Publications by authors named "Giovanni Ruotolo"

20 Publications

  • Page 1 of 1

Antimitochondrial Antibodies and Primary Biliary Cholangitis in Patients with Polymyalgia Rheumatica/Giant Cell Arteritis.

Medicina (Kaunas) 2021 Apr 6;57(4). Epub 2021 Apr 6.

Azienda Ospedaliera "Pugliese-Ciaccio", Geriatric Medicine Department, 88100 Catanzaro, Italy.

: Laboratory liver abnormalities can be observed in patients affected with polymyalgia rheumatica (PMR) and/or giant cell arteritis (GCA), especially with a cholestatic pattern. The first objective of our review article is to discuss the potential link between antimitochondrial antibodies (AMA) and/or primary biliary cholangitis (PBC) and PMR/GCA, according to the evidences of literature. The second objective is to discuss the association of PMR/GCA with the other rheumatic diseases having PBC as a common manifestation. : A literature search was performed on PubMed and Medline (OVID interface) using these terms: polymyalgia rheumatica, giant cell arteritis, antimitochondrial antibodies, primary biliary cholangitis, primary Sjogren's syndrome, systemic sclerosis, and systemic lupus erythematosus. The search was restricted to all studies and case reports published in any language. Reviews, conference abstracts, comments, and non-original articles were excluded; however, each review's reference list was scanned for additional publications meeting this study's aim. When papers reported data partially presented in previous articles, we referred to the most recent published data. : Our literature search highlighted that cases reporting an association between AMA, PBC and PMR/GCA were very uncommon; AMA antigenic specificity had never been detected and biopsy-proven PBC was reported only in one patient with PMR/GCA. Finally, the association of PMR/GCA with autoimmune rheumatic diseases in which PBC is relatively common was anecdotal.
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http://dx.doi.org/10.3390/medicina57040350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067448PMC
April 2021

The multidimensional prognostic index (MPI) for the prognostic stratification of older inpatients with COVID-19: A multicenter prospective observational cohort study.

Arch Gerontol Geriatr 2021 Apr 5;95:104415. Epub 2021 Apr 5.

Department of Primary Care, District 3, ULSS 3, Venice, Italy,; Department of Internal Medicine and Geriatrics, University of Palermo, Italy. Electronic address:

Background: The topic of prognosis in COVID-19 research may be important in adopting appropriate clinical decisions. Multidimensional prognostic index (MPI) is a frailty assessment tool widely used for stratifying prognosis in older people, but data regarding inpatients, affected by COVID-19, are not available.

Objectives: To evaluate whether MPI can predict in-hospital mortality and the admission to intensive care unit (ICU) in older inpatients hospitalized for COVID-19 infection.

Methods: In this longitudinal, Italian, multi-center study, older patients with COVID-19 were included. MPI was calculated using eight different domains typical of comprehensive geriatric assessment and categorized in three groups (MPI 1 ≤ 0.33, MPI 2 0.34-0.66, MPI 3 > 0.66). A multivariable Cox's regression analysis was used reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs).

Results: 227 older patients hospitalized for SARS-CoV-2 infection were enrolled (mean age: 80.5 years, 59% females). Inpatients in the MPI 3 were subjected less frequently than those in the MPI 1 to non-invasive ventilation (NIV). In the multivariable analysis, people in MPI 3 experienced a higher risk of in hospital mortality (HR = 6.30, 95%CI: 1.44-27.61), compared to MPI 1. The accuracy of MPI in predicting in hospital mortality was good (Area Under the Curve (AUC) = 0.76, 95%CI: 0.68-0.83). People in MPI 3 experienced a significant longer length of stay (LOS) in hospital compared to other participants. No association between MPI and ICU admission was found.

Conclusions: Frailty- as assessed by high MPI score - was associated with a significant higher risk of in-hospital mortality, longer LOS, and lower use NIV, whilst the association with ICU admission was not significant. These findings suggest that prognostic stratification by using the MPI could be useful in clinical decision making in older inpatients affected by COVID-19.
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http://dx.doi.org/10.1016/j.archger.2021.104415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020604PMC
April 2021

COVID-19 and cardiovascular problems in elderly patients: Food for thought.

Aging Med (Milton) 2021 Feb 28. Epub 2021 Feb 28.

Geriatric Unit Center for Cognitive Disorders and Dementia Azienda Ospedaliera Pugliese-Ciaccio di Catanzaro Catanzaro Italy.

