Marco Masina - Academia.edu (original) (raw)
Papers by Marco Masina
Italian Journal of Medicine, Mar 4, 2013
Patients with acute stroke have better outcomes in terms of survival or regaining independence if... more Patients with acute stroke have better outcomes in terms of survival or regaining independence if they receive organized inpatient care in a specific setting (Stroke Unit, SU) where a coordinated multidisciplinary team can ensure the best level of care. The clinical governance of an SU requires a systematic monitoring of diagnostic, clinical and therapeutic processes through a structured audit. The entire project and set up of a new SU in Bentivoglio, Italy, were based on a model that focused on multidisciplinary teamwork and clinical governance. An audit based on the Benjamin audit cycle followed every step of the set up of the new SU. Markers from national and international guidelines and from the Italian Regional Audit, together with a specific database were used. The audit showed a high level of care and a significant improvement in the majority of clinical, diagnostic and therapeutic parameters. Only a few markers (i.e. waiting times for ultrasound tomography and prescription of oral anticoagulation therapy) required specific projects in order to improve the results. Our experience confirmed that a structured audit can support clinical governance of an SU by monitoring clinical processes and quality of care. Such an audit involves the whole professional team and shows the effects of any single actions. It also helps integration and cooperation among staff. Furthermore, a structured audit is a useful instrument for professional accountability for both qualitative and quantitative aspects of care.
Italian Journal of Medicine, Feb 4, 2014
A large number of stroke patients cannot be discharged at home. Studies on post stroke dispositio... more A large number of stroke patients cannot be discharged at home. Studies on post stroke disposition have low validity outside the country in which they are carried out because healthcare systems offer different rehabilitative and long-term facilities. Moreover absolute selection criteria for admission to rehabilitation are not available yet. Few studies on post-stroke disposition from Italian stroke units are available. Authors evaluated data of a 18-month period from a geriatric managed stroke care area where comprehensive multi-professional assessment and discharge planning are routinely carried out. Only patients discharged with diagnosis related to acute stroke were considered. Baseline characteristics, clinical, neurological and functional conditions according to the structured multidimensional assessment were prospectively collected in the stroke unit registry. Univariate and multinomial logistic regression were performed to identify independent variables associated with three discharge settings: home, rehabilitation and skilled long-term ward. Out of 188 patients evaluated, 56.4% were discharged home, 18.6% to rehabilitation and 25.0% to long-term ward. Data showed an efficient disposition to intermediate settings with a shorter length of stay compared to other international studies. Factors associated with post-stroke disposition were age, dysphagia, neurological impairment on admission (NIH-SS≥6), after stroke functional status (mRankin≥3), poor pre-stroke functional level (mRankin≥3) and hemorrhagic stroke. Dysphagia, severe neurological impairment and post-stroke disability were associated with discharge to rehabilitation and long term ward. These two settings differed in age and pre-stroke functional condition. Patients discharged to long-term wards were about 10 years older than those admitted to rehabilitative ward. Only 5% of patients discharged to rehabilitation had a pre-stroke mRankin score ≥3. Disposition to a skilled longterm ward of older patients with pre-stroke disability seemed positive on an economic ground but further studies are mandatory to understand the consequences in terms of functional recovery and social costs.
Journal of The American Academy of Dermatology, Oct 1, 1987
Use of theoretical partition coefficients determined from solubility parameters to predict permea... more Use of theoretical partition coefficients determined from solubility parameters to predict permeability coefficients for 5-fluorouracil. J Invest Dermatol (in press). 6. Schiltz JR, Lanigan J, Nabial W, Petty B, Birnbaum JE. Retinoic acid induces cyclic changes in epidermal thickness and den'nal collagen and glycosaminoglycan biosynthesis rates. J Invest Dermatol 1986;87:663-7. 7. Zil JS. Vitamin A acid effects on epidermal mitotic activity, thickness and cellularity in the hairless mouse.
Italian Journal of Medicine, Sep 11, 2017
The Authors analyze the path of the publication of a study starting from the choice of the journa... more The Authors analyze the path of the publication of a study starting from the choice of the journal. Subsequently they summarize the different systems of data reporting and how to format a manuscript according to well-established international editorial structures. In conclusion they suggest how to positively manage a rejection.
