is conclusive. The TSA of the protective role of vitamin D in mortality risk showed that the z-curve was inside the alpha boundaries, indicating that the positive results need further studies. Discussion: The results of the meta-analyses and respective TSAs suggest a definitive association between the protective role of vitamin D and ICU hospitalization

An Overview of Systematic Reviews of the Role of Vitamin D on Inflammation in Patients with Diabetes and the Potentiality of Its Application on Diabetic Patients with COVID-19

Almost two years have passed since the outbreak reported for the first time in Wuhan of coronavirus disease 2019 (COVID-19), due to severe acute respiratory syndrome (SARS)-CoV-2 coronavirus, rapidly evolved into a pandemic. This infectious disease has stressed global health care systems. The mortality rate is higher, particularly in elderly population and in patients with comorbidities such as hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, chronic renal disease, and malignancy. Among them, subjects with diabetes have a high risk of developing severe form of COVID-19 and show increased mortality. How diabetes contributes to COVID-19 severity remains unclear. It has been hypothesized that it may be correlated with the effects of hyperglycemia on systemic inflammatory responses and immune system dysfunction. Vitamin D (VD) is a modulator of immune-response. Data from literature showed that vitamin D deficiency in COVID-19 patients increases COVID-19 severity, likely because of its negative impact on immune and inflammatory responses. Therefore, the use of vitamin D might play a role in some aspects of the infection, particularly the inflammatory state and the immune system function of patients. Moreover, a piece of evidence highlighted a link among vitamin D deficiency, obesity and diabetes, all factors associated with COVID-19 severity. Given this background, we performed an overview of the systematic reviews to assess the association between vitamin D supplementation and inflammatory markers in patients with diabetes; furthermore, vitamin D&rsquo;s possible role in COVID-19 patients was assessed as well. Three databases, namely MEDLINE, PubMed Central and the Cochrane Library of Systematic Reviews, were reviewed to retrieve the pertinent data. The aim of this review is to provide insight into the recent advances about the molecular basis of the relationship between vitamin D, immune response, inflammation, diabetes and COVID-19

Impact of Diabetes Mellitus and Its Comorbidities on Elderly Patients Hospitalized in Internal Medicine Wards: Data from the RePoSi Registry

Background: Currently, diabetes represents the seventh leading cause of death worldwide, with a significant economic burden. The number and severity of comorbidities increase with age, and are identified as important determinants that influence the prognosis. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients affected by diabetes. Methods: In this observational study, we retrospectively analyzed data collected from the REgistro dei pazienti per lo studio delle POlipatologie e politerapie in reparti della rete Simi (RePoSi) registry. Socio-demographic, clinical characteristics, and laboratory findings were considered. The association between variables and in-hospital and 1-year follow-up were analyzed. Results: Among 4708 in-patients, 1378 (29.3%) had a diagnosis of diabetes. Patients with diabetes had more previous hospitalization, a clinically significant disability, and more need for a urinary catheter in comparison with subjects without diabetes. Patients affected by diabetes took more drugs, both at admission, at in-hospital stay, at discharge, and at 1-year follow-up. Thirty-five comorbidities were more frequent in patients with diabetes, and the first five were hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and chronic obstructive pulmonary disease (22.7%). Heart rate was an independent predictor of in-hospital mortality. At 1-year follow-up, cancer and male sex were strongly independently associated with mortality. Conclusions: Our findings showed the severity of the impact of diabetes and its comorbidities in the real life of internal medicine and geriatric wards, and provide data to be used for a better tailored management of elderly in-patients with diabetes

Clinical complexity and diabetes: a multidimensional approach for the management of cardiorenal metabolic syndrome

: Diabetes mellitus (DM) is one of the fastest-growing health emergencies of the 21st century, and one of the chronic diseases with the highest socio-economic impact on health care systems. DM is the main cause of chronic kidney disease, and is associated with a significant increase in cardiovascular risk and clinical and care complexity. The presence of a constellation of cardiac, metabolic, and renal diseases, in a complex patient with DM, constitutes the CardioRenal Metabolic Syndrome (CRMS). The management of these patients should include a paradigm shift from a reactive strategy to a proactive approach, and the integration of territorial, hospital and social assistance services according to the Chronic Care Model (CCM). Complexity science suggests an alternative model in which disease and health arise from complex, dynamic, and unique interactions among the different components of the overall system. The hospital should be viewed as a highly specialized hub of the chronic care system, which interacts with the outpatient specialist and primary care. In order to create effective communication among territorial care units and highly specialized hospitals, levels of clinical complexity are here proposed and included in a multidimensional management model for the complex patient with diabetes and cardiorenal comorbidity