Noninvasive imaging methods for evaluating cardiovascular involvement in patients with rheumatoid arthritis before and after anti-TNF drug treatment

Aim: To use 2D speckle-tracking echocardiography, and conventional and tissue Doppler echocardiography to detect subclinical left ventricular myocardial dysfunction in patients with rheumatoid arthritis (RA). Methods: Thirty RA outpatients were assessed before and after 18 months of treatment with antiTNF drugs, along with 30 healthy controls. Cardiovascular risk was assessed by means of ultrasound carotid assessment and comprehensive echocardiographic evaluation (conventional and speckle-tracking calculation). Results: The speckle-tracking analyses were significantly different between the two groups, with global longitudinal strain deformation in the apical four-chamber view being significantly lower in the RA patients (median: 18.78%, interquartile range [IQR]: 15.80-20.82% vs 20.16%, IQR: 19.03-21.89%; [p <0.05]). After 18 months of biological treatment, global longitudinal strain showed a significant improvement (18.78%, IQR: 15.80-20.82 vs 19.24%, IQR: 18.23-19.98; [p < 0.01]), such as for DAS28 (4.80, IQR: 4.65-5.22 vs 2.78; IQR: 2.52-2.99; [p < 0.01]). Conclusion: Speckle-tracking echocardiography showed that left ventricular myocardial longitudinal strain was impaired in the RA patients. Lay abstract: The different structures of the heart may be affected by rheumatoid arthritis (RA)-related inflammation, with the most frequent lesion being conduction defects, followed by pericarditis, cardiomyopathy and valve disease. We demonstrated, in a study involving 30 RA patients and using speckle-tracking echocardiography, that left ventricular myocardial longitudinal strain was impaired in the RA patients, in the absence of any clinical or other echocardiographic evidence of cardiovascular disease. The results suggest that inflammation is associated with myocardial alteration, as it returns to healthy controls levels upon therapy with anti-TNF drugs

Autonomic abnormalities in patients with primary Sjogren’s syndrome – Preliminary results

Primary Sjogren's syndrome (pSS) is an autoimmune disease affecting exocrine glands and extra-glandular organs. There are conflicting reports on the presence of autonomic dysfunction in pSS and no data are available on the functional status of sympathetic outflow to the vessels and baroreceptor [baroreflex sensitivity (BRS)] control mechanisms. We investigated the cardiac (cBRS) and sympathetic (sBRS) baroreