Search

Shortening and rotational deformity of the lower limb (SRD) is a major complication of hip fracture surgery. It causes not only hip joint dysfunction but also functional impairments due to abnormal gait parameters, decreased gait velocity, and poor balance. Despite a number of previous studies, the effect of SRD on the postsurgical recovery of these patients is still not clear.To compare the functional abilities and balance before and after rehabilitation for people with and without SRD after hip fracture surgery and to assess whether SRD affects rehabilitation.Prospective observational study.Inpatients of a rehabilitation unit.A total of 102 people with hip fracture (62 without SRD and 40 with SRD at the time of admission to the unit).Berg Balance Scale (BBS) and Functional Independence Measure (FIM) motor score, administered before and after rehabilitation.Motor rehabilitation.Before rehabilitation, patients with SRD had lower motor-FIM (p = .002) and BBS (p = .001) scores than those without SRD. After rehabilitation, both groups showed similar improvements in motor-FIM, BBS, range of motion, muscle strength, and pain scores (p .001, for all), but patients with SRD still had lower motor-FIM and BBS scores (p = .014 and .003, respectively) and lower effectiveness in motor-FIM and BBS (p = .039 and p = .034, respectively) than those without SRD.SRD is associated with lower levels of balance and functional abilities before and after rehabilitation and it adversely affects rehabilitation for patients with hip fractures.

Little is known about the outcome predictors in peripheral neuropathy (PN). This prospective observational study aimed to identify possible factors predicting the functional abilities in older patients with PN undergoing motor rehabilitation. Data were collected in 80 PN patients, aged over 65 years, performing a standard inpatient motor rehabilitation program. The total Functional Independence Measure (FIM) score after rehabilitation, as well as efficiency and effectiveness in total-FIM, were the outcome measures. Backward multiple regression analyses identified the predictors of functional status. At the end of rehabilitation, total-FIM score was 102.66 ± 10.75, efficiency in total-FIM 0.64 ± 0.29 and effectiveness in total-FIM 48.81 ± 15.35%. Katz index at admission was a predictor of the final total-FIM score (beta 0.46, p

The aim of this prospective observational cohort study was to verify the relationship between number of drugs used and functional outcome in hip fracture patients undergoing rehabilitation. This study was conducted on 139 patients with hip fracture who underwent a rehabilitation program. Efficiency rate in the Functional Independence Measure (FIM) and Berg Balance Scale (BBS), and length of stay (LOS) were the outcome measures. At the end of rehabilitation, 66.1% of patients showed an increase in number of drugs used, while 33.9% used the same or lower number of drugs than at admission. At the end of rehabilitation patients with increased pharmacotherapy took a higher total number of drug classes (p = 0.001), had longer LOS (p = 0.009) and lower Berg efficiency (p = 0.048) than patients with the same or lower pharmacotherapy. The number of drugs used at discharge was an independent determinant of LOS (beta = 0.19, p = 0.022) and FIM efficiency (beta = − 0.20, p = 0.025). Age was a determinant of LOS (beta = 0.17, p = 0.044) and BBS efficiency (beta = − 0.23, p = 0.009), while CIRS severity was a determinant of BBS efficiency only (beta = − 0.22, p = 0.016). Findings of study indicate that in hip fracture patients, the number of drugs prescribed at discharge is an important indicator of LOS and rehabilitation efficiency. These findings can help the physician to better plan the rehabilitation of hip fracture patients who require polypharmacy.

This prospective observational cohort study aimed to verify whether single Berg Balance Scale (BBS) items were important determinants of improvement in functional abilities in patients with peripheral neuropathy (PN). Data were collected in 75 older patients with PN performing a standard motor rehabilitation program. Backward stepwise multiple regression analyses were performed to identify determinants of outcome measures. Gain in total and motor Functional Independence Measure (FIM) and gain in motor-FIM areas were the outcome measures. Among BBS items, at the end of rehabilitation, the score was higher in "sitting unsupported" (3.94 ± 0.22) and lower in "standing on one foot" (1.18 ± 1.06). The gain was higher in "standing to sitting" (1.02 ± 0.67) and "standing unsupported" (1.00 ± 1.00), and lower in "sitting unsupported" (0.22 ± 0.60) and "standing on one foot" (0.65 ± 0.77). "Standing unsupported" was the only determinant of gain in motor-FIM (beta − 0.36, p = 0.002) and gain in self-care (beta − 0.37, p = 0.002). The R2 value of the models was 0.13 and 0.14, respectively. No independent variable was a determinant of gain in total-FIM. The study shows that "unsupported standing" is an important determinant of results of ADL rehabilitation in PN patients and indicates that ability to stand without support for a fairly long time is an essential requirement to achieve with rehabilitation higher gain levels in functional abilities in PN patients.

