Minerva medica最新文献

A large proportion, possibly over half, of patients presenting for preoperative evaluation will be taking antihypertensive agents. The multiple classes of agents and their use in different combinations can make management decisions challenging. Poor blood pressure control and lack of evidence or conflicting evidence for certain agents can further complicate management. Appropriate antihypertensive management is important because it can have an effect on meaningful perioperative outcomes, including mortality. In this review, we discuss the factors that should be considered when making preoperative hypertension management decisions and we summarize the available evidence for the most common classes of antihypertensive agents, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and diuretics. In addition to preoperative management, the review includes information on perioperative and postoperative blood pressure management considerations. Where possible, we provide recommendations based on the available evidence and the guidance published by expert bodis. However, due to the variety of factors that may influence management, clinical decisions for individual patients must be made on a case-by-case basis.

Background: Early diagnosis of idiopathic pulmonary fibrosis (IPF) is fundamental to slow disease progression; multidisciplinary teams (MDTs) play a central role in posing the final diagnosis of IPF, thus aiming to improve patient outcomes. However, the practical implementation of MDTs in clinical real-life settings may be hindered by the lack of local expertise or time constraints, with the diagnosis being made without the support of complementary professional health care figures. This study aims to evaluate the impact of MDT meetings on the latency between the symptom onset and the final diagnosis of IPF.

Methods: Patients referred to a regional center for IPF between January 2019 and August 2019 were included. The length of time to pose a definite diagnosis by means of MDT evaluation was compared with that of patients diagnosed elsewhere (no MDT evaluation) in an observational case-control investigation.

Results: Among 24 IPF patients, those evaluated by MDT (M/F: 14/2, age: 69.8±8.2 yrs) showed a time interval from the first outpatient visit to the definite diagnosis of 3±2.3 months; on the other hand, patients in the control group (M/F: 7/1, age: 76.9±7.7 yrs) showed a time interval of 12.8±9.4 months (P=0.02). The time elapsed between the onset of symptoms and the definite diagnosis was 11.1±5.3 months for patients evaluated within the MDT, compared to 33.8±21.5 months for the control group (P=0.02).

Conclusions: These exploratory findings confirm the essential role of the MDT in the early diagnosis of IPF, thus discouraging the acquisition of diagnosis solely on individual basis. The current findings highlight the need for the implementation of MDTs in clinical practice to optimize patient care.

The global aging population has been increasingly vulnerable to environmental stressors, particularly air pollution. Advancing age is associated with physiological declines and a higher prevalence of chronic diseases, heightening susceptibility to pollution-related health effects. This review explores the relationship between advancing age and mortality/morbidity due to pollution exposure, consolidating evidence on how pollution exacerbates health risks in elderly populations. Based on the epidemiological evidence, this comprehensive literature review evaluates the interaction between aging, pollution exposure, and the biological mechanisms that make older adults more vulnerable to pollution-related mortality/morbidity. Google Scholar, PubMed, and Scopus were systematically searched to identify relevant studies, including cohort studies, meta-analyses, and reviews. Studies were selected based on their focus on air pollution, aging populations, and mortality. Inclusion criteria included peer-reviewed articles addressing pollution-related health outcomes in older adults, specifically emphasizing cardiovascular, respiratory, and neurological impacts. Aging amplifies the harmful effects of air pollution through mechanisms like oxidative stress, impaired immune responses, and chronic inflammation. Elderly populations are disproportionately affected by pollutants such as particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone. Mortality, specifically due to cardiovascular, respiratory, and neurodegenerative diseases, is significantly higher in older adults exposed to long-term pollution. Air pollution, as an effect modifier, intensifies the health risks associated with aging. Older adults face heightened mortality risks due to pollution, demanding public health strategies to prioritize pollution reduction and protective interventions at individual and population levels.

Introduction: Psoriasis is a chronic, immune-mediated skin disorder associated with systemic conditions like cardiovascular diseases, metabolic syndrome, and type 2 diabetes mellitus. Individuals with psoriasis show a higher risk of diabetes compared to the general population. This review aims to examine the relationship between the physiopathology and treatment of psoriasis and diabetes mellitus.

Evidence acquisition: A systematic search was conducted across PubMed and Google Scholar up to July 2024. Observational studies and clinical trials involving all age groups and genders were included, focusing on the pathophysiology, inflammatory pathways, and therapeutic interventions for psoriasis and diabetes.

