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1. Dementia, infections and vaccines: 30 years of controversy

Author

Fiona Ecarnot, Virginia Boccardi, Andrea Calcagno, Claudio Franceschi, Tamas Fülop, Ruth F. Itzhaki, Jean-Pierre Michel, Francesco Panza, Innocenzo Rainero, Vincenzo Solfrizzi, Andrea Ticinesi, Nicola Veronese, and Stefania Maggi

Subjects
Aging, Geriatrics and Gerontology
Abstract

This paper reports the proceedings of a virtual meeting convened by the European Interdisciplinary Council on Ageing (EICA), to discuss the involvement of infectious disorders in the pathogenesis of dementia and neurological disorders leading to dementia. We recap how our view of the infectious etiology of dementia has changed over the last 30 years in light of emerging evidence, and we present evidence in support of the implication of infection in dementia, notably Alzheimer’s disease (AD). The bacteria and viruses thought to be responsible for neuroinflammation and neurological damage are reviewed. We then review the genetic basis for neuroinflammation and dementia, highlighting the genes that are currently the focus of investigation as potential targets for therapy. Next, we describe the antimicrobial hypothesis of dementia, notably the intriguing possibility that amyloid beta may itself possess antimicrobial properties. We further describe the clinical relevance of the gut–brain axis in dementia, the mechanisms by which infection can move from the intestine to the brain, and recent findings regarding dysbiosis patterns in patients with AD. We review the involvement of specific pathogens in neurological disorders, i.e. SARS-CoV-2, human immunodeficiency virus (HIV), herpes simplex virus type 1 (HSV1), and influenza. Finally, we look at the role of vaccination to prevent dementia. In conclusion, there is a large body of evidence supporting the involvement of various infectious pathogens in the pathogenesis of dementia, but large-scale studies with long-term follow-up are needed to elucidate the role that infection may play, especially before subclinical or clinical disease is present.

Published
2023

2. Effects of a 2‐year exercise training on neuromuscular system health in older individuals with low muscle function

Author

Elena Monti, Sara Tagliaferri, Sandra Zampieri, Fabio Sarto, Giuseppe Sirago, Martino Vladimiro Franchi, Andrea Ticinesi, Yari Longobucco, Elisa Adorni, Fulvio Lauretani, Stephan Von Haehling, Emanuele Marzetti, Riccardo Calvani, Roberto Bernabei, Matteo Cesari, Marcello Maggio, and Marco Vincenzo Narici

Subjects
sarcopenia, C-terminal agrin fragment (CAF), elderly, exercise intervention, neurofilament light chain (NfL), skeletal muscle, Physiology (medical), Settore MED/09 - MEDICINA INTERNA, Orthopedics and Sports Medicine
Published
2023

3. Untangling the link between the human gut microbiota composition and the severity of the symptoms of the <scp>COVID</scp> ‐19 infection

Author

Leonardo, Mancabelli, Christian, Milani, Federico, Fontana, Gabriele Andrea, Lugli, Chiara, Tarracchini, Alice, Viappiani, Tecla, Ciociola, Andrea, Ticinesi, Antonio, Nouvenne, Tiziana, Meschi, Francesca, Turroni, and Marco, Ventura

Subjects
Microbiology, Ecology, Evolution, Behavior and Systematics
Abstract

Recent pandemic infection caused by SARS-CoV-2 (COVID-19) led the scientific community to investigate the possible causes contributing to the physiopathology of this disease. In this context, analyses of the intestinal microbiota highlighted possible correlation between host-associated bacterial communities and development of the COVID-19. Nevertheless, a detailed investigation of the role of the human microbiota in the severity of the symptoms of this disease is still lacking. This study performed a comprehensive meta-analysis of 323 faecal samples from public and novel Italian data sets based on the shotgun metagenomic approach. In detail, the comparative analyses revealed possible differences in the microbial biodiversity related to the individual health status, highlighting a species richness decrease in COVID-19 patients with a severe prognosis. Moreover, healthy subjects resulted characterized by a higher abundance of protective and health-supporting bacterial species, while patients affected by COVID-19 disease displayed a significant increase of opportunistic pathogen bacteria involved in developing putrefactive dysbiosis. Furthermore, prediction of the microbiome functional capabilities suggested that individuals affected by COVID-19 subsist in an unbalanced metabolism characterized by an overrepresentation of enzymes involved in the protein metabolism at the expense of carbohydrates oriented pathways, which can impact on disease severity and in excessive systemic inflammation.

Published
2022

4. Thoracic Ultrasound Strain Elastosonography as a Noninvasive Biomarker of Chronic Obstructive Pulmonary Disease-Associated Lung Injury: A Feasibility Study

Author

Antonio Nouvenne, Ilaria Zanichelli, Nicoletta Cerundolo, Gianluca Milanese, Nicola Sverzellati, Martina Rendo, Erminia Ridolo, Simone Scarlata, Tiziana Meschi, and Andrea Ticinesi

Subjects
Pulmonary and Respiratory Medicine, Pulmonary Disease, Chronic Obstructive, Spirometry, Case-Control Studies, Forced Expiratory Volume, Smoking, Feasibility Studies, Humans, Lung Injury, Lung, Biomarkers
Abstract

Background: Transthoracic strain elastosonography (TSE) is being increasingly studied for estimating lung-pleura interface stiffness in pulmonary fibrosis. To date, no data exist on its application in chronic obstructive pulmonary disease (COPD). Objectives: The aim of this article was to describe the TSE pattern in patients with COPD and healthy subjects, either smokers or nonsmokers, and evaluate the feasibility of this technique for early detection of COPD in smokers. Methods: Nineteen patients with COPD, twenty-one healthy smokers, and twenty healthy nonsmokers underwent spirometry and TSE. Elastosonography was performed by one ultrasound-certified operator on 12 different scans for each participant, on right and left sides, anteriorly and posteriorly, on upper and lower lobes. For each scan, lung-pleura interface stiffness index (SI) was calculated, and the average SI on all 12 scans (SI-12) and on posterior basal scans (SI-PB) was calculated and used for comparisons among groups of participants and correlations with spirometric parameters. Results: Patients with lung injury (i.e., with COPD or healthy smokers) exhibited significantly increased lung-pleura interface stiffness on TSE, measured by SI-12 and SI-PB, than healthy nonsmokers (p < 0.05). Unlike SI-12, SI-PB was able to discriminate between subjects with lung injury and healthy nonsmokers on receiver operating characteristics analysis (area under the curve 0.846, 95% confidence interval 0.730–0.926, p < 0.001) and correlated with forced expiratory volume in the first second (r = −0.31, p = 0.018). Conclusion: The measurement of lung-pleura interface stiffness by TSE in posterior basal scans was able to discriminate patients with lung injury from healthy nonsmokers. The role of TSE for detecting early lung damage in COPD should be further investigated.

Published
2022

5. Insights from comparison of the clinical presentation and outcomes of patients hospitalized with COVID-19 in an Italian internal medicine ward during first and third wave

Author

Andrea Ticinesi, Alberto Parise, Antonio Nouvenne, Nicoletta Cerundolo, Beatrice Prati, Angela Guerra, Domenico Tuttolomondo, Nicola Gaibazzi, and Tiziana Meschi

Subjects
General Medicine
Abstract

BackgroundThe reasons of variability of clinical presentation of coronavirus disease-19 (COVID-19) across different pandemic waves are not fully understood, and may include individual risk profile, SARS-CoV-2 lineage and seasonal variations of viral spread. The objective of this retrospective study was to compare the characteristics and outcomes of patients admitted with confirmed coronavirus disease-19 (COVID-19) in the same season during the first (March 2020) and the third pandemic wave (March 2021, dominance of SARS-CoV-2 B.1.1.7 lineage) in an internal medicine ward of a large teaching hospital in Italy.Materials and methodsData of 769 unvaccinated patients (399 from the first and 370 from the third wave) were collected from clinical records, including symptom type and duration, extension of lung abnormalities on chest computed tomography (CT) and PaO2/FiO2 ratio on admission arterial blood gas analysis.ResultsThird wave patients were in average younger (median 65, interquartile range [IQR] 55–75, vs. 72, IQR 61–81 years old, p p = 0.017) and respiratory involvement (PaO2/FiO2 median 288, IQR 237–338, vs. 233, IQR 121–326 mmHg, age- and sex-adjusted p p p 2/FiO2 (OR 0.991, 95% CI 0.988–0.994, p ConclusionDespite the higher virulence of B.1.1.7 lineage, we detected milder clinical presentation and improved mortality in patients hospitalized during the third COVID-19 wave, with involvement of younger subjects. The reasons of this discrepancy are unclear, but could involve the population effect of vaccination campaigns, that were being conducted primarily in older frail subjects during the third wave.

Published
2023

6. Implementing a multidisciplinary rapid geriatric observation unit for non-critical older patients referred to hospital: observational study on real-world data

Author

Angela Guerra, Andrea Ticinesi, Laura Frosio, Giulia Chiussi, Massimo Fabi, Nicoletta Cerundolo, Antonio Nouvenne, Ettore Brianti, Tiziana Meschi, Alberto Parise, and Beatrice Prati

Subjects
Aging, medicine.medical_specialty, Vital signs, Older patients, Clinical Observation Units, Multidisciplinary approach, medicine, Humans, Geriatric Assessment, Aged, Retrospective Studies, Aged, 80 and over, Frailty, business.industry, Medical record, Red blood cell distribution width, Length of Stay, Hospitals, Hospitalization, Emergency medicine, Delirium, Observational study, Geriatrics and Gerontology, medicine.symptom, business, Observation unit
Abstract

Geriatric rapid observation units may represent an alternative to hospitalization in older patients with non-critical acute illness. To describe the characteristics and outcomes of patients admitted to a geriatric observation unit called URGe (Unita Geriatrica Rapida), implemented in an Italian hospital and characterized by multidisciplinary medical staff with geriatric expertise, fast-track access to diagnostic resources, regular use of point-of-care ultrasound and predicted length of stay (LOS)

Published
2021

7. Natural heteroclitic-like peptides are generated by SARS-CoV-2 mutations

Author

Camilla Tiezzi, Andrea Vecchi, Marzia Rossi, Davide Cavazzini, Angelo Bolchi, Diletta Laccabue, Luca Sacchelli, Federica Brillo, Tiziana Meschi, Andrea Ticinesi, Antonio Nouvenne, Gaetano Donofrio, Paola Zanelli, Magda Benecchi, Silvia Giuliodori, Paola Fisicaro, Ilaria Montali, Simona Urbani, Giuseppe Pedrazzi, Gabriele Missale, Amalio Telenti, Davide Corti, Simone Ottonello, Carlo Ferrari, and Carolina Boni

Abstract

Mutations carried by SARS-CoV-2 spike protein variants may promote viral escape from immune protection. Humoral immunity is sensitive to evasion by SARS-CoV-2 mutants, but the impact of viral evolution on the interplay between virus and host CD8 T cell reactivity remains uncertain. By a systematic functional analysis of 30 spike variant mutations, we show that in vaccinated as well as convalescent subjects, mutated epitopes can have not only a neutral or abrogating effect on the recognition by CD8 T cells but can also enhance or even generate de novo CD8 T cell responses. Large pools of peptides spanning the entire spike sequence and comprising previously identified CD8 T cell epitopes were then used in parallel with variant peptides to define strength and multispecificity of total anti-spike CD8 responses. In some individuals, CD8 cells were narrowly focused on a few epitopes indicating that in this context of weak and oligospecific responses the overall antiviral protection can likely benefit of the function enhancing effect of heteroclitic-like mutations. In conclusion, appearance of mutated stimulatory epitopes likely reflects an epiphenomenon of SARS-CoV-2 evolution driven by antibody evasion and increased transmissibility, that might bear clinical relevance in a subset of individuals with weak and oligospecific CD8 T cell responses.

Published
2022

8. Impact of probiotics on muscle mass, muscle strength and lean mass: a systematic review and meta-analysis of randomized controlled trials

Author

Konstantinos Prokopidis, Panagiotis Giannos, Richard Kirwan, Theocharis Ispoglou, Francesco Galli, Oliver C. Witard, Konstantinos K. Triantafyllidis, Konstantinos S. Kechagias, Jordi Morwani‐Mangnani, Andrea Ticinesi, and Masoud Isanejad

Subjects
Lactobacillus, Sarcopenia, Muscle strength, Physiology (medical), Probiotics, Orthopedics and Sports Medicine, Muscle mass, Bifidobacterium
Abstract

Probiotics have shown potential to counteract sarcopenia, although the extent to which they can influence domains of sarcopenia such as muscle mass and strength in humans is unclear. The aim of this systematic review and meta-analysis was to explore the impact of probiotic supplementation on muscle mass, total lean mass and muscle strength in human adults. A literature search of randomized controlled trials (RCTs) was conducted through PubMed, Scopus, Web of Science and Cochrane Library from inception until June 2022. Eligible RCTs compared the effect of probiotic supplementation versus placebo on muscle and total lean mass and global muscle strength (composite score of all muscle strength outcomes) in adults (18 years). To evaluate the differences between groups, a meta-analysis was conducted using the random effects inverse-variance model by utilizing standardized mean differences. Twenty-four studies were included in the systematic review and meta-analysis exploring the effects of probiotics on muscle mass, total lean mass and global muscle strength. Our main analysis (k = 10) revealed that muscle mass was improved following probiotics compared with placebo (SMD: 0.42, 95% CI: 0.10-0.74, I

Published
2022

9. Intestinal microbiome in normal ageing, frailty and cognition decline

Author

Barbara Strasser and Andrea Ticinesi

Subjects
Nutrition and Dietetics, Medicine (miscellaneous)
Abstract

The intestinal microbiome modulates the risk of several age-related chronic diseases and syndromes, including frailty and neurodegenerative diseases. Herein we provided an update on the influence of gut microbiota on physical and cognitive performance in older age and suggest microbiota-targeted interventions for healthy ageing.Low uniqueness index of the gut microbiome and high representation of Bacteroides are independently associated with mortality in older individuals, while the centenarian microbiome is characterized by high abundance of Lactobacilli and Bifidobacteria . Frailty syndrome, sarcopenia and cognitive decline are associated with reduced faecal microbiota biodiversity, reduced abundance of bacteria able to synthetize short-chain fatty acids (SCFA), including Faecalibacterium prausnitzii , and reduced faecal butyrate levels. Dietary intervention, especially involving Mediterranean diet, and exercise training seem to be associated with improved biodiversity of the microbiota, increased capacity of SCFA synthesis and, probably, protection against the onset of frailty and cognitive decline.The gut microbiota biodiversity and composition may reflect the different ageing trajectory, but further research is needed to understand potential independent and combined effects of environmental and lifestyle factors in older adults, especially from a clinical point of view.

Published
2022

10. The Clinical Significance of Procalcitonin Elevation in Patients over 75 Years Old Admitted for COVID-19 Pneumonia

Author

Beatrice Prati, Tiziana Meschi, Loredana Guida, Antonio Nouvenne, Nicoletta Cerundolo, Andrea Ticinesi, Alberto Parise, Rosalia Aloe, Chiara Bonaguri, and Angela Guerra

Subjects
Male, Risk, medicine.medical_specialty, Multivariate analysis, Article Subject, Immunology, Comorbidity, 030204 cardiovascular system & hematology, behavioral disciplines and activities, Procalcitonin, Electrocardiography, 03 medical and health sciences, COVID-19 Testing, Patient Admission, 0302 clinical medicine, Internal medicine, Pathology, RB1-214, Humans, Medicine, Clinical significance, Hospital Mortality, 030212 general & internal medicine, Aged, Proportional Hazards Models, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Proportional hazards model, COVID-19, Retrospective cohort study, Cell Biology, Middle Aged, medicine.disease, Pneumonia, Italy, Multivariate Analysis, Female, Tomography, X-Ray Computed, business, Biomarkers, Research Article
Abstract

Aim. To investigate the clinical significance of procalcitonin (PCT) elevation on hospital admission for coronavirus disease-19 (COVID-19) and its association with mortality in oldest old patients ( age > 75 years ). Methods. The clinical records of 1074 patients with chest high-resolution computed-tomography (HRCT) positive for interstitial pneumonia and symptoms compatible for COVID-19, hospitalized in medical wards during the first pandemic wave in a single academic center in Northern Italy, were retrospectively analyzed. All patients had serum PCT testing performed within six hours from admission. Information on COVID-19-related symptoms, comorbidities, drugs, autonomy in daily activities, respiratory exchanges, other routine lab tests, and outcomes were collected. Clinical characteristics were compared across different admission PCT levels and ages. The association of admission PCT with mortality was tested separately in participants aged > 75 and ≤75 years old by stepwise multivariate Cox regression model with forward selection. Results. With increasing classes of PCT levels ( P < 0.0001 ) towards older age, male gender, wider extension of lung involvement on HRCT, worse respiratory exchanges, and several other laboratory abnormalities. Each incremental PCT class was associated with increased risk of hospital death at multivariate models in subjects older than 75 (hazard ratio for PCT ≥ 2 vs. P = 0.001 ), but not in subjects aged 75 or younger. Conclusions. In patients admitted for COVID-19, PCT elevation was associated with several clinical, radiological, and laboratory characteristics of disease severity. However, PCT elevation was strongly associated with hospital mortality only in oldest old subjects ( age > 75 ).

Published
2021

11. Guideline for the analysis of the microbial communities of the human upper airways

Author

Leonardo Mancabelli, Tecla Ciociola, Gabriele Andrea Lugli, Chiara Tarracchini, Federico Fontanta, Alice Viappiani, Francesca Turroni, Andrea Ticinesi, Tiziana Meschi, Stefania Conti, Marco Ventura, and Christian Milani

Subjects
Microbiology (medical), Infectious Diseases, Dentistry (miscellaneous)
Abstract

The recent COVID-19 pandemic prompted a rapid-growing interest in the investigation of the human microbiota of the upper airways. In fact, the resident microbial community of this body district may have an influence on the onset of SARS-CoV-2 infection and its clinical course in terms of presence, symptom severity, and outcomes. However, several microbiological methodologies are available to study the human microbiota, reflecting the extensive fragmentation of methodological approaches. We investigate the impact of two critical steps that can induce biases in the downstream analyses, i.e. sampling method and microbial DNA extraction kit employed. We observed major discrepancies regarding the total amount of prokaryotic DNA that could be retrieved from a biological sample and the proportion between bacterial DNA and human host DNA. Moreover, shotgun DNA sequencing and taxonomic profile reconstruction also revealed correlations between sampling methods and the procedures applied for microbial DNA extraction. Based on all the data collected in this study, we formulate indications regarding the most efficient and reliable methodological procedures for the metagenomic analyses of the upper airways' microbiota to maximize accuracy and reproducibility.

Published
2022

12. Interaction Between Diet and Microbiota in the Pathophysiology of Alzheimer’s Disease: Focus on Polyphenols and Dietary Fibers

Author

Andrea Ticinesi, Leonardo Mancabelli, Luca Carnevali, Antonio Nouvenne, Tiziana Meschi, Daniele Del Rio, Marco Ventura, Andrea Sgoifo, and Donato Angelino

Abstract

Animal studies increasingly indicate that the gut microbiota composition and function can be involved in the pathophysiology and progression of Alzheimer’s disease (AD) at multiple levels. However, few studies have investigated this putative gut-brain axis in human beings, and none of them considered diet as a determinant of intestinal microbiota composition. Epidemiological studies highlight that a high intake of fruit and vegetables, such as that typical of the Mediterranean diet, can modulate AD progression. Thus, nutritional interventions are being increasingly studied as a possible non-pharmacological strategy to slow down the progression of AD. In particular, polyphenols and fibers represent the nutritional compounds with the higher potential of counterbalancing the pathophysiological mechanisms of dementia due to their antioxidant, anti-inflammatory, and anti-apoptotic properties. These actions are mediated by the gut microbiota, that can transform polyphenols and fibers into biologically active compounds including, among others, phenyl-γ-valerolactones, urolithins, butyrate, and other short-chain fatty acids. In this review, the complex mechanisms linking nutrition, gut microbiota composition, and pathophysiology of cognitive decline in AD are discussed, with a particular focus on the role of polyphenols and fibers. The gaps between pre-clinical and clinical studies are particularly emphasized, as well as the urgent need for studies comprehensively evaluating the link between nutrition, microbiome, and clinical aspects of AD.

