Panminerva medica
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Osteoporosis is a widespread disease, affecting about 75 million people, mostly postmenopausal women. It is called ''the silent disease'', since there are very few associated symptoms: anyway osteoporotic fractures are the chief clinical feature, with an enormous burden on health related quality of life and mortality. The aim of this study was to review the literature on the evaluation of mortality and health related quality of life as consequences of osteoporotic fractures. ⋯ Hip and spine fractures are linked with increased mortality, and all fractures may lead to disability and reduced quality of life. Since patients with osteoporosis usually have no symptoms before fracture, early diagnosis and treatment of the disease are of great importance to the quality of life in these patients. To reduce mortality, attention must focus on optimising health status preoperatively, preventing postoperative complications, and, when these complications develop, providing optimal specialist medical care.
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Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death, affecting 14 millions adults in the United States. Symptoms related to sleep disturbances are common in individuals with moderate to severe COPD, particularly in the elderly, which is commonly manifested as morning fatigue and early awakenings. One major cause of morbidity in this population is abnormalities in gas exchange and resultant hypoxemia as they can lead to elevated pulmonary pressures, dyspnea and in severe cases right ventricular overload and failure. ⋯ They include decreased functional residual capacity, diminished ventilatory responses to hypoxia and hypercapnia, impaired respiratory mechanics, diminished arousal, respiratory muscle fatigue, diminished nonchemical respiratory drive, increased upper airway resistance, and the starting point of baseline saturation values while awake on the oxyhemoglobin dissociation curve. Smoking cessation, bronchodilation, inhaled steroids in those with a reversible component and pulmonary rehabilitation are corner stones of treatment of COPD. The goals of therapy for the clinician should be to improve lung mechanics as well as gas exchange ultimately leading to better sleep quality and health status.
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Aspiration pneumonias occur more frequently than reported and, in many cases, the disease is not recognised. In hospitalised and institutionalised patients with predisposing diseases prompt diagnosis of this complication and correct preventive measures can drastically reduce the worsening of clinical conditions and the deaths due to aspiration pneumonia. Normal airway structure, effective defence mechanisms, and preventive measures are decisive in reducing aspiration episodes. ⋯ Chronic patients education and correct health care practices are the keys for preventing the events of aspiration. In patients at risk a clinical and instrumental assessment of dysphagia should be evaluated. Management includes the removal of etiologic factors (drugs, tubes, mobilisation, oral hygiene), supportive care, and in bacterial pneumonias a specific antibiotic therapy for community-acquired or nosocomial events.