1
|
Agosti P, D'Avanzo B, Monti I, Cortesi L, Nobili A, Tettamanti M. Development and validation of the Medical Attitudes Towards Deprescribing Questionnaire. Intern Emerg Med 2024; 19:413-422. [PMID: 38123904 DOI: 10.1007/s11739-023-03489-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023]
Abstract
Polypharmacy and inappropriate prescriptions in the elderly are widely discussed themes in scientific literature. Although more and more studies showed the safety and feasibility of deprescribing strategies, these are not implemented in clinical practice. In order to measure the attitudes of Italian doctors towards deprescribing and address their awareness, experiences, difficulties in applying these strategies and potential suggestions, we aimed to develop and validate a questionnaire, the Medical Attitudes Towards Deprescribing Questionnaire (MATD-Q). Between November 2017 and October 2018 an e-mail was sent to internists, geriatricians and general practitioners, to invite them to connect to a platform and answer to the questionnaire, consisting in 38 items (with a five level score) and five questions. After 2-3 weeks, a second e-mail was sent for a second completion of the questionnaire. Test-retest reliability was assessed by means of the intraclass correlation coefficient (ICC). The correlations between items were assessed by means of Pearson linear correlation coefficients and Cronbach Alpha was used to assess internal consistency. A total of 77 questionnaires completed twice were collected. By a principal component analysis we defined a smaller set of variables (n = 12), which resulted to be representative of the 38-item questionnaire.The final version of the questionnaire we developed (MATDQ-12), after validation in other cohorts, could be a useful tool to measure the efficacy of educational interventions aimed at improving the attitude of physicians towards deprescribing strategies with the final goal to allow their implementation in clinical practice.
Collapse
Affiliation(s)
- Pasquale Agosti
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
| | - Barbara D'Avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche, Milan, Italy.
| | - Igor Monti
- Department of Health Policy, Istituto di Ricerche Farmacologiche, Milan, Italy
| | - Laura Cortesi
- Department of Clinical Epidemiology and Biostatistics, IRCCS Ca' Granda Ospedale Maggiore Policlinico Mario Negri IRCCS, Milan, Italy
| | - Alessandro Nobili
- Department of Health Policy, Istituto di Ricerche Farmacologiche, Milan, Italy
| | - Mauro Tettamanti
- Department of Health Policy, Istituto di Ricerche Farmacologiche, Milan, Italy
| |
Collapse
|
2
|
Agosti P, Siboni SM, Ciavarella A, Arcudi S, Boggio F, Gualtierotti R, Peyvandi F. Safety and efficacy of combined dual antiplatelet therapy and factor VIII prophylaxis in patients with haemophilia A after acute coronary syndrome. Haemophilia 2024; 30:336-344. [PMID: 38379212 DOI: 10.1111/hae.14963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION The increased life expectancy of patients with haemophilia A (HA) has led to a growing prevalence of cardiovascular risk factors and events. There is still scarce evidence on the safety and appropriate duration of dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) in HA patients. AIM We describe our experience on the clinical management of Italian HA patients after ACS. METHODS Nine patients with congenital HA treated with DAPT after a revascularization procedure performed for ACS have been enrolled and followed at the Angelo Bianchi Bonomi Haemophilia and Thrombosis Center in Milan between 2005 and September 2022. The safety and efficacy of DAPT with or without FVIII prophylaxis were assessed. RESULTS Ten ACS events occurred in the nine HA patients (four mild and five severe). All events were treated with percutaneous transluminal coronary angioplasty with deployment of 1 to 3 drug-eluting stents followed by DAPT for 1-12 months. All patients except one were treated with FVIII prophylaxis during DAPT aimed at achieving FVIII trough levels ≥20-30 IU/dL. DAPT was effective in all cases in preventing early ACS recurrence, with only a late recurrence. We observed two clinically relevant non-major bleeds (one in a patient without FVIII prophylaxis) and three minor bleeds. No venous thrombosis occurred. CONCLUSION The long-term secondary antithrombotic prevention consisting of DAPT and FVIII prophylaxis achieving a trough level of 20-30 IU/dL can be effective and safe in HA patients.
Collapse
Affiliation(s)
- Pasquale Agosti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Milan, Italy
| | - Simona Maria Siboni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Milan, Italy
| | - Alessandro Ciavarella
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Milan, Italy
| | - Sara Arcudi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Milan, Italy
| | - Federico Boggio
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Roberta Gualtierotti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Milan, Italy
| |
Collapse
|
3
|
Tripodi A, Clerici M, Scalambrino E, Agosti P, Bucciarelli P, Peyvandi F. How the Hemostasis Laboratory Can Help Clinicians to Manage Patients on Oral Anticoagulants. Mediterr J Hematol Infect Dis 2024; 16:e2024027. [PMID: 38468834 PMCID: PMC10927209 DOI: 10.4084/mjhid.2024.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
Oral anticoagulants are widely used to treat or prevent cardiovascular diseases in millions of patients worldwide. They are the drugs of choice for stroke prevention and systemic embolism in patients with non-valvular atrial fibrillation and prosthetic heart valves, as well as for treatment/prevention of venous thromboembolism. Oral anticoagulants include vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). The hemostasis laboratory plays a crucial role in the management of treated patients, spanning from dose adjustment based on laboratory testing that applies to VKAs to the measurement of drug concentrations in special situations that apply to DOACs. This article aims to overview how the hemostasis laboratory can help clinicians manage patients on oral anticoagulants. Special interest is devoted to the international normalized ratio, used to manage patients on VKAs and to the measurement of DOAC concentrations, for which the role of the laboratory is still not very well defined, and most interferences of DOACs with some of the most common hemostatic parameters are not widely appreciated.
Collapse
Affiliation(s)
- Armando Tripodi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi, Heomophilia and Thrombosis Center, Milan, Italy
| | - Marigrazia Clerici
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi, Heomophilia and Thrombosis Center, Milan, Italy
| | - Erica Scalambrino
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi, Heomophilia and Thrombosis Center, Milan, Italy
| | - Pasquale Agosti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi, Heomophilia and Thrombosis Center, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
| | - Paolo Bucciarelli
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi, Heomophilia and Thrombosis Center, Milan, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi, Heomophilia and Thrombosis Center, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
4
|
Capecchi M, Gazzola G, Agosti P, De Leo P, Mancini I, Ferrari B, Giannotta JA, Artoni A, Peyvandi F. Treatment of immune-mediated thrombotic thrombocytopenic purpura without plasma exchange. Haematologica 2024. [PMID: 38385305 DOI: 10.3324/haematol.2023.284438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Indexed: 02/23/2024] Open
Abstract
Not available.