Published
2022

14. Standardization of microbiome studies for urolithiasis: an international consensus agreement

Author

Andrea Ticinesi, Dirk Lange, Kristina L. Penniston, Manoj Monga, Aaron W. Miller, Petar Bajic, Alan J. Wolfe, Tiziana Meschi, Gregory E. Tasian, Joshua M. Stern, Naveen Kachroo, and Mangesh V. Suryavanshi

Subjects
Microbiological Techniques, 0301 basic medicine, Future studies, Renal calculi, Standardization, business.industry, Microbiota, Urology, Consensus Statement, 030232 urology & nephrology, MEDLINE, Urological Diseases, Data science, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Urolithiasis, Humans, Medicine, Relevance (information retrieval), Microbiome, Sample collection, business, Urinary stone disease
Abstract

Numerous metagenome-wide association studies (MWAS) for urolithiasis have been published, leading to the discovery of potential interactions between the microbiome and urolithiasis. However, questions remain about the reproducibility, applicability and physiological relevance of these data owing to discrepancies in experimental technique and a lack of standardization in the field. One barrier to interpreting MWAS is that experimental biases can be introduced at every step of the experimental pipeline, including sample collection, preservation, storage, processing, sequencing, data analysis and validation. Thus, the introduction of standardized protocols that maintain the flexibility to achieve study-specific objectives is urgently required. To address this need, the first international consortium for microbiome in urinary stone disease — MICROCOSM — was created and consensus panel members were asked to participate in a consensus meeting to develop standardized protocols for microbiome studies if they had published an MWAS on urolithiasis. Study-specific protocols were revised until a consensus was reached. This consensus group generated standardized protocols, which are publicly available via a secure online server, for each step in the typical clinical microbiome–urolithiasis study pipeline. This standardization creates the benchmark for future studies to facilitate consistent interpretation of results and, collectively, to lead to effective interventions to prevent the onset of urolithiasis, and will also be useful for investigators interested in microbiome research in other urological diseases., Metagenome-wide association studies have led to the discovery of potential interactions between the microbiome and urolithiasis, but a lack of standardization has raised questions about the reproducibility, applicability and physiological relevance of metagenome-wide association study data. This Consensus Statement describes the formation of the first international consortium for microbiome in urinary stone disease — MICROCOSM — and the outcomes of a consensus meeting to develop standardized protocols for microbiome studies and generate a data repository, which are both publicly available via a secure online server.

Published
2021

15. Accounting Gut Microbiota as the Mediator of Beneficial Effects of Dietary (Poly)phenols on Skeletal Muscle in Aging

Author

Andrea Ticinesi, Antonio Nouvenne, Nicoletta Cerundolo, Alberto Parise, and Tiziana Meschi

Subjects
Nutrition and Dietetics, Food Science
Abstract

Sarcopenia, the age-related loss of muscle mass and function increasing the risk of disability and adverse outcomes in older people, is substantially influenced by dietary habits. Several studies from animal models of aging and muscle wasting indicate that the intake of specific polyphenol compounds can be associated with myoprotective effects, and improvements in muscle strength and performance. Such findings have also been confirmed in a smaller number of human studies. However, in the gut lumen, dietary polyphenols undergo extensive biotransformation by gut microbiota into a wide range of bioactive compounds, which substantially contribute to bioactivity on skeletal muscle. Thus, the beneficial effects of polyphenols may consistently vary across individuals, depending on the composition and metabolic functionality of gut bacterial communities. The understanding of such variability has recently been improved. For example, resveratrol and urolithin interaction with the microbiota can produce different biological effects according to the microbiota metabotype. In older individuals, the gut microbiota is frequently characterized by dysbiosis, overrepresentation of opportunistic pathogens, and increased inter-individual variability, which may contribute to increasing the variability of biological actions of phenolic compounds at the skeletal muscle level. These interactions should be taken into great consideration for designing effective nutritional strategies to counteract sarcopenia.

Published
2023

16. Natural heteroclitic-like peptides are generated by SARS-CoV-2 mutations

Author

Camilla Tiezzi, Andrea Vecchi, Marzia Rossi, Davide Cavazzini, Angelo Bolchi, Diletta Laccabue, Sara Doselli, Amalia Penna, Luca Sacchelli, Federica Brillo, Tiziana Meschi, Andrea Ticinesi, Antonio Nouvenne, Gaetano Donofrio, Paola Zanelli, Magda Benecchi, Silvia Giuliodori, Paola Fisicaro, Ilaria Montali, Camilla Ceccatelli Berti, Valentina Reverberi, Anna Montali, Simona Urbani, Giuseppe Pedrazzi, Gabriele Missale, Amalio Telenti, Davide Corti, Simone Ottonello, Carlo Ferrari, and Carolina Boni

Subjects
Multidisciplinary
Published
2023

19. Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register

Author

Mannucci, Pier Mannuccio, Nobili, Alessandro, Pasina, Luca, Tettamanti, Mauro, Franchi, Carlotta, Corrao, Salvatore, Marengoni, Alessandra, Salerno, Francesco, Cesari, Matteo, Perticone, Francesco, Licata, Giuseppe, Violi, Francesco, Corazza, Gino Roberto, Cortesi, Laura, Ardoino, Ilaria, Prisco, Domenico, Silvestri, Elena, Cenci, Caterina, Emmi, Giacomo, Biolo, Gianni, Zanetti, Michela, Guadagni, Martina, Zaccari, Michele, Vanoli, Massimo, Grignani, Giulia, Pulixi, Edoardo Alessandro, Bernardi, Mauro, Bassi, Silvia Li, Santi, Luca, Zaccherini, Giacomo, Mannarino, Elmo, Lupattelli, Graziana, Bianconi, Vanessa, Paciullo, Francesco, Nuti, Ranuccio, Valenti, Roberto, Ruvio, Martina, Cappelli, Silvia, Palazzuoli, Alberto, Olivieri, Oliviero, Girelli, Domenico, Matteazzi, Thomas, Barbagallo, Mario, Dominguez, Ligia, Cocita, Floriana, Beneduce, Vincenza, Plances, Lidia, Zoli, Marco, Lazzari, Ilaria, Brunori, Mattia, Pasini, Franco Laghi, Capecchi, Pier Leopoldo, Palasciano, Giuseppe, Modeo, Maria Ester, Di Gennaro, Carla, Cappellini, Maria Domenica, Maira, Diletta, Di Stefano, Valeria, Fabio, Giovanna, Seghezzi, Sonia, Mancarella, Marta, Rossi, Paolo Dionigi, Damanti, Sarah, Clerici, Marta, Conti, Federica, Miceli, Emanuela, Lenti, Marco Vincenzo, Pisati, Martina, Dominioni, Costanza Caccia, Murialdo, Giovanni, Marra, Alessio, Cattaneo, Federico, Secchi, Maria Beatrice, Ghelfi, Davide, Anastasio, Luigi, Sofia, Lucia, Carbone, Maria, Cipollone, Francesco, Guagnano, Maria Teresa, Angelucci, Ermanno, Valeriani, Emanuele, Mancuso, Gerardo, Calipari, Daniela, Bartone, Mosè, Delitala, Giuseppe, Berria, Maria, Muscaritoli, Maurizio, Molfino, Alessio, Petrillo, Enrico, Zuccalà, Giuseppe, D’Aurizio, Gabriella, Romanelli, Giuseppe, Zucchelli, Alberto, Picardi, Antonio, Gentilucci, Umberto Vespasiani, Gallo, Paolo, Dell’Unto, Chiara, Annoni, Giorgio, Corsi, Maurizio, Bellelli, Giuseppe, Zazzetta, Sara, Mazzola, Paolo, Szabo, Hajnalka, Bonfanti, Alessandra, Arturi, Franco, Succurro, Elena, Rubino, Mariangela, Serra, Maria Grazia, Bleve, Maria Antonietta, Gasbarrone, Laura, Sajeva, Maria Rosaria, Brucato, Antonio, Ghidoni, Silvia, Fabris, Fabrizio, Bertozzi, Irene, Bogoni, Giulia, Rabuini, Maria Victoria, Cosi, Elisabetta, Manfredini, Roberto, Fabbian, Fabio, Boari, Benedetta, De Giorgi, Alfredo, Tiseo, Ruana, Paolisso, Giuseppe, Rizzo, Maria Rosaria, Borghi, Claudio, Strocchi, Enrico, De Sando, Valeria, Pareo, Ilenia, Sabbà, Carlo, Vella, Francesco Saverio, Suppressa, Patrizia, Agosti, Pasquale, Schilardi, Andrea, Loparco, Francesca, Fenoglio, Luigi, Bracco, Christian, Giraudo, Alessia Valentina, Fargion, Silvia, Periti, Giulia, Porzio, Marianna, Tiraboschi, Slivia, Peyvandi, Flora, Rossio, Raffaella, Ferrari, Barbara, Colombo, Giulia, Monzani, Valter, Savojardo, Valeria, Folli, Christian, Ceriani, Giuliana, Pallini, Giada, Dallegri, Franco, Ottonello, Luciano, Liberale, Luca, Caserza, Lara, Salam, Kassem, Liberato, Nicola Lucio, Tognin, Tiziana, Bianchi, Giovanni Battista, Giaquinto, Sabrina, Purrello, Francesco, Di Pino, Antonino, Piro, Salvatore, Rozzini, Renzo, Falanga, Lina, Spazzini, Elena, Ferrandina, Camillo, Montrucchio, Giuseppe, Petitti, Paolo, Salmi, Raffaella, Gaudenzi, Piergiorgio, Perri, Ludovica, Landolfi, Raffaele, Montalto, Massimo, Mirijello, Antonio, Guasti, Luigina, Castiglioni, Luana, Maresca, Andrea, Squizzato, Alessandro, Molaro, Marta, Grossi, Alessandra, Bertolotti, Marco, Mussi, Chiara, Libbra, Maria Vittoria, Dondi, Giulia, Pellegrini, Elisa, Carulli, Lucia, COLANGELO, LIDIA, Falbo, Tania, Stanghellini, Vincenzo, De Giorgio, Roberto, Ruggeri, Eugenio, del Vecchio, Sara, Salvi, Andrea, LEONARDI, ROBERTO, Damiani, Giampaolo, Gabrielli, Armando, Capeci, William, Mattioli, Massimo, Martino, Giuseppe Pio, Biondi, Lorenzo, Pettinari, Pietro, Ghio, Riccardo, Col, Anna Dal, Minisola, Salvatore, Colangelo, Luciano, Afeltra, Antonella, Marigliano, Benedetta, Pipita, Maria Elena, Castellino, Pietro, Blanco, Julien, Zanoli, Luca, Pignataro, Samuele, Saracco, Valter, Fogliati, Marisa, Bussolino, Carlo, Mete, Francesca, Gino, Miriam, Cittadini, Antonio, Vigorito, Carlo, Arcopinto, Michele, Salzano, Andrea, Bobbio, Emanuele, Marra, Alberto Maria, Sirico, Domenico, Moreo, Guido, Gasparini, Francesca, Prolo, Silvia, Pina, Gloria, Ballestrero, Alberto, Ferrando, Fabio, Berra, Sergio, Dassi, Simonetta, Nava, Maria Cristina, Graziella, Bruno, Baldassarre, Stefano, Fragapani, Salvatore, Gruden, Gabriella, Galanti, Giorgio, Mascherini, Gabriele, Petri, Cristian, Stefani, Laura, Girino, Margherita, Piccinelli, Valeria, Nasso, Francesco, Gioffrè, Vincenza, DI PASQUALE, MARIA GRAZIA, Scattolin, Giuseppe, Martinelli, Sergio, Turrin, Mauro, Sechi, Leonardo, Catena, Cristina, Colussi, Gianluca, Passariello, Nicola, Rinaldi, Luca, Berti, Franco, Famularo, Giuseppe, Patrizia, Tarsitani, Castello, Roberto, Pasino, Michela, Ceda, Gian Paolo, Maggio, Marcello Giuseppe, Morganti, Simonetta, Artoni, Andrea, Del Giacco, Stefano, Firinu, Davide, Losa, Francesca, Paoletti, Giovanni, Montalto, Giuseppe, Licata, Anna, Malerba, Valentina, Antonino, Lasco, Basile, Giorgio, Antonino, Catalano, Malatino, Lorenzo, Stancanelli, Benedetta, Terranova, Valentina, Di Marca, Salvatore, Mecocci, Patrizia, Ruggiero, Carmelinda, Boccardi, Virginia, Meschi, Tiziana, Lauretani, Fulvio, Ticinesi, Andrea, Minuz, Pietro, Fondrieschi, Luigi, Pirisi, Mario, Fra, Gian Paolo, Sola, Daniele, Porta, Massimo, Riva, Piero, Quadri, Roberto, Scanzi, Giorgio, Mengoli, Caterina, Provini, Stella, Ricevuti, Laura, Simeone, Emilio, Scurti, Rosa, Tolloso, Fabio, Tarquini, Roberto, Valoriani, Alice, Dolenti, Silvia, Vannini, Giulia, Tedeschi, Alberto, Trotta, Lucia, Volpi, Riccardo, Bocchi, Pietro, Vignali, Alessandro, Harari, Sergio, Lonati, Chiara, Cattaneo, Mara, Nieves, Ramirez Duque, Alberto, Muela Molinero, Pedro, Abad Requejo, Vanessa, Lopez Pelaez, Lara, Tamargo, Xavier, Corbella Viros, Francesc, Formiga, Jesus, Diez Manglano, Esperanza, Bejarano Tello, Esther, Del Corral Behamonte, Maria, Sevil Puras, Romero, Manuel, Blanca, Pinilla Llorente, Cristina, Lopez Gonzalez-Cobos, Victoria, Villalba Garcia M., Saez, Lopez, Bosco, Juan, Susana, Sanz Baena, Marta, Arroyo Gallego, Concepcion, Gonzalez Becerra, Antonio, Fernandez Moyano, Hernandez, Mercedes Gomez, Borrego, Manuel Poyato, Raquel, Pacheco Cuadros, Florencia, Perez Rojas, Beatriz, Garcia Olid, Sara, Carrascosa Garcia, Alfonso, Gonzalez-Cruz Cervellera, Marta, Peinado Martinez, Garcia, Sara Carrascosa, Alberto, Ruiz Cantero, Antonio, Albarracín Arraigosa, Montserrat, Godoy Guerrero, Ángel, Barón Ramos Miguel, Manuel, Machin Jose, Ignacio, Novo Veleiro, Lucía, Alvela Suarez, Alfonso, Lopez, David, Rubal Bran, Iria, Iñiguez Vazquez, Monica, Rios Prego, Mannucci, Pier Mannuccio, Nobili, Alessandro, Pasina, Luca, Tettamanti, Mauro, Franchi, Carlotta, Corrao, Salvatore, Marengoni, Alessandra, Salerno, Francesco, Cesari, Matteo, Perticone, Francesco, Licata, Giuseppe, Violi, Francesco, Corazza, Gino Roberto, Cortesi, Laura, Ardoino, Ilaria, Prisco, Domenico, Silvestri, Elena, Cenci, Caterina, Emmi, Giacomo, Biolo, Gianni, Zanetti, Michela, Guadagni, Martina, Zaccari, Michele, Vanoli, Massimo, Grignani, Giulia, Pulixi, Edoardo Alessandro, Bernardi, Mauro, Bassi, Silvia Li, Santi, Luca, Zaccherini, Giacomo, Mannarino, Elmo, Lupattelli, Graziana, Bianconi, Vanessa, Paciullo, Francesco, Nuti, Ranuccio, Valenti, Roberto, Ruvio, Martina, Cappelli, Silvia, Palazzuoli, Alberto, Olivieri, Oliviero, Girelli, Domenico, Matteazzi, Thoma, Barbagallo, Mario, Dominguez, Ligia, Cocita, Floriana, Beneduce, Vincenza, Plances, Lidia, Zoli, Marco, Lazzari, Ilaria, Brunori, Mattia, Pasini, Franco Laghi, Capecchi, Pier Leopoldo, Palasciano, Giuseppe, Modeo, Maria Ester, Di Gennaro, Carla, Cappellini, Maria Domenica, Maira, Diletta, Di Stefano, Valeria, Fabio, Giovanna, Seghezzi, Sonia, Mancarella, Marta, Rossi, Paolo Dionigi, Damanti, Sarah, Clerici, Marta, Conti, Federica, Miceli, Emanuela, Lenti, Marco Vincenzo, Pisati, Martina, Dominioni, Costanza Caccia, Murialdo, Giovanni, Marra, Alessio, Cattaneo, Federico, Secchi, Maria Beatrice, Ghelfi, Davide, Anastasio, Luigi, Sofia, Lucia, Carbone, Maria, Cipollone, Francesco, Guagnano, Maria Teresa, Angelucci, Ermanno, Valeriani, Emanuele, Mancuso, Gerardo, Calipari, Daniela, Bartone, Mosè, Delitala, Giuseppe, Berria, Maria, Muscaritoli, Maurizio, Molfino, Alessio, Petrillo, Enrico, Zuccalà, Giuseppe, D’Aurizio, Gabriella, Romanelli, Giuseppe, Zucchelli, Alberto, Picardi, Antonio, Gentilucci, Umberto Vespasiani, Gallo, Paolo, Dell’Unto, Chiara, Annoni, Giorgio, Corsi, Maurizio, Bellelli, Giuseppe, Zazzetta, Sara, Mazzola, Paolo, Szabo, Hajnalka, Bonfanti, Alessandra, Arturi, Franco, Succurro, Elena, Rubino, Mariangela, Serra, Maria Grazia, Bleve, Maria Antonietta, Gasbarrone, Laura, Sajeva, Maria Rosaria, Brucato, Antonio, Ghidoni, Silvia, Fabris, Fabrizio, Bertozzi, Irene, Bogoni, Giulia, Rabuini, Maria Victoria, Cosi, Elisabetta, Manfredini, Roberto, Fabbian, Fabio, Boari, Benedetta, De Giorgi, Alfredo, Tiseo, Ruana, Paolisso, Giuseppe, Rizzo, Maria Rosaria, Borghi, Claudio, Strocchi, Enrico, De Sando, Valeria, Pareo, Ilenia, Sabbà, Carlo, Vella, Francesco Saverio, Suppressa, Patrizia, Agosti, Pasquale, Schilardi, Andrea, Loparco, Francesca, Fenoglio, Luigi, Bracco, Christian, Giraudo, Alessia Valentina, Fargion, Silvia, Periti, Giulia, Porzio, Marianna, Tiraboschi, Slivia, Peyvandi, Flora, Rossio, Raffaella, Ferrari, Barbara, Colombo, Giulia, Monzani, Valter, Savojardo, Valeria, Folli, Christian, Ceriani, Giuliana, Pallini, Giada, Dallegri, Franco, Ottonello, Luciano, Liberale, Luca, Caserza, Lara, Salam, Kassem, Liberato, Nicola Lucio, Tognin, Tiziana, Bianchi, Giovanni Battista, Giaquinto, Sabrina, Purrello, Francesco, Di Pino, Antonino, Piro, Salvatore, Rozzini, Renzo, Falanga, Lina, Spazzini, Elena, Ferrandina, Camillo, Montrucchio, Giuseppe, Petitti, Paolo, Salmi, Raffaella, Gaudenzi, Piergiorgio, Perri, Ludovica, Landolfi, Raffaele, Montalto, Massimo, Mirijello, Antonio, Guasti, Luigina, Castiglioni, Luana, Maresca, Andrea, Squizzato, Alessandro, Molaro, Marta, Grossi, Alessandra, Bertolotti, Marco, Mussi, Chiara, Libbra, Maria Vittoria, Dondi, Giulia, Pellegrini, Elisa, Carulli, Lucia, Colangelo, Lidia, Falbo, Tania, Stanghellini, Vincenzo, De Giorgio, Roberto, Ruggeri, Eugenio, del Vecchio, Sara, Salvi, Andrea, Leonardi, Roberto, Damiani, Giampaolo, Gabrielli, Armando, Capeci, William, Mattioli, Massimo, Martino, Giuseppe Pio, Biondi, Lorenzo, Pettinari, Pietro, Ghio, Riccardo, Col, Anna Dal, Minisola, Salvatore, Colangelo, Luciano, Afeltra, Antonella, Marigliano, Benedetta, Pipita, Maria Elena, Castellino, Pietro, Blanco, Julien, Zanoli, Luca, Pignataro, Samuele, Saracco, Valter, Fogliati, Marisa, Bussolino, Carlo, Mete, Francesca, Gino, Miriam, Cittadini, Antonio, Vigorito, Carlo, Arcopinto, Michele, Salzano, Andrea, Bobbio, Emanuele, Marra, Alberto Maria, Sirico, Domenico, Moreo, Guido, Gasparini, Francesca, Prolo, Silvia, Pina, Gloria, Ballestrero, Alberto, Ferrando, Fabio, Berra, Sergio, Dassi, Simonetta, Nava, Maria Cristina, Graziella, Bruno, Baldassarre, Stefano, Fragapani, Salvatore, Gruden, Gabriella, Galanti, Giorgio, Mascherini, Gabriele, Petri, Cristian, Stefani, Laura, Girino, Margherita, Piccinelli, Valeria, Nasso, Francesco, Gioffrè, Vincenza, Pasquale, Maria, Scattolin, Giuseppe, Martinelli, Sergio, Turrin, Mauro, Sechi, Leonardo, Catena, Cristina, Colussi, Gianluca, Passariello, Nicola, Rinaldi, Luca, Berti, Franco, Famularo, Giuseppe, Patrizia, Tarsitani, Castello, Roberto, Pasino, Michela, Ceda, Gian Paolo, Maggio, Marcello Giuseppe, Morganti, Simonetta, Artoni, Andrea, Del Giacco, Stefano, Firinu, Davide, Losa, Francesca, Paoletti, Giovanni, Montalto, Giuseppe, Licata, Anna, Malerba, Valentina, Antonino, Lasco, Basile, Giorgio, Antonino, Catalano, Malatino, Lorenzo, Stancanelli, Benedetta, Terranova, Valentina, Di Marca, Salvatore, Mecocci, Patrizia, Ruggiero, Carmelinda, Boccardi, Virginia, Meschi, Tiziana, Lauretani, Fulvio, Ticinesi, Andrea, Minuz, Pietro, Fondrieschi, Luigi, Pirisi, Mario, Fra, Gian Paolo, Sola, Daniele, Porta, Massimo, Riva, Piero, Quadri, Roberto, Scanzi, Giorgio, Mengoli, Caterina, Provini, Stella, Ricevuti, Laura, Simeone, Emilio, Scurti, Rosa, Tolloso, Fabio, Tarquini, Roberto, Valoriani, Alice, Dolenti, Silvia, Vannini, Giulia, Tedeschi, Alberto, Trotta, Lucia, Volpi, Riccardo, Bocchi, Pietro, Vignali, Alessandro, Harari, Sergio, Lonati, Chiara, Cattaneo, Mara, Nieves, Ramirez Duque, Alberto, Muela Molinero, Pedro, Abad Requejo, Vanessa, Lopez Pelaez, Lara, Tamargo, Xavier, Corbella Viro, Francesc, Formiga, Jesus, Diez Manglano, Esperanza, Bejarano Tello, Esther, Del Corral Behamonte, Maria, Sevil Pura, Romero, Manuel, Blanca, Pinilla Llorente, Cristina, Lopez Gonzalez-Cobo, Victoria, Villalba Garcia M., Saez, Lopez, Bosco, Juan, Susana, Sanz Baena, Marta, Arroyo Gallego, Concepcion, Gonzalez Becerra, Antonio, Fernandez Moyano, Hernandez, Mercedes Gomez, Borrego, Manuel Poyato, Raquel, Pacheco Cuadro, Florencia, Perez Roja, Beatriz, Garcia Olid, Sara, Carrascosa Garcia, Alfonso, Gonzalez-Cruz Cervellera, Marta, Peinado Martinez, Garcia, Sara Carrascosa, Alberto, Ruiz Cantero, Antonio, Albarracín Arraigosa, Montserrat, Godoy Guerrero, Ángel, Barón Ramos Miguel, Manuel, Machin Jose, Ignacio, Novo Veleiro, Lucía, Alvela Suarez, Alfonso, Lopez, David, Rubal Bran, Iria, Iñiguez Vazquez, Monica, Rios Prego, Pier Mannuccio Mannucci, Alessandro Nobili, Luca Pasina, REPOSI Collaborators [.., Gino Roberto Corazza, Elena Silvestri, Mauro Bernardi, Silvia Li Bassi, Luca Santi, Giacomo Zaccherini, Marco Zoli, Ilaria Lazzari, Mattia Brunori, Claudio Borghi, Enrico Strocchi, Valeria De Sando, Ilenia Pareo, Vincenzo Stanghellini, Roberto De Giorgio, Eugenio Ruggeri, Sara del Vecchio, ], Mannucci, P, Nobili, A, Pasina, L, Dominguez Rodriguez, L, Barbagallo, M, Licata, A, Tettamanti, M, Franchi, C, Corrao, S, Marengoni, A, Salerno, F, Cesari, M, Perticone, F, Licata, G, Violi, F, Corazza, G, Cortesi, L, Ardoino, I, Prisco, D, Silvestri, E, Cenci, C, Emmi, G, Biolo, G, Zanetti, M, Guadagni, M, Zaccari, M, Vanoli, M, Grignani, G, Pulixi, E, Bernardi, M, Bassi, S, Santi, L, Zaccherini, G, Mannarino, E, Lupattelli, G, Bianconi, V, Paciullo, F, Nuti, R, Valenti, R, Ruvio, M, Cappelli, S, Palazzuoli, A, Olivieri, O, Girelli, D, Matteazzi, T, Dominguez, L, Cocita, F, Beneduce, V, Plances, L, Zoli, M, Lazzari, I, Brunori, M, Pasini, F, Capecchi, P, Palasciano, G, Modeo, M, di Gennaro, C, Cappellini, M, Maira, D, di Stefano, V, Fabio, G, Seghezzi, S, Mancarella, M, Rossi, P, Damanti, S, Clerici, M, Conti, F, Miceli, E, Lenti, M, Pisati, M, Dominioni, C, Murialdo, G, Marra, A, Cattaneo, F, Secchi, M, Ghelfi, D, Anastasio, L, Sofia, L, Carbone, M, Cipollone, F, Guagnano, M, Angelucci, E, Valeriani, E, Mancuso, G, Calipari, D, Bartone, M, Delitala, G, Berria, M, Muscaritoli, M, Molfino, A, Petrillo, E, Zuccala, G, D'Aurizio, G, Romanelli, G, Zucchelli, A, Picardi, A, Gentilucci, U, 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, Serra, M, Bleve, M, Gasbarrone, L, Sajeva, M, Brucato, A, Ghidoni, S, Fabris, F, Bertozzi, I, Bogoni, G, Rabuini, M, Cosi, E, Manfredini, R, Fabbian, F, Boari, B, de Giorgi, A, Tiseo, R, Paolisso, G, Rizzo, M, Borghi, C, Strocchi, E, de Sando, V, Pareo, I, Sabba, C, Vella, F, Suppressa, P, Agosti, P, Schilardi, A, Loparco, F, Fenoglio, L, Bracco, C, Giraudo, A, Fargion, S, Periti, G, Porzio, M, Tiraboschi, S, Peyvandi, F, Rossio, R, Ferrari, B, Colombo, G, Monzani, V, Savojardo, V, Folli, C, Ceriani, G, Pallini, G, Dallegri, F, Ottonello, L, Liberale, L, Caserza, L, Salam, K, Liberato, N, Tognin, T, Bianchi, G, Giaquinto, S, Purrello, F, di Pino, A, Piro, S, Rozzini, R, Falanga, L, Spazzini, E, Ferrandina, C, Montrucchio, G, Petitti, P, Salmi, R, Gaudenzi, P, Perri, L, Landolfi, R, Montalto, M, Mirijello, A, Guasti, L, Castiglioni, L, Maresca, A, Squizzato, A, Molaro, M, Grossi, A, Bertolotti, M, Mussi, C, Libbra, M, Dondi, G, Pellegrini, E, Carulli, L, Colangelo, L, Falbo, T, Stanghellini, V, De Giorgio, R, Ruggeri, E, del Vecchio, S, Salvi, A, Leonardi, R, Damiani, G, Gabrielli, A, Capeci, W, Mattioli, M, Martino, G, Biondi, L, Pettinari, P, Ghio, R, Col, A, Minisola, S, Afeltra, A, Marigliano, B, Pipita, M, Castellino, P, Blanco, J, Zanoli, L, Pignataro, S, Saracco, V, Fogliati, M, Bussolino, C, Mete, F, Gino, M, Cittadini, A, Vigorito, C, Arcopinto, M, Salzano, A, Bobbio, E, Sirico, D, Moreo, G, Gasparini, F, Prolo, S, Pina, G, Ballestrero, A, Ferrando, F, Berra, S, Dassi, S, Nava, M, Graziella, B, Baldassarre, S, Fragapani, S, Gruden, G, Galanti, G, Mascherini, G, Petri, C, Stefani, L, Girino, M, Piccinelli, V, Nasso, F, Gioffre, V, Pasquale, M, Scattolin, G, Martinelli, S, Turrin, M, Sechi, L, Catena, C, Colussi, G, Passariello, N, Rinaldi, L, Berti, F, Famularo, G, Patrizia, T, Castello, R, Pasino, M, Ceda, G, Maggio, M, Morganti, S, Artoni, A, Giacco, S, Firinu, D, Losa, F, Paoletti, G, Montalto, G, Malerba, V, Antonino, L, Basile, G, Antonino, C, Malatino, L, Stancanelli, B, Terranova, V, di Marca, S, Mecocci, P, Ruggiero, C, Boccardi, V, Meschi, T, Lauretani, F, Ticinesi, A, Minuz, P, Fondrieschi, L, Pirisi, M, Fra, G, Sola, D, Porta, M, Riva, P, Quadri, R, 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, Nieves, R, Alberto, M, Pedro, A, Vanessa, L, Lara, T, Xavier, C, Francesc, F, Jesus, D, Esperanza, B, Esther, D, Maria, S, Romero, M, Blanca, P, Cristina, L, Victoria, V, Saez, L, Bosco, J, Susana, S, Marta, A, Concepcion, G, Antonio, F, Hernandez, M, Borrego, M, Raquel, P, Florencia, P, Beatriz, G, Sara, C, Alfonso, G, Marta, P, Garcia, S, Alberto, R, Antonio, A, Montserrat, G, Angel, B, Manuel, M, Ignacio, N, Lucia, A, Alfonso, L, David, R, Iria, I, Monica, R, DI PASQUALE, MARIA GRAZIA, di Gennaro, Carla, di Stefano, Valeria, de Giorgi, Alfredo, de Sando, Valeria, di Pino, Antonino, Giacco, Stefano Del, and di Marca, Salvatore

Subjects
Male, medicine.medical_specialty, Population ageing, Deprescribing, Inappropriate prescription, Medication reconciliation, Multimorbidity, Polypharmacy, Population, Socio-culturale, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 80 and over, Internal Medicine, Emergency Medicine, medicine, Deprescribing, Inappropriate prescription, Medication reconciliation, Multimorbidity, Polypharmacy, Humans, Registries, 030212 general & internal medicine, Medical prescription, Adverse effect, education, Aged, Aged, 80 and over, Geriatrics, education.field_of_study, business.industry, Patient Discharge, Hospitalization, Female, Italy, Family medicine, business
Abstract

As a consequence of population aging, we have witnessed in internal medicine hospital wards a progressive shift from a population of in-patients relatively young and mainly affected by a single ailment to one of ever older and more and more complex patients with multiple chronic diseases, followed as out-patients by many different specialists with poor integration andinevitably treated with multiple medications. Polypharmacy (defined as the chronic intake of five or more drugs) is associated with increased risks of drug-drug interactions and related adverse effects, prescription and intake errors, poor compliance, re-hospitalization and mortality. With this background, the Italian Society of Internal Medicine chose to start in 2008 a prospective register called REPOSI (REgistro POliterapie SIMI, Società Italiana di Medicina Interna) in internal medicine and geriatric hospital wards. The country wide register is an ongoing observatory on multimorbidity and polypharmacy in the oldest old, with the goal to improve prescription appropriateness and, thus to avoid potentially inappropriate medications. The main findings of the register, that has accrued so far, 7005 older patients throughout a 10year period, are summarized herewith, with special emphasis on the main patterns of poor prescription appropriateness and related risks of adverse events.

Published
2018

20. Point-of-Care Chest Ultrasonography as a Diagnostic Resource for COVID-19 Outbreak in Nursing Homes

Author

Annalisa Volpi, Marcello Esposito, Elena Bignami, Andrea Ticinesi, Ettore Brianti, Antonio Nouvenne, Tiziana Meschi, Sandra Rossi, Massimo Fabi, Valentina Cocchi, Alberto Parise, Marco Baciarello, Beatrice Prati, and Emanuele Crisafulli

Subjects
Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Referral, Point-of-Care Systems, Pneumonia, Viral, coronavirus, viral pneumonia, Severe Acute Respiratory Syndrome, Article, Disease Outbreaks, 03 medical and health sciences, 0302 clinical medicine, Outcome Assessment, Health Care, Humans, Medicine, 030212 general & internal medicine, Pandemics, General Nursing, lung ultrasound, Aged, Point of care, interstitial pneumonia, Aged, 80 and over, business.industry, Health Policy, COVID-19, Outbreak, Ultrasonography, Doppler, General Medicine, medicine.disease, Nursing Homes, Long-term care, Pneumonia, Italy, Viral pneumonia, Chest ultrasonography, Emergency medicine, long-term care, Feasibility Studies, Female, Geriatrics and Gerontology, Coronavirus Infections, business, 030217 neurology & neurosurgery
Abstract

Objective Bedside chest ultrasound, when integrated with clinical data, is an accurate tool improving the diagnostic process of many respiratory diseases. This study aims to evaluate the feasibility of a chest ultrasound screening program in nursing homes for detecting coronavirus disease-19 (COVID-19)-related pneumonia and improving the appropriateness of hospital referral of residents. Design Pragmatic, descriptive, feasibility study from April 2nd to April 9th, 2020. Setting and participants: A total of 83 older residents (age 85±8) presenting mild to moderate respiratory symptoms and not previously tested for COVID-19, residing in five nursing homes in Northern Italy. Methods Chest ultrasound was performed at the bedside by a team of hospital specialists with certified expertise in thoracic ultrasonography, following a systematic approach exploring four different areas for each hemithorax, from the anterior and posterior side. Presence of ultrasonographic signs of interstitial pneumonia, including comet-tail artifacts (B-lines) with focal or diffuse distribution, subpleural consolidations and pleural line indentation was detected. The specialist team integrated ultrasound data with clinical and anamnestic information, and gave personalized therapeutic advice for each patient, including hospital referral when needed. Results The most frequent reasons for ultrasound evaluation were fever (63% of participants) and mild dyspnea (40%). Fifty-six patients (67%) had abnormal ultrasound findings. The most common patterns were presence of multiple subpleural consolidations (32 patients) and diffuse B-lines (24 patients), with bilateral involvement. A diagnosis of suspect COVID-19 pneumonia was made in 44 patients, and six of them required hospitalization. Twelve patients had ultrasound patterns suggesting other respiratory diseases, and two patients with normal ultrasound findings were diagnosed with COPD exacerbation. Conclusions and implications In nursing home residents, screening of COVID-19 pneumonia with bedside chest ultrasonography is feasible and may represent a valid diagnostic aid for an early detection of COVID-19 outbreaks and adequate patient management., This study shows the possible use of bedside chest ultrasonography as a screening tool for COVID-19 pneumonia in nursing home residents, for early detection of outbreaks and adequate management.

Published
2020

21. Chest ultrasound in Italian geriatric wards: use, applications and clinicians’ attitudes

Author

Simone Scarlata, Raffaele Antonelli Incalzi, Antonio Nouvenne, Andrea Ungar, Andrea Ticinesi, and Fulvio Lauretani

Subjects
Geriatrics, Chest ultrasound, Aging, medicine.medical_specialty, business.industry, Ultrasound, Clinical settings, medicine.disease, Patient care, Heart failure, Emergency medicine, medicine, In patient, Geriatrics and Gerontology, Acute dyspnea, business
Abstract

On behalf of the GRETA (Gruppo di Ricerca sull’Ecografia Toracica nell’Anziano) , Group of the Italian Society of Gerontology and Geriatrics (SIGG) Background and aims. Bedside chest ultrasound has emerged as a versatile and accurate diagnostic tool for the management of respiratory conditions in several clinical settings, integrating traditional imaging. The current utilization of this technique in geriatric hospital wards is still unknown. Our aim was to assess availability, uses and applications of chest ultrasonography in a convenience sample of 25 Italian geriatric wards. Methods. A questionnaire, based on the current literature state-of-theart, was e-mailed to head doctors of geriatric wards of Italian hospitals. The questionnaire explored ultrasound equipment availability, practice of chest ultrasound, expertise of ward physicians, clinical indications, and perceived impact on patient care. Results. Ultrasound equipment was available in 92% of wards, and chest ultrasound was performed in 82% of cases. Among the wards where chest ultrasound was performed, it was considered as routine assessment in only 52% of cases, mainly for diagnosis of pleural effusions (95%) and acute heart failure (89%), assessment of volemic state (79%), and assistance to invasive procedures (79%). It was used in emergency/ urgency assessment of acute dyspnea in only 53% of cases. In most wards, only three or less physicians were able to perform chest ultrasound. In 53% of cases, head doctors declared that they perceived benefits of chest ultrasound in patient care in only selected cases. Conclusions. Chest ultrasound utilization in Italian geriatric wards is inhomogeneous, and the number of trained physicians is still limited. Geriatricians’ attitude towards chest ultrasound is generally cautious. Research and training programs are needed to spread the correct use of this technique in geriatric practice.

Published
2020

22. Exercise-microbiota interactions in aging-related sarcopenia

Author

Johannes Burtscher, Andrea Ticinesi, Gregoire P. Millet, Martin Burtscher, and Barbara Strasser

Subjects
Aging, Sarcopenia, Physiology (medical), Microbiota, Humans, Orthopedics and Sports Medicine, Muscle, Skeletal, Exercise, Muscle, Skeletal/pathology, Sarcopenia/etiology, Sarcopenia/pathology
Published
2022

23. Disentangling the Complexity of Nutrition, Frailty and Gut Microbial Pathways during Aging: A Focus on Hippuric Acid

Author

Andrea Ticinesi, Angela Guerra, Antonio Nouvenne, Tiziana Meschi, and Stefania Maggi

Subjects
Nutrition and Dietetics, Food Science
Abstract

Hippuric acid (HA) is a metabolite resulting from the hepatic glycine conjugation of benzoic acid (BA) or from the gut bacterial metabolism of phenylalanine. BA is generally produced by gut microbial metabolic pathways after the ingestion of foods of vegetal origin rich in polyphenolic compounds, namely, chlorogenic acids or epicatechins. It can also be present in foods, either naturally or artificially added as a preservative. The plasma and urine HA levels have been used in nutritional research for estimating the habitual fruit and vegetable intake, especially in children and in patients with metabolic diseases. HA has also been proposed as a biomarker of aging, since its levels in the plasma and urine can be influenced by the presence of several age-related conditions, including frailty, sarcopenia and cognitive impairment. Subjects with physical frailty generally exhibit reduced plasma and urine levels of HA, despite the fact that HA excretion tends to increase with aging. Conversely, subjects with chronic kidney disease exhibit reduced HA clearance, with HA retention that may exert toxic effects on the circulation, brain and kidneys. With regard to older patients with frailty and multimorbidity, interpreting the HA levels in the plasma and urine may result particularly challenging because HA is at the crossroads between diet, gut microbiota, liver and kidney function. Although these considerations may not make HA the ideal biomarker of aging trajectories, the study of its metabolism and clearance in older subjects may provide valuable information for disentangling the complex interaction between diet, gut microbiota, frailty and multimorbidity.

Published
2023

24. The possible role of gut microbiota dysbiosis in the pathophysiology of delirium in older persons

Author

Andrea Ticinesi, Alberto Parise, Antonio Nouvenne, Nicoletta Cerundolo, Beatrice Prati, and Tiziana Meschi

Abstract

Delirium is a clinical syndrome characterized by an acute change in attention, awareness and cognition with fluctuating course, frequently observed in older patients during hospitalization for acute medical illness or after surgery. Its pathogenesis is multifactorial and still not completely understood, but there is general consensus on the fact that it results from the interaction between an underlying predisposition, such as neurodegenerative diseases, and an acute stressor acting as a trigger, such as infection or anesthesia. Alterations in brain insulin sensitivity and metabolic function, increased blood-brain barrier permeability, neurotransmitter imbalances, abnormal microglial activation and neuroinflammation have all been involved in the pathophysiology of delirium. Interestingly, all these mechanisms can be regulated by the gut microbiota, as demonstrated in experimental studies investigating the microbiota-gut-brain axis in dementia. Aging is also associated with profound changes in gut microbiota composition and functions, which can influence several aspects of disease pathophysiology in the host. This review provides an overview of the emerging evidence linking age-related gut microbiota dysbiosis with delirium, opening new perspectives for the microbiota as a possible target of interventions aimed at delirium prevention and treatment.

