Nutritional Status and Potentially Inappropriate Medications in Elderly: Real-World Experience

(1) Background: The association between polypharmacy and malnutrition has been investigated in several studies; however, few of these specifically deepened the relationship between potentially inappropriate medication and malnutrition. With a descriptive approach, the primary aim of our study was to evaluate the impact of the nutritional status, assessed with the Mini Nutritional Assessment (MNA), on potentially inappropriate medications (PIM), estimated 10-year survival, and the risk of adverse drug reactions in elderly patients; the secondary aim was to evaluate how the Screening Tool of Older People’s Prescriptions (STOPP), Screening Tool to Alert to Right Treatment (START), and BEERS 2019 criteria identify PIM compared to nutritional status. (2) Methods: In this study, 3091 subjects were enrolled, of whom 2748 (71.7%) were women; the median age was 80 years, with an interquartile range between 75 and 85 years of age. The subjects were assessed at the outpatient service for frail older people of the University Hospital of Cagliari. The study population was evaluated for their: MNA, Charlson Comorbidity Index, 10-year survival estimation, BEERS 2019, STOPP and START criteria, and ADR Risk scores. (3) Results: We divided the study population into three groups: MNA1 (MNA score ≥ 24), MNA2 (23.5–17), and MNA3 (<17): the severity of comorbidities, STOPP and START alerts, and BEERS 2019 criteria were significantly worse in both MNA2 and MNA3 compared to MNA1—with the exception of BEERS “non-anti-infective medications that should be avoided or have their dosage reduced with varying levels of kidney function in older adults”. Moreover, the estimated 10-year survival was significantly higher in MNA1 than in MNA2 and MNA3, and also in MNA2 compared to MNA3. Finally, the ADR risk scores were significantly lower in MNA1 than in MNA2 and MNA3. (4) Conclusions: Our study demonstrated the association between nutritional status and PIM checked with the BEERS 2019 criteria, and, for the first time, with the STOPP and START criteria

SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern

According to the Italian national statistical institute, severe bacterial infections (SBI) in Italy are responsible for 1.7% of mortality under five years of age and their recognition is often challenging, especially in the first stages of the disease. We tried to estimate the prevalence of SBI in our target population and to identify signs and symptoms that could guide in the initial evaluation of a child with a possible SBI

A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Background: Mechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated. Objectives: To develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD. Methods: From the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis < 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD. Results: Among the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11 years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions: Integrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations. Clinical trial registration: NCT02737982

The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study

Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes and gender-related factors on medication adherence among women and men at high risk for ischemic heart disease (IHD) has not yet been fully investigated.Aim: To explore the role of sex, gender-related factors, and diabetes in pre-admission medication adherence among patients hospitalized for IHD.Materials and Methods: Data were obtained from the Endocrine Vascular disease Approach (EVA) (ClinicalTrials.gov Identifier: NCT02737982), a prospective cohort of patients admitted for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire. We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence.Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of the patients were low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed that low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men. Interestingly, women reporting medication low-adherence were similar for clinical and gender-related factors to those with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004). In a multivariate adjusted model only employed status was associated with poor medication adherence (OR 0.55, 95%CI 0.31–0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95%CI 0.13–0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95%CI 0.35–0.99).Conclusion: Pre-admission medication adherence is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors such as diabetes, employment, and personality traits are associated with adherence in a sex-specific manner

Macrocephaly and palmoplantar pitting

N/

Child presenting with breathlessness 1 month after cardiac surgery

N/

Adolescent with painful vesicular otitis and vertigo

N/

The Impact of wildland fires on calcareous Mediterranean pedosystems (Sardinia, Italy): an integrated multiple approach

