Aspirin for primary prevention of cardiovascular disease in diabetes mellitus

Aspirin is effective for the prevention of cardiovascular events in patients with a history of vascular disease, as so-called secondary prevention. In general populations with no history of previous myocardial infarction or stroke, aspirin also seems useful for primary prevention of cardiovascular events, although the absolute benefits are smaller than those seen in patients with previous cardiovascular disease. Patients with diabetes mellitus are at an increased risk of cardiovascular events, but new trials have raised questions about the benefit of aspirin for primary prevention in patients with this disorder. This Review comprehensively examines the basic pharmacology of aspirin and provides an overview of the randomized, controlled trials of aspirin therapy that have included patients with diabetes mellitus. On the basis of currently available evidence from primary prevention trials, aspirin is estimated to reduce the relative risk of myocardial infarction and stroke by about 10% in patients with diabetes mellitus; however, aspirin also increases the risk of gastrointestinal bleeding. As such, low-dose aspirin therapy (75–162 mg) is reasonable for patients with diabetes mellitus and a 10-year risk of cardiovascular events >10%. Results from upcoming large trials will help clarify the effects of aspirin with greater precision, including whether the benefits differ between men and women

Evidence based management of hypertension: Using cardiovascular risk profiles to individualise hypertensive treatment

This is the fourth in a series of five articles Individual risks must be assessed in order to for the best decision to be made as to which patients to treat and how. Assessment identifies important cardiovascular risk factors that may warrant treatment and helps to establish the absolute benefits that patients can expect from particular treatments. The benefits of treating hypertensive patients also vary, depending on each patient's competing risks of dying from other than cardiovascular causes. For example, patients with multiple serious conditions, such as end stage Alzheimer's disease, obstructive lung disease, frequent falls, gout, and urinary incontinence, have high competing risks that may minimise or negate the benefits of treating their hypertension. #### Summary points Several treatment options reduce risk of cardiovascular disease and improve outcomes in patients with hypertension Providers should consider the expected benefits and potential adverse effects of different treatment options and discuss them with patients The use of decision tools may help decision making about options for reducing cardiovascular risk Establishing treatment priorities for patients with multiple cardiovascular risk factors and multiple conditions is difficult. Factors such as those given in the box deserve consideration. Knowing and weighing up multiple risk factors, conditions, and treatments is difficult. Explaining them to patients is daunting and time consuming. Some patients prefer to be told what to do rather than to have to take in the diverse, complicated information necessary to make their

Rocket: a Mediterranean crop for the world: Report of a workshop,13-14 December 1996, Legnaro (Padova), Italy

This publication represents the outcome of the second meeting of the Rocket Genetic Resources Network, an initiative launched in 1994 in the framework of IPGRI's project on Underutilized Mediterranean Species (UMS). The proceedings contain scientific contributions related to genetic resources, breeding and cultivation aspects of rocket, representing an extremely useful tool for all those interested in the cultivation and improvement of this crop. In particular, the paper on cultivation in the Veneto region can well be considered the first thorough scientific presentation ever made of rocket cultivation techniques in greenhouse environments. Apart from this paper, other contributions from India, Israel, Portugal and Turkey provide an overview of the degree of cultivation, uses and popularity of the crop around the world. Chapter III on International Cooperation provides a useful insight into the activity of the Rocket Network and supplies information on the initiatives promoted by UMS for safeguarding the genetic resources of this multipurpose crop

Salt content of prepacked cereal-based products and their potential contribution to salt intake of the Italian adult population: Results from a simulation study

Background and aims: High sodium intake is one of the main risk factors for noncommunicable diseases, and its consumption should be reduced. This study aimed to simulate changes in the daily salt intake of the Italian adult population based on consumption scenarios of prepacked cereal-based foods sold in Italy. Methods and results: Information on food packages was retrieved from 2893 cereal-based products. Potential changes in salt intake were simulated based on food consumption scenarios that consider the daily consumption of cereal-based products suggested in the Italian Dietary Guidelines and their current daily consumption by Italian adults. The highest salt content was retrieved in bread (median, 25th–75th percentile: 1.3, 1.1–1.4 g/100 g) and bread substitutes (1.8, 1.0–2.2 g/100 g). If the suggested daily amounts were consumed, bread would contribute to 44% of the 5 g salt/day target, whereas bread substitutes, breakfast cereals, biscuits and sweet snacks would marginally contribute (1–2%). Compared to bread with median salt content, a −44% and +10% salt intake would be observed if products within the first and the last quartile of salt content were chosen, respectively. However, considering the actual intake of Italian consumers, bread would cover 25% and bread substitutes 7% of the daily salt target. Conclusion: Food labels have a pivotal role and efforts are required to encourage consumers to use them to make healthy choices. Moreover, these results may contribute to setting sodium benchmarks in cereal-based products and encourage the food industry to reduce the salt content in the products