Published
2023

25. Antibiotic use and associated factors in a large sample of hospitalised older people

Author

Ardoino, I, Mannucci, Pm, Nobili, A, Franchi, C, Tettamanti, M, Pasina, L, Corrao, S, Marengoni, A, Salerno, F, Cesari, M, Perticone, F, Licata, G, Violi, F, Corazza, Gr, Prisco, D, Silvestri, E, Emmi, G, Bettiol, A, Caterina, C, Biolo, G, Zanetti, M, Guadagni, M, Zaccari, M, Chiuch, 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, Natoli, G, Mularo, S, Raspanti, M, Cavallaro, F, Zoli, M, Lazzari, I, Brunori, M, Fabbri, E, Magalotti, D, Arn?, R, Pasini, Fl, Capecchi, Pl, Palasciano, G, Modeo, Me, Di Gennaro, C, Cappellini, Md, Maira, D, Di Stefano, V, Fabio, G, Seghezzi, S, Mancarella, M, De Amicis, Mm, De Luca, G, Scaramellini, N, 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, Zuccal?, G, D'Aurizio, G, Romanelli, G, 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, 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, De Giorgi, A, Tiseo, R, De Giorgio, R, Paolisso, G, Rizzo, Mr, Borghi, C, Strocchi, E, Ianniello, E, Soldati, M, Sabb?, C, Vella, Fs, Suppressa, P, Agosti, 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, Monzani, V, Savojardo, V, Folli, C, Ceriani, G, 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, 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, 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, Dal Col, A, 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, Gioffr?, 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, Nieves, Rd, Alberto, Mm, Pedro, Ar, Vanessa, Lp, Lara, T, Xavier, Cv, Francesc, F, Jesus, Dm, Esperanza, Bt, Esther, Dcb, Maria, Sp, Romero, M, Blanca, Pl, Cristina, Lgc, Victoria, Vgm, Saez, L, Bosco, J, Susana, Sb, Marta, Ag, Concepcion, Gb, Antonio, Fm, Hernandez, Mg, Borrego, Mp, Raquel, Pc, Florencia, Pr, Beatriz, Go, Sara, Cg, Alfonso, Gcc, Marta, Pm, Alberto, Rc, Antonio, Aa, Montserrat, Gg, Angel, Brm, Manuel, Mj, Ignacio, Nv, Lucia, As, Alfonso, L, David, Rb, Iniguez, Vi, Monica, Rp, Ardoino I., Mannucci P.M., Nobili A., Franchi C., Tettamanti M., Pasina L., Corrao S., Marengoni A., Salerno F., Cesari M., Perticone F., Licata G., Violi F., Corazza G.R., Ardoino, I, Mannucci, P M, Nobili, A, Franchi, C, and Rinaldi, Luca

Subjects
Registrie, Male, 0301 basic medicine, Antibiotics, Logistic regression, 0302 clinical medicine, Drug Prescription, 80 and over, Prevalence, Immunology and Allergy, LS4_4, Hospital Mortality, Registries, 030212 general & internal medicine, Multivariate Analysi, Respiratory Tract Infections, Aged, 80 and over, Anti-Bacterial Agents, Hospitalization, Italy, Antibiotic use, Female, Human, Microbiology (medical), medicine.medical_specialty, Logistic Model, Internal medicine ward, medicine.drug_class, 030106 microbiology, Immunology, Socio-culturale, Drug Prescriptions, Microbiology, Odds, 03 medical and health sciences, Antibiotic resistance, Anti-Bacterial Agent, medicine, Older people, Aged, Geriatric Assessment, Humans, Logistic Models, Multivariate Analysis, Medical prescription, business.industry, Confidence interval, Antibiotic use, Internal medicine ward, Older people, Emergency medicine, business
Abstract

Objectives: The aims of this study were to assess (i) the prevalence of antibiotic use, (ii) factors associated with their use and (iii) the association with in-hospital mortality in a large sample of hospitalised older people in Italy.Methods: Data were obtained from the 2010-2017 REPOSI register held in more than 100 internal medicine and geriatric wards in Italy. Patients aged >= 65 years with at least one antibiotic prescription during their hospitalisation were selected. Multivariable logistic regression models were used to determine factors associated with antibiotic use.Results: A total of 5442 older patients were included in the analysis, of whom 2786 (51.2%) were prescribed antibiotics during their hospitalisation. The most frequently prescribed antibiotic class was beta-lactams, accounting for 50% of the total prescriptions. Poor physical independence, corticosteroid use and being hospitalised in Northern Italy were factors associated with a higher likelihood of being prescribed antibiotics. Antibiotic use was associated with an increased risk of in-hospital mortality (odds ratio = 2.52, 95% confidence interval 1.82-3.48) also when accounting for factors associated with their use.Conclusion: Hospitalised older people are often prescribed antibiotics. Factors related to poor physical independence and corticosteroid use are associated with increased antibiotic use. Being prescribed antibiotics is also associated with an increased risk of in-hospital death. These results demand the implementation of specific stewardship programmes to improve the correct use of antibiotics in hospital settings and to reduce the risk of antimicrobial resistance. (C) 2019 International Society for Antimicrobial Chemotherapy. Published by Elsevier Ltd. All rights reserved.

Published
2019

26. Defining SARS-CoV-2 breakthrough infection needing hospitalization in mass vaccination era: from disease-centered to patient-centered care

Author

Andrea, Ticinesi, Antonio, Nouvenne, Alberto, Parise, Beatrice, Prati, and Tiziana, Meschi

Subjects
Hospitalization, COVID-19 Vaccines, SARS-CoV-2, Patient-Centered Care, Vaccination, COVID-19, Humans, Mass Vaccination
Abstract

After the implementation of mass vaccination campaigns, breakthrough infections by SARS-CoV-2 are being increasingly observed worldwide, due to high pervasiveness of viral spread, emergence of novel variants, progressive ease of restrictive measures and waning protection against infection. Although breakthrough infections have generally lower clinical severity than COVID-19 in unvaccinated subjects, a consistent number of patients may still require hospitalization. These patients are generally old, frail and with a high number of comorbidities. Despite COVID-19-related symptoms are generally milder, they may still exhibit complicated clinical course for their intrinsic clinical complexity. The organization of hospital care should thus consider the changing epidemiology of patients admitted with SARS-CoV-2 infection in the post-vaccine era, to improve the quality and appropriateness of care.

Published
2021

27. Accounting for frailty and multimorbidity when interpreting high-sensitivity troponin I tests in oldest old

Author

Antonio Nouvenne, Andrea Ticinesi, Claudio Tana, Tiziana Meschi, Beatrice Prati, Martina Rendo, Angela Guerra, Alberto Parise, and Nicoletta Cerundolo

Subjects
Male, Acute coronary syndrome, Longitudinal study, medicine.medical_specialty, Time Factors, Myocardial Infarction, Risk Assessment, Geriatric cardiology, Rating scale, Internal medicine, Troponin I, medicine, Humans, Myocardial infarction, Longitudinal Studies, Aged, 80 and over, Frailty, business.industry, Multimorbidity, Stepwise regression, musculoskeletal system, medicine.disease, Comorbidity, Hospitalization, cardiovascular system, Female, Geriatrics and Gerontology, business, Biomarkers
Abstract

BACKGROUND Older patients evaluated in Emergency Departments (ED) for suspect Myocardial Infarction (MI) frequently exhibit unspecific elevations of serum high-sensitivity troponin I (hs-TnI), making interpretation particularly challenging for emergency physicians. The aim of this longitudinal study was to identify the interaction of multimorbidity and frailty with hs-TnI levels in older patients seeking emergency care. METHODS A group of patients aged≥75 with suspected MI was enrolled in our acute geriatric ward immediately after ED visit. Multimorbidity and frailty were measured with Cumulative Illness Rating Scale (CIRS) and Clinical Frailty Scale (CFS), respectively. The association of hs-TnI with MI (main endpoint) was assessed by calculation of the Area Under the Receiver-Operating Characteristic Curve (AUROC), deriving population-specific cut-offs with Youden test. The factors associated with hs-TnI categories, including MI, CFS and CIRS, were determined with stepwise multinomial logistic regression. The association of hs-TnI with 3-month mortality (secondary endpoint) was also investigated with stepwise logistic regression. RESULTS Among 268 participants (147 F, median age 85, IQR 80-89), hs-TnI elevation was found in 191 cases (71%, median 23 ng/L, IQR 11-65), but MI was present in only 12 cases (4.5%). hs-TnI was significantly associated with MI (AUROC 0.751, 95% CI 0.580-0.922, p = 0.003), with an optimal cut-off of 141 ng/L. hs-TnI levels ≥141 ng/L were significantly associated with CFS (OR 1.58, 95% CI 1.15-2.18, p = 0.005), while levels

Published
2021

28. Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

Author

Vincenzo, Arcoraci, Maria Antonietta Barbieri, Michelangelo, Rottura, Alessandro, Nobili, Giuseppe, Natoli, Christiano, Argano, Giovanni, Squadrito, Francesco, Squadrito, Salvatore, Corrao, Domenico, Prisco, Elena, Silvestri, Giacomo, Emmi, Alessandra, Bettiol, Irene, Mattioli, Gianni, Biolo, Michela, Zanetti, Giacomo, Bartelloni, Massimo, Vanoli, Giulia, Grignani, Edoardo Alessandro Pulixi, Graziana, Lupattelli, Vanessa, Bianconi, Riccardo, Alcidi, Domenico, Girelli, Fabiana, Busti, Giacomo, Marchi, Mario, Barbagallo, Ligia, Dominguez, Vincenza, Beneduce, Federica, Cacioppo, Massimo, Raspanti, Marco, Zoli, Maria Laura Matacena, Giuseppe, Orio, Eleonora, Magnolfi, Giovanni, Serafini, Angelo, Simili, Giuseppe, Palasciano, Maria Ester Modeo, Carla Di Gennaro, Maria Domenica Cappellini, Giovanna, Fabio, Margherita Migone De Amicis, Giacomo De Luca, Natalia, Scaramellini, Matteo, Cesari, Paolo Dionigi Rossi, Sarah, Damanti, Marta, Clerici, Simona, Leoni, Alessandra Danuta Di Mauro, Antonio Di Sabatino, Emanuela, Miceli, Marco Vincenzo Lenti, Martina, Pisati, Costanza Caccia Dominioni, Roberto, Pontremoli, Valentina, Beccati, Giulia, Nobili, Giovanna, Leoncini, Luigi, Anastasio, Maria, Carbone, Francesco, Cipollone, Maria Teresa Guagnano, Ilaria, Rossi, Gerardo, Mancuso, Daniela, Calipari, Mosè, Bartone, Giuseppe, Delitala, Maria, Berria, Alessandro, Delitala, Maurizio, Muscaritoli, Alessio, Molfino, Enrico, Petrillo, Antonella, Giorgi, Christian, Gracin, Giuseppe, Zuccalà, Gabriella, D’Aurizio, Giuseppe, Romanelli, Alessandra, Marengoni, Andrea, Volpini, Daniela, Lucente, Antonio, Picardi, Umberto Vespasiani Gentilucci, Paolo, Gallo, Giuseppe, Bellelli, Maurizio, Corsi, Cesare, Antonucci, Chiara, Sidoli, Giulia, Principato, Franco, Arturi, Elena, Succurro, Bruno, Tassone, Federica, Giofrè, Maria Grazia Serra, Maria Antonietta Bleve, Antonio, Brucato, Teresa De Falco, Fabrizio, Fabris, Irene, Bertozzi, Giulia, Bogoni, Maria Victoria Rabuini, Tancredi, Prandini, Manfredini, Roberto, Fabbian, Fabio, Benedetta, Boari, DE GIORGI, Alfredo, Ruana, Tiseo, Giuseppe, Paolisso, Maria Rosaria Rizzo, Claudia, Catalano, Claudio, Borghi, Enrico, Strocchi, Eugenia, Ianniello, Mario, Soldati, Silvia, Schiavone, Alessio, Bragagni, Carlo, Sabbà, Francesco Saverio Vella, Patrizia, Suppressa, Giovanni Michele De Vincenzo, Alessio, Comitangelo, Emanuele, Amoruso, Carlo, Custodero, Luigi, Fenoglio, Andrea, Falcetta, Fracanzani, Anna L., Silvia, Tiraboschi, Annalisa, Cespiati, Giovanna, Oberti, Giordano, Sigon, Flora, Peyvandi, Raffaella, Rossio, Giulia, Colombo, Pasquale, Agosti, Valter, Monzani, Valeria, Savojardo, Giuliana, Ceriani, Francesco, Salerno, Giada, Pallini, Fabrizio, Montecucco, Luciano, Ottonello, Lara, Caserza, Giulia, Vischi, Nicola Lucio Liberato, Tiziana, Tognin, Francesco, Purrello, Antonino Di Pino, Salvatore, Piro, Renzo, Rozzini, Lina, Falanga, Maria Stella Pisciotta, Francesco Baffa Bellucci, Stefano, Buffelli, Giuseppe, Montrucchio, Paolo, Peasso, Edoardo, Favale, Cesare, Poletto, Carl, Margaria, Maura, Sanino, Francesco, Violi, Ludovica, Perri, Luigina, Guasti, Luana, Castiglioni, Andrea, Maresca, Alessandro, Squizzato, Leonardo, Campiotti, Alessandra, Grossi, Roberto Davide Diprizio, Marco, Bertolotti, Chiara, Mussi, Giulia, Lancellotti, Maria Vittoria Libbra, Matteo, Galassi, Yasmine, Grassi, Alessio, Greco, Angela, Sciacqua, Maria, Perticone, Rosa, Battaglia, Raffaele, Maio, Vincenzo, Stanghellini, Eugenio, Ruggeri, Sara del Vecchio, Andrea, Salvi, Roberto, Leonardi, Giampaolo, Damiani, William, Capeci, Massimo, Mattioli, Giuseppe Pio Martino, Lorenzo, Biondi, Pietro, Pettinari, Riccardo, Ghio, Anna Dal Col, Salvatore, Minisola, Luciano, Colangelo, Mirella, Cilli, Giancarlo, Labbadia, Antonella, Afeltra, Benedetta, Marigliano, Maria Elena Pipita, Pietro, Castellino, Luca, Zanoli, Alfio, Gennaro, Agostino, Gaudio, Valter, Saracco, Marisa, Fogliati, Carlo, Bussolino, Francesca, Mete, Miriam, Gino, Carlo, Vigorito, Antonio, Cittadini, Guido, Moreo, Silvia, Prolo, Gloria, Pina, Alberto, Ballestrero, Fabio, Ferrando, Roberta, Gonella, Domenico, Cerminara, Sergio, Berra, Simonetta, Dassi, Maria Cristina Nava, Bruno, Graziella, Stefano, Baldassarre, Salvatore, Fragapani, Gabriella, Gruden, Giorgio, Galanti, Gabriele, Mascherini, Cristian, Petri, Laura, Stefani, Margherita, Girino, Valeria, Piccinelli, Francesco, Nasso, Vincenza, Gioffrè, Maria, Pasquale, Leonardo, Sechi, Cristiana, Catena, Gianluca, Colussi, Alessandro, Cavarape, Andea Da Porto, Nicola, Passariello, Luca, Rinaldi, Franco, Berti, Giuseppe, Famularo, Patrizia, Tarsitani, Roberto, Castello, Michela, Pasino, Gian Paolo Ceda, Marcello Giuseppe Maggio, Simonetta, Morganti, Andrea, Artoni, Margherita, Grossi, Stefano Del Giacco, Davide, Firinu, Giulia, Costanzo, Giacomo, Argiolas, Giuseppe, Montalto, Anna, Licata, Filippo Alessandro Montalto, Francesco, Corica, Giorgio, Basile, Antonino, Catalano, Federica, Bellone, Concetto, Principato, Lorenzo, Malatino, Benedetta, Stancanelli, Valentina, Terranova, Salvatore Di Marca, Rosario Di Quattro, Lara La Malfa, Rossella, Caruso, Patrizia, Mecocci, Carmelinda, Ruggiero, Virginia, Boccardi, Tiziana, Meschi, Andrea, Ticinesi, Antonio, Nouvenne, Pietro, Minuz, Luigi, Fondrieschi, Giandomenico Nigro Imperiale, Mario, Pirisi, Gian Paolo Fra, Daniele, Sola, Mattia, Bellan, Massimo, Porta, Piero, Riva, Roberto, Quadri, Erica, Larovere, Marco, Novelli, Giorgio, Scanzi, Caterina, Mengoli, Stella, Provini, Laura, Ricevuti, Emilio, Simeone, Rosa, Scurti, Fabio, Tolloso, Roberto, Tarquini, Alice, Valoriani, Silvia, Dolenti, Giulia, Vannini, Riccardo, Volpi, Pietro, Bocchi, Alessandro, Vignali, Sergio, Harari, Chiara, Lonati, Federico, Napoli, Italia, Aiello, Raffaele, Landolfi, Massimo, Montalto, Antonio, Mirijello, Silvia, Ghidoni, Teresa, Salvatore, Lucio, Monaco, Carmen, Ricozzi, Alberto, Pilotto, Ilaria, Indiano, Federica, Gandolfo., Arcoraci V., Barbieri M.A., Rottura M., Nobili A., Natoli G., Argano C., Squadrito G., Squadrito F., and Corrao S.

Subjects
medicine.medical_specialty, appropriateness of prescription, prescribing patterns, Renal function, Context (language use), RM1-950, Logistic regression, NO, chemistry.chemical_compound, older patient, Internal medicine, hospital setting, medicine, Pharmacology (medical), LS4_4, Medical prescription, prescribing pattern, appropriateness of prescriptions, chronic kidney disease, hospital setting, older patients, prescribing patterns, real-world data, Original Research, Pharmacology, Creatinine, real-world data, business.industry, Retrospective cohort study, medicine.disease, older patients, appropriateness of prescriptions, chronic kidney disease, chemistry, Observational study, Therapeutics. Pharmacology, business, Kidney disease
Abstract

Aging with multimorbidity and polytherapy are the most significant factors that could led to inappropriate prescribing of contraindicated medications in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the prescriptions of contraindicated drugs in older adults in CKD and to identify their associated factors in a hospital context. An observational retrospective study was carried out considering all patients ≥65 years with at least one serum creatinine value recorded into the REPOSI register into 2010–2016 period. The estimated glomerular filtration rate (eGFR) was applied to identify CKD. A descriptive analysis was performed to compare demographic and clinical characteristics; logistic regression models were used to estimate factors of inappropriate and percentage changes of drug use during hospitalization. A total of 4,713 hospitalized patients were recorded, of which 49.8% had an eGFR 2; the 21.9% were in treatment with at least one inappropriate drug at the time of hospital admission with a decrease of 3.0% at discharge (p = 0.010). The probability of using at least one contraindicated drug was significantly higher in patients treated with more several drugs (OR 1.21, 95% CI 1.16–1.25, p p < 0.001; G5: 19.38, 11.51–32.64, p < 0.001). Low-dose acetylsalicylic acid was the contraindicated drug mainly used at the time of admission, reducing 1.2% at discharge. An overall increase in therapeutic appropriateness in hospitalized older patients with CKD was observed, despite a small percentage of therapeutic inappropriateness at discharge that underlines the need for a closer collaboration with the pharmacologist to improve the drug management.

Published
2021

29. Sarcoidosis and COVID-19: At the Cross-Road between Immunopathology and Clinical Manifestation

Author

Claudio Tana, Francesco Cinetto, Cesare Mantini, Nicol Bernardinello, Marco Tana, Fabrizio Ricci, Andrea Ticinesi, Tiziana Meschi, Riccardo Scarpa, Francesco Cipollone, Maria Adele Giamberardino, and Paolo Spagnolo

Subjects
translational medicine, SARS-CoV-2, COVID-19, cell, granuloma, imaging, immunopathology, sarcoidosis, Medicine (miscellaneous), General Biochemistry, Genetics and Molecular Biology
Abstract

Coronavirus disease 2019 (COVID-19) has been associated with dysregulation of the immune system featuring inappropriate immune responses, exacerbation of inflammatory responses, and multiple organ dysfunction syndrome in patients with severe disease. Sarcoidosis, also known as Besnier–Boeck–Schaumann disease, is an idiopathic granulomatous multisystem disease characterized by dense epithelioid non-necrotizing lesions with varying degrees of lymphocytic inflammation. These two diseases have similar clinical manifestations and may influence each other at multiple levels, eventually affecting their clinical courses and prognosis. Notably, sarcoidosis patients are at high risk of severe COVID-19 pneumonia because of the underlying lung disease and chronic immunosuppressive treatment. In this narrative review, we will discuss interactions between sarcoidosis and COVID-19 in terms of clinical manifestations, treatment, and pathogenesis, including the role of the dysregulated renin–angiotensin system, altered immune responses involving increased cytokine levels and immune system hyperactivation, and cellular death pathways.

Published
2022

30. Multimorbidity and Frailty Are the Key Characteristics of Patients Hospitalized with COVID-19 Breakthrough Infection during Delta Variant Predominance in Italy: A Retrospective Study

Author

Andrea Ticinesi, Alberto Parise, Nicoletta Cerundolo, Antonio Nouvenne, Beatrice Prati, Giulia Chiussi, Angela Guerra, and Tiziana Meschi

Subjects
SARS-CoV-2, vaccine failure, viral pneumonia, geriatric patient, comorbidity, General Medicine
Abstract

The aims of this study were to describe the characteristics of patients hospitalized with delta SARS-CoV-2 breakthrough infection, and to identify factors associated with pneumonia on chest Computed Tomography (CT) and mortality. The clinical records of 229 patients (105 F), with a median age of 81 (interquartile range, IQR, 73–88) years old, hospitalized between June and December 2021 after completion of the primary vaccination cycle, were retrospectively analyzed, retrieving data on comorbidities, Clinical Frailty Scale (CFS), clinical presentation and outcomes. Multimorbidity (91.7% with ≥2 chronic illnesses) and frailty (61.6% with CFS ≥ 5) were highly prevalent. CFS (OR 0.678, 95% CI 0.573–0.803, p < 0.001) and hypertension were independently associated with interstitial pneumonia. Mortality was 25.1% and unrelated with age. PaO2/FiO2 on blood gas analysis performed upon admission (OR 0.986, 95% CI 0.977–0.996, p = 0.005), and CFS (OR 1.723, 95% CI 1.152–2.576, p = 0.008) were independently associated with mortality only in subjects < 85 years old. Conversely, serum PCT levels were associated with mortality in subjects ≥ 85 years old (OR 3.088, 95% CI 1.389–6.8628, p = 0.006). In conclusion, hospitalization for COVID-19 breakthrough infection mainly involved geriatric patients, with those aged ≥ 85 more characterized by decompensation of baseline comorbidities rather than typical COVID-19 respiratory symptoms.

Published
2022

31. Prevalence of use and appropriateness of antidepressants prescription in acutely hospitalized elderly patients

Author

Franchi Carlotta, Rossio Raffaella, Ardoino Ilaria, Nobili Alessandro, Mannucci Pier Mannuccio, Pier Mannuccio Mannucci, Alessandro Nobili, Antonello Pietrangelo, Francesco Perticone, Giuseppe Licata, Francesco Violi, Gino Roberto Corazza, Salvatore Corrao, Alessandra Marengoni, Francesco Salerno, Matteo Cesari, Mauro Tettamanti, Luca Pasina, Carlotta Franchi, Laura Cortesi, Gabriella Miglio, Ilaria Ardoino, Alessio Novella, Domenico Prisco, Elena Silvestri, Giacomo Emmi, Alessandra Bettiol, Cenci Caterina, Gianni Biolo, Michela Zanetti, Martina Guadagni, Michele Zaccari, Massimiliano Chiuch, Massimo Vanoli, Giulia Grignani, Edoardo Alessandro Pulixi, Mauro Bernardi, Silvia Li Bassi, Luca Santi, Giacomo Zaccherini, Graziana Lupattelli, Elmo Mannarino, Vanessa Bianconi, Francesco Paciullo, Riccardo Alcidi, Ranuccio Nuti, Roberto Valenti, Martina Ruvio, Silvia Cappelli, Alberto Palazzuoli, Domenico Girelli, Fabiana Busti, Giacomo Marchi, Mario Barbagallo, Ligia Dominguez, Floriana Cocita, Vincenza Beneduce, Lidia Plances, Giuseppe Natoli, Salvatore Mularo, Massimo Raspanti, Federica Cavallaro, Marco Zoli, Ilaria Lazzari, Mattia Brunori, Elisa Fabbri, Donatella Magalotti, Raffaella Arnò, Franco Laghi Pasini, Pier Leopoldo Capecchi, Giuseppe Palasciano, Maria Ester Modeo, Carla Di Gennaro, Maria Domenica Cappellini, Diletta Maira, Valeria Di Stefano, Giovanna Fabio, Sonia Seghezzi, Marta Mancarella, Margherita Migone De Amicis, Giacomo De Luca, Natalia Scaramellini, Paolo Dionigi Rossi, Sarah Damanti, Marta Clerici, Federica Conti, Giulia Bonini, Barbara Brignolo Ottolini, Antonio Di Sabatino, Emanuela Miceli, Marco Vincenzo Lenti, Martina Pisati, Costanza Caccia Dominioni, Giovanni Murialdo, Alessio Marra, Federico Cattaneo, Roberto Pontremoli, Valentina Beccati, Giulia Nobili, Maria Beatrice Secchi, Davide Ghelfi, Luigi Anastasio, Lucia Sofia, Maria Carbone, Francesco Cipollone, Maria Teresa Guagnano, Emanuele Valeriani, Ilaria Rossi, Gerardo Mancuso, Daniela Calipari, Mosè Bartone, Giuseppe Delitala, Maria Berria, Chiara Pes, Alessandro Delitala, Maurizio Muscaritoli, Alessio Molfino, Enrico Petrillo, Giuseppe Zuccalà, Gabriella D’Aurizio, Giuseppe Romanelli, Alberto Zucchelli, Francesca Manzoni, Andrea Volpini, Antonio Picardi, Umberto Vespasiani Gentilucci, Paolo Gallo, Chiara Dell’Unto, Giorgio Annoni, Maurizio Corsi, Giuseppe Bellelli, Sara Zazzetta, Paolo Mazzola, Hajnalka Szabo, Alessandra Bonfanti, Franco Arturi, Elena Succurro, Mariangela Rubino, Bruno Tassone, Giorgio Sesti, Medicina Interna, Maria Grazia Serra, Maria Antonietta Bleve, Laura Gasbarrone, Maria Rosaria Sajeva, Antonio Brucato, Silvia Ghidoni, Fabrizio Fabris, Irene Bertozzi, Giulia Bogoni, Maria Victoria Rabuini, Elisabetta Cosi, Paolo Scarinzi, Annalisa Amabile, Elisabetta Omenetto, Tancredi Prandini, Roberto Manfredini, Fabio Fabbian, Benedetta Boari, Alfredo De Giorgi, Ruana Tiseo, Roberto De Giorgio, Giuseppe Paolisso, Maria Rosaria Rizzo, Claudio Borghi, Enrico Strocchi, Eugenia Ianniello, Mario Soldati, Carlo Sabbà, Francesco Saverio Vella, Patrizia Suppressa, Andrea Schilardi, Francesca Loparco, Giovanni Michele De Vincenzo, Alessio Comitangelo, Emanuele Amoruso, Luigi Fenoglio, Andrea Falcetta, Christian Bracco, Anna L. Fracanzani, Silvia Fargion, Silvia Tiraboschi, Annalisa Cespiati, Giovanna Oberti, Giordano Sigon, Flora Peyvandi, Raffaella Rossio, Barbara Ferrari, Giulia Colombo, Pasquale Agosti, Valter Monzani, Valeria Savojardo, Christian Folli, Giuliana Ceriani, Giada Pallini, Franco Dallegri, Luciano Ottonello, Luca Liberale, Lara Caserza, Kassem Salam, Nicola Lucio Liberato, Tiziana Tognin, Giovanni Battista Bianchi, Sabrina Giaquinto, Francesco Purrello, Antonino Di Pino, Salvatore Piro, Renzo Rozzini, Lina Falanga, Elena Spazzini, Camillo Ferrandina, Giuseppe Montrucchio, Paolo Petitti, Paolo Peasso, Edoardo Favale, Cesare Poletto, Raffaella Salmi, Piergiorgio Gaudenzi, Ludovica Perri, Raffaele Landolfi, Massimo Montalto, Antonio Mirijello, Luigina Guasti, Luana Castiglioni, Andrea Maresca, Alessandro Squizzato, Leonardo Campiotti, Alessandra Grossi, Marco Bertolotti, Chiara Mussi, Giulia Lancellotti, Maria Vittoria Libbra, Giulia Dondi, Elisa Pellegrini, Lucia Carulli, Matteo Galassi, Yasmine Grassi, Maria Perticone, Rosa Battaglia, Marco FIlice, Raffaele Maio, Vincenzo Stanghellini, Eugenio Ruggeri, Sara del Vecchio, Andrea Salvi, Roberto Leonardi, Giampaolo Damiani, William Capeci, Armando Gabrielli, Massimo Mattioli, Giuseppe Pio Martino, Lorenzo Biondi, Pietro Pettinari, Riccardo Ghio, Anna Dal Col, Salvatore Minisola, Luciano Colangelo, Mirella Cilli, Giancarlo Labbadia, Antonella Afeltra, Benedetta Marigliano, Maria Elena Pipita, Pietro Castellino, Luca Zanoli, Samuele Pignataro, Alfio Gennaro, Julien Blanco, Valter Saracco, Marisa Fogliati, Carlo Bussolino, Francesca Mete, Miriam Gino, Antonio Cittadini, Carlo Vigorito, Michele Arcopinto, Andrea Salzano, Emanuele Bobbio, Alberto Maria Marra, Domenico Sirico, Guido Moreo, Francesca Gasparini, Silvia Prolo, Gloria Pina, Alberto Ballestrero, Fabio Ferrando, Sergio Berra, Simonetta Dassi, Maria Cristina Nava, Bruno Graziella, Stefano Baldassarre, Salvatore Fragapani, Gabriella Gruden, Giorgio Galanti, Gabriele Mascherini, Cristian Petri, Laura Stefani, Margherita Girino, Valeria Piccinelli, Francesco Nasso, Vincenza Gioffrè, Maria Pasquale, Giuseppe Scattolin, Sergio Martinelli, Mauro Turrin, Leonardo Sechi, Cristina Catena, Gianluca Colussi, Nicola Passariello, Luca Rinaldi, Franco Berti, Giuseppe Famularo, Patrizia Tarsitani, Roberto Castello, Michela Pasino, Gian Paolo Ceda, Marcello Giuseppe Maggio, Simonetta Morganti, Andrea Artoni, Stefano Del Giacco, Davide Firinu, Francesca Losa, Giovanni Paoletti, Giulia Costanzo, Giuseppe Montalto, Anna Licata, Valentina Malerba, Filippo Alessandro Montalto, Antonino Lasco, Giorgio Basile, Antonino Catalano, Lorenzo Malatino, Benedetta Stancanelli, Valentina Terranova, Salvatore Di Marca, Rosario Di Quattro, Lara La Malfa, Rossella Caruso, Patrizia Mecocci, Carmelinda Ruggiero, Virginia Boccardi, Tiziana Meschi, Fulvio Lauretani, Andrea Ticinesi, Antonio Nouvenne, Pietro Minuz, Luigi Fondrieschi, Mario Pirisi, Gian Paolo Fra, Daniele Sola, Massimo Porta, Piero Riva, Roberto Quadri, Erica Larovere, Marco Novelli, Giorgio Scanzi, Caterina Mengoli, Stella Provini, Laura Ricevuti, Emilio Simeone, Rosa Scurti, Fabio Tolloso, Roberto Tarquini, Alice Valoriani, Silvia Dolenti, Giulia Vannini, Alberto Tedeschi, Lucia Trotta, Riccardo Volpi, Pietro Bocchi, Alessandro Vignali, Sergio Harari, Chiara Lonati, Mara Cattaneo, Federico Napoli, Carlotta, F., Raffaella, R., Ilaria, A., Alessandro, N., Mannuccio, M. P., Mannucci, P. M., Nobili, A., Pietrangelo, A., Perticone, F., Licata, G., Violi, F., Corazza, G. R., Corrao, S., Marengoni, A., Salerno, F., Cesari, M., Tettamanti, M., Pasina, L., Franchi, C., Cortesi, L., Miglio, G., Ardoino, I., Novella, A., Prisco, D., Silvestri, E., Emmi, G., Bettiol, A., Caterina, C., Biolo, G., Zanetti, M., Guadagni, M., Zaccari, M., Chiuch, M., Vanoli, M., Grignani, G., Pulixi, E. A., Bernardi, M., Bassi, S. L., 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., Natoli, G., Mularo, S., Raspanti, M., Cavallaro, F., Zoli, M., Lazzari, I., Brunori, M., Fabbri, E., Magalotti, D., Arno, R., Pasini, F. L., Capecchi, P. L., Palasciano, G., Modeo, M. E., Gennaro, C. D., Cappellini, M. D., Maira, D., Di Stefano, V., Fabio, G., Seghezzi, S., Mancarella, M., De Amicis, M. M., De Luca, G., Scaramellini, N., Rossi, P. D., Damanti, S., Clerici, M., Conti, F., Bonini, G., Ottolini, B. B., Di Sabatino, A., Miceli, E., Lenti, M. V., Pisati, M., Dominioni, C. C., Murialdo, G., Marra, A., Cattaneo, F., Pontremoli, R., Beccati, V., Nobili, G., Secchi, M. B., Ghelfi, D., Anastasio, L., Sofia, L., Carbone, M., Cipollone, F., Guagnano, M. T., Valeriani, E., Rossi, I., Mancuso, G., Calipari, D., Bartone, M., Delitala, G., Berria, M., Pes, C., Delitala, A., Muscaritoli, M., Molfino, A., Petrillo, E., Zuccala, G., D'Aurizio, G., Romanelli, G., Zucchelli, A., Manzoni, F., Volpini, A., Picardi, A., Gentilucci, U. V., 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, M. G., Bleve, M. A., Gasbarrone, L., Sajeva, M. R., Brucato, A., Ghidoni, S., Fabris, F., Bertozzi, I., Bogoni, G., Rabuini, M. V., Cosi, E., Scarinzi, P., Amabile, A., Omenetto, E., Prandini, T., Manfredini, R., Fabbian, F., Boari, B., Giorgi, A. D., Tiseo, R., De Giorgio, R., Paolisso, G., Rizzo, M. R., Borghi, C., Strocchi, E., Ianniello, E., Soldati, M., Sabba, C., Vella, F. S., Suppressa, P., Schilardi, A., Loparco, F., De Vincenzo, G. M., Comitangelo, A., Amoruso, E., Fenoglio, L., Falcetta, A., Bracco, C., Fracanzani, A. L., 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., Pallini, G., Dallegri, F., Ottonello, L., Liberale, L., Caserza, L., Salam, K., Liberato, N. L., Tognin, T., Bianchi, G. B., 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., 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, M. V., Dondi, G., Pellegrini, E., Carulli, L., Galassi, M., Grassi, Y., 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, G. P., Biondi, L., Pettinari, P., Ghio, R., Col, A. D., Minisola, S., Colangelo, L., Cilli, M., Labbadia, G., Afeltra, A., Marigliano, B., Pipita, M. E., 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, A. M., Sirico, D., Moreo, G., Gasparini, F., Prolo, S., Pina, G., Ballestrero, A., Ferrando, F., Berra, S., Dassi, S., Nava, M. C., Graziella, B., Baldassarre, S., Fragapani, S., Gruden, G., Galanti, G., Mascherini, G., Petri, C., Stefani, L., Girino, M., Piccinelli, V., Nasso, F., Gioffre, 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, G. P., Maggio, M. G., Morganti, S., Artoni, A., Del Giacco, S., Firinu, D., Losa, F., Paoletti, G., Costanzo, G., Montalto, G., Licata, A., Malerba, V., Montalto, F. A., 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, G. P., 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., Carlotta F., Raffaella R., Ilaria A., Alessandro N., Mannuccio M.P., Mannucci P.M., Nobili A., Pietrangelo A., Perticone F., Licata G., Violi F., Corazza G.R., Corrao S., Marengoni A., Salerno F., Cesari M., Tettamanti M., Pasina L., Franchi C., Cortesi L., Miglio G., Ardoino I., Novella A., Prisco D., Silvestri E., Emmi G., Bettiol A., Caterina C., Biolo G., Zanetti M., Guadagni M., Zaccari M., Chiuch M., Vanoli M., Grignani G., Pulixi E.A., Bernardi M., Bassi S.L., 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., Natoli G., Mularo S., Raspanti M., Cavallaro F., Zoli M., Lazzari I., Brunori M., Fabbri E., Magalotti D., Arno R., Pasini F.L., Capecchi P.L., Palasciano G., Modeo M.E., Gennaro C.D., Cappellini M.D., Maira D., Di Stefano V., Fabio G., Seghezzi S., Mancarella M., De Amicis M.M., De Luca G., Scaramellini N., Rossi P.D., Damanti S., Clerici M., Conti F., Bonini G., Ottolini B.B., Di Sabatino A., Miceli E., Lenti M.V., Pisati M., Dominioni C.C., Murialdo G., Marra A., Cattaneo F., Pontremoli R., Beccati V., Nobili G., Secchi M.B., Ghelfi D., Anastasio L., Sofia L., Carbone M., Cipollone F., Guagnano M.T., Valeriani E., Rossi I., Mancuso G., Calipari D., Bartone M., Delitala G., Berria M., Pes C., Delitala A., Muscaritoli M., Molfino A., Petrillo E., Zuccala G., D'Aurizio G., Romanelli G., Zucchelli A., Manzoni F., Volpini A., Picardi A., Gentilucci U.V., 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 M.G., Bleve M.A., Gasbarrone L., Sajeva M.R., Brucato A., Ghidoni S., Fabris F., Bertozzi I., Bogoni G., Rabuini M.V., Cosi E., Scarinzi P., Amabile A., Omenetto E., Prandini T., Manfredini R., Fabbian F., Boari B., Giorgi A.D., Tiseo R., De Giorgio R., Paolisso G., Rizzo M.R., Borghi C., Strocchi E., Ianniello E., Soldati M., Sabba C., Vella F.S., Suppressa P., Schilardi A., Loparco F., De Vincenzo G.M., Comitangelo A., Amoruso E., Fenoglio L., Falcetta A., Bracco C., Fracanzani A.L., 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., Pallini G., Dallegri F., Ottonello L., Liberale L., Caserza L., Salam K., Liberato N.L., Tognin T., Bianchi G.B., 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., 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 M.V., Dondi G., Pellegrini E., Carulli L., Galassi M., Grassi Y., 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 G.P., Biondi L., Pettinari P., Ghio R., Col A.D., Minisola S., Colangelo L., Cilli M., Labbadia G., Afeltra A., Marigliano B., Pipita M.E., 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 A.M., Sirico D., Moreo G., Gasparini F., Prolo S., Pina G., Ballestrero A., Ferrando F., Berra S., Dassi S., Nava M.C., Graziella B., Baldassarre S., Fragapani S., Gruden G., Galanti G., Mascherini G., Petri C., Stefani L., Girino M., Piccinelli V., Nasso F., Gioffre 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 G.P., Maggio M.G., Morganti S., Artoni A., Del Giacco S., Firinu D., Losa F., Paoletti G., Costanzo G., Montalto G., Licata A., Malerba V., Montalto F.A., 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 G.P., 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., Carlotta, F, Raffaella, R, Ilaria, A, Alessandro, N, Mannuccio, M, Mannucci, P, Nobili, A, Pietrangelo, A, Perticone, F, Licata, G, Violi, F, Corazza, G, Corrao, S, Marengoni, A, Salerno, F, Cesari, M, Tettamanti, M, Pasina, L, Franchi, C, Cortesi, L, Miglio, G, Ardoino, I, Novella, A, Prisco, D, Silvestri, E, Emmi, G, Bettiol, A, Caterina, C, Biolo, G, Zanetti, M, Guadagni, M, Zaccari, M, Chiuch, M, Vanoli, M, Grignani, G, Pulixi, E, Bernardi, M, Bassi, S, 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, Natoli, G, Mularo, S, Raspanti, M, Cavallaro, F, Zoli, M, Lazzari, I, Brunori, M, Fabbri, E, Magalotti, D, Arno, R, Pasini, F, Capecchi, P, Palasciano, G, Modeo, M, Gennaro, C, Cappellini, M, Maira, D, Di Stefano, V, Fabio, G, Seghezzi, S, Mancarella, M, De Amicis, M, De Luca, G, Scaramellini, N, Rossi, P, Damanti, S, Clerici, M, Conti, F, Bonini, G, Ottolini, B, Di Sabatino, A, Miceli, E, Lenti, M, Pisati, M, Dominioni, C, Murialdo, G, Marra, A, Cattaneo, F, Pontremoli, R, Beccati, V, Nobili, G, Secchi, M, Ghelfi, D, Anastasio, L, Sofia, L, Carbone, M, Cipollone, F, Guagnano, M, Valeriani, E, Rossi, I, Mancuso, G, Calipari, D, Bartone, M, Delitala, G, Berria, M, Pes, C, Delitala, A, Muscaritoli, M, Molfino, A, Petrillo, E, Zuccala, G, D'Aurizio, G, Romanelli, G, Zucchelli, A, Manzoni, F, Volpini, A, Picardi, A, Gentilucci, U, 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, M, Bleve, M, Gasbarrone, L, Sajeva, M, Brucato, A, Ghidoni, S, Fabris, F, Bertozzi, I, Bogoni, G, Rabuini, M, Cosi, E, Scarinzi, P, Amabile, A, Omenetto, E, Prandini, T, Manfredini, R, Fabbian, F, Boari, B, Giorgi, A, Tiseo, R, De Giorgio, R, Paolisso, G, Rizzo, M, Borghi, C, Strocchi, E, Ianniello, E, Soldati, M, Sabba, C, Vella, F, Suppressa, P, Schilardi, A, Loparco, F, De Vincenzo, G, Comitangelo, A, Amoruso, E, Fenoglio, L, Falcetta, A, Bracco, C, Fracanzani, A, 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, Pallini, G, Dallegri, F, Ottonello, L, Liberale, L, Caserza, L, Salam, K, Liberato, N, Tognin, T, Bianchi, G, 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, 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, M, Dondi, G, Pellegrini, E, Carulli, L, Galassi, M, Grassi, Y, 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, G, Biondi, L, Pettinari, P, Ghio, R, Col, A, Minisola, S, Colangelo, L, Cilli, M, Labbadia, G, Afeltra, A, Marigliano, B, Pipita, M, 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, Sirico, D, Moreo, G, Gasparini, F, Prolo, S, Pina, G, Ballestrero, A, Ferrando, F, Berra, S, Dassi, S, Nava, M, Graziella, B, Baldassarre, S, Fragapani, S, Gruden, G, Galanti, G, Mascherini, G, Petri, C, Stefani, L, Girino, M, Piccinelli, V, Nasso, F, Gioffre, 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, G, Maggio, M, Morganti, S, Artoni, A, Del Giacco, S, Firinu, D, Losa, F, Paoletti, G, Costanzo, G, Montalto, G, Licata, A, Malerba, V, Montalto, F, 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, G, 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, and Napoli, F

