Minerva medica最新文献

Antimicrobial resistance (AMR) remains a critical global health concern, largely driven by inappropriate antibiotic use. To address this challenge, the World Health Organization (WHO) developed the AWaRe (Access, Watch, Reserve) classification, prioritizing the use of Access antibiotics - narrow-spectrum agents with proven efficacy and low resistance potential. Amoxicillin/clavulanate, included in the Access group, is widely endorsed in international and national guidelines, as a first-line option for common community-acquired infections. This Expert Opinion reviews the positioning of amoxicillin/clavulanate within stewardship frameworks, synthesizing its pharmacological characteristics, clinical evidence, and relevance in both Italian and global contexts. The combination of amoxicillin with the β-lactamase inhibitor clavulanic acid provides broad activity against key respiratory pathogens such as Haemophilus influenzae, and Moraxella catarrhalis, including β-lactamase-producing strains. Evidence from randomized controlled trials and meta-analyses demonstrates high bacteriological eradication and clinical cure rates across acute bacterial rhinosinusitis, otitis media, community-acquired pneumonia, and chronic bronchitis exacerbations. In pediatric populations, amoxicillin/clavulanate has shown significant efficacy in protracted bacterial bronchitis and chronic wet cough. Comparative data confirm its equivalence or superiority to macrolides and fluoroquinolones while maintaining a lower resistance selection potential and favorable tolerability. The integration of WHO AWaRe targets, Italian stewardship recommendations, and robust clinical evidence underscores the central role of amoxicillin/clavulanate in rational antibiotic prescribing. Its stewardship-aligned use - emphasizing short-course therapy, targeted prescribing, and avoidance in viral syndromes - represents a pragmatic and evidence-based strategy to optimize treatment outcomes while contributing to AMR mitigation in both national and global contexts.

Chronic kidney disease (CKD) remains a major global health burden, contributing significantly to morbidity, mortality, and healthcare costs. Over the past century, therapeutic approaches to CKD have evolved substantially, reflecting advances in the understanding of renal pathophysiology. Early strategies centered around dietary interventions, notably low-protein diets, aimed at mitigating the progression of renal impairment. Subsequently, rigorous blood pressure control and the introduction of renin-angiotensin-aldosterone system (RAAS) blockade with ACE inhibitors and ARBs markedly improved renal outcomes. In the modern era, the emergence of sodium-glucose cotransporter 2 (SGLT2) inhibitors, non-steroidal mineralocorticoid receptor antagonists (nsMRAs) such as finerenone, and glucagon-like peptide-1 receptor agonists (GLP-1RAs) has redefined the therapeutic landscape, offering robust cardiorenal protection. Despite these advances, CKD often remains a progressive disease, underscoring the need for continued innovation. Future therapeutic strategies, including aldosterone synthase inhibitors, soluble guanylate cyclase activators, and therapies currently in preclinical development - such as gene-editing technologies, novel peptide therapies, and renal regenerative approaches - aim to target the fundamental drivers of CKD progression. These emerging modalities hold the promise not merely of slowing disease progression but potentially restoring renal function. As the field moves toward personalized, mechanism-based interventions, early diagnosis and prompt initiation of therapy will remain pivotal. This review traces the historical evolution of CKD management, highlights contemporary advances, and explores the exciting horizon of future therapeutic opportunities.

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are commonly used to manage type 2 diabetes (T2DM), offering benefits not only for blood sugar control but also potentially for kidney health. While some studies have looked at kidney function, no review has specifically focused on how these medications impact kidney health in people with diabetes.

Evidence acquisition: We conducted a review of existing studies following established guidelines. We searched databases like PubMed, Embase, Web of Science, and the Cochrane Library for studies that examined kidney outcomes - such as estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) - in T2DM patients treated with GLP-1RAs. We also assessed the quality of these studies using well-known bias risk tools.

Evidence synthesis: We included 13 studies, including clinical trials and observational research. Overall, the findings suggest that GLP-1RAs may help slow the decline in kidney function, reduce proteinuria and improve other kidney health markers in people with T2DM. However, the results weren't consistent - some studies showed clear benefits, while others found little to no effect.

Conclusions: This review highlights the potential for GLP-1RAs to protect kidney function in people with type 2 diabetes. Although the evidence is encouraging, the differences between studies suggest the need for more large-scale, well-designed trials to confirm these effects and help guide treatment decisions.

The use of extracorporeal cardiopulmonary resuscitation (ECPR) has risen exponentially worldwide. Following favorable observational studies, randomized controlled trials yielded conflicting results in patients with out of hospital cardiac arrest when compared to conventional advanced life support. Additionally, several important questions remain incompletely answered, from patient selection criteria, logistics of care and post-cardiac arrest management, to cost-benefit thresholds, withdrawal of care and organ donation. We offer a narrative review of current literature, critically appraising the existing evidence and discussing pragmatic hurdles to ECPR implementation.

Contrast-enhanced ultrasound (CEUS) is a reliable examination procedure to differentiate benign and malignant liver lesions, which is superior to contrast enhanced computed tomography (CECT) and equally to contrast enhanced magnetic resonance imaging (CEMRI) in large comparative studies. In this review, the data on the enhancement of malignant liver lesions in the late phase in CEUS are analyzed in detail. Hypoenhancement in the late phase on CEUS with SonoVue^® is a typical feature of metastases and other malignant tumors. However, this is not guaranteed in every case. It is explicitly analyzed in the present studies which malignant lesions did not demonstrate washout in the late phase with SonoVue^®. Lack of washout is known for some hepatocellular carcinomas. However, there are also a few rare exceptions described for metastases of neuroendocrine tumors. The possible causes are analyzed. While metastases and cholangiocellular carcinoma demonstrate an early marked washout, this can start very late in neuroendocrine metastases. Some predominantly well differentiated hepatocellular carcinomas in the cirrhotic liver may also show no or only very delayed and faintly washout in the late phase. Isoenhancement at the beginning of the late phase does not rule out metastases or HCC (in the cirrhotic liver). This contrast behavior is known for some HCC in the cirrhotic liver, but it is atypical, poorly reported and understood, especially in liver metastases. The present review analyzes the data on isoenhancement in the late phase of malignant liver lesions. The novel aspect is the focus on liver metastases.