PubMed, 1989
The Authors report a 24 year-old female who presented a linear localized epidermal nevus, from bi... more The Authors report a 24 year-old female who presented a linear localized epidermal nevus, from birth. Few months after a diagnosis of HIV infection (ARC WR 4) they observed the flaring-up of psoriasis both on the typical cutaneous sites, and on nevus, which looked like linear psoriasis.
Journal of The American Academy of Dermatology, Aug 1, 1989
A 54-year-old man and his son had porokeratoses of the trunk and extremities, predominantly on th... more A 54-year-old man and his son had porokeratoses of the trunk and extremities, predominantly on the palms and soles. Numerous small, slightly depressed, opalescent rings with hyperemic borders were present on the oral mucosa. The spectrum of porokeratosis palmaris et plantaris disseminata and the differential diagnosis of other types of porokeratosis are discussed.
Neurological Sciences, Aug 20, 2014
The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening instrument developed by N... more The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening instrument developed by Nasreddine et al. to detect mild cognitive impairment, a high-risk condition for Alzheimer's disease and other forms of dementia. In this study we report normative data on the MoCA-Italian version, collected on a sample of 225 Italian healthy subjects ranged in age between 60 and 80 years, and in formal education from 5 to 23 years. The global normal cognition was established in accordance with the Mini-Mental State Examination score and with the Prose Memory Test score (Spinnler and Tognoni, Ital J Neurol Sci 6:25-27, 1987). None of the participants had a history of psychiatric, neurological, cerebrovascular disorders or brain injury or took drugs affecting cognition. Linear regression analysis was performed to evaluate the potential effect of age, education and sex on the MoCA total performance score. We provide correction grids to adjust raw scores and equivalent scores with cutoff value to allow comparison between MoCA performance and others neuropsychological test scores that can be administered on the same subject.
Acta Dermato-Venereologica
A 64/year/old man affected by acute monoblastic leukemia developed a cutis verticis gyrata during... more A 64/year/old man affected by acute monoblastic leukemia developed a cutis verticis gyrata during the terminal phase of hemopathy. The association between these two diseases is rare. The classification of cutis verticis gyrata in primary essential, primary non/essential and secondary forms is reviewed. Performing a skin biopsy is necessary in the diagnostic approach to patients with cutis verticis gyrata.
In Vivo
Background: Patients with autosomal dominant polycystic kidney disease (ADPKD) may require specif... more Background: Patients with autosomal dominant polycystic kidney disease (ADPKD) may require specific therapy with vasopressin receptor antagonists to slow the progression of renal disease. Because of its mechanism of action, the most common side effects are polyuria, nocturia, and polydipsia. Elevations of liver enzyme levels can also occur during treatment with Tolvaptan. Temporary drug withdrawal may be indicated if the patient is unable to hydrate adequately or if there are concomitant causes of dehydration, including major infectious events. During the Coronavirus Disease 2019 (COVID-19) pandemic, this should be considered in the management of patients on Tolvaptan therapy. Case Report: We present the clinical case of a 51-year-old male with severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) infection and ADPKD receiving Tolvaptan therapy with particular reference to the medical management of the patient during the infectious event. The patient was instructed to discontinue promptly Tolvaptan as soon as symptoms appeared. He was treated with forced hydration and symptomatic therapy. Nevertheless, a transient elevation of liver enzyme levels was detected. The timely discontinuation of Tolvaptan therapy avoided the risk of potential hepatotoxicity in a condition of known susceptibility. Conclusion: Tolvaptan therapy of patients with ADPKD is safe even during SARS-CoV-2 infection. There is need for appropriate and prompt patient counseling to avoid potentially adverse side effects. Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder (1) responsible for up to 10% of European patients on renal replacement therapy (2) and the fourth most common cause for renal replacement therapy worldwide (3). ADPKD is genetically heterogeneous and is associated with a high degree of inter-and intra-family variability in disease course (3) until the end of stage renal disease (ESRD). Tolvaptan is indicated for adults with evidence of rapidly progressing disease with the aim of slowing cyst development and kidney function decline (2, 4) according to the EMA and FDA recommendations. Tolvaptan, a selective antagonist of renal collecting duct Vasopressin receptor 2 (V2R), inhibits the activity of the antidiuretic hormone arginine vasopressin (AVP) inducing aquaresis and reducing urine osmolality. Because of its mechanism of action (increased excretion of electrolyte-free water), the most common side effects are polyuria, nocturia, and polydipsia (4). Elevation of liver enzyme levels can also occur during treatment with Tolvaptan; however, these abnormalities respond to drug withdrawal or discontinuation (4). Therefore, all patients receiving this therapy should appropriately be instructed to increase water intake regardless of feeling thirsty (5), avoiding further additional potentially hepatotoxic factors such as drugs inhibiting the cytochrome P-450 enzyme CYP3A4 (4). Even infectious diseases can expose these patients to dehydration and 1994