Executed studies did not clearly identify which index of comorbidity was an independent outcome determinant. The aim of this prospective observational cohort study was to address this issue. We analyzed 200 consecutive patients with hip fracture. All patients underwent rehabilitation. At admission comorbidity was assessed through the cumulative severity, severity index, and comorbidity index of the Cumulative Illness Rating Scale. Discharge scores and effectiveness in the Functional Independence Measure motor subscale, and discharge destination were the outcome measures. Multivariate regression analyses were performed to identify determinants of outcome. Mini Mental State Examination and comorbidity index of the Cumulative Illness Rating Scale were important independent determinants of final (respectively, β = 0.46 and −0.25) and effectiveness (respectively, β = 0.47 and −0.25) in motor Functional Independence Measure scores, while hip strength and Rankin score were determinants of final motor Functional Independence Measure score (respectively, β = 0.21 and −0.20). Comorbidity index of the Cumulative Illness Rating Scale (odds ratio 8.18 for ≥3 versus < 3 comorbidity score; 95% confidence interval, 1.03–64.7) and Geriatric Depression Scale (odds ratio 4.02 for ≥6 versus ≤5 depression scale score; 95% confidence interval, 1.52–10.63) were risk indicators for nursing home. Among the indices of the Cumulative Illness Rating Scale, comorbidity index is the sole independent determinant of both motor Functional Independence Measure scores and discharge destination in hip fracture patients. This suggests to specifically evaluate this index to identify the patients who may be admitted to a rehabilitation program.

The aim of study was to identify factors predicting balance in older hip fracture patients undergoing motor rehabilitation.The aim of study was to identify factors predicting balance in older hip fracture patients undergoing motor rehabilitation. Cognitive function, comorbidity and hip muscles strength are important predictors of balance in hip fracture patients. Knowledge of specific predictors could be useful for physicians to identify patients needing specific rehabilitation programs for balance. Little is known about the factors predicting balance in hip fracture patients. The aim of this retrospective observational study was to assess balance before and after inpatient rehabilitation and, secondarily, to identify factors predicting the balance levels in older hip fracture patients after motor rehabilitation. Data were collected in 124 hip fracture patients over a 2-year period. All patients underwent a standard motor rehabilitation program. A modified version of Berg Balance Scale (BBS) score after rehabilitation, daily gain and percentage of improvement in BBS were the outcome measures. Multivariate regression analysis was performed to identify the predictors of balance. The mean BBS score was 8.33 ± 7.23 at admission and 21.79 ± 12.15 at the end of rehabilitation (p

To date treatment protocols in Respiratory and or Internal departments across Italy for treatment of chronic obstructive pulmonary disease (COPD) patients at hospital admission with relapse due to exacerbation do not find adequate support in current guidelines. Here we describe the results of a recent clinical audit, including a systematic review of practices reported in literature and an open discussion comparing these to current real-life procedures. The process was dived into two 8-hour-audits 3 months apart in order to allow work on the field in between meeting and involved 13 participants (3 nurses, 1 physiotherapist, 2 internists and 7 pulmonologists). This document reports the opinions of the experts and their consensus, leading to a bundle of multidisciplinary statements on the use of inhaled drugs for hospitalized COPD patients. Recommendations and topics addressed include: i) monitoring and diagnosis during the first 24 h after admission; ii) treatment algorithm and options (i.e., short and long acting bronchodilators); iii) bronchodilator dosages when switching device or using spacer; iv) flow measurement systems for shifting to LABA+LAMA within 48 h; v) when nebulizers are recommended; vi) use of SMI to deliver LABA+LAMA when patient needs SABA 30 litres/min; viii) contraindication to use DPI; ix) continuation of LABA-LAMA when patient is already on therapy; x) possible LABA-LAMA dosage increase; xi) use of SABA and/or SAMA in addition to LABA+LABA; xii) use of SABA+SAMA restricted to real need; xiii) reconciliation of drugs in presence of comorbidities; xiv) check of knowledge and skills on inhalation therapy; xv) discharge bundle; xvi) use of MDI and SMI in tracheostomized patients in spontaneous and ventilated breathing.

Few studies have investigated the relationships between aphasia and activities of daily living (ADLs) in stroke patients.This study was aimed firstly to determine which task within the ADLs has poorer functional recovery in stroke patients with aphasia after rehabilitation, second to identify which specific task is related to aphasia.This is a prospective and observational study.Inpatients of our Rehabilitation Unit.The study was carried out in 219 patients with primary diagnosis of stroke with (104) and without aphasia (115).All patients underwent usual rehabilitation. Aachen Aphasia Test and Functional Independence Measure scale were used to assess severity of aphasia and ADLs, respectively. Gain in ADLs was the main outcome measure.At the end of rehabilitation patients with aphasia had lower gain in bathing, dressing upper body, dressing lower body, toileting, stair climbing, and higher gain in social interaction, problem solving, and memory with respect to patients without aphasia. However, when data were adjusted for side of hemiplegia, Fugl-Meyer score and trunk control test, patients with aphasia showed lower gain in dressing upper body (P=0.027), dressing lower body (P=0.009), lower toileting (P=0.027), and higher gain in social interaction (P0.001). In the multivariate regression analysis, aphasia was an important determinant of gain in bathing (β=0.26), dressing upper body (β=0.24), dressing lower body (β=0.22), lower toileting (β=0.22), and social interaction (β=-0.29).The current study points out that, after usual rehabilitation, the patients with aphasia show a poor gain in personal care activities and higher gain in social interaction.Knowledge of these findings: 1) can guide the rehabilitation team in selecting specific and appropriate therapies aimed to give patient with aphasia the highest possible functional independence in ADLs; 2) is useful to family members and social rehabilitation services for domiciliary management of patients with aphasia.

Very few studies have investigated the predictive value of functional outcome, social outcome and discharge destination in patients with cerebrovascular accident (CVA) with aphasia. The aim of this study was to verify whether aphasia is predictor for outcome in patients with stroke with aphasia.The study was carried out in 262 patients with primary diagnosis of CVA and aphasia, included over a 6-year period (2001-2007): 131 with and 131 without aphasia. Statistically significant variables at the univariate regression analysis were submitted to the multivariate analysis. Backward stepwise regression analysis was applied to predict final motor-Functional Independence Measure (FIM), effectiveness in motor-FIM, final cognitive-FIM score and effectiveness in cognitive-FIM and discharge destination. Independent variables were age, gender, aphasia, stroke type, stroke lesion size, comorbidity, bladder catheter, motor function, trunk control test, initial motor-FIM and committed caregiver identified on admission to rehabilitation.Patients with aphasia had lower motor-FIM and cognitive-FIM scores both at admission and at discharge, if compared with those without aphasia. Effectiveness in motor-FIM and cognitive-FIM scores was also poorer in patients with aphasia. Seventy-seven per cent of patients with aphasia and 91.6% of patients without aphasia returned at home. In the multivariate regression analysis, aphasia was predictor of final motor-FIM (β = 0.15), final cognitive FIM (β = 0.72), effectiveness in motor-FIM (β = 0.17) and discharge destination (β = 0.20).Aphasia is a predicting factor of outcome and it is the most important predictor of social outcome in patients with stroke with aphasia.

