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Anemia is a common but often underdiagnosed and undertreated geriatric syndrome in hospitalized older patients. In this retrospective multicenter study, we aimed at characterizing the prevalence, risk factors, diagnostic and treatment approach to anemia in older patients admitted to acute care hospitals, focusing on differences between nephrology and geriatrics units. Prevalence and risk factors for anemia, diagnostic inertia (lack of iron, vitamin B12, and folate status assessment), replacement inertia (omitted treatment with iron, vitamin B12 or folic acid), and erythropoiesis-stimulating agents (ESA) inertia were explored. 1963 patients aged 82.7 (6.8) years were included in the study; 66.7% of the study population had anemia; among anemic patients, diagnostic inertia and replacement inertia were common with rates of 22-31% and 50-87%, respectively; omitted treatment with ESA affected 67.2% of patients and was more prevalent in geriatric units. In most cases, patients with ESA inertia were not routinely screened for iron tests. COPD, cancer, eGFR 45-60 ml/min were associated with increased tendency to ESA inertia. In conclusion, anemia had a high prevalence in older patients discharged from acute care units, but it is often underdiagnosed and undertreated.
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Anemia , Hospitalização , Humanos , Idoso de 80 Anos ou mais , Anemia/epidemiologia , Anemia/terapia , Feminino , Masculino , Fatores de Risco , Prevalência , Itália/epidemiologia , Idoso , Estudos Retrospectivos , Hematínicos/uso terapêutico , Nefrologia , Geriatria/métodosRESUMO
The availability of field experimental data plays a pivotal role in advancing agricultural research, particularly in the Mediterranean, where farmers face significant challenges due to water scarcity and changing climatic conditions. We present a multi-year homogenized dataset of agro-physiological traits collected on industrial tomatoes and focused on the effect of deficit irrigation (DI). The dataset has been compiled over nine years and comprises 100 experimental plots, where 32 DI strategies have been tested. Visual observations on tomato phenology and qualitative and quantitative production data have been collected in field and laboratory surveys, complemented with detailed information on pedo-climatic conditions and irrigation scheduling (timing and volume). Researchers can find in this dataset a rich source for calibrating and evaluating agro-physiological models and a reference basis to study the relationships between DI strategies, weather variability, and the performance of tomato growing systems. Agronomists from the public and private sectors can gain domain knowledge to support local farmers with the best DI strategies to achieve high yields while optimizing water use. Moreover, this dataset serves as ground truth for digital decision support systems, which need real-world data to enhance their accuracy in guiding farmers on efficient water use. This data source is intended to become a crucial asset for researchers, agronomists, and decision-makers in the Mediterranean as it bridges the gap between research and practice in an area where farmers are already striving with water scarcity for industrial tomato cultivation.
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The reuse of treated wastewater for crop irrigation is vital in water-scarce semi-arid regions. However, concerns arise regarding emerging contaminants (ECs) that persist in treated wastewater and may accumulate in irrigated crops, potentially entering the food chain and the environment. This pilot-scale study conducted in southern Italy focused on tomato plants (Solanum lycopersicum L. cv Taylor F1) irrigated with treated wastewater to investigate EC uptake, accumulation, and translocation processes. The experiment spanned from June to September 2021 and involved three irrigation strategies: conventional water (FW), treated wastewater spiked with 10 target contaminants at the European average dose (TWWx1), and tertiary WWTP effluent spiked with the target contaminants at a triple dose (TWWx3). The results showed distinct behavior and distribution of ECs between the TWWx1 and TWWx3 strategies. In the TWWx3 strategy, clarithromycin, carbamazepine, metoprolol, fluconazole, and climbazole exhibited interactions with the soil-plant system, with varying degradation rates, soil accumulation rates, and plant accumulation rates. In contrast, naproxen, ketoprofen, diclofenac, sulfamethoxazole, and trimethoprim showed degradation. These findings imply that some ECs may be actively taken up by plants, potentially introducing them into the food chain and raising concerns for humans and the environment.
