Objective: to investigate both muscular manifestations and CK levels of a large cohort of patients with COVID-19 infection and to determine whether hyperckemia is associated with morbidity and mortality.Methods: Data of 615 patients discharged from ASST Ovest Milanese (Milan, Lombardy, Italy) with final diagnosis of COVID-19 infection were retrospectively extracted from electronical medical records from 21 February to 1 May 2020. Patients were descriptively analyzed with respect to the following variables: sex, age, muscular manifestations (including myalgia/arthralgia and fatigue), respiratory involvement (SARS pneumonia or respiratory failure) and history of falls. Association between patients’ characteristics and CK levels was investigated. In addition, the proportion of patients who died following access to the ER was calculated. Finally, the effect of CK levels and other patients’ features on mortality was estimated using a logistic regression model.Results: 176 (28.6%) patients had raised serum CK levels. 88 (14.3%) had muscular manifestations, of which 81 (13.2%) complained fatigue and 17 (2.8%) had myalgia and/or arthralgia. CK levels were significantly associated with respiratory involvement and fatal outcome.Conclusions: Our study provides preliminary evidence that hyperckemia is a predictor of respiratory involvement and fatal outcome in patients with COVID-19 infection. For patients with muscle damage symptoms, screening for COVID-19 infection is recommended together with the dosage of CK level.

Objective: Randomized controlled trials have shown that renal denervation lowers office and ambulatory blood pressure. However, the clinical environment of controlled trials is different from that characterizing medical practice, making real-life data appropriate to provide information on a number of issues, e.g. whether renal denervation is followed by a change in the intensity and type of antihypertensive drug use. The aim of the present study was to evaluate whether patients undergoing renal denervation procedure in a real-life setting have a reduction in antihypertensive drug prescription over the subsequent years. Design and method: Using the healthcare utilization database of the Lombardy Region (Italy), the 136 patients who, during the period 2011–2016, were prescribed four or more antihypertensive drugs and underwent renal denervation were included in the study cohort. The number and type of antihypertensive drugs were assessed over the year before and during the three-year period after renal denervation. Hospitalizations for cardiovascular diseases were also assessed during the three years before and during the three years after renal denervation. Results: The median age of the patients was 67 years and 68% of them were men. Based on a multisource comorbidity score, about 40% of patients showed a poor or very poor clinical status. Before renal denervation, about 80% of the patients were prescribed four or five antihypertensive drugs. The number of drugs decreased after the denervation: after three years, patients prescribed 4/5 drugs were 57% and patients prescribed six drugs decreased from 18% to 2%. Reduced prescription extended to all antihypertensive drugs throughout the post-denervation period. Compared to the year before the denervation, after three years prescription of diuretics was reduced by 15%, calcium channel blockers by 21%, angiotensin-converting enzyme inhibitors by 32%, angiotensin receptor blockers by 22%, beta-blockers by 20%, alfa-blockers by 30%, and mineralocorticoid receptor antagonists by 30%. Hospitalizations for cardiovascular diseases did not show appreciable differences between the two periods (before and after the renal denervation). Conclusions: In the real-life setting, patients who underwent renal denervation had a clearcut reduction in antihypertensive drug prescription over the following years.

s e425pills. Compared with patients on the two pill combination, those treated with a SPC were slightly younger (68 vs 71 years) and more frequently men (54% vs 48%) with no between group difference in the clinical profile. About 59% and 25% of patients prescribed the three drug treatment as SPC and two pill combination showed high adherence, respectively. Compared with patients under two pill combination, those who were treated with the SPC had a higher propensity to be highly adherent to the triple combination (risk ratio: 2.38, 95% confidence interval 2.32 2.44). This was the case regardless of the sex, age, patient clinical status, and number of co treatments. The odds of being poorly adherent to treatment was much lower in the SPC than in the two pill combination group (risk ratio: 0.33, 0.31 0.34). Conclusions:In a real life setting, patients who were prescribed the perindopril/amlodipine/indapamide SPC exhibited more frequently a good adherence to antihypertensive treatment than those prescribed a two pill combination of ACEI/CCB/D.

Objective:Aim of the study was to evaluate the protective effect of antidiabetic drugs in a large cohort of unselected elderly diabetic patients differing for their clinical status and life expectancy. The evaluation focused, in particular, on a group of patients with a very low survival rate because frail patients are usually excluded from intervention trials, limiting evidence on treatment effectiveness. The protective effect of drug therapy, quantified by the reduction in all-cause mortality with increased adherence to antidiabetic agent therapy, was studied by stratifying patients according to their life expectancy.Design and method:The Lombardy (Italy) residents, aged > 65 years, who received > 2 consecutive prescriptions of antidiabetic agents during 2012 were identified and the date of the third prescription was defined as the index date. A case-control study was nested into the cohort of antidiabetic drug users. Death from any cause was the outcome of interest, and cases were cohort members who died during follow-up (up to 2018). For each case, a control was selected and matched for age, gender, and clinical profile. Conditional logistic regression was used to model the risk of outcome associated with four categories of adherence to antidiabetic drugs. Adherence to drug therapy was measured by considering the proportion of days of the follow-up covered by the drugs. The analysis was stratified according to four categories of the clinical profile (good, intermediate, poor, and very poor) differing for life expectancies, as evaluated by a multisource comorbidity score able to accurately predict the risk of death.Results:Among the 276,336 patients in treatment with antidiabetic agents during 2012, 188,983 met the inclusion criteria and generated 49,219 deaths during follow-up, 49,201 of whom were matched to a control. The 6-year survival decreased from 85% to 52% from the group of patients with good to the group of patients with a very poor clinical status.Adherence to treatment was associated with a progressive decrease in the risk of mortality in all categories of clinical status. The reduction from lowest to highest adherence level was 36% (95% CI, 25–46%), 50% (44–56%), 38% (33–42%) and 26% (17–34%) from good to very poor clinical status (Figure).Conclusions:In a real-life context, adherence to antidiabetic drugs is associated with a reduction in the risk of mortality regardless of the clinical status of the patients. However, in more frail patients, the benefit of treatment is less than in patients in good clinical condition.

Objective: To evaluate access (availability, price, affordability) to essential medicines (EMs) and diagnostic tests and technologies for management of hypertension and heart failure (HF) in Maputo City, Mozambique.Results: 28,210 patients prescribed the perindopril/amlodipine/indapamide SPC were identified and matched to 28,210 patients prescribed ACEI/CCB/D in two