Is contrast enhancement needed for diagnostic prostate MRI?

Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) provides clinical guidelines for multiparametric magnetic resonance imaging (mpMRI) [T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)] of prostate. However, DCE-MRI seems to show a limited contribution in prostate cancer (PCa) detection and management. In our experience, DCE-MRI, did not show significant change in diagnostic performance in addition to DWI and T2WI [biparametric MRI (bpMRI)] which represent the predominant sequences to detect suspected lesions in peripheral and transitional zone (TZ). In this article we reviewed the role of DCE-MRI also indicating the potential contribute of bpMRI approach (T2WI and DWI) and lesion volume evaluation in the diagnosis and management of suspected PCa

Unsuspected role of the brain morphogenetic gene Otx1 in hematopoiesis

Otx1 belongs to the paired class of homeobox genes and plays a pivotal role in brain development. Here, we show that Otx1 is expressed in hematopoietic pluripotent and erythroid progenitor cells. Moreover, bone marrow cells from mice lacking Otx1 exhibit a cell-autonomous impairment of the erythroid compartment. In agreement with these results, molecular analysis revealed decreased levels of erythroid genes that include the SCL and GATA-1 transcription factors. Accordingly, a gain of function of SCL rescues the erythroid deficiency in Otx1-/- mice. Taken together, our findings indicate a function for Otx1 in the regulation of blood cell production. There is growing evidence suggesting that common cellular and molecular mechanisms orchestrate differentiation in various tissues. Homeobox-containing genes seem to be strong candidate genes to regulate a number of developmental processes, including neurogenesis and hematopoiesis. Members of the Otx family (Otx1, Otx2, Otx3, and Crx) are the vertebrate homologues of the Drosophila head gap gene orthodenticle and encode transcription factors containing a bicoid-like homeodomain. They are temporally and spatially regulated during development and seem to be required for proper head and sense organ patterning. Otx1, Otx2, and Otx3 show partially overlapping, but distinct expression patterns, and Otx2, the first to be activated during development, plays a major role in gastrulation and in the early specification of the anterior neural plate. In contrast, Otx1 shows a later onset and is involved in corticogenesis, sense organ development, and pituitary function. Mice bearing targeted deletion of Otx1 are affected by a permanent epileptic phenotype and show multiple brain abnormalities and morphological defects of the acoustic and visual sense organs. In addition, at the prepubescent stage, they exhibit transient dwarfism and hypogonadism because of low levels of pituitary hormones. In the present study, we have investigated whether Otx1 also plays a role in blood cell production, as several homeobox genes of different families are involved in normal and/or malignant hematopoiesis

Anti-PD1 Consolidation in Patients with Hodgkin Lymphoma at High Risk of Relapse after Autologous Stem Cell Transplantation: A Multicenter Real-Life Study

(1) Background: Consolidation therapy is an emerging strategy for patients with relapsed/refractory (RR) Hodgkin Lymphoma (HL) at high risk of failing salvage autologous stem cell transplantation (ASCT). (2) Objectives: To assess the safety and effectiveness of PD1-blockade consolidation for these high-risk patients. (3) Design: Multi-center retrospective analysis. (4) Methods: We identified 26 patients given anti-PD1 consolidation, from June 2016 to May 2020. (5) Results: Patients displayed the following risk factors: refractory disease (69%), relapse 3, occurred in 12 patients (46.15%) and mainly included skin rashes (41.7%), transaminitis (33.3%), and thyroid hypofunction (25%). Patients completed a median of 13 courses (range 6–30). At a median follow-up of 25.8 months post-ASCT, the median progression-free (PFS) was 42.6 months, with a 2-year PFS and overall survival rates of 79% and 87%, respectively. (6) Conclusions: Post-ASCT consolidation with anti-PD1 is feasible and effective. Further studies are warranted to define the optimal treatment length and patients’ subsets more likely to benefit from this approach

