Introduction. Respiratory failure in older adults is associated with high mortality. The Multidimensional Prognostic Index, derived from comprehensive geriatric assessment, is a validated prognostic tool. This study evaluated the association between the Multidimensional Prognostic Index and in-hospital mortality in geriatric patients with respiratory failure. Materials and Methods. We conducted a retrospective observational study including patients aged 65 years or older hospitalized for respiratory failure. Demographic and clinical data and the Multidimensional Prognostic Index at admission were collected. The primary outcome was in-hospital mortality. Logistic regression with bootstrap validation and penalized models was applied. Discrimination was assessed by receiver operating characteristic curve. Results. Higher values of the Multidimensional Prognostic Index were independently associated with increased in-hospital mortality. Each 0.1-point increase corresponded to a higher risk of death. The model showed good discriminative ability, with an area under the curve of 0.74. Results were confirmed by bootstrap and penalized regression. The type of respiratory failure had a limited impact compared to the Multidimensional Prognostic Index. Conclusions. The Multidimensional Prognostic Index is an independent predictor of in-hospital mortality in older patients with respiratory failure and may support risk stratification and clinical decision-making in frail patients.
Chronic pain in older adults is a major clinical challenge due to its high prevalence, complex pathophysiology, and frequent impact on function and quality of life. Polypharmacy and prolonged analgesic use, particularly opioids, often complicate management, leading to dependence and adverse effects. We report the case of a 75-year-old woman with chronic low back pain associated with significant functional impairment and opioid dependence. A multimodal, patient-centered approach was implemented, including gradual morphine tapering, transcutaneous electrical nerve stimulation, functional rehabilitation, and structured psychological support. This integrated strategy aimed to control pain while improving mobility and autonomy and addressing psychological dimensions of chronic pain. The patient showed a favorable evolution, with reduced pain intensity, improved functional capacity, and decreased reliance on opioids. Functional autonomy improved the Instrumental Activities of Daily Living score from 4/8 to 6/8; transition from Groupes Iso-Ressources 2 to 4, along with social reintegration. She also reported a subjective improvement in quality of life and increased engagement in her care. This case emphasizes the value of multimodal, non-pharmacological strategies and individualized, function-oriented management in older adults with chronic pain.
Limited data exist regarding the effectiveness of high-flow nasal cannula (HFNC) oxygen therapy in older patients with terminal acute respiratory failure (ARF). We examined the impact of HFNC on arterial oxygenation after failure of conventional oxygen therapy (COT) and non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) in a retrospective physiologic study of 37 consecutive patients admitted to a geriatric ward with end-stage ARF who received HFNC for refractory hypoxemia after failure of NIV/CPAP (n=18) or COT (n=19). Oxygenation parameters obtained during initial respiratory support were compared with those measured after the transition to HFNC. We observed that 22 patients died, 2 were transferred to the intensive care unit, and 13 were discharged alive. A “do not intubate” status was identified in 17 of the 22 deceased patients. Following HFNC application, improvements were observed in partial pressure of oxygen (PaO2, p<0.0001), oxygen saturation (SO2, p<0.0001), PaO2/fraction of inspired oxygen (FiO2) ratio (p=0.004), and peripheral SO2 (p<0.0001). Oxygenation improvements were greater after transition from NIV/CPAP despite lower FiO2 set with HFNC and in patients discharged alive despite unchanged FiO2. HFNC successfully corrected refractory hypoxemia following NIV/CPAP or COT failure in patients with terminal ARF hospitalized in a geriatric acute-care ward.
Introduction. Gallbladder diseases in elderly patients without pain and relevant symptoms often are detected with ultrasonography (US) performed in patients with metabolic syndrome. Objective of our study is to evaluate with US 300 elderly patients with diabetes. Materials and methods. Abdominal US was performed in 300 diabetic elderly patients (300 women and 200 men, age from 75 to 95 years). Results. Gallstones were detected in 150 patients (95 women and 55 men); acute colecystitis with gallstones were detected in 17 patients (10 women and 10 men); Gallbladder cancer was detected in patients (4 women, 3 men); jaundice was detected in 12 asymptomatic patients. Conclusions. The US in elderly patients with diabetes is very useful if there are clinical symptoms. When the symptoms are few or absent US is the only diagnostic tecnique that can detect gallstones, cancer and cholecystitis.
Introduction. In the Emergency Department (ED) of the Sant’Orsola University Hospital in Bologna, the patient's clinical conditions and social needs are systematically considered as closely interconnected to ensure appropriate discharge pathways through early multidimensional assessment. Objectives. To evaluate the role of the Social Worker in the ED in planning the most proper care pathway for frail older patients. Materials and Methods. Since 2024, at the ED of the Sant’Orsola University Hospital in Bologna, 10 beds have been dedicated to frail older adults. Patients aged ≥65 years with a Triage Risk Screening Tool (TRST) score ≥2 and clinical frailty and/or social needs are eligible, in the absence of indications for intensive or surgical treatment. Care is managed by the Continuity of Care Team, including a Geriatrician, a Nurse, and a Social Worker, who perform a multidimensional assessment and define the most appropriate pathway within 72 hours. Options include: supported discharge home through the Simple Multidimensional Evaluation Unit (UVMs); institutionalization pathways via the Complex Multidimensional Evaluation Unit (UVMc) for permanent admission to nursing homes, including emergency placements; short-term residential care in ED-dedicated nursing home beds; waiting list placement for respite admissions. Results. Between 01/01/2025 and 31/12/2025, 657 patients were assessed. Care pathways included: - 139 supported discharges, 111 via UVMs - 22 admissions to ED-dedicated nursing home beds - 6 respite admissions - 66 UVMc evaluations, 24 in emergency placements - 13 patients received both supported discharge and UVMc Conclusions. Given the close interplay between clinical and social frailty, the presence of a Social Worker in the ED working within a multidisciplinary team is essential in managing frail older adults. Early assessment of patient and caregiver needs allows safe discharge when clinically appropriate and reduces inappropriate hospital admissions.
Introduction. In the current demographic context, identifying frailty and the needs of older people requires specific tools. The Comprehensive Geriatric Assessment (CGA) is a key resource for defining personalized care plans, serving as a driver of healthcare reorganization and the development of community-based services, in line with recent policy reforms. Objectives. This study aims to build a multidimensional national system by classifying existing well-being indicators into the four CGA domains (clinical, functional, cognitive, socio-environmental), in order to support national and regional health policies in the geriatric field. Materials and Methods. Starting from the Italian Equitable and Sustainable Well-being (BES) framework, 22 indicators referring to the population aged 75+ and one of healthy life expectancy at age 65 were selected, covering the period 2016–2024. For each indicator, the desired direction (polarity) was defined. Indicators were allocated across the four domains (6, 3, 3, 11), normalized through a base-100 index (2016=100), and aggregated via arithmetic mean. Results. The least favorable results concern the clinical domain, which in 2024 remains at 2016 levels after a temporary improvement in 2021–2023, mainly due to negative trends in smoking and diet. The cognitive domain shows a gradual recovery after the pandemic (+5 in 2024 vs 2016), as does the functional domain (+8), both previously affected by increased limitations and sedentary behavior. Despite rising inequalities and poverty risk, the socio-environmental domain constantly remains above the baseline, reaching +11 in 2024. Conclusions. The study supports the development of a dashboard to inform national health policies for older people. Future research will involve healthcare professionals in refining indicator selection and classification, as well as defining weighting systems for the aggregation phase.
