bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperglycemia, hypoglycemia and glycemic variability in the elderly: a fatal triad?
Authors: Monami Matteo , Aleffi Sara 
Published: June 2016

Diabetes mellitus is one of the most important causes of cardiovascular morbidity and mortality; the incidence of chronic complications of diabetes appears to be closely related to the degree of hyperglycaemia. However, results of clinical trials showed that intensive treatment of hyperglycaemia prevents microvascular complications, but has little or no effect on the incidence of cardiovascular events. Different hypoglycaemic drugs show different effects on cardiovascular risk. However, those trials have shown a neutral effect on cardiovascular mortality. This paradoxical result could be explained with the frequent use, in the past, of glucose-lowering agents capable of increasing the risk of hypoglicemia, glycemic variability and weight gain. In conclusion, an adequate glycemic control, in particular in elderly patients, should be achieved, whenever possible, using agents not inducing hypogycemia, glucose fluctuations, and weight gain. In fact, hypoglycaemia and glucose variability should be considered as independent cardiovascular risk factors to a similar extent to hyperglycemia. In this article, the author will review literature supporting the hypothesis that hyperglycemia, hypoglycaemia and glycemic variability are a fatal triad capable of increasing morbidity and mortality in patients with diabetes mellitus.Â RiassuntoIl diabete mellito Ã¨ una delle piÃ¹ importanti cause di morbilitÃ e mortalitÃ cardiovascolare, ed Ã¨ stata dimostrata una stretta correlazione tra compenso glicometabolico ed incidenza di complicanze croniche del diabete mellito. Tuttavia, negli studi di intervento, il controllo accurato dellâ€™iperglicemia sembra poter prevenire le complicanze microvascolari, ma ha effetti soltanto marginali sullâ€™incidenza di eventi cardiovascolari secondari a malattia macrovascolare. Inoltre, i grandi trial di intervento hanno mostrato come la riduzione degli eventi cardiovascolari non si accompagni ad una riduzione della mortalitÃ cardiovascolare. Tale paradosso potrebbe essere spiegato dal fatto che spesso, in passato, per ottenere un miglioramento glicometabolico si sono utilizzati farmaci ipoglicemizzanti in grado di aumentare il rischio ipoglicemico, la variabilitÃ glicemica ed il peso corporeo. In conclusione, il miglioramento del compenso glicemico, specie nel paziente anziano, dovrebbe essere ottenuto, quando possibile, con farmaci a basso rischio ipoglicemico e non inducenti aumenti di peso, per evitare gli effetti negativi di ipoglicemie e eccessive fluttuazioni della glicemia che di per sÃ© costituiscono dei fattori di rischio cardiovascolari al pari dellâ€™iperglicemia. In questo articolo, si esplorerÃ lâ€™ipotesi che iperglicemia, ipoglicemia e variabilitÃ glicemica costituiscano una triade fatale in grado di aumentare morbilitÃ e mortalitÃ nei pazienti affetti da diabete mellito.
Aging clinical problems: a difficult balance between age and frailty
Authors: Rozzini Renzo 
Published: June 2016

Frailty is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among older adults. Frailty is a condition associated with ageing with associated weakness, slowing, decreased energy, lower activity, and, when severe, unintended weight loss. As a population ages, a central focus of geriatricians and public health practitioners is to understand, and then beneficially intervene on, the factors and processes that put elders at such risk, especially the increased vulnerability to stressors (e.g. extremes of heat and cold, infection, injury, or even changes in medication) that characterizes many older adults. The syndrome of geriatric frailty is hypothesized to reflect impairments in the regulation of multiple physiologic systems, embodying a lack of resilience to physiologic challenges and thus elevated risk for a range of deleterious endpoints. The empirical assessment of geriatric frailty in individuals seeks to capture this or related features.RiassuntoFragilitÃ Ã¨ la predisposizione alla rottura, al danno. Lâ€™etimologia della parola fragilitÃ da "frango", rompere, rimanda alla nozione di qualche cosa che se sottoposto a una pressione, a un impatto, rischia di danneggiarsi facilmente. Eâ€™ dunque una nozione ampia e intuitiva che puÃ² avere ambiti di precisazione piÃ¹ diversi a seconda che se ne parli in fisica (dove esistono dei coefficienti esatti) piuttosto che nei campi della morale o del sentimento, dove la valutazione sarÃ sempre piÃ¹ "poetica" e affidata alla sensibilitÃ individuale.
High blood pressure in older subjects with cognitive impairment
Authors: Mossello Enrico , Simoni David 
Published: June 2016

