Medication management ability in older patients: Time for a reappraisal

Background. Adhering to drug regimens is a complex and multidimensional task. Elderly patients usually take an average of seven drugs but most fail to adhere to the prescribed regimen. Several performance-based instruments have been developed to assess a patient\u2019s capacity to manage drugs but with inconsistent results. Aims. The aim of the study was to assess the prevalence of impaired medical management capacity in a sample of the oldest old hospitalized elderly patients and the main clinical factors associated with potential unintentional non-adherence. Methods. Forty-six consecutive patients were enrolled in the geriatric transitional care unit of Ospedale Policlinico San Martino, Genoa, Italy. All patients received an abbreviated comprehensive geriatric assessment and a hand grip assessment for sarcopenia. Patients\u2019 medication management ability was assessed by administering the DRUGS tool 48-74 hours before hospital discharge. Results. The results showed a negative correlation between age and total medication management score. A positive correlation was detected between functional status, cognitive status, and medication management score. Hand grip strength < 9 kg correlated with a significant worsening of medical management capacity. In contrast, multiple morbidities and the mean number of drugs were not associated with the medical management score. Conclusions. This preliminary study indicated that drug management capacity mainly relies on frailty markers, such as functional status, sarcopenia, and cognitive performance. Further studies are warranted to identify a subset of medical parameters that can accurately predict impaired medical management ability early, particularly for highly vulnerable elderly patients

Behavioral disturbances in dementia and beyond: Time for a new conceptual frame?

Alzheimer\u2019s disease and vascular dementia are estimated to be the most common causes of dementia, although mixed dementia could represent the most prevalent form of dementia in older adults aged more than 80 years. Behavioral disturbances are common in the natural history of dementia. However, so far, there is a paucity of studies that investigated the causal association between behavioral psychological symptoms of dementia and dementia sub-types, due to the high heterogeneity of methodology, study design and type of clinical assessment. To understand the scant evidence on such a relevant clinical issue, it could be hypothesized that a new shifting paradigm could result in a better identification of the relationship between behavioral disturbances and dementia. This narrative review provides an update of evidence on the behavioral patterns associated with different dementia sub-types and offers a potential future perspective as common ground for the development of new translational studies in the field of behavioral disturbances in dementia and the appropriateness of psychoactive treatments

Resistin: A reappraisal

Abstract From a biological point of view, aging can be considered a progressive inability of an organism to react to stress, maintain homeostasis, and survive unfavourable changes during post-maturational life. The expression of several adipokines changes during aging and for some changes, a role in the onset of chronic disease and frailty has been proposed. Among adipokines, resistin was shown in recent studies to play a key role in aging. Resistin is a small secreted protein that regulates glucose metabolism in mammalians. High resistin levels induce insulin resistance and exert proinflammatory effects. Consistently, resistin has been shown to play a pivotal role in various metabolic, inflammatory, and autoimmune diseases. Herein, the role of resistin as a molecular link between aging and age-related conditions was reviewed and the clinical implications of this knowledge discussed

The OPERA magnetic spectrometer

The OPERA neutrino oscillation experiment foresees the construction of two magnetized iron spectrometers located after the lead-nuclear emulsion targets. The magnet is made up of two vertical walls of rectangular cross section connected by return yokes. The particle trajectories are measured by high precision drift tubes located before and after the arms of the magnet. Moreover, the magnet steel is instrumented with Resistive Plate Chambers that ease pattern recognition and allow a calorimetric measurement of the hadronic showers. In this paper we review the construction of the spectrometers. In particular, we describe the results obtained from the magnet and RPC prototypes and the installation of the final apparatus at the Gran Sasso laboratories. We discuss the mechanical and magnetic properties of the steel and the techniques employed to calibrate the field in the bulk of the magnet. Moreover, results of the tests and issues concerning the mass production of the Resistive Plate Chambers are reported. Finally, the expected physics performance of the detector is described; estimates rely on numerical simulations and the outcome of the tests described above.Comment: 6 pages, 10 figures, presented at the 2003 IEEE-NSS conference, Portland, OR, USA, October 20-24, 200