Collapse
Affiliation(s)
- Marco Capecchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Gruppo Ospedaliero Moncucco - Clinica Moncucco, Division of Hematology, Lugano
| | - Giada Gazzola
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Università degli Studi di Milano, Department of Oncology and Onco-hematology, Milan
| | - Pasquale Agosti
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Milan
| | - Pasqualina De Leo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Ilaria Mancini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Barbara Ferrari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Juri Alessandro Giannotta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Andrea Artoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Milan.
| |
Collapse
|
5
|
De Waele L, Sakai K, Mancini I, Sinkovits G, Falter T, Inoue T, Agosti P, Rossmann H, Von Auer C, Tersteeg C, De Meyer SF, Joly BS, Veyradier A, Coppo P, Fijnheer R, Peyvandi F, Prohászka Z, Lämmle B, Vanhoorelbeke K. Open ADAMTS-13 conformation index predicts earlier relapse in immune-mediated thrombotic thrombocytopenic purpura. J Thromb Haemost 2024; 22:493-502. [PMID: 37866519 DOI: 10.1016/j.jtha.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND ADAMTS-13 adopts an open conformation in patients with immune-mediated thrombotic thrombocytopenic purpura (iTTP) in acute phase while being closed in healthy donors. We reported that a substantial number of patients with iTTP in remission with restored ADAMTS-13 activity (>50%) still had an open ADAMTS-13 conformation, although a closed conformation is expected given the extent of remission. OBJECTIVES To investigate whether open ADAMTS-13, represented by a conformation index >0.5, is associated with a risk of earlier ADAMTS-13 and/or clinical relapse. METHODS We collected follow-up data (ADAMTS-13 parameters, ADAMTS-13 and clinical relapse, and treatment) from 81 patients with iTTP in remission with ADAMTS-13 activity >50%. RESULTS During follow-up, 19 ADAMTS-13 and 10 clinical relapses were reported (median follow-up period, 20 months). First, open or closed ADAMTS-13 conformation was dichotomized based on the 0.5 conformation index cutoff. Open ADAMTS-13 (conformation index, >0.5) was not identified as a risk factor for ADAMTS-13 and clinical relapse (log-rank test and Cox regression model). In contrast, by identifying the optimal conformation index cutoff for relapse prediction, using classification and regression tree analysis, a conformation index >0.645 and >0.835 was shown to be a risk factor for ADAMTS-13 relapse (hazard ratio, 3.3; 95% CI, 1.3-8.3; P = .01) and clinical relapse (hazard ratio, 4.4; 95% CI, 1.3-15.3; P = .02), respectively. CONCLUSION Patients with open ADAMTS-13 with a conformation index >0.645 and >0.835 have a >3- and >4-fold higher risk of earlier ADAMTS-13 and clinical relapse, respectively. Hence, ADAMTS-13 conformation index could be used to complement ADAMTS-13 activity monitoring to timely notice ADAMTS-13 relapse and prevent clinical relapse.
Collapse
Affiliation(s)
- Laure De Waele
- Laboratory for Thrombosis Research, Interdisciplinary Research Facility Life Sciences, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Kazuya Sakai
- Laboratory for Thrombosis Research, Interdisciplinary Research Facility Life Sciences, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium; Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan
| | - Ilaria Mancini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Università degli Studi di Milano, Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Milan, Italy
| | - György Sinkovits
- Department of Internal Medicine and Hematology, Semmelweis University and Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
| | - Tanja Falter
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Takashi Inoue
- Department of Evidence-Based Medicine, Nara Medical University, Kashihara, Japan
| | - Pasquale Agosti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Università degli Studi di Milano, Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Milan, Italy
| | - Heidi Rossmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Charis Von Auer
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Hematology, Oncology and Pneumology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, Interdisciplinary Research Facility Life Sciences, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, Interdisciplinary Research Facility Life Sciences, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Bérangère S Joly
- Service d'Hématologie Biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris and EA3518, Institut de Recherche Saint Louis, Université de Paris, Paris, France
| | - Agnès Veyradier
- Service d'Hématologie Biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris and EA3518, Institut de Recherche Saint Louis, Université de Paris, Paris, France
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques, Service d'hématologie, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris and Sorbonne Université, Paris, France
| | - Rob Fijnheer
- Department for Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Università degli Studi di Milano, Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Milan, Italy
| | - Zoltán Prohászka
- Department of Internal Medicine and Hematology, Semmelweis University and Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
| | - Bernhard Lämmle
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Haemostasis Research Unit, University College London, London, United Kingdom
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, Interdisciplinary Research Facility Life Sciences, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium.
| |
Collapse
|
6
|
Agosti P, Siboni SM, Scardo S, Torri A, Gualtierotti R, Peyvandi F. Minimum factor VIII levels to prevent joint bleeding in mild hemophilia A. Blood Adv 2023; 7:7209-7215. [PMID: 37871302 PMCID: PMC10698262 DOI: 10.1182/bloodadvances.2023011366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/25/2023] Open
Abstract
The severity of the bleeding phenotype in patients with hemophilia A (HA) broadly correlates with the degree of coagulation factor VIII (FVIII) deficiency in plasma. However, the FVIII level necessary to achieve the goal of zero joint bleeds remains unclear. This study aimed to identify the minimum FVIII level necessary to prevent joint bleeds in patients with HA. In this retrospective study, patients with congenital mild HA treated on demand, aged ≥16 years, with no history of FVIII inhibitors, followed at the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center in Milan, were enrolled. We investigated 270 male patients with a median age of 45 years (16-88) and median lifelong FVIII of 21 IU/dL. One hundred patients (37%) had a lifelong history of at least 1 joint bleed. The mean annualized joint bleeding rate (AJBR) and spontaneous AJBR were 0.016 (standard deviation [SD], 0.032) and 0.001 (SD, 0.010), respectively. After adjusting for age, for each IU/dL increase in FVIII, there was a 6% reduction in AJBR and an 11% reduction in spontaneous AJBR. The minimum FVIII levels needed to prevent lifelong any joint bleeds and spontaneous joint bleeds resulted to be 19.2 IU/dL and 17.7 IU/dL, respectively. In this large cohort of persons with mild HA, we identified the minimum FVIII levels needed to prevent total and spontaneous joint bleeds (19.2 IU/dL and 17.7 IU/dL, respectively). These findings could suggest important implications for the accurate design of prophylactic therapies for persons with moderate and severe HA, including gene therapy.
