Atrial fibrillation: all the elderly go hospitalized? A minireview

Atrial fibrillation (AF) is a very common in clinical practice. The prevalence of AF is high after the age of 65 years. Patients with AF have a worse quality of life than healthy controls. However, concomitant higher hemorrhagic risks, severe cognitive and functional impairment may at least partly explain under-prescription of oral anticoagulants in the elderly

Dysphagia: what we known? a minireview

Dysphagia refers either to the difficulty someone may have with the initial phases of a swallow (usually described as oropharyngeal dysphagia, "OD") or to the sensation that foods and or liquids are somehow being obstructed in their passage from the mouth to the stomach (usually described as "esophageal dysphagia"). In patients with no indication of a somatic disease or abnormality, psychiatric conditions must be considered as a possible cause of OD. Moreover, diagnosis and treatment of dysphagia are not standardized. There is no universal standard tool for screening or clinical assessment of OD. Education of health professionals on early diagnosis and improvement of therapeutic strategies are mainstays to allow maximal recovery potential in this population. Future studies, clinical trials, clinical evidence and clear guidelines are needed to manage this condition

Gender differences in treatment of Coronavirus Disease-2019

Coronavirus Disease-2019 (COVID-19) is the worst worldwide pandemic with more than 12,000,000 cases and 560,000 deaths until 14th July 2020. Men were more infected by COVID-19 than women, and male subjects with underlying conditions, including diabetes, hypertension, and cardiovascular diseases developed a severe form of the affection, with increased mortality rate. Many factors can contribute to the disparity in disease outcomes, such as hormone-specific reaction and activity of X-linked genes, which modulate the innate and adaptive immune response to virus infection. Until now, only the Remdesivir was approved by FDA (Food Drug Administration) for COVID-19 treatment, although several clinical trials are ongoing worldwide also on other drugs. In this review, we analyzed published studies on several drugs (chloroquine or hydroxychloroquine, remdesivir, favipiravir, lopinavir-ritonavir in combination, tocilizumab, plasma, and immunoglobulins) with some efficacy to COVID-19 in humans, and evaluated if there were a gender analysis of the available data. In our opinion, it is essential to report data about COVID-19 disaggregated by sex, age, and race, because the knowledge of gender differences is fundamental to identify effective and customized treatments to reduce hospitalizations, admissions to intensive care units, and mortality

What is known in male gender differences, comorbidity and age for covid-19 pandemia? A narrative minireview

Background. On March 2020, WHO declares the world pandemic by COVID-19. In this report we report the COVID-19 infection, related to male gender, comorbidity and special population. Data resources. We describe the published studies by PubMed, Medscape and Scopus between December 2019 to May 2020. Keywords used: male/man gender, sex differences, COVID-19, comorbidity, diabetes, hypertension, elderly, pregnancy, children. Results. The elderly population and infants are a population at higher risk. The comorbidities are risk factors for the development of a more severe form of disease. There may be a sex predisposition to COVID-19 infection, with men more prone to be affected. 83.9% of COVID-19 patients with chronic kidney disease (CKD) and 57.3% of COVID-19 patients with liver diseases, have a severe disease. Conclusions. Older age, infants, male gender and comorbidity describe a crucial role for severity of COVID-19 disease. Future studies are need for the management of these patients

Sexual differences regarding Alzheimer's disease: a narrative review

Background. Actually, there are about 5.2 million people with Alzheimer's dementia (AD) in the USA, 3.3 million are women and 1.9 million are men. Objective. We will find out the status on the Alzheimer disease in relation to the brain structure, diagnosis, symptoms and therapy by gender. Methods. We analyzed, in this narrative review, the literature between 1989-2019 published on the Pubmed about Alzheimer disease and gender. The keywords were: Alzheimer disease and sex differences. Conclusions. Women over 80 years have a higher incidence of AD than men. Women have a faster age-related decline and are more likely to respond to donepezil and rivastigmina leading to less cognitive decline. At more advanced ages, women incurred greater costs than men of the same age. Woman gender could be a risk factor for evolution of AD. We will emphasize the importance of considering sex as a biological variable in the design of preclinical and clinical studies that investigate underlying pathologies or response to pharmacological interventions in AD

Correlation of Hyperchloremic Metabolic Acidosis and Renal Function in Critically ill Patients of Emergency Department: an Observational Study