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.
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http://dx.doi.org/10.1002/agm2.12149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014783PMC
February 2021

Progress in the risk assessment of hydroxychloroquine in frail elderly people.

Aging Med (Milton) 2021 Mar 25;4(1):53-57. Epub 2020 Dec 25.

Azienda Sanitaria Locale Napoli 3 Sud Internal and Geriatric Medicine Department - Gerontorheumatological Outpatient Clinic Poliambulatorio "Mariano Lauro" - Distretto Sanitario 59 Naples Italy.

Hydroxychloroquine (HCQ) is an antimalarial drug also known to have anti-inflammatory and antiviral effects. The antiviral action of HCQ has been a point of interest for many researchers because of its mechanism of action and the potential use it could have during the current COVID-19 pandemic. However, HCQ can cause QT interval prolongation. The current therapies used in COVID-19 are changing as the pandemic develops. The aim of this article is to promote a validated risk score for QT prolongation in multidimensional assessment of COVID-19 patients, especially in elderly and polypathological patients.
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http://dx.doi.org/10.1002/agm2.12140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954841PMC
March 2021

Correction to: The CITIMERIVA Study: CITIcoline plus MEmantine plus RIVAstigmine in Older Patients Affected with Alzheimer's Disease.

Clin Drug Investig 2021 Apr;41(4):413

Azienda Ospedaliera Pugliese-Ciaccio di Catanzaro, Geriatric Unit, Center for Cognitive Disorders and Dementia, Catanzaro, Italy.

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http://dx.doi.org/10.1007/s40261-021-01015-8DOI Listing
April 2021

Can SARS-CoV-2 trigger relapse of polymyalgia rheumatica?

Joint Bone Spine 2021 05 4;88(3):105150. Epub 2021 Feb 4.

Azienda Ospedaliera "Pugliese-Ciaccio", Geriatric Medicine department, Catanzaro, Italy.

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http://dx.doi.org/10.1016/j.jbspin.2021.105150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857978PMC
May 2021

Hydroxychloroquine and QT Prolongation in Older Patients with Rheumatic Diseases: Who is afraid of the Boogeyman? We are not!

Mediterr J Rheumatol 2020 Dec 22;31(4):433-435. Epub 2020 Dec 22.

Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine department - Geronthorheumatological Outpatient Clinic, poliambulatorio "Mariano Lauro", Sant'Agnello, Naples, Italy.

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http://dx.doi.org/10.31138/mjr.31.4.433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841093PMC
December 2020

The CITIMERIVA Study: CITIcoline plus MEmantina plus RIVAstigmine in Older Patients Affected with Alzheimer's Disease.

Clin Drug Investig 2021 Feb 23;41(2):177-182. Epub 2021 Jan 23.

Azienda Ospedaliera Pugliese-Ciaccio di Catanzaro, Geriatric Unit, Center for Cognitive Disorders and Dementia, Catanzaro, Italy.

Objective: Combined therapy of memantine or acetylcholinesterase inhibitors, with cholinergic precursors such as citicoline, can be effective in Alzheimer's disease. Indeed, they are able to increase the intrasynaptic levels of acetylcholine more than the single drug. Our aim was to evaluate the efficacy and safety of oral citicoline plus memantine plus rivastigmine in patients with Alzheimer's disease.

Methods: This was a multi-centric, retrospective case-control study conducted in Italian Centers for Cognitive Impairment and Dementia on consecutive patients aged 65 years or older affected with Alzheimer's disease. Overall, 104 patients were recruited (27% male, mean age 76.04 ± 4.92 years); 41 (39.42%) treated with citicolin 1000 mg/day given orally + memantine + rivastigmine (Cases) and 63 (60.58%) treated with memantine + rivastigmine (Controls). At baseline (T0), month 6 (T1) and month 12 (T2), cognitive functions were assessed by the Mini Mental State Examination (MMSE), functional dependence by basal Activities (ADL) and Instrumental Activities of Daily Living (IADL), comorbidity by the Cumulative Illness Rating Scale (CIRS), mood by the Geriatric Depression Scale (GDS), and behavioural disturbances by the Neuropsychiatric Inventory (NPI). Adverse events were reported during the study.