Collapse
Affiliation(s)
- Pasquale Agosti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione Luigi Villa, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Simona Maria Siboni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Sara Scardo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Adriana Torri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Roberta Gualtierotti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione Luigi Villa, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione Luigi Villa, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| |
Collapse
|
7
|
Mannucci PM, Agosti P, Lettino M. Guidance for the antithrombotic management of persons with haemophilia and cardiovascular disease. Haemophilia 2023; 29:1390-1393. [PMID: 37729476 DOI: 10.1111/hae.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasquale Agosti
- Department of Pathophysiology and Transplantation and Fondazione Luigi Villa, Università degli Studi di Milano, Milan, Italy
| | - Maddalena Lettino
- Department for Cardiac, Thoracic and Vascular Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| |
Collapse
|
8
|
Agosti P, Novella A, Custodero C, Elli C, Pasina L. Undiagnosed cognitive impairment in older adults hospitalized in internal medicine wards: Data from the REPOSI registry. Eur J Intern Med 2023; 117:129-133. [PMID: 37544848 DOI: 10.1016/j.ejim.2023.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Pasquale Agosti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
| | - Alessio Novella
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, P.zza Giulio Cesare, 11, Bari 70124, Italy.
| | - Chiara Elli
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Luca Pasina
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
9
|
Capecchi M, De Leo P, Abbattista M, Mancini I, Agosti P, Biganzoli M, Suffritti C, Ferrari B, Lecchi A, La Marca S, Padovan L, Scalambrino E, Clerici M, Tripodi A, Artoni A, Gualtierotti R, Peyvandi F. Risk of relapse after SARS-CoV-2 vaccine in the Milan cohort of thrombotic thrombocytopenic purpura patients. Haematologica 2023; 108:3152-3155. [PMID: 36951158 PMCID: PMC10620557 DOI: 10.3324/haematol.2022.282478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Affiliation(s)
- Marco Capecchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Clinica Moncucco, Division of Hematology, Lugano
| | - Pasqualina De Leo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Maria Abbattista
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Ilaria Mancini
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation and Fondazione Luigi Villa, Milan
| | - Pasquale Agosti
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation and Fondazione Luigi Villa, Milan
| | - Marina Biganzoli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Chiara Suffritti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Barbara Ferrari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Anna Lecchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Silvia La Marca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Lidia Padovan
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Erica Scalambrino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Marigrazia Clerici
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Armando Tripodi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Andrea Artoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan
| | - Roberta Gualtierotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation and Fondazione Luigi Villa, Milan
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation and Fondazione Luigi Villa, Milan.
| |
Collapse
|
10
|
Agosti P, De Leo P, Capecchi M, Ferrari B, Mancini I, Gattillo S, Trisolini SM, Rinaldi E, Podda GM, Prezioso L, Salutari P, Facchini L, Caramazza D, Tolomelli G, Artoni A, Peyvandi F. Caplacizumab use for immune thrombotic thrombocytopenic purpura: the Milan thrombotic thrombocytopenic purpura registry. Res Pract Thromb Haemost 2023; 7:102185. [PMID: 37720483 PMCID: PMC10502422 DOI: 10.1016/j.rpth.2023.102185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 09/19/2023] Open
Abstract
•Data on caplacizumab use for thrombotic thrombocytopenic purpura (TTP) in Italy are missing.•Twenty-six Italian patients were treated with caplacizumab for an acute immune TTP episode.•Caplacizumab was effective in treating acute TTP in the Italian real-world clinical setting.•Two major bleeds leading to drug discontinuation were observed.
Collapse
Affiliation(s)
- Pasquale Agosti
- Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Università degli Studi di Milano, Milan, Italy
| | - Pasqualina De Leo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Marco Capecchi
- Clinica Moncucco, Hematology Service, Lugano, Switzerland
| | - Barbara Ferrari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Ilaria Mancini
- Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Gattillo
- Immuno-Hematology and Transfusion Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Silvia Maria Trisolini
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
| | | | - Gian Marco Podda
- U.O.C. Medicina II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Lucia Prezioso
- Haematology and BMT Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Luca Facchini
- Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I n, 50 42123 Reggio Emilia, Italy
| | - Domenica Caramazza
- Hematology, University Hospital “Ospedale di Circolo e Fondazione Macchi” - ASST Sette Laghi, Viale L. Borri 57, 21100, Varese, Italy
| | | | - Andrea Artoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| |
Collapse
|
11
|
Custodero C, Agosti P, Anton SD, Manini TM, Lozupone M, Panza F, Pahor M, Sabbà C, Solfrizzi V. Effect of Physical Activity Intervention on Gait Speed by Frailty Condition: A Randomized Clinical Trial. J Am Med Dir Assoc 2023; 24:489-496. [PMID: 36878264 DOI: 10.1016/j.jamda.2023.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES There is uncertainty about effects of physical activity on physical performance, such as gait speed, among community-dwelling older adults according to their physical frailty status. We determined whether a long-term, moderate-intensity physical activity program was associated with different responses on gait speed over 4 m and 400 m based on physical frailty status. DESIGN Post hoc analysis from the Lifestyle Interventions and Independence for Elders (LIFE) (NCT01072500), a single-blind randomized clinical trial testing the effect of physical activity intervention compared with health education program. SETTING AND PARTICIPANTS We analyzed data on 1623 community-dwelling older adults (78.9 ± 5.2 years) at risk for mobility disability. METHODS Physical frailty was assessed at baseline using the Study of Osteoporotic Fractures frailty index. Gait speed over 4 m and 400 m was measured at baseline, and 6, 12, and 24 months. RESULTS We estimated significantly better 400-m gait speed at 6, 12, and 24 months for nonfrail older adults in the physical activity group, but not for frail participants. Among frail participants, physical activity showed a potentially clinically meaningful benefit on 400-m gait speed at 6 months (0.055; 95% CI 0.016-0.094; P = .005), compared with the healthy educational intervention, only in those who, at baseline, were able to rise from a chair 5 times without using their arms. CONCLUSIONS AND IMPLICATIONS A well-structured physical activity program produced a faster 400-m gait speed potentially able to prevent mobility disability among physically frail individuals with preserved muscle strength in lower limbs.
Collapse
Affiliation(s)
- Carlo Custodero
- Dipartimento Interdisciplinare di Medicina, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, Bari, Italy
| | - Pasquale Agosti
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Università degli Studi di Milano, Milan, Italy
| | - Stephen D Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Madia Lozupone
- Population Health Unit-"Salus In Apulia Study", National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Francesco Panza
- Population Health Unit-"Salus In Apulia Study", National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Carlo Sabbà
- Dipartimento Interdisciplinare di Medicina, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Solfrizzi
- Dipartimento Interdisciplinare di Medicina, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, Bari, Italy.
| |
Collapse
|
12
|
Agosti P, Mancini I, Sadeghian S, Pagliari MT, Abbasi SH, Pourhosseini H, Boroumand M, Lotfi-Tokaldany M, Pappalardo E, Maino A, Rosendaal FR, Peyvandi F. Factor V Leiden but not the factor II 20210G>A mutation is a risk factor for premature coronary artery disease: a case-control study in Iran. Res Pract Thromb Haemost 2023; 7:100048. [PMID: 36798900 PMCID: PMC9926016 DOI: 10.1016/j.rpth.2023.100048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/06/2022] [Accepted: 12/18/2022] [Indexed: 01/13/2023] Open
Abstract
Background Factor V Leiden (FVL) and factor II c.∗97G>A (rs1799963) are genetic risk factors for venous thromboembolism. Their contribution to coronary artery disease (CAD) is less clear. Objectives This study aimed to investigate the association between FVL, rs1799963, and premature CAD in Iranians. Methods We performed a genetic case-control study of 944 cases and 1081 controls from the premature CAD Milano-Iran study, including patients aged 18-55 (female) and 18-45 years (male) who underwent coronary angiography at the Tehran Heart Centre (Iran) in 2004-2011. Cases had luminal stenosis ≥50% in at least 1 main coronary artery or branch. Controls were age- and sex-matched with no CAD history. FVL and rs1799963 were genotyped using TaqMan SNP genotyping assays. Association was tested by logistic regression adjusted for matching factors and ethnicity. Effect modification by sex and cardiovascular risk factors (metabolic [obesity, hypertension, hyperlipidemia, and diabetes], and smoking) was assessed. Results The risk of premature CAD was increased by 50% in FVL carriers (adjusted odds ratio [adjOR] 1.54 [95% CI, 0.95-2.48]) and slightly reduced in rs1799963 carriers (adjOR 0.71 [95% CI, 0.40-1.27]). These effects were more pronounced in women than men (FVL, adjOR 1.66 vs 1.25; rs1799963, adjOR 0.60 vs 1.07). The risk of premature CAD was substantially increased in carriers of FVL with at least 1 metabolic risk factor compared with noncarriers without metabolic risk factors (adjOR 25.14 [95% CI, 12.51-50.52]). Conclusion FVL but not FII rs1799963 was associated with an increased risk of CAD in young Iranians. This risk increased considerably when combined with metabolic cardiovascular risk factors.
