Prevalence of different comorbidities in COPD patients by gender and GOLD stage.

BACKGROUND: Several comorbidities frequently affect COPD progression. Aim of the study was to assess the prevalence of main comorbidities by gender and disease severity in a cohort of COPD patients referring for the first time to a specialist institution. METHODS: The study was a non-interventional, cross-sectional investigation carried out via automatic and anonymous selection from the institutional data base over the period 2012-2015. Inclusion criteria were: subjects of both sex aged ≥40 years; diagnosis of COPD according to GOLD guidelines 2014; the availability of a complete clinical record file. Variables collected were: lung function; smoking history; BMI; the Charlson Comorbidity Index (CCI); number and kind of comorbidities for each patient. RESULTS: At least one comorbidity of clinical relevance was found in 78.6 % of patients, but at least two in 68.8 %, and three or more were found in 47.9 % of subjects. Mean CCI was 3.4 ± 1.6sd. The overall prevalence was 2.6 comorbidities per patient, but 2.5 in males, and 3.0 in females, respectively (p < 0.05). Cardio-vascular disorders were the most frequent, but significantly more frequent in males (44.7 vs 30.7 %, respectively), while the metabolic, the digestive and the osteo-articular disorders were prevailing in females (12.4 vs 9.2; 14.2 vs 4.8, and 6.0 vs 3.8, respectively). In particular, chronic cor pumonale and arrhythmias mainly prevailed in men and congestive heart failure in females, while arterial hypertension resulted equally distributed. As concerning respiratory disorders, pneumonia, pleural effusions and chronic respiratory failure were more frequently found in men, while bronchiectasis and asthma-COPD overlap syndrome (ACOS) in females. Anaemia, gall bladder stones, osteoporosis and spontaneous fractures mostly prevailed in females, while gastric disorders of inflammatory origin and arthrosis were more frequent in males. Cognition disorders, dementia and signs of degenerative brain disorders were more frequently found in men, while depression in females. Finally, lung cancer was at the first place in men, but at the second in females. CONCLUSIONS: All comorbidities increased their prevalence progressively up to the last stage of COPD severity, except the cardio-vascular and the metabolic ones which dropped in the IV GOLD stage, presumably due to the high mortality rate in this severe COPD stage. The gender-dependency of comorbidities was confirmed in general terms, even if lung cancer proved a dramatic increase almost independently of sex.

Changes of clinical outcomes and health care resources in moderate and in severe COPD treated uniquely with tiotropium 18 mcg od for twenty-four months.

UNLABELLED: Chronic obstructive pulmonary disease (COPD) is a complex and progressive respiratory disease characterized by incompletely reversible bronchial obstruction. The effects of current therapeutic options in early stages of COPD have been poorly investigated in the past, being this specific topic revamped by the results of recent secondary analyses from large international trials. AIM: To measure and monitor in real life the changes in main clinical outcomes and health care resources in patients suffering from mild-to-moderate and severe COPD treated with only tiotropium br. for twenty-four months. METHODS: The population sample of the present observational retrospective study consists of 319 COPD subjects (214 males; average age 71.7 years ± 06 se) automatically extracted from the DataBase of the Health Care Institution. Inclusion criteria were: age ≥ 40 y; basal FEV1 < 80% predicted and FEV1/FVC < 70%; regular treatment with only 18 mcg tiotropium br. for the following two years. All subjects were divided into two subsets according to their FEV1 basal value: (Group A ≤ 50%, and Group B >50% predicted). Lung function; n. exacerbations; n. hospitalizations; absenteeism; n. GP's visits, and use of systemic steroids or antibiotics were checked during the observational period and mean values compared in both subsets with those of the twelve months preceding tiotropium br. (such as during other therapeutic strategies). T test was used for checking the comparability of groups, while ANOVA--Duncan test was used to compare the trends of all variables over time; p < 0.05 was accepted. RESULTS: Group A, 154 individuals (104 males; mean age 72.1 years ± 0.51 se) had a mean FEV1 value of 45.4% pred. ± 0.61 se, while the remaining 165, Group B (111 males; mean age 71.4 years ± 0.60 se) had a mean FEV1 value of 65.5% pred. ± 5.7 se (p < 0,01). The two subsets were well matched for gender, age, and previous use of systemic steroids, but significantly different in terms of basal lung function, COPD morbidity, and antibiotic use. Basically, the impact of COPD confirmed higher in severe patients even if it was unexpectedly remarkable in mild-to-moderate individuals in terms of consumption of health care resources. The overall reduction in COPD morbidity was significant in both groups, but the improvement in FEV1 and in other main long-term outcomes observed in subjects with mild-to-moderate COPD was particularly significant and substantial (p < 0.001), these subjects confirming to be worth of earlier therapeutic attention. CONCLUSIONS: 18 mcg tiotropium br. monotherapy for twenty-four months on a regular daily basis enables a significant minimization of COPD impact, and consents the progressive lung function recovery also in mild-to-moderate individuals, thus suggesting a possible role of tiotropium br. in affecting the natural history of COPD.

[Therapeutic education in urology: a fundamental resource for the sick and the health carers].