Aging Clinical and Experimental Research
Clinical severity of pneumonia in older persons increases the risk for short-term mortality. Comp... more Clinical severity of pneumonia in older persons increases the risk for short-term mortality. Comprehensive geriatric assessment (CGA) may provide further insight in prognostic stratification. To investigate whether CGA may improve prognostic stratification among older patients with pneumonia admitted to hospital. Our series consisted of 318 consecutive patients hospitalized for pneumonia in a multicenter observational study. Disease severity was assessed by Sequential Organ Failure Assessment (SOFA) and Pneumonia Severity Index (PSI). CGA included the occurrence of delirium, Basic Activities of Daily Living (BADL) disability, cognitive impairment at Short Portable Mental Status Questionnaire (SPMSQ) and overall comorbidity assessed by Cumulative Illness Rating Scale (CIRS). The outcomes were in-hospital and post-discharge 3 month mortality. Statistical analysis was carried out by Cox regression, area under receiver operating curve (AUC) and net reclassification index (NRI). Overall, 53 patients died during hospitalization and 52 after discharge. Delirium, SOFA score and admission BADL disability were significant predictors of in-hospital mortality. SOFA score, CIRS, previous long-term oxygen therapy and discharge BADL dependency significantly predicted post-discharge mortality. The accuracy of SOFA in predicting in-hospital and post-discharge mortality was fair (AUC = 0.685, 95% CI = 0.610–0.761 and AUC = 0.663, 95% CI = 0.593–0.734, respectively). BADL dependency and delirium improved predictive accuracy for in-hospital mortality (ΔAUC = 0.144, 95% CI = 0.062–0.227, p < 0.001), while pre-admission oxygen therapy, CIRS and BADL dependency improved predictivity for 3 month mortality (ΔAUC = 0.177, 95% CI = 0.102–0.252, p < 0.001). Among older pneumonia patients, prognostic stratification obtained by clinical severity indexes is significantly improved by CGA risk factors. CGA provides important information for prognostic stratification and clinical management of older pneumonia patients.
The group of experts who developed this consensus document has to be congratulated for delivering... more The group of experts who developed this consensus document has to be congratulated for delivering clear and updated guidelines on the management of leg ulcers by compression. A classification of compression devices is proposed that is based more on the performance in vivo than on laboratory data from the producers alone. This has become possible by the introduction of devices measuring the sub-bandage pressure on the individual leg, which is the dosage of compression therapy. Pressure measurement has improved our understanding of compression management and is also very useful for training purposes. Since most of the bandages performed in daily practice consist of mixture of several types of materials, all with different elastic properties, the physical data alone given for the individual components are insufficient to describe the performance of the final bandage. The complex effects of compression are explained as a logic basis for the clinical indications that do not only concentr...
In the three months period between March and June 2016 we launched a survey on the AUIC website, ... more In the three months period between March and June 2016 we launched a survey on the AUIC website, open to the contribution of all members, to evaluate the dissemination and use of modern information technology in the treatment of Chronic Skin Lesions (CSL). The now ubiquitous diffusion of desktop and portable computers and mobile devices such as smartphones and tablets has confirmed the World Wide Web (“the Internet”) as a tool for communication and sharing of information and knowledge. With the current daily use of the Internet and the advent of social media there are no longer any limits to communication in all social and employment contexts. In our view, it is clear that the world of wound care could, or rather should, use these important tools in order to improve the standards of care offered to patients on a daily basis. In addition, the entry of a new generation of “digital natives” in the labor market will make the use of these technologies no longer an exception, but the most...
