Aims
Antiplatelet therapy is recommended for the secondary prevention of cardio‐ and cerebrovascular disease, but for primary prevention it is advised only in patients at very high risk. With this ...background, this study aims to assess the appropriateness of antiplatelet therapy in acutely hospitalized older people according to their risk profile.
Methods
Data were obtained from the REPOSI register held in Italian and Spanish internal medicine and geriatric wards in 2012 and 2014. Hospitalized patients aged ≥65 assessable at discharge were selected. Appropriateness of the antiplatelet therapy was evaluated according to their primary or secondary cardiovascular prevention profiles.
Results
Of 2535 enrolled patients, 2199 were assessable at discharge. Overall 959 (43.6%, 95% CI 41.5–45.7) were prescribed an antiplatelet drug, aspirin being the most frequently chosen. Among patients prescribed for primary prevention, just over half were inappropriately prescribed (52.1%), being mainly overprescribed (155/209 patients, 74.2%). On the other hand, there was also a high rate of inappropriate underprescription in the context of secondary prevention (222/726 patients, 30.6%, 95% CI 27.3–34.0%).
Conclusions
This study carried out in acutely hospitalized older people shows a high degree of inappropriate prescription among patients prescribed with antiplatelets for primary prevention, mainly due to overprescription. Further, a large proportion of patients who had had overt cardio‐ or cerebrovascular disease were underprescribed, in spite of the established benefits of antiplatelet drugs in the context of secondary prevention.
CO2 Reduction Reaction
In article number 2300328, Anna Laurenzana, Tommaso Del Rosso, and co‐workers show the fixation of CO2 into solid nanomaterials in the colloidal phase by laser synthesis and ...processing of gold colloids in water, traditionally considered a green approach leading to ligand‐free nanoparticles without the formation of by‐products. The pulsed laser driven CO2 reduction reaction leads to the formation of carbon monoxide rich gold nanoparticles and organometallic nanocomposites composed by gold nanoclusters and carboxylic acid salts, characterized by a photoluminescent quantum yield of about 20% in the visible (blue) region.
Over the last decade, the CO 2 reduction reaction (CO 2 RR) has been increasingly exploited for the synthesis of high‐value raw materials in gaseous or liquid form, although no examples of CO 2 ...fixation in nanoparticle systems have been demonstrated. Herein, CO 2 fixation into solid nanomaterials by laser synthesis and processing of gold colloids in water, traditionally considered a green approach leading to ligand‐free nanoparticles without the formation of by‐products, is reported. If carbon monoxide‐rich gold nanoparticles are observable even after synthesis in deionized water, the presence of CO 2 derivatives in alkaline water environment leads to C 2 and C 3 coupling with the production of carboxylic acids as a typical CO 2 RR fingerprint. While laser processing of preformed gold colloids is selective for C 2 coupling, both C 2 and C 3 coupling to lactic acid are observed during pulsed laser ablation of a gold target. In the latter case, it is demonstrated that it is possible to synthesize photoluminescent organometallic nanocomposites in the blue spectral region with a quantum yield of about 20% under adequate experimental conditions. In this research, new pathways are offered to be explored in energetics, photonics, catalysis, and synthesis at the nanoscale.
Chronic renal failure is characterized by a marked sympathetic activation. No information exists, however, as to whether the adrenergic overdrive is confined to selected vascular districts or is ...rather generalized to the whole cardiovascular system.
In 15 patients aged 60.5 +/- 2.0 years (mean +/- SEM) with stable chronic renal failure belonging to stage 2-3 of the Kidney Foundation classification and in 12 age-matched healthy controls, we measured arterial blood pressure (Finapres), heart rate (ECG), venous plasma norepinephrine (high-performance liquid chromatography) and postganglionic sympathetic nerve traffic in skeletal muscle and skin areas (microneurography). Muscle and skin nerve traffic measurements were made in a randomized sequence over two periods of 30 min each, spaced by a 20-30-min interval. Measurements also included evaluation of skin sympathetic responses to emotional stimuli.
Muscle sympathetic nerve traffic was markedly and significantly greater in renal failure patients compared with controls (58.2 +/- 3.6 vs. 36.8 +/- 5.7 bursts/100 heart beats, P < 0.01), with this also being the case for plasma norepinephrine (380.6 +/- 63 vs. 210.8 +/- 29 pg/ml, P < 0.05). By contrast, skin sympathetic nerve traffic was superimposable in the two groups (11.5 +/- 0.8 vs. 12.7 +/- 1.7 bursts/minute, P = not significant), this being the case also for the responses to emotional arousal.
These data provide the first evidence that the sympathetic activation characterizing renal failure is not generalized to the entire cardiovascular system. This may depend on the fact that the two sympathetic districts are governed by mechanisms that are differently affected by the chronic uraemic state.
Abstract Background and purpose Oropharyngeal mycosis (OPM) is a complication of radiotherapy (RT) treatments for head and neck (H&N) cancer, worsening mucositis and dysphagia, causing treatment ...interruptions and increasing overall treatment time. Prophylaxis with antifungals is expensive. Better patient selection through the analysis of prognostic factors should improve treatment efficacy and reduce costs. Materials and methods A multicentre, prospective, controlled longitudinal study, with ethics committee approval, examined H&N cancer patients who were candidates for curative treatments with radio-chemotherapy. Patients were divided in groups according to OPM appearance: before the starting of RT (cases), during RT (new cases) and never (no cases). Results Of 410 evaluable patients, 20 were existing cases, 201 new cases and 189 did not report OPM. In our study OPM appears in 42.4% of people >70 years and in 58.2% of younger individuals ( p = 0.0042), and in 68.6% of women versus 50.8% of men ( p = 0.0069). Mucositis and dysphagia were higher and salivation reduced among people with OPM ( p < 0.0000). Patients with OPM had longer hospitalization ( p = 0.0002) and longer (>12 days) treatment interruptions ( p = 0.0288). Conclusions Patients with OPM had higher toxicity and a greater number of long treatment interruptions. Analyses of prognostic factors can help clinicians understand OPM distribution and select patients with the highest probability of OPM for antifungal prophylaxis.
PDF
