The global number of COVID‐19 infections, as of December 23, 2020, stood at approximately 79 million, with over 1.7 million deaths. The development of vascular inflammation may also contribute to a ...hypercoagulable state and endothelial dysfunction in such patients. It is known that multi‐organ damage is more likely in patients with sepsis if they develop coagulopathy and that inhibition of thrombin synthesis can have a positive impact in reducing mortality. In this review, we will focus on the protection of the most fragile groups of the population, such as the elderly. This segment of the population will be a key issue and probably of primary interest to all. Biomarkers appear to be extremely useful as an indicator of what is happening from a pathophysiological point of view in the heart, allowing us to better stratify the prognosis of our patients affected by COVID‐19, especially in the most severe cases and those with comorbidities.
Initially, COVID‐19 disease was identified as a disease involving the respiratory tract, with the possibility of progressing to severe interstitial pneumonia and Acute Respiratory Distress Syndrome; Ever increasing data highlight the possibility that in addition to the lungs, the heart is also a possible target of the coronavirus and cardiovascular diseases seem to represent a multiplier of the risk of death in case of infection with Covid‐19.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
On 11 March 2020, the World Health Organization declared a pandemic state, in relation to the spread of the severe acute respiratory syndrome-coronavirus disease- 2, responsible for the coronavirus ...disease- 2019 (COVID-19). The pandemical blast of COVID-19 uncovered well known weakness of financial chain and put our economic organizations facing off dramatic consequences if new strategies will not be developed to adapt health-care on detailed sub-groups of patients. Frail individual aged >65 years affected by cardiovascular disease are an aged population that showed a particular attitude to contract infection and a higher mortality rate compared to general population. In this brief article, we will focus on the management of issues related to cardiovascular patients facing coronavirus infection, in particular in the most fragile groups of the population such as the elderly, increasingly numerous and affected by multimorbidity. Protecting aged populations will be a central question, probably primary in everyone’s interest.
The aim of our study was to characterize the repolarization disorders propensity induced by drug-drug interaction. In this observational retrospective study, we report our experience on all elderly ...patients with ascertained diagnosis of coronavirus disease 2019 through nasopharyngeal swab with real time-polymerase chain reaction at our Pugliese-Ciaccio hospital in Catanzaro, who received hydroxychloroquine (HCQ), with or without azithromycin (AZY). 33 hospitalized patients were examined. We calculated QT value, cQT, QT dispersion, and cQT dispersion and examined possible progression on the basal electrocardiogram (T0) and after the insertion of the drug (T1). The QT value is increased by T0 vs T1 (370±40.74 vs 420±36.91 ms; P=0.000), as well as the cQT value (408±25.40 vs 451.54±58.81; P=0.003), the QT dispersion (QTd: 36.36±14.53 vs 50.90±13.12 ms; P=0.000); the dispersion of cQTc (cQTd 46.27±18.72 vs 63.18±21.93 ms; P=0.001). The ΔQT was 37.44±44.09 while the ΔcQT was 32.01±56.47). The main determinant of QTc prolongation is the number of drug at risk of prolongation of the QT that could influence the ventricular repolarization phase. The use of HCQ in combination with AZY, in patients suffering from severe acute respiratory syndrome-related coronavirus-2, can favor the onset of serious side effects, even potentially fatal. Finally, the measures of QTd and cQTd confirmed additional electrocardiographic parameters useful in identifying patients being treated with drugs at risk of potential adverse arrhythmic events following drug interaction.
Hydroxychloroquine and QTc: beyond COVID-19 Castagna, Alberto; Vetta, Francesco; Attisani, Giuseppe ...
Geriatric care (Pavia),
10/2020, Volume:
6, Issue:
4
Journal Article
Peer reviewed
Open access
Hydroxychloroquine is an antimalarial drug also known for its anti-inflammatory and antiviral effects, which have raised the interest of many researchers for its potential use in COVID-19 patients. ...It is known that this drug, being able to influence the cardiac repolarization phase with QTc interval prolongation, can be potentially harmful, chiefly in elderly subjects with frailty syndrome, several comorbidities and polypharmacotherapy. Therefore, although electrocardiogram monitoring of QTc prolongation is the focal point for reducing the arrhythmic risk of these patients, in order to identify the most exposed patients, the traditional Comprehensive Geriatric Assessment should be combined with a multiparametric risk score for QTc prolongation.
The aim of this study was to evaluate the management practices of internal medicine clinicians for patients with cardiovascular risk factors, with particular respect to treatment thresholds, ...medication choices and target goals. A sample of internists - representatives of Internal Medicine Units (IMUs) from all the regions in Italy - were identified by the cardiovascular medicine study group of the Italian Internal Medicine FADOI (Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti) Society and invited to fill out a questionnaire about hypertension, dyslipidemia and hyperuricemia. From the 101 questionnaires collected, it was found that despite large heterogeneity between IMUs in terms of patient management and adherence to guidelines, internists were experts in the management of patients with multiple cardiovascular risk factors and associated comorbidities. We hope that these data prompt the internal medicine community to consider the value of producing shared, real-world guidelines on the management of cardiovascular disease.