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BACKGROUND: Reports of stuck hemodialysis catheters have been on the rise in recent years. Aim of this work is to report how this complication has been managed and the relative outcomes in a multicente Italian survey. METHODS: Since 2012, the Italian Society of Nephrology (SIN) Project Group of Vascular Access has collected data among nephrologists on this complication. Data regarding 72 cases of stuck tunnelled central venous catheter (tCVC) in 72 patients were retrieved thanks to this survey. RESULTS: In 11 patients (15%) the stuck catheter was directly buried or left in place. Sixty-one cases were managed through advanced removal techniques. Among these, 47 (77%) stuck tunnelled central venous catheters were successfully removed, while 14 (23%) failed to be withdrawn. Considering removed tCVCs, the use of endoluminal balloon dilatation alone or in combination with other tools showed a percentage of success of 88%. The removal procedure involved numerous specialists. Some complications occurred, such as breakage of the line or bleeding, and two cases of haemopericardium during an advanced procedure. CONCLUSION: The survey shows how the stuck catheter complication was managed in different ways, with conflicting results. When utilized, endoluminal balloon dilatation proved to be the most effective and most often utilized technique, while some cases had suboptimal management or failure. This underlines how delicate the procedure is, and the need for both precise knowledge of this complication and timely organization of removal attempts.
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Cateterismo Venoso Central , Cateteres Venosos Centrais , Humanos , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Resultado do Tratamento , Remoção de Dispositivo/métodos , Cateteres Venosos Centrais/efeitos adversos , Diálise Renal/efeitos adversos , ItáliaRESUMO
Older hospitalized patients with chronic kidney disease (CKD) are part of the geriatric population with a substantial risk of potentially inappropriate medication (PIM) use. The high rates of multimorbidity and polypharmacy, along with the progressive decline of eGFR, contribute to increasing the risk of drug-drug and drug-disease interactions, overdosing, and adverse drug reactions (ADRs). In this multicenter cross-sectional study, we aimed to evaluate the prevalence of CKD under-reporting and PIMs among older patients discharged from acute geriatric and nephrology units throughout Italy. Renal function was determined by estimated glomerular filtration rate (eGFR) through the Berlin Initiative Study (BIS) equation; the prevalence of PIMs was calculated by revising drug prescriptions at discharge according to STOPP criteria, Beers criteria, and summaries of product characteristics (smPCs). A descriptive analysis was performed to compare the clinical and pharmacological characteristics of patients in the two distinct settings; univariate and multivariate logistic regression models were performed to explore factors associated with CKD under-reporting in the discharge report forms and PIM prevalence. Overall, the study population consisted of 2,057 patients, aged 83 (77-89) years, more commonly women, with a median of seven (5-10) drugs prescribed at discharge. CKD under-reporting was present in 50.8% of the study population, with higher rates in geriatric vs. nephrology units (71.1% vs. 10.2%, p < 0.001). 18.5% of the study population was discharged with at least one renally inappropriate medication; factors associated with at least one contraindicated drug at discharge were the number of drugs (PR 1.09, 95% CI 1.14-1.19); atrial fibrillation (PR 1.35, 95% CI 1.01-1.81); diabetes (PR 1.61, 95% CI 1.21-2.13); being hospitalized in nephrology units (PR 1.62, 95% CI 1.14-2.31), CKD stage 3b (PR 2.35, 95% CI 1.34-4.13), and stage 4-5 (PR 14.01, 95% CI 7.36-26.72). Conversely, CKD under-reporting was not associated with the outcome. In summary, CKD under-reporting and inappropriate medication use were common in older patients discharged from hospital; the relatively high number of PIMs in both nephrology and geriatric settings underlines the need to improve appropriate prescribing during hospital stay and to decrease the risk of ADRs and side effects in this highly vulnerable population.
