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OBJECTIVE: Patients with Parkinson’s disease (PD) are at a higher risk of hospitalization and recurrent hospitalizations, with consequent complications. Polypharmacy is associated with several adverse outcomes, including hospitalization, increased length of hospital stay, and mortality. The aim of this study was to evaluate among patients with PD the association between the number of medications and incident hospitalizations. PATIENTS AND METHODS: We analysed the data of 165 patients with Parkinson’s disease attending a geriatric Day Hospital who were enrolled in a cohort study and followed for a median of two years. RESULTS: Over the follow-up, 46 participants (46%) were hospitalized at least one time; multiple admissions were observed in 12 subjects (7%). The median number of agents was 5 (4-7). In Cox regression, the number of drugs was associated with increased hospitalization rates (HR=1.23; 95% CI=1.06-1.43), also after excluding non-neurological medications (HR=1.18; 95% CI=1.01-1.38). Using Poisson regression, polypharmacy (i.e., use of >5 drugs) predicted the number of repeated hospitalizations (IRR=2.62; 95% CI=1.28-5.36; p=.008). CONCLUSIONS: Among patients with PD, the number of daily medications is associated with increased risk of hospitalization; an increasing number of drugs is associated with increasing number of hospitalizations. [ABSTRACT FROM AUTHOR]

For survivors of severe COVID-19 disease, having defeated the virus is just the beginning of an uncharted recovery path. What follows after the acute phase of SARS-CoV-2 infection depends on the extension and severity of viral attacks in different cell types and organs. Despite the ridiculously large number of papers that have flooded scientific journals and preprint-hosting websites, a clear clinical picture of COVID-19 aftermath is vague at best. Without larger prospective observational studies that are only now being started, clinicians can retrieve information just from case reports and or small studies. This is the time to understand how COVID-19 goes forward and what consequences survivors may expect to experience. To this aim, a multidisciplinary post-acute care service involving several specialists has been established at the Fondazione Policlinico Universitario A. Gemelli IRCSS (Rome, Italy). Although COVID-19 is an infectious disease primarily affecting the lung, its multi-organ involvement requires an interdisciplinary approach encompassing virtually all branches of internal medicine and geriatrics. In particular, during the post-acute phase, the geriatrician may serve as the case manager of a multidisciplinary team. The aim of this article is to describe the importance of the interdisciplinary approach––coordinated by geriatrician––to cope the potential post-acute care needs of recovered COVID-19 patients. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Severe vitamin D deficiency is associated with the occurrence of simultaneous fractures at both hip and upper limb due to a single fall. We hypothesized that reduced bone mineral density (BMD) could explain the association. Methods: We investigated 549 white women consecutively admitted to a rehabilitation hospital because of their first fall-related hip fracture. Thirty-three (6%) of the 549 women sustained a concomitant upper limb fracture of either distal radius (24 women) or proximal humerus (nine women). We assessed serum levels of 25-hydroxyvitamin D, hip BMD by dual-energy X-ray absorptiometry, and spine deformity index scores by lateral spine radiographs, 19.5±7.1 (mean±SD) days after fracture occurrence. Results: Serum levels of 25-hydroxyvitamin D were significantly lower in the 33 women with concomitant fractures of both hip and upper limbs than in the remaining 516 (mean difference between groups 5.6ng/ml, 95% CI from 3.5 to 7.6, P <0.001). Conversely, no significant differences were found in hip BMD or spine deformity index scores between the two groups. After adjustment for eight potential confounders, the occurrence of simultaneous fractures due to a single fall was significantly associated with low levels of 25-hydroxyvitaimn D (P =0.001), but not with femoral BMD or spine deformity index scores. Conclusion: The association between severe vitamin D deficit and the occurrence of concomitant fractures at both hip and upper limbs due to a single fall is independent of femur BMD. Further investigations should focus on altered fall pattern or reaction to fall. [Copyright &y& Elsevier]

