Antonio Nouvenne - Academia.edu (original) (raw)

Papers by Antonio Nouvenne

Nutrition, Metabolism and Cardiovascular Diseases, 2015

ABSTRACT Animal protein intake may cause an acid load that predisposes individuals to stones by i... more ABSTRACT Animal protein intake may cause an acid load that predisposes individuals to stones by influencing calcium and citrate excretion. These associations were not confirmed in recent studies. Therefore the present study was aimed to compare acid load of diet in stone formers and controls. Participants to the study were 157 consecutive calcium stone formers and 144 controls. Diet was analyzed in these subjects using a software that evaluated nutrient intake from a three-day food intake diary. This software also estimated the potential renal acid load (PRAL, mEq/day). Twenty-four-hour urine excretion of ions and citrate was measured in stone formers. Stone former diet had lower intake of glucose, fructose, potassium and fiber and higher PRAL in comparison with controls. The multinomial logistic regression analysis showed that stone risk decreased in association with the middle and the highest tertiles of fiber intake and increased in association with the highest tertile of PRAL. The linear multiple regression analysis showed that calcium excretion was associated with the sodium excretion and that citrate excretion was associated with the PRAL and animal protein intake in stone formers. Our findings suggest that stone formers may undergo a greater dietary acid load sustained by a low vegetable intake and base provision. Dietary acid load does not appear as the main determinant of calcium excretion, but may promote stone risk by decreasing citrate excretion. Sodium intake may predispose to stones by stimulating calcium excretion. Copyright © 2015 Elsevier B.V. All rights reserved.

Translational andrology and urology, 2014

The influence of unhealthy dietary habits on urinary stone formation has been widely recognized i... more The influence of unhealthy dietary habits on urinary stone formation has been widely recognized in literature. Dietary advice is indeed the cornerstone prescription for prevention of nephrolithiasis as well. However, only a small amount of medical literature has addressed the influence of popular or fad diets, often self-prescribed for the management of obesity and overweight or for cultural beliefs, on the risk of kidney stones. Thereby in this paper we analyze the current knowledge on the effects of some popular diets on overall lithogenic risk. High-protein diets, like Dukan diet, raise some concerns, since animal proteins are able to increase urinary calcium and to decrease urinary citrate excretion, thus leading to a high overall lithogenic risk. Low-carbohydrate diets, like Atkins diet or zone diet, may have a protective role against kidney stone formation, but there are also evidences stating that this dietary approach may rise calciuria and decrease citraturia, since it is g...

Internal and emergency medicine, Jan 4, 2016

Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcro... more Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcrowding are great challenges for modern medicine. Traditional hospital organizations are often too rigid to solve them without consistently rising healthcare costs. In this paper we present a new organizational model achieved at Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, a 106-bed internal medicine area organized by intensity of care and specifically dedicated to such patients. The unit is partitioned into smaller wards, each with a specific intensity level of care, including a rapid-turnover ward (mean length of stay <4 days) admitting acutely ill patients from the ED, a subacute care ward for chronic critically ill subjects and a nurse-managed ward for stable patients who have socio-economic trouble preventing discharge. A very-rapid-turnover ("come'n'go") ward has also been instituted to manage sudden ED overflows. Continu...

Digestive and Liver Disease Official Journal of the Italian Society of Gastroenterology and the Italian Association For the Study of the Liver, Jun 1, 2003

Digestive and Liver Disease Official Journal of the Italian Society of Gastroenterology and the Italian Association For the Study of the Liver, Jun 1, 2003

BMC Geriatrics, 2016

Serum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) elevations have been associa... more Serum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) elevations have been associated with pneumonia in adults. Our aim was to establish their diagnostic usefulness in a cohort of hospitalized multimorbid patients ≥65 years old admitted to hospital with acute respiratory symptoms. With a retrospective cohort study design, all multimorbid patients ≥65 years-old with acute respiratory symptoms admitted to an internal medicine hospital ward in Italy from January to August 2013 were evaluated. Pneumonia diagnosis, comorbidities expressed through Cumulative Illness Rating Scale (CIRS), setting of living, length of stay, serum hs-CRP and procalcitonin at admission were collected for each patient. Data were analyzed with Mann-Whitney&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s U test and multivariate Cox logistic regression analysis. A Receiver Operating Characteristic (ROC) curve was used to verify each biomarker&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s association with pneumonia diagnosis. Four hundred fifty five patients (227 M) were included in the study, of whom 239 with pneumonia (138 M, mean age 80 ± 13) and 216 without pneumonia (89 M, mean age 80 ± 14). After adjustment for age and sex, median levels of hs-CRP were significantly higher in patients with pneumonia (116 mg/L, IQR 46.5-179.0, vs 22.5 mg/dl, IQR 6.9-84.4, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), while procalcitonin median levels were not (0.22 ng/ml IQR 0.12-0.87, vs 0.15 ng/ml, IQR 0.10-0.35, p = 0.08). The ROC analysis showed that, unlike procalcitonin, hs-CRP values were predictive of pneumonia (AUC 0.76, 95 % CI 0.72-0.79, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001, cut-off value 61 mg/L), even after adjustment for possible confounders including nursing home residence and dementia. Serum hs-CRP levels &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;61 mg/L were independently associated with a 3.59-fold increased risk of pneumonia (OR 3.59, 95 % CI 2.35-5.48, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). In elderly multimorbid patients who require hospital admission for respiratory symptoms, serum hs-CRP testing seems to be more useful than procalcitonin for guiding the diagnostic process when clinical suspicion of pneumonia is present. Procalcitonin testing might hence be not recommended in this setting.