Results: The difference in MMSE score was not significant when comparing the two groups at T0, T1 or T2. However, in the case group, the MMSE total score showed a statistically significant difference at T0 versus T1 (13.63 ± 2.46 vs. 14.17 ± 2.24; p = 0.008), and at T0 versus T2 (13.63 ± 2.46 vs. 14.32 ± 2.53; p = 0.002). In the control group, no statistical differences were found at baseline (T0), T1 and T2. ADL, IADL, GDS and NPI total score did not improve during the study in either the case or the control group.

Conclusions: In our study we observed absence of a statistically significant difference between case and control groups for the MMSE total scores. However, in the case group in the MMSE total scores, there was a statistically significant increase between the baseline and the end of the study.
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http://dx.doi.org/10.1007/s40261-020-00996-2DOI Listing
February 2021

A Retrospective Study on the Benefits of Combined Citicoline, Memantine, and Acetylcholinesterase Inhibitor Treatments in Older Patients Affected with Alzheimer's Disease.

J Alzheimers Dis 2021 ;79(4):1509-1515

Azienda Ospedaliera Pugliese-Ciaccio, Geriatric Unit, Center for Cognitive Disorders and Dementia, Catanzaro, Italy.

Background: Background: Citicoline has been proven to have beneficial effects in patients with cognitive impairment. In previous studies, combined treatment with memantine and acetylcholinesterase inhibitors (AChEIs) maintained cognitive function in patients with Alzheimer's disease (AD) better than memantine or AChEIs alone.

Objective: To evaluate the effectiveness and safety of a combination therapy of oral citicoline, memantine, and an AChEI in AD when compared with memantine and an AChEI without citicoline.

Methods: This was a retrospective multi-centric case-control study, conducted in Italian Centers for Cognitive Impairment and Dementia. Overall, 170 patients were recruited (34.11%of men, mean age 76,81±4.93 years): 48.8%treated with memantine and donepezil; 48.2%with memantine and rivastigmine; 2.9%with memantine and galantamine. 89 patients (control-group) were treated with memantine and an AChEI, whereas 81 patients (case-group) were treated with oral citicoline 1000 mg/day added to memantine and an AChEI given orally. Cognitive functions, activities of daily living, instrumental activities of daily living, comorbidities, mood and behavioral disturbances were assessed at baseline, month 6, and month 12.

Results: In the case group, MMSE score had a statistically significant increasing trend between T0 and T2 (14.88±2.95 versus 15.09±3.00; p = 0.040), whereas in the control group, MMSE score showed a statistically significant decrease trend (14.37±2.63 versus 14.03±2.92 p = 0.024).

Conclusion: In older patients with AD, a triple therapy with citicoline, memantine, and AChEI was more effective than memantine and AChEI without citicoline in maintaining the MMSE total score after 12 months.
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http://dx.doi.org/10.3233/JAD-201211DOI Listing
January 2021

Comprensive Geriatric Assessment in hospitalized older patients with COVID-19.

Geriatr Gerontol Int 2021 Jan 1;21(1):118-119. Epub 2020 Dec 1.

Geriatric Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.

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http://dx.doi.org/10.1111/ggi.14103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753837PMC
January 2021

Comment on: Coronavirus 2019 in Geriatrics and Long-Term Care: The ABCDs of COVID-19.

J Am Geriatr Soc 2020 12 9;68(12):2746. Epub 2020 Sep 9.

Geriatric Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.

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http://dx.doi.org/10.1111/jgs.16795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436577PMC
December 2020

Werner syndrome: a rare mutation.

Aging Clin Exp Res 2019 03 6;31(3):425-429. Epub 2018 Jun 6.

SOC Geriatrics, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.

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http://dx.doi.org/10.1007/s40520-018-0982-1DOI Listing
March 2019

Kidney function and cognitive decline in frail elderly: two faces of the same coin?

Int Urol Nephrol 2018 Aug 4;50(8):1505-1510. Epub 2018 Jun 4.

Center for Cognitive Disorders and Dementia, Azienda Sanitaria Provinciale di Catanzaro, Catanzaro, Italy.

Background And Aims: Cognitive and renal impairment are pervasive among elderly frails, a high-risk, geriatric sub-population with peculiar clinical characteristics. In a series of frail individuals with non-advanced chronic kidney disease (CKD), we aimed at assessing the entity of functional, general health and cognitive impairment and the possible relationship between these types of dysfunction and the severity of renal impairment.

Methods: 2229 geriatric subjects were screened for frailty and CKD. Severity of CKD was assessed by eGFR (CKD-EPI formula). Frailty was established by the Fried Index. Functional, general health and cognitive status were assessed by validated score measures.