Introduction. Older Age Bipolar Disorder (OABD) represents a significant diagnostic challenge. The clinical overlap between affective symptoms and cognitive decline makes identifying the etiology of these deficits difficult. Discriminating between psychiatric neuroprogression and the onset of a Neurocognitive Disorder (NCD) requires the integration of clinical, metabolic and instrumental data. Objectives. To describe the case of a 78-year-old woman affected by bipolar disorder, hypertension, cardiopathy, hyperglycemia, hypercholesterolemia, and hypothyroidism, referred to our clinic for suspected cognitive impairment. Materials and Methods. The diagnostic process included monitoring of blood parameters, electrocardiogram, electroencephalogram, carotid artery ultrasound, Computed Tomography (CT) of the brain, and neuropsychological assessment. A comparison was performed between the baseline CT and a one-year follow-up scan. Results. The CT comparison showed unchanged cortical-subcortical atrophy in the absence of acute ischemic lesions. Neuropsychological evaluation evidenced a clear dissociation between preserved cognitive functioning on the Mini-Mental State Examination and episodic memory tests, contrasted by marked executive impairment. This was associated with a reduction in autonomy in activities of daily living. Consistent neuroimaging findings, the integrity of episodic memory, and the selective executive impairment—along with the relative functional decline—appear consistent with Older Age Bipolar Disorder and the influence of metabolic burden (hypothyroidism), rather than a primary Neurocognitive Disorder. Conclusions. A multidisciplinary approach and the preserved memory profile allowed for the correct classification of the patient, directing clinical management toward the appropriate therapeutic path and avoiding the misdiagnosis of a Neurocognitive Disorder.
Introduction. Femoral fractures in older adults represent a significant cause of morbidity and mortality. To address this issue, multidisciplinary care models integrating geriatric, orthopedic, and rehabilitative expertise have been developed at the S. Orsola Polyclinic in Bologna. Objectives. To evaluate, within the Post-Acute Care and Continuity of Care setting (PACA)—where patients with the highest clinical and social frailty are concentrated—the possibility of identifying clinical characteristics predictive of failure to recover functional autonomy. Materials and Methods. This retrospective observational study included patients aged over 75 years who underwent surgery for femoral fracture and were admitted to PACA between August 2022 and September 2025. Frailty was assessed using the Clinical Frailty Scale (CFS), and comorbidities were evaluated using the Charlson Comorbidity Index (CCI). Rehabilitation outcomes were analyzed in comparison with pre-fracture functional status, along with complications and discharge setting. Results. Out of 71 patients, 71% did not recover their pre-fracture functional autonomy. Patients with poor outcomes had higher mean CFS (5.87 vs 5.33; p=0.52) and CCI (7.33 vs 6; p=0.15) scores, although these differences were not statistically significant. Among patients with dementia (n=27), 88% failed to achieve rehabilitation goals. The most frequent complications hindering rehabilitation were infections (9 cases) and delirium (19 cases). Conclusions. High levels of frailty, comorbidity, and the presence of dementia are associated with an increased risk of rehabilitation failure, despite geriatric care and early initiation of rehabilitation. Early planning of the post-discharge pathway is therefore essential, taking into account the likelihood of returning home with increased disability and care needs. Furthermore, a cut-off value of 6 for both CCI and CFS may help identify patients at higher risk of functional decline.
Introduction. Healthy cognitive functioning is a primary component of well-being, independence, and successful aging. Cognitive deficits can arise from various conditions, such as brain injury, mental illness, and neurological disorders. Rehabilitation is a specialized service limited to patients with access to institutional settings. In response to this unmet need, telehealth solutions are ideal for triggering the migration of care from clinics to patients’ homes. Objectives. This project aims to: 1) test the efficacy of a digital health at-home intervention (tele@cognitive) compared to unstructured cognitive at-home rehabilitation (Active Control Group, ACG) in subjects with Mild Cognitive Impairment (MCI), Subjective Cognitive Complaints (SCCs), and Parkinson’s Disease (PD); 2) investigate the effects of tele@cognitive on biomolecular and neurophysiological markers; 3) analyze cognitive, neurobiological and neurophysiological predictors of treatment response. Materials and Methods. This multicenter, single-blind randomized controlled pilot study will include 60 participants with MCI, SCCs, and PD. Subjects will be randomized to tele@cognitive or ACG. Clinical and neuropsychological assessments will be conducted at baseline (T0), post-treatment (5 weeks, T1) and 3-month follow-up (T2). Neurophysiological (Transcranial Magnetic Stimulation, TMS) and biomolecular data will be collected at T0 and T1. Results. We hypothesize that tele@cognitive treatment will yield significant benefits than ACG in cognitive performance, global functioning, and well-being, with measurable neurobiological effects. Conclusions. This project could lead to a paradigm shift from the traditional therapeutic approach, forcing a reassessment on how CNDs could take advantage of a digital solution. This research was funded by the European Union—Next Generation EU—PNRR M6C2—Investimento 2.1 Valorizzazione e potenziamento della ricerca biomedica del SSN (PNRR-MCNT2-2023-12377069; CUP=C83C24000200007).