In the three months period between March and June 2016 we launched a survey on the AUIC website, ... more In the three months period between March and June 2016 we launched a survey on the AUIC website, open to the contribution of all members, to evaluate the most widespread habits and the most common practices (for therapy and overall healthcare) concerning pain management for patients with chronic skin lesions (CSL). We decided to evaluate this aspect of our clinical practice because we believe that the problems connected to “pain” in patients affected by CSL often becomes an issue even larger than the ulcer itself for both patients and their families. Furthermore, the theme “pain” is strongly felt at all levels; the body of knowledge in its regard is increasingly large and widespread and the means at our disposal to address this particular aspect of the care of CSL are continually increasing. For these reasons it seemed fair to focus the attention of all members on this clinical and healthcare problem, in order to collect useful information to improve the overall quality of care for ...
Journal of the American Medical Directors Association, 2021
Objective: Sensory deficits are important risk factors for delirium but have been investigated in... more Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 "Delirium Day" project. Setting and Participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2e2.1; P ¼ .00] and in Model 2 (OR 1.4; CI 1.1e1.9; P ¼ .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6e1.2, P ¼ .36; OR 1.1; CI 0.8e1.4; P ¼ .42) or in Model 2 (OR 0.8, CI 0.6e1.2, P ¼ .27; OR 1.1, CI 0.8e1.4, P ¼ .63).
Journal of the American Medical Directors Association, 2020
Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, w... more Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the "Delirium Day" study, a nationwide Italian pointprevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors.
Italian Journal of Wound Care, 2017
In the three months period between March and June 2016 we launched a survey on the AUIC website, ... more In the three months period between March and June 2016 we launched a survey on the AUIC website, open to the contribution of all members, to evaluate the dissemination and use of modern information technology in the treatment of Chronic Skin Lesions (CSL). The now ubiquitous diffusion of desktop and portable computers and mobile devices such as smartphones and tablets has confirmed the World Wide Web (“the Internet”) as a tool for communication and sharing of information and knowledge. With the current daily use of the Internet and the advent of social media there are no longer any limits to communication in all social and employment contexts. In our view, it is clear that the world of wound care could, or rather should, use these important tools in order to improve the standards of care offered to patients on a daily basis. In addition, the entry of a new generation of “digital natives” in the labor market will make the use of these technologies no longer an exception, but the most...
Italian Journal of Wound Care, 2017
In the three months period between March and June 2016 we launched a survey on the AUIC website, ... more In the three months period between March and June 2016 we launched a survey on the AUIC website, open to the contribution of all members, to evaluate the most widespread habits and the most common practices (for therapy and overall healthcare) concerning pain management for patients with chronic skin lesions (CSL). We decided to evaluate this aspect of our clinical practice because we believe that the problems connected to “pain” in patients affected by CSL often becomes an issue even larger than the ulcer itself for both patients and their families. Furthermore, the theme “pain” is strongly felt at all levels; the body of knowledge in its regard is increasingly large and widespread and the means at our disposal to address this particular aspect of the care of CSL are continually increasing. For these reasons it seemed fair to focus the attention of all members on this clinical and healthcare problem, in order to collect useful information to improve the overall quality of care for ...
Italian Journal of Medicine, 2016
The new clinical construct of embolic stroke of undetermined source (ESUS) suggests that many cry... more The new clinical construct of embolic stroke of undetermined source (ESUS) suggests that many cryptogenic strokes are related to minor-risk covert embolic cardiac sources or to embolus from non-occlusive plaques in the aortic arch or in the cerebral arteries. The authors analyzed the prevalence of ESUS in a real-life condition in Italy and compared the recurrence rates in cryptogenic strokes, cardioembolic strokes, and ESUS. The authors retrospectively reassessed according to ESUS criteria 391 consecutive admissions in a stroke unit where extensive diagnostic search was routinely performed. Recurrences in each stroke type within a 3-year follow-up period (mean time: 25.44 months - standard deviation: 9.42) were also compared. The prevalence of ESUS in the aforementioned cohort was 10.5%. All ESUS patients received antiplatelet agents. Warfarin was prescribed in 56.9% of cardioembolic strokes. The recurrence rate in ESUS patients was 4.4% per year, slightly higher than in cardioembol...
