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The aim of the study was to explore the association of dementia with in-hospital OBJECTIVE:The aim of the study was to explore the association of dementia with in-hospital death in acutely ill medical patients. METHODS: Thirty-four internal medicine and 4 geriatric wards in Italy participated in the Registro Politerapie SIMI-REPOSI-study during 2008. One thousand three hundred and thirty two in-patients aged 65 years or older were enrolled. Logistic regression models were used to evaluate the association of dementia with in-hospital death. Socio-demographic characteristics, morbidity (single diseases and the Charlson Index), number of drugs, and adverse clinical events during hospitalization were considered as potential confounders. RESULTS: One hundred and seventeen participants were diagnosed as being affected by dementia. Patients with dementia were more likely to be women, older, to have cerebrovascular diseases, pneumonia, and a higher number of adverse clinical events during hospitalization. The percentage of patients affected by dementia who died during hospitalization was higher than that of patients without dementia (9.4 versus 4.9%). After multiadjustment, the diagnosis of dementia was associated with in-hospital death (OR = 2.1; 95% CI = 1.0-4.5). Having dementia and at least one adverse clinical event during hospitalization showed an additive effect on in-hospital mortality (OR = 20.7; 95% CI = 6.9-61.9). CONCLUSIONS: Acutely ill elderly patients affected by dementia are more likely to die shortly after hospital admission. Having dementia and adverse clinical events during hospital stay increases the risk of death.

Centenarians experience successful ageing, although they still present high heterogeneity in their health status. The frailty index is a biomarker of biological age, able to capture such heterogeneity, even at extreme old age. At the same time, other biomarkers (e.g., epigenetic clocks) may be informative the biological age of the individual and potentially describe the ageing status in centenarians. In this article, we explore the relationship between epigenetic clocks and frailty index in a cohort of Italian centenarians. No association was reported, suggesting that these two approaches may describe different aspects of the same ageing process.

Oral anticoagulation therapy, largely performed by warfarin-based drugs, is commonly used for patients with a high risk of blood clotting which can lead to stroke or thrombosis. The state of the patient, with respect to anticoagulation, is captured by the index INR, which is to be kept within a therapeutic range. The patient’s response is marked by high inter-individual and inter-temporal variability, which can lead to serious adverse events. The Food and Drug Administration (FDA)’s Adverse Event Reporting System indicated that warfarin is among the 10 top drugsfor the adverse events reported during the 1990 and 2000 decades . In the last years genetic testing has been argued as a base for personalize dosing: indeed polymorphisms of two genes CYP2C9 and VKORC1 are markers of lower dosing requirements, but still account for a relatively minor part of this variability. For these reason there is no widely agreed conclusion as to whether the net economic results, keeping the cost of testing into account of the therapeutic improvement allowed by genetic testing are positive. In this paper the authors develop a model based on a decision tree to assess the cost-effectiveness of genotype based warfarin dosing. Clinical/therapeutical data inputs for the model have been derived from a database of nearly 4000 patients of which around 350 have been so far genotyped. Several scenarios have been simulated about the prevalence of major bleeding and ischemic events among anticoagulated patients and the rate of their reduction attributable, according to the literature, to genotyped dosing.

Oral anticoagulation therapy, largely performed by warfarin-based drugs, is commonly used for patients with a high risk of blood clotting which can lead to stroke or thrombosis. The state of the patient, with respect to anticoagulation, is captured by the index INR, which is to be kept within a therapeutic range. The patients' response is marked by high interindividual and inter-temporal variability, which can lead to serious adverse events. Polymorphisms of two genes CYP2C9 and VKORC1, considered markers of lower dosage requirements, still account for a relatively minor part of this variability. In this work, authors show that classification methods can identify groups of patients homogeneous with respect to the dynamics of INR. In particular, authors use classification methods in order to characterize patients according to their warfarin metabolism and hence their sensitivity to different doses. Finally a Markov model to capture the dynamics of the patient's response over the years is proposed. ©2009 IEEE.

On March 19, 2008 a Symposium on Pathophysiology of Ageing and Age-Related Diseases was held in Palermo, Italy. The lecture of D. Mari on Hemostasis and ageing is summarized herein. Physiological ageing is associated with increased plasma levels of many proteins of blood coagulation together with fibrinolysis impairment. This may be of great concern in view of the known association between vascular and thromboembolic diseases and ageing. On the other hand, centenarians are characterized by a state of hypercoagulability and possession of several high-risk alleles and well-known atherothrombotic risk markers but this appears to be compatible with longevity and/or health. Parameters considered risk factors for atherosclerotic vascular diseases in young people may lose their biological significance in advanced age and assume a different role.