High blood pressure and cognitive impairment often coexist in old age, but their pathophysiological association is complex. Several longitudinal studies have shown that high blood pressure at midlife is a risk factor for cognitive impairment and dementia, although this association is much less clear in old age. The effect of blood pressure lowering in reducing the risk of dementia is only borderline significant in clinical trials of older subjects, partly due to the insufficient follow-up time. Conversely, dementia onset is associated with a decrease of blood pressure values, probably secondary to neurodegeneration. Prognostic effect of blood pressure values in cognitively impaired older subjects is still unclear, with aggressive blood pressure lowering being potentially harmful in this patients category. Brief cognitive screening, coupled with simple motor assessment, are warranted to identify frail older subjects who need a more cautious approach to antihypertensive treatment. Values obtained with ambulatory blood pressure monitoring seem more useful than clinical ones to predict the outcome of cognitively impaired older subjects. Future studies should identify the most appropriate blood pressure targets in older subjects with cognitive impairment.Â RiassuntoIpertensione arteriosa e decadimento cognitivo spesso coesistono in etÃ avanzata, sebbene la loro associazione sia complessa dal punto di vista fisiopatologico. Diversi studi longitudinali hanno mostrato che elevati valori pressori in etÃ adulta rappresentano un fattore di rischio per decadimento cognitivo e demenza, sebbene tale associazione sia molto meno chiara in etÃ avanzata. Lâ€™effetto della terapia antiipertensiva Ã¨ risultato ai limiti della significativitÃ statistica nel ridurre il rischio di demenza negli studi di intervento su soggetti anziani, in parte a causa della durata insufficiente del follow-up. Dâ€™altra parte, lâ€™insorgenza di demenza Ã¨ associata con una riduzione dei valori pressori, probabilmente secondaria alla neurodegenerazione. Lâ€™effetto prognostico dei valori pressori in anziani con decadimento cognitivo non Ã¨ stato ancora chiarito, in presenza di un possibile effetto dannoso di un trattamento antiipertensivo aggressivo in questa categoria di pazienti. Un breve screening cognitivo, associato con una semplice valutazione motoria, Ã¨ raccomandato per identificare gli anziani fragili, che necessitano di un approccio piÃ¹ cauto alla terapia antiipertensiva. I risultati del monitoraggio della pressione arteriosa nelle 24 ore sembrano piÃ¹ utili della misurazione clinica per predire la prognosi degli anziani cognitivamente compromessi. Studi futuri dovrebbero identificare gli obiettivi pressori piÃ¹ appropriati nel trattamento di anziani con decadimento cognitivo.
Concurrent sensitization to Aspergillus Fumigatus in tropical pulmonary eosinophilia
Authors: Chhabra Sunil K. , Dash Devi Jyoti 
Published: June 2016

Tropical pulmonary eosinophilia (TPE) is characterized by lung tissue and peripheral blood eosinophilia. Serum total IgE is also markedly increased in TPE. However, an association with asthma or other hypersensitivity conditions has not been described. During the diagnostic workup of three patients eventually confirmed to have TPE, hypersensitivity to the fungus, Aspergillus Fumigatus was found. However, there was no evidence of diseases of aspergillus hypersensitivity such as severeÂ asthmaÂ with fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA). This association however raises the possibility of a future risk of these potentially serious allergic respiratory manifestations.RiassuntoLâ€™eosinofilia polmonare tropicale (TPE) Ã¨ caratterizzata da tessuto polmonare e eosinofilia nel sangue periferico. Anche il siero IgE totale Ã¨ notevolmente aumentato in TPE. Tuttavia, unâ€™associazione con asma o altre condizioni di ipersensibilitÃ non Ã¨ stata descritta. Durante l'iter diagnostico di tre pazienti, che alla fine si sono rivelati presentare TPE, ipersensibilitÃ al fungo, Ã¨ stato trovato lâ€™Aspergillus fumigatus. Tuttavia, non vi era alcuna evidenza di malattie di Aspergillus ipersensibilitÃ come l'asma grave con sensibilizzazione fungina (SAF) e aspergillosi broncopolmonare allergica (ABPA). Questa associazione pone tuttavia la possibilitÃ di un rischio futuro di queste potenzialmente gravi manifestazioni allergiche respiratorie.
Cardiac rehabilitation is safe and effective also in the elderly, but don't forget about drugs!
Authors: Del Sindaco Donatella , Tinti Maria Denitza , Pulignano Giovanni , Tolone Stefano , Minardi Giovanni , Uguccioni Massimo , Lax Antonio 
Published: June 2016

