Sezione di Medicina Interna e Lungodegenza Critica

Parma, Italy

Sezione di Medicina Interna e Lungodegenza Critica

Parma, Italy
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Montagnana M.,University of Verona | Meschi T.,Sezione di Medicina Interna e Lungodegenza Critica | Borghi L.,Sezione di Medicina Interna e Lungodegenza Critica
Aging Clinical and Experimental Research | Year: 2012

Background and aims: Vitamin D deficiency is a major health problem worldwide, especially in the elderly, so that an accurate assessment of its prevalence is essential for planning reliable healthcare policy throughout the lifespan. The aim of the present study was to assess the concentration as well as the mild and moderate deficiencies of 25-hydroxyvitamin D (25OHD) across different ages and genders. Methods: We searched the database of the local Laboratory Information System to retrieve results of 25OHD tests performed on the whole cohort of presumably healthy Caucasian outpatients aged >12 yrs, who were referred to our laboratory in the North-East of Italy for routine laboratory testing ordered by general practitioners, over a 3-year period (October 2008 - October 2011). Results: Cumulative results for 25OHD testing were retrieved for 2327 outpatients (1744 females and 583 males). No significant differences between females and males were observed for 25OHD values (71 [25-140] vs 67 [27-130] nmol/L; p=0.40), as well as a similar prevalence of mild (32.8 vs 33.4%; p=0.89) and moderate (21.7 vs 25.6%; p=0.37) 25OHD deficiency. A non significant variation of 25OHD values was also found by ANOVA analysis throughout four age cohorts (<21, 21-40, 41-60 and >60 yrs), in both genders. In each age group, the values of 25OHD did not significantly differ between genders. The percentage of subjects displaying mild and moderate 25OHD deficiencies in the older subgroup was comparable to that observed in the younger adult population. Conclusions: The results of this large epidemiological investigation show that the prevalence of mild and moderate vitamin D deficiency does not significantly increase with aging and seems lower than that observed in other European and American countries. © 2012, Editrice Kurtis.

Meschi T.,Sezione di Medicina Interna e Lungodegenza Critica | Cervellin G.,U.O. Pronto Soccorso e Medicina dUrgenza
European Journal of Internal Medicine | Year: 2011

Community-acquired pneumonia (CAP) is defined as an infection of the alveolar or gas-exchanging portions of the lungs occurring outside the hospital, with clinical symptoms accompanied by the presence of an infiltrate in the chest radiograph. Due to the high prevalence and the large demand of healthcare resources, an accurate clinical and therapeutic decision making is crucial in patients with CAP. As such, there is increasing interest on the use of traditional and innovative biomarkers such as procalcitonin (PCT) and C-reactive protein (CRP). At variance with other traditional inflammatory and innovative biomarkers, PCT might help limiting unnecessary antibiotic use, reduce bacterial resistance and decrease medical costs and drug-related adverse events. PCT however carries some additional advantages over CRP, such as the greater specificity for infections and a more narrow range of normal concentrations. © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Montagnana M.,University of Verona | Cervellin G.,U.O. Pronto Soccorso e Medicina dUrgenza | Meschi T.,Sezione di Medicina Interna e Lungodegenza Critica
Clinical Chemistry and Laboratory Medicine | Year: 2012

The red blood cell (RBC) distribution width (RDW) is a measurement of the size variation as well as an index of the heterogeneity of the erythrocytes (i.e., anysocytosis), which is typically used in combination with the mean corpuscular volume to troubleshoot the cause of an underlying anemia. Reliable data emerged from a variety of clinical studies have, however, disclosed a new and unpredictable scenario in the clinical usefulness of this measure, supporting the hypothesis that RDW might be a useful parameter for gathering meaningful clinical information, either diagnostic or prognostic, on a variety of cardiovascular and thrombotic disorders. Highly significant associations have been described between RDW value and all-cause, non-cardiac and cardiac mortality in patients with coronary artery disease, acute and chronic heart failure, peripheral artery disease, stroke, pulmonary embolism and pulmonary arterial hypertension. It is however still unclear whether anysocytosis might be the cause, or a simple epiphenomenon of an underlying disease, such as inflammation, impaired renal function, undernutrition, oxidative damage, or perhaps an element of both. Nevertheless, RDW is an easy, inexpensive, routinely reported test, whose assessment might allow the acquisition of significant diagnostic and prognostic information in patients with cardiovascular and thrombotic disorders. © 2012 by Walter de Gruyter Berlin Boston.