BMC Geriatrics, 2016

Serum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) elevations have been associa... more Serum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) elevations have been associated with pneumonia in adults. Our aim was to establish their diagnostic usefulness in a cohort of hospitalized multimorbid patients ≥65 years old admitted to hospital with acute respiratory symptoms. With a retrospective cohort study design, all multimorbid patients ≥65 years-old with acute respiratory symptoms admitted to an internal medicine hospital ward in Italy from January to August 2013 were evaluated. Pneumonia diagnosis, comorbidities expressed through Cumulative Illness Rating Scale (CIRS), setting of living, length of stay, serum hs-CRP and procalcitonin at admission were collected for each patient. Data were analyzed with Mann-Whitney&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s U test and multivariate Cox logistic regression analysis. A Receiver Operating Characteristic (ROC) curve was used to verify each biomarker&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s association with pneumonia diagnosis. Four hundred fifty five patients (227 M) were included in the study, of whom 239 with pneumonia (138 M, mean age 80 ± 13) and 216 without pneumonia (89 M, mean age 80 ± 14). After adjustment for age and sex, median levels of hs-CRP were significantly higher in patients with pneumonia (116 mg/L, IQR 46.5-179.0, vs 22.5 mg/dl, IQR 6.9-84.4, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), while procalcitonin median levels were not (0.22 ng/ml IQR 0.12-0.87, vs 0.15 ng/ml, IQR 0.10-0.35, p = 0.08). The ROC analysis showed that, unlike procalcitonin, hs-CRP values were predictive of pneumonia (AUC 0.76, 95 % CI 0.72-0.79, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001, cut-off value 61 mg/L), even after adjustment for possible confounders including nursing home residence and dementia. Serum hs-CRP levels &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;61 mg/L were independently associated with a 3.59-fold increased risk of pneumonia (OR 3.59, 95 % CI 2.35-5.48, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). In elderly multimorbid patients who require hospital admission for respiratory symptoms, serum hs-CRP testing seems to be more useful than procalcitonin for guiding the diagnostic process when clinical suspicion of pneumonia is present. Procalcitonin testing might hence be not recommended in this setting.

European Journal of Internal Medicine, 2015

To investigate the association of different chronic comorbidities, considered singularly and toge... more To investigate the association of different chronic comorbidities, considered singularly and together in Cumulative Illness Rating Scale (CIRS) indexes, with pneumonia diagnosis in a group of elderly frail hospitalized patients. With a retrospective cohort design, all clinical records of frail (Rockwood ≥5) nonterminal patients ≥65years old acutely admitted over a 8-month span in an internal medicine ward were evaluated. Pneumonia status and its categorization (community-acquired, CAP, vs healthcare-associated, HCAP) were defined according to chest radiology findings and validated criteria. Chronic comorbidities, CIRS Comorbidity Score and CIRS Severity Index were collected for each participant through a standardized methodology. Multivariate logistic regression models were applied to assess the association of each comorbid condition or scores with pneumonia. 1199 patients (546M, median age 81.9, IQR 72.8-87.9years), of whom 239 with pneumonia (180 CAP, 59 HCAP) were evaluated. CIRS Comorbidity Score was significantly associated with pneumonia, both at an age- and sex-adjusted model and at a multivariate model (OR for each unitary increase 1.03, 95% CI 1.001-1.062, p=0.04), together with provenience from nursing home (OR 1.96, 95% CI 1.41-2.73, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Among single comorbidities, only COPD (OR 2.7, 95% CI 1.9-3.6, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and dementia (OR 2.3, 95% CI 1.7-3.3, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) were associated with pneumonia, while stroke, cancer, cardiovascular, chronic liver and kidney disease were not. In a small cohort of elderly frail hospitalized patients, measures of multimorbidity, like CIRS, are significantly associated with the risk of pneumonia. COPD and dementia are the main conditions concurring to define this risk.

European Journal of Internal Medicine, 2015

To investigate the association of different chronic comorbidities, considered singularly and toge... more To investigate the association of different chronic comorbidities, considered singularly and together in Cumulative Illness Rating Scale (CIRS) indexes, with pneumonia diagnosis in a group of elderly frail hospitalized patients. With a retrospective cohort design, all clinical records of frail (Rockwood ≥5) nonterminal patients ≥65years old acutely admitted over a 8-month span in an internal medicine ward were evaluated. Pneumonia status and its categorization (community-acquired, CAP, vs healthcare-associated, HCAP) were defined according to chest radiology findings and validated criteria. Chronic comorbidities, CIRS Comorbidity Score and CIRS Severity Index were collected for each participant through a standardized methodology. Multivariate logistic regression models were applied to assess the association of each comorbid condition or scores with pneumonia. 1199 patients (546M, median age 81.9, IQR 72.8-87.9years), of whom 239 with pneumonia (180 CAP, 59 HCAP) were evaluated. CIRS Comorbidity Score was significantly associated with pneumonia, both at an age- and sex-adjusted model and at a multivariate model (OR for each unitary increase 1.03, 95% CI 1.001-1.062, p=0.04), together with provenience from nursing home (OR 1.96, 95% CI 1.41-2.73, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Among single comorbidities, only COPD (OR 2.7, 95% CI 1.9-3.6, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and dementia (OR 2.3, 95% CI 1.7-3.3, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) were associated with pneumonia, while stroke, cancer, cardiovascular, chronic liver and kidney disease were not. In a small cohort of elderly frail hospitalized patients, measures of multimorbidity, like CIRS, are significantly associated with the risk of pneumonia. COPD and dementia are the main conditions concurring to define this risk.

