Giulio Masotti

Central but not brachial blood pressure predicts cardiovascular events in an unselected geriatric population: the ICARe Dicomano Study.

OBJECTIVES The present study investigated whether central blood pressure (BP) predicts cardiovascular (CV) events better than brachial BP in a cohort of normotensive and untreated hypertensive elderly individuals. BACKGROUND Limited and conflicting data have been reported on the prognostic relevance of central BP compared with brachial BP. METHODS Community-dwelling individuals > or =65 years of age, living in Dicomano, Italy, underwent an extensive clinical assessment in 1995 including echocardiography and carotid ultrasonography and applanation tonometry. In 2003, vital status and CV events were assessed, reviewing the electronic database of the Regional Ministry of Health. Only normotensive (n = 173) and untreated hypertensive subjects (95 diastolic and 130 isolated systolic) were included in the present analysis. RESULTS During 8 years, 106 deaths, 45 of which were cardiovascular, and 122 CV events occurred. In univariate analyses, both central and brachial systolic blood pressure (SBP) and pulse pressure (PP) predicted CV events (all p < 0.005); however, in multivariate analyses, adjusting for age and gender, higher carotid SBP and PP (hazard ratios 1.19/10 and 1.23/10 mm Hg, respectively; both p < 0.0001) but neither brachial SBP nor PP independently predicted CV events. Similarly, higher carotid SBP but not brachial pressures independently predicted CV mortality (hazard ratio 1.37/10 mm Hg; p < 0.0001). CONCLUSIONS Our prospective study in an unselected geriatric population demonstrates superior prognostic utility of central compared with brachial BP.

DIFFERENTIAL INHIBITION OF PROSTACYCLIN PRODUCTION AND PLATELET AGGREGATION BY ASPIRIN

Abstract The effect of aspirin ingestion on platelet aggregation, malondialdehyde (MDA) formation, and prostacyclin (PGI 2 ) production by the blood-vessel wall was investigated in twenty-five healthy young volunteers. PGI 2 production induced by ischaemia in the arm was assayed in venous blood. MDA formation and platelet aggregation induced by adenosine disphosphate (ADP), collagen, and adrenaline were inhibited by doses of aspirin smaller than those inhibiting prostacyclin production. The doses which inhibited 50% of platelet aggregation (ID 50) were 3·2 mg/kg for adrenaline, 3·4 for ADP, and 3·2 for collagen, whereas the ID 50 for prostacyclin production was 4·9 mg/kg. Inhibition of platelet aggregation increased only slightly with increasing doses, whereas inhibition of PGI 2 production increased linearly up to 8 mg/kg. Inhibition of platelet aggregation and MDA formation was still present after 72 h, whereas prostacyclin inhibition reversed within 24 h in all subjects after 2, 3·5, and 5 mg/kg and in 6 out of 9 subjects after 8 and 10 mg/kg. These findings indicate that inhibition of platelet cyclo-oxygenase occurs with smaller doses of aspirin and lasts longer than inhibition of vessel-wall cyclo-oxygenase. 3·5 mg/kg is the dose of aspirin most likely to produce a consistent inhibition of platelet aggregation and only a slight inhibition of prostacyclin production.

Reduced Cardiocirculatory Complications With Unrestrictive Visiting Policy in an Intensive Care Unit Results From a Pilot, Randomized Trial

Background— Observational studies suggest that open visiting policies are preferred by most patients and visitors in intensive care units (ICUs), but no randomized trial has compared the safety and health outcomes of unrestrictive (UVP) and restrictive (RVP) visiting policies. The aim of this pilot, randomized trial was to compare the complications associated with UVP (single visitor with frequency and duration chosen by patient) and RVP (single visitor for 30 minutes twice a day). Methods and Results— Two-month sequences of the 2 visiting policies were randomly alternated for 2 years in a 6-bed ICU, with 226 patients enrolled (RVP/UVP, n=115/111). Environmental microbial contamination, septic and cardiovascular complications, emotional profile, and stress hormones response were systematically assessed. Patients admitted during the randomly scheduled periods of UVP received more frequent (3.2±0.2 versus 2.0±0.0 visits per day, mean±SEM) and longer (2.6±0.2 versus 1.0±0.0 h/d) visits (P<0.001 for both comparisons). Despite significantly higher environmental microbial contamination during the UVP periods, septic complications were similar in the 2 periods. The risk of cardiocirculatory complications was 2-fold (odds ratio 2.0; 95% CI, 1.1 to 3.5; P=0.03) in the RVP periods, which were also associated with a nonsignificantly higher mortality rate (5.2% versus 1.8%; P=0.28). The UVP was associated with a greater reduction in anxiety score and a significantly lower increase in thyroid stimulating hormone from admission to discharge. Conclusions— Despite greater environmental microbial contamination, liberalizing visiting hours in ICUs does not increase septic complications, whereas it might reduce cardiovascular complications, possibly through reduced anxiety and more favorable hormonal profile.