Collapse
Affiliation(s)
- Pasquale Agosti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, Milan, Italy
| | - Ilaria Mancini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, Milan, Italy
| | - Saeed Sadeghian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maria Teresa Pagliari
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Seyed Hesameddin Abbasi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran,Department of Global Health and Population, Bernard Lown Scholar in Cardiovascular Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Hamidreza Pourhosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadali Boroumand
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Lotfi-Tokaldany
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Emanuela Pappalardo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, Milan, Italy
| | - Alberto Maino
- Azienda Provinciale per i Servizi Sanitari, Ospedale Santa Chiara, Unit of Internal Medicine, Trento, Italy
| | - Frits R. Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, Milan, Italy,Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy,Correspondence Flora Peyvandi, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Pace 9, 20122, Milan, Italy. @flora_peyvandi
| |
Collapse
|
13
|
Mancini I, Agosti P, Boscarino M, Ferrari B, Artoni A, Palla R, Spreafico M, Crovetti G, Volpato E, Rossini S, Novelli C, Gattillo S, Barcella L, Salmoiraghi M, Falanga A, Peyvandi F. Lombardy diagnostic and therapeutic network of thrombotic microangiopathy. Orphanet J Rare Dis 2022; 17:246. [PMID: 35739601 PMCID: PMC9229100 DOI: 10.1186/s13023-022-02400-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/12/2022] [Indexed: 11/14/2022] Open
Abstract
Background Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy (TMA) requiring urgent treatment. Standardization of its diagnosis and optimal management is challenging. This study aimed to evaluate the role of centralized, rapid testing of ADAMTS13 in patients experiencing acute TMAs requiring plasma-exchange (PEX) and to estimate the incidence of TTP in a large Italian Region. Methods We perfomed a cohort study in the frame of the project “Set-up of a Lombardy network for the study and treatment of patients undergoing apheresis”, including 11 transfusion centers in the Region. Consecutive patients referred from 2014 to 2016 with acute TMAs requiring PEX were enrolled. Centralized ADAMTS13 activity testing was performed at the Milan Hemophilia and Thrombosis Center within 24 h. Results Forty-three TMA patients (44 events) were enrolled, of whom 35 (81%) had severe ADAMTS13 deficiency. Patients with severe ADAMTS13 deficiency were younger, mainly women, with a higher prevalence of autoimmune disorders and a lower prevalence of cancer. Clinical and laboratory characteristics of patients with and without severe ADAMTS13 deficiency largely overlapped, with a lower platelet count being the only baseline marker that significantly differed between the two patient groups (ADAMTS13 activity < 10% vs ≥ 10%: median difference of -27 × 109/l, 95% CI − 37 to − 3). PEX treatment was initiated in all patients, but soon discontinued in cases without severe ADAMTS13 deficiency. In this group, the mortality rate was higher and no episode exacerbations or relapses within 6 months occured. The estimated average annual incidence of acute acquired TTP events was 1.17 [0.78–1.55] per million people. Conclusions Severe ADAMTS13 deficiency distinguished two groups of patients with largely overlapping clinical features but different treatment and disease course. This study provides a feasible model implemented in a large Italian region for the practical clinical approach to TMAs and underlines the importance of urgent ADAMTS13 activity testing for an accurate differential diagnosis and therapeutic approach. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02400-y.
Collapse
Affiliation(s)
- I Mancini
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, and Fondazione Luigi Villa, Via Pace 9, 20122, Milan, Italy
| | - P Agosti
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, and Fondazione Luigi Villa, Via Pace 9, 20122, Milan, Italy
| | - M Boscarino
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, and Fondazione Luigi Villa, Via Pace 9, 20122, Milan, Italy
| | - B Ferrari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - A Artoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - R Palla
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, and Fondazione Luigi Villa, Via Pace 9, 20122, Milan, Italy
| | - M Spreafico
- Transfusion Medicine and Haematology Department, "A. Manzoni" Hospital, ASST-Lecco, Lecco, Italy
| | - G Crovetti
- SIMT, ASST Valle Olona, Busto Arsizio, Italy
| | - E Volpato
- Division of Immunohaematology and Transfusion Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - S Rossini
- Division of Immunohaematology and Transfusion Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - C Novelli
- Transfusion Center and Haematology Laboratory, Legnano Hospital, ASST Ovest Milanese, Legnano, Italy
| | - S Gattillo
- Immuno-Hematology and Transfusion Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - L Barcella
- Immunohematology Division, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - M Salmoiraghi
- Unità Organizzativa Programmazione Della DG Welfare, Unità Organizzativa Programmazione Della DG Welfare Regione Lombardia, Regione Lombardia, Milan, Italy
| | - A Falanga
- Immunohematology Division, Hospital Papa Giovanni XXIII, Bergamo, Italy.,Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - F Peyvandi
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, and Fondazione Luigi Villa, Via Pace 9, 20122, Milan, Italy. .,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.