Introduction. In Europe, patients aged ≥80 years account for 10-20% of adult Intensive Care Unit (ICU) admissions, with 30-day mortality rates around 37% and 1-year mortality reaching 50% for the oldest old. Locally, over the last 5 years, our ICU admitted more than 3700 patients with nearly 30% aged ≥75. ICU mortality was only slightly higher than the 55-65 age group, leaving a large population at risk of Post-Intensive Care Syndrome (PICS). Assessing residual autonomy and sustainable follow-up is urgent to improve long-term outcomes. Objectives. We aim to implement multidisciplinary follow up clinic for ICU survivors aged ≥75. Key goals include: assessing current cognitive and functional status vs. pre-admission baseline; identifying unmet clinical or social needs and ensuring continuity of care through hospital-territory integration; monitoring clinical trajectories over time. Materials and Methods. The project targets patients ≥75 surviving at least 3 months post-ICU discharge. Its core consists of a multidisciplinary joint-visit model, where Intensivist, Geriatrician and Psychologist perform a simultaneous and collaborative assessment of the patient. A systematic clinical follow-up is scheduled at 6 months to monitor long-term outcomes. Results. We expect to intercept PICS early and reduce the care gap often seen after discharge. Identifying specific geriatric syndromes (sarcopenia, cognitive decline, depression) will allow for targeted interventions, potentially reducing hospital readmissions and improving the perceived quality of life for both patients and caregivers. Conclusions. The high survival rate of older patients in our ICU justifies a shift in focus from short-term survival to long-term functional recovery. A multidisciplinary approach is essential to ensuring functional recovery and sustainable care for the expanding cohort of very old ICU survivors.
The “Weancare” intervention, a nutritional protocol based on enriched meals and fortified nutrition, evaluated the efficacy of personalized nutritional support in 52 frail elderly subjects with dysphagia, living in four Nursing Homes managed by Casa di Dio Foundation in Brescia (Italy). A key feature of the protocol was that the introduction of Weancare meals replaced all pre-existing caloric-protein oral nutritional supplements, which were entirely discontinued upon enrolment. Dysphagia is a condition that significantly increases the risk of malnutrition, pneumonia, and pressure sores. The study monitored clinical and functional parameters at 3 and 6 months to measure the treatment's impact. At baseline, the sample had an average age of 84, high comorbidities (high CIRS), cognitive impairment (MMSE often
The Service Charter of the Local Palliative Care Network (RLCP) of the ASL Roma 3, updated to Revision 1 of October 2025, represents the official guidance tool for citizens and healthcare professionals. The document, drafted in accordance with Law 38/2010 and regional guidelines (DCA) No. U00311/2014, outlines the care offered to patients suffering from advanced cancer or chronic-degenerative diseases. The Network's primary objective is to ensure the best possible quality of life through relief from physical, psychological, and spiritual suffering, while protecting the dignity of the vulnerable. The organizational model is headed by the Casal Bernocchi Palliative Care Network UOSD, which coordinates the care pathways in synergy with the Local Operations Centers (COT) and the Hospital Operations Team (TOH). Its key principles include universal accessibility, multi-professional integration, continuity of care between hospital and community, and respect for patient self-determination. Care is provided in multiple settings, starting with residential hospices (Fondazione Sanità e Ricerca, Villa Maria Immacolata, and Merry House), designed as home environments for 24-hour specialized care. The network also provides home-based palliative care through accredited institutions and outpatient services in the districts of Ostia, Fiumicino, Municipio XI, and XII, where Individualized Care Plans are developed. A specific chapter focuses on pediatric palliative care, coordinated by the regional referral center at Bambino Gesù Hospital in Passoscuro. Access to services is based on the referral of a general practitioner or specialist, by submitting the Single Care Form to the COT-A. Finally, the document emphasizes the role of the multiprofessional team and volunteers, ensuring transparency and protection of rights through the Public Relations Office (URP) and the Patients' Rights Tribunal.