In the setting of heart failure (HF) pharmacotherapy demonstrates a quantifiable improvement in exercise tolerance also in HF with preserved ejection fraction (HFpEF). For patients with HFpEF, often older, with higher prevalence of hypertension, diabetes mellitus, atrial fibrillation and other comorbidities, endpoints such as quality of life and functional capacity may be more clinically relevant. However several study show as the use of ACE-I and B-blocker were lesser than expected. Beta-blocker therapy is the keystone of pharmacotherapy of HF patients and exercise training is the essential core of rehabilitation programs, it is important to elucidate the relationship between these therapies. Exercise training improves the clinical status of HF, improving left ventricular ejection fraction and improving quality of life, but it is possible that b-blocker may attenuate exercise training adaptations. Despite this, possible adverse b-blocker effects are just presumed and not confirmed by published randomized clinical trials. Metanalysis suggests that b-blocker compared with placebo enhances improvements in cardiorespiratory performance in exercise training intervention. Despite these evidences, prescription of gold standard therapy and adherence are still suboptimal and should be a priority goal for all CR program.Â RiassuntoNellâ€™ambito dei pazienti con scompenso cardiaco (SC) la terapia farmacologica permette di ottenere un miglioramento della tolleranza allâ€™esercizio fisico anche nei pazienti con frazione di eiezione conservata. Questi pazienti spesso piÃ¹ anziani, con una piÃ¹ elevata incidenza di ipertensione, diabete mellito, fibrillazione atriale e comorbiditÃ , endpoints quali qualitÃ della vita e capacitÃ funzionale dovrebbero risultare piÃ¹ clinicamente rilevanti. Tuttavia molti studi mostrano come lâ€™utilizzo di ACE-I e Beta-bloccanti sia minore di quanto ci si aspetterebbe. Va evidenziato comunque come la terapia beta-bloccante costituisca il cardine della terapia farmacologica dello SC e come lâ€™esercizio fisico sia il cuore dei programmi di riabilitazione, pertanto Ã¨ importante valutarne le possibili interazioni. Lâ€™esercizio fisico migliora lo stato clinico dei pazienti con SC, ma Ã¨ possibile che la terapia con Beta-bloccanti possa attenuare questi vantaggi. Tale assunto tuttavia rimane solo presunto e non confermato dai risultati dei trial pubblicati. Infatti una metanalisi suggerisce che la terapia Beta-bloccante, confrontata con il placebo, migliori la performance cardiorespiratoria nel gruppo sottoposto ad esercizio fisico. Malgrado tali evidenze, la prescrizione di una terapia medica ottimale e lâ€™aderenza alla stessa rimangono ancora non ottimali e dovrebbe rappresentare un obiettivo primario per tutti i programmi di riabilitazione.Â
Resistance training and sarcopenia
Authors: Giallauria Francesco , Cittadini Antonio , Smart Neil Andrew , Vigorito Carlo 
Published: June 2016