European Journal of Internal Medicine, 2015

Acute allergic reactions are important causes of emergency department (ED) admission, imposing a ... more Acute allergic reactions are important causes of emergency department (ED) admission, imposing a significant clinical and organizational burden. Since the season of birth is linked with early exposure to allergens, this study was aimed to establish whether an association exists between season of birth and incidence and severity of acute allergic reactions in the ED. The electronic hospital database was searched to identify all consecutive adult patients who were admitted to the ED for acute allergic reactions (acute urticaria, acute angioedema, urticaria-angioedema and anaphylaxis) during a 1-year period. The final study population consisted in 588 patients (328 women and 260 men; mean age 43±18years, range 16-96years). Increased frequency of ED admission was observed for patients born in spring, whereas the lowest frequency was found for those born in autumn. Patients born in spring exhibited 1.19 and 1.12 higher risk of ED admission for acute allergic reactions compared to those born in autumn and in all other seasons, respectively. This difference remained significant in patients with allergic reaction attributable to drugs and in those with unknown triggers, whereas no pattern of seasonality was observed in patients with allergic reactions attributable to aliments, hymenoptera, chemicals or inhalants. Patients born in spring also exhibited 1.86 and 1.52 higher risk of being admitted to the ED for severe acute allergic reactions compared to those born in autumn and in all other seasons, respectively. Patients born in spring appear particularly vulnerable to allergic reactions requiring ED visit.

European Journal of Internal Medicine, 2015

Acute allergic reactions are important causes of emergency department (ED) admission, imposing a ... more Acute allergic reactions are important causes of emergency department (ED) admission, imposing a significant clinical and organizational burden. Since the season of birth is linked with early exposure to allergens, this study was aimed to establish whether an association exists between season of birth and incidence and severity of acute allergic reactions in the ED. The electronic hospital database was searched to identify all consecutive adult patients who were admitted to the ED for acute allergic reactions (acute urticaria, acute angioedema, urticaria-angioedema and anaphylaxis) during a 1-year period. The final study population consisted in 588 patients (328 women and 260 men; mean age 43±18years, range 16-96years). Increased frequency of ED admission was observed for patients born in spring, whereas the lowest frequency was found for those born in autumn. Patients born in spring exhibited 1.19 and 1.12 higher risk of ED admission for acute allergic reactions compared to those born in autumn and in all other seasons, respectively. This difference remained significant in patients with allergic reaction attributable to drugs and in those with unknown triggers, whereas no pattern of seasonality was observed in patients with allergic reactions attributable to aliments, hymenoptera, chemicals or inhalants. Patients born in spring also exhibited 1.86 and 1.52 higher risk of being admitted to the ED for severe acute allergic reactions compared to those born in autumn and in all other seasons, respectively. Patients born in spring appear particularly vulnerable to allergic reactions requiring ED visit.

Objective. To devise an adverse event (AE) detection system and assess its validity and utility.

Objective. To devise an adverse event (AE) detection system and assess its validity and utility.

Clinical Cases in Mineral and Bone Metabolism the Official Journal of the Italian Society of Osteoporosis Mineral Metabolism and Skeletal Diseases, May 1, 2008

The prevalence of idiopathic nephrolithiasis is increasing in rich countries. Dietary manipulatio... more The prevalence of idiopathic nephrolithiasis is increasing in rich countries. Dietary manipulation could contribute to the prevention of both its first appearance and the recurrence of the disease. The target of dietary treatment is to decrease the "urinary lithogenic risk factors" such as low urine volume, hypercalciuria, hyperoxaluria, hyperuricosuria, hyperphosphaturia, hypocitraturia, hypomagnesuria and excessively alkaline or acid urinary pH. Due to the lack of randomized controlled trials focused on this problem, there is not ample evidence to confidently recommend dietary changes. Despite this, numerous recent and past experiences support modification of diet as having a primary role in the prevention of nephrolithiasis. In particular, it is recommended to limit animal protein and salt intake, to consume milk and derivatives in amounts corresponding to calcium intake of about 1200 mg/day and to assume fiber (40 g/day), vegetables and fruit daily avoiding foods with high oxalate content. Furthermore, vitamin C intake not exceeding 1500 mg/day plays a protective role as well as avoiding vitamin B6 deficiency and abstaining, if possible, from vitamin D supplements. Lastly, it is recommended to drink enough water to bring the urinary volume up to at least 2 L/day and, as much as possible, to use fresh or frozen products rather than prepacked or precooked foods which are often too rich in sodium chloride.

Clinical Cases in Mineral and Bone Metabolism the Official Journal of the Italian Society of Osteoporosis Mineral Metabolism and Skeletal Diseases, May 1, 2008

The prevalence of idiopathic nephrolithiasis is increasing in rich countries. Dietary manipulatio... more The prevalence of idiopathic nephrolithiasis is increasing in rich countries. Dietary manipulation could contribute to the prevention of both its first appearance and the recurrence of the disease. The target of dietary treatment is to decrease the "urinary lithogenic risk factors" such as low urine volume, hypercalciuria, hyperoxaluria, hyperuricosuria, hyperphosphaturia, hypocitraturia, hypomagnesuria and excessively alkaline or acid urinary pH. Due to the lack of randomized controlled trials focused on this problem, there is not ample evidence to confidently recommend dietary changes. Despite this, numerous recent and past experiences support modification of diet as having a primary role in the prevention of nephrolithiasis. In particular, it is recommended to limit animal protein and salt intake, to consume milk and derivatives in amounts corresponding to calcium intake of about 1200 mg/day and to assume fiber (40 g/day), vegetables and fruit daily avoiding foods with high oxalate content. Furthermore, vitamin C intake not exceeding 1500 mg/day plays a protective role as well as avoiding vitamin B6 deficiency and abstaining, if possible, from vitamin D supplements. Lastly, it is recommended to drink enough water to bring the urinary volume up to at least 2 L/day and, as much as possible, to use fresh or frozen products rather than prepacked or precooked foods which are often too rich in sodium chloride.