| | | |
Collapse
|
14
|
De Vincentis A, Vespasiani-Gentilucci U, Costanzo L, Novella A, Cortesi L, Nobili A, Mannucci PM, Incalzi RA, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Mattioli I, Biolo G, Zanetti M, Bartelloni G, Vanoli M, Grignani G, Pulixi EA, Lupattelli G, Bianconi V, Alcidi R, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Beneduce V, Cacioppo F, Corrao S, Natoli G, Mularo S, Raspanti M, Zoli M, Matacena ML, Orio G, Magnolfi E, Serafini G, Simili A, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Fabio G, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Leoni S, Di Mauro AD, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Pontremoli R, Beccati V, Nobili G, Leoncini G, Anastasio L, Carbone M, Cipollone F, Guagnano MT, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Giorgi A, Gracin C, Zuccalà G, D'Aurizio G, Romanelli G, Marengoni A, Volpini A, Lucente D, Picardi A, Gentilucci UV, Bellelli G, Corsi M, Antonucci C, Sidoli C, Principato G, Arturi F, Succurro E, Tassone B, Giofrè F, Serra MG, Bleve MA, Brucato A, De Falco T, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Prandini T, Manfredini R, Fabbian F, Boari B, De Giorgi A, Tiseo R, Paolisso G, Rizzo MR, Catalano C, Borghi C, Strocchi E, Ianniello E, Soldati M, Schiavone S, Bragagni A, Sabbà C, Vella FS, Suppressa P, De Vincenzo GM, Comitangelo A, Amoruso E, Custodero C, Fenoglio L, Falcetta A, Fracanzani AL, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Colombo G, Agosti P, Monzani V, Savojardo V, Ceriani G, Salerno F, Pallini G, Montecucco F, Ottonello L, Caserza L, Vischi G, Liberato NL, Tognin T, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Pisciotta MS, Bellucci FB, Buffelli S, Montrucchio G, Peasso P, Favale E, Poletto C, Margaria C, Sanino M, Violi F, Perri L, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Diprizio RD, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Galassi M, Grassi Y, Greco A, Sciacqua A, Perticone M, Battaglia R, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Pipita ME, Castellino P, Zanoli L, Gennaro A, Gaudio A, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Vigorito C, Cittadini A, Moreo G, Prolo S, Pina G, Ballestrero A, Ferrando F, Gonella R, Cerminara D, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Sechi L, Catena C, Colussi G, Cavarape A, Da Porto A, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Grossi M, Del Giacco S, Firinu D, Costanzo G, Argiolas G, Montalto G, Licata A, Montalto FA, Corica F, Basile G, Catalano A, Bellone F, Principato C, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, Malfa LL, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Imperiale GN, Pirisi M, Fra GP, Sola D, Bellan M, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Napoli F, Aiello I, Landolfi R, Montalto M, Mirijello A, Purrello F, Di Pino A, del Primario NEC, Ghidoni S, Salvatore T, Monaco L, Ricozzi C, Pilotto A, Indiano I, Gandolfo F. The multifaceted spectrum of liver cirrhosis in older hospitalised patients: analysis of the REPOSI registry. Age Ageing 2021; 50:498-504. [PMID: 32926127 DOI: 10.1093/ageing/afaa150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 01/03/2023] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | - Luisa Costanzo
- Unit of Geriatrics, University Campus Bio-Medico, Rome, Italy
| | - Alessio Novella
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Laura Cortesi
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandro Nobili
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Pepe J, Agosti P, Cipriani C, Tettamanti M, Nobili A, Colangelo L, Santori R, Cilli M, Minisola S. Underdiagnosis and undertreatment of osteoporotic patients admitted in internal medicine wards in Italy between 2010 and 2016 (the REPOSI Register). Endocrine 2021; 71:484-493. [PMID: 33433894 DOI: 10.1007/s12020-020-02553-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate clinical features, treatments, and outcomes of osteoporotic patients admitted to internal medicine and geriatric wards compared with non-osteoporotic patients (REPOSI registry). METHODS We studied 4714 patients hospitalized between 2010 and 2016. We reported age, sex, educational level, living status, comorbidities and drugs taken, Cumulative Illness Rating Scale (CIRS), Barthel Index, Short-Blessed Test, 4-item Geriatric Depression Scale, serum hemoglobin, creatinine, and clinical outcomes. Osteoporosis was defined based on the diagnoses recorded at admission, according to the following ICD9: 733, 805-813, 820-823. RESULTS Twelve percent of the patients had a preadmission diagnosis of osteoporosis. Only 20% of these had been prescribed oral bisphosphonates; 34% were taking vitamin D supplements. Osteoporotic patients were significantly older, with lower BMI, higher CIRS, and taking more drugs. They were significantly more depressed, less independent, with a higher severity of cognitive impairment compared with non-osteoporotic patients. At discharge, the number of patients receiving treatment for osteoporosis did not change. Length of stay and inhospital mortality did not differ between groups. Osteoporotic patients were more frequently nonhome discharged compared with those without osteoporosis (14.8 vs. 7.9%, p = 0.0007), mostly discharged to physical therapy or rehabilitation (8.8 vs. 2.5% of patients, p < 0.0001). Among osteoporotic patients deceased 3 months after discharge, the number of those treated with vitamin D, with or without calcium supplements, was significantly lower compared with survivors (12 vs. 32%, p = 0.0168). CONCLUSIONS The diagnosis of osteoporosis is poorly considered both during hospital stay and at discharge; osteoporotic patients are frailer compared to non-osteoporotic patients.
Collapse
Affiliation(s)
- Jessica Pepe
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - Pasquale Agosti
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Università degli Studi di Milano, Milan, Italy
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Mauro Tettamanti
- Neuroscience Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandro Nobili
- Neuroscience Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Luciano Colangelo
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Rachele Santori
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Mirella Cilli
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Salvatore Minisola
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
16
|
Agosti P, Mancini I, Gianniello F, Bucciarelli P, Artoni A, Ferrari B, Pontiggia S, Trisolini SM, Facchini L, Carbone C, Peyvandi F. Prevalence of the age-related diseases in older patients with acquired thrombotic thrombocytopenic purpura. Eur J Intern Med 2020; 75:79-83. [PMID: 32201091 DOI: 10.1016/j.ejim.2020.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prevalence of older patients with acquired thrombotic thrombocytopenic purpura (TTP) is increasing. There is scarce information on the prevalence of multimorbidity, polypharmacy and age-related diseases in aging TTP patients. This study aimed to evaluate the prevalence of multimorbidity and polypharmacy in a population of acquired TTP patients aged 65 years or more compared with a group of age-matched controls. METHODS Acquired TTP patients enrolled in the Milan TTP registry from December 1st 1999 to March 31th 2018 and aged 65 years or more at the date of last follow-up were evaluated. Controls were Italian healthy individuals recruited from 2006 to March 31th 2018 among friends and non-consanguineous relatives of patients tested for thrombophilia screening at the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center of Milan. RESULTS 36 TTP patients and 127 age-matched controls were included. Compared with controls, TTP patients had a higher prevalence of multimorbidity and polypharmacy. They also showed a higher prevalence of autoimmune diseases, osteoporosis and arterial hypertension and were more chronically treated with corticosteroids and antiplatelets for primary cardiovascular prevention. All these results were confirmed after adjusting for sex. Compared with the general elderly population, TTP patients showed a higher prevalence of ischemic heart disease and stroke. CONCLUSIONS Our findings suggest that a careful comprehensive geriatric assessment of acquired TTP patients is necessary. It is important to look for other autoimmune diseases and such age-related comorbidities as osteoporosis, arterial hypertension, ischemic heart disease and cerebrovascular disease.