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Organic farming systems are often constrained by limited soil nitrogen (N) availability. Here we evaluated the effect of foliar organic N and sulphur (S), and selenium (Se) application on durum wheat, considering N uptake, utilization efficiency (NUtE), grain yield, and protein concentration as target variables. Field trials were conducted in 2018 and 2019 on two old (Cappelli and old Saragolla) and two modern (Marco Aurelio and Nadif) Italian durum wheat varieties. Four organic fertilization strategies were evaluated, i.e., the control (CTR, dry blood meal at sowing), the application of foliar N (CTR + N) and S (CTR + S), and their joint use (CTR + NS). Furthermore, a foliar application of sodium selenate was evaluated. Three factors-variety, fertilization strategies and selenium application-were arranged in a split-split-plot design and tested in two growing seasons. The modern variety Marco Aurelio led to the highest NUtE and grain yield in both seasons. S and N applications had a positive synergic effect, especially under drought conditions, on pre-anthesis N uptake, N translocation, NUtE, and grain yield. Se treatment improved post-anthesis N uptake and NUtE, leading to 17% yield increase in the old variety Cappelli, and to 13% and 14% yield increase in Marco Aurelio and Nadif, mainly attributed to NUtE increase. This study demonstrated that the synergistic effect of foliar applications could improve organic durum wheat yields in Mediterranean environments, especially on modern varieties.
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The viability of co-composting of olive mill pomace added to sewage sludge with other organic residues was evaluated and the agronomic use of the final composts was investigated. Two composting piles at different carbon-nitrogen ratios were performed, in which olive mill pomace (OMP), sewage sludge from vegetable processing (SS), fresh residues from artichoke processing residues (AR), and wheat straw (WS) were used. The two composting piles were placed inside a specially built greenhouse and a turning machine pulled by a tractor was used for turning and shredding the organic matrix (every 6 days) during the process. The humidity and temperature of organic matrices have been monitored and controlled during the entire composting process, which lasted 90 days. The process was also monitored to evaluate the microbiological safety of the final compost. The humidity of both piles was always kept just above 50% until the end of the thermophilic phase and the maximum temperature was about 50 °C during the thermophilic phase. The carbon-nitrogen ratio decreased from 21.4 and 28.2, respectively (initial value at day 1 in Pile A and B), to values ranging from 12.9 to 15.1, both composts that originated from the two different piles were microbiologically safe. During a two-year period, the effects of different types of compost on the main qualitative parameters of processing tomato and durum wheat was evaluated. Five fertilization treatments were evaluated for tomato and durum wheat crops: unfertilized control (TR1); compost A (TR2); compost B (TR3); ½ mineral and ½ compost A (TR4); and mineral fertilizer commonly used for the two crops (TR5). Concerning the processing tomato yield, TR5 and TR4 showed the best results (2.73 and 2.51 kg, respectively). The same trend was observed considering the marketable yield per plant. The only difference was related to the treatments that included the compost (2.32, 1.77, and 1.73 kg/plant for TR4, TR3, and TR2, respectively). As regards the qualitative parameters of tomato, the highest average weight of the fruits was found in the TR5, TR4, and TR3 treatments (respectively, 73.67 g, 70.34 g, and 68.10 g). For durum wheat, only the protein component was differentiated between treatments. Furthermore, wheat grain yield parameters generally increased by combined application of mineral fertilizer and compost.
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Questo documento è stato tradotto dall'inglese a nome dell'ERBP (European Renal Best Practice), un organo ufficiale dell'ERA-EDTA (European Renal Association - European Dialysis and Transplant Association), e si basa su una pubblicazione ufficiale edita su Nephrology, Dialysis and Transplantation (NDT). ERBP si assume la piena responsabilità solo per la versione completa delle linee guida in originale e in lingua inglese pubblicate su NDT: Gallieni M, Hollenbeck M, Inston N, et al. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant 2019; 34(S_2):ii1-ii42. https://doi.org/10.1093/ndt/gfz072.