Results: Final analysis included 271 frail CKD subjects (162 women, 109 men). Mean eGFR was 64.25 ± 25.04 mL/min/1.73 m. Prevalence of mild-to-moderate CKD (stage 3-4) was 44%. Twenty-six percent of patients had severe cognitive impairment, while mild and moderate impairment was found in 7 and 67% of individuals, respectively. All subjects had poor functional and general health status. Cognitive capacities significantly decreased across CKD stages (p for trend < 0.0001). In fully adjusted multivariate analyses, cognitive status remained an independent predictor of eGFR (β = 0.465; p < 0.0001).

Conclusions: Mild-to-moderate CKD is highly pervasive among frail elderly individuals and the severity of renal dysfunction is independently correlated with that of cognitive impairment. Future studies are advocated to clarify whether the combination of kidney and mental dysfunction may portend a higher risk of worsen outcomes in this high-risk population.
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http://dx.doi.org/10.1007/s11255-018-1900-3DOI Listing
August 2018

Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital: a prospective study.

Aging Clin Exp Res 2018 Aug 11;30(8):977-984. Epub 2017 Nov 11.

Unit of Geriatric Pharmacoepidemiology, Italian National Research Center on Aging (INRCA), Cosenza, Italy.

Background: Polypharmacy and potentially inappropriate medications (PIMs) are known to affect several negative outcomes in older patients. However, studies comparatively assessing polypharmacy and PIMs in relation to readmission are distinctively lacking.

Aims: To compare the impact of polypharmacy and PIMs on 3-month readmission among older patients discharged from acute care hospital.

Methods: Our series consisted of 647 patients consecutively enrolled in a multicenter observational study. The outcome of the study was the occurrence of any admission during the 3-month follow-up after discharge. Polypharmacy was defined as use of more than eight medications. PIMs were identified using 2015 version of Beers and Screening Tool of Older Persons Prescriptions (STOPP) criteria. Statistical analysis was performed using logistic regression models.

Results: After adjusting for potential confounders, polypharmacy (OR 2.72, 95% CI 1.48-4.99) was found associated with the outcome, while Beers (OR 0.85, 95% CI 0.46-1.56), STOPP (OR 1.60, 95% CI 0.85-3.01), or combined Beers and STOPP violations (OR 0.99, 95% CI 0.57-1.74) were not. The association between polypharmacy and 3-month readmission was confirmed in logistic regression models including Beers (OR 2.88, 95% CI 1.55-5.34), STOPP (OR 2.64, 95% CI 1.43-4.87), or combined Beers and STOPP violations (OR 2.80, 95% CI 1.51-5.21).

Discussion: Besides confirming that polypharmacy should be considered as a marker for readmission risk among older patients discharged from acute care hospital, our findings suggest that the association between polypharmacy and 3-month readmission is substantially independent of use of PIMs.

Conclusions: Polypharmacy, but not PIMs was significantly associated with readmission. Hospitalization should always be considered as a clue to individuate unnecessary polypharmacy and to reduce the burden of medications whenever possible.
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http://dx.doi.org/10.1007/s40520-017-0856-yDOI Listing
August 2018

The CITIRIVAD Study: CITIcoline plus RIVAstigmine in Elderly Patients Affected with Dementia Study.

Clin Drug Investig 2016 Dec;36(12):1059-1065

Center for Cognitive Disorders and Dementia, Catanzaro Lido and Soverato-Chiaravalle-ASP Catanzaro, 88100, Catanzaro, Italy.

Background: Acetylcholinesterase inhibitors (AchEIs), such as rivastigmine, coadministered with cholinergic precursors, such as citicoline, could be effective in Alzheimer's disease (AD) and in mixed dementia (MD), because they are able to increase the intrasynaptic levels of acetylcholine more than the single drugs given alone.

Objective: The aim of the present study was to show the effectiveness of oral citicoline plus rivastigmine in patients with AD and MD.

Methods: The CITIRIVAD study was a retrospective case-control study on 174 consecutive outpatients aged ≥65 years, affected with AD or MD, mean age 81.3 ± 4.5 years. Of the 174 patients, 92 had been treated with rivastigmine + citicoline 1000 mg/day given orally (group A); 82 patients had been treated with rivastigmine (group B). In both groups rivastigmine patch had been used for at least six months at the highest tolerated dosage. Group A comprised 62 patients affected with AD and 30 patients with MD. Group B comprised 53 patients affected with AD and 29 with MD. Cognitive functions had been assessed by Mini Mental State Examination (MMSE), daily life functions by activities of daily living (ADL) and instrumental activities (IADL), behavioral symptoms by neuropsychiatric inventory (NPI), comorbidities by the Cumulative Illness Rating Scale and mood by geriatric depression scale (GDS)-short form tests, which had been administered at baseline, 3 and 9 months.