Introduction: Early detection is crucial for prompt management of acute kidney injury (AKI) patients in emergency department (ED). This study aimed to investigate the usefulness of hyperchloremic metabolic acidosis (HCMA) levels in this regard. Methods: In this retrospective observational study, > 18 years old critically ill patients presenting to ED of Marcianise Hospital, Italy, were divided into non-AKI and AKI group according to KDIGO guideline. The level of HCMA ((arterial pH x bicarbonate)/chloride) was compared between groups and correlation of HCMA with estimated glomerular filtration rate (e-GFR) in ARF patients was evaluated.Results: 134 patients with the mean age of 76.5 ± 3.1 years were enrolled (64 non-AKI and 70 AKI; 64% female). Two groups were similar regarding mean age (p = 0.251), sex (p = 0.091), APACHII score (p = 0.215), Charlson Comorbidity Index (p= 0.187), and body mass index (p = 0.129). The mean HCMA level was 1.98 ± 0.09 in the non-AKI group and 1.56 ± 0.07 in the AKI group (p=0.039). There was a positive correlation between HCMA and e-GFR levels in AKI group (r: 0.467, p=0.0092).Conclusions: If confirmed and validated in a future study, ABG derived formula for HCMA may be a useful tool for early detection of AKI patients in emergency department

Management of pericarditis

Pericarditis is an inflammatory syndrome involving pericardium, which is a double-walled sac consisting of two leaves, a serous visceral layer in contact with the myocardium (pericardium) and a parietal fibrous one, delimiting a cavity (pericardial cavity) containing pericardial fluid. Pericarditis may occur isolated or as a manifestation of a systemic disorder. Diagnosis and correct management of pericarditis can be difficult and its natural history is often characterized by a lot of relapses. Treatment of acute pericarditis should target the underlying etiology. The diagnosis is based on characteristic clinical findings, electrocardiogram, and echocardiography. The goals of treatment are relief of pain, resolution of inflammation (and, if present, pericardial effusion), and prevention of recurrence. Despite a significant impairment of the quality of life, pericarditis usually has good long-term outcomes

Nattokinase historical sketch on experimental and clinical evidence

Nattokinase (NK) is a protease derived from food used mainly in the Japanese diet that has several properties. The main activity is related to improving fibrinolytic activities. Other activities have been demonstrated in the regulation of blood pressure by the action toward angiotensin proteases and in the antiplatelet activities. NK can be given orally and reaches its maximal concentration after 12 hours. In addition, an antithrombotic activity based on various NK activities has been proposed. First, increased fibrinolytic activity increases thrombus dissolution and/or the formation of atherosclerotic plaques; second, its enhanced antiplatelet action adds to clot dissolution. All activities have been studied in animals and humans in vitro and in vivo. Relevant adverse effects of NK therapy have not been described, however clinical experience is restricted to case series and volunteers and is not based on clinical studies, thus clinical trials are required to confirm

Circulating miRNA-195-5p and -451a in Patients with Acute Hemorrhagic Stroke in Emergency Department

(1) Background: In our previous study, acute ischemic stroke (AIS) patients showed increased levels of circulating miRNAs (-195-5p and -451a) involved in vascular endothelial growth factor A (VEGF-A) regulation. Here, we evaluated, for the first time, both circulating miRNAs in acute intracerebral hemorrhagic (ICH) patients. (2) Methods: Circulating miRNAs and serum VEGF-A were assessed by real-time PCR and ELISA in 20 acute ICH, 21 AIS patients, and 21 controls. These were evaluated at hospital admission (T0) and after 96 h (T96) from admission. (3) Results: At T0, circulating miRNAs were five-times up-regulated in AIS patients, tending to decrease at T96. By contrast, in the acute ICH group, circulating miRNAs were significantly increased at both T0 and T96. Moreover, a significant decrease was observed in serum VEGF-A levels at T0 in AIS patients, tending to increase at T96. Conversely, in acute ICH patients, the levels of VEGF-A were significantly decreased at both T0 and T96. (4) Conclusions: The absence of a reduction in circulating miRNAs (195-5p and -451a), reported in acute ICH subjects after 96 h from hospital admission, together with the absence of increment of serum VEGF-A, may represent useful biomarkers indicating the severe brain damage status that characterizes acute ICH patients