Evidence synthesis: Evidence consistently showed an increased prevalence of type 2 diabetes among psoriasis patients. The IL-23/IL-17 axis plays a critical role in the inflammation driving both psoriasis and insulin resistance. This inflammation promotes metabolic syndrome components such as obesity. Conversely, insulin resistance and obesity amplify systemic inflammation, creating a vicious cycle in psoriasis patients. Integrated treatment approaches, combining targeted pharmacologic therapies with lifestyle modifications, demonstrated potential in managing both conditions effectively. Multidisciplinary care is vital to address the dermatological and metabolic aspects of these interconnected diseases.

Conclusions: The shared inflammatory pathways between psoriasis and type 2 diabetes highlight the complex, bidirectional relationship between the two. Integrated therapeutic strategies that include lifestyle changes and targeted drug interventions show promise in improving outcomes for individuals affected by both conditions.

Insomnia is a prevalent public health issue, characterized by dissatisfaction with the duration, continuity, and quality of sleep. It is closely associated with daytime symptoms, which are essential for diagnosing insomnia disorder. The condition is more common among women, middle-aged and older adults, and individuals with coexisting mental or physical health conditions. Evidence suggests that insomnia increases the risk of various health problems. Addressing insomnia is therefore crucial not only to enhance patients' quality of life but also to mitigate its significant health, social, and economic impacts. However, further studies are needed to evaluate the cost-effectiveness of insomnia treatments. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for chronic insomnia in adults. When CBT-I proves ineffective or is unavailable, pharmacological treatments may be considered. Benzodiazepines (BZs) and benzodiazepine receptor agonists (BZRAs) are suitable for short-term treatment (up to 4 weeks). Among BZs, triazolam is notable for its short half-life and demonstrated efficacy in treating sleep-onset and middle-of-the-night (MOTN) insomnia, supported by robust clinical evidence. Additionally, triazolam does not impair psychomotor performance. In certain cases, longer-term use of BZs or BZRAs may be appropriate; however, this approach requires careful individual assessment of the benefits and risks. Non-nightly use of hypnotic medications may also be a viable option for patients who do not require nightly treatment. Low-dose sedating antidepressants may be considered for short-term insomnia management (off-label), while antipsychotics and antihistamines are not recommended for this purpose. Orexin receptor antagonists are an option for treating insomnia for up to three months. It is important to note that although insomnia guidelines are based on daily use as evaluated in randomized controlled trials, clinical practice may vary.

The diagnosis and management of small bowel bleeding (SBB) can be a clinical challenge. Advances in video capsule endoscopy, balloon-assisted enteroscopy, and multiphasic computed tomography allow for localization and therapeutic intervention. Etiologies of SBB including vascular, neoplastic, and inflammatory conditions are associated with age and comorbidities. The present review highlights terminologies that describe SBB, provides a differential diagnosis for bleeding etiologies, and summarizes a clinical approach to managing this condition.

Venous thromboembolism (VTE) is a leading cause of maternal mortality. The risk of VTE in pregnant and postpartum women is ~ five times higher compared with non-pregnant women. There is a physiological tendency to a hypercoagulable state, from conception to the postpartum period. Several non-obstetric risk factors independently increase the risk of VTE. Since most signs and symptoms of VTE might mimic those of a normal pregnancy, a high index of suspicion is warranted to establish the diagnosis. D-dimer, ultrasonography and computed tomography pulmonary angiography are the primary tools for VTE diagnosis. Management mainly revolves around systemic anticoagulation with heparin. Advanced therapy options exist, but these can be considered for selected high-risk cases.

Every year millions of people fly to high-altitude destinations. They thereby expose themselves to specific high-altitude conditions. The hypoxic environment (low ambient oxygen availability) constitutes a major factor affecting health and well-being at high altitude. While the oxygen availability is already moderately reduced inside the aircraft cabin, this reduction becomes aggravated when leaving the plane at high-altitude destinations. Especially if not pre-acclimatized, the risk of suffering from high-altitude illnesses, e.g., acute mountain sickness, high-altitude cerebral or pulmonary edema, increases with the level of altitude. In addition, diminished oxygen availability impairs exercise tolerance, which not only limits physical activity at high altitude but may also provoke symptomatic exacerbation of pre-existing diseases. Moreover, the cold and dry ambient air and increased levels of solar radiation may contribute to adverse health effects at higher altitude. Thus, medical pre-examination and pre-flight advice, and proper preparation (pre-acclimatization, exercise training, and potentially adaptation of pharmacological regimes) are of utmost importance to reduce negative health impacts and frustrating travel experiences.