Subjects
Male, medicine.medical_specialty, Socio-culturale, Inappropriate Prescribing, Potentially inappropriate medication, older, Practice Patterns, depression, hospitalized patients, drugs, elderly, drugs, antidepressivi anziano, Polypharmacy | Inappropriate Prescribing | Medications PIMs, antidepressant agent, escitalopram, paroxetine, Internal Medicine, medicine, Hospital discharge, older, Escitalopram, Humans, LS4_4, Medical prescription, Practice Patterns, Physicians', Depression (differential diagnoses), Aged, Polypharmacy, Sertraline, Physicians', antidepressant, business.industry, Trazodone, hospitalized patients, Antidepressive Agents, Hospitalization, Acute Disease, Female, Italy, antidepressants, Emergency medicine, depression, Polypharmacy , Inappropriate Prescribing , Medications, PIM, Delirium, Potentially inappropriate medication, medicine.symptom, business, medicine.drug
Abstract

Depression is often under-recognized in older patients, even if antidepressants (AD) are commonly prescribed, with a prevalence of use that increase with ageing [ 1 ]. Nevertheless, even if a diagnosis of depression is established, inappropriate treatment can occur [ 2 ]. Beers criteria are the most widely screening tools used to detect inappropriate prescription of drugs in people aged 65 years or more [ 3 ]. Since 2010, attempts to adapt the Beers' criteria have been made in Europe [ 4 , 5 ]. Tricyclic drugs are the ADs to be always avoided in the elderly, owing to their anticholinergic side effects, such as cognitive impairment, delirium, urinary retention and falls [ 3 ]. Selective serotonin reuptake inhibitors (SSRIs) should be used with caution because they can cause or exacerbate hyponatraemia [ 3 ]. To our knowledge no studies have been conducted on recent data collected in hospitalized older patients in order to assess the appropriateness of prescription of ADs. With this background, the objectives of this study were to investigate the prevalence of AD use and prescription appropriateness, according to the above-cited criteria, in a large cohort of older patients hospitalized in Italian internal medicine and geriatric wards from 2010 to 2017.

Published
2019

32. Meta-analysis of Clinical Microbiome Studies in Urolithiasis Reveal Age, Stone Composition, and Study Location as the Predominant Factors in Urolithiasis-Associated Microbiome Composition

Author

Manoj Monga, Tiziana Meschi, Gregory E. Tasian, Alan J. Wolfe, Aaron W. Miller, Kristina L. Penniston, Dirk Lange, Petar Bajic, Andrea Ticinesi, Mangesh V. Suryavanshi, Naveen Kachroo, Joshua Stern, and Bonomo, Robert A

Subjects
Male, Urologic Diseases, microbiome, Microbiology, clinical, metagenome, Virology, medicine, Prevotella, Humans, 2.1 Biological and endogenous factors, Stone composition, Microbiome, Aetiology, Urinary Tract, health care economics and organizations, Genetic association, metagenomics, biology, business.industry, Microbiota, urolithiasis, kidney stone, medicine.disease, biology.organism_classification, QR1-502, meta-analysis, Metagenomics, Meta-analysis, Urinary Calculi, Kidney stones, Sample collection, business, Research Article, Demography
Abstract

To determine whether functionally relevant questions associated with the urinary or gut microbiome and urinary stone disease (USD) can be answered from metagenome-wide association studies (MWAS), we performed the most comprehensive meta-analysis of published clinical MWAS in USD to date, using publicly available data published prior to April 2021. Six relevant studies met inclusion criteria. For alpha-diversity, significant differences were noted between USD status, stone composition, sample type, study location, age, diet, and sex. For beta-diversity, significant differences were noted by USD status, stone composition, sample type, study location, antibiotic use (30 days and 12 months before sampling), sex, hypertension, water intake, body habitus, and age. Prevotella and Lactobacillus in the gut and urinary tract, respectively, were associated with healthy individuals, while Enterobacteriaceae was associated with USD in the urine and stones. Paradoxically, other Prevotella strains were also strongly associated with USD in the gut microbiome. When data were analyzed together, USD status, stone composition, age group, and study location were the predominant factors associated with microbiome composition. Meta-analysis showed significant microbiome differences based on USD status, stone composition, age group or study location. However, analyses were limited by a lack of public data from published studies, metadata collected, and differing study protocols. Results highlight the need for field-specific standardization of experimental protocols in terms of sample collection procedures and the anatomical niches to assess, as well as in defining clinically relevant metadata and subphenotypes such as stone composition. IMPORTANCE Studies focused on the microbiome broadly support the hypothesis that the microbiome influences the onset of chronic diseases such as urinary stone disease. However, it is unclear what environmental factors shape the microbiome in ways that increase the risk for chronic disease. In addition, it is unclear how differences in study methodology can impact the results of clinical metagenome-wide association studies. In the current meta-analysis, we show that age, stone composition, and study location are the predominant factors that associate with the microbiome and USD status. Furthermore, we reveal differences in results based on specific analytical protocols, which impacts the interpretation of any microbiome study.

Published
2021

33. Diverticular Disease: a Gut Microbiota Perspective

Author

Francesco Di Mario, Antonio Nouvenne, Andrea Ticinesi, Tiziana Meschi, V. Corrente, and Claudio Tana

Subjects
Disease, Gut flora, Bioinformatics, digestive system, Feces, Risk Factors, medicine, Animals, Humans, Microbiome, Intestinal Mucosa, Diverticulitis, Bacteria, biology, business.industry, Gastrointestinal Microbiome, Gastroenterology, Akkermansia, medicine.disease, biology.organism_classification, Diverticulosis, Diverticulum, Host-Pathogen Interactions, Diverticular disease, Dysbiosis, business
Abstract

Gut microbiota composition and functionality are involved in the pathophysiology of several intestinal andextraintestinal diseases, and are increasingly considered a modulator of local and systemic inflammation.However, the involvement of gut microbiota in diverticulosis and in diverticular disease is still poorlyinvestigated. In this review, we critically analyze the existing evidence on the fecal and mucosa-associatedmicrobiota composition and functionality across different stages of diverticular disease. We also explorethe influence of risk factors for diverticulosis on gut microbiota composition, and speculate on the possiblerelevance of these associations for the pathogenesis of diverticula. We overview the current treatments ofdiverticular disease targeting the intestinal microbiome, highlighting the current areas of uncertainty andthe need for future studies. Although no conclusive remarks on the relationship between microbiota anddiverticular disease can be made, preliminary data suggest that abdominal symptoms are associated withreduced representation of taxa with a possible anti-inflammatory effect, such as Clostridium cluster IV, andovergrowth of Enterobacteriaceae, Bifidobacteria and Akkermansia. The role of the microbiota in the earlystages of the disease is still very uncertain. Future studies should help to disentangle the role of the microbiomein the pathogenesis of diverticular disease and its progression towards more severe forms.

Published
2019

34. Ultrasound imaging of abdominal sarcoidosis: State of the art

Author

Tiziana Meschi, Francesco Cipollone, Fabrizio Ricci, Christoph F. Dietrich, Andrea Ticinesi, Maria Adele Giamberardino, Claudio Tana, Cosima Schiavone, and Mauro Silingardi

Subjects
Endoscopic ultrasound, medicine.medical_specialty, Sarcoidosis, Granulomatous disorders, Organomegaly, 03 medical and health sciences, 0302 clinical medicine, Sarcoid lesions, Ultrasound, medicine, Kidney, medicine.diagnostic_test, business.industry, Minireviews, General Medicine, medicine.disease, Rare diseases, medicine.anatomical_structure, Liver, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Radiology, Elastography, medicine.symptom, Pancreas, business, Spleen, Contrast-enhanced ultrasound
Abstract

Since it has been recognized that sarcoidosis (SA) is not an exclusive disorder of the lungs but can also affect other organs such as the liver and spleen, efforts have been made to define specific imaging criteria for the diagnosis of the single organ involvement, and the concept has been reinforced that the exclusion of alternative causes is important to achieve the correct diagnosis. Ultrasound (US) is a useful tool to evaluate patients with suspected abdominal SA, such as of the liver, spleen, kidney, pancreas and other organs, showing findings such as organomegaly, focal lesions and lymphadenopathy. While the diagnosis of abdominal SA is more predictable in the case of involvement of other organs (e.g., lungs), the problem is more complex in the case of isolated abdominal SA. The recent use of contrast-enhanced ultrasound and endoscopic ultrasound elastography has provided additional information about the enhancement patterns and tissue rigidity in abdominal SA. Here we critically review the role of US in abdominal SA, reporting typical findings and limitations of current evidence and by discussing future perspectives of study.

Published
2019

35. Human gut microbiome: the hypothesis of a gut-muscle axis in the elderly

Author

Antonio Nouvenne, C Tana, Andrea Ticinesi, and Tiziana Meschi

Subjects
0301 basic medicine, 03 medical and health sciences, 030109 nutrition & dietetics, Human gut, business.industry, Immunology, Medicine, Physical Therapy, Sports Therapy and Rehabilitation, Orthopedics and Sports Medicine, Microbiome, business
Published
2018

36. Standardization of microbiome studies for urolithiasis: an international consensus agreement

Author

Kachroo, Naveen, Lange, Dirk, Penniston, Kristina L, Stern, Joshua, Tasian, Gregory, Bajic, Petar, Wolfe, Alan J, Suryavanshi, Mangesh, Ticinesi, Andrea, Meschi, Tiziana, Monga, Manoj, and Miller, Aaron W

Subjects
Microbiological Techniques, Urologic Diseases, Urolithiasis, Microbiota, Clinical Sciences, Humans, Urology & Nephrology
Abstract

Numerous metagenome-wide association studies (MWAS) for urolithiasis have been published, leading to the discovery of potential interactions between the microbiome and urolithiasis. However, questions remain about the reproducibility, applicability and physiological relevance of these data owing to discrepancies in experimental technique and a lack of standardization in the field. One barrier to interpreting MWAS is that experimental biases can be introduced at every step of the experimental pipeline, including sample collection, preservation, storage, processing, sequencing, data analysis and validation. Thus, the introduction of standardized protocols that maintain the flexibility to achieve study-specific objectives is urgently required. To address this need, the first international consortium for microbiome in urinary stone disease - MICROCOSM - was created and consensus panel members were asked to participate in a consensus meeting to develop standardized protocols for microbiome studies if they had published an MWAS on urolithiasis. Study-specific protocols were revised until a consensus was reached. This consensus group generated standardized protocols, which are publicly available via a secure online server, for each step in the typical clinical microbiome-urolithiasis study pipeline. This standardization creates the benchmark for future studies to facilitate consistent interpretation of results and, collectively, to lead to effective interventions to prevent the onset of urolithiasis, and will also be useful for investigators interested in microbiome research in other urological diseases.

Published
2021

37. The right immune-modulation at the right time: thymosin α1 for prevention of severe COVID-19 in cancer patients

Author

Melissa Bersanelli, Sebastiano Buti, Tiziana Meschi, Antonio Nouvenne, Andrea Ticinesi, Riccardo Danielli, Diana Giannarelli, Alessandro Leonetti, Marcello Tiseo, and Giuseppe Procopio

Subjects
0301 basic medicine, Research design, Cancer Research, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Thymalfasin, Disease, law.invention, 03 medical and health sciences, 0302 clinical medicine, Clinical Trials, Phase II as Topic, Randomized controlled trial, Adjuvants, Immunologic, prevention, law, Neoplasms, Medicine, Humans, Clinical significance, caner, Intensive care medicine, Special Report, Randomized Controlled Trials as Topic, business.industry, SARS-CoV-2, Cancer, COVID-19, General Medicine, Vaccine efficacy, medicine.disease, vaccination, COVID-19 Drug Treatment, Vaccination, 030104 developmental biology, Oncology, Research Design, 030220 oncology & carcinogenesis, prophylaxis, business, cancer patients
Abstract

We presented the rationale for the use of thymosin α1 as prophylaxis of severe COVID-19 in cancer patients undergoing active treatment, constituting the background for the PROTHYMOS study, a prospective, multicenter, open-label, Phase II randomized study, currently in its start-up phase (Eudract no. 2020-006020-13). We aim to offer new hope for this incurable disease, especially to frail patient population, such as patients with cancer. The hypothesis of an effective prophylactic approach to COVID-19 would have immediate clinical relevance, especially given the lack of curative approaches. Moreover, in the ‘COVID-19 vaccine race era’ both clinical and biological results coming from the PROTHYMOS trials could even support the rationale for future combinatorial approaches, trying to rise vaccine efficacy in frail individuals., Lay abstract We present scientific evidence in favor of using a drug (thymosin-α1) that modulates the immune system functions to try and prevent severe COVID-19 in cancer patients who are currently receiving anticancer treatment. Thymosin-α1 is produced normally by the body in the thymus, which is present in children but not in adults. Given the better outcomes of SARS-CoV-2 infections in children, we thought that thymosin-α1 could help to protect adults from severe infections as well. In this review, we explain some scientific evidence and the background of our clinical trial, PROTHYMOS, which is investigating this preventive treatment. Our aim is to offer a new hope to these at-risk cancer patients, particularly for the elderly who are at most risk of developing severe COVID-19. Given the lack of approaches that can provide cures to COVID-19, any possibility to prevent severe infection should be explored.

Published
2021

38. Effects of the COVID-19 Epidemic on Hospital Admissions for Non-Communicable Diseases in a Large Italian University-Hospital: A Descriptive Case-Series Study

Author

Mário J. Silva, Giuseppe Maglietta, Caterina Caminiti, Tiziana Meschi, Nicola Sverzellati, and Andrea Ticinesi

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), hospital admissions, lcsh:Medicine, 030204 cardiovascular system & hematology, Article, coronavirus infection, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, medicine, 030212 general & internal medicine, Myocardial infarction, Prospective cohort study, business.industry, Mortality rate, lcsh:R, COVID-19, General Medicine, University hospital, medicine.disease, non-communicable diseases, Collateral damage, epidemiology, business, Demography, Case series
Abstract

Background: Concern is growing about the negative consequences that response measures to the COVID-19 epidemic may have on the management of other medical conditions. Methods: A retrospective descriptive case-series study conducted at a large University-hospital in northern Italy, an area severely hit by the epidemic. Results: Between 23 February and 14 May 2020, 4160 (52%) COVID-19 and 3778 (48%) non-COVID-19 patients were hospitalized. COVID-19 admissions peaked in the second half of March, a period characterized by an extremely high mortality rate (27.4%). The number of admissions in 2020 was similar to 2019, but COVID-19 patients gradually occupied all available beds. Comparison between COVID-19 and non-COVID-19 admissions in 2020 revealed significant differences concerning all age classes and gender. Specifically, COVID-19 patients were older, predominantly male, and exhibited more comorbidities. Overall, admissions for non-communicable diseases (NCDs) in 2020 vs. 2019 dropped by approximately one third. Statistically significant reductions were observed for acute myocardial infarction (−78, −33.9%), cerebrovascular disease (−235, −41.5%), and cancer (−368, −31.9%). While the first two appeared equally distributed between COVID-19 and non-COVID-19 patients, chronic NCDs were statistically significantly more frequent in the former, except cancer, which was less frequent in COVID-19 patients. Conclusions: Prevention of collateral damage to patients with other diseases should be an integral part of epidemic response plans. Prospective cohort studies are needed to understand the long-term impact.

Published
2021

39. The Gut-Muscle Axis in Older Subjects with Low Muscle Mass and Performance: A Proof of Concept Study Exploring Fecal Microbiota Composition and Function with Shotgun Metagenomics Sequencing

Author

Marcello Maggio, Leonardo Mancabelli, Antonio Nouvenne, Marco Ventura, Fulvio Lauretani, Sara Tagliaferri, Christian Milani, Andrea Ticinesi, Daniele Del Rio, and Tiziana Meschi

Subjects
0301 basic medicine, Male, Aging, Sarcopenia, Anabolism, Faecalibacterium prausnitzii, Gut flora, lcsh:Chemistry, Feces, 0302 clinical medicine, lcsh:QH301-705.5, Spectroscopy, Genetics, Aged, 80 and over, Clostridiales, biology, General Medicine, Computer Science Applications, Female, Metabolic Networks and Pathways, 030209 endocrinology & metabolism, frailty, Catalysis, Article, Inorganic Chemistry, 03 medical and health sciences, physical function, Roseburia inulinivorans, medicine, Humans, Physical and Theoretical Chemistry, Muscle, Skeletal, gut-muscle axis, Molecular Biology, Aged, Inflammation, geriatrics, gut microbiota, Bacteroidetes, Organic Chemistry, gut–muscle axis, biology.organism_classification, medicine.disease, Fatty Acids, Volatile, Alistipes shahii, Gastrointestinal Microbiome, Metabolic pathway, 030104 developmental biology, lcsh:Biology (General), lcsh:QD1-999, Metagenomics, Metagenome
Abstract

The gut microbiota could influence the pathophysiology of age-related sarcopenia through multiple mechanisms implying modulation of chronic inflammation and anabolic resistance. The aim of this study was to compare the fecal microbiota composition and functionality, assessed by shotgun metagenomics sequencing, between two groups of elderly outpatients, differing only for the presence of primary sarcopenia. Five sarcopenic elderly subjects and twelve non-sarcopenic controls, classified according to lower limb function and bioimpedance-derived skeletal muscle index, provided a stool sample, which was analyzed with shotgun metagenomics approaches, to determine the overall microbiota composition, the representation of bacteria at the species level, and the prediction of bacterial genes involved in functional metabolic pathways. Sarcopenic subjects displayed different fecal microbiota compositions at the species level, with significant depletion of two species known for their metabolic capacity of producing short-chain fatty acids (SCFAs), Faecalibacterium prausnitzii and Roseburia inulinivorans, and of Alistipes shahii. Additionally, their fecal metagenome had different representation of genes belonging to 108 metabolic pathways, namely, depletion of genes involved in SCFA synthesis, carotenoid and isoflavone biotransformation, and amino acid interconversion. These results support the hypothesis of an association between microbiota and sarcopenia, indicating novel possible mediators, whose clinical relevance should be investigated in future studies.