Epidemiological profile of symptomatic osteoarthritis in older adults: a population based study in Dicomano, Italy

Objectives: To assess the prevalence of hand, hip, and knee osteoarthritis (OA) in an older Italian community dwelling population and its association with disability. Method: A cross sectional survey of the whole community aged 65 years and over, was carried out in Dicomano, a small rural town in Tuscany, Italy. Subjects were screened by geriatricians for major chronic conditions, including hip, knee, and hand OA, using diagnostic algorithms based on the American College of Rheumatology (ACR) clinical criteria. A rheumatologist examined subjects who screened positive. Disability was assessed by a World Health Organisation questionnaire. Results: 697 of 864 eligible subjects (81% of the eligible population) were screened. OA of the knee, hand, or hip was identified by clinical ACR criteria respectively in 159, 139, and 81 subjects, and was confirmed by the rheumatologist in 158/182 (87%), 75/101 (74%), and 63.2% of cases. The estimated prevalence was 29.8%, 14.9%, and 7.7%, respectively. Only hip OA was significantly associated with disability in basic activities of daily living. Conclusions: About one third of community dwelling older people are affected by symptomatic peripheral OA. Hip OA was strongly associated with disability.

Diagnosis and Characteristics of Syncope in Older Patients Referred to Geriatric Departments

OBJECTIVES: To test the applicability and safety of a standardized diagnostic algorithm in geriatric departments and to define the prevalence of different causes of syncope in older patients.

Are sulphonylureas all the same? A cohort study on cardiovascular and cancer‐related mortality

Aim of the present study is the comparison of all‐cause, cardiovascular and non‐cardiovascular mortality, and cardiac morbidity, between patients treated with glibenclamide and gliclazide.

Three-year mortality in diabetic patients treated with different combinations of insulin secretagogues and metformin.

Several studies have shown an increase of mortality in diabetic patients treated with combinations of sulphonylureas and biguanides. Comparisons between different insulin secretagogues in combination with metformin with respect to all‐cause mortality have not been reported so far.

Efficacy of physiotherapy interventions late after stroke: a meta-analysis

Objective Physiotherapy is usually provided only in the first few months after stroke, while its effectiveness and appropriateness in the chronic phase are uncertain. The authors conducted a systematic review and meta-analysis of randomised clinical trials (RCT) to evaluate the efficacy of physiotherapy interventions on motor and functional outcomes late after stroke. Methods The authors searched published studies where participants were randomised to an active physiotherapy intervention, compared with placebo or no intervention, at least 6 months after stroke. The outcome was a change in mobility and activities of daily living (ADL) independence. The quality of the trials was evaluated using the PEDro scale. Findings were summarised across studies as effect size (ES) or, whenever possible, weighted mean difference (WMD) with 95% CI in random effects models. Results Fifteen RCT were included, enrolling 700 participants with follow-up data. The meta-analysis of primary outcomes from the original studies showed a significant effect of the intervention (ES 0.29, 95% CI 0.14 to 0.45). The efficacy of the intervention was particularly evident when short- and long-distance walking were considered as separate outcomes, with WMD of 0.05 m/s (95% CI 0.008 to 0.088) and 20 m (95% CI 3.6 to 36.0), respectively. Also, ADL improvement was greater, though non-significantly, in the intervention group. No significant heterogeneity was found. Interpretation A variety of physiotherapy interventions improve functional outcomes, even when applied late after stroke. These findings challenge the concept of a plateau in functional recovery of patients who had experienced stroke and should be valued in planning community rehabilitation services.

Predictive Validity of Measures of Comorbidity in Older Community Dwellers: The Insufficienza Cardiaca negli Anziani Residenti a Dicomano Study

OBJECTIVES: To compare the ability of five measures of comorbidity to predict mortality and incident disability in basic activities of daily living (BADLs) in unselected older persons.

Thoracic kyphosis and ventilatory dysfunction in unselected older persons: an epidemiological study in Dicomano, Italy.

Objectives: To assess whether kyphosis is associated with ventilatory dysfunction in older community dwellers.