Summary: Background: Community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) is responsible for severe infections in previously healthy people acquired in the community in different areas of the world. Aim: To report an outbreak of CA-MRSA in a hospital newborn nursery in northern Italy in September–October 2010, its investigation and control measures. Methods: The epidemiology of the outbreak is reported. The investigation included screening neonates, parents and staff for MRSA carriage. Molecular strain typing was performed on MRSA isolates. Findings: The outbreak affected nine neonates with three severe infections. In addition, four mothers had postpartum mastitis, and three mothers and one father had skin infection. The outbreak strain belonged to the USA300 CA-MRSA clone. Asymptomatic carriage of the outbreak strain was found among neonates, parents and hospital staff. The implementation of appropriate infection control measures in the hospital terminated the outbreak. Conclusions: To our knowledge, this is the first report of a hospital outbreak caused by the USA300 CA-MRSA clone in Europe. It is important to reinforce infection control measures, particularly in high-risk groups, such as neonates, to prevent USA300 from becoming endemic in European hospitals. [ABSTRACT FROM AUTHOR]

Di Monaco M, Vallero F, Di Monaco R, Tappero R, Cavanna A. Bone mineral density in hip-fracture patients with Parkinson's disease: a case-control study. OBJECTIVE: To investigate bone mineral density (BMD) levels in patients with Parkinson's disease (PD) who sustained a hip fracture. DESIGN: Case-control study. SETTING: Rehabilitation hospital in Italy. PARTICIPANTS: We investigated 831 out of 887 white patients consecutively admitted to a rehabilitation hospital because of an original hip fracture resulting from a fall. Twenty-eight (3.37%) of the 831 patients were affected by PD. Twenty-eight controls matched for sex, age, and hip-fracture type (cervical or trochanteric) were found among the 803 non-PD patients. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: BMD was assessed by dual-energy x-ray absorptiometry (DXA) at the unfractured femur. Five sites were investigated in each subject: total proximal femur, femoral neck, trochanter, intertrochanteric area, and Ward's triangle. DXA scan was performed a mean +/- standard deviation of 22.2+/-7.8 days after fracture occurrence in the 28 patients and 22.0+/-5.3 days after fracture occurrence in the 28 controls. RESULTS: BMD expressed as a T score did not differ significantly between the 28 PD patients and the 28 controls, whereas z score in the PD patients was significantly lower than 0+/-1 in the age- and sex-matched general population at 4 of the 5 sites of BMD assessment. CONCLUSIONS: A sample of PD fallers who sustained a hip fracture had femoral BMD levels similar to those found in matched hip-fracture fallers who did not suffer from PD and significantly lower than those found in the matched reference population. © 2006 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation [ABSTRACT FROM AUTHOR]

Hip fracture is a common condition in the elderly, because of both reduced bone strength and high risk of falling. Excess mortality after hip fractures ranges from 10% to 30%. In the survivors the restoration of function is often poor, despite successful surgical operation. The aim of this article is to review the factors associated with functional prognosis after hip fracture in the elderly. I conducted a Medline search of articles published in the English language literature from 1993 to January, 2004. All of the studies that showed an association between at least one prognostic factor and functional outcome after hip fracture were reviewed. Evaluations of functional outcome included at least one among the following: ambulation, mobility, activities of daily living (ADL), living status, and quality of life. Substantial evidence supported a negative prognostic role of older age, cognitive impairment, impaired prefracture status, and various comorbidities. Consistent evidence from a limited number of studies indicated that poorer social support, depression, pain, delirium, and pressure ulcers were associated with worse functional recovery. Muscle strength assessed postoperatively was associated with a better functional outcome in a few studies assessing small samples of patients. Two studies showed that bowel and/or bladder control was associated with better function. Single studies pointed out a positive association between either bone mineral density or vitamin D status and functional outcome, and a negative association between previous employment in a prestigious occupation and functional outcome. Conflicting data were reported on the prognostic role of gender, hip-fracture type, time of surgery, and type of both anesthesia and surgical operation, with the exception of cemented prostheses that were associated with better function than uncemented prostheses. Limited data excluded a prognostic role of both previous hip fractures and concomitant fractures of an upper limb. In conclusion, a major prognostic role in functional recovery after hip fracture was played by patient-related factors, whereas a marginal role (if any) was played by both fracture-related and surgery-related factors. [ABSTRACT FROM AUTHOR]