Hypereosinophilia and hepatitis C

We report a case of a 59-year-old Italian man with a history of alcoholic abuse and sustained peripheral blood eosinophilia since 2 years. He arrived at our hospital with progressive oedema, palpitations, dyspnea by heart failure. During hospital stay a diagnosis of CEL-NOS, heart failure and hepatitis C was made. Due to the severe hepatopathy and the mild HCV genotype, along with the therapeutic effect of interferon in chronic myeloid disorders, the patient was treated with PEG-interferon alpha-2a 180 μg weekly and ribavirin 1,000 mg daily. At the end of the treatment the patient showed an important decrease of eosinophil count, normalisation of liver enzymes and the absence of circulating HCV-RNA

Diaphragmatic flutter in a patient with a pacemaker

Diaphragmatic flutter is a rarely reported disorder characterized by an abnormal diaphragmatic activity, which may be associated with respiratory symptoms (respiratory myoclonus). We describe a case of a 65-year-old patient with abnormal abdominal movements and no other symptoms. These movements resulted from rapid involuntary contractions of the diaphragm. Emotional tension and anxiety were the most common precipitating factors, the etiology was unclear and several pharmacologic agents have shown to be ineffective until the flutter was suppressed with high dose of clonazepam

A “strange” case of COPD

Common variable immunodeficiency (CVID) is a rare syndrome, characterized by hypogammaglobulinemia and limited antibody responses due to either impaired B-lymphocyte development or B-cell responses to T-lymphocyte signals. CVID is frequently associated with bacterial infections, particularly against respiratory tract, that could determine a permanent organ damage (COPD, asthma), increased incidence of both autoimmune diseases and cancer, high prevalence of gastrointestinal inflammatory diseases (ulcerative colitis, Crohn’s disease, celiac disease), lymphoproliferative and granulomatous diseases. Given that the gastrointestinal tract is the largest lymphoid organ in the body, it’s not surprising that intestinal diseases are common in immunodeficiency. CVID is considered a congenital condition but it is usually diagnosed in adulthood. We describe the case of a 43-year-old man affected by recurrent infections of respiratory tract with CVID, celiac disease and type 1 diabetes. With the exclusion of gluten from the diet, patient achieved an improvement of serum level of immunoglobulins and a reduction of recurrent infections. This fact suggests that the interruption of the gluten stimulus could have a positive influence on the other diseases, improving the metabolic compensation and stabilizing the immune system

Diabetes mellitus and clopidogrel “resistance”

In our Department arrives a 75-year-old patient with hypertension, diabetes mellitus (DM) treated with hypoglycaemic drugs, dyslipidaemia and ischaemic heart disease post-acute myocardial infarction treated with triple coronary artery bypass surgery and subsequent percutaneous transluminal coronary angioplasty (PTCA). After a new PTCA and positioning of medical stent he is discharged with a double antiplatelet therapy. But after one month two thrombotic events occur in this patients almost simultaneously. Antiplatelet therapy such as clopidogrel and aspirin in combination, is the current gold standard for reducing cardiovascular events in patients with DM, providing a synergistic platelet inhibition through different platelet activation pathways, but platelets of DM patients are characterised by disregulation of several signalling pathways which may play a role not only in the higher risk of developing cardiovascular events and the worse outcome, but also in the larger proportion of DM patients with inadequate response to antiplatelet drugs compared to non DM subjects

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations