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Biomedical subjects

Raffaele Antonelli Incalzi

Publications and source records attributed to Raffaele Antonelli Incalzi.

At least 19 recordsLinked to original sources
PubMed2007

Decline of neuroadrenergic bronchial innervation and respiratory function in type 1 diabetes mellitus: a longitudinal study.

BACKGROUND AND AIM: Type 1 diabetes mellitus complicated by autonomic neuropathy (AN) is characterized by depressed cholinergic bronchomotor tone and neuroadrenergic denervation of the lung. We explored the effects of AN on the rate of decline of pulmonary sympathetic innervation and respiratory function during a 5-year follow-up. METHODS: Twenty diabetic patients, 11 with AN, were enrolled in 1998 and then followed-up until 2003. During follow-up, glycosylated haemoglobin (HbA1c) was measured every 3 months. In 1998 and 2003 the patients underwent respiratory function tests and a ventilatory scintigraphic study of neuroadrenergic bronchial innervation using 123I-MIBG. RESULTS: During follow-up 4 patients, all with AN, were lost, and 1 developed AN. Forced vital capacity (FVC), and diffusing capacity of the lung for carbon monoxide (DLCO) showed comparable rates of decrease in patients with and without AN. The yearly decline of forced expiratory volume in 1 s (FEV1) was about double the physiologic rate, in both AN and AN-free patients. The MIBG clearance significantly increased both in patients with AN (T1/2: 118.88 +/- 30.14 min at baseline and 92.10 +/- 24.52 min at the end of follow-up) and without AN (135.14 +/- 17.09 min and 92.68 +/- 13.52 min, respectively), indicating a rapidly progressive neuroadrenergic denervation. The rate of the neuroadrenergic denervation was inversely related to the severity of autonomic dysfunction at baseline (Spearman's rho - 0.62, p = 0.017). Neither respiratory function indexes nor MIBG clearance changes correlated with the overall HbA1c values. CONCLUSIONS: Neuroadrenergic denervation of the lung parallels the decline of respiratory function indexes in diabetic patients both with and without AN and seems to be independent from the quality of glycemic control.

3-Iodobenzylguanidine↗
PubMed2006

Estimating renal function in older people: a comparison of three formulas.

BACKGROUND: Estimation of the glomerular filtration rate (GFR) at the bedside is important because renal insufficiency is related to increased mortality and morbidity. A discrepancy between the Cockroft-Gault (CG) and the Modification of Diet in Renal Disease (MDRD) formulas has been observed in older people. OBJECTIVE: To compare the GFR of inpatients aged 65 or older estimated using the CG and two of the MDRD formulas. SETTING: Acute care geriatrics and internal medicine wards. SUBJECTS AND METHODS: Data come from the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA). To quantify the agreement between the formulas, we used the 95% limits of agreement, the kappa statistic and a graphic approach to evaluate the influence of potential confounders on the magnitude of the difference in the GFR estimates. RESULTS: We studied 7,747 persons [51.1% women, mean age 77.8 (SD 7.2)]. The mean GFR estimated using the CG, MDRD1 and MDRD2 formulas was 51.2 ml/min (21.3), 54.9 ml/min (19.8) and 64.7 ml/min (24.2), respectively. At the individual level, the MDRD formulas can yield estimates that differ by more than 50% compared with the CG formula. The formulas showed a moderate agreement in diagnosing moderate renal insufficiency and a fair agreement in diagnosing severe renal insufficiency. The magnitude of the difference in GFR estimates was influenced by age and weight. CONCLUSIONS: The CG and MDRD formulas have a good average agreement, but at the individual level, they can give estimates that differ substantially, and cannot be used interchangeably to measure renal function in elderly people.

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PubMed2006

Use of antibiotics in elderly patients with exacerbated COPD: the OLD-chronic obstructive pulmonary disease study.

OBJECTIVES: To verify how frequently geriatric patients hospitalized for exacerbated chronic obstructive pulmonary disorder (COPD) had not been given antibiotics at home and to identify the relationship between the patient's condition and the prescribing practice. DESIGN: Observational study. SETTING: General medicine acute care wards. PARTICIPANTS: Four hundred fifty-nine elderly patients admitted to the hospital because of exacerbated COPD. MEASUREMENTS: Indices of severity of COPD exacerbation, such as age, St. George Respiratory Questionnaire (SGRQ) score, number of exacerbations in the previous year, and Cumulative Illness Rating Scale score were considered in the analyses. RESULTS: Ninety (19.6%) patients had an antibiotic prescribed before admission. The prescription was not associated with older age and was weakly associated with greater comorbidity. Having more than four exacerbations (odds ratio (OR)=2.16, 95% confidence interval (CI)=1.27-3.66) and a SGRQ symptoms subscore greater than 70 (OR=1.61, 95% CI=1.0-2.68) were independent correlates of the use of antibiotics before admission, although 67% of patients reporting more than four exacerbations in the previous year and 73.1% of patients with a SGRQ symptoms subscore greater than 70 had not been given any antibiotic prescription at home. CONCLUSION: The majority of older patients hospitalized for exacerbated COPD had not been given antibiotics at home, although they had at least one index of exacerbation severity.

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PubMed2006

From Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines to current clinical practice : an overview of the pharmacological therapy of stable chronic obstructive pulmonary disorder.

BACKGROUND: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have been promulgated to improve the management of chronic obstructive pulmonary disorder (COPD). OBJECTIVE: To evaluate the extent to which the current therapeutic approach to COPD conforms to GOLD guidelines. METHODS: This was a multicentre observational study of elderly COPD patients enrolled for acute care in general medicine or geriatric wards in tertiary hospitals in Italy in April 2002. Our series consisted of 471 patients >64 years of age consecutively admitted for acute exacerbations of COPD to wards participating in the study. Data describing drugs used prior to exacerbation and prescribed at discharge were collected using a standardised protocol. Changes in prescription at discharge were then compared with home therapy. Demographic variables and indices of COPD severity and co-morbidity were tested as potential correlates for the main outcome measure 'variant prescription', i.e. prescription of a drug considered as a third-line treatment (e.g. methylxanthines) or not recommended (e.g. mucolytics) by GOLD guidelines. The correlation was assessed first by univariate analysis and then by logistic regression analysis. RESULTS: At discharge, prescription of short-acting beta(2)-adrenoceptor agonists had decreased from 26.3% to 14.0%. Conversely, increases in prescription of long-actingbeta(2)-adrenoceptor agonists (from 43.1% to 68.4%), inhaled corticosteroids (50.7% to 69.6%) and anticholinergics (17.2% to 22.3%) were seen. The rate of use of methylxanthines was 49.7% before admission and 44.8% at discharge, with previous use being the main correlate of discharge prescription for this class of drugs (odds ratio [OR] = 4.35; 95% CI 2.88, 6.54). The rate of use of mucolytics was 26.3% before admission and 26.8% at discharge, with use of mucolytics prior to admission being the only correlate of discharge prescription (OR = 4.10; 95% CI 2.47, 6.82). CONCLUSIONS: Hospitalisation resulted in increased adherence to GOLD guidelines in patients with COPD, but the rate of use of anticholinergics was distinctly low and that of methylxanthines and mucolytics surprisingly high. A carry-over effect (i.e. of therapy prescribed by general practitioners on that prescribed by hospital-based physicians) likely accounts for most of the 'variant prescriptions' seen at discharge from the acute care hospital.

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PubMed2006

[Role of renal failure in the pathogenesis of adverse drug reactions in the elderly].

The high prevalence of multiple chronic disorders and polypharmacotherapy expose elderly patient to an increased risk of adverse drug reactions. Aging is associated with relevant morphological and functional changes in the kidney, with consequent changes in the pharmacokinetics of hydrosoluble drugs. Changes in renal function are not always clinically evident, and a concealed renal failure can lead to an increased risk of adverse drug reactions to hydrosoluble drugs. Targeting these at-risk patients could contribute to reduce the risk of adverse drug reactions with relevant cost saving.

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PubMed2005

Health status in older hospitalized patients with cancer or non-neoplastic chronic diseases.

BACKGROUND: Whether cancer is more disabling than other highly prevalent chronic diseases in the elderly is not well understood, and represents the objective of the present study. METHODS: We used data from the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) study, a large collaborative observational study based in community and university hospitals located throughout Italy. Our series consisted of three groups of patients with non-neoplastic chronic disease (congestive heart failure, CHF, N = 832; diabetes mellitus, N = 939; chronic obstructive pulmonary disease, COPD, N = 399), and three groups of patients with cancer (solid tumors without metastasis, N = 813; solid tumors with metastasis, N = 259; leukemia/lymphoma, N = 326). Functional capabilities were ascertained using the activities of daily living (ADL) scale, and categorical variables for dependency in at least 1 ADL or dependency in 3 or more ADLs were considered in the analysis. Cognitive status was evaluated by the 10-items Hodgkinson Abbreviated Mental Test (AMT). RESULTS: Cognitive impairment was more prevalent in patients with CHF (28.0%) or COPD (25.8%) than in those with cancer (solid tumors = 22.9%; leukemia/lymphoma = 19.6%; metastatic cancer = 22.8%). Dependency in at least 1 ADL was highly prevalent in patients with metastatic cancer (31.3% vs. 24% for patients with CHF and 22.4% for those with non-metastatic solid tumors, p < 0.001). In people aged 80 years or more, metastatic cancer was not associated with increased prevalence of physical disability. In multivariable analysis, metastatic cancer was associated with a greater prevalence of physical (OR 2.09, 95%CI 1.51-2.90) but not cognitive impairment (OR 1.34, 95%CI 0.94-1.91) with respect to CHF patients. Finally, diabetes was significantly associated with cognitive impairment (OR 1.40, 95%CI 1.11-1.78). CONCLUSION: Cancer should not be considered as an ineluctable cause of severe cognitive and physical impairment, at least not more than other chronic conditions highly prevalent in older people, such as CHF and diabetes mellitus.

Activities of Daily Living↗
PubMed2005

Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients.

BACKGROUND: Adverse drug reactions (ADRs) are common causes of in-hospital complications for elderly people. The purpose of the present study is to verify whether concealed renal insufficiency, that is, reduction of the estimated glomerular filtration rate (GFR) in people with normal serum creatinine levels, is a risk factor for ADRs in elderly hospitalized patients. METHODS: We used data on 11,687 hospitalized patients enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano study. The outcomes of the study were any ADR, ADR to hydrosoluble drugs, and ADR to any other drug during the hospital stay. We compared 3 groups: normal renal function (normal serum creatinine levels and normal estimated GFRs), concealed (normal serum creatinine levels and reduced estimated GFRs), or overt (increased creatinine levels and reduced estimated GFRs) renal insufficiency. The relationship between renal function and ADR was evaluated using contingency tables and multiple regression analysis including potential confounders. RESULTS: Concealed renal insufficiency was detected in 1631 (13.9%) patients and was frequently associated with male sex and poor nutritional status. Hydrosoluble drugs were responsible for 301 of the 941 recorded ADRs. After adjusting for potential confounders, both concealed (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.15-1.25) and overt (OR, 2.02; 95% CI, 1.54-2.65) renal failure were associated with ADR to hydrosoluble drugs, but not with ADR to other drugs (OR, 0.83 [95% CI, 0.65-1.08], and OR, 1.01 [95%CI, 0.83-1.23], respectively). CONCLUSION: Older hospitalized patients frequently have impaired renal function despite normal serum creatinine levels and are exposed to an increased risk of ADRs to hydrosoluble drugs.

Age Factors↗
PubMed2005

Ruffled hair and fever in an old woman with Alzheimer's disease.

In patients with dementia, the clinical presentation of unrelated medical conditions may be concealed or atypical, and symptoms difficult to interpret, or confounded by existing cognitive deterioration or by medications. These difficulties pose an extraordinary challenge to clinicians, and may contribute to the disturbing evidence of inadequate assessment and treatment of medical conditions in patients with dementia. Here, we report the case of an 82-year old woman diagnosed with Alzheimer's disease, whose MMSE score started to deteriorate rapidly after six years of steady decline as a result of a temporal arteritis. Temporal arteritis, a diagnosis which is often made several months after the onset of symptoms even in the general population, can be difficult to identify in patients with pre-existing dementia.

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PubMed2005

Age, cancer and the risk of venous thromboembolism.

Cancer increases the risk for venous thromboembolism (VTE) and patients presenting with a seemingly idiopathic VTE often have an occult cancer. Aging also is a risk factor for VTE. Therefore, old patients with cancer are supposed to be at very high risk for VTE, but inherent data are sporadic and contrasting. We reviewed the literature about the relation between cancer and VTE, with particular attention to findings concerning elderly patients. While aging and postmenopausal status enhance the risk of chemotherapy-induced VTE in women with breast cancer, the rate of a cancer diagnosis in the first year after VTE seems to be even lower in elderly compared to young subjects. Thus, further studies are needed to understand whether or not aging and cancer have additive thrombogenic effects. Finally, we discuss prophylactic and therapeutic strategies.

Age Factors↗
PubMed2005

Aggressive behavior of classical Kaposi's sarcoma and coexistence with angiosarcoma.

UNLABELLED: An 82-year-old Caucasian man presented with initially asymptomatic livid red plaques on the plantar surface of the feet that become confluent and evolved into invasively growing nodules accompanied by massive edema. Histology allowed a diagnosis of the classical form of Kaposi's sarcoma; the serology test result for HIV was negative, whereas the associated human herpes virus type 8 was detected by polymerase chain reaction on the skin sample. Over the subsequent 6 months, skin lesions become vegetative and partially necrotic, and extended to the hands and eyelids. Chemotherapy with vinblastine appeared to stabilize the cutaneous disease, but the patient developed a massive gastrointestinal hemorrhage secondary to dissemination to the stomach. Twelve months after the onset of the disease, vegetative and easily bleeding lesions progressively occluded the mouth of the patient: histological features were consistent with a low-grade angiosarcoma distinct from that of Kaposi's sarcoma. The patient could not chew and swallow anymore; he was put on an artificial nutrition but died shortly thereafter. This case illustrates that, even in its classical form, Kaposi's sarcoma may be a malignant, rapidly progressing tumor. LEARNING POINTS: a) The extent and rate of spread of initial skin lesions should be considered to be early signs of aggressive dissemination, even in the absence of other variables (i.e., histological pattern, human herpes virus type 8 positive mononuclear cells) associated with progression of the disease. b) An endoscopy may be useful given the high prevalence of gastrointestinal involvement. c) When classical Kaposi's sarcoma displays aggressive behavior a second, primary malignant tumor arising from the vascular tissue should be investigated. TAKE-HOME MESSAGE: Even in its classical form, Kaposi's sarcoma may be a malignant, rapidly progressing tumor with visceral involvement; also, a second malignancy may occur in nearly one patient of four. Because localized skin lesions can regress completely with radiotherapy, watchful waiting is probably inappropriate in most cases.

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PubMed2005

Concealed renal failure and adverse drug reactions in older patients with type 2 diabetes mellitus.

BACKGROUND: In elderly patients serum creatinine may be normal despite decreased glomerular filtration rate (GFR). The aim of this study was to evaluate the prevalence of this "concealed" renal failure, i.e., renal failure with normal serum creatinine levels, in elderly diabetic patients, and to verify whether it is a risk factor for adverse drug reactions (ADR) to hydrosoluble drugs. METHODS: We used data on 2257 hospitalized patients with type 2 diabetes mellitus enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano study. On the basis of serum creatinine and calculated GFR, patients were grouped as follows: normal renal function (normal serum creatinine levels and normal GFR), concealed (normal serum creatinine levels and reduced GFR), or overt (increased creatinine levels and reduced GFR) renal failure. GFR was calculated using the Modification of Diet in Renal Disease (MDRD) equation. The outcome of the study was the incidence of ADR to hydrosoluble drugs during the hospital stay. The relationship between renal function and ADR was evaluated using Cox regression analysis including potential confounders. RESULTS: Concealed renal failure was observed in 363 (16.1%) of patients studied. Patients with concealed or overt renal failure were older, had more frequently cognitive impairment and polypharmacy, and had lower serum albumin levels than did those with normal renal function. Both concealed (hazard ratio = 1.90; 95% confidence interval, 1.04-3.48; p =.036) and overt (hazard ratio = 2.23; 95% confidence interval, 1.40-3.55; p =.001) renal failure were significantly associated with ADR to hydrosoluble drugs. The use of more than four drugs also qualified as an independent risk factor for ADRs to hydrosoluble drugs during hospital stay. CONCLUSIONS: Older diabetic patients should be systematically screened to ascertain the presence of concealed renal failure in an attempt to optimize the pharmacological treatment and reduce the risk of ADRs.

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PubMed2005

Construct validity of activities of daily living scale: a clue to distinguish the disabling effects of COPD and congestive heart failure.

STUDY OBJECTIVES: To assess differences, if any, in the pattern of disability measured using basic activities of daily living (BADL) and instrumental activities of daily living (IADL) in COPD and congestive heart failure (CHF), using diabetes mellitus as a reference noncardiorespiratory disabling condition. DESIGN: Multicenter survey. SETTING: General medicine or geriatric wards in tertiary hospitals throughout Italy. PATIENTS: Patients admitted because of CHF (n = 432), COPD (n = 305), and diabetes mellitus (n = 534). MEASUREMENTS AND RESULTS: Construct validity of self-reported preadmission BADL-IADL was assessed for each group by main component analysis. The three populations had a comparable average degree of dependency in BADL-IADL. In both CHF and diabetes mellitus patients, three components cumulatively explained most of variance in BADL-IADL: the BADL, 10 IADL, and 4 housework-related IADL. In COPD, a four-factor solution was generated, with factor 4 having loading with IADL items assessing mobility and outdoor moving, and factor 3 with selected IADL requiring both physical and mental capabilities such as managing money, taking medicine, and traveling. Correlates of dependency in IADL related to factor 4 in COPD were older age, cognitive impairment, widowhood, and comorbidity. Both factors 3 and 4 were associated with longer stay (factor 3: 13.9 +/- 9.5 days vs 11.5 +/- 7.6 days, p < 0.05; factor 4: 14.2 +/- 8.8 days vs 11.0 +/- 5.5 days, p < 0.05) of COPD patients (mean +/- SD). CONCLUSION: COPD was associated with a distinctive pattern of disability expressed by loss of selected BADL-IADL but not by the crude number of lost BADL-IADL.

Activities of Daily Living↗