Pain and Frailty in Hospitalized Older Adults

Introduction: Pain and frailty are prevalent conditions in the older population. Many chronic diseases are likely involved in their origin, and both have a negative impact on quality of life. However, few studies have analysed their association. Methods: In light of this knowledge gap, 3577 acutely hospitalized patients 65 years or older enrolled in the REPOSI register, an Italian network of internal medicine and geriatric hospital wards, were assessed to calculate the frailty index (FI). The impact of pain and some of its characteristics on the degree of frailty was evaluated using an ordinal logistic regression model after adjusting for age and gender. Results: The prevalence of pain was 24.7%, and among patients with pain, 42.9% was regarded as chronic pain. Chronic pain was associated with severe frailty (OR = 1.69, 95% CI 1.38–2.07). Somatic pain (OR = 1.59, 95% CI 1.23–2.07) and widespread pain (OR = 1.60, 95% CI 0.93–2.78) were associated with frailty. Osteoarthritis was the most common cause of chronic pain, diagnosed in 157 patients (33.5%). Polymyalgia, rheumatoid arthritis and other musculoskeletal diseases causing chronic pain were associated with a lower degree of frailty than osteoarthritis (OR = 0.49, 95%CI 0.28–0.85). Conclusions: Chronic and somatic pain negatively affect the degree of frailty. The duration and type of pain, as well as the underlying diseases associated with chronic pain, should be evaluated to improve the hospital management of frail older people

The multifaceted spectrum of liver cirrhosis in older hospitalised patients: Analysis of the REPOSI registry

Background: Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. Objectives: To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. Methods: A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. Results: LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. Conclusions: LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

A Dynamic Calibration System For Trace Analysis In Ion Chromatography

A dynamic method for the preparation of diluted standards in trace analysis by Ion Chromatography is described. The proposed system uses a diffusion cell that through a capillary tube of known dimension, continuously provides large volumes of highly diluted standard. The diffusion cell setting-up and its working conditions are described, and the advantages and difficulties of the dynamic method are pointed out. Loading the cell with concentrated standard solutions (200-10000 ppm), it was possible to produce diluted Na2SO4 standards in the 0.1-10 ppb concentration range. The cell is able to work for nearly a month before the source amount decreased by 1 %. The linearity of the calibration device is good and the method is free of systematic errors. Under strictly controlled experimental condition, the diffusion cell provides primary standards because it allows to obtain concentrations only depending on its geometry

Definition of a land quality index to preserve the best territories from future land take: An application to a study area in Lombardy (Italy)

Land take is a process of land-use change in which the agricultural and natural land is taken by residential, industrial, infrastructure and other developments. This change causes the loss of a non-renewable resource, such as the agricultural/natural soil, and the relative natural, cultural and landscape resources. The growing awareness about the loss of ecosystem services related to land take led developed countries to try to reduce the quantity of land taken with new laws and regulations. The European Union has set the goal of zero land take by 2050. It is not only a problem of limiting and slowing down the phenomenon, but it is always clearer that the quality of the land taken has to be assessed and adequately considered during the land-use planning process. In fact, in some cases like in the Lombardy Region, the law focuses not only on reducing the amount of land take, but also on limiting the loss of land with high qualities, requiring municipalities to assess the productive, naturalistic and landscape qualities of the territory. In this paper, the authors develop, using the geographical information system technology, a methodology to define and calculate a composite land quality index (LQI). The methodology has been applied to a case study in the Lombardy region and has allowed to assess the quality of the territory in a rigorous and transparent way using available official data. In order to take into account the relative importance that stakeholders and land-use planners can give to the different components of LQI, analytic hierarchy process has been performed ad 4 different scenarios have been developed. LQI can support the land-use planning process in an ex-ante evaluation of different transformations hypotheses and in the definition of quality-based quantitative thresholds and monitoring of their trend over the time

Synthesis of 1-aryl-3-formyl-3-methyltriazenes, potential metabolites of 1-aryl-3,3-dimethyltriazenes.

Some para-substituted 1-aryl-3,3-dimethyltriazenes were oxidized with tert-butyl hydroperoxide in the presence of vanadium pentoxide as a catalyst. Under these conditions, the corresponding 1-aryl-3-formyl-3-methyltriazenes, 1-aryl-3-tert-butylperoxymethyl-3-methyltriazenes, and p-nitrobenzenes were obtained. The 1-aryl-3-formyl-3-methyltriazenes might play a role in the metabolic oxidation of the 1-aryl-3,3-dimethyltriazenes, which are active as mutagenic, carcinogenic, and antitumor agents

La nutrizione parenterale totale in corso di pancreatite acuta e cronica

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