Few studies have assessed the relationship between aphasia and rehabilitation length of stay (LOS). The aim of the current prospective study was to evaluate LOS in patients with aphasia and its relation to functional improvement.The study was performed in 252 patients admitted for rehabilitation follow-up of their first stroke (126 patients with aphasia and hemiparesis [aphasia group] and 126 patients with hemiparesis but without aphasia [control group]). All patients were submitted to clinical, neurological, and neuropsychological examinations. The following tests were performed: Aachen Aphasia Test, Albert's test, anosognosia scale, Cumulative Illness Rating Scale (CIRS), Fugl-Meyer Scale, and FIM.LOS was 50.7 and 46.7 days in the aphasia and control groups, respectively. There was no statistically significant difference in the LOS between aphasia and control groups (p = .056). A longer LOS was correlated with low admission aphasia score (r = -0.19). The increase in motor FIM per day obtained by therapy (LOS-Eff) was 0.54 +/- 0.3 in the aphasia group and 0.75 +/- 0.5 in the control group. The LOS-Eff was significantly poorer in the aphasia group (p = .000). A high LOS-Eff was correlated with high aphasia score (r = 0.31). In multivariate regression analyses, aphasia was an important predictor of LOS-Eff (beta = 0.18).In patients with aphasia, LOS is few days longer and LOS-Eff is significantly poorer compared to patients without aphasia. Aphasia is a significant independent predictor of LOS-Eff at discharge.

Objectives: To investigate the effect of cardiovascular changes (i.e., QT interval, QT dispersion (QTD), heart rate variability (HRV), and other cardiovascular measures) in subjects with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Design: Each subject underwent clinical and cognitive examination, a structural brain imaging study, echocardioDoppler, electrocardiogram (ECG), HRV analysis using 24-hour ECG monitoring, and 24-hour blood pressure monitoring. Setting: Community population-based sample of patients admitted to an AD center for investigation of cognitive disturbances. Participants: Thirty-three subjects with AD, 39 subjects with MCI, and 29 cognitive healthy subjects (controls) matched for demographic characteristics, hypertensive condition, smoking habits, and laboratory parameters were enrolled consecutively. Measurements: Clinical and cognitive examination, structural brain imaging study, echocardioDoppler, ECG, HRV analysis using 24-hour ECG monitoring, and 24-hour blood pressure monitoring. Results: QTD and QT corrected dispersion mean values were significantly higher in patients with AD than in patients with MCI and controls and higher in patients with MCI than in controls. HRV time and domain parameters were lower in patients with AD than in patients with MCI and controls. No difference in other cardiovascular measures was found. QTD and HRV were found to be significantly correlated with the degree of cognitive impairment. Conclusion: These findings support the presence of a peculiar neuroanatomic dysfunction in patients with AD and MCI that parallels the disease progression. These noninvasive parameters might prove to be powerful predictive tools in the worsening of cognitive function and mortality risk.

Aim: To describe the unusual course of a patient with cerebellar ataxia who underwent rehabilitation. Method: At admission, the patient underwent motor rehabilitation and assessment by Tinetti Assessment, Klockgether Score, National Institute of Health Stroke Scale, Trunk Control Test, Fugl-Meyer Scale, Barthel Index, and Mini Mental State Examination. Results: The patient showed very rapid and severe decline of motor and functional tests during the first month of hospitalization and complete dependence in

The correlation between single neuropsychiatric symptoms and functional outcome in hip fracture patients is little investigated in the literature, and it is not yet established which neuropsychiatric symptoms are the most important determinants of functional outcome.To determine which neuropsychiatric symptoms are the most important determinants of functional outcome.This prospective study was carried out in 204 consecutive patients with primary diagnosis of hip fracture admitted to our Rehabilitation Unit for a course of rehabilitation. Neuropsychiatric symptoms were assessed at admission with the Neuropsychiatric Inventory (NPI). Outcome measures of rehabilitation were: final score, efficiency and effectiveness in motor-Functional Independence Measure (motor-FIM), and discharge destination. Pearson's correlation coefficients were used to assess the relationship between NPI variables and the outcome measures, while backward stepwise regression was used to identify determinants of the outcome measures.Pearson's correlation showed that night-time behavior disturbances were related to all outcome measures, while agitation, depression, elation, apathy, disinhibition and irritability were significantly related to motor-FIM outcomes. At multivariate regression analysis agitation was the only determinant of final motor-FIM score, while irritability was the only determinant of efficiency and effectiveness in motor-FIM score. No neuropsychiatric symptom was a determinant of discharge destination.This study highlights that in hip fracture patients there are relationships between specific neuropsychiatric symptoms and functional outcome. Among the neuropsychiatric symptoms, irritability and agitation are the most important. They are associated to poor functional outcome and are the only determinants of motor-FIM outcome measures.Relationships between specific neuropsychiatric symptoms and functional outcome have not been clearly described in hip fracture patients. Irritability and agitation have been shown to have the strongest relationship with poor functional outcomes. Appropriate identification, assessment and treatment of neuropsychiatric symptoms may be useful to physicians for the management of hip fracture patients.

OBJECTIVE: The aim of this study was to determine the association between functional recovery and neuropsychiatric symptoms in hip fracture patients undergoing in-hospital rehabilitation. Very few studies have extensively evaluated neuropsychiatric symptoms in hip fracture patients, and the relationship between these symptoms and rehabilitation outcome is not yet clearly defined. DESIGN: This study was conducted on 200 patients with hip fracture who underwent a rehabilitation program. The Neuropsychiatric Inventory was used to identify neuropsychiatric symptoms. Efficiency and effectiveness in terms of the motor-Functional Independence Measure and length of stay were considered as outcome measures. RESULTS: At admission, 74% of the patients had neuropsychiatric symptoms. At the end of rehabilitation, the patients with neuropsychiatric symptoms had a lower motor-Functional Independence Measure effectiveness (P = 0.015) and efficiency (P = 0.002) and a longer length of stay (P = 0.008) than those without neuropsychiatric symptoms. However, after adjustment for the Mini-Mental State Examination, the patients with neuropsychiatric symptoms differed from those without symptoms only in terms of longer length of stay (P = 0.006) and lower motor-Functional Independence Measure efficiency (P = 0.008). CONCLUSIONS: Neuropsychiatric symptoms make the rehabilitation process slower and less efficient in hip fracture patients. Understanding the relationship between neuropsychiatric symptoms and outcome may be useful to physicians for the management of hip fracture patients. Language: en

Up to date studies have assessed costs and outcomes of rehabilitation in outpatients. Aim of the current prospective study was to evaluate the rehabilitative and economical effectiveness of an outpatient rehabilitative practice.The study was performed in 349 patients admitted for rehabilitation due to sequelae of orthopaedic surgery (repair of rotator cuff tear, anterior cruciate ligament reconstruction), limbs fracture (should, wrist, foot), whiplash neck pain, and chronic spinal pain (low back pain and neck pain). All patients were submitted to rehabilitation. Before and after rehabilitation, range of motion of joint or pain were assessed. Economical effectiveness and rehabilitative effectiveness in range of motion and pain were considered as outcome measures.Rehabilitative effectiveness was 71.9%+/-30%. Length of rehabilitation (beta=0.29) and initial joint status (beta=0.36) had the strongest relationship with rehabilitative effectiveness. Rehabilitative effectiveness was higher in patients with sequelae of anterior cruciate ligament reconstruction. Economical effectiveness was 48.0%+01 and was related to length of rehabilitation (beta=0.11) only. Economical effectiveness was higher in low back pain carried out in group (136%+/-0.0).The study gives evidence that in outpatient rehabilitation the rehabilitative effectiveness is higher than economical one. In addition, the study shows that rehabilitative treatments carried out in group only have higher economical effectiveness. These data must be considered useful in planning the ambulatory rehabilitation.

The aim of this study was to evaluate if the Biodex Fall Risk Assessment could provide an age-adjusted index useful for classifying patients at “risk of fall.” This was a cohort study conducted on 61 chronic patients, in stable conditions, having a history of ataxia, difficulty in walking or loss of balance, and aged >64 years. These patients were coming from home to our Institute undergoing a period of in-hospital standard rehabilitation. Assessment of clinical parameters was performed at entry. Functional scales (Functional Independence Measure [FIM] for motor and cognitive function, Barthel G, Tinetti POMA), and the Biodex Fall Risk Index (FRI) were performed at entry and discharge. The Normalized FRI, obtained adjusting FRI to the reported maximum predictive FRI for the relevant age, identified 2 types of patients: those with a greater risk of fall than expected for that age, labeled Case 1 (Normalized FRI>1); and those with an equal or even lesser risk of fall than expected for that age, labeled Case 0 (Normalized FRI≤1). FRI, Normalized FRI as well as independent variables as age, sex, pathology group, FIM, BarthelG, were considered in a multiple regression analysis to predict the functional improvement (i.e., delta Tinetti Total score) after rehabilitation. Normalized FRI is useful in assessing patients at risk of falls both before and after rehabilitation. At admission, the Normalized FRI evidenced high fall risk in 46% of patients (Case 1) which decreased to 12% after rehabilitation, being greater than age-predicted in 7 patients (Case 1–1) despite the functional improvement observed after the rehabilitation treatment. Normalized FRI evidenced Case 1–1 patients as neurological, “very old” (86% in age-group 75–84 years), and with serious events at 18 to 24 months’ follow-up. Normalized FRI, but not FRI, at admission was a predictor of improvement in Tinetti Total scores. The normalized FRI effectively indicated patients at higher risk of fall, in whom health deterioration, falls, or cognitive decline was later documented at follow-up. The normalized FRI could be a standardized measure for identifying frailer patients becoming a further criterium of discharge home and marker of fall risk at home.

Objective. The aim of this study was to evaluate the effect of intraarticular injections of corticosteroids (triamcinolone) in patients with symptomatic rotator cuff tears (RCT). Design. Randomized controlled study. Setting. Rehabilitation unit. Patients. Sixty patients with full-thickness RCT were enrolled in the study. Patients were randomly divided into three equal groups of 20 patients. The first group received single intraarticular injection of 40 mg triamcinolone, the second group received two injections of 40 mg triamcinolone at 21-day interval, and the third group received no treatment (control group). All patients underwent rehabilitation sessions. Outcome measures were pain, evaluated using a visual analog scale, and shoulder functional status, evaluated by Constant–Murley score. Measures. Outcome measures were pain, evaluated using a visual analog scale, and shoulder functional status, evaluated by Constant-Murley score. Results. Pain at night score of both groups who received triamcinolone was lower than that of Control Group at 1 month ( P < 0.05 and P < 0.01 in first and second groups, respectively) and at 3 months ( P < 0.05 and P < 0.01 in the first and second groups, respectively). Similarly, activity pain score of groups treated with triamcinolone was lower than that of the control group at 1 month ( P < 0.001 in both groups) and at 3 months ( P < 0.001 in both groups). There was no statistically significant difference in pain at night between the first and second groups at 1 and at 3 months. There was no statistically significant difference among groups at 3 and 6 months in Constant–Murley scores. Conclusions. Our study indicates that intraarticular injection of triamcinolone improves pain relief for 3 months in RCT and its action is not prolonged or potentiated by two injections of the drug done at 21-day intervals.

Objective To assess the prevalence and the characteristics of silent myocardial ischaemia (SMI) and ventricular arrhythmias (VA) in subjects with Alzheimer's disease (AD) and mild cognitive impairment (MCI) and their relationships with QT interval dispersion (QTD). Methods Thirty-three subjects with AD, 39 subjects with MCI, and 29 cognitive healthy control subjects matched for demographic characteristics, hypertensive condition, smoking habits, and laboratory parameters were enrolled. Each subject underwent clinical and cognitive examination, a structural brain imaging study, electrocardiogram (ECG), 24-h ECG recording, 24-h blood pressure monitoring, and echocardiogram. Detection and characterization of QT dispersion, SMI and VA were performed. Results The three groups were comparable regarding demographic and basal cardiovascular characteristics: notwithstanding this, SMI episodes were observed only in AD and MCI patients (19 and 14, respectively). A significantly greater prevalence of repetitive ventricular premature beats was observed in AD (mean 8.56 ± 13.1) and in MCI (1.8 ± 7.2) vs. control (0.7 ± 1.7). The QTD, the ischaemic burden and the number of repetitive ventricular beats revealed to be significantly related. Conclusions Increased prevalence of SMI and potentially ominous VA were found in AD and, to a lesser extent, in MCI. SMI and repetitive VA were significantly related with QTD. These findings could be related to an increased risk of sudden cardiac death in AD and MCI patients.

Inhomogeneity of ventricular repolarization as detected by QT dispersion may be a potential leading mechanism of sudden death in hypertensive and normotensive (age related) left ventricular hypertrophy. Aim of this study was to investigate QT dispersion, ventricular arrhythmias, and left ventricular mass index in elderly hypertensive and normotensive patients. Study population consisted of 60 consecutive patients (sex: 34 men/26 women; age: 63 ± 11 years) with essential arterial hypertension and 48 age and sex-matched control subjects (24 men/24 women; 64 ± 16 years). Measurements included QTc dispersion, ventricular arrhythmias, and left ventricular hypertrophy. Hypertensive patients had greater left ventricular mass index ( P = .006) and higher QTc dispersion ( P = .004) than controls. Left ventricular hypertrophy was diagnosed in 57 (31 men/26 women) of all subjects. These patients had higher blood pressure ( P < .05), Lown's score ( P < .001), and QTc dispersion ( P < .001). QTc dispersion and Lown's score were independent predictors of left ventricular mass index ( P < .001). Conclusively, QTc dispersion is a strong indicator of left ventricular mass index and might be used in risk stratification of hypertensive and normotensive elderly patients.

Long-term nocturnal non-invasive mechanical ventilation (NIMV) is an effective treatment for obesity-hypoventilation syndrome (OHS), improving central carbon dioxide (CO(2)) sensitivity. Leptin might contribute to sustain adequate ventilation in obesity. The aim of the study was to investigate the role of leptin in the OHS pathogenesis looking at its relationship to CO(2) sensitivity before and after NIMV in OHS patients.In six obese patients (3F/3M; aged 63+/-9 yr; BMI 47.0+/-4.5 kg/m(2)) with OHS and without obstructive sleep apnoea-hypopnoea (OSAH) diurnal arterial blood gases, fasting plasma leptin concentration and CO(2) chemosensitivity were determined before and after 10.3+/-5.6 (range 6-20) months of NIMV.After NIMV improvements were observed in gas exchange (PaO(2) from 51.3+/-6.7 to 75.0+/-10.3 mmHg, p0.01; PaCO(2) from 55.5+/-4.8 to 43.7+/-1.2 mmHg, p0.01; [HCO(3)(-)] from 33.3+/-3.8 to 29.8+/-1.7 mmol/l, p0.05) and CO(2) chemosensitivity, measured as P(0.1)/PetCO(2) slope (from 0.09+/-0.07 to 0.18+/-0.07 cmH(2)O/mmHg, p0.05) and V(E)/PetCO(2) slope (from 0.4+/-0.3 to 0.9+/-0.5l/min/mmHg, p=0.07). Plasma leptin increased from 34.5+/-21.1 ng/ml to 50.2+/-22.9 ng/ml (p0.01) after NIMV and changes of the P(0.1)/PetCO(2) slope correlated with percent changes of plasma leptin (r(2)=0.79, p0.05).These findings suggest a possible role of leptin in the recovery of neuromuscular response to hypercapnia obtained during long-term nocturnal NIMV in OHS patients without OSAH.

To investigate the effect of cardiovascular changes (i.e., QT interval, QT dispersion (QTD), heart rate variability (HRV), and other cardiovascular measures) in subjects with Alzheimer's disease (AD) and mild cognitive impairment (MCI).Each subject underwent clinical and cognitive examination, a structural brain imaging study, echocardioDoppler, electrocardiogram (ECG), HRV analysis using 24-hour ECG monitoring, and 24-hour blood pressure monitoring.Community population-based sample of patients admitted to an AD center for investigation of cognitive disturbances.Thirty-three subjects with AD, 39 subjects with MCI, and 29 cognitive healthy subjects (controls) matched for demographic characteristics, hypertensive condition, smoking habits, and laboratory parameters were enrolled consecutively.Clinical and cognitive examination, structural brain imaging study, echocardioDoppler, ECG, HRV analysis using 24-hour ECG monitoring, and 24-hour blood pressure monitoring.QTD and QT corrected dispersion mean values were significantly higher in patients with AD than in patients with MCI and controls and higher in patients with MCI than in controls. HRV time and domain parameters were lower in patients with AD than in patients with MCI and controls. No difference in other cardiovascular measures was found. QTD and HRV were found to be significantly correlated with the degree of cognitive impairment.These findings support the presence of a peculiar neuroanatomic dysfunction in patients with AD and MCI that parallels the disease progression. These noninvasive parameters might prove to be powerful predictive tools in the worsening of cognitive function and mortality risk.

Neuroimaging techniques such as PET and SPECT demonstrated a consistent reduction of cerebral blood flow (CBF) in Alzheimer’s disease (AD). The aim of the study was to assess the potential role of ultrasonography for CBF measurement in AD patients and whether the CBF volume correlates positively with disease severity. Fifty patients who met the diagnostic criteria of probable AD (NINDS-ADRDA) were compared to 50 age-matched healthy elderly volunteers. The extracranial internal carotid arteries (ICAs) and the vertebral arteries (VAs) of the patients and controls were examined. Angle-corrected time-averaged flow velocity (TAV) and the diameter of the vessel were measured. Intravascular flow volumes were calculated as the product of TAV and the cross-sectional area of the circular vessel. CBF volume was calculated as the sum of flow volumes in the ICAs and VAs of both sides. All subjects underwent the MMSE. The mean global CBF (474.87 ± 94.085 vs. 744.26 ± 94.082 ml/min; p < 0.0001) was lower in AD patients than in healthy volunteers. A significant decline in global flow volumes (r = 0.48; p < 0.0007) with the degree of cognitive impairment was also present. The ability of ultrasonography to characterize flow decreases makes such a technique an attractive tool for the study of AD, for the evaluation of pharmacological therapies and, possibly, for early diagnosis.

Accumulating evidence from epidemiological and clinical studies suggests that vascular risk factors may be involved in Alzheimer disease (AD). Although the precise contribution of vascular disturbances to the pathogenesis of AD is still unclear, various biochemical and neuropathological data strengthen the view that cerebrovascular deficiencies such as reduced blood supply to the brain and disrupted microvascular integrity in brain parenchyma play a direct or intermediate role in the chain of events ending with a dementia syndrome. The present review focuses on platelet abnormalities and hemostatic alterations in AD. In particular, data from our group, along with current literature, are discussed with regard to the evidence of platelets amyloid precursor protein (APP) processing disturbances in early AD as well as to the recent observations of increased serum levels of thrombomodulin and sE-selectin, which are sensitive markers of endothelial dysfunction. These findings strongly indicate that platelet dysfunction and microvasculature deficiencies occur rather early during the course of AD, thus suggesting a further link between AD-related processes and vascular disorders.

In this open, prospective, study were enrolled 204 hospitalized elderly patients with severe (88 males, 116 females, age range 70-94). Patients were randomized to receive one of the following antibiotic treatment regimens: meropenem 500 mg i.v. t.i.d. (52); imipenem/cilastatin 500 mg i.v. t.i.d. (51), clarithromycin 500 mg + ceftriaxone 1 g i.v. b.i.d. (52), clarithromycin 500 mg + amikacin 250 mg i.v. b.i.d. (49). In 99 cases causative germs were isolated (24 meropenem, 26 imipenem, 23 clarithromycin + ceftriaxone, 26 ceftriaxone + amikacin). A satisfactory clinical, bacteriological response was achieved respectively in 86.5% 77% in meropenem; 86.3% 71% in imipenem/cilastatin; 69% 61% in ceftriaxone + clarithromycin and in 85.7% 77% in clarithromycin + amikacin. The mean total cost for each patient was $1,560; $1,620; $1,760 and $1,792 in meropenem, imipenem/cilastatin, clarithromycin + ceftriaxone and clarithromycin + amikacin respectively. This study shows that treatment with either meropenem or imipenem is as efficacious as conventional therapy in the treatment of community acquired pneumonia (CAP), and that meropenem is the most cost-effective.