Therapeutic Education (TE) means to build a partnership between doctors and patients comparing knowledge and therapeutic procedures to manage the disease and its treatment. Patients cannot be a mere passive beneficiary of therapeutic services, but they must play an active role, be conscious and participate in charging proper and community health. Patient TE is a pathway characterized by an "educational diagnosis" including identification of patient demands about pathology; an "educational-therapeutic policy" based on assignment of tasks and rules to manage every aspect of pathology; and the "evaluation" of results of patients' educational process. The aim of TE is to allow the patients to know their pathology, to properly perform therapeutic procedures, to self-manage and prevent complications and to adopt a correct lifestyle. It can be useful to organize theoretical and practical lessons reserved to groups of patients. TE can be applied to urologic pathologies. These pathologies are often chronic diseases and affect elderly patients, who are organically and psychologically fragile. Urologic patients must often manage urostomies, urinary drains, complex follow-up plans. The patients' learning about procedures and disease management represents a professional duty of the urologic team: bladder and prostate cancer, urinary drains management are fields where we can apply a TE plan to support and safeguard the patients' health.

Mutation K448E in the external loop 5 of rat GABA transporter rGAT1 induces pH sensitivity and alters substrate interactions.

1. The effect of the mutation K448E in the rat GABA transporter rGAT1 was studied using heterologous expression in Xenopus oocytes and voltage clamp. 2. At neutral pH, the transport-associated current vs. voltage (I-V) relationship of the mutated transporter was different from wild-type, and the pre-steady-state currents were shifted towards more positive potentials. The mutated transporter showed an increased apparent affinity for Na+ (e.g. 62 vs. 152 mM at -60 mV), while the opposite was true for GABA (e.g. 20 vs. 13 microM at -60 mV). 3. In both isoforms changes in [Na+]o shifted the voltage dependence of the pre-steady-state and of the transport-associated currents by similar amounts. 4. In the K448E form, the moved charge and the relaxation time constant were shifted by increasing pH towards positive potentials. The transport-associated current of the mutated transporter was strongly reduced by alkalinization, while acidification slightly decreased and distorted the shape of the I-V curve. Accordingly, uptake of [3H]GABA was strongly reduced in K448E at pH 9.0. The GABA apparent affinity of the mutated transporter was reduced by alkalinization, while acidification had the opposite result. 5. These observations suggest that protonation of negatively charged residues may regulate the Na+ concentration in the proximity of the transporter. Calculation of the unidirectional rate constants for charge movement shows that, in the K448E form, the inward rate constant is increased at alkaline pH, while the outward rate constant does not change, in agreement with an effect due to mass action law. 6. A possible explanation for the complex effect of pH on the transport-associated current may be found by combining changes in local [Na+]o with a direct action of pH on GABA concentration or affinity. Our results support the idea that the extracellular loop 5 may participate to form a vestibule to which sodium ions must have access before proceeding to the steps involving charge movement.

Current perspectives of therapeutic patient education in Italy.

Therapeutic patient education is a well-defined branch of health education aimed at patient empowerment. It consists of helping the patient to understand his own disease and its treatment, actively collaborating to its fulfillment and to take care of his own health status in order to maintain and improve his life quality. The correct implementation of both communication and therapeutic patient education involves the mastery of specific professional skills by healthcare personnel. In Italy, institutional therapeutic patient education is delivered mainly to diabetic patients. However, other activities and projects aimed at therapeutic education of chronic patients are gradually appearing. An overview of current situation and perspective of therapeutic patient education practice in Italy are presented.

Glutathione peroxidase, selenium, and prostaglandin synthesis in platelets.

Glutathione peroxidase (GSH-Px) contains 4 selenium atoms/molecule; its activity is increased by selenium dietary intake. The enzyme destroys H2O2 and organic hydroperoxides, contributing to the integrity of biological membranes. GSH-Px activity increased (+100%) in washed platelets of rats administered selenium (0.3 ppm given as sodium selenite) for 60 days from 10.44 +/- 1.10 U/g protein (control rats fed a standard diet) to 20.50 +/- 1.21 U/g protein (mean +/- SE; P less than 0.001). GSH-Px in washed erythrocytes was also stimulated (+70%) after 80 days of selenium dietary intake from 11.60 +/0 0.82 U/g Hb to 19.74 +/- 0.94 U/g Hb (P less than 0.001). Malondialdehyde (MDA), the typical breakdown product of peroxidized lipid and a suitable indicator of platelet prostaglandin production, increased from 0.343 +/- 0.035 nM/3 X 10(8) platelets (control) to 0.478 +/- 0.052 nM/3 X 10(8) platelets after 30 days of selenium treatment (P less than 0.05) and to 0.527 +/- 0.051 nM/3 X 10(8) platelets after 80 days (P less than 0.01). MDA was measured by the thiobarbituric acid method after stimulation with 25 X 10(-4) M arachidonic acid. It is concluded that platelets are very rich in GSH-Px, i.e., activity is greatly increased by oral administration of selenium and that the synthesis of prostaglandins is stimulated too.

Importance of the liver in the regulation of platelet activity: effect of its functional exclusion (Eck fistula).

The functional exclusion of the liver, obtained with end-to-side anastomosis of the porta into the cava vein results in impairment of platelet activity. In fact the maximal amplitude and velocity of platelet aggregation in vitro are reduced in animals which undergo the operation and are examined 1 month later. Adding fibrinogen to the platelet-rich plasma after portacal anastomosis restores a normal type of aggregation indicating that the lack of this factor is involved in the phenomenon, even if alterations occurring to platelets may be implied, too.

Thrombocytopenia and coagulation impairment after portacaval shunt in the rat.

A study has been performed to evaluate the effect of the portacaval shunt on some coagulation tests in the rats. Thrombocytopenia develops, accompanied by a decrease in the total protein and fibrinogen concentrations. Moreover, the Quick time is lengthened, whereas the partial thromboplastin time is not modified. The maximal amplitude and elasticity of the clot, recorded by thrombelastography, appear reduced, and k is lengthened. The results are discussed.