11 research outputs found

    Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

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    Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

    The hominin inside: an automatic tool to reproduce the internal and external anatomy of bony structures

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    In recent years, the use of CT-scans in physical anthropology yielded huge improvements of the analysis of skeletal remains. Such process made the “virtual anthropology” one of the most important approaches in the study of human evolution and bioarchaeology. The virtual reproduction of inner volumes has become a frequent procedure for studying the internal anatomy of fossil hominins. Such procedure has usually been carried out by filling manually (segmentation) the regions of interest (ROI), which is a time consuming task. At the same time, isolating the outer shell of a skeletal element is very useful in Geometrics Morphometric applications, for example when using semilandmarks. During “projection” and “sliding”, the semilandmarks can intercept the inner surface failing the superimposition of the reference model on the target sample. Here we describe the application of two methods aiming to automatically generate inner and outer surfaces of the 3D model of a skeletal element. The methods have been implemented in the statistical environment R. A development version of the R-package “Morpho” [2] contains the function virtualMeshScan, that allows to select all vertices of a given triangular mesh that are visible from at least one of several specified points of view (POVs). Visibility is determined by evaluating whether a straight line between vertices and the POV intersects the mesh. To obtain the part of the visible mesh from the POVs, all vertices not tagged as “visible” are removed from the mesh itself.There are no constraints to where the POVs are placed. The R-package “Arothron” [3] provides functions useful for the extraction, from a point of view (POV), of the visible vertices belonging to the point cloud of a mesh.This method, developed by Katz [1], is based on the definition of a given number of POVs placed on a sphere that surrounds the object. In this way, the procedure simulates a scan of a 3D mesh, in which the vertices forming the external surface are marked as visible points. The vertices of the mesh that define the internal structure (not marked as visible points) are subtracted from the whole vertices matrix. Here we present the application of these two methods on three examples: a modern human skull (VA023) from Germany repository, the d1 tooth (Homo neanderthalensis) from Krapina and a malleus from a Middle Ages individual (Portico D’Ottavia, Roma). In conclusion, we introduce two procedures capable of isolating the inner volume of a skeletal element and useful to separate both inner (no visible) and outer (visible) components of a 3D model. In this communication, we tested and showed the performance applying these methods on anatomical area of different complex morphology and size. Potentially the massive application on huge samples could lead to an increased production of ROIs and thus of their availability to the researchers via online sharing

    Reproducing the internal and external anatomy of fossil bones: Two new automatic digital tools

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    OBJECTIVES: We present two new automatic tools, developed under the R environment, to reproduce the internal and external structures of bony elements. The first method, Computer-Aided Laser Scanner Emulator (CA-LSE), provides the reconstruction of the external portions of a 3D mesh by simulating the action of a laser scanner. The second method, Automatic Segmentation Tool for 3D objects (AST-3D), performs the digital reconstruction of anatomical cavities. MATERIALS AND METHODS: We present the application of CA-LSE and AST-3D methods to different anatomical remains, highly variable in terms of shape, size and structure: a modern human skull, a malleus bone, and a Neanderthal deciduous tooth. Both methods are developed in the R environment and embedded in the packages "Arothron" and "Morpho," where both the codes and the data are fully available. RESULTS: The application of CA-LSE and AST-3D allows the isolation and manipulation of the internal and external components of the 3D virtual representation of complex bony elements. In particular, we present the output of the four case studies: a complete modern human endocast and the right maxillary sinus, the dental pulp of the Neanderthal tooth and the inner network of blood vessels of the malleus. DISCUSSION: Both methods demonstrated to be much faster, cheaper, and more accurate than other conventional approaches. The tools we presented are available as add-ons in existing software within the R platform. Because of ease of application, and unrestrained availability of the methods proposed, these tools can be widely used by paleoanthropologists, paleontologists and anatomists

    Correction to: Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

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    Undiagnosed cognitive impairment in older adults hospitalized in internal medicine wards: Data from the REPOSI registry

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    Statins, ACE/ARBs drug use, and risk of pneumonia in hospitalized older patients: a retrospective cohort study

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    The aims of this study is to evaluate the association between angiotensin-converting enzyme inhibitor (ACE-I), angiotensin II receptor blocker (ARBs) and/or statin use with the risk of pneumonia, as well as and with in-hospital and short-term outpatient mortality in hospitalized older patients with pneumonia. Patients aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro Politerapuie SIMI-Societa Italiana di Medicina Interna) register from 2010 to 2019 were screened to assess the diagnosis of pneumonia and classified on whether or not they were prescribed with at least one drug among ACE-I, ARBs, and/or statins. Further study outcomes were mortality during hospital stay and at 3 months after hospital discharge. Among 5717 cases included (of whom 18.0% with pneumonia), 2915 (51.0%) were prescribed at least one drug among ACE-I, ARBs, and statins. An inverse association was found between treatment with ACE-I or ARBs and pneumonia (OR = 0.79, 95% CI 0.65-0.95). A higher effect was found among patients treated with ACE-I or ARBs in combination with statins (OR = 0.67, 95% CI 0.52-0.85). This study confirmed in the real-world setting that these largely used medications may reduce the risk of pneumonia in older people, who chronically take them for cardiovascular conditions

    Statins, ACE/ARBs drug use, and risk of pneumonia in hospitalized older patients: a retrospective cohort study

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    : The aims of this study is to evaluate the association between angiotensin-converting enzyme inhibitor (ACE-I), angiotensin II receptor blocker (ARBs) and/or statin use with the risk of pneumonia, as well as and with in-hospital and short-term outpatient mortality in hospitalized older patients with pneumonia. Patients aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro Politerapuie SIMI-Società Italiana di Medicina Interna) register from 2010 to 2019 were screened to assess the diagnosis of pneumonia and classified on whether or not they were prescribed with at least one drug among ACE-I, ARBs, and/or statins. Further study outcomes were mortality during hospital stay and at 3 months after hospital discharge. Among 5717 cases included (of whom 18.0% with pneumonia), 2915 (51.0%) were prescribed at least one drug among ACE-I, ARBs, and statins. An inverse association was found between treatment with ACE-I or ARBs and pneumonia (OR = 0.79, 95% CI 0.65-0.95). A higher effect was found among patients treated with ACE-I or ARBs in combination with statins (OR = 0.67, 95% CI 0.52-0.85). This study confirmed in the real-world setting that these largely used medications may reduce the risk of pneumonia in older people, who chronically take them for cardiovascular conditions
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