Early data about the use of roflumilast in patients with COPD

Η ροφλουμιλάστη αποτελεί έναν νεότερο αντιφλεγμονώδη παράγοντα 2ης γραμμής για τη θεραπεία ασθενών με συγκεκριμένο φαινότυπο Χρόνιας Αποφρακτικής Πνευμονοπάθειας. Στο παρόν άρθρο μετά από αναδίφηση της πλέον πρόσφατης διεθνούς βιβλιογραφίας, επιχειρείται η παρουσίαση των έως τώρα πειραματικών αλλά και κλινικών αποτελεσμάτων, όσον αφορά στα οφέλη που προκύπτουν από τη χρήση της, τους περιορισμούς της χορήγησης της, αλλά και τις μελλοντικές προοπτικές για τη βελτιστοποίηση της δράσης της.Roflumilast is a new second line anti-inflammatory drug, approved by the FDA in March 2011, for the treatment of patients with a specific phenotype of Chronic Obstructive Pulmonary Disease (COPD). In this review article, after systematically reviewing the latest published references on roflumilast, we aim at presenting the experimental and clinical results that have emerged so far, concerning the benefits and the limitations of its use and the future prospects for the optimization of its effects

The Therapeutic Role of SGLT-2 Inhibitors in Acute Heart Failure: From Pathophysiologic Mechanisms to Clinical Evidence with Pooled Analysis of Relevant Studies across Safety and Efficacy Endpoints of Interest

(1) Background: Sodium-glucose co-transporter-2 (SGLT-2) inhibitors constitute a novel drug class with remarkable cardiovascular benefits for patients with chronic heart failure (HF). Recently, this class has been utilized in acute HF as an additional treatment option to classic diuretics, which remain the cornerstone of treatment. (2) Methods: We attempted to identify those pathophysiologic mechanisms targeted by SGLT-2 inhibitors, which could be of benefit to patients with acute HF. We then conducted a comprehensive review of the literature within the PubMed database in order to identify relevant studies, both randomized controlled trials (RCTs) and observational studies, assessing the safety and efficacy of SGLT-2 inhibitors in acute HF. (3) Results: SGLT-2 inhibitors induce significant osmotic diuresis and natriuresis, decrease interstitial fluid volume and blood pressure, improve left ventricular (LV) function, ameliorate LV remodeling and prevent atrial arrhythmia occurrence, mechanisms that seem to be beneficial in acute HF. However, currently available studies, including six RCTs and two real-world studies, provide conflicting results concerning the true efficacy of SGLT-2 inhibitors, including "hard" surrogate endpoints. (4) Conclusions: Current evidence appears insufficient to substantiate the use of SGLT-2 inhibitors in acute HF. Further trials are required to shed more light on this issue

Editorial: Oxidative stress and inflammation in cardiometabolic disorders

Editorial on the Research Topic: Oxidative stress and inflammation in cardiometabolic disorder

Multimarker Approach as More Reliable Method Than Single Vitamin D in Relationship with Type 2 Diabetes Mellitus in Montenegrin Postmenopausal Women

Objective: Previous studies suggested that ethnic differences, sex and obesity could modify the relationship between 25-hydroxyvitamin D [25(OH)D], glycometabolic markers and/or type 2 di- abetes mellitus (T2D). We aimed to examine the potential relationship between [25(OH)D] and T2D in postmenopausal women in Montenegro. In addition, we aimed to explore if a set of biomarkers, rather than [25(OH)D] as a single biomarker, could better explain its potential association with T2D. Patients and Methods: A total of 116 postmenopausal, otherwise healthy women and 48 postmenopausal women with T2D were included. Univariable and multivariable binary logistic regression analy- sis, along with principal component analysis (PCA), were applied to test the associations between examined biomarkers/set of biomarkers with T2D. Results: Women with T2D had lower serum [25(OH)D] levels than healthy controls (p = 0.024). No independent relationship between [25(OH)D] and T2D was found. PCA extracted three significant factors that were associated with T2D, i.e., age-glycometabolic-related factor (i.e., with positive loadings of age, glucose and insulin; OR = 11.321, p < 0.001), obesity-inflammation- related factor (i.e., with positive loadings of hsCRP and WC, and negative loading of [25(OH)D]; (OR = 2.079, p < 0.001)) and lipid-related factor (i.e., with positive loadings of TG and LDL-c, and negative loading of HDL-c; OR = 1.423, p = 0.044). Conclusions: The relationship between [25(OH)D] and T2D is modulated by central obesity (as measured by WC) and inflammation (as measured with hsCRP) in postmenopausal women. Their joint measurement, rather than [25(OH)D] itself, could provide better information for the risk assessment for T2D in postmenopausal women