Results And Conclusions: Data show the effectiveness of combined administration versus the AchEI alone, mainly in slowing disease progression and consequently in disease management, both in AD and in MD. No differences regarding the combined treatment were found between the two groups. Treatment with citicoline plus rivastigmine was safe and well tolerated.
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http://dx.doi.org/10.1007/s40261-016-0454-3DOI Listing
December 2016

Medication-Induced Nephrotoxicity in Older Patients.

Curr Drug Metab 2016 ;17(6):608-25

Unit of Geriatric Pharmacopidemiology, Italian National Research Centre on Aging, C. da Muoio Piccolo, 87100 Cosenza, Italy.

Objective: To summarize current evidence about mechanisms, clinical features, diagnostic issues, and strategies for prevention of medication-induced nephrotoxicity among older people.

Methods: A Pubmed search was performed, and studies concerning age-related changes in kidney structure and function predisposing to nephrotoxicity, pathophysiological mechanisms, kidney drug metabolism enzymes, clinical epidemiology of medication-induced kidney damage, biomarkers for early identification of nephrotoxicity and strategies for prevention of medication-induced nephrotoxicity among older people were selected. Finally, 245 papers were included in the review.

Results: Medications may induce nephrotoxicity through several pathophysiological mechanisms. People aged 75 or more are especially exposed to potential nephrotoxic medications or combinations of medications in the context of complex polypharmacy regimens. Estimated glomerular filtration rate (eGFR) may be useful to identify medication-induced alterations in kidney function, but creatinine-based methods have important limitation in older patients. Several innovative biomarkers have been proposed to identify AKI but these methodologies are not standardized and older people have not been evaluated systematically. Factors related to patient, medication, and interactions should be taken into account for effective prevention.

Conclusions: Medication-induced nephrotoxicity is a relevant problem in older populations. Nevertheless, several areas of uncertainty remain to be explored, including the impact of nephrotoxicity on functional outcomes relevant to older patients, the reliability of currently recommended methods for diagnosing and staging AKI, the use of innovative biomarkers in such a heterogeneous population, the effectiveness of preventing strategies and treatments and their impact on functional outcomes.
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http://dx.doi.org/10.2174/1389200217666160406115959DOI Listing
February 2017

Transient cerebral ischemia in an elderly patient with patent foramen ovale and atrial septal aneurysm.

Clin Interv Aging 2015 7;10:1445-9. Epub 2015 Sep 7.

Geriatric Unit, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy.

Cerebrovascular disease is one of the most common causes of cerebrovascular morbidity and mortality in developed countries; up to 40% of acute ischemic strokes in young adults are cryptogenic in nature - that is, no cause is determined. However, in more than half of these patients, patent foramen ovale (PFO) is seen along with an increased incidence of atrial septal aneurysm (ASA). The following is a report of an interesting case: a 68-year-old man with ASA and transient cerebral ischemia. Transesophageal echocardiography (TEE) showed the presence of ASA; a test with microbubbles derived from a mixture of air and saline or colloids pointed out a shunt on the foramen ovale following Valsalva's maneuver. The patient underwent percutaneous transcatheter closure of the interatrial communication by an interventional cardiologist. TEE and transcranial Doppler or TEE with the microbubbles test are the recommended methods for detecting and quantifying intracardiac shunts, both at rest and following Valsalva's maneuver. In patients following the first event of transient ischemic attack, and without clinical and anatomical risk factors (such as the presence of ASA, PFO, and basal shunt), pharmacological treatment with antiplatelets or anticoagulants is closely recommended. On the contrary, in patients following the first event of transient ischemic attack, or a recurrent event during antiplatelet treatment, the percutaneous closure of PFO is recommended.
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http://dx.doi.org/10.2147/CIA.S80190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567244PMC
June 2016

Brugada syndrome (BS) and syncope: a complex therapeutic issue.

Arch Gerontol Geriatr 2012 Nov-Dec;55(3):706-8. Epub 2011 Nov 23.