Published
2020

40. Lung Ultrasound in COVID-19 Pneumonia: Correlations with Chest CT on Hospital admission

Author

Tiziana Meschi, Marco Davìd Zani, Gianluca Milanese, Alberto Parise, Antonio Nouvenne, Marco Baciarello, Elena Bignami, Anna Odone, Nicola Sverzellati, and Andrea Ticinesi

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Point-of-care testing, Pneumonia, Viral, Chest ct, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Thoracic ultrasonography, Correlation of Data, Lung, Pandemics, Ultrasonography, business.industry, Diagnostic Tests, Routine, SARS-CoV-2, Ultrasound, COVID-19, Reproducibility of Results, Middle Aged, medicine.disease, Lung ultrasound, Pneumonia, 030228 respiratory system, Italy, Point-of-Care Testing, Hospital admission, Female, Radiology, business, Coronavirus Infections, Tomography, X-Ray Computed, Editorial Comment
Abstract

Background: Lung ultrasound (LUS) is an accurate, safe, and cheap tool assisting in the diagnosis of several acute respiratory diseases. The diagnostic value of LUS in the workup of coronavirus disease-19 (COVID-19) in the hospital setting is still uncertain. Objectives: The aim of this observational study was to explore correlations of the LUS appearance of COVID-19-related pneumonia with CT findings. Methods: Twenty-six patients (14 males, age 64 ± 16 years) urgently hospitalized for COVID-19 pneumonia, who underwent chest CT and bedside LUS on the day of admission, were enrolled in this observational study. CT images were reviewed by expert chest radiologists, who calculated a visual CT score based on extension and distribution of ground-glass opacities and consolidations. LUS was performed by clinicians with certified competency in thoracic ultrasonography, blind to CT findings, following a systematic approach recommended by ultrasound guidelines. LUS score was calculated according to presence, distribution, and severity of abnormalities. Results: All participants had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 43 ± 24%. LUS identified 4 different possible ­abnormalities, with bilateral distribution (average LUS score 15 ± 5): focal areas of nonconfluent B lines, diffuse confluent B lines, small subpleural microconsolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (r = 0.65, p < 0.001) and oxygen saturation in room air (r = –0.66, p < 0.001). Conclusion: When integrated with clinical data, LUS could represent a valid diagnostic aid in patients with suspect COVID-19 pneumonia, which reflects CT findings.

Published
2020

41. Reorganization of a large academic hospital to face COVID‐19 outbreak: The model of Parma, Emilia‐Romagna region, Italy

Author

Nicola Sverzellati, Andrea Ticinesi, Ettore Brianti, Tiziana Meschi, Antonio Nouvenne, Sandra Rossi, Massimo Fabi, Carlo Ferrari, and Annalisa Volpi

Subjects
hospital organization, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, Clinical Biochemistry, Biochemistry, SARS‐CoV‐2, Disease Outbreaks, Workflow, Hospitals, University, care algorithm, pneumonia, Humans, Medicine, Bed Conversion, Letters to the Editor, Socioeconomics, Letter to the Editor, Pandemics, Radiology Department, Hospital, business.industry, COVID-19, Outbreak, General Medicine, Hospitalization, Intensive Care Units, Tomography x ray computed, Italy, Hospital Bed Capacity, Public Health, Triage, Coronavirus Infections, Emergency Service, Hospital, Tomography, X-Ray Computed, business, Hospital Units
Published
2020

42. Muscle weakness, cognitive impairment and their interaction on altered balance in elderly outpatients: results from the TRIP observational study

Author

Luciano Gionti, Tiziana Meschi, Marcello Maggio, Andrea Ticinesi, Claudio Tana, Beatrice Prati, Antonio Nouvenne, and Fulvio Lauretani

Subjects
Male, medicine.medical_specialty, Frail Elderly, malnutrition, Affect (psychology), 03 medical and health sciences, Grip strength, 0302 clinical medicine, Humans, Medicine, Cognitive Dysfunction, 030212 general & internal medicine, Cognitive impairment, Geriatric Assessment, Postural Balance, Original Research, cognitive impairment, Aged, Balance (ability), Aged, 80 and over, Muscle Weakness, business.industry, Muscle weakness, balance, General Medicine, medicine.disease, Malnutrition, Cross-Sectional Studies, Nutrition Assessment, Clinical Interventions in Aging, Test score, muscle strength, older persons, Physical therapy, Female, Observational study, Geriatrics and Gerontology, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Fulvio Lauretani,1,2 Marcello Maggio,1,2 Andrea Ticinesi,1,2 Claudio Tana,1,2 Beatrice Prati,1,2 Luciano Gionti,1,2 Antonio Nouvenne,1,2 Tiziana Meschi1,2 1Department of Medicine and Surgery, University of Parma, Parma, Italy; 2Internal Medicine and Critical Subacute Care Unit, Geriatric Rehabilitation Department, University Hospital of Parma, Parma, Italy Background: The determinants of altered balance in older subjects and, particularly, the contribution of muscle strength and cognitive impairment are still uncertain. We hypothesized that both these conditions and their interactions could affect balance in older persons. To address this hypothesis, we studied the cross-sectional association between handgrip strength and balance performance in subjects with and without cognitive impairment. Methods: Two hundred and sixty-three elderly outpatients (104 men and 159 women, aged 81.44 ± 7.36years) were evaluated for the comprehensive geriatric assessment. The patients were enrolled from the cross-sectional observational Traumatic Risk Identikit Parma study that was aimed at identifying risk factors for falling in older outpatients. Results: Balance deficit, defined as an inability to maintain tandem position for at least 10seconds, was present in 185 patients (70.34%). The mean mini-mental state examination score was 20.79 ± 6.5, the median short physical performance battery score was 5.0 and the mean grip strength was 18.54 ± 9.14 kg. After dividing the subjects into four categories according to the presence of low grip strength and/or cognitive impairment, we found that the mini nutritional assessment short-form scale score was negatively and independently (β: -0.02 ± 0.01; p=0.04) associated with balance deficit in the group with low grip strength and cognitive impairment. In the other three categories, grip strength was negatively and significantly associated with balance deficit. Conclusion: The loss of muscle strength, presence of cognitive impairment and their interaction, influenced probably by malnutrition, could affect balance in older persons. Keywords: muscle strength, cognitive impairment, balance, malnutrition, older persons

Published
2018

43. Prognostic relevance of glomerular filtration rate estimation obtained through different equations in hospitalized elderly patients

Author

Gallo, Paolo, De Vincentis, Antonio, Pedone, Claudio, Nobili, Alessandro, Tettamanti, Mauro, Gentilucci, Umberto Vespasiani, Picardi, Antonio, Mannucci, Pier Mannuccio, Incalzi, Raffaele Antonelli, Prisco, Domenico, Silvestri, Elena, Emmi, Giacomo, Bettiol, Alessandra, Caterina, Cenci, Biolo, Gianni, Zanetti, Michela, Guadagni, Martina, Zaccari, Michele, Chiuch, Massimiliano, Vanoli, Massimo, Grignani, Giulia, Pulixi, Edoardo Alessandro, Bernardi, Mauro, Bassi, Silvia Li, Santi, Luca, Zaccherini, Giacomo, Lupattelli, Graziana, Mannarino, Elmo, Bianconi, Vanessa, Paciullo, Francesco, Alcidi, Riccardo, Nuti, Ranuccio, Valenti, Roberto, Ruvio, Martina, Cappelli, Silvia, Palazzuoli, Alberto, Girelli, Domenico, Busti, Fabiana, Marchi, Giacomo, Barbagallo, Mario, Dominguez, Ligia, Cocita, Floriana, Beneduce, Vincenza, Plances, Lidia, Corrao, Salvatore, Natoli, Giuseppe, Mularo, Salvatore, Raspanti, Massimo, Cavallaro, Federica, Zoli, Marco, Lazzari, Ilaria, Brunori, Mattia, Fabbri, Elisa, Magalotti, Donatella, Arno, Raffaella, Pasini, Franco Laghi, Capecchi, Pier Leopoldo, Palasciano, Giuseppe, Modeo, Maria Ester, Di Gennaro, Carla, Cappellini, Maria Domenica, Maira, Diletta, Di Stefano, Valeria, Fabio, Giovanna, Seghezzi, Sonia, Mancarella, Marta, De Amicis, Margherita Migone, De Luca, Giacomo, Scaramellini, Natalia, Cesari, Matteo, Rossi, Paolo Dionigi, Damanti, Sarah, Clerici, Marta, Conti, Federica, Bonini, Giulia, Ottolini, Barbara Brignolo, Di Sabatino, Antonio, Miceli, Emanuela, Lenti, Marco Vincenzo, Pisati, Martina, Dominioni, Costanza Caccia, Murialdo, Giovanni, Marra, Alessio, Cattaneo, Federico, Pontremoli, Roberto, Beccati, Valentina, Nobili, Giulia, Secchi, Maria Beatrice, Ghelfi, Davide, Anastasio, Luigi, Sofia, Lucia, Carbone, Maria, Cipollone, Francesco, Guagnano, Maria Teresa, Valeriani, Emanuele, Rossi, Ilaria, Mancuso, Gerardo, Calipari, Daniela, Bartone, Mose, Delitala, Giuseppe, Berria, Maria, Pes, Chiara, Delitala, Alessandro, Muscaritoli, Maurizio, Molfino, Alessio, Petrillo, Enrico, Zuccala, Giuseppe, D'Aurizio, Gabriella, Romanelli, Giuseppe, Marengoni, Alessandra, Zucchelli, Alberto, Manzoni, Francesca, Volpini, Andrea, Dell'Unto, Chiara, Annoni, Giorgio, Corsi, Maurizio, Bellelli, Giuseppe, Zazzetta, Sara, Mazzola, Paolo, Szabo, Hajnalka, Bonfanti, Alessandra, Arturi, Franco, Succurro, Elena, Rubino, Mariangela, Tassone, Bruno, Sesti, Giorgio, Serra, Maria Grazia, Bleve, Maria Antonietta, Gasbarrone, Laura, Sajeva, Maria Rosaria, Brucato, Antonio, Ghidoni, Silvia, Fabris, Fabrizio, Bertozzi, Irene, Bogoni, Giulia, Rabuini, Maria Victoria, Cosi, Elisabetta, Scarinzi, Paolo, Amabile, Annalisa, Omenetto, Elisabetta, Prandini, Tancredi, Manfredini, Roberto, Fabbian, Fabio, Boari, Benedetta, De Giorgi, Alfredo, Tiseo, Ruana, De Giorgio, Roberto, Paolisso, Giuseppe, Rizzo, Maria Rosaria, Borghi, Claudio, Strocchi, Enrico, Ianniello, Eugenia, Soldati, Mario, Sabba, Carlo, Vella, Francesco Saverio, Suppressa, Patrizia, Agosti, Pasquale, Schilardi, Andrea, Loparco, Francesca, De Vincenzo, Giovanni Michele, Comitangelo, Alessio, Amoruso, Emanuele, Fenoglio, Luigi, Falcetta, Andrea, Bracco, Christian, Fracanzani, Anna L., Fargion, Silvia, Tiraboschi, Silvia, Cespiati, Annalisa, Oberti, Giovanna, Sigon, Giordano, Peyvandi, Flora, Rossio, Raffaella, Ferrari, Barbara, Colombo, Giulia, Monzani, Valter, Savojardo, Valeria, Folli, Christian, Ceriani, Giuliana, Salerno, Francesco, Pallini, Giada, Dallegri, Franco, Ottonello, Luciano, Liberale, Luca, Caserza, Lara, Salam, Kassem, Liberato, Nicola Lucio, Tognin, Tiziana, Bianchi, Giovanni Battista, Giaquinto, Sabrina, Purrello, Francesco, Di Pino, Antonino, Piro, Salvatore, Rozzini, Renzo, Falanga, Lina, Spazzini, Elena, Ferrandina, Camillo, Montrucchio, Giuseppe, Petitti, Paolo, Peasso, Paolo, Favale, Edoardo, Poletto, Cesare, Salmi, Raffaella, Gaudenzi, Piergiorgio, Violi, Francesco, Perri, Ludovica, Landolfi, Raffaele, Montalto, Massimo, Mirijello, Antonio, Guasti, Luigina, Castiglioni, Luana, Maresca, Andrea, Squizzato, Alessandro, Campiotti, Leonardo, Grossi, Alessandra, Bertolotti, Marco, Mussi, Chiara, Lancellotti, Giulia, Libbra, Maria Vittoria, Dondi, Giulia, Pellegrini, Elisa, Carulli, Lucia, Galassi, Matteo, Grassi, Yasmine, Perticone, Francesco, Perticone, Maria, Battaglia, Rosa, Filice, Marco, Maio, Raffaele, Stanghellini, Vincenzo, Ruggeri, Eugenio, del Vecchio, Sara, Salvi, Andrea, Leonardi, Roberto, Damiani, Giampaolo, Capeci, William, Gabrielli, Armando, Mattioli, Massimo, Martino, Giuseppe Pio, Biondi, Lorenzo, Pettinari, Pietro, Ghio, Riccardo, Dal Col, Anna, Minisola, Salvatore, Colangelo, Luciano, Cilli, Mirella, Labbadia, Giancarlo, Afeltra, Antonella, Marigliano, Benedetta, Pipita, Maria Elena, Castellino, Pietro, Zanoli, Luca, Pignataro, Samuele, Gennaro, Alfio, Blanco, Julien, Saracco, Valter, Fogliati, Marisa, Bussolino, Carlo, Mete, Francesca, Gino, Miriam, Cittadini, Antonio, Vigorito, Carlo, Arcopinto, Michele, Salzano, Andrea, Bobbio, Emanuele, Marra, Alberto Maria, Sirico, Domenico, Moreo, Guido, Gasparini, Francesca, Prolo, Silvia, Pina, Gloria, Ballestrero, Alberto, Ferrando, Fabio, Berra, Sergio, Dassi, Simonetta, Nava, Maria Cristina, Graziella, Bruno, Baldassarre, Stefano, Fragapani, Salvatore, Gruden, Gabriella, Galanti, Giorgio, Mascherini, Gabriele, Petri, Cristian, Stefani, Laura, Girino, Margherita, Piccinelli, Valeria, Nasso, Francesco, Gioffre, Vincenza, Pasquale, Maria, Scattolin, Giuseppe, Martinelli, Sergio, Turrin, Mauro, Sechi, Leonardo, Catena, Cristina, Colussi, Gianluca, Passariello, Nicola, Rinaldi, Luca, Berti, Franco, Famularo, Giuseppe, Tarsitani, Patrizia, Castello, Roberto, Pasino, Michela, Ceda, Gian Paolo, Maggio, Marcello Giuseppe, Morganti, Simonetta, Artoni, Andrea, Del Giacco, Stefano, Firinu, Davide, Losa, Francesca, Paoletti, Giovanni, Costanzo, Giulia, Montalto, Giuseppe, Licata, Anna, Malerba, Valentina, Montalto, Filippo Alessandro, Lasco, Antonino, Basile, Giorgio, Catalano, Antonino, Malatino, Lorenzo, Stancanelli, Benedetta, Terranova, Valentina, Di Marca, Salvatore, Di Quattro, Rosario, La Malfa, Lara, Caruso, Rossella, Mecocci, Patrizia, Ruggiero, Carmelinda, Boccardi, Virginia, Meschi, Tiziana, Lauretani, Fulvio, Ticinesi, Andrea, Nouvenne, Antonio, Minuz, Pietro, Fondrieschi, Luigi, Pirisi, Mario, Fra, Gian Paolo, Sola, Daniele, Porta, Massimo, Riva, Piero, Quadri, Roberto, Larovere, Erica, Novelli, Marco, Scanzi, Giorgio, Mengoli, Caterina, Provini, Stella, Ricevuti, Laura, Simeone, Emilio, Scurti, Rosa, Tolloso, Fabio, Tarquini, Roberto, Valoriani, Alice, Dolenti, Silvia, Vannini, Giulia, Tedeschi, Alberto, Trotta, Lucia, Volpi, Riccardo, Bocchi, Pietro, Vignali, Alessandro, Harari, Sergio, Lonati, Chiara, Cattaneo, Mara, Duque Nieves, Ramirez, Molinero Alberto, Muela, Requejo Pedro, Abad, Pelaez Vanessa, Lopez, Lara, Tamargo, Viros Xavier, Corbella, Francesc, Formiga, Manglano Jesus, Diez, Tello Esperanza, Bejarano, Behamonte Esther, Del Corral, Puras Maria, Sevil, Romero, Manuel, Llorente Blanca, Pinilla, Gonzalez-Cobos Cristina, Lopez, Victoria, Villalba Garcia M., Saez, Lopez, Bosco, Juan, Baena Susana, Sanz, Gallego Marta, Arroyo, Becerra Concepcion, Gonzalez, Moyano Antonio, Fernandez, Gomez Hernandez, Mercedes, Poyato Borrego, Manuel, Cuadros Raquel, Pacheco, Rojas Florencia, Perez, Olid Beatriz, Garcia, Garcia Sara, Carrascosa, Cervellera Alfonso, Gonzalez-Cruz, Martinez Marta, Peinado, Cantero Alberto, Ruiz, Arraigosa Antonio, Albarracin, Guerrero Montserrat, Godoy, Miguel Angel, Baron Ramos, Jose Manuel, Machin, Veleiro Ignacio, Novo, Suarez Lucia, Alvela, Alfonso, Lopez, Bran David, Rubal, Vazquez Iria, Iniguez, and Prego Monica, Rios

Subjects
Male, medicine.medical_specialty, Population, Socio-culturale, Renal function, Disease, 030204 cardiovascular system & hematology, Elderly in-patients, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, Acute care, Epidemiology, eGFR, 80 and over, Internal Medicine, medicine, Humans, Renal Insufficiency, Hospital Mortality, 030212 general & internal medicine, Renal Insufficiency, Chronic, Chronic, education, Glomerular filtration rate estimation, Aged, Aged, 80 and over, Estimation, Creatinine, education.field_of_study, business.industry, Prognosis, Female, Italy, Glomerular Filtration Rate, Hospitalization, medicine.disease, Elderly in-patients, Glomerular filtration rate estimation, Prognosis, eGFR, chemistry, business, Kidney disease
Abstract

The estimated glomerular filtration rate (eGFR) is a predictor of important outcomes and its reduction has been associated with the risk of all-cause mortality in both general population and elderly patients. However while reduced renal function is common in older people, the best method for estimating GFR remains unclear, especially in an acute care setting. Most studies analyzing the accuracy of eGFR in the elderly were carried out in different heterogeneous settings. In this study, we compare the prognostic value of different formulas estimating GFR in predicting the risk of in-hospital morbidity and mortality within 3 months from discharge in elderly hospitalized patients. Data were extracted from “Registro Politerapia Societa Italiana di Medicina Interna (REPOSI)”. Patients with available creatinine values at hospital admission were selected and eGFR was calculated according to the different formulas: Cockcroft-Gault, Modification of Diet in Renal Disease equation, Chronic Kidney Disease Epidemiology Collaboration, Berlin Initiative Study and Full Age Spectrum. 4621 patients were included in the analysis. Among these, 4.2% and 14.2% died during hospitalization and within 3 months from discharge, respectively. eGFR > 60 ml/min/1.73 m2 at admission was associated with a very low risk of mortality during the hospital stay and within 90 days from discharge, while an eGFR

Published
2018

44. Management of hyperuricemia and gout in obese patients undergoing bariatric surgery

Author

Tiziana Meschi, Fabrizio Ricci, Francesco Cipollone, Roberto Vettor, Claudio Tana, Andrea Ticinesi, Luca Busetto, Angelo Di Vincenzo, Antonio Nouvenne, Fulvio Lauretani, and Maria Adele Giamberardino

Subjects
Male, musculoskeletal diseases, obesity, congenital, hereditary, and neonatal diseases and abnormalities, Pediatrics, medicine.medical_specialty, Gout, Bariatric Surgery, Hyperuricemia, Overweight, metabolic syndrome, 03 medical and health sciences, 0302 clinical medicine, Patient Education as Topic, medicine, bariatric surgery, gout, Medicine (all), Humans, 030212 general & internal medicine, 030203 arthritis & rheumatology, business.industry, nutritional and metabolic diseases, General Medicine, medicine.disease, Obesity, Obesity, Morbid, Treatment Outcome, Female, medicine.symptom, Metabolic syndrome, business, Developed country
Abstract

Hyperuricemia and gout represent important issues in the obese patients. Considering the epidemic trend of overweight and obesity in developed countries, the impact of these conditions is likely to increase. At present, bariatric surgery represents the most effective treatment for the management of severe obesity for reducing weight and the impact of associated comorbidities, but its effects on hyperuricemia and gout have not been fully elucidated.In this narrative review, we discuss the current knowledge about hyperuricemia and gout in obese patients undergoing bariatric surgery. We also suggest a useful approach to prevent gouty attacks in the perioperative period.Weight loss seems to reduce hyperuricemia in the long-term follow-up, but there is evidence also of a high frequency of acute attacks early after surgery in patients with a diagnosis of gout.Bariatric surgery has a high impact on hyperuricemia and gout. A perioperative approach is suggested, based on appropriate hydration, early physical resumption, urate lowering drugs and nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine and corticosteroids if NSAIDs are ineffective or not tolerated.

