No abstract

Background: Heart failure (HF) is frequently complicated by malnutrition. We estimated nutrient intake in HF patients and evaluated the correlation between serum cytokines and dietary pattern. Methods: We studied 124 elderly (≥ 60 years) patients with severe HF (N = 62) or without HF (controls, N = 62), matched for age and sex. Nutritional data were obtained from the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire. We compared the intake of macro-and micronutrients in the two groups; in the HF group nutritional intake was correlated with serum cytokines. Results: HF patients had a lower energy intake (26.8 Kcal/Kg of ideal weight vs. 37.3 Kcal /Kg ideal weight in controls, P b 0.001) due to a lower intake of all macronutrients. The energy intake was lower than the recommended (30 Kcal/Kg of ideal body weight) in 72% of HF and 34% of the controls. The intake of several minerals and vitamins was inferior to the recommended dietary allowance (RDA) in most participants. Those HF patients with a caloric intake below the median (22.6 Kcal/Kg ideal weight) did not differ substantially from those with higher caloric intake with regard to age, functional characteristics, and lean body mass as expressed by the mid-arm muscle circumference, however, they had a higher concentration of IL4 (61.5 pg/ml vs. 37.7 pg/ml, P = 0.075) and of IL10 (6.32 pg/ml vs. 2.06 pg/ml, P = 0.046). Conclusions: Nutritional intake is frequently inadequate in patients with severe HF. Our results suggest that some interleukins might affect caloric intake in patients with HF.

Paget's disease of bone is characterized by focal areas of increased bone turnover, affecting one or several bones throughout the skeleton. Paget's disease is often asymptomatic, but can be associated with bone pain and other skeletal and non-skeletal complications. We report a case of a 84-year old woman who presented a clinical condition suggesting Paget's disease of bone complicated by congestive heart failure.

Iron deficiency affects up to 50% of heart failure patients, and is associated with poor quality of life, impaired exercise tolerance, and mortality independent of haematopoietic effects in this patient population. Iron absorption from oral iron preparations is generally poor, with slow and often inefficient iron repletion; moreover, up to 60% of patients experience gastrointestinal side effects. These problems may be exacerbated in heart failure due to decreased gastrointestinal absorption and poor compliance due to pill burden. Intravenous (i.v.) iron sucrose has consistently been shown to improve exercise capacity, cardiac function, symptom severity, and quality of life. Similar findings were observed recently for i.v. ferric carboxymaltose in patients with systolic heart failure and impaired left ventricular ejection fraction. I.v. iron therapy may be better tolerated than oral iron. Routine diagnosis and management of iron deficiency in patients with symptomatic heart failure regardless of anaemia status is advisable, and, based on current evidence, prompt intervention using i.v. iron therapy should now be considered.

Pain is a common complaint of the elderly and the prevalence of persistent discomfort increases with aging. Suffering may be underreported as some elderly patients incorrectly believe that pain is a normal process of aging. The aim of this study is to assess the analgesic effectiveness and tolerability of tapentadol in elderly patients with assessment of cognitivebehavioral aspects. During treatment with tapentadol, elderly patients experienced reduced pain intensity and improved physical and mental health.