Italian Journal of Medicine, 2016
Italian Journal of Medicine, Mar 4, 2013
Patients with acute stroke have better outcomes in terms of survival or regaining independence if... more Patients with acute stroke have better outcomes in terms of survival or regaining independence if they receive organized inpatient care in a specific setting (Stroke Unit, SU) where a coordinated multidisciplinary team can ensure the best level of care. The clinical governance of an SU requires a systematic monitoring of diagnostic, clinical and therapeutic processes through a structured audit. The entire project and set up of a new SU in Bentivoglio, Italy, were based on a model that focused on multidisciplinary teamwork and clinical governance. An audit based on the Benjamin audit cycle followed every step of the set up of the new SU. Markers from national and international guidelines and from the Italian Regional Audit, together with a specific database were used. The audit showed a high level of care and a significant improvement in the majority of clinical, diagnostic and therapeutic parameters. Only a few markers (i.e. waiting times for ultrasound tomography and prescription of oral anticoagulation therapy) required specific projects in order to improve the results. Our experience confirmed that a structured audit can support clinical governance of an SU by monitoring clinical processes and quality of care. Such an audit involves the whole professional team and shows the effects of any single actions. It also helps integration and cooperation among staff. Furthermore, a structured audit is a useful instrument for professional accountability for both qualitative and quantitative aspects of care.
Italian Journal of Medicine, Feb 4, 2014
A large number of stroke patients cannot be discharged at home. Studies on post stroke dispositio... more A large number of stroke patients cannot be discharged at home. Studies on post stroke disposition have low validity outside the country in which they are carried out because healthcare systems offer different rehabilitative and long-term facilities. Moreover absolute selection criteria for admission to rehabilitation are not available yet. Few studies on post-stroke disposition from Italian stroke units are available. Authors evaluated data of a 18-month period from a geriatric managed stroke care area where comprehensive multi-professional assessment and discharge planning are routinely carried out. Only patients discharged with diagnosis related to acute stroke were considered. Baseline characteristics, clinical, neurological and functional conditions according to the structured multidimensional assessment were prospectively collected in the stroke unit registry. Univariate and multinomial logistic regression were performed to identify independent variables associated with three discharge settings: home, rehabilitation and skilled long-term ward. Out of 188 patients evaluated, 56.4% were discharged home, 18.6% to rehabilitation and 25.0% to long-term ward. Data showed an efficient disposition to intermediate settings with a shorter length of stay compared to other international studies. Factors associated with post-stroke disposition were age, dysphagia, neurological impairment on admission (NIH-SS≥6), after stroke functional status (mRankin≥3), poor pre-stroke functional level (mRankin≥3) and hemorrhagic stroke. Dysphagia, severe neurological impairment and post-stroke disability were associated with discharge to rehabilitation and long term ward. These two settings differed in age and pre-stroke functional condition. Patients discharged to long-term wards were about 10 years older than those admitted to rehabilitative ward. Only 5% of patients discharged to rehabilitation had a pre-stroke mRankin score ≥3. Disposition to a skilled longterm ward of older patients with pre-stroke disability seemed positive on an economic ground but further studies are mandatory to understand the consequences in terms of functional recovery and social costs.
Journal of The American Academy of Dermatology, Oct 1, 1987
Use of theoretical partition coefficients determined from solubility parameters to predict permea... more Use of theoretical partition coefficients determined from solubility parameters to predict permeability coefficients for 5-fluorouracil. J Invest Dermatol (in press). 6. Schiltz JR, Lanigan J, Nabial W, Petty B, Birnbaum JE. Retinoic acid induces cyclic changes in epidermal thickness and den'nal collagen and glycosaminoglycan biosynthesis rates. J Invest Dermatol 1986;87:663-7. 7. Zil JS. Vitamin A acid effects on epidermal mitotic activity, thickness and cellularity in the hairless mouse.
Italian Journal of Medicine, Sep 11, 2017
The Authors analyze the path of the publication of a study starting from the choice of the journa... more The Authors analyze the path of the publication of a study starting from the choice of the journal. Subsequently they summarize the different systems of data reporting and how to format a manuscript according to well-established international editorial structures. In conclusion they suggest how to positively manage a rejection.