Histórias em Intercompreensão: a voz dos autores

Este relatório foi elaborado no âmbito do lote 7 (Inserção Curricular da Intercompreensão) do projeto MIRIADI. Trata-se de um lote cujo objetivo é desenvolver processos de integração curricular da Intercompreensão (IC) à distância em grupos plurilingues, a partir de trabalhos experimentais levados a cabo no terreno e realizados numa lógica de investigação-ação, tendo em vista compreender as “condições de exequibilidade” desta abordagem didática nos curricula de aprendizagem de línguas e de formação. Procura-se, em particular, identificar empiricamente permeabilidades e resistências dos contextos e dos atores educativos face à IC como conceito prático com relevância profissional, bem como vantagens e limites do ponto de vista da aprendizagem linguística que possam justificar o seu valor educativo. A Intercompreensão tem vindo, nas últimas décadas, a percorrer um percurso de destaque em Didática de Línguas (sobretudo Estrangeiras) na Europa e fora dela, em particular no âmbito das atuais abordagens plurais, ocupando um lugar de visibilidade nos discursos e práticas de investigação e formação desta disciplina e contribuindo para a tonalidade da sua voz mais propriamente politico-ideológica (Alarcão, Andrade, Araújo e Sá, Melo-Pfeifer & Santos, 2009). Contudo, a presença do conceito nos espaços concretos de educação em línguas (tais como escolas, liceus, universidades e outras instituições) é extremamente débil, limitando-se a algumas experiências pontuais, sob o impulso (e mesmo a condução), na maior parte dos casos, dos investigadores e tendo como finalidade principal a produção de conhecimento didático (Degache & Tavares, 2011). Assim, pouco se sabe ainda do que pode ser efetivamente o contributo da IC para o projeto educativo das instituições, e muito menos do modo como o conceito pode ser integrado em práticas curriculares continuadas e sistemáticas de educação em línguas, sabendo-se que estas mesmas práticas são reguladas por múltiplas instâncias, internas e externas, objetivas e subjetivas, que atuam a vários níveis (macro, meso, micro) e que não podem deixar de ser consideradas. O lote 7 de Miriadi propõe abordar estas questões, relativas à integração curricular da IC, a partir de uma outra lógica epistemológica, uma lógica que não busca propostas desenhadas a partir dos resultados da investigação e orientadas para a transferência do conhecimento, ou seja, que não reflete uma perspetiva aplicacionista do saber didático. Ao invés, o trabalho realizado por este lote entende o currículo como uma construção dinâmica que se (re)define e se (re)negocia em função dos contextos específicos em que ocorre, atribuindo-lhe por conseguinte uma natureza contingente, situada, intersubjetiva e local. Nesta perspetiva sócio-construtivista, em que o currículo é uma co-construção que ocorre entre sujeitos precisos nas suas ações educativas quotidianas, a integração curricular da IC produz-se no âmbito destas ações, ou, dito de outra forma, através de práticas situadas nas especificidades e possibilidades que oferecem os contextos concretos, em particular os sujeitos que deles fazem parte. Esta perspetiva de trabalho do lote 7 parece-nos ser a mais coerente com o posicionamento teórico relativamente à IC enquanto conceito didático do projeto MIRIADI. Com efeito, está amplamente estudado que a IC tem vindo a ser tratada segundo diferentes pontos de vista, de acordo com as escolas epistemológicas e as proveniências e ancoragens disciplinares dos seus autores (para uma revisão recente, ver Araújo e Sá, 2013; Olliver, 2013). No âmbito do percurso específico de investigação/formação/intervenção do grupo e-Gala (www.e-gala.eu), no seio do qual emergiu MIRIADI, em particular das suas mais disseminadas realizações – as plataformas Galanet (www.galanet.eu) e Galapro (www-galapro.eu/sessions) -, a IC é abordada numa perspetiva socio-construtivista do saber e da relação comunicativa. Dito de outra forma, MIRIADI define a IC como um processo e uma prática interacional que ocorre entre sujeitos, atores sociais que vivem em diferentes línguas e que se implicam coletivamente num quadro dialógico “où le grand enjeu devient la construction d’un territoire de parole partagé” (Araújo e Sá, Degache & Spita, 2010: 26). Esta aceção interacionista (e plurilingue e intercultural) é complementada pelo recurso a meios de comunicação tecnológicos. Definido o enquadramento conceptual e metodológico do lote7, importa agora explicitar como se desenvolveu o trabalho ao longo dos seus 36 meses de execução. O lote organizou-se em 3 grandes etapas, que envolveram toda a equipa: Etapa 1. Identificação e caracterização de contextos de ensino e formação linguística suscetíveis de poderem beneficiar de uma integração curricular da IC (plurilingue e à distância) (os resultados desta etapa encontram-se na Prestation 7.1. do projeto, referida na nota anterior). Etapa 2. Planificação e desenvolvimento de múltiplas e diversificadas iniciativas de divulgação da IC nesses mesmos contextos, destinadas à comunidade educativa na generalidade (públicos, professores/formadores, órgãos de gestão, funcionários, etc.), tendo em vista a sua familiarização com a IC enquanto conceito didático e prática de educação em línguas, de modo a criar condições (e aberturas) para a sua integração curricular; uma atenção especial foi dada à formação dos agentes educativos. Etapa 3. Planificação, experimentação e avaliação, numa lógica de investigação-ação e em rede (aproveitando-se as potencialidades das plataformas Galapro e Galanet), de propostas de integração