A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.
In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients' clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen.
Currently, chronic obstructive pulmonary disease (COPD) represents the fourth cause of death worldwide with significant economic burden. Comorbidities increase in number and severity with age and are identified as important determinants that influence the prognosis. In this observational study, we retrospectively analyzed data collected from the RePoSI register. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients with the clinical diagnosis of COPD. Socio-demographic, clinical characteristics and laboratory findings were considered. The association between variables and in-hospital, 3-month and 1-year follow-up were analyzed. Among 4696 in-patients, 932 (19.8%) had a diagnosis of COPD. Patients with COPD had more hospitalization, a significant overt cognitive impairment, a clinically significant disability and more depression in comparison with non-COPD subjects. COPD patients took more drugs, both at admission, in-hospital stay, discharge and 3-month and 1-year follow-up. 14 comorbidities were more frequent in COPD patients. Cerebrovascular disease was an independent predictor of in-hospital mortality. At 3-month follow-up, male sex and hepatic cirrhosis were independently associated with mortality. ICS-LABA therapy was predictor of mortality at in-hospital, 3-month and 1-year follow-up. This analysis showed the severity of impact of COPD and its comorbidities in the real life of internal medicine and geriatric wards.
An increased vascular risk is present in patients with ankylosing spondylitis (AS). In this report, we evaluate the presence and grade of atherosclerosis in patients with AS, uninterruptedly treated with tumor necrosis factor-α (TNF-α) antagonists for 2 years, in comparison to that in a nontreated group of healthy controls.Fourteen patients with AS and 14 healthy controls underwent carotid sonography to measure intima-media thickness (IMT) and to evaluate the presence of plaque. Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index scores, erythrocyte sedimentation rate, C-reactive protein, glycemia, total cholesterol, and triglyceride levels were also recorded.Patients with AS showed significantly lower values of mean and maximum IMT at the level of the common carotid (P = .02 and .04, respectively) and the carotid bulb (P = .0006 and .0005, respectively) compared to those of healthy controls. They also had a number of carotid plaques significantly lower than that of healthy controls (P = .02). No differences were found in IMT values at the level of internal carotid between the 2 populations.The significantly lower carotid atherosclerosis found in patients with AS treated with TNF antagonists than in healthy controls shows the important complementary role of this treatment in reducing vascular disease progression probably by decreasing inflammation.
Background/Aim: To compare patients affected by ankylosing spondylitis (AS) treated with anti-TNF-α for two years with controls in terms of Achilles tendon stiffness, ultrasound structure and thickness. Patients and Methods: Bmode ultrasound evaluation and strain ultrasound elastography were performed in longitudinal and transverse planes on 22 Achilles tendons of 11 AS patients and 26 of 13 controls. Results: There were no significant differences in thickness and stiffness of the Achilles tendon between AS patients and controls, except for an increased thickness in the middle third of the tendon in the AS patients (p=0.04). The Achilles tendon stiffness ratio of AS patients was 1.02±0.36 vs. 1.14±0.38 in the controls (p=0.2). Conclusion: AS patients had an Achilles tendon thickness greater than controls at the middle third, but no difference in the stiffness was found among them. Strain ultrasound elastography may be useful to exclude early changes in mechanical properties of tendons.Ankylosing spondylitis (AS) is a chronic inflammatory spondyloarthritis, the diagnosis of which is based upon clinical, laboratory, and imaging assessment (1). In AS, inflammation affects the axial skeleton, from cervical tract to sacro-iliac joints, and, not infrequently, the ankles. The Achilles tendon is often involved in patients who develop tendinitis and enthesitis, causing pain and stiffness at the posterior aspect of the heel.Ultrasound is an effective tool in the evaluation of the Achilles tendon in patients with AS (2) given the standardization of the definition and of the detection of spondyloarthritis-related enthesitis (3) and the accuracy in detecting peripheral joint features (4, 5); the implementation of power Doppler increased its diagnostic performance (6, 7). Ultrasound can also be used to evaluate in a longitudinal fashion the degree of enthesitis and thus to monitor the clinical course of spondyloarthritis (8).Ultrasound may also be employed in monitoring the therapeutic response to TNF-α antagonists in patients with Achilles enthesitis (9, 10). Furthermore, the continued development of imaging techniques has allowed the introduction of elastography in many commercial ultrasound devices (11)(12)(13).Recently, ultrasound elastography has been used in several cases to identify changes in stiffness of muscles and tendons (14-16). Moreover, ultrasound elastography is more sensitive than B-mode ultrasound in identifying changes in mechanical properties of tendons (14) as confirmed by histological diagnosis (17).Since little information is available on the effect of anti-TNF-α therapy on Achilles tendon of AS patients (18), ultrasound evaluation of this tendon was performed to evaluate the enthesis and the diameter of Achilles tendon in 1635 This article is freely accessible online.
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