Acta bio-medica: Atenei Parmensis

This case is a report of a male, 52 year old, heavy smoker, with a history of about 10 years of a... more This case is a report of a male, 52 year old, heavy smoker, with a history of about 10 years of alcohol abuse (he quitted in 1993), gastric resection for ulcer (Billroth II 1970), hypoparathyroidism and macroamylasemia, died for undiagnosed pancreatic carcinoma revealed at necroscopy. The only clinical evidence of carcinoma were pulmonary metastasis and paraneoplastic syndrome characterized from hyponatriemia due to inappropriate secretion of antidiuretic hormone and elevation of seric calcium caused by parathyroid hormone related protein. In patients without endocrine abnormalities, such unusual paraneoplastic syndrome could cause hypercalcemia, but in our patient, the increased calcemia did not reach abnormal levels due to the previous hypoparathyroidism. At present time, there are no clinical reports of parathyroid related protein secretion by pancreatic carcinoma and therefore, it could speculate that this modification together with ectopic secretion of antidiuretic hormone, represent a peculiar evidence of otherwise unknown and undetectable pancreatic carcinoma.

Acta bio-medica: Atenei Parmensis

This case is a report of a male, 52 year old, heavy smoker, with a history of about 10 years of a... more This case is a report of a male, 52 year old, heavy smoker, with a history of about 10 years of alcohol abuse (he quitted in 1993), gastric resection for ulcer (Billroth II 1970), hypoparathyroidism and macroamylasemia, died for undiagnosed pancreatic carcinoma revealed at necroscopy. The only clinical evidence of carcinoma were pulmonary metastasis and paraneoplastic syndrome characterized from hyponatriemia due to inappropriate secretion of antidiuretic hormone and elevation of seric calcium caused by parathyroid hormone related protein. In patients without endocrine abnormalities, such unusual paraneoplastic syndrome could cause hypercalcemia, but in our patient, the increased calcemia did not reach abnormal levels due to the previous hypoparathyroidism. At present time, there are no clinical reports of parathyroid related protein secretion by pancreatic carcinoma and therefore, it could speculate that this modification together with ectopic secretion of antidiuretic hormone, represent a peculiar evidence of otherwise unknown and undetectable pancreatic carcinoma.

Urology, Jan 19, 2015

To investigate the association between vitamin D deficiency (25-hydroxyvitamin D <20 ng/ml) an... more To investigate the association between vitamin D deficiency (25-hydroxyvitamin D <20 ng/ml) and idiopathic calcium nephrolithiasis (ICN). 884 ICN patients (363 males, mean age 51±14) and 967 controls (162 males, mean age 59±15) from an area with no food fortification policy were considered following a case-control study design. Patients were enrolled at a third-level outpatient stone clinic. Controls were selected from a laboratory database after exclusion of those with nephrolithiasis, bone, endocrine, liver and kidney diseases. Serum 25-hydroxyvitamin-D (25-OH-D), date of test, presence/history of diabetes and cardiovascular disease including hypertension were recorded for all subjects. Serum parathormone, calcium, phosphorus and urinary factors of lithogenic risk were available in stone formers (SF). After univariate statistical analysis, propensity score matching with conditional logistic regression was used to control for the possible effects of covariates. The prevalence of...

BMJ Open, 2015

To identify the role of chronic comorbidities, considered together in a literature-validated inde... more To identify the role of chronic comorbidities, considered together in a literature-validated index (Cumulative Illness Rating Scale, CIRS), and antibiotic or proton-pump inhibitor (PPI) treatments as risk factors for hospital-acquired Clostridium difficile infection (CDI) in elderly multimorbid hospitalised patients. Retrospective cohort study. Subacute hospital geriatric care ward in Italy. 505 (238 male (M), 268 female (F)) elderly (age≥65) multimorbid patients. The relationship between CDI and CIRS Comorbidity Score, number of comorbidities, antibiotic, antifungal and PPI treatments, and length of hospital stay was assessed through age-adjusted and sex-adjusted and multivariate logistic regression models. The CIRS Comorbidity Score was handled after categorisation in quartiles. Mean age was 80.7±11.3 years. 43 patients (22 M, 21 F) developed CDI. The prevalence of CDI increased among quartiles of CIRS Comorbidity Score (3.9% first quartile vs 11.1% fourth quartile, age-adjusted and sex-adjusted p=0.03). In the multivariate logistic regression analysis, patients in the highest quartile of CIRS Comorbidity Score (≥17) carried a significantly higher risk of CDI (OR 5.07, 95% CI 1.28 to 20.14, p=0.02) than patients in the lowest quartile (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;9). The only other variable significantly associated with CDI was antibiotic therapy (OR 2.62, 95% CI 1.21 to 5.66, p=0.01). PPI treatment was not associated with CDI. Multimorbidity, measured through CIRS Comorbidity Score, is independently associated with the risk of CDI in a population of elderly patients with prolonged hospital stay.