curricular da IC; pretendia-se, em especial, com estas propostas, identificar contributos da IC para a qualidade dos projetos educativos dos contextos de integração caracterizados (na etapa 1), mas também constrangimentos, fragilidades, obstáculos e resistências, numa abordagem crítica do conceito que fosse sensível às propriedades dos espaços-alvo de educação em línguas. Neste sentido, foram recolhidos, analisados e discutidos, em função das suas características contextuais (definidas na etapa 1), dados empíricos de natureza diversa (produções dos alunos, transcrições de excertos de aulas, testemunhos espontâneos de alunos e professores, respostas a questionários, entre outros). Este Rapport é um produto da Etapa 3. Trata-se de um documento multimédia, que pretende dar acesso sistematizado e crítico aos discursos e vozes de sujeitos reais que experienciaram propostas didáticas concretas de IC elaboradas durante esta etapa do lote. Mais concretamente, este relatório oferece 6 narrativas de estudos de caso (3 em contexto de ensino secundário e outros 3 no ensino superior), realizados em vários países (Brasil, França, Itália Portugal e República da Maurícia), contendo uma descrição detalhada das situações educativas experimentadas e uma análise dos dados recolhidos, com apresentação dos recursos e materiais utilizados e testemunhos dos sujeitos concretos (professores e alunos). Incluem-se igualmente os instrumentos de recolha de dados e alguns exemplos dos mesmos. Cada narrativa obedece a uma mesma estrutura discursiva, de forma a mais facilmente poderem ser comparáveis, permitindo a extração de conclusões transversais aos vários estudos: introdução; descrição do contexto de intervenção; descrição da intervenção (objetivos, atividades, com acesso aos recursos utilizados, e avaliação); resultados obtidos; conclusões e implicações A secção final, “Témoignages”, apresenta-se sob a forma de um conjunto de vídeos e podcasts, identificados de acordo com a instituição parceira do projeto que os recolheu e organizados segundo três critérios: • as línguas dos locutores (espanhol, francês, italiano e português); • os contextos de formação onde decorreram as experiências de IC (ensino secundário e ensino universitário); • o tipo de intervenientes nas experiências de IC (alunos ou professores). Assume-se mais uma vez, neste Rapport, as dinâmicas de trabalho plurilingue da equipa Miriadi, cuja rentabilidade para a produção do conhecimento didático foi analisada e evidenciada no âmbito de projetos anteriores (ver Melo-Pfeifer, 2014) e se encontra ilustrada, numa outra linguagem, nos nossos postais (disponíveis no Facebook). Assim, com exceção desta introdução, que foi traduzida para francês (ver acima), o documento encontra-se nas línguas de trabalho dos membros da equipa que o redigiram.Ce rapport a été préparé par le lot 7 (Insertion Curriculaire de l’Intercompréhension) du projet MIRIADI. Il s'agit d'un lot dont l’objectif est de développer des processus d’intégration curriculaire de l’Intercompréhension (IC) à distance dans des groupes plurilingues, à partir de travaux expérimentaux menés sur le terrain et réalisés dans une logique de recherche-action, pour comprendre les "conditions de faisabilité" de cette approche didactique dans les programmes d'apprentissage et de formation. Il est question, en particulier, d'identifier empiriquement des perméabilités et des résistances des contextes (abordés à partir d’une approche holistique) et des acteurs éducatifs confrontés à l’IC en tant que concept pratique à visée professionnelle. L'intercompréhension a, au cours des dernières décennies, réalisé un parcours marquant dans l'enseignement des Langues (principalement Étrangères) en Europe et en dehors, en particulier dans le contexte des approches plurielles, occupant une place de grande visibilité dans les discours et dans les pratiques de recherche et de formation de cette discipline et lui apportant une nette tonalité idéologique qui contribue pour la définition de sa voix politique (Alarcão, Andrade, Araújo e Sá, Melo-Pfeifer & Santos, 2009). Cependant, la circulation du concept sur les terrains de l'éducation en langues (tels que les écoles, les collèges, les universités et autres institutions) est très faible, limitée à quelques expériences ponctuelles, sous l'impulsion (et même la conduite), dans la plupart cas, des chercheurs, le but principal étant la production du savoir didactique (Degache & Tavares, 2011). Ainsi, on en sait peu sur ce que peut effectivement être la contribution de l'IC pour le projet éducatif des établissements d'enseignement, et encore moins sur la manière dont elle peut être intégrée dans les pratiques curriculaires continues et systématiques en langues, sachant que ces mêmes pratiques sont réglementées par plusieurs instances, internes et externes, objectives et subjectives, qui agissent à différents niveaux (macro, méso, micro) et qui ne peuvent manquer d'être prises en considération. Le lot 7 de Miriadi propose d’aborder ces questions, liées à l'intégration curriculaire de l’IC, à partir d'une autre logique épistémologique : une logique qui ne cherche pas des propositions obtenues à partir des résultats de la recherche et orientées vers le transfert de connaissance, c'est-à-dire qui ne reflète pas une perspective applicationniste du savoir didactique. Dans un autre sens, on comprend le curriculum comme une construction dynamique qui se fait entre des sujets dans leurs activités éducatives quotidiennes et qui se (re)définit et se (re)négocie selon les contextes, lui donnant un caractère contingent, situé, intersubjectif