Minerva medica最新文献

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.

Both heart failure and type 2 diabetes are prevalent conditions and share similar pathogenesis, risk factors, and treatment medications. This review aims to inform clinical practice by summarizing the interaction between heart failure and type 2 diabetes, as well as the medications used to manage them. Novel medications such as Sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-likepeptide-1 receptor agonists, and finerenone have been shown to protect patients with type 2 diabetes from hospitalization for heart failure. SGLT2 inhibitors have also proven effective in patients with heart failure, regardless of the presence of type 2 diabetes. When choosing diabetes treatment medications for patients with heart failure and type 2 diabetes, shared decision-making can be helpful in weighing the benefits and harms based on individual scenarios. The selection of guideline-directed medical therapy aligns with patients without type 2 diabetes. Given the rapid evolution of knowledge in this field, clinicians need to stay updated with the latest evidence to provide optimal medical care.

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome characterized by diastolic dysfunction and high morbidity. It presents significant challenges in diagnosis and treatment due to its heterogeneous etiology and pathophysiology. This review evaluates the efficacy and clinical utility of current and emerging pharmacological therapies for HFpEF, emphasizing personalized approaches to improve patient outcomes. A comprehensive analysis of literature was conducted to assess the role of established treatments, such as diuretics, RAAS inhibitors, and beta-blockers, alongside emerging therapies, including sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, and novel agents like mavacamten. SGLT2 inhibitors have demonstrated significant reductions in heart failure hospitalizations and symptom burden, while GLP-1 agonists show promise in managing HFpEF with obesity or metabolic syndrome. Mineralocorticoid receptor antagonists provide benefits in selecting patients, although broader therapeutic options remain limited. Other novel agents, such as nitrates and PDE-5 inhibitors, require further validation through clinical trials. HFpEF management demands a multifaceted approach combining lifestyle interventions, optimized pharmacotherapy, and emerging therapeutic strategies. Personalized treatment plans and continued research are vital for addressing the complexities of this syndrome and improving patient outcomes.

Introduction: Pneumonia is a severe public health problem on a global scale. Pneumonia continues to be the leading infectious disease-related cause of mortality worldwide. Selecting appropriate antimicrobial treatment is a significant challenge including multi-drug resistant bacteria. The use of monotherapy and combination therapy of antibiotics in pneumonia is still controversial. Considering the wide range of patient characteristics and illness severity in pneumonia, it is important to investigate the variables that affect mortality in different treatment plans. Therefore, this study aimed to systematically review the available evidence regarding comparing monotherapy and combination regimens in pneumonia patients.

Evidence acquisition: A systematic search across various electronic databases like PubMed, Google Scholar, Proquest, and Cochrane was conducted to identify articles published from 2014 to 2024. Review papers, incomplete articles, and duplicates were excluded.

Evidence synthesis: Initially, 179 articles were retrieved from the database search. After a systematic elimination process, sox pertinent articles were identified. These articles involved a total of 11,513 patients across 11 studies. All studies were conducted at single centers, comprising three retrospective cohort studies, one prospective cohort study, one randomized controlled trial, and one cross-sectional study.

Conclusions: Monotherapy and combination therapy have comparable outcomes in mortality rate and hospital length of stay. However, combination therapy is linked with a lower mortality rate in immunocompromised and APACHE ≥15 patients.

Background: This study investigated the potential use of a food supplement, Pycnogenol^® (French maritime Pine Bark Extract) as an anti-inflammatory management during the remission phases of four conditions with a vasculitis component: systemic lupus erythematosus, Behçet's disease, Sjögren Syndrome and polyarteritis nodosa. Symptoms were minimal but persisting and the subjects did not use any chronic drug treatment.

Methods: The aim of this pilot registry study was to evaluate the safety and the preventive effects of oral Pycnogenol^® on the residual symptoms of the inflammatory conditions and possible effects on the recurrence of symptoms in a 4-week, open, supplement registry study.

Results: The registry study included 124 otherwise healthy subjects, suffering from one of the vasculitis conditions with 63 patients taking Pycnogenol^® 150 mg per day and 61 serving as controls. There were no dropouts. Symptom distribution was comparable in the control and in the supplement groups at baseline. No side effects of Pycnogenol^® supplementation were observed. The symptom scores that ranged from 0 to 10, decreased significantly in all the Pycnogenol^® groups after 4 weeks compared to controls (P<0.05). After 4 weeks ESR values decreased significantly in all Pycnogenol^® groups compared to controls (P<0.05). The proportion of subjects with high IL-6 (>5.9 pg/mL) decreased significantly after 4 weeks in the Pycnogenol^® group compared to controls. The proportion of subjects that needed to take nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids to relieve signs and symptoms was significantly lower across all Pycnogenol^® subjects at 4 weeks compared to controls. Finally, plasma oxidative stress (high, >300 Carr Units, in all subjects at inclusion) was significantly reduced (P<0.05) in the supplemented subjects, with minimal improvements in the control groups.

Conclusions: In conclusion, supplementation with Pycnogenol^® may offer advantages and management possibilities for patients with vasculitis diseases allowing to avoid more potentially dangerous drug treatments. Considering a prolonged course, it is possible that chronic management with Pycnogenol^® may prevent the recurrence of diseases with a vasculitis component to clinically significant levels.

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.