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Derivação Arteriovenosa Cirúrgica/normas , Prótese Vascular , Cuidados Pós-Operatórios/normas , Cuidados Pré-Operatórios/normas , Diálise Renal , Adulto , HumanosRESUMO
In order to evaluate if the reuse of food industry treated wastewater is compatible for irrigation of food crops, without increased health risk, in the present study a cropping system, in which ground water and treated wastewater were used for irrigation of tomato and broccoli, during consecutive crop seasons was monitored. Water, crop environment and final products were monitored for microbial indicators and pathogenic bacteria, by conventional and molecular methods. The microbial quality of the irrigation waters influenced sporadically the presence of microbial indicators in soil. No water sample was found positive for pathogenic bacteria, independently from the source. Salmonella spp. and Listeria monocytogenes were detected in soil samples, independently from the irrigation water source. No pathogen was found to contaminate tomato plants, while Listeria monocytogenes and E. coli O157:H7 were detected on broccoli plant, but when final produce were harvested, no pathogen was detected on edible part. The level of microbial indicators and detection of pathogenic bacteria in field and plant was not dependent upon wastewater used. Our results, suggest that reuse of food industry wastewater for irrigation of agricultural crop can be applied without significant increase of potential health risk related to microbial quality.
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Irrigação Agrícola/métodos , Brassica/microbiologia , Produtos Agrícolas/microbiologia , Solanum lycopersicum/microbiologia , Águas Residuárias/microbiologia , Escherichia coli O157/isolamento & purificação , Listeria monocytogenes/isolamento & purificação , Salmonella/isolamento & purificação , Estações do Ano , Solo , Microbiologia do Solo , Qualidade da ÁguaRESUMO
BACKGROUND: Mutations in the NPHS2 gene, encoding podocin, and in the ACTN4 gene, encoding alpha-actinin-4, have been identified in familial childhood-onset forms of focal and segmental glomerulosclerosis (FSGS). NPHS2 may be also responsible for some sporadic cases. The role of NPHS2 and ACTN4 in the adult sporadic form of the disease is being clarifying. METHODS: Thirty-three adult subjects affected by sporadic FSGS were studied at molecular level. At biopsy, 12 patients had nephrotic syndrome, 5 patients had isolated proteinuria and 16 patients showed proteinuria and hematuria. Glomerular filtration rate (GFR) was in the normal range in 19 subjects and 14 patients had a variable degree of renal failure. Multiplex families presenting with a clear familial inheritance for proteinuria or other congenital nephrotic syndrome were excluded. The whole coding region, all intron/exon boundaries and flanking intronic regions of NPHS2 gene and the exon 8, i.e. hot-spot mutations of the ACTN4 gene, were analyzed in all patients by denaturing high-performance liquid chromatography (DHPLC) to search disease-causing defects. RESULTS: The analysis identified four already described and two new polymorphisms, IVS3-21C>T and IVS3-46C>T, on the NPHS2 gene. Moreover, the R229Q allele was identified in 3/33 patients and in 7/124 controls, accounting for an allelic frequency of 0.045 and 0.028, respectively. The new intronic polymorphism IVS7-54C>T was also found in the exon 8 of the ACTN4 gene. CONCLUSIONS: In this study, we exhaustively analyzed the NPHS2 and the exon 8 of the ACTN4 genes in a series of sporadic 'adult-onset' FSGS patients. No causative mutations were found while the R229Q allele was identified in 3 patients confirming its possible role as a 'disease-associated NPHS2 allele' although its pathogenetic involvement needs to be further clarified. Moreover, the description of new intronic polymorphisms in both genes is reported.
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Actinina/genética , Glomerulosclerose Segmentar e Focal/genética , Proteínas de Membrana/genética , Proteínas dos Microfilamentos/genética , Criança , Cromatografia Líquida de Alta Pressão , Éxons , Feminino , Humanos , Peptídeos e Proteínas de Sinalização Intracelular , Masculino , MutaçãoRESUMO
BACKGROUND: Although the methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism has been identified as an independent cardiovascular risk factor (CRF) in the general population and among uraemic subjects, the validity of this association remains controversial. METHODS: To verify this hypothesis, we enrolled all subjects on maintenance dialysis treatment from a specific Italian district. We also enrolled, from the same area, 1307 subject to serve as controls. Genomic DNA was obtained and MTHFR C677T gene polymorphisms were determined. After a baseline evaluation, patients were followed-up for 37+/-13 months, and all cardiovascular events and causes of mortality were recorded. RESULTS: A total of 461 patients (417 on haemodialysis and 44 on peritoneal dialysis) were investigated, and these included patients with and without cardiovascular diseases at baseline. At enrollment, mean age was 58.8+/-15.6 years and dialytic age was 82+/-69 months. Genotype frequencies were not different between controls and uraemics. During the follow-up, the mean mortality rate was 8.81%/year, with cardiovascular events as the most frequent cause of death (n = 68, 56.6%). There was no relationship between the MTHFR genotype and cardiovascular morbidity, overall mortality or cardiovascular mortality. CONCLUSIONS: In end-stage renal disease, MTHFR C677T polymorphisms were not associated with cardiovascular disease or mortality.