Collapse
Affiliation(s)
- Pasquale Agosti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano,Via Pace 9, Milan, 20122, Italy
| | - Ilaria Mancini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano,Via Pace 9, Milan, 20122, Italy
| | - Francesca Gianniello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
| | - Paolo Bucciarelli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
| | - Andrea Artoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
| | - Barbara Ferrari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
| | - Silvia Pontiggia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy
| | - Silvia Maria Trisolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Luca Facchini
- Hematology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Carbone
- UO Ematologia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano,Via Pace 9, Milan, 20122, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, Italy.
| |
Collapse
|
17
|
D'Avanzo B, Agosti P, Reeve E, Pasina L, Sabbà C, Mannucci PM, Nobili A. Views of medical practitioners about deprescribing in older adults: Findings from an Italian qualitative study. Maturitas 2020; 134:29-33. [PMID: 32143773 DOI: 10.1016/j.maturitas.2020.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/07/2020] [Accepted: 01/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Even though increasing attention is given to deprescribing owing to the risks related to polypharmacy in older adults, deprescribing is not yet part of clinical culture. METHODS We conducted three focus groups with 25 internists, geriatricians and general practitioners to explore the factors influencing the implementation of deprescribing in the Italian context, and more specifically: i. to investigate the barriers to deprescribing; ii. to define strategies and actions to address these barriers; and iii. to identify skills and tools that may assist in implementing deprescribing in clinical practice. Thematic analysis was used. RESULTS Six themes were identified: Good reasons for deprescribing, Difficulties and doubts about deprescribing, System factors affecting polypharmacy and deprescribing, Perspectives on how to practically approach polypharmacy, Need for effective communication with patients and caregivers, Taking responsibility and starting action. Participants reported a willingness to challenge themselves by addressing the barriers to deprescribing through regular review of prescriptions and collaboration with colleagues and patients. CONCLUSIONS Italian internists, geriatricians and general practitioners reported many system-level barriers to deprescribing as well as some doubts about its necessity. Strategies to address the barriers to deprescribing include regular medication review and enhancing collaboration with colleagues and patients. Additionally, participants were willing to challenge themselves and use uncertainty as an impetus for deprescribing.
Collapse
Affiliation(s)
- Barbara D'Avanzo
- Laboratory of Quality Assessment of Geriatric Therapies and Services, Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa 19, 20156 Milan, Italy.
| | - Pasquale Agosti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, 20122 Italy
| | - Emily Reeve
- College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada; NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, 5000, Australia; Geriatric Medicine Research, Faculty of Medicine and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, NS, B3H 2E1, Canada
| | - Luca Pasina
- Laboratory of Quality Assessment of Geriatric Therapies and Services, Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa 19, 20156 Milan, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy
| | - Alessandro Nobili
- Laboratory of Quality Assessment of Geriatric Therapies and Services, Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa 19, 20156 Milan, Italy
| |
Collapse
|
18
|
Carlotta F, Raffaella R, Ilaria A, Alessandro N, Mannuccio MP, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Caterina C, Biolo G, Zanetti M, Guadagni M, Zaccari M, Chiuch M, Zaccari M, Vanoli M, Grignani G, Pulixi EA, Bernardi M, Bassi SL, Santi L, Zaccherini G, Lupattelli G, Mannarino E, Bianconi V, Paciullo F, Alcidi R, Nuti R, Valenti R, Ruvio M, Cappelli S, Palazzuoli A, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Cocita F, Beneduce V, Plances L, Corrao S, Natoli G, Mularo S, Raspanti M, Cavallaro F, Zoli M, Lazzari I, Brunori M, Fabbri E, Magalotti D, Arnò R, Pasini FL, Capecchi PL, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Maira D, Di Stefano V, Fabio G, Seghezzi S, Mancarella M, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Conti F, Bonini G, Ottolini BB, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Murialdo G, Marra A, Cattaneo F, Pontremoli R, Beccati V, Nobili G, Secchi MB, Ghelfi D, Anastasio L, Sofia L, Carbone M, Cipollone F, Guagnano MT, Valeriani E, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Pes C, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Zuccalà G, D’Aurizio G, Romanelli G, Marengoni A, Zucchelli A, Manzoni F, Volpini A, Picardi A, Gentilucci UV, Gallo P, Dell’Unto C, Annoni G, Corsi M, Bellelli G, Zazzetta S, Mazzola P, Szabo H, Bonfanti A, Arturi F, Succurro E, Rubino M, Tassone B, Sesti G, Interna M, Serra MG, Bleve MA, Gasbarrone L, Sajeva MR, Brucato A, Ghidoni S, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Cosi E, Scarinzi P, Amabile A, Omenetto E, Prandini T, Manfredini R, Fabbian F, Boari B, Giorgi AD, Tiseo R, De Giorgio R, Paolisso G, Rizzo MR, Borghi C, Strocchi E, Ianniello E, Soldati M, Sabbà C, Vella FS, Suppressa P, Schilardi A, Loparco F, De Vincenzo GM, Comitangelo A, Amoruso E, Fenoglio L, Falcetta A, Bracco C, Fracanzani AL, Fargion S, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Ferrari B, Colombo G, Agosti P, Monzani V, Savojardo V, Folli C, Ceriani G, Salerno F, Pallini G, Dallegri F, Ottonello L, Liberale L, Caserza L, Salam K, Liberato NL, Tognin T, Bianchi GB, Giaquinto S, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Spazzini E, Ferrandina C, Montrucchio G, Petitti P, Peasso P, Favale E, Poletto C, Salmi R, Gaudenzi P, Violi F, Perri L, Landolfi R, Montalto M, Mirijello A, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Dondi G, Pellegrini E, Carulli L, Galassi M, Grassi Y, Perticone F, Perticone M, Battaglia R, FIlice M, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Gabrielli A, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Marigliano B, Pipita ME, Castellino P, Zanoli L, Pignataro S, Gennaro A, Blanco J, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Cittadini A, Vigorito C, Arcopinto M, Salzano A, Bobbio E, Marra AM, Sirico D, Moreo G, Gasparini F, Prolo S, Pina G, Ballestrero A, Ferrando F, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Scattolin G, Martinelli S, Turrin M, Sechi L, Catena C, Colussi G, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Del Giacco S, Firinu D, Losa F, Paoletti G, Costanzo G, Montalto G, Licata A, Malerba V, Montalto FA, Lasco A, Basile G, Catalano A, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, La Malfa L, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Lauretani F, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Pirisi M, Fra GP, Sola D, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Tedeschi A, Trotta L, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Cattaneo M, Napoli F. Prevalence of use and appropriateness of antidepressants prescription in acutely hospitalized elderly patients. Eur J Intern Med 2019; 68:e7-e11. [PMID: 31405773 DOI: 10.1016/j.ejim.2019.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
|
19
|
Riva S, Mancini I, Maino A, Ferrari B, Artoni A, Agosti P, Peyvandi F. Long-term neuropsychological sequelae, emotional wellbeing and quality of life in patients with acquired thrombotic thrombocytopenic purpura. Haematologica 2019; 105:1957-1962. [PMID: 31558667 PMCID: PMC7327631 DOI: 10.3324/haematol.2019.226423] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022] Open
Abstract
Neurological symptoms related to microthrombosis are the hallmark of acute manifestations of acquired thrombotic thrombocytopenic purpura (TTP). Despite the achievement of hematological remission, patients may report persisting neurological impairment that affects their quality of life. To assess the long-term neuropsychological consequences of acute TTP, we recruited 35 acquired TTP patients (77% females, median age at onset 41 years, interquartile range: 35–48) regularly followed at our out-patient clinic of thrombotic microangiopathies in Milan (Italy) from December 2015 to October 2016. Patients underwent a psychological evaluation of memory and attentional functions, emotional wellbeing and health-related quality of life at least three months after their last acute TTP event (median 36 months, interquartile range: 17–54). During the psychological consultation, 17 patients (49%) referred persisting subjective neurological impairment in the frame of a remission phase, with at least one symptom as disorientation, loss of concentration, dizziness, lack of balance, headache and diplopia. Neuropsychological assessment revealed lower scores than the Italian general population pertaining to direct, indirect and deferred memory. A higher degree of impairment of memory domains was found in patients with neurological involvement at the time of presentation of the first acute TTP episode. Anxiety and depression were detected in seven (20%) and 15 (43%) patients, respectively. Health-related quality of life was lower than the Italian general population, with mental domains more impacted than physical domains (mean difference 58.43, 95% confidence interval: 71.49–45.37). Our study demonstrates compromised memory and attention functions, persisting anxiety/depression symptoms and a generally reduced quality of life in patients recovering from acute acquired TTP. New clinical strategies should be considered to improve these symptoms.