Sardinia (Italy), the second largest island of the Mediterranean Sea, is a fire-prone land. Most Sardinian environments over time were shaped by fire, but some of them are too intrinsically fragile to withstand the currently increasing fire frequency. Calcareous pedoenvironments represent a significant part of Mediterranean areas, and require important efforts to prevent long-lasting degradation from fire. The aim of this study was to assess through an integrated multiple approach the impact of a single and highly severe wildland fire on limestone-derived soils. For this purpose, we selected two recently burned sites, Sant'Antioco and Laconi. Soil was sampled from 80 points on a 100 × 100 m grid – 40 in the burned area and 40 in unburned one – and analyzed for particle size fractions, pH, electrical conductivity, organic carbon, total N, total P, and water repellency (WR). Fire behavior (surface rate of spread (ROS), fireline intensity (FLI), flame length (FL)) was simulated by BehavePlus 5.0.5 software. Comparisons between burned and unburned areas were done through ANOVA as well as deterministic and stochastic interpolation techniques; multiple correlations among parameters were evaluated by principal factor analysis (PFA) and differences/similarities between areas by principal component analysis (PCA). In both sites, fires were characterized by high severity and determined significant changes to some soil properties. The PFA confirmed the key ecological role played by fire in both sites, with the variability of a four-modeled components mainly explained by fire parameters, although the induced changes on soils were mainly site-specific. The PCA revealed the presence of two main “driving factors”: slope (in Sant'Antioco), which increased the magnitude of ROS and FLI; and soil properties (in Laconi), which mostly affected FL. In both sites, such factors played a direct role in differentiating fire behavior and sites, while they played an indirect role in determining some effects on soil

Production of interferon-β (INF-β) in E. coli and strategies for improving its bioavailability and pharmacological profile.

IFN-β is the main therapeutic agent which convincingly reduces multiple sclerosis relapse rate and retards disability. IFN-β, expressed both in mammalian and bacterial cells, is used in therapy. However, even if costs and yield in E. coli are very advantageous, its production is extremely difficult, due to its toxicity and extreme insolubility. Bio-Ker set up a thermoinducible expression system with optimized codon usage, which allows the expression of a fusion protein reaching a yield up to 2mg/l. Biological activity of the purified protein was evaluated by measuring inhibition of cell multiplication, and phosphorylation of Stat1 in Hela cells. Principal issues related to IFN-β are protein aggregation, with loss of bioavailability up to 70%, and high immunogenicity, with production of neutralizing Ab which interrupt therapy. In order to ameliorate the bio-similar product, Bio-Ker produced some site-specific muteins, according to molecular modelling design. Muteins have been evaluated for in vitro and in vivo pharmacological profiles. Moreover, IFN-β naturally exhibits a relatively short serum half-life, and we are planning to obtain a long lasting IFN-β mutein by conjugation to polymers which will entrap the protein in pharmaceutical controlled release devices to increase their bioavailability and to improve their pharmacological profile. Pharmacological, pharmacokinetic and pharmacodynamic data will be discussed

I primi disegni di Cagliari dal mare

Dall'edizione del 1550 della Cosmographia Universalis, stampata a Basilea da Sebastian Münster, Cagliari è oggetto di vedute disegnate secondo evidenti caratteristiche iconografighe, spesso comuni a quelle di altre città italiane e europee incluse nella monumentale opera. Nel progetto dell'immagine, oggetto di un mio precedente studio nel 2004, si individuano nuovi elementi che confermano le attribuzioni di autore, incisore e disegnatore. L'impaginazione della veduta della città dal mare, evidentemente derivata da precedenti modelli, così come quelle di altre incluse nella Cosmographia quali Firenze o Roma, segue con cura i principi del progetto urbano medievale. Secondo i modi dettati dall'arte del navigare, documentati dai portolani duecenteschi, il principio del punto di vista coincide con quello necessario per l'accesso sicuro al porto, quindi con la progettazione del sistema di torri segnale utilizzate per la difesa urbana. Secondo un cosciente processo di recupero di segni e memorie, la tradizione iconografica si trasmette prima nella vedutistica seicentesca e quindi ai portolani ottocenteschi. La identificazione degli edifici più rilevanti, dei processi progettuali perseguiti nella costruzione della interfaccia portuale di Cagliari, permette di sottolineare la costruzione dei waterfront secondo i modelli moderni dettati da logiche estetiche e militari