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Doenças Cardiovasculares/epidemiologia , Diálise Peritoneal , Polimorfismo de Nucleotídeo Único , Diálise Renal , Doenças Cardiovasculares/mortalidade , Causas de Morte , Feminino , Seguimentos , Humanos , Masculino , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Pessoa de Meia-Idade , Análise de Sobrevida , Fatores de TempoRESUMO
BACKGROUND: Calcitriol (C) improves anemia in chronic renal failure. This effect may be related to the suppression of iPTH release, or to a direct effect on erythropoiesis. METHODS: Thirty-three patients with chronic renal failure were enrolled; among them, 24 were on chronic hemodialysis and 9 on conservative management. None had other chronic or hematological disease, aluminum levels were below 20 microg/l and DFO testing was negative. The iPTH range was 250-480 pg/l. None were treated with C or r-HuEpo. In vitro study: Samples were drawn for a basal erythroid precursor (burst forming unit-erythroid BFU-E) study: Mononuclear cells were incubated for 14 days with r-HuEpo 3U/ml (A), r-HuEpo 3U/l + C 30 pg (B), r-HuEpo 3U/ml + C 300 pg (C), or r-HuEpo 30 U/ml + C 300 pg (D). In vivo study: After the basal evaluation, 10 patients on chronic dialysis were treated with C (Calcijex-Abbott) 1 microg three times a week, and 4 patients served as controls. BFU-E studies were performed after 1, 2 and 4 months. RESULTS: In vitro, culture B showed increased BFU-E proliferation vs. A (41 +/- 23 vs. 27 +/- 15, p < 0.02); in cultures C and D, proliferation was 61 +/- 31 and 78 +/- 42, respectively, p < 0.01 vs. A. There was no difference among patients with predialysis renal failure and those on dialysis. BFU-E proliferation was inversely related to basal Hb (p < 0.04) and CRP levels (p < 0.05). During the in vivo study, all cultures showed a progressive increase in proliferation without a plateau level (basal, after 1, 2 and 4 months, respectively) In A: 17 +/- 8, 22 +/- 13, 30.9 +/- 14.9, 41.4 +/- 20; in B: 27.3 +/- 15, 35.6 +/- 20, 45.5 +/- 21, 57 +/- 26; in C: 48.2 +/- 20.6, 63.7 +/- 32, 75.7 +/- 37, 83 +/- 40; in D: 72 +/- 24, 91 +/- 42, 106 +/- 42, 110 +/- 42.3 (all p < 0.001). Hb and Hct showed a significant increase (p < 0.03) in the treatment group. The decrease in iPTH was not related to BFU-E proliferation. CONCLUSIONS: In chronic uremia, C has a direct effect on erythroid precursors proliferation, as demonstrated both in vitro and in vivo, with a synergistic effect with r-HuEpo. C may be a useful adjuvant therapy to r-HuEpo treatment.