Published
2018

45. Gut microbiome and kidney stone disease: not just an Oxalobacter story

Author

Tiziana Meschi, Antonio Nouvenne, and Andrea Ticinesi

Subjects
0301 basic medicine, biology, Oxalobacter, 030232 urology & nephrology, biology.organism_classification, medicine.disease, Intervention studies, Gut microbiome, Microbiology, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Oxalobacter formigenes, Nephrology, Metagenomics, Kidney stone disease, medicine, Stone formers
Abstract

Intestinal regulation of oxalate absorption is a complex mechanism, not exclusively reliant on the oxalate-degrading anaerobe Oxalobacter formigenes. Using metagenomics, Miller et al. were able to describe a network of bacterial taxa co-occurring with Oxalobacter formigenes in fecal samples from non–stone forming controls and less represented in stone formers. These findings may help to illuminate why previous intervention studies with probiotics have failed to reduce the risk of hyperoxaluria, opening new possibilities for future research.

Published
2019

46. 'Brain-muscle loop' in the fragility of older persons: from pathophysiology to new organizing models

Author

Marcello Maggio, Andrea Ticinesi, Tiziana Meschi, and Fulvio Lauretani

Subjects
Male, Gerontology, Sarcopenia, Aging, medicine.medical_specialty, Poison control, Fear of falling, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, Injury prevention, medicine, Humans, Cognitive Dysfunction, 030212 general & internal medicine, Cognitive decline, Gait, Geriatric Assessment, Aged, Aged, 80 and over, Geriatrics, Frailty, Brain, Cognition, medicine.disease, Quality of Life, Accidental Falls, Female, Geriatrics and Gerontology, medicine.symptom, Psychology, 030217 neurology & neurosurgery
Abstract

The imperative action of the geriatric medicine is to prevent disability in older persons. Many epidemiological studies have been conducted in the last decades for improving knowledge of the aging process and their interactions with age-related diseases, especially for the identification of the relationship between sarcopenia and loss of mobility. Factors influencing muscle integrity can be classified into six main physiologic subsystems, but the central nervous system certainly plays a crucial role for maintaining muscle integrity in older persons. Recent data show that the reduced muscle strength and not muscle mass could be considered the core of the fragility in predicting changes of gait velocity and mobility and conferring a higher risk of mortality in older persons. Sarcopenia and cognitive decline could, therefore, produce slow gait velocity in older persons, with devastating effect and consequences. Perhaps the most notorious corollary is falling, which is often caused by an underlying gait problem. Injuries caused by accidental falls range from relatively innocent bruises to major fractures or head trauma. Another important consequence is reduced mobility, which leads to loss of independence. This immobility is often compounded by a fear of falling, which further immobilises patients and affects their quality of life and physical performance. When we search the association between brain pathology and muscle function in older persons, we amazingly find that established composite measure of physical frailty is associated with brain pathology. Sarcopenia, which produces muscle dysfunction, slow gait velocity and cognitive decline, could share a strong bidirectional relationship, and this suggests the coexistence of both cognitive and motor dysfunctions in older persons to characterize a new syndrome characterized by slow gait and cognitive complaints, the motoric-cognitive risk syndrome (MRC). In this review, we want to emphasize the relationship between memory complaints with muscle function integrating cognitive and physical evaluation, even with amyloid PET study, to identify older patients at high risk of cognitive and physical decline.

Published
2017

47. Water and other fluids in nephrolithiasis: State of the art and future challenges

Author

Tiziana Meschi, Antonio Nouvenne, Andrea Ticinesi, and Loris Borghi

Subjects
medicine.medical_specialty, Urinary stone, 030232 urology & nephrology, Nephrolithiasis, Industrial and Manufacturing Engineering, law.invention, Scientific evidence, Beverages, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Recurrence, Risk Factors, law, Water therapy, Prevalence, medicine, Humans, 030212 general & internal medicine, Medical prescription, Intensive care medicine, Randomized Controlled Trials as Topic, Urinary volume, business.industry, Drinking Water, General Medicine, medicine.disease, Surgery, Fluid Therapy, Kidney stones, Stone formers, business, Food Science
Abstract

Adequate hydration, as to maintain urinary volume over 2 L/day, has long been considered as the cornerstone medical prescription for preventing nephrolithiasis. However, scientific evidence about what kind of water stone formers should drink and about the effects of other beverages on urinary stone risk factors is sometimes unclear. Moreover, the recommendation that water therapy prevents kidney stone recurrence relies on only one randomized controlled trial, even if more epidemiologic and basic science studies seem to support this assumption. Therefore, in this review we analyze current evidence that support water therapy in nephrolithiasis and we highlight the possible effects of different types of water and other beverages on lithogenic risk, giving some practical recommendations for what stone formers should be advised to prevent recurrence.

Published
2016

48. Gut Microbiota and Microbiota-Related Metabolites as Possible Biomarkers of Cognitive Aging

Author

Andrea, Ticinesi, Antonio, Nouvenne, Claudio, Tana, Beatrice, Prati, and Tiziana, Meschi

Subjects
Feces, Cognitive Aging, Microbiota, Animals, Humans, Biomarkers, Gastrointestinal Microbiome
Abstract

Gut microbiota composition and functionality can influence the pathophysiology of age-related cognitive impairment and dementia, according to a large number of animal studies. The translation of this concept to humans is still uncertain, due to the relatively low number of clinical studies focused on fecal microbiota and large number of environmental factors that influence the microbiota composition. However, the fecal microbiota composition of older patients with dementia is deeply different from that of healthy active controls, conditioning a different metabolic profile. The possible use of fecal microbiota-related parameters and microbiota-derived metabolites as biomarkers of cognitive performance and dementia is critically reviewed in this paper, focusing on the most promising areas of research for the future.

Published
2019

49. The Urinary Microbiome and Anticancer Immunotherapy: The Potentially Hidden Role of Unculturable Microbes

Author

Andrea Ticinesi, Sebastiano Buti, Matteo Santoni, and Melissa Bersanelli

Subjects
0301 basic medicine, Cancer Research, Bacteriuria, Urinary system, Urinary incontinence, Context (language use), Gut flora, 03 medical and health sciences, 0302 clinical medicine, Antineoplastic Agents, Immunological, Lactobacillus, Neoplasms, medicine, Humans, Pharmacology (medical), Microbiome, Urinary Tract, biology, business.industry, Microbiota, Interstitial cystitis, Cell Cycle Checkpoints, biology.organism_classification, medicine.disease, 030104 developmental biology, Oncology, Overactive bladder, 030220 oncology & carcinogenesis, Immunology, Immunotherapy, medicine.symptom, business, Biomarkers
Abstract

Several urinary disorders, including overactive bladder, urinary incontinence, and interstitial cystitis, are often characterized by negative urine cultures. The application of metagenomics (i.e., 16S rRNA microbial profiling or whole-genome shotgun sequencing) to urine samples has enabled the identification of previously undetected bacteria, contributing to the discovery and characterization of the urinary microbiome. The most frequent species isolated are Lactobacillus (15%), Corynebacterium (14.2%), Streptococcus (11.9%), Actinomyces (6.9%), and Staphylococcus (6.9%). Although several studies are emerging in this context, the role of urinary microbiota in the pathogenesis of infections and in tumor carcinogenesis remains unclear. Furthermore, data on the activity of gut microbiota in modulating sensitivity to immune checkpoint inhibitors in advanced cancer patients suggest that the influence of urinary microbiota on tumor response to anticancer therapy should also be investigated. Moreover, its possible relationship with tumor mutational burden, which is in turn correlated with response to immunotherapy, should be the focus of future studies. Of note, the effect of antibiotics on this complex scenario seems to deserve careful consideration.

Published
2019

50. Use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease in hospitalized older people

Author

Carlotta, Franchi, Pier Mannuccio Mannucci, Alessandro, Nobili, Ilaria, Ardoino, Domenico, Prisco, Elena, Silvestri, Giacomo, Emmi, Alessandra, Bettiol, Cenci, Caterina, Gianni, Biolo, Michela, Zanetti, Martina, Guadagni, Michele, Zaccari, Massimiliano, Chiuch, Massimo, Vanoli, Giulia, Grignani, Edoardo Alessandro Pulixi, Mauro, Bernardi, Silvia Li Bassi, Luca, Santi, Giacomo, Zaccherini, Graziana, Lupattelli, Elmo, Mannarino, Vanessa, Bianconi, Francesco, Paciullo, Riccardo, Alcidi, Ranuccio, Nuti, Roberto, Valenti, Martina, Ruvio, Silvia, Cappelli, Alberto, Palazzuoli, Domenico, Girelli, Fabiana, Busti, Giacomo, Marchi, Mario, Barbagallo, Ligia, Dominguez, Floriana, Cocita, Vincenza, Beneduce, Lidia, Plances, Salvatore, Corrao, Giuseppe, Natoli, Salvatore, Mularo, Massimo, Raspanti, Federica, Cavallaro, Marco, Zoli, Ilaria, Lazzari, Mattia, Brunori, Elisa, Fabbri, Donatella, Magalotti, Raffaella, Arnò, Franco Laghi Pasini, Pier Leopoldo Capecchi, Giuseppe, Palasciano, Maria Ester Modeo, Carla Di Gennaro, Maria Domenica Cappellini, Diletta, Maira, Valeria Di Stefano, Giovanna, Fabio, Sonia, Seghezzi, Marta, Mancarella, Margherita Migone De Amicis, Giacomo De Luca, Natalia, Scaramellini, Matteo, Cesari, Paolo Dionigi Rossi, Sarah, Damanti, Marta, Clerici, Federica, Conti, Giulia, Bonini, Barbara Brignolo Ottolini, Antonio Di Sabatino, Emanuela, Miceli, Marco Vincenzo Lenti, Martina, Pisati, Costanza Caccia Dominioni, Giovanni, Murialdo, Alessio, Marra, Federico, Cattaneo, Roberto, Pontremoli, Valentina, Beccati, Giulia, Nobili, Maria Beatrice Secchi, Davide, Ghelfi, Luigi, Anastasio, Lucia, Sofia, Maria, Carbone, Francesco, Cipollone, Maria Teresa Guagnano, Emanuele, Valeriani, Ilaria, Rossi, Gerardo, Mancuso, Daniela, Calipari, Mosè, Bartone, Giuseppe, Delitala, Maria, Berria, Chiara, Pes, Alessandro, Delitala, Maurizio, Muscaritoli, Alessio, Molfino, Enrico, Petrillo, Giuseppe, Zuccalà, Gabriella, D’Aurizio, Giuseppe, Romanelli, Alessandra, Marengoni, Alberto, Zucchelli, Francesca, Manzoni, Andrea, Volpini, Antonio, Picardi, Umberto Vespasiani Gentilucci, Paolo, Gallo, Chiara, Dell’Unto, Giorgio, Annoni, Maurizio, Corsi, Giuseppe, Bellelli, Sara, Zazzetta, Paolo, Mazzola, Hajnalka, Szabo, Alessandra, Bonfanti, Franco, Arturi, Elena, Succurro, Mariangela, Rubino, Bruno, Tassone, Giorgio, Sesti, Maria Grazia Serra, Maria Antonietta Bleve, Laura, Gasbarrone, Maria Rosaria Sajeva, Antonio, Brucato, Silvia, Ghidoni, Fabrizio, Fabris, Irene, Bertozzi, Giulia, Bogoni, Maria Victoria Rabuini, Elisabetta, Cosi, Paolo, Scarinzi, Annalisa, Amabile, Elisabetta, Omenetto, Tancredi, Prandini, Manfredini, Roberto, Fabbian, Fabio, Benedetta, Boari, Alfredo De Giorgi, Ruana, Tiseo, DE GIORGIO, Roberto, Giuseppe, Paolisso, Maria Rosaria Rizzo, Claudio, Borghi, Enrico, Strocchi, Eugenia, Ianniello, Mario, Soldati, Carlo, Sabbà, Francesco Saverio Vella, Patrizia, Suppressa, Pasquale, Agosti, Andrea, Schilardi, Francesca, Loparco, Giovanni Michele De Vincenzo, Alessio, Comitangelo, Emanuele, Amoruso, Luigi, Fenoglio, Andrea, Falcetta, Christian, Bracco, Fracanzani Silvia Fargion, Anna L., Silvia, Tiraboschi, Annalisa, Cespiati, Giovanna, Oberti, Giordano, Sigon, Flora, Peyvandi, Raffaella, Rossio, Barbara, Ferrari, Giulia, Colombo, Valter, Monzani, Valeria, Savojardo, Christian, Folli, Giuliana, Ceriani, Francesco, Salerno, Giada, Pallini, Franco, Dallegri, Luciano, Ottonello, Luca, Liberale, Lara, Caserza, Kassem, Salam, Nicola Lucio Liberato, Tiziana, Tognin, Giovanni Battista Bianchi, Sabrina, Giaquinto, Francesco, Purrello, Antonino Di Pino, Salvatore, Piro, Renzo, Rozzini, Lina, Falanga, Elena, Spazzini, Camillo, Ferrandina, Giuseppe, Montrucchio, Paolo, Petitti, Paolo, Peasso, Edoardo, Favale, Cesare, Poletto, Raffaella, Salmi, Piergiorgio, Gaudenzi, Francesco, Violi, Ludovica, Perri, Raffaele, Landolfi, Massimo, Montalto, Antonio, Mirijello, Luigina, Guasti, Luana, Castiglioni, Andrea, Maresca, Alessandro, Squizzato, Leonardo, Campiotti, Alessandra, Grossi, Marco, Bertolotti, Chiara, Mussi, Giulia, Lancellotti, Maria Vittoria Libbra, Giulia, Dondi, Elisa, Pellegrini, Lucia, Carulli, Matteo, Galassi, Yasmine, Grassi, Francesco, Perticone, Maria, Perticone, Rosa, Battaglia, Marco, Filice, Raffaele, Maio, Vincenzo, Stanghellini, Eugenio, Ruggeri, Sara del Vecchio, Andrea, Salvi, Roberto, Leonardi, Giampaolo, Damiani, William, Capeci, Armando, Gabrielli, Massimo, Mattioli, Giuseppe Pio Martino, Lorenzo, Biondi, Pietro, Pettinari, Riccardo, Ghio, Anna Dal Col, Salvatore, Minisola, Luciano, Colangelo, Mirella, Cilli, Giancarlo, Labbadia, Antonella, Afeltra, Benedetta, Marigliano, Maria Elena Pipita, Pietro, Castellino, Luca, Zanoli, Samuele, Pignataro, Alfio, Gennaro, Julien, Blanco, Valter, Saracco, Marisa, Fogliati, Carlo, Bussolino, Francesca, Mete, Miriam, Gino, Antonio, Cittadini, Carlo, Vigorito, Michele, Arcopinto, Andrea, Salzano, Emanuele, Bobbio, Alberto Maria Marra, Domenico, Sirico, Guido, Moreo, Francesca, Gasparini, Silvia, Prolo, Gloria, Pina, Alberto, Ballestrero, Fabio, Ferrando, Sergio, Berra, Simonetta, Dassi, Maria Cristina Nava, Bruno, Graziella, Stefano, Baldassarre, Salvatore, Fragapani, Gabriella, Gruden, Giorgio, Galanti, Gabriele, Mascherini, Cristian, Petri, Laura, Stefani, Margherita, Girino, Valeria, Piccinelli, Francesco, Nasso, Vincenza, Gioffrè, Maria, Pasquale, Giuseppe, Scattolin, Sergio, Martinelli, Mauro, Turrin, Leonardo, Sechi, Cristina, Catena, Gianluca, Colussi, Nicola, Passariello, Luca, Rinaldi, Franco, Berti, Giuseppe, Famularo, Patrizia, Tarsitani, Roberto, Castello, Michela, Pasino, Gian Paolo Ceda, Marcello Giuseppe Maggio, Simonetta, Morganti, Andrea, Artoni, Stefano Del Giacco, Davide, Firinu, Francesca, Losa, Giovanni, Paoletti, Giulia, Costanzo, Giuseppe, Montalto, Anna, Licata, Valentina, Malerba, Filippo Alessandro Montalto, Antonino, Lasco, Giorgio, Basile, Antonino, Catalano, Lorenzo, Malatino, Benedetta, Stancanelli, Valentina, Terranova, Salvatore Di Marca, Rosario Di Quattro, Lara La Malfa, Rossella, Caruso, Patrizia, Mecocci, Carmelinda, Ruggiero, Virginia, Boccardi, Tiziana, Meschi, Fulvio, Lauretani, Andrea, Ticinesi, Antonio, Nouvenne, Pietro, Minuz, Luigi, Fondrieschi, Mario, Pirisi, Gian Paolo Fra, Daniele, Sola, Massimo, Porta, Piero, Riva, Roberto, Quadri, Erica, Larovere, Marco, Novelli, Giorgio, Scanzi, Caterina, Mengoli, Stella, Provini, Laura, Ricevuti, Emilio, Simeone, Rosa, Scurti, Fabio, Tolloso, Roberto, Tarquini, Alice, Valoriani, Silvia, Dolenti, Giulia, Vannini, Alberto, Tedeschi, Lucia, Trotta, Riccardo, Volpi, Pietro, Bocchi, Alessandro, Vignali, Sergio, Harari, Chiara, Lonati, Mara, Cattaneo, and Federico, Napoli.

Subjects
Drug, Male, medicine.medical_specialty, Peptic Ulcer, Appropriateness, Drug prescription, Hospital setting, Older people, Proton pump inhibitors, Prescription Drugs, Proton pump inhibitors, media_common.quotation_subject, Drug prescription, Socio-culturale, Context (language use), Inappropriate Prescribing, 030226 pharmacology & pharmacy, Drug Prescriptions, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Gastrooesophageal reflux disease, medicine, Prevalence, LS7_3, Humans, Pharmacology (medical), Appropriateness, 030212 general & internal medicine, Medical prescription, Reimbursement, media_common, Aged, Pharmacology, biology, business.industry, General Medicine, Helicobacter pylori, biology.organism_classification, medicine.disease, digestive system diseases, Drug Utilization, Patient Discharge, Hospitalization, Cross-Sectional Studies, Italy, Peptic ulcer, GERD, Gastroesophageal Reflux, Female, Hospital setting, Older people, business
Abstract

The aims of this study were to assess the prevalence of use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease (GERD) at hospital admission and discharge. Patients aged 65 years or more hospitalized from 2010 to 2016 in 101 Italian internal medicine and geriatric wards in the context of the REPOSI register were scrutinized to assess if they were prescribed with drugs for peptic ulcer and GERD at hospital admission and discharge. Appropriateness of prescription was assessed considering the presence of specific conditions (i.e., history of peptic ulcer or gastrointestinal hemorrhages, advanced age, Helicobacter Pylori) or gastro-toxic drug combinations, according to the criteria provided by the reimbursement rules of the Agenzia Italiana del Farmaco (NOTA 1 and 48). Among 4715 enrolled patients, 3899 were discharged alive. At hospital discharge, 2412 (61.9%, 95%CI: 60.3–63.4%) patients were prescribed with drugs for peptic ulcer and GERD, a 12% of increase from hospital admission. Almost half of the patients (N = 1776, 45.6%, 95%CI: 44.0–47.1%) were inappropriately prescribed or not prescribed: among the drugs for peptic ulcer and GERD users, about 60% (1444/2412) were overprescribed, and among nonusers, 22% (332/1487) were underprescribed. Among patients newly prescribed at hospital discharge, 60% (392/668) were inappropriately prescribed. The appropriateness of drugs for peptic ulcer and GERD therapy decreased by 3% from hospital admission to discharge. Hospitalization missed the opportunity to improve the quality of prescription of this class of drug.

Published
2019

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