Comparison of the Nutritional Quality of Branded and Private-Label Food Products Sold in Italy: Focus on the Cereal-Based Products Collected From the Food Labeling of Italian Products Study

The packaged foods sold in food stores may be \u201cprivate-label\u201d products (PL), when branded by the supermarket, and \u201cbranded\u201d products (BR). PL products are generally cheaper than the BR counterparts, and this can be perceived as a sign of general low quality by consumers, when items are compared with their branded counterparts. Thus, the aim of the present study was to compare the nutrient content of BR and PL cereal-based foods, by evaluating the nutritional declaration reported on the food pack of products on the home-shopping website of major retailers present on the Italian market. A total of 3,775 items (~58% BR and ~42% PL), collected in the period from July 2018 to March 2019 and updated in March 2020, were included in the final analysis. Data were analyzed by means of the Mann\u2013Whitney nonparametric test for two independent samples for differences between BR and PL categories and types. Overall, BR products showed higher contents of total and saturates than PL items. When products were grouped for categories and types, items only differed for the content of total fats, saturates, total carbohydrates, proteins, and salt. No differences were instead found for energy and sugar contents among any of the categories. However, we did not find any consistency in the direction of results. These results could be useful for future education activities aimed to help consumers in making informed food choices

Patient education and extracorporeal membrane oxygenation preferences of patients and providers in COVID care

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) represents an important but limited treatment for patients with severe COVID-19. We assessed the effects of an educational intervention on a person's ECMO care preference and examined whether patients and providers had similar ECMO preferences. METHODS: In the Video+Survey group, patients watched an educational video about ECMO's purpose, benefits, and risks followed by an assessment of ECMO knowledge and care preferences in seven scenarios varying by hypothetical patient age, function, and comorbidities. Patients in the Survey Only group and providers didn't watch the video. Logistic regression was used to estimate the probability of agreement for each ECMO scenario between the two patient groups and then between all patients and providers. RESULTS: Video+Survey patients were more likely (64% vs. 17%; p = 0.02) to correctly answer all ECMO knowledge questions than Survey Only patients. Patients in both groups agreed that ECMO should be considered across all hypothetical scenarios, with predicted agreement above 65%. In adjusted analyses, patients and providers had similar predicted agreement for ECMO consideration across six of the seven scenarios, but patients showed greater preference (84% vs. 41%, p = 0.003) for the scenario of a functionally dependent 65-year-old with comorbidities than providers. DISCUSSION AND CONCLUSIONS: An educational video increased a person's ECMO knowledge but did not change their ECMO preferences. Clinicians were less likely than patients to recommend ECMO for older adults, so advanced care planning discussion between patients and providers about treatment options in critically ill patients with COVID-19 is critical

Oral lactobacillus species in systemic sclerosis

In systemic sclerosis (SSc), the gastrointestinal tract (GIT) plays a central role in the patient’s quality of life. The microbiome populates the GIT, where a relationship between the Lactobacillus and gastrointestinal motility has been suggested. In this study, the analysis of oral Lactobacillus species in SSc patients and healthy subjects using culture-independent molecular techniques, together with a review of the literature on microbiota and lactobacilli in SSc, has been carried out. Twenty-nine SSc female patients (mean age 62) and twenty-three female healthy subjects (HS, mean age 57.6) were enrolled and underwent tongue and gum swab sampling. Quantitative PCR was conducted in triplicate using Lactobacillus specific primers rpoB1, rpoB1o and rpoB2 for the RNA-polymerase β subunit gene. Our data show significantly (p = 0.0211) lower LactobacillusspprpoB sequences on the tongue of patients with SSc compared to HS. The mean value of the amount of Lactobacillus ssprpoB gene on the gumsofSSc patients was minor compared to HS. A significant difference between tongue and gums (p = 0.0421) was found in HS but not in SSc patients. In conclusion, our results show a lower presence of Lactobacillus in the oral cavity of SSc patients. This strengthens the hypothesis that Lactobacillus may have both a protective and therapeutic role in SSc patients