PubMed, 1989
The Authors report a 24 year-old female who presented a linear localized epidermal nevus, from bi... more The Authors report a 24 year-old female who presented a linear localized epidermal nevus, from birth. Few months after a diagnosis of HIV infection (ARC WR 4) they observed the flaring-up of psoriasis both on the typical cutaneous sites, and on nevus, which looked like linear psoriasis.
Journal of The American Academy of Dermatology, Aug 1, 1989
A 54-year-old man and his son had porokeratoses of the trunk and extremities, predominantly on th... more A 54-year-old man and his son had porokeratoses of the trunk and extremities, predominantly on the palms and soles. Numerous small, slightly depressed, opalescent rings with hyperemic borders were present on the oral mucosa. The spectrum of porokeratosis palmaris et plantaris disseminata and the differential diagnosis of other types of porokeratosis are discussed.
Neurological Sciences, Aug 20, 2014
The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening instrument developed by N... more The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening instrument developed by Nasreddine et al. to detect mild cognitive impairment, a high-risk condition for Alzheimer's disease and other forms of dementia. In this study we report normative data on the MoCA-Italian version, collected on a sample of 225 Italian healthy subjects ranged in age between 60 and 80 years, and in formal education from 5 to 23 years. The global normal cognition was established in accordance with the Mini-Mental State Examination score and with the Prose Memory Test score (Spinnler and Tognoni, Ital J Neurol Sci 6:25-27, 1987). None of the participants had a history of psychiatric, neurological, cerebrovascular disorders or brain injury or took drugs affecting cognition. Linear regression analysis was performed to evaluate the potential effect of age, education and sex on the MoCA total performance score. We provide correction grids to adjust raw scores and equivalent scores with cutoff value to allow comparison between MoCA performance and others neuropsychological test scores that can be administered on the same subject.
Acta Dermato-Venereologica
A 64/year/old man affected by acute monoblastic leukemia developed a cutis verticis gyrata during... more A 64/year/old man affected by acute monoblastic leukemia developed a cutis verticis gyrata during the terminal phase of hemopathy. The association between these two diseases is rare. The classification of cutis verticis gyrata in primary essential, primary non/essential and secondary forms is reviewed. Performing a skin biopsy is necessary in the diagnostic approach to patients with cutis verticis gyrata.
In Vivo
Background: Patients with autosomal dominant polycystic kidney disease (ADPKD) may require specif... more Background: Patients with autosomal dominant polycystic kidney disease (ADPKD) may require specific therapy with vasopressin receptor antagonists to slow the progression of renal disease. Because of its mechanism of action, the most common side effects are polyuria, nocturia, and polydipsia. Elevations of liver enzyme levels can also occur during treatment with Tolvaptan. Temporary drug withdrawal may be indicated if the patient is unable to hydrate adequately or if there are concomitant causes of dehydration, including major infectious events. During the Coronavirus Disease 2019 (COVID-19) pandemic, this should be considered in the management of patients on Tolvaptan therapy. Case Report: We present the clinical case of a 51-year-old male with severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) infection and ADPKD receiving Tolvaptan therapy with particular reference to the medical management of the patient during the infectious event. The patient was instructed to discontinue promptly Tolvaptan as soon as symptoms appeared. He was treated with forced hydration and symptomatic therapy. Nevertheless, a transient elevation of liver enzyme levels was detected. The timely discontinuation of Tolvaptan therapy avoided the risk of potential hepatotoxicity in a condition of known susceptibility. Conclusion: Tolvaptan therapy of patients with ADPKD is safe even during SARS-CoV-2 infection. There is need for appropriate and prompt patient counseling to avoid potentially adverse side effects. Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder (1) responsible for up to 10% of European patients on renal replacement therapy (2) and the fourth most common cause for renal replacement therapy worldwide (3). ADPKD is genetically heterogeneous and is associated with a high degree of inter-and intra-family variability in disease course (3) until the end of stage renal disease (ESRD). Tolvaptan is indicated for adults with evidence of rapidly progressing disease with the aim of slowing cyst development and kidney function decline (2, 4) according to the EMA and FDA recommendations. Tolvaptan, a selective antagonist of renal collecting duct Vasopressin receptor 2 (V2R), inhibits the activity of the antidiuretic hormone arginine vasopressin (AVP) inducing aquaresis and reducing urine osmolality. Because of its mechanism of action (increased excretion of electrolyte-free water), the most common side effects are polyuria, nocturia, and polydipsia (4). Elevation of liver enzyme levels can also occur during treatment with Tolvaptan; however, these abnormalities respond to drug withdrawal or discontinuation (4). Therefore, all patients receiving this therapy should appropriately be instructed to increase water intake regardless of feeling thirsty (5), avoiding further additional potentially hepatotoxic factors such as drugs inhibiting the cytochrome P-450 enzyme CYP3A4 (4). Even infectious diseases can expose these patients to dehydration and 1994
