Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

Hydroxychloroquine reduces low-density lipoprotein cholesterol levels in systemic lupus erythematosus: a longitudinal evaluation of the lipid-lowering effect

The influence of antimalarials on lipids in systemic lupus erythematosus (SLE) has been identified in several studies but not in many prospective cohorts. The aim of this study was to longitudinally determine the effect of antimalarials on the lipoprotein profile in SLE. Patients and methods: Fasting total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL) and low-density lipoprotein cholesterol (LDL) plasma levels were determined at entry and after 3 months of hydroxychloroquine (HCQ) treatment in a longitudinal evaluation of 24 patients with SLE. Results: a significant decrease in TC (198 +/- 33.7 vs. 183 +/- 30.3 mg/dl, p = 0.023) and LDL levels (117 +/- 31.3 vs. 101 +/- 26.2 mg/dl, p = 0.023) were detected after the 3 months of HCQ therapy. The reduction of 7.6% in TC (p = 0.055) and 13.7% in LDL levels (p = 0.036) determined a significant decrease in the frequency of dyslipidemia (26% vs. 12.5%, p = 0.013) after HCQ therapy. Conclusion: This longitudinal study demonstrated the beneficial effect of antimalarials on lipids in SLE since this therapy induced a reduction of atherogenic lipoproteins. Lupus (2012) 21, 1178-1182.Programa para la Investigacion Biomedica PROINBIO, Facultad de Medicina, Universidad de la RepublicaPrograma para la Investigacion Biomedica PROINBIO, Facultad de Medicina, Universidad de la RepublicaComision Sectorial de Investigacion Cientifica (CSIC), Universidad de la RepublicaComision Sectorial de Investigacion Cientifica (CSIC), Universidad de la RepublicaAgencia Nacional de Investigacion e Innovacion (ANII), UruguayAgencia Nacional de Investigacion e Innovacion (ANII), UruguayPrograma para la Investigacion Biomedica PROINBIO, Facultad de Medicina, Universidad de la RepublicaPrograma para la Investigacion Biomedica", PROINBIO, Facultad de Medicina, Universidad de la RepublicaConselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPQ) [303165/2008-1]Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Federico FoundationFederico Foundatio

Obesity and health conditions in elderly of residential homes in Rome

I.F.: 0,81

Phase II study of pemetrexed in combination with carboplatin in patients with malignant pleural mesothelioma (MPM)

none15Background: The aim of this study was to evaluate the activity and toxicity of pemetrexed and carboplatin combination as first-line chemotherapy in malignant pleural mesothelioma (MPM). Patients and methods: Patients with measurable advanced MPM and a zero to two Eastern Cooperative Oncology Group (ECOG) performance status (PS) were enrolled. The schedule was pemetrexed 500 mg/m2 in combination with carboplatin area under the curve 5, every 21 days. In all, 76 patients were treated. Median age was 65 years; median ECOG PS was zero. Results: Grade 3 hematological toxicity according to World Health Organization criteria was seen in 36 (47.3%) patients; grade 4 hematological toxicity in 5 (6.5%) patients. There were 16 (21%) partial responses and 3 (4%) complete responses, for an overall response rate of 19 (25%) [95% confidence interval (CI) 15.3–34.7]. In all, 29 (39%) (95% CI 28–48) patients reported stable disease. The median survival was estimated at 14 months. Conclusion: This combination of carboplatin and pemetrexed is moderately active and the toxicity is acceptable.Castagneto B; Botta M; Aitini E; Spigno F; Degiovanni D; Alabiso O; Serra M; Muzio A; Carbone R; Buosi R; Galbusera V; Piccolini E; Giaretto L; Rebella L; Mencoboni M.Castagneto, B; Botta, M; Aitini, E; Spigno, Fabio; Degiovanni, D; Alabiso, O; Serra, M; Muzio, A; Carbone, R; Buosi, R; Galbusera, V; Piccolini, E; Giaretto, L; Rebella, L; Mencoboni, M