Nutrition, Metabolism and Cardiovascular Diseases, 2015

ABSTRACT Animal protein intake may cause an acid load that predisposes individuals to stones by i... more ABSTRACT Animal protein intake may cause an acid load that predisposes individuals to stones by influencing calcium and citrate excretion. These associations were not confirmed in recent studies. Therefore the present study was aimed to compare acid load of diet in stone formers and controls. Participants to the study were 157 consecutive calcium stone formers and 144 controls. Diet was analyzed in these subjects using a software that evaluated nutrient intake from a three-day food intake diary. This software also estimated the potential renal acid load (PRAL, mEq/day). Twenty-four-hour urine excretion of ions and citrate was measured in stone formers. Stone former diet had lower intake of glucose, fructose, potassium and fiber and higher PRAL in comparison with controls. The multinomial logistic regression analysis showed that stone risk decreased in association with the middle and the highest tertiles of fiber intake and increased in association with the highest tertile of PRAL. The linear multiple regression analysis showed that calcium excretion was associated with the sodium excretion and that citrate excretion was associated with the PRAL and animal protein intake in stone formers. Our findings suggest that stone formers may undergo a greater dietary acid load sustained by a low vegetable intake and base provision. Dietary acid load does not appear as the main determinant of calcium excretion, but may promote stone risk by decreasing citrate excretion. Sodium intake may predispose to stones by stimulating calcium excretion. Copyright © 2015 Elsevier B.V. All rights reserved.

Translational andrology and urology, 2014

The influence of unhealthy dietary habits on urinary stone formation has been widely recognized i... more The influence of unhealthy dietary habits on urinary stone formation has been widely recognized in literature. Dietary advice is indeed the cornerstone prescription for prevention of nephrolithiasis as well. However, only a small amount of medical literature has addressed the influence of popular or fad diets, often self-prescribed for the management of obesity and overweight or for cultural beliefs, on the risk of kidney stones. Thereby in this paper we analyze the current knowledge on the effects of some popular diets on overall lithogenic risk. High-protein diets, like Dukan diet, raise some concerns, since animal proteins are able to increase urinary calcium and to decrease urinary citrate excretion, thus leading to a high overall lithogenic risk. Low-carbohydrate diets, like Atkins diet or zone diet, may have a protective role against kidney stone formation, but there are also evidences stating that this dietary approach may rise calciuria and decrease citraturia, since it is g...

Internal and emergency medicine, Jan 4, 2016

Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcro... more Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcrowding are great challenges for modern medicine. Traditional hospital organizations are often too rigid to solve them without consistently rising healthcare costs. In this paper we present a new organizational model achieved at Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, a 106-bed internal medicine area organized by intensity of care and specifically dedicated to such patients. The unit is partitioned into smaller wards, each with a specific intensity level of care, including a rapid-turnover ward (mean length of stay <4 days) admitting acutely ill patients from the ED, a subacute care ward for chronic critically ill subjects and a nurse-managed ward for stable patients who have socio-economic trouble preventing discharge. A very-rapid-turnover ("come'n'go") ward has also been instituted to manage sudden ED overflows. Continu...

Digestive and Liver Disease Official Journal of the Italian Society of Gastroenterology and the Italian Association For the Study of the Liver, Jun 1, 2003

Digestive and Liver Disease Official Journal of the Italian Society of Gastroenterology and the Italian Association For the Study of the Liver, Jun 1, 2003

BMC Geriatrics, 2016

Serum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) elevations have been associa... more Serum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) elevations have been associated with pneumonia in adults. Our aim was to establish their diagnostic usefulness in a cohort of hospitalized multimorbid patients ≥65 years old admitted to hospital with acute respiratory symptoms. With a retrospective cohort study design, all multimorbid patients ≥65 years-old with acute respiratory symptoms admitted to an internal medicine hospital ward in Italy from January to August 2013 were evaluated. Pneumonia diagnosis, comorbidities expressed through Cumulative Illness Rating Scale (CIRS), setting of living, length of stay, serum hs-CRP and procalcitonin at admission were collected for each patient. Data were analyzed with Mann-Whitney&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s U test and multivariate Cox logistic regression analysis. A Receiver Operating Characteristic (ROC) curve was used to verify each biomarker&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s association with pneumonia diagnosis. Four hundred fifty five patients (227 M) were included in the study, of whom 239 with pneumonia (138 M, mean age 80 ± 13) and 216 without pneumonia (89 M, mean age 80 ± 14). After adjustment for age and sex, median levels of hs-CRP were significantly higher in patients with pneumonia (116 mg/L, IQR 46.5-179.0, vs 22.5 mg/dl, IQR 6.9-84.4, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), while procalcitonin median levels were not (0.22 ng/ml IQR 0.12-0.87, vs 0.15 ng/ml, IQR 0.10-0.35, p = 0.08). The ROC analysis showed that, unlike procalcitonin, hs-CRP values were predictive of pneumonia (AUC 0.76, 95 % CI 0.72-0.79, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001, cut-off value 61 mg/L), even after adjustment for possible confounders including nursing home residence and dementia. Serum hs-CRP levels &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;61 mg/L were independently associated with a 3.59-fold increased risk of pneumonia (OR 3.59, 95 % CI 2.35-5.48, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). In elderly multimorbid patients who require hospital admission for respiratory symptoms, serum hs-CRP testing seems to be more useful than procalcitonin for guiding the diagnostic process when clinical suspicion of pneumonia is present. Procalcitonin testing might hence be not recommended in this setting.

