Minerva medica最新文献

Background: The aim of this pilot supplement registry study was to investigate the efficacy of the anti-inflammatory supplement Pycnogenol^® in subjects with history of Lyme disease and persistent symptoms with no active bacteria present (Stage 2 and 3 of Lyme disease), on the reduction of inflammation and the relieve of the main symptoms. There is currently no specific treatment for this condition.

Methods: The subjects were divided into two groups: one group received 150 mg/day of Pycnogenol^® alongside standard management, while the control group received only standard management. The observation period lasted for six months.

Results: Forty subjects with history of Lyme Disease and persistent symptoms completed the study: 20 in the Pycnogenol^® group, 20 in the control group. No side effects from the supplementation were observed. The tolerability was optimal as no supplemented subject had to stop management and compliance was optimal with 97% of the Pycnogenol^® capsules correctly used. The two groups were comparable for sex, age distribution and for their main clinical findings and signs/symptoms at inclusion. During the study, corticosteroids at low dose were used on demand in 10% of subjects using Pycnogenol^® and significantly more, in 45% of the control patients (P<0.05). After 6 months, the number of patients experiencing symptoms was significantly lower in the Pycnogenol^® group compared to the control group across all symptoms (P<0.05). After 6 months, the intensity of all symptoms in the Pycnogenol^® group, was significantly lower, according to the scores in comparison with the control group (P<0.05). Plasma oxidative stress was significantly reduced in subjects of the Pycnogenol^® group (P<0.05) in comparison with controls. The improvement in plasma oxidative stress was seen in all subjects using Pycnogenol^®. Knee effusion on ultrasound was seen in 12 subjects of the supplement group at inclusion and in 3 Pycnogenol^® subjects at the end of the study in comparison with 12/20 subjects in the control group at inclusion and 8/20 at the end of the study. (P<0.05). Finally, ESR (Erythrocyte sedimentation rate, a global marker of inflammation) was significantly more reduced in the Pycnogenol^® group by the end of the study compared to controls (P<0.05).

Conclusions: In conclusion, the present registry study showed that Pycnogenol^® intake for 6 months in patients with persistent symptoms of Lyme disease can help relieve the main symptoms by reducing inflammation and oxidative stress. Pycnogenol's anti-inflammatory and antioxidant double activity may help safely and effectively controlling the chronic inflammatory process.

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.

The American Heart Association has reformulated the chronic cardiorenal syndromes into the cardiovascular-kidney-metabolic syndrome. This formulation emphasizes the importance of adipose tissue as the key element in the development of chronic diseases, including diabetes, cardiac disease, and renal disease. The pathogenesis involves multidirectional pathways which have adverse effects on the vascular system, the heart, and the kidneys. Important outcomes in these patients include coronary disease, chronic heart failure, diabetes, and renal failure. The development of new drugs, including SGLT2 inhibitors, GLP-1 agonists, and mineralocorticoid receptor blockers have provided important advances in the treatment of these patients, and multiple randomized controlled trials have reported reductions in adverse cardiac and renal outcomes. This review summarizes the clinical trials with these drugs and provides a brief discussion of their pharmacology.

Background: The role of Transesophageal bronchoscopic ultrasound-guided fine needle aspiration (EUS-B-FNA) in the diagnosis of malignant pulmonary lesions adjacent to the esophagus is a well-known procedure with high diagnostic yield. Moreover, it is indicated for lung cancer staging. Franseen needle tip is a crown-cut needle that allow to obtain tissue cores and provide huge amount of tissue for pathologist's evaluation, moving from fine needle aspiration (FNA) to fine needle biopsy (FNB). Few data about EUS-B-FNB and Franseen needle tip are available in Literature.

Methods: Between May 2022 and June 2024, 33 patients with lymphadenopathy who underwent EUS-B with Franseen needle tip were consecutively enrolled. Chest CT scan was performed prior procedure. Lymphnodes' dimension at imaging and EUS-B were recorded. EUS-B-TBNB was performed with 22G or 25G needle size. Diagnostic yield and specimen adequacy (SA) for predictive markers were evaluated.

Results: 22G needle was used in 18 patients and 25G in 15, and no statistically significant differences were observed between sex and age in the two groups. Overall Diagnostic Yield was 91% (30/33), with no statistically significant differences between 22G and 25G needle group (89% and 93%, respectively). SA for predictive markers was achieved in 20 of 23 patients (87%) with cancer diagnosis, with no significant differences between 22G and 25G group (P=0.59). No adverse events were observed.