Rastelli G.,U.O. Pronto Soccorso e Medicina dUrgenza | Meschi T.,Sezione di Medicina Interna e Lungodegenza Critica | Borghi L.,Sezione di Medicina Interna e Lungodegenza Critica | Cervellin G.,U.O. Pronto Soccorso e Medicina dUrgenza
Clinical Biochemistry | Year: 2012

The toxicity of carbon monoxide has been recognized for long throughout history and is unquestionably the leading cause of unintentional poisoning deaths in the Western countries. The severity of poisoning is dependent upon environmental and human factor. The leading pathophysiological mechanism resides in the ability of carbon monoxide to bind to hemoglobin molecules with high affinity, displacing oxygen and generating carboxyhemoglobin, which is virtually ineffective to deliver oxygen to the tissues. The organs with the highest demand for oxygen such as the brain and the heart are more vulnerable to injury. Myocardial involvement is commonplace in moderate to severe carbon monoxide poisoning and is associated with a substantially higher risk of mortality. Besides hypoxic damage, carbon monoxide produces myocardium injuries with cardiospecific mechanisms, mostly attributable to direct damage at cellular or subcellular level. The clinical spectrum of heart involvement is broad and encompasses cardiomyopathy, angina attack, myocardial infarction, arrhythmias and heart failure up to myocardial stunning, cardiogenic shock and sudden death. Patients with underlying cardiac disease, especially coronary heart disease, are at greater risk of infarction and arrhythmias. Single photon emission computed tomography (SPECT) is the technique of choice for diagnosing cardiac involvement, whereas the recent introduction of the highly sensitive troponin immunoassays seems promising for the early triage of patients. No specific treatment other than oxygen delivery can be advocated for cardiac toxicity at present, and 100% oxygen therapy should be continued until the patient is asymptomatic and carboxyhemoglobin levels decrease below 5-10%. © 2012 The Canadian Society of Clinical Chemists.

Montagnana M.,University of Verona | Meschi T.,Sezione di Medicina Interna e Lungodegenza Critica | Borghi L.,Sezione di Medicina Interna e Lungodegenza Critica
Seminars in Thrombosis and Hemostasis | Year: 2011

Patients undergoing chronic hemodialysis have a high risk of arterial thrombotic events as well as vascular access thrombosis (VAT). The latter complication has been consistently associated with inherited (i.e., the prothrombin 20210 polymorphism, and polymorphisms in the genes encoding for transforming growth factor-1, nitric oxide synthase, plasminogen activator inhibitor-1, angiotensin converting enzyme, and methylene tetrahydrofolate reductase), and acquired thrombotic risk factors (i.e., diabetes, obesity, atrial fibrillation, hypertension, hyperhomocysteinemia, hyperlipoproteinemia(a) , low serum albumin, antiphospholipid antibodies, autoantibodies against protein C and S, erythropoietin administration, malnutrition, and cytomegalovirus infection). The three main factors involved in the pathogenesis of VAT overlap those of venous thrombosis and therefore include endothelial cell injury, blood stasis, and hypercoagulability. These changes are characteristic of patients affected by end-stage renal disease and might be further aggravated during and after hemodialysis. The aim of this review is to describe the epidemiology and pathogenesis of thrombosis of dialysis vascular access and to discuss the application of therapeutic interventions in prevention and treatment of this clinical problem. © Georg Thieme Verlag KG Stuttgart - New York.

Lippi G.,U.O. Diagnostica Ematochimica | Meschi T.,Sezione di Medicina Interna e Lungodegenza Critica | Borghi L.,Sezione di Medicina Interna e Lungodegenza Critica | Targher G.,Sezione di Endocrinologia e Metabolismo
Rivista Italiana della Medicina di Laboratorio | Year: 2012

Background. Chronic kidney disease (CKD) is a major public health problem worldwide. According to available guidelines, the estimated glomerular filtration rate (GFR) should be reported by hospital and commercial laboratories preferentially using the Modification of Diet in Renal Disease (MDRD) study equation. Although the clinical performance of the newer Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation has been assessed against directly measured GFR, the correlation between this new equation and the MDRD equation and the Cockcroft-Gault (C-G) equation, which is largely used for estimating GFR by general practition-ers and hospital physicians, has not been fully evaluated. Methods. We automatically generated 14 classes of serum creatinine values (from 0.7 to 2.0 mg/dl in increments of 0.1 mg/dl) each containing 68 classes of age (from 18 to 85 years in increments of 1 year) and 46 classes of body weight (from 40 to kg in increments of 1 kg), for both genders. In each case, GFR was estimated with the C-G, MDRD and CKD-EPI equations. Results. The data generation procedure resulted in 87,584 different virtual cases representing Caucasians. The median estimated GFR values generated with each of the three equations were 56.4, 56.8 and 60.7 ml/min/1.73 m2for the C-G, MDRD and CKD-EPI equations, respectively, in men (all p<0.001), and 47.9, 42.2 and 45.8 ml/min/1.73 m2 for the C-G, MDRD and CKD-EPI equations, respectively, in women (all p<0.001). The overall correlation between the CKD-EPI and C-G equations was marginally better than that between the MDRD and C-G equations (i.e. 0.844 versus 0.811 in men and 0.842 versus 0.811 in women), and the overall diagnostic performance (AUC 0.91 versus 0.89 in men and 0.93 versus 0.91 in women; both p<0.001) were also in favour of the CKD-EPI. The good agreement with the data obtained with the previous MDRD equation (i.e. kappa 0.89 in men and 0.86 in women) also confirms that replacing one equation with another would not generate a substantial change in laboratory-related risk assessment or patient classification according to the GFR values. Conclusions. With careful consideration of the inherent drawbacks of serum creatinine for assessing GFR, but due to a good correlation with the reference method and a better correlation with the C-G equation than with the former MDRD equation, we suggest that the novel CKDEPI equation might be appropriate to use in laboratory reports for reporting the estimated GFR. © Springer 2012.

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