BMC Geriatrics, 2016

Serum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) elevations have been associa... more Serum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) elevations have been associated with pneumonia in adults. Our aim was to establish their diagnostic usefulness in a cohort of hospitalized multimorbid patients ≥65 years old admitted to hospital with acute respiratory symptoms. With a retrospective cohort study design, all multimorbid patients ≥65 years-old with acute respiratory symptoms admitted to an internal medicine hospital ward in Italy from January to August 2013 were evaluated. Pneumonia diagnosis, comorbidities expressed through Cumulative Illness Rating Scale (CIRS), setting of living, length of stay, serum hs-CRP and procalcitonin at admission were collected for each patient. Data were analyzed with Mann-Whitney&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s U test and multivariate Cox logistic regression analysis. A Receiver Operating Characteristic (ROC) curve was used to verify each biomarker&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s association with pneumonia diagnosis. Four hundred fifty five patients (227 M) were included in the study, of whom 239 with pneumonia (138 M, mean age 80 ± 13) and 216 without pneumonia (89 M, mean age 80 ± 14). After adjustment for age and sex, median levels of hs-CRP were significantly higher in patients with pneumonia (116 mg/L, IQR 46.5-179.0, vs 22.5 mg/dl, IQR 6.9-84.4, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), while procalcitonin median levels were not (0.22 ng/ml IQR 0.12-0.87, vs 0.15 ng/ml, IQR 0.10-0.35, p = 0.08). The ROC analysis showed that, unlike procalcitonin, hs-CRP values were predictive of pneumonia (AUC 0.76, 95 % CI 0.72-0.79, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001, cut-off value 61 mg/L), even after adjustment for possible confounders including nursing home residence and dementia. Serum hs-CRP levels &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;61 mg/L were independently associated with a 3.59-fold increased risk of pneumonia (OR 3.59, 95 % CI 2.35-5.48, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). In elderly multimorbid patients who require hospital admission for respiratory symptoms, serum hs-CRP testing seems to be more useful than procalcitonin for guiding the diagnostic process when clinical suspicion of pneumonia is present. Procalcitonin testing might hence be not recommended in this setting.

European Journal of Internal Medicine, 2015

To investigate the association of different chronic comorbidities, considered singularly and toge... more To investigate the association of different chronic comorbidities, considered singularly and together in Cumulative Illness Rating Scale (CIRS) indexes, with pneumonia diagnosis in a group of elderly frail hospitalized patients. With a retrospective cohort design, all clinical records of frail (Rockwood ≥5) nonterminal patients ≥65years old acutely admitted over a 8-month span in an internal medicine ward were evaluated. Pneumonia status and its categorization (community-acquired, CAP, vs healthcare-associated, HCAP) were defined according to chest radiology findings and validated criteria. Chronic comorbidities, CIRS Comorbidity Score and CIRS Severity Index were collected for each participant through a standardized methodology. Multivariate logistic regression models were applied to assess the association of each comorbid condition or scores with pneumonia. 1199 patients (546M, median age 81.9, IQR 72.8-87.9years), of whom 239 with pneumonia (180 CAP, 59 HCAP) were evaluated. CIRS Comorbidity Score was significantly associated with pneumonia, both at an age- and sex-adjusted model and at a multivariate model (OR for each unitary increase 1.03, 95% CI 1.001-1.062, p=0.04), together with provenience from nursing home (OR 1.96, 95% CI 1.41-2.73, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Among single comorbidities, only COPD (OR 2.7, 95% CI 1.9-3.6, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and dementia (OR 2.3, 95% CI 1.7-3.3, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) were associated with pneumonia, while stroke, cancer, cardiovascular, chronic liver and kidney disease were not. In a small cohort of elderly frail hospitalized patients, measures of multimorbidity, like CIRS, are significantly associated with the risk of pneumonia. COPD and dementia are the main conditions concurring to define this risk.

European Journal of Internal Medicine, 2015

To investigate the association of different chronic comorbidities, considered singularly and toge... more To investigate the association of different chronic comorbidities, considered singularly and together in Cumulative Illness Rating Scale (CIRS) indexes, with pneumonia diagnosis in a group of elderly frail hospitalized patients. With a retrospective cohort design, all clinical records of frail (Rockwood ≥5) nonterminal patients ≥65years old acutely admitted over a 8-month span in an internal medicine ward were evaluated. Pneumonia status and its categorization (community-acquired, CAP, vs healthcare-associated, HCAP) were defined according to chest radiology findings and validated criteria. Chronic comorbidities, CIRS Comorbidity Score and CIRS Severity Index were collected for each participant through a standardized methodology. Multivariate logistic regression models were applied to assess the association of each comorbid condition or scores with pneumonia. 1199 patients (546M, median age 81.9, IQR 72.8-87.9years), of whom 239 with pneumonia (180 CAP, 59 HCAP) were evaluated. CIRS Comorbidity Score was significantly associated with pneumonia, both at an age- and sex-adjusted model and at a multivariate model (OR for each unitary increase 1.03, 95% CI 1.001-1.062, p=0.04), together with provenience from nursing home (OR 1.96, 95% CI 1.41-2.73, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Among single comorbidities, only COPD (OR 2.7, 95% CI 1.9-3.6, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and dementia (OR 2.3, 95% CI 1.7-3.3, p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) were associated with pneumonia, while stroke, cancer, cardiovascular, chronic liver and kidney disease were not. In a small cohort of elderly frail hospitalized patients, measures of multimorbidity, like CIRS, are significantly associated with the risk of pneumonia. COPD and dementia are the main conditions concurring to define this risk.

