Comparing the Prevalence of Polypharmacy and Potential Drug-Drug Interactions in Nursing Homes and in the Community Dwelling Elderly of Emilia Romagna Region

Backround: We aimed at assessing the prevalence of polypharmacy and potential drug-drug interactions (DDIs) with clinical relevance in elderly patient on Emilia Romagna area. Both outpatients and residents in nursing homes were assessed, with only partially overlapping strategies. Methods: We defined a list of 190 pairs of potentially interacting drugs, based on literature appraisal and availability of therapeutic alternatives. January-June 2018 data on drug use in patients over 65 years-old were collected from nine Local Health Authorities of Emilia Romagna: data on community-dwelling subjects were extracted from archives of reimbursed prescriptions, while drug use in a sample of nursing homes was recorded from clinical charts in one index day within the same semester. The frequency of polypharmacy (at least five or at least 10 concurrent drugs) and of each DDI was calculated. Results: In line with different rates of polypharmacy (80% vs 16%), the risk of exposure to at least one interaction was 53.7% in nursing homes and 26.4% in outpatients. Among DDIs, in nursing homes antidepressants—anxiolytics (11.9%) ranked first, followed by antidepressants—aspirin (7.4%). In outpatients, ACE-inhibitors—non-steroidal anti-inflammatory drugs (NSAIDs) reached 7.2% followed by the calcium channel blockers—α-blockers (2.4%). Discussion: Polypharmacy and risk of DDIs appeared very different in the two settings, due to both technical and clinical reasons. In order to reduce use of benzodiazepines, NSAIDs, antidepressants and relevant DDIs, 1) defining alternative options for pain relief in elderly outpatients, and 2) implementing non-pharmacological management of insomnia and anxiety in nursing homes should be prioritized

Parathyroid function study in patients submitted to laryngeal surgery for squamous cell carcinoma

Aim of this study was to investigate any eventual quantitative variations in the serological concentration of parathormone in a homogenous sample of patients suffering from laryngeal squamous cell carcinoma who underwent only surgery. A total of 12 patients (2 female, 10 male), aged between 58 and 76 years, were treated between June 2002 and June 2003. The patients were all affected by T2-T3 laryngeal squamous cell carcinoma. Serum intact parathyroid hormone and calcaemia were measured pre- and post-operatively. Of these patients, 2 underwent total laryngectomy (including thyroid isthmectomy), 5 patients received partial supraglottic laryngectomy, while the remaining 5 were submitted to supracricoid laryngectomy. Results showed a progressive regression of parathyroid hormone level, in only one case and was not, however, below normal limits. Contrary to data reported in the literature, this study indicated that the incidence of hypoparathyroidism following laryngeal surgery, even in radical surgical approaches, proved to be closer to zero

Patent Foramen Ovale as Possible Cause of Sudden Sensorineural Hearing Loss: A Case Report

OBJECTIVE: To present a case of sudden sensorineural hearing loss (SSNHL) and the related diagnostic workup. CLINICAL PRESENTATION AND INTERVENTION: A 54-year-old man presented with a unilateral SSNHL episode and vertigo. A severe patent foramen ovale (PFO) that included a complete ear nose and throat, audiological, and neurological examination was discovered during the diagnostic workup. Audiometry, blood, and serological tests were performed. Magnetic resonance imaging and color Doppler echography of the supra-aortic trunks and lower limbs were carried out. Finally, transthoracic followed by transesophageal echocardiography and transcranial Doppler were performed in order to confirm the diagnosis of PFO. Medical therapy with systemic steroid and antiplatelet drugs was administered. CONCLUSIONS: This case showed a small PFO associated with an aneurysmatic interatrial septum. The PFO and paradoxical thromboembolism could be involved in the pathogenesis of SSNHL

Occipital Headache and septicemia. An unusual case of isolated sphenoid sinusitis

Isolated sphenoid sinusitis is a rare disease with potential devastating complications such as cranial nerve involvement, brain abscess, and meningitis. We report a case of unilateral sphenoid sinusitis presenting as persistent occipital headache and septicemia