Aging Clinical and Experimental Research
Clinical severity of pneumonia in older persons increases the risk for short-term mortality. Comp... more Clinical severity of pneumonia in older persons increases the risk for short-term mortality. Comprehensive geriatric assessment (CGA) may provide further insight in prognostic stratification. To investigate whether CGA may improve prognostic stratification among older patients with pneumonia admitted to hospital. Our series consisted of 318 consecutive patients hospitalized for pneumonia in a multicenter observational study. Disease severity was assessed by Sequential Organ Failure Assessment (SOFA) and Pneumonia Severity Index (PSI). CGA included the occurrence of delirium, Basic Activities of Daily Living (BADL) disability, cognitive impairment at Short Portable Mental Status Questionnaire (SPMSQ) and overall comorbidity assessed by Cumulative Illness Rating Scale (CIRS). The outcomes were in-hospital and post-discharge 3 month mortality. Statistical analysis was carried out by Cox regression, area under receiver operating curve (AUC) and net reclassification index (NRI). Overall, 53 patients died during hospitalization and 52 after discharge. Delirium, SOFA score and admission BADL disability were significant predictors of in-hospital mortality. SOFA score, CIRS, previous long-term oxygen therapy and discharge BADL dependency significantly predicted post-discharge mortality. The accuracy of SOFA in predicting in-hospital and post-discharge mortality was fair (AUC = 0.685, 95% CI = 0.610–0.761 and AUC = 0.663, 95% CI = 0.593–0.734, respectively). BADL dependency and delirium improved predictive accuracy for in-hospital mortality (ΔAUC = 0.144, 95% CI = 0.062–0.227, p < 0.001), while pre-admission oxygen therapy, CIRS and BADL dependency improved predictivity for 3 month mortality (ΔAUC = 0.177, 95% CI = 0.102–0.252, p < 0.001). Among older pneumonia patients, prognostic stratification obtained by clinical severity indexes is significantly improved by CGA risk factors. CGA provides important information for prognostic stratification and clinical management of older pneumonia patients.
The group of experts who developed this consensus document has to be congratulated for delivering... more The group of experts who developed this consensus document has to be congratulated for delivering clear and updated guidelines on the management of leg ulcers by compression. A classification of compression devices is proposed that is based more on the performance in vivo than on laboratory data from the producers alone. This has become possible by the introduction of devices measuring the sub-bandage pressure on the individual leg, which is the dosage of compression therapy. Pressure measurement has improved our understanding of compression management and is also very useful for training purposes. Since most of the bandages performed in daily practice consist of mixture of several types of materials, all with different elastic properties, the physical data alone given for the individual components are insufficient to describe the performance of the final bandage. The complex effects of compression are explained as a logic basis for the clinical indications that do not only concentr...
In the three months period between March and June 2016 we launched a survey on the AUIC website, ... more In the three months period between March and June 2016 we launched a survey on the AUIC website, open to the contribution of all members, to evaluate the dissemination and use of modern information technology in the treatment of Chronic Skin Lesions (CSL). The now ubiquitous diffusion of desktop and portable computers and mobile devices such as smartphones and tablets has confirmed the World Wide Web (“the Internet”) as a tool for communication and sharing of information and knowledge. With the current daily use of the Internet and the advent of social media there are no longer any limits to communication in all social and employment contexts. In our view, it is clear that the world of wound care could, or rather should, use these important tools in order to improve the standards of care offered to patients on a daily basis. In addition, the entry of a new generation of “digital natives” in the labor market will make the use of these technologies no longer an exception, but the most...