Thyrogastric syndrome is the association between autoimmune atrophic gastritis and autoimmune thyroid disease, and they appear to share a complex pathogenetic mechanism involving genetic predisposition, embryological origin, and environmental factors. We describe a case of autoimmune thyrogastric syndrome in an adult man aged approximately 50 years. The most significant clinical factors are impaired iron and thyroxine absorption, attributable to changes in gastric acidity and changes in the gastric microbiota, followed by the intestinal microbiota. Autoimmune atrophic gastritis is a disease characterized by loss of gastric glands with or without metaplasia, often resulting from Helicobacter pylori infection, but less frequently from autoimmune changes with the presence of antiparietal and anti-intrinsic factor antibodies; the diagnosis is histological. As in our case, there is an association of vitamin B12 deficiency with macrocytic anemia, iron deficiency with increased liver deposits (secondary hemosiderosis), and the presence of antithyroid peroxidase antibodies. Gastric atrophy is considered the first of a multi-stage precancerous cascade and ultimately the progression to gastric adenosine carcinoma. Indeed, patients with chronic atrophic gastritis develop low gastric acid production and hypergastrinemia, which over time leads to enterochromaffin-like cell hyperplasia and neuroendocrine tumors (carcinoid tumors). Thus, geriatrics can also be the cause of potentially serious consequences, such as anemia, micronutrient deficiencies, drug malabsorption, neurological disorders, and an increased risk of cancer. Therefore, management requires vigilance (follow-up) with periodic prevention, through endoscopic, histological, and imaging examinations, for gastric cancer and neuroendocrine tumors.
Introduction.The value of Ultrasound (US) in the assessment of aging related muscle loss is demonstrated. The aim of the work is to evaluate the role of US associated with Sonoelastography in the diagnosis of sarcopenia in elderly patients. Materials and Methods. We selected 20 patients from 65 to 85 years,10 women and 10 men, and we performed US and Shear Wave Sonoelastography. The muscles identified for the US and sonoelastography evaluation were the vastus lateralis and the rectus femoris. We evaluated the muscle thickness and the muscle echogenicity and the correlation between the muscle fatty infiltration (myosteatosis) and the muscle stiffness measured by sonoelastography. All patients had cardiovascular disease, in 5 associated with diabetes, in 5 associated with diabetes and obesity, in 5 associated with chronic kidney disease (CKD) and in 5 associated with diabetes and CKD. Results. In the patients with diabetes US detected reduced muscle thickness and increased muscle echogenicity and increased fatty infiltration. The myosteatosis was higher in the patients with diabetes and obesity.. Shear Wave Sonoelastography revealed increased muscle stiffness. The muscle stiffness was increased in patients with diabetes and with high myosteatosis. The muscle stiffness was also increased in patients with age from 75 to 85 years. The reduced muscle thickness was higher in patients with age from 80 to 85. Conclusions. US and Sonoelastography are very useful imaging techniques for the evaluation of sarcopenia in elderly patients. The measurement of muscle thickness and stiffness and the evaluation of myosteatosis performed on our elderly patients confirm that the sarcopenia and the associated muscle’s pathological US findings are more significant in all elderly patients with diabetes, obesity and metabolic syndrome.