European Journal of Internal Medicine, 2015

Acute allergic reactions are important causes of emergency department (ED) admission, imposing a ... more Acute allergic reactions are important causes of emergency department (ED) admission, imposing a significant clinical and organizational burden. Since the season of birth is linked with early exposure to allergens, this study was aimed to establish whether an association exists between season of birth and incidence and severity of acute allergic reactions in the ED. The electronic hospital database was searched to identify all consecutive adult patients who were admitted to the ED for acute allergic reactions (acute urticaria, acute angioedema, urticaria-angioedema and anaphylaxis) during a 1-year period. The final study population consisted in 588 patients (328 women and 260 men; mean age 43±18years, range 16-96years). Increased frequency of ED admission was observed for patients born in spring, whereas the lowest frequency was found for those born in autumn. Patients born in spring exhibited 1.19 and 1.12 higher risk of ED admission for acute allergic reactions compared to those born in autumn and in all other seasons, respectively. This difference remained significant in patients with allergic reaction attributable to drugs and in those with unknown triggers, whereas no pattern of seasonality was observed in patients with allergic reactions attributable to aliments, hymenoptera, chemicals or inhalants. Patients born in spring also exhibited 1.86 and 1.52 higher risk of being admitted to the ED for severe acute allergic reactions compared to those born in autumn and in all other seasons, respectively. Patients born in spring appear particularly vulnerable to allergic reactions requiring ED visit.

European Journal of Internal Medicine, 2015

Acute allergic reactions are important causes of emergency department (ED) admission, imposing a ... more Acute allergic reactions are important causes of emergency department (ED) admission, imposing a significant clinical and organizational burden. Since the season of birth is linked with early exposure to allergens, this study was aimed to establish whether an association exists between season of birth and incidence and severity of acute allergic reactions in the ED. The electronic hospital database was searched to identify all consecutive adult patients who were admitted to the ED for acute allergic reactions (acute urticaria, acute angioedema, urticaria-angioedema and anaphylaxis) during a 1-year period. The final study population consisted in 588 patients (328 women and 260 men; mean age 43±18years, range 16-96years). Increased frequency of ED admission was observed for patients born in spring, whereas the lowest frequency was found for those born in autumn. Patients born in spring exhibited 1.19 and 1.12 higher risk of ED admission for acute allergic reactions compared to those born in autumn and in all other seasons, respectively. This difference remained significant in patients with allergic reaction attributable to drugs and in those with unknown triggers, whereas no pattern of seasonality was observed in patients with allergic reactions attributable to aliments, hymenoptera, chemicals or inhalants. Patients born in spring also exhibited 1.86 and 1.52 higher risk of being admitted to the ED for severe acute allergic reactions compared to those born in autumn and in all other seasons, respectively. Patients born in spring appear particularly vulnerable to allergic reactions requiring ED visit.

Objective. To devise an adverse event (AE) detection system and assess its validity and utility.

Objective. To devise an adverse event (AE) detection system and assess its validity and utility.

Clinical Cases in Mineral and Bone Metabolism the Official Journal of the Italian Society of Osteoporosis Mineral Metabolism and Skeletal Diseases, May 1, 2008

The prevalence of idiopathic nephrolithiasis is increasing in rich countries. Dietary manipulatio... more The prevalence of idiopathic nephrolithiasis is increasing in rich countries. Dietary manipulation could contribute to the prevention of both its first appearance and the recurrence of the disease. The target of dietary treatment is to decrease the "urinary lithogenic risk factors" such as low urine volume, hypercalciuria, hyperoxaluria, hyperuricosuria, hyperphosphaturia, hypocitraturia, hypomagnesuria and excessively alkaline or acid urinary pH. Due to the lack of randomized controlled trials focused on this problem, there is not ample evidence to confidently recommend dietary changes. Despite this, numerous recent and past experiences support modification of diet as having a primary role in the prevention of nephrolithiasis. In particular, it is recommended to limit animal protein and salt intake, to consume milk and derivatives in amounts corresponding to calcium intake of about 1200 mg/day and to assume fiber (40 g/day), vegetables and fruit daily avoiding foods with high oxalate content. Furthermore, vitamin C intake not exceeding 1500 mg/day plays a protective role as well as avoiding vitamin B6 deficiency and abstaining, if possible, from vitamin D supplements. Lastly, it is recommended to drink enough water to bring the urinary volume up to at least 2 L/day and, as much as possible, to use fresh or frozen products rather than prepacked or precooked foods which are often too rich in sodium chloride.

Clinical Cases in Mineral and Bone Metabolism the Official Journal of the Italian Society of Osteoporosis Mineral Metabolism and Skeletal Diseases, May 1, 2008

The prevalence of idiopathic nephrolithiasis is increasing in rich countries. Dietary manipulatio... more The prevalence of idiopathic nephrolithiasis is increasing in rich countries. Dietary manipulation could contribute to the prevention of both its first appearance and the recurrence of the disease. The target of dietary treatment is to decrease the "urinary lithogenic risk factors" such as low urine volume, hypercalciuria, hyperoxaluria, hyperuricosuria, hyperphosphaturia, hypocitraturia, hypomagnesuria and excessively alkaline or acid urinary pH. Due to the lack of randomized controlled trials focused on this problem, there is not ample evidence to confidently recommend dietary changes. Despite this, numerous recent and past experiences support modification of diet as having a primary role in the prevention of nephrolithiasis. In particular, it is recommended to limit animal protein and salt intake, to consume milk and derivatives in amounts corresponding to calcium intake of about 1200 mg/day and to assume fiber (40 g/day), vegetables and fruit daily avoiding foods with high oxalate content. Furthermore, vitamin C intake not exceeding 1500 mg/day plays a protective role as well as avoiding vitamin B6 deficiency and abstaining, if possible, from vitamin D supplements. Lastly, it is recommended to drink enough water to bring the urinary volume up to at least 2 L/day and, as much as possible, to use fresh or frozen products rather than prepacked or precooked foods which are often too rich in sodium chloride.