SOC Geriatric Unit, Pugliese-Ciaccio Hospital, via Madonna dei Cieli, I-88100 Catanzaro, Italy.

A 66 year-old man was brought to the emergency room (ER) for syncope and sphincter incontinence; syncope duration was about 15 min. Similar short duration episodes had been referred by his relatives during the last months, following small traumas; no seizures had been registered. Patient told he was affected with BS, having already been diagnosed 5 years before, after performing an electrocardiogram (ECG) highly suggestive for it. He had performed an electrophysiologic study, which had not shown any sustained ventricular arrhythmias after scheduled stimulation. This finding together to the lack of symptoms had suggested a conservative treatment, notwithstanding that familiar history documented his father's sudden death. Patient was also affected with hypertension and gastroesophageal reflux disease. Clinical examination did not suggest any significant findings. Laboratory tests, supra aortic Doppler ultrasound, electroencephalogram (EEG) and brain CT were normal. ECG showed sinus rhythm with a heart frequency of 82 bpm, QRS axis was normal, as well as atrioventricular conduction. ST coved-type elevation with right bundle branch block pattern and repolarization abnormalities were found. Holter ECG and Doppler echocardiography were also performed. The onset of syncope in presence of BS suggested the evaluation of this case report together with electrophysiolgists and neurologists. Therefore, an implantable cardioverter defibrillator (ICD) was implanted through left subclavian vein. He was discharged eight days after hospitalization, diagnosis was "Syncope in patient affected with BS, hypertension". Arrhythmogenic risk stratification is necessary; the indication for implanting this device is obvious in symptomatic patients, whereas it is controversial in patients presenting only ECG patterns of BS. In conclusion, the above mentioned case report rises remarkable diagnostic and therapeutic issues. The finding of BS in a patient with syncope indicates the opportunity of implanting a defibrillator and only clinical experience and common opinions may help doctors in taking the most appropriated, often difficult, decisions.
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http://dx.doi.org/10.1016/j.archger.2011.10.018DOI Listing
February 2013

Laxative-induced rhabdomyolysis.

Clin Interv Aging 2010 Apr 7;5:71-3. Epub 2010 Apr 7.

Geriatrist, Geriatric Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy.

The present study describes a case of laxative-induced rhabdomyolysis in an elderly patient. An 87-year-old woman was hospitalized for the onset of confusion, tremors, an inability to walk, and a fever that she had been experiencing for 36 hours. She often took high dosages of lactulose and sorbitol syrup as a laxative (about 70 g/day). During her physical examination, the patient was confused, drowsy, and she presented hyposthenia in her upper and lower limbs, symmetric and diffuse moderate hyporeflexia, and her temperature was 37.8 degrees C. Laboratory tests revealed severe hyponatremia with hypokalemia, hypocalcemia, hypochloremia, and metabolic alkalosis. Moreover, rhabdomyolysis markers were found. The correction of hydroelectrolytic imbalances with saline, potassium and sodium chlorure, calcium gluconate was the first treatment. During her hospitalization the patient presented acute delirium, treated with haloperidol and prometazine chloridrate intramuscularly. She was discharged 12 days later, after resolution of symptoms, and normalized laboratory tests. Over-the-counter drugs such as laxatives are usually not considered dangerous; on the other hand, they may cause serum electrolytic imbalance and rhabdomyolysis. A careful monitoring of all the drugs taken by the elderly is one of the most important duties of a physician since drug interactions and their secondary effects may be fatal.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854053PMC
http://dx.doi.org/10.2147/cia.s8832DOI Listing
April 2010

Adrenal incidentaloma: a case of carcinoma.

Clin Interv Aging 2010 Apr 7;5:31-5. Epub 2010 Apr 7.

Head Physician Geriatric Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy.

Adrenal incidentaloma (AI) is a term applied to an accidentally discovered adrenal mass on imaging performed for reasons unrelated to adrenal pathology. The widespread application of abdominal imaging procedure has resulted in an increased frequency of clinically silent adrenal masses. Although most AIs are nonfunctioning benign adenomas, a multidisciplinary approach with biochemical and radiological evaluation is needed to characterize these lesions and identify patients who are at high risk for hormonal or malignant evolution. Herein, we describe a case of a 69-year-old man with a pain at the base of right chest. On the basis of clinical evaluation, biochemical analysis, as well as imaging procedures, a diagnosis of right adrenocortical carcinoma was made. The patient underwent medical treatment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854049PMC
April 2010