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Calcitriol/farmacologia , Calcitriol/uso terapêutico , Células Eritroides/citologia , Células Eritroides/efeitos dos fármacos , Células Precursoras Eritroides/efeitos dos fármacos , Eritropoetina/farmacologia , Eritropoetina/uso terapêutico , Falência Renal Crônica/tratamento farmacológico , Anemia/tratamento farmacológico , Divisão Celular/efeitos dos fármacos , Células Cultivadas , Quimioterapia Adjuvante , Sinergismo Farmacológico , Células Eritroides/metabolismo , Humanos , Pessoa de Meia-Idade , Proteínas Recombinantes/farmacologia , Proteínas Recombinantes/uso terapêuticoRESUMO
BACKGROUND: Myocardial infarction (MI) is a leading cause of death, particularly in high-risk settings such as uraemia, in which it is not yet known to what extent genetic factors contribute to the overall risk of MI. We have prospectively evaluated the effect of plasminogen activator inhibitor-1 (PAI-1) 4G/5G and angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphisms on the occurrence of MI in uraemics. METHODS: All patients undergoing intermittent dialysis in an Italian district were enrolled as subjects. From the same area, 1307 individuals served as controls. Genomic DNA was obtained and ACE I/D and PAI-1 4G/5G gene polymorphisms were determined. After a baseline evaluation, patients were followed for 28.8+/-9.8 months. MIs and other causes of death were recorded. RESULTS: A total of 461 patients (417 on haemodialysis and 44 on peritoneal dialysis) were investigated. At entry, their mean age was 58.2+/-16.2 years and dialytic age was 82+/-69 months. Genotype frequencies were not different between controls and uraemics and, in the latter group, between patients with or without cardiovascular diseases at baseline evaluation. During the follow-up, 22 fatal and 16 non-fatal MIs were recorded (mean incidence 1.99 and 1.45%/year, respectively). The adjusted risk of fatal and total MI was related to the presence at entry of a history of MI [hazard ratios (HR) 4.3; 95% confidence interval (CI) 1.5-12.0 and HR 6.8; 95% CI: 3.3-14.0, respectively] and to the PAI-1 4/4 genotype (HR 2.8; 95% CI 1.2-6.9 and HR 2.1; 95% CI 1.1-4.2, respectively). CONCLUSIONS: In end-stage renal disease, PAI-1 4G/5G gene polymorphism may have a significant role in the occurrence of fatal and non-fatal MI.
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Infarto do Miocárdio/genética , Peptidil Dipeptidase A/genética , Inibidor 1 de Ativador de Plasminogênio/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Elementos de DNA Transponíveis/genética , Feminino , Genótipo , Humanos , Itália , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Polimorfismo Genético , Estudos Prospectivos , Diálise Renal , Fatores de RiscoRESUMO
The effects of sterilization modalities on dialysis-induced cytokine release are still unknown. To investigate these effects, 8 patients on chronic hemodialysis were enrolled for evaluating at different intervals interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) production (pg/ml/106). They were using a 1.3 m2 ethylene oxide (E3) or steam (E3S) sterilized Cuprophan membrane. The patients underwent a basal test with E3 (A1) and 2 following tests after 1 (B1) and 2 (B2) months of E3S treatment, respectively. Finally, the last test was performed 1 month after the switch to E3 (A2). Il-1beta predialysis release by mononuclear cells was 162 +/- 114 pg/ml/106 in A1, 185 +/- 129 pg/ml/106 in B1, and 226 +/- 138 pg/ml/106 in B2, then decreased to 123 +/- 134 in A2 (p < 0.07). Il-1beta postdialysis levels were 234 +/- 238 pg/ml/106 in A1, 429 +/- 285 pg/ml/106 (B1), and 438 +/- 473 pg/ml/106 (B2) with the steam membrane, decreasing to 204 +/- 134 pg/ml/106 in A2 (p < 0.01). TNF-alpha predialysis basal release (A1) was 826 +/- 817 pg/ml/106, 720 +/- 496 in B1, and 1079 +/- 515 pg/ml/106 in B2, and finally 680 +/- 588 pg/ml/106 in A2 (p < 0.03). In postdialysis TNF-alpha levels were 963 +/- 542 pg/ml/106 in A1, 1,226 +/- 541 pg/ml/106, and 1,183 +/- 776 in B1 and B2 respectively, and 388 +/- 297 pg/ml/106 in A2 (p < 0.003). Steam sterilization seems to induce a higher cytokine release by mononuclear cells when a Cuprophan membrane is used. This finding may be related to a less physiologic action of the steam in the case of Cuprophan membranes. Further studies are needed to clarify this hypothesis.