Acta bio-medica: Atenei Parmensis

This case is a report of a male, 52 year old, heavy smoker, with a history of about 10 years of a... more This case is a report of a male, 52 year old, heavy smoker, with a history of about 10 years of alcohol abuse (he quitted in 1993), gastric resection for ulcer (Billroth II 1970), hypoparathyroidism and macroamylasemia, died for undiagnosed pancreatic carcinoma revealed at necroscopy. The only clinical evidence of carcinoma were pulmonary metastasis and paraneoplastic syndrome characterized from hyponatriemia due to inappropriate secretion of antidiuretic hormone and elevation of seric calcium caused by parathyroid hormone related protein. In patients without endocrine abnormalities, such unusual paraneoplastic syndrome could cause hypercalcemia, but in our patient, the increased calcemia did not reach abnormal levels due to the previous hypoparathyroidism. At present time, there are no clinical reports of parathyroid related protein secretion by pancreatic carcinoma and therefore, it could speculate that this modification together with ectopic secretion of antidiuretic hormone, represent a peculiar evidence of otherwise unknown and undetectable pancreatic carcinoma.

Acta bio-medica: Atenei Parmensis

This case is a report of a male, 52 year old, heavy smoker, with a history of about 10 years of a... more This case is a report of a male, 52 year old, heavy smoker, with a history of about 10 years of alcohol abuse (he quitted in 1993), gastric resection for ulcer (Billroth II 1970), hypoparathyroidism and macroamylasemia, died for undiagnosed pancreatic carcinoma revealed at necroscopy. The only clinical evidence of carcinoma were pulmonary metastasis and paraneoplastic syndrome characterized from hyponatriemia due to inappropriate secretion of antidiuretic hormone and elevation of seric calcium caused by parathyroid hormone related protein. In patients without endocrine abnormalities, such unusual paraneoplastic syndrome could cause hypercalcemia, but in our patient, the increased calcemia did not reach abnormal levels due to the previous hypoparathyroidism. At present time, there are no clinical reports of parathyroid related protein secretion by pancreatic carcinoma and therefore, it could speculate that this modification together with ectopic secretion of antidiuretic hormone, represent a peculiar evidence of otherwise unknown and undetectable pancreatic carcinoma.

Urology, Jan 19, 2015

To investigate the association between vitamin D deficiency (25-hydroxyvitamin D <20 ng/ml) an... more To investigate the association between vitamin D deficiency (25-hydroxyvitamin D <20 ng/ml) and idiopathic calcium nephrolithiasis (ICN). 884 ICN patients (363 males, mean age 51±14) and 967 controls (162 males, mean age 59±15) from an area with no food fortification policy were considered following a case-control study design. Patients were enrolled at a third-level outpatient stone clinic. Controls were selected from a laboratory database after exclusion of those with nephrolithiasis, bone, endocrine, liver and kidney diseases. Serum 25-hydroxyvitamin-D (25-OH-D), date of test, presence/history of diabetes and cardiovascular disease including hypertension were recorded for all subjects. Serum parathormone, calcium, phosphorus and urinary factors of lithogenic risk were available in stone formers (SF). After univariate statistical analysis, propensity score matching with conditional logistic regression was used to control for the possible effects of covariates. The prevalence of...

BMJ Open, 2015

To identify the role of chronic comorbidities, considered together in a literature-validated inde... more To identify the role of chronic comorbidities, considered together in a literature-validated index (Cumulative Illness Rating Scale, CIRS), and antibiotic or proton-pump inhibitor (PPI) treatments as risk factors for hospital-acquired Clostridium difficile infection (CDI) in elderly multimorbid hospitalised patients. Retrospective cohort study. Subacute hospital geriatric care ward in Italy. 505 (238 male (M), 268 female (F)) elderly (age≥65) multimorbid patients. The relationship between CDI and CIRS Comorbidity Score, number of comorbidities, antibiotic, antifungal and PPI treatments, and length of hospital stay was assessed through age-adjusted and sex-adjusted and multivariate logistic regression models. The CIRS Comorbidity Score was handled after categorisation in quartiles. Mean age was 80.7±11.3 years. 43 patients (22 M, 21 F) developed CDI. The prevalence of CDI increased among quartiles of CIRS Comorbidity Score (3.9% first quartile vs 11.1% fourth quartile, age-adjusted and sex-adjusted p=0.03). In the multivariate logistic regression analysis, patients in the highest quartile of CIRS Comorbidity Score (≥17) carried a significantly higher risk of CDI (OR 5.07, 95% CI 1.28 to 20.14, p=0.02) than patients in the lowest quartile (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;9). The only other variable significantly associated with CDI was antibiotic therapy (OR 2.62, 95% CI 1.21 to 5.66, p=0.01). PPI treatment was not associated with CDI. Multimorbidity, measured through CIRS Comorbidity Score, is independently associated with the risk of CDI in a population of elderly patients with prolonged hospital stay.