Collapse
Affiliation(s)
- Silvia Riva
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.,St Mary's University, Twickenham, London, UK
| | - Ilaria Mancini
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Milan, Italy
| | - Alberto Maino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.,Azienda Provinciale per i Servizi Sanitari, Internal Medicine Unit, Trento, Italy
| | - Barbara Ferrari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Andrea Artoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Pasquale Agosti
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Milan, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.,Università degli Studi di Milano, Department of Pathophysiology and Transplantation, and Fondazione Luigi Villa, Milan, Italy
| |
Collapse
|
20
|
Solfrizzi V, Agosti P, Lozupone M, Custodero C, Schilardi A, Valiani V, Sardone R, Dibello V, Di Lena L, Lamanna A, Stallone R, Bellomo A, Greco A, Daniele A, Seripa D, Sabbà C, Logroscino G, Panza F. Nutritional Intervention as a Preventive Approach for Cognitive-Related Outcomes in Cognitively Healthy Older Adults: A Systematic Review. J Alzheimers Dis 2019; 64:S229-S254. [PMID: 29865058 DOI: 10.3233/jad-179940] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The link diet-cognitive function/dementia has been largely investigated in observational studies; however, there was a lack of evidence from randomized clinical trials (RCTs) on the prevention of late-life cognitive disorders though dietary intervention in cognitively healthy older adults. In the present article, we systematically reviewed RCTs published in the last four years (2014-2017) exploring nutritional intervention efficacy in preventing the onset of late-life cognitive disorders and dementia in cognitively healthy subjects aged 60 years and older using different levels of investigation (i.e., dietary pattern changes/medical food/nutraceutical supplementation/multidomain approach and dietary macro- and micronutrient approaches) as well as possible underlying mechanisms of nutritional prevention. From the 35 included RCTs, there was moderate evidence that intervention through dietary pattern changes, medical food/nutraceutical supplementation, and multidomain approach improved specific cognitive domains or cognitive-related blood biomarkers. There was high evidence that protein supplementation improved specific cognitive domains or functional status in prefrail older adults without effect on cognitive function. For fatty acid supplementation, mainly long-chain polyunsaturated fatty acids, there was emerging evidence suggesting an impact of this approach in improving specific cognitive domains, magnetic resonance imaging (MRI) findings, and/or cognitive-related biomarkers also in selected subgroups of older subjects, although some results were conflicting. There was convincing evidence of an impact of non-flavonoid polyphenol and flavonoid supplementations in improving specific cognitive domains and/or MRI findings. Finally, there was only low evidence suggesting efficacy of intervention with homocysteine-related and antioxidant vitamins in improving cognitive functions, dementia incidence, or cognitive-related biomarkers in cognitively healthy older subjects.
Collapse
Affiliation(s)
- Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy.,Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Pasquale Agosti
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Madia Lozupone
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Carlo Custodero
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Andrea Schilardi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Vincenzo Valiani
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Rodolfo Sardone
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | - Vittorio Dibello
- Department of Interdisciplinary Medicine (DIM), Section of Dentistry, University of Bari Aldo, Moro, Bari, Italy
| | - Luca Di Lena
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | - Angela Lamanna
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | - Roberta Stallone
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | - Antonio Greco
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Davide Seripa
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Carlo Sabbà
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Giancarlo Logroscino
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Francesco Panza
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.,Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| |
Collapse
|
21
|
Solfrizzi V, Agosti P, Lozupone M, Custodero C, Schilardi A, Valiani V, Santamato A, Sardone R, Dibello V, Di Lena L, Stallone R, Ranieri M, Bellomo A, Greco A, Daniele A, Seripa D, Sabbà C, Logroscino G, Panza F. Nutritional interventions and cognitive-related outcomes in patients with late-life cognitive disorders: A systematic review. Neurosci Biobehav Rev 2018; 95:480-498. [PMID: 30395922 DOI: 10.1016/j.neubiorev.2018.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 12/30/2022]
Abstract
There have been a large number of observational studies on the impact of nutrition on neuroprotection, however, there was a lack of evidence from randomized clinical trials (RCTs). In the present systematic review, from the 32 included RCTs published in the last four years (2014-2017) in patients aged 60 years and older with different late-life cognitive disorders, nutritional intervention through medical food/nutraceutical supplementation and multidomain approach improved magnetic resonance imaging findings and other cognitive-related biomarkers, but without clear effect on cognition in mild Alzheimer's disease (AD) and mild cognitive impairment (MCI). Antioxidant-rich foods (nuts, grapes, cherries) and fatty acid supplementation, mainly n-3 polyunsaturated fatty acids (PUFA), improved specific cognitive domains and cognitive-related outcomes in MCI, mild-to-moderate dementia, and AD. Antioxidant vitamin and trace element supplementations improved only cognitive-related outcomes and biomarkers, high-dose B vitamin supplementation in AD and MCI patients improved cognitive outcomes in the subjects with a high baseline plasma n-3 PUFA, while folic acid supplementation had positive impact on specific cognitive domains in those with high homocysteine.