et local. Dans cette perspective socio-constructiviste, l'intégration curriculaire de l’IC se produit dans ces activités, à travers des pratiques situées dans les spécificités et les possibilités offertes par les contextes concrets, en particulier par les sujets qui les construisent. Cette approche de travail du lot 7 nous semble être la plus cohérente par rapport au positionnement théorique de l’IC en tant que concept didactique du projet MIRIADI. En effet, il est largement connu que l'IC est abordée selon différents points de vue, dépendants des écoles épistémologiques et des origines et ancrages disciplinaires de leurs auteurs (pour une révision, voir Araújo e Sá, 2013; Olliver, 2013 ). Dans le parcours spécifique du groupe de recherche / formation / intervention e-Gala (www.e-gala.eu), duquel a émergé MIRIADI, et en particulier de ses réalisations les plus répandues Galanet (www.galanet.eu) et Galapro (www-galapro.eu/sessions), l’IC est abordée dans une perspective socio-constructiviste du savoir et de la relation communicative, c'est-à-dire comme un processus et une pratique interactionnelle qui se produit entre individus, acteurs sociaux qui vivent dans différentes langues et qui s’ impliquent collectivement dans un cadre dialogique “où le grand enjeu devient la construction d’un territoire de parole partagé” (Araújo e Sá, Degache & Spita, 2010: 26). Ce sens interactionnel (et plurilingue et interculturel) est complété par l'utilisation de la communication technologique. L’encadrement conceptuel et méthodologique du lot 7 étant défini, nous présentons maintenant le plan de travail du lot au cours de ses 36 mois de mise en œuvre. Le lot a été organisé en trois grandes étapes, qui ont impliqué la participation de toute l'équipe: Étape 1. Identification et caractérisation des contextes d'enseignement et de formation linguistique susceptibles de bénéficier d'une intégration curriculaire de l'IC (plurilingue et à distance) (les résultats de cette étape se trouvent dans la Prestation 7.1. du projet, voir note antérieure). Étape 2. Planification et développement de multiples initiatives de diffusion de l’IC dans ces contextes, adressées à la communauté éducative en général (publics-cibles, enseignants / formateurs, organes de gestion, autres personnels, etc.), afin de se familiariser avec l'IC en tant que concept didactique et pratique d’éducation en langues, de manière à créer les conditions (et ouvertures) pour son intégration curriculaire; une attention particulière est accordée à la formation des agents éducatifs. Étape 3. Planification, expérimentation et évaluation, dans une logique de recherche-action et de mise en réseau, de propositions d'intégration curriculaire de l’IC; il visait, en particulier, avec ces propositions, identifier non seulement les contributions de l’IC à la qualité des projets éducatifs des contextes d'intégration caractérisés (dans l’étape 1), mais aussi les contraintes, les faiblesses, les obstacles et les résistances, dans une approche critique du concept qui soit sensible aux spécificités des espaces-cible de l'éducation en langues. En ce sens, des données empiriques de nature diverse (productions d’étudiants, témoignages d'étudiants et d'enseignants, réponses à des questionnaires, transcriptions d’extraits de cours, entre autres) ont été recueillies, analysées et discutées, en fonction de leurs caractéristiques contextuelles (définis à l'étape 1). Ce Rapport est un produit de l'étape 3. Il s’agit d’un document multimédia qui donne accès aux discours et voix des sujets réels qui ont expérimenté les propositions didactiques de l’IC développés au cours de cette dernière étape du lot. En particulier, ce rapport propose six récits d'études de cas (3 dans un contexte d’enseignement secondaire et 3 autres dans l'enseignement supérieur), menées dans divers pays (Brésil, France, Italie, Portugal et la République de Maurice), contenant une description détaillée des situations éducatives expérimentées et une analyse des données recueillies, avec la présentation des ressources et des matériaux utilisés et des témoignages de sujets (enseignants et étudiants). Il comprend également des outils de collecte de données et quelques exemples de celles-ci. Chaque récit suit la même structure du discours, afin qu'ils puissent être plus facilement comparés, permettant l’obtention de conclusions transversales aux différentes études: introduction; description du contexte d'intervention; description de l'intervention (objectifs, activités, avec accès aux ressources utilisées, et évaluation); résultats obtenus; conclusions et implications La dernière section, "Témoignages", se présente sous la forme d'un ensemble de vidéos et de podcasts, identifiés conformément à l'institution partenaire du projet qui les a recueilli et organisés selon trois critères: • les langues des locuteurs (espagnol, français, italien et portugais); • les contextes de formation où ont eu lieu les expériences de l’lC (enseignement secondaire et universitaire); • le type d’intervenants dans les expériences d’IC (étudiants ou enseignants). Dans ce Rapport, nous assumons les dynamiques de travail plurilingue de l’équipe Miriadi, dont la rentabilité pour la production de la connaissance didactique a été analysée et démontrée dans le cadre de projets antérieurs (voir Melo-Pfeifer, 2014) et qui a été illustré, dans un autre langage, dans nos cartes-postales (disponibles sur Facebook). Ainsi, à l’exception de cette Introduction, qui a été traduite du portugais, ce document se trouve rédigé dans les langues de travail des membres de l’équipe qui l’ont élaboré

Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

Background: In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine. Methods: Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published. Results: The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm. Conclusions: We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research

Lopinavir/Ritonavir and Darunavir/Cobicistat in Hospitalized COVID-19 Patients: Findings From the Multicenter Italian CORIST Study

Background: Protease inhibitors have been considered as possible therapeutic agents for COVID-19 patients. Objectives: To describe the association between lopinavir/ritonavir (LPV/r) or darunavir/cobicistat (DRV/c) use and in-hospital mortality in COVID-19 patients. Study Design: Multicenter observational study of COVID-19 patients admitted in 33 Italian hospitals. Medications, preexisting conditions, clinical measures, and outcomes were extracted from medical records. Patients were retrospectively divided in three groups, according to use of LPV/r, DRV/c or none of them. Primary outcome in a time-to event analysis was death. We used Cox proportional-hazards models with inverse probability of treatment weighting by multinomial propensity scores. Results: Out of 3,451 patients, 33.3% LPV/r and 13.9% received DRV/c. Patients receiving LPV/r or DRV/c were more likely younger, men, had higher C-reactive protein levels while less likely had hypertension, cardiovascular, pulmonary or kidney disease. After adjustment for propensity scores, LPV/r use was not associated with mortality (HR = 0.94, 95% CI 0.78 to 1.13), whereas treatment with DRV/c was associated with a higher death risk (HR = 1.89, 1.53 to 2.34, E-value = 2.43). This increased risk was more marked in women, in elderly, in patients with higher severity of COVID-19 and in patients receiving other COVID-19 drugs. Conclusions: In a large cohort of Italian patients hospitalized for COVID-19 in a real-life setting, the use of LPV/r treatment did not change death rate, while DRV/c was associated with increased mortality. Within the limits of an observational study, these data do not support the use of LPV/r or DRV/c in COVID-19 patients

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes 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) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

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