Purple urine bag syndrome is a rare condition that occurs predominantly in the elderly, immobilized and bearer of chronic bladder catheter. It is a phenomenon usually associated with urinary tract ...infection, particularly in the presence of high bacterial load. The presence of alkaline urine, constipation, high-protein diet and dehydration are predisposing factors. In most cases it is an asymptomatic condition. We described the case of an elderly patient admitted to the geriatric Department in which purple urine was found in the urine collection bag. The culture of urine showed the presence of infection with Klebsiella pneumoniae. Targeted antibiotic treatment and proper hydration determined the resolution of the phenomenon and the resolution of the infection. Although it is an alarming phenomenon due to the particularity of the color of the urine, it is a treatable and solvable condition with an adequate specific antibiotic treatment. Prevention measures are equally effective and consist in eliminating the risk factors for this condition.
Purple urine bag syndrome (PUBS) is a rare condition that occurs predominantly in the elderly, immobilized and bearer of chronic bladder catheter. It is a phenomenon usually associated with urinary ...tract infection, particularly in the presence of high bacterial load. The presence of alkaline urine, constipation, high-protein diet and dehydration are predisposing factors. In most cases it is an asymptomatic condition. We described the case of an elderly patient admitted to the geriatric Department in which purple urine was found in the urine collection bag. The culture of urine showed the presence of infection with Klebsiella Pneumoniae. Targeted antibiotic treatment and proper hydration determined the resolution of the phenomenon and the resolution of the infection. Although it is an alarming phenomenon due to the particularity of the color of the urine, it is a treatable and solvable condition with an adequate specific antibiotic treatment. Prevention measures are equally effective and consist in eliminating the risk factors for this condition.
Introduction: Aging is associated with a large increase in the prevalence of hypovitaminosis D. 25-
Hydroxyvitamin D, 25(OH)D, is the best indicator for vitamin D status. Its possible role in the ...pathogenesis
of Alzheimer’s disease (AD), the leading cause of dementia in the elderly, is particularly important. The
aim of the present study was to examine the association between 25-hydroxyvitamin D (25(OH)D) and
cognitive functions in a group of Italian elderly patients affected with AD.
Methods: We studied the relationship between 25(OH)D and cognitive functions assessed by MMSE (Mini
Mental State Examination) in 150 consecutive elderly patients (F 76 %, age 78,66+ 6,05 years old) attending
our Geriatric ambulatory for cognitive disorders with diagnosis of AD.
Results: In our sample hypovitaminosis D was present in 100% of the screened patients; 111 patients (74%)
had 25(OH)D serum levels inferior to 20 ng/ml; 39 (26%) patients had serum levels included between 20
and 30 ng/ml. After adjustment for age, gender, systolic blood pressure, education, cardiovascular diseases
and antihypertensive treatment, a significant relationship was observed between 25(OH)D and cognitive
status. MMSE appeared significantly higher in subjects with 25(OH)D serum levels ≥ 20 ng/ml than in those
with 25(OH)D < 20 ng/ml (18,42+4,33 vs 12,22+4,44; p=0,000).
Conclusion: Our results showed a relationship between 25(OH)D and cognitive impairment in patients with
AD, suggesting that 25(OH)D could be involved in the onset of dementia.
Abstract Background Diabetes mellitus (DM), neuromuscolar, hereditary or immunological disorders are the most common identified causes of blepharoptosis. However, in about 15–25% they remained ...uncertain. Objective To determined the role of glucose metabolism abnormality in idiopathic blepharoptosis. Methods We identified 162 patients with unilateral idiopathic blepharoptosis and 128 control subjects. In all we evaluated a glucose and insulin levels at fasting and after 2 h-OGTT. In addition we determined insulin resistance (IR), by HOMA-index. Results Following a 2 h-OGTT the prevalence of undiagnosed glucose metabolism abnormality was significantly higher in blepharoptosis patients vs. control group ( P < .001). The IR was documented in 129 patients (78%), of whom 55 (34%) had Impaired Glucose Tolerance (IGT), 36 (22%) newly diagnosed DM (NDDM) and 38 (30%) only IR. The Body Mass Index, blood pressure, serum lipids, triglycerides and smoking were not associated with an increased risk of developing ptosis. Conversely, waist circumference were significantly increased in blepharoptosis patients ( P = .003). Conclusions In this study we focused on emerging evidence that prediabetic status may represent a risk factor for developing blepharoptosis. We propose that 2 h-OGTT and mainly HOMA-index should be determined as a rule in all patients with idiopathic blepharoptosis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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