Introduction. Malnutrition frequently affects hospitalized older adults under metabolic stress, such as sepsis. Management focuses on ensuring adequate energy/protein intake, with oral nutritional supplements (ONS) recommended when dietary intake is insufficient. Objectives. This study aims to characterize the nutritional profile of geriatric patients hospitalized with sepsis and evaluate early ONS impact on clinical outcomes. Materials and Methods. We prospectively randomized 41 septic patients (≥ 65 years), enrolled per Sepsis-3 criteria, to standard care or early ONS. Assessments included Cumulative Illness Rating Scale (CIRS), Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL), Short Portable Mental State Questionnaire (SPMSQ), 4A test, Clinical Frailty Scale (CFS), and Multidimensional Prognostic Index (MPI). Nutritional status was evaluated via Mini Nutritional Assessment Short-Form (MNA-SF), Malnutrition Universal Screening Tool (MUST), and laboratory markers. Outcomes included in-hospital/post-discharge mortality (up to 90 days) and length of stay. Results. Patients showed significant frailty and functional dependence. Malnutrition (MNA-SF: 68.3%) and weight loss >10% (58.5%) were widespread. Cumulative 90-day mortality was 36.6%; risk factors included frailty, low handgrip strength, and high MUST scores. Early ONS showed superior outcomes: significantly higher 30-day (p=0.03) and overall survival (65.4% vs 27%, p=0.047). A trend toward reduced in-hospital mortality was observed (17% vs 83%, p=0.06). ONS did not significantly alter inflammation or length of stay. Conclusions. Multidimensional assessment is essential for risk stratification. Since early ONS correlates with superior survival, integrating nutritional support into routine sepsis protocols is warranted to optimize recovery and autonomy.
Introduction. Respiratory failure in older adults is associated with high mortality. The Multidimensional Prognostic Index, derived from comprehensive geriatric assessment, is a validated prognostic tool. This study evaluated the association between the Multidimensional Prognostic Index and in-hospital mortality in geriatric patients with respiratory failure. Materials and Methods. We conducted a retrospective observational study including patients aged 65 years or older hospitalized for respiratory failure. Demographic and clinical data and the Multidimensional Prognostic Index at admission were collected. The primary outcome was in-hospital mortality. Logistic regression with bootstrap validation and penalized models was applied. Discrimination was assessed by receiver operating characteristic curve. Results. Higher values of the Multidimensional Prognostic Index were independently associated with increased in-hospital mortality. Each 0.1-point increase corresponded to a higher risk of death. The model showed good discriminative ability, with an area under the curve of 0.74. Results were confirmed by bootstrap and penalized regression. The type of respiratory failure had a limited impact compared to the Multidimensional Prognostic Index. Conclusions. The Multidimensional Prognostic Index is an independent predictor of in-hospital mortality in older patients with respiratory failure and may support risk stratification and clinical decision-making in frail patients.
Introduction. Acute geriatric patients often present with advanced chronic conditions and complex needs requiring a proactive palliative approach. The Necesidades Paliativas (NECPAL) tool, centered on the "Surprise Question" (SQ), identifies patients at risk of death who may benefit from palliative care planning. Objectives. To evaluate the NECPAL-SQ in predicting long-term prognosis and guiding clinical decisions, such as pharmacological optimization and palliative care activation, in hospitalized older adults. Materials and Methods. A prospective observational study was conducted on 150 consecutive patients (mean age 84.7± 6.4 years, 49% women) admitted to the Acute Geriatric Ward of Baggiovara Civil Hospital (Modena, Italy) between January 1 and March 31, 2023. The NECPAL tool and Comprehensive Geriatric Assessment (CGA) was completed for all patients. 24-month survival was analyzed using Kaplan-Meier curves and multivariate Cox model. Results. The Surprise Question (SQ-NO: "I would not be surprised if the patient died") identified 49.3% (74/150) of the sample as high-risk. This group showed significantly higher frailty (p
Post-stroke sarcopenia compromises rehabilitation outcomes and worsens residual disability; ultrasound study is a potential gold standard for muscle assessment. The aim of this study is to evaluate sarcopenia in patients with subacute stroke and analyze its impact on functional recovery. This is a prospective, observational study on 16 patients with subacute stroke. Assessments were performed at admission and discharge, collecting data on nutritional status, sarcopenia risk (MUST, SARC-F), handgrip strength test, Timed Up and Go (TUG), sit-stand test, Barthel index, and FAC. Ultrasound assessments of various muscles were performed on both healthy and hemiplegic limbs. The results were compared with a control group (simple linear regression and backward stepwise multiple regression). Stroke patients showed significantly reduced muscle strength and worse performance on motor tests; the difference diminished upon discharge. Comparison between healthy and affected limbs revealed a general tendency toward muscle atrophy also in the contralateral limb, suggesting a systemic component of post-stroke sarcopenia. Simple linear regression showed a statistically significant negative correlation between MUST and SARC-F at time T0 and between FAC and Barthel index at time T1, indicating worse recovery in ADL and ambulation in patients at greater risk of malnutrition and sarcopenia. By regression analysis, lower muscle tissue quality in the affected limb is a negative predictor of functional outcome, whereas better preserved morphology in the healthy limb is positively correlated with recovery. The study highlights that early identification and treatment of post-stroke sarcopenia, supported by nutritional screening and ultrasound assessment, are key strategies for optimizing functional recovery in stroke survivors. Due to the small sample size, the findings require confirmation in larger studies to consolidate their clinical value and guide targeted interventions.