Epididymal Adenomatoid Tumor: A Very Rare Paratesticular Tumor of Childhood

Adenomatoid tumor is an uncommon benign mesothelial neoplasm, usually localized in the epididymis. It is the most common paratesticular tumor of middle-aged patients (average age of clinical presentation: 36 years). However, these tumors in pediatric and pubertal patients are extremely rare. Due to their rarity, we present a case of adenomatoid tumor of the tail of the epididymis in a 16-year-old patient. After systematic research of the current literature, we did not find another case report of epididymal adenomatoid tumor in a male patient aged 16 years old or less. This notice and our concern, as well, about the patient’s surveillance protocol during the postoperative period were the motive for this case study

Βilocular cystic ileal duplication

The aim of this study is to present two rare entities: a) a bilocular cystic intestinal duplication and b) the oc­currence of bleeding from the duplication due to lesions associated with chronic hemorrhagic enteritis rather than ectopic gastric mucosa. A 13-year-old male was hospitalized in the Department of Pediatrics for severe lower GI hemorrhage. During neonatal life, the boy had been hospitalized in the Intensive Care Neonatal Unit for necrotizing enterocolitis treated by peritoneal drainage (drains entered into iliac fossae bilaterally). Imaging and scintigraphic exams failed to identify the cause of the current GI hemorrhage. After a second episode of bleeding, pediatricians asked for a pediatric surgical consult and we decided to proceed to an urgent exploratory laparotomy. A diverticular lesion of considerable size and with a wide base was identified 30 cm proximal to the ileocecal valve at the antimesenteric intestinal surface. The lateral wall of the lesion was adhered to the sigmoid colon while its upper surface was adhered to the lateral abdominal wall. Our attempt to mobilize the small bowel from the sigmoid colon revealed the absence of muscular layers in both the small and large bowel walls for a length of 1.5 cm. Segmental intestinal resection including the duplication was performed followed by an end to end anastomosis in two layers. The histopathologic examination showed a bilocular cystic duplication with lesions of active chronic hemorrhagic enteritis; no ectopic gastric mucosa was identified

Novel anthropometric parameters in the adult population with prediabetes

OBJECTIVE: Although it is assumed that novel-derived anthropometric indices can better reflect cardiometabolic risk than traditional ones, the results are conflicting. Previous studies have mainly focused on patients with type 2 diabetes mellitus. However, studies conducted on populations with prediabetes are scarce. The present study aimed to examine the potential relationship between prediabetes and novel anthropometric parameters [that is, cardiometabolic index (CMI), visceral adiposity index (VAI), lipid accumulation product index (LAP), body roundness index (BRI), and body adiposity index (BAI)] and traditional parameters [that is, waist circumference (WC), hip circumference (HC), body mass index (BMI), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR)] in adults with prediabetes. PATIENTS AND METHODS: This case-control cross-sectional study included 177 patients with prediabetes and 609 control subjects. Biochemical and simple anthropometric parameters were measured (WC, HC, body weight, and height), whereas the other parameters were calculated. RESULTS: WC, CMI, VAI, and LAP independently correlated with prediabetes. Principal component analysis (PCA) was used to extract several factors that correlated with prediabetes. Significant predictive capability was demonstrated for non-traditional anthropometric/lipid-related factors and WHipR-related factors for prediabetes (OR=1.334 and OR=1.202, respectively). However, only non-traditional anthropometric/lipid-related factors (i.e., VAI, CMI, and LAP) demonstrated an independent significant positive relationship with prediabetes in multivariate binary regression analysis. CONCLUSIONS: CMI, VAI, and LAP could be superior to BAI, BRI, and conventional anthropometric parameters for discriminating patients with prediabetes in the adult population. Prospective trials are needed to confirm our results

Case Report Multiple Gastric Erosion Early after a 3 V Lithium Battery (CR2025) Ingestion in an 18-Month-Old Male Patient: Consideration about the Proper Time of Intervention

Introduction. Button battery ingestion is considered an emergency situation in pediatric patients that needs to be managed promptly; otherwise, it may lead to serious and potentially lethal complications, especially when it is impacted in the esophagus. Less attention has been given in cases where the battery passes into the stomach, with guidelines for emergency intervention being based on the presence of symptoms. Case Report. We present a case of an 18-month-old male patient who presented to our emergency department after button battery ingestion. He did not have any symptoms and no pathological findings were encountered during clinical examination. X-ray investigation revealed the presence of the battery in the stomach. The patient was admitted for observation and two hours later he had two episodes of vomiting. He underwent urgent endoscopic removal of the battery where multiple acute gastric mucosal erosion in place of direct contact of the battery&apos;s negative pole with the mucosa of the gastric antrum was found. Conclusion. In specific cases the urgent endoscopic intervention for removal of an ingested button battery that is located in the stomach even in asymptomatic patients should be suggested