Aging is inexorably accompanied by a progressive decline of muscle mass, quality and strength. The resulting condition has been termed sarcopenia. Age-related sarcopenia can be accelerated by a variety of factors including changes in the hormonal milieu, inactivity, poor nutrition, chronic illness, and loss of integrity and function in the peripheral and central nervous systems. The downstream mechanisms by which these risk factors cause sarcopenia are not completely understood. Exercise training (particularly resistance training) has long been identified as the most promising method for increasing muscle mass and strength among older people. New interventions aimed at preventing muscle atrophy, promoting muscle growth and ultimately, maintaining muscle functions during aging are discussed. Understanding how age affects muscle-related gene expression, protein recycling and resynthesis, post-translational modification and turnover will be crucial to identify new treatment options.Â RiassuntoLâ€™invecchiamento Ã¨ inesorabilmente accompagnato da un progressivo declino della massa, della qualitÃ e della forza muscolare. La conseguente condizione viene definita sarcopenia. La sarcopenia correlata allâ€™invecchiamento puÃ² essere accelerata da una serie di fattori tra cui le modifiche degli equilibri ormonali, la sedentarietÃ , la scarsa nutrizione, le patologie croniche, e la perdita di integritÃ e funzione del sistema nervoso centrale e periferico. I meccanismi attraverso i quali questi fattori causano sarcopenia sono ancora non completamente chiari. Lâ€™esercizio fisico (in particolare il training di resistenza) Ã¨ da tempo identificato come una delle piÃ¹ promettenti stratefie per aumentare la massa muscolare e la forza negli anziani. Interventi mirati a prevenire la atrofia muscolare, a promuovere la crescita muscolare e, in ultima analisi, preservare le funzioni muscolari durante lâ€™invecchiamento verranno discussi. Comprendere come lâ€™invecchiamento interferisce con lâ€™espressione genica ai livello muscolare, con i sistemi di riciclo e resintesi proteica, con le modifiche post-traslatzionali e il turnover, sarÃ cruciale per identificare e implementare nuove strategie terapeutiche.
Linking HIV & family planning services to improve dual methods of contraception among women infected with HIV in Mumbai, Maharashtra, India
Authors: Joshi Beena , Velhal Gajanan , Chauhan Sanjay , Kulkarni Ragini , Begum Shahina 
Published: June 2016

Background & objectives:
Preventing unintended pregnancies among people living with HIV (PLHIV) is one of the strategies of WHO for preventing parent-to-child transmission (PPTCT). Given the limitation of only condom use, the objective of this study was to improve use of dual contraceptive methods among HIV infected women.

Methods:
An experimental study among HIV positive women was conducted at two tertiary care level hospitals in Mumbai. Linking HIV with family planning services was the focus of intervention at one site and standard level of care was maintained at the control site. At each site, 150 HIV+ve women attending counselling and testing centres, who did not intend to get pregnant in the next one year and were eligible to use dual methods, were enrolled and followed up to one year.

Results:
At the end of one year, 60 per cent women in the intervention group reached Family Planning Centres compared to eight per cent in the control group. There was three times more acceptance and continuation of use of dual methods along with increase in consistent use of condoms and less number of unplanned pregnancies in the intervention group than the control group.

Interpretation & conclusions:
The study findings demonstrate that linking HIV and family planning services may facilitate the uptake of dual methods of contraception without reducing consistent condom use among HIV infected women. The PPTCT programmes need to focus on the component of Prong 2 of PPTCT which aims to prevent unintended pregnancies among HIV positive women.
Prescription pattern of antidepressants in five tertiary care psychiatric centres of India
Authors: Tripathi Adarsh , Avasthi Ajit , Desousa Avinash , Bhagabati Dipesh , Shah Nilesh , Kallivayalil Roy Abraham , Grover Sandeep , Trivedi J.K. , Shinfuku Naotaka 
Published: June 2016

Background & objectives:
Limited data are available on prescription patterns of the antidepressants from India. We studied antidepressants’ prescription pattern from five geographically distant tertiary psychiatric care centers of the India.

Method:
In this cross-sectional study, all patients who attended outpatients department or were admitted in the psychiatry wards at Lucknow, Chandigarh, Tiruvalla, Mumbai and Guwahati on a fixed day, who were using or had been prescribed antidepressant medications, were included. The data were collected on a unified research protocol.

Results:
A total of 312 patients were included. Mean age was 39±14.28 yr and 149 (47.76%) were females, 277 (87.5%) were outpatients. Among the patients receiving antidepressants, 150 (48.1%) were of diagnoses other than depression. Diabetes mellitus 18 (5.78%) was the most common co-morbid medical illness. A total of 194 (62.2%) patients were using selective serotonin reuptake inhibitors (SSRIs) with escitalopram 114 (36.53%) being the most common antidepressant used. Overall, 272 (87.18%) patients were using newer antidepressants. Thirty (9.62%) were prescribed more than one antidepressant; 159 (50.96%) patients were prescribed hypnotic or sedative medications with clonazepam being the most common (n=116; 37.18%).