In the three months period between March and June 2016 we launched a survey on the AUIC website, ... more In the three months period between March and June 2016 we launched a survey on the AUIC website, open to the contribution of all members, to evaluate the most widespread habits and the most common practices (for therapy and overall healthcare) concerning pain management for patients with chronic skin lesions (CSL). We decided to evaluate this aspect of our clinical practice because we believe that the problems connected to “pain” in patients affected by CSL often becomes an issue even larger than the ulcer itself for both patients and their families. Furthermore, the theme “pain” is strongly felt at all levels; the body of knowledge in its regard is increasingly large and widespread and the means at our disposal to address this particular aspect of the care of CSL are continually increasing. For these reasons it seemed fair to focus the attention of all members on this clinical and healthcare problem, in order to collect useful information to improve the overall quality of care for ...
Journal of the American Medical Directors Association, 2021
Objective: Sensory deficits are important risk factors for delirium but have been investigated in... more Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 "Delirium Day" project. Setting and Participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2e2.1; P ¼ .00] and in Model 2 (OR 1.4; CI 1.1e1.9; P ¼ .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6e1.2, P ¼ .36; OR 1.1; CI 0.8e1.4; P ¼ .42) or in Model 2 (OR 0.8, CI 0.6e1.2, P ¼ .27; OR 1.1, CI 0.8e1.4, P ¼ .63).
Journal of the American Medical Directors Association, 2020
Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, w... more Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the "Delirium Day" study, a nationwide Italian pointprevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors.
Italian Journal of Wound Care, 2017
In the three months period between March and June 2016 we launched a survey on the AUIC website, ... more In the three months period between March and June 2016 we launched a survey on the AUIC website, open to the contribution of all members, to evaluate the dissemination and use of modern information technology in the treatment of Chronic Skin Lesions (CSL). The now ubiquitous diffusion of desktop and portable computers and mobile devices such as smartphones and tablets has confirmed the World Wide Web (“the Internet”) as a tool for communication and sharing of information and knowledge. With the current daily use of the Internet and the advent of social media there are no longer any limits to communication in all social and employment contexts. In our view, it is clear that the world of wound care could, or rather should, use these important tools in order to improve the standards of care offered to patients on a daily basis. In addition, the entry of a new generation of “digital natives” in the labor market will make the use of these technologies no longer an exception, but the most...
Italian Journal of Wound Care, 2017
In the three months period between March and June 2016 we launched a survey on the AUIC website, ... more In the three months period between March and June 2016 we launched a survey on the AUIC website, open to the contribution of all members, to evaluate the most widespread habits and the most common practices (for therapy and overall healthcare) concerning pain management for patients with chronic skin lesions (CSL). We decided to evaluate this aspect of our clinical practice because we believe that the problems connected to “pain” in patients affected by CSL often becomes an issue even larger than the ulcer itself for both patients and their families. Furthermore, the theme “pain” is strongly felt at all levels; the body of knowledge in its regard is increasingly large and widespread and the means at our disposal to address this particular aspect of the care of CSL are continually increasing. For these reasons it seemed fair to focus the attention of all members on this clinical and healthcare problem, in order to collect useful information to improve the overall quality of care for ...
Italian Journal of Medicine, 2016
The new clinical construct of embolic stroke of undetermined source (ESUS) suggests that many cry... more The new clinical construct of embolic stroke of undetermined source (ESUS) suggests that many cryptogenic strokes are related to minor-risk covert embolic cardiac sources or to embolus from non-occlusive plaques in the aortic arch or in the cerebral arteries. The authors analyzed the prevalence of ESUS in a real-life condition in Italy and compared the recurrence rates in cryptogenic strokes, cardioembolic strokes, and ESUS. The authors retrospectively reassessed according to ESUS criteria 391 consecutive admissions in a stroke unit where extensive diagnostic search was routinely performed. Recurrences in each stroke type within a 3-year follow-up period (mean time: 25.44 months - standard deviation: 9.42) were also compared. The prevalence of ESUS in the aforementioned cohort was 10.5%. All ESUS patients received antiplatelet agents. Warfarin was prescribed in 56.9% of cardioembolic strokes. The recurrence rate in ESUS patients was 4.4% per year, slightly higher than in cardioembol...
Italian Journal of Medicine, 2016