Collapse
Affiliation(s)
- Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy.
| | - Pasquale Agosti
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Carlo Custodero
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Andrea Schilardi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Vincenzo Valiani
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Andrea Santamato
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Foggia, Italy
| | - Rodolfo Sardone
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy; Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari AldoMoro, Bari, Italy
| | - Vittorio Dibello
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Luca Di Lena
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy; Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari AldoMoro, Bari, Italy
| | - Roberta Stallone
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy; Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari AldoMoro, Bari, Italy
| | - Maurizio Ranieri
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonio Greco
- Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Davide Seripa
- Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Carlo Sabbà
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy; Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
| |
Collapse
|
22
|
Agosti P, Tettamanti M, Vella FS, Suppressa P, Pasina L, Franchi C, Nobili A, Mannucci PM, Sabbà C. Living alone as an independent predictor of prolonged length of hospital stay and non-home discharge in older patients. Eur J Intern Med 2018; 57:25-31. [PMID: 29934241 DOI: 10.1016/j.ejim.2018.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 12/31/2022]
Affiliation(s)
- P Agosti
- Interdisciplinary Department of Medicine, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy.
| | - M Tettamanti
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - F S Vella
- Interdisciplinary Department of Medicine, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - P Suppressa
- Interdisciplinary Department of Medicine, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - L Pasina
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - C Franchi
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Sabbà
- Interdisciplinary Department of Medicine, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
| |
Collapse
|
23
|
Pasina L, Recchia A, Agosti P, Nobili A, Rizzi B. Prevalence of Preventive and Symptomatic Drug Treatments in Hospice Care: An Italian Observational Study. Am J Hosp Palliat Care 2018; 36:216-221. [PMID: 30114944 DOI: 10.1177/1049909118794926] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of pharmacotherapy in people at the end of life should be symptom control, more than prolonging life. Drugs for disease prevention should therefore be discouraged, but this is not the usual practice. The prevalence of unnecessary preventive drugs at the end of life is not well described, although some studies suggest it is common. METHODS This retrospective longitudinal study describes the prevalence of patients receiving preventive and symptomatic drug treatments at admission (T1) and before death (T2) in an Italian hospice. All adults admitted to the VIDAS hospice between March 2015 and February 2017 were included in the analysis. RESULTS The study sample comprised 589 end-of-life patients with a mean age of 75.3 (12.1) years. The mean number of drugs decreased from admission to the hospice to the time of death (mean [standard deviation]: 9.7 [3.4] and 8.7 [3.0]). All patients were appropriately treated with symptomatic drugs at T1 and T2, while there were significantly fewer patients from T1 to T2 with at least 1 preventive medication that could be considered for deprescription at the end of life (511, 86.8% and 286, 48.6%; P < .0001). CONCLUSIONS Hospice admission can be associated with a definite reduction in the use of commonly prescribed preventive medications. However, about half of end-of-life patients can be prescribed avoidable medications. Drugs for peptic ulcer and gastroesophageal reflux disease and antithrombotics were the potentially avoidable preventive medications most frequently prescribed at admission to the hospice and before death.
Collapse
Affiliation(s)
- Luca Pasina
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, MI, Italy
| | | | - Pasquale Agosti
- Interdisciplinary Department of Medicine, University of Bari, BA, Italy
| | | | | |
Collapse
|
24
|
Solfrizzi V, Custodero C, Lozupone M, Imbimbo BP, Valiani V, Agosti P, Schilardi A, D’Introno A, La Montagna M, Calvani M, Guerra V, Sardone R, Abbrescia DI, Bellomo A, Greco A, Daniele A, Seripa D, Logroscino G, Sabbá C, Panza F. Relationships of Dietary Patterns, Foods, and Micro- and Macronutrients with Alzheimer’s Disease and Late-Life Cognitive Disorders: A Systematic Review. J Alzheimers Dis 2017; 59:815-849. [DOI: 10.3233/jad-170248] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro, Bari, Italy
| | - Carlo Custodero
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro, Bari, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Bruno P. Imbimbo
- Department of Research and Development, Chiesi Farmaceutici, Parma, Italy
| | - Vincenzo Valiani
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro, Bari, Italy
| | - Pasquale Agosti
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Schilardi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro, Bari, Italy
| | - Alessia D’Introno
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro, Bari, Italy
| | - Maddalena La Montagna
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | - Mariapaola Calvani
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Vito Guerra
- National Institute for Digestive Diseases, IRCCS “Saverio de Bellis”, Castellana, Bari, Italy
| | - Rodolfo Sardone
- National Institute for Digestive Diseases, IRCCS “Saverio de Bellis”, Castellana, Bari, Italy
| | - Daniela I. Abbrescia
- National Institute for Digestive Diseases, IRCCS “Saverio de Bellis”, Castellana, Bari, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | - Antonio Greco
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Davide Seripa
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| | - Carlo Sabbá
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy
- Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| |
Collapse
|
25
|
Lopane C, Agosti P, Gigante I, Sabbà C, Mazzocca A. Implications of the lysophosphatidic acid signaling axis in liver cancer. Biochim Biophys Acta Rev Cancer 2017; 1868:277-282. [PMID: 28591560 DOI: 10.1016/j.bbcan.2017.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 01/25/2023]
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death in western countries. The major risk factors for HCC are hepatitis C or B viruses, alcohol and metabolic disorders. The increasing risk of HCC in patients with metabolic disorders (i.e. obesity, diabetes and non-alcoholic steatohepatitis/NASH) regardless of the presence of liver cirrhosis is becoming relevant. Nevertheless, molecular mechanisms linking these risk factors to liver oncogenesis are unclear. This review focuses on the pathogenic role of the lysophosphatidic acid (LPA) pathway in HCC, highlighting the implications of this bioactive phospholipid in liver cancer biology and metabolism and as potential therapeutic target.
Collapse
Affiliation(s)
- Chiara Lopane
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Pasquale Agosti
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Isabella Gigante
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Antonio Mazzocca
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124 Bari, Italy.
| |
Collapse
|
26
|
Sangineto M, Perrone A, Agosti P, Boccuti V, Campobasso A, Sabbà C. Hemophagocytic Lymphohistiocytosis, an Unclear Nosologic Entity: Case Report of an Adult Man with Rising of Amylase and Lipase and Spinal Cord Infiltration. Hematol Rep 2017; 9:6859. [PMID: 28286628 PMCID: PMC5337822 DOI: 10.4081/hr.2017.6859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/27/2016] [Accepted: 12/05/2016] [Indexed: 02/07/2023] Open
Abstract
Here we present the case of a 57-years old patient affected by hemophagocytic lymphohistiocytosis (HLH), a rare disease characterized by an uncontrolled immune activation, resulting in clinical and biochemical manifestations of extreme inflammation. In a previous hospitalization, the patient showed fever, hepato-splenomegaly, pancytopenia, hyperferrtitinemia, lymphadenopathy and cholestasis. No diagnosis was done, however, he totally recovered after splenectomy. Eight months later, he relapsed, showing also hypofibrinogenemia, hypertriglyceridemia, hemophagocytic signs in bone marrow, cholestatic jaundice, high LDH and high PT-INR. Interestingly, he presented increased levels of amylase and lipase in absence of radiologic signs of pancreatitis. He was treated with Dexamethasone and Cyclosporine according to HLH-2004 guidelines. The clinical and biochemical manifestations disappeared in a few weeks, but he was newly hospitalized for lower limbs hypotonia caused by a hemophagocytic lesion of the cauda equina and lumbar cord. The death occurred in a few days, despite the immunosuppressive treatment.
Collapse
|
27
|
Starling RD, Pizza FX, Flynn HC, Naureth M, Davenport R, Salbany P, Agosti P. RUN TRAINING VS. CROSS-TRAINING. Med Sci Sports Exerc 1992. [DOI: 10.1249/00005768-199205001-00604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|