Conclusions: EUS-B-FNB is a safe and an effective diagnostic method that should be performed in every bronchoscopy suite. Franseen needle tip provides high quality samples for pathologists, avoiding procedure repetition and/or more invasive procedures.

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.

Post-COVID conditions, also termed "long COVID," are a heterogeneous set of conditions persisting greater than 28 days after initial infection. These conditions, which include fatigue, brain fog, orthostatic intolerance, and pain, are a significant source of morbidity and limited function worldwide. Nonetheless, both the pathophysiology and treatment of long COVID remain poorly understood. Several pathophysiologic mechanisms have been proposed including neuroinflammatory drivers, endothelial dysfunction, neurotransmitter dysregulation, mitochondrial dysfunction, autonomic dysfunction, and central sensitization. In this article, we present a conceptual framework for evaluation of long COVID symptoms, as well as the evidence behind their proposed pathophysiologic mechanisms. Patients may struggle with one or more of the proposed mechanisms listed above, and the contributions from each process may vary depending on the patient. Although no FDA-approved therapies exist for long COVID, we review several potential promising and mechanistically plausible therapies.

Background: In acute respiratory distress syndrome (ARDS) obesity is associated with lower mortality but the mechanism(s) have not been elucidated.

Methods: We aimed at assessing plasma biomarker levels interleukin-8 (IL-8), matrix metalloproteinase-7 (MMP-7), Toll-like receptor 2 (TLR-2), tumor necrosis factor-α (TNF-α) and procalcitonin (PCT) at baseline and 3 days later in 20 consecutive moderate-severe ARDS consecutively admitted to our Center.

Results: Our population includes 20 consecutive mechanically ventilated patients with moderate-to severe ARDS. The incidence of obesity was 40% (8/20). No differences were detectable between obese and normal patients in baseline characteristics. In particular, ICU mortality was comparable between the two subgroups. No differences were detectable between the two subgroups at baseline and after 72 hours in biomarker plasma levels. When examining the behavior of each biomarker, obese patients showed a significant increase in MMP7 and TLR-2 values at 72 hours in respect to baseline, differently from normal patients.

Conclusions: Our data strongly suggest that obese patients with moderate to severe ARDS have an altered inflammatory response to acute lung injury, since a significant increase in MMP-7 and TLR-2 was detectable at 72 hours only in these patients. Further investigations are needed to confirm our results in larger cohorts.

Background: The atrial functional mitral regurgitation (AFMR) refers to a newly recognized disease entity in which mitral regurgitation occurs secondary to left atrial (LA) disease, without left ventricular (LV) dilatation and dysfunction (at least initially) and intrinsic mitral valve (MV) disease.

Methods: We conducted an observational analysis on 28 subjects, mean age and standard deviation 72.7±8.4 years, with AFMR who underwent mini-thoracotomy MV surgery (mitral annuloplasty and tricuspid ring annuloplasty when needed). No surgical treatment of atrial fibrillation (AF) has been performed.

Results: There was no in-hospital mortality. At one-year follow-up, we observe a reverse remodeling of the LV and LA, with a significant reduction of the end-diastolic volume of the LV (110 mL [95-148 mL] vs. 55 mL [48-59 mL], z: -0.7, P<0.001), of antero-posterior (A-P) diameter of left atrium (50 mm [38-60] vs. 46 mm [35-55], z: -3.3, P<0.01) and volume (83.5 mL [63.2-96.5 mL] vs. 63 mL [45.5-78.7 mL], z: -3.2, P<0.01), of the estimated systolic pulmonary artery pressure (PAP) (35 mmHg [30-43] vs. 25 [22-32.7], z: -3.9, P<0.001). Results were not altered by the presence or absence of AF. The overall 1-year survival rates were 100% and all the patients recovered to NYHA functional class I/II at the end of follow-up (z: -6, P<0.001).

Conclusions: The results of our small study showed that mini-thoracotomy valve surgery for AFMR is safe and effective. It improves functional class (NYHA) and results in reverse-remodeling of LA, regardless of the presence or absence of AF. A reduction in left ventricular volumes was also observed, although baseline volumes were still within normal limits, as an expression of reduction in left ventricular overload. Mitral insufficiency should be the primary target of treatment, while AF appears to be an epiphenomenon rather than a causal element of AFMR.