IgG4 related disease in elderly: A case report

IgG4-related systemic disease (IgG4-RSD) is an emerging autoimmune disorder that may affect several organs, with signs of organ fibrosis, storiform masses for hystopathological plasmacellular infiltration and plasmatic elevation of IgG4. This clinical condition frequently occurs in the sixth decade and may be considered an autoimmunity of the elderly; the disease may have a smouldering course with frequent misdiagnosis for the co-occurrence of comorbidity and clinical complexity. The present case report describes the clinical case of an 81 years old woman admitted to the geriatric ward for remittent fever and functional decline. The past clinical history reported an isolated CT scan suggestive of retroperitoneal fibrosis of unknown origin with and a drug regimen that included chronic corticosteroids (prednisone 5 mg oad). The in hospital diagnostic workout demonstrated the presence of a thoracic aneurysm. Several possible diagnoses among inflammatory, autoimmune (connective tissue disease, vasculitis, sarcoidosis, amyloidosis), infectious (mycotic) or neoplastic conditions were ruled out, as well as any drug association with higher risk of retroperitoneal fibrosis. Thus, the clinical hypothesis of an IgG4 chronic periaortitis was formulated due to the co-occurrence of all the three major components: the presence of a retroperitoneal fibrosis, IgG4 related abdominal aortitis and peryaneurysmal fibrosis. Patient\u2019s comorbidity did not allow performing the histological analysis. The present clinical case is original and adds knowledge to the 76 cases of thoracic aortitis due to IgG4 systemic disease out of the 3482 cases of disease reported so far. Further clinical investigation is needed to provide a homogeneous diagnostic workout for tailored early therapeutic intervention on the single geriatric patient. Moreover, a growing awareness of the disease is needed, especially in geriatrics, to providing a better standard of care and to improving the disease clinical knowledge and managemen

Male breast cancer, clinical presentation, diagnosis and treatment: Twenty years of experience in our Breast Unit

BACKGROUND: The male breast cancer (MBC) is a rare and represents less than 1% of all malignancies in men and only 1% of all breast cancers incident. We illustrate the experience of our team about the clinico-pathological characteristics, treatment and prognostic factors of patients treated over a period of twenty years . RESULTS: Forty-seven patients were collected 1995-2014 at the Breast Unit of the Hospital of Terni, Italy. The average age was 67 years and the median time to diagnosis from the onset of symptoms was 16 months. The main clinical complaint was sub areolar swelling in 36, 76% of cases. Most patients have come to our attention with advanced disease. The histology of about ninety percent of the tumors were invasive ductal carcinoma. Management consisted mainly of radical mastectomy; followed by adjuvant radiotherapy and hormonal therapy with or without chemotherapy. The median follow-up was 38 months. The evolution has been characterized by local recurrences; in eight cases (17% of all patients). Metastasis occurred in 15 cases (32% of all patients). The site of bone metastases was in eight cases; lung in four cases; liver in three cases; liver and skin in one case and pleura and skin in one case. CONCLUSION: The male breast cancer has many similarities to breast cancer in women, but there are distinct functions that need to be appreciated. Future research for a better understanding of the disease should provide a better account of genetic and epigenetic characteristics of these forms; but, above all, epidemiological and biological cohorts numerically more consistent

POSEIDON: An integrated system for analysis and forecast of hydrological, meteorological and surface marine fields in the Mediterranean area

The Mediterranean area is characterized by relevant hydrological, meteorological and marine processes developing at horizontal space-scales of the order of 1–100 km. In the recent past, several international programs have been addressed (ALPEX, POEM, MAP, etc.)to “resolving” the dynamics of such motions. Other projects (INTERREG-Flooding, MEDEX, etc.)are at present being developed with special emphasis on catastrophic events with major impact on human society that are, quite often, characterized in their manifestation by processes with the above-mentioned scales of motion. In the dynamical evolution of such events, however, equally important is the dynamics of interaction of the local (and sometimes very damaging)pro cesses with others developing at larger scales of motion. In fact, some of the most catastrophic events in the history of Mediterranean countries are associated with dynamical processes covering all the range of space-time scales from planetary to local. The Prevision Operational System for the mEditerranean basIn and the Defence of the lagOon of veNice (POSEIDON)is an integrated system for the analysis and forecast of hydrological, meteorological, oceanic fields specifically designed and set up in order to bridge the gap between global and local scales of motion, by modeling explicitly the above referred to dynamical processes in the range of scales from Mediterranean to local. The core of POSEIDON consists of a “cascade” of numerical models that, starting from global scale numerical analysisforecast, goes all the way to very local phenomena, like tidal propagation in Venice Lagoon. The large computational load imposed by such operational design requires necessarily parallel computing technology: the first model in the cascade is a parallelised version of BOlogna Limited Area Model (BOLAM)running on a Quadrics 128 processors computer (also known as QBOLAM). POSEIDON, developed in the context of a co-operation between the Italian Agency for New technologies, Energy and Environment (Ente per le Nuove tecnologie, l’Energia e l’Ambiente, ENEA)and the Italian Agency for Environmental Protection and Technical Services (Agenzia per la Protezione dell’Ambiente e per i Servizi Tecnici, APAT), has become operational in 2000 and we are presently in the condition of drawing some preliminary conclusions about its performance. In the paper we describe the scientific concepts that were at the basis of the original planning, the structure of the system, its operational cycle and some preliminary scientific and technical evaluations after two years of experimentation