Porphyrias are a group of disorders of heme biosynthesis, each characterized by an enzymatic defect in the heme biosynthetic pathway. The pathogenesis of Porphyria Cutanea Tarda involves a hepatic deficiency of uroporphyrinogen decarboxylase (UROD). Under normal conditions, UROD converts uroporphyrinogen to coproporphyrinogen through a series of decarboxylations. In the presence of iron and free radicals, uroporphyrinogen is partially oxidized, leading to the formation of a uroporphyrinogen inhibitor of UROD. Subsequent accumulation and oxidation of the corresponding porphyrins, predominantly uroporphyrins in plasma, are responsible for the cutaneous manifestations of PCT. Most patients with PCT show signs of siderosis during liver biopsy and resolve with depletion. PCT manifests as skin fragility, blisters and skin lesions on sun-exposed areas, dark urine, and elevated porphyrins in plasma and urine. One of the most frequent risk factors is the presence of HCV-related hepatitis, obviously associated with a genetic predisposition. In our case, a patient over 80 years of age was an asymptomatic HCV carrier with no signs of cytolysis. Based on the appearance of a beard, blisters, and sores on the backs of the hands and subsequent investigations, a diagnosis of Porphyria Cutanea Tarda was made, also associated with elevated ferritin levels and a positive HCV RNA. The biopsy confirmed the presence of liver iron. Treatment with direct-acting antiviral drugs (DAAs) led to HCV eradication and clinical and biochemical remission of the porphyria cutanea tarda. Porphyria cutanea tarda is therefore an acquired condition with susceptibility factors associated with the pathogenesis of the disease.
Introduction. It has been demonstrated that the incidence of adverse drug reactions and many hospital admissions in the elderly population are related to medications taken. Objectives. We implemented a medication review and deprescribing intervention in elderlys on polypharmacy who presented to the Emergency Department (ED) with acute kidney injury and electrolyte imbalances. The endpoints of this project were to assess that clinical data could be linked to drug interactions in home medications; to reduce hospital stay duration; to decrease the risk of readmissions within three months. Materials and Methods. Data were collected between March and May 2025 from 10 patients over 65 years who takes polypharmacy and presented to the ED with an increasing serum creatinine; hypo or hypernatremia; hypo or hyperkalemia. We applied a simplified Comprehensive Geriatric Assessment including Clinical Frailty Scale, Activities of Daily Living, Instrumental Activities of Daily Living and Gerontonet Risk Score. The intervention was divided into reconciliation and verification, in which geriatrician and hospital pharmacologist jointly evaluated potential adverse reactions with dedicated tools, Beers and STOPP/START Criteria. Three-month follow-up were performed via interviews to track any hospital readmissions. Results. In most analyzed cases, there was a strong correlation between the clinical condition leading to ED observation and home polypharmacy. Most of the patients had a moderate frailty, with high risk of adverse events. This diagnostic evaluation has halved the time spent in the ED, except for cases of hypo and hyperkalaemia. At three-month follow-up, six patients vs. four were not readmitted within three months. Conclusions. The analyzed cases showed a reducing dialysis risk with shorten hospital stays for electrolyte disorders. We also observed that a rapid medication washout could markedly improve health outcomes, shortening hospital stays by 48–72 hours and avoiding overtreatment.