Interpretation & conclusions:
About half of the patients with diagnoses other than depression were prescribed antidepressants. SSRIs were the most common group and escitalopram was the most common medication used. Concomitant use of two antidepressants was infrequent. Hypnotic and sedatives were frequently prescribed along with antidepressants.
Workarounds and Test Results Follow-up in Electronic Health Record-Based Primary Care
Authors: Menon Shailaja , Murphy Daniel , Singh Hardeep , Meyer Ashley N. , Sittig Dean 
Published: June 2016

SummaryElectronic health records (EHRs) have potential to facilitate reliable communication and follow-up of test results. However, limitations in EHR functionality remain, leading practitioners to use workarounds while managing test results. Workarounds can lead to patient safety concerns and signify indications as to how to build better EHR systems that meet provider needs.To understand why primary care practitioners (PCPs) use workarounds to manage test results by analyzing data from a previously conducted national cross-sectional survey on test result management.We conducted a secondary data analysis of quantitative and qualitative data from a national survey of PCPs practicing in the Department of Veterans Affairs (VA) and explored the use of workarounds in test results management. We used multivariate logistic regression analysis to examine the association between key sociotechnical factors that could affect test results follow-up (e.g., both technology-related and those unrelated to technology, such as organizational support for patient notification) and workaround use. We conducted a qualitative content analysis of free text survey data to examine reasons for use of workarounds.Of 2554 survey respondents, 1104 (43%) reported using workarounds related to test results management. Of these 1028 (93%) described the type of workaround they were using; 719 (70%) reported paper-based methods, while 230 (22%) used a combination of paper- and computer-based workarounds. Primary care practitioners who self-reported limited administrative support to help them notify patients of test results or described an instance where they personally (or a colleague) missed results, were more likely to use workarounds (p=0.02 and p=0.001, respectively). Qualitative analysis identified three main reasons for workaround use: 1) as a memory aid, 2) for improved efficiency and 3) for facilitating internal and external care coordination.Workarounds to manage EHR-based test results are common, and their use results from unmet provider information management needs. Future EHRs and the respective work systems around them need to evolve to meet these needs.
Las potencias subregionales en el sistema internacional de posguerra fría: ¿nuevos actores en la política internacional?
Authors: Morales Ruvalcaba Daniel , Rocha Valencia Alberto , Durán González Tania 
Published: June 2016

En trabajos anteriores, hemos avanzado en la identificación y diferenciación de tres categorías de potencias: potencias mundiales, potencias medias y potencias regionales. Pero, más allá de las potencias mundiales y las potencias medias que se encuentran en el centro del sistema-mundial, y las potencias regionales que se ubican en la semiperiferia, ¿es posible hablar de potencias que se encuentren en la periferia? Como se trata de Estados periféricos, ¿pueden ser calificados como “potencias”? ¿En qué radicaría su relevancia y envergadura? Dichas “potencias” ¿pueden ser agrupadas en una nueva categoría? De ser así ¿qué características compartirían? El objetivo de este documento es proponer una nueva categoría de potencias en el sistema internacional: las potencias subregionales.
Thrombosis in Centrifugal Pumps: Location and Composition in Clinical and in Vitro Circuits
Authors: Hastings Susan M. , Deshpande Shriprasad R. , Wagoner Scott , Maher Kevin , Ku David N. 
Published: June 2016

Purpose Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary mechanical life support for critically ill patients. ECMO is burdened by both thrombotic and hemorrhagic complications. Recently there has been a clinical shift from roller pumps to centrifugal pumps. In this study, we report on bulk thrombus formation within pumps recovered from clinical use. We then replicate this thrombus formation in vitro. Methods Clinical pediatric ECMO circuits driven with the Sorin Revolution were collected from 16 patients. The location and extent of thrombus formation in the pumps were recorded. Pump heads were also tested in a laboratory circulatory loop. The location, extent, and appearance of the thrombi were recorded. Thrombi were examined histologically using Carstairs' stain. Results Gross thrombus was observed in all pump heads at the stainless steel bearing at the inlet. In 19% of the pumps larger thrombi grew into the head over the cone and along the vanes. The thrombi were adherent and cohesive upon extraction. The thrombus formation was strikingly similar between the clinical pump heads and in vitro pump heads. Histology of both clinical and experimental samples exhibited a platelet-rich thrombus. Conclusions Our studies have revealed platelet-rich thrombus in clinical and in vitro circuits. The location and composition of the thrombi suggest that the exposed metal shaft was initially covered by contact activated coagulation followed by large-scale growth by rapid platelet accumulation from high shear rates at the inlet. The in vitro system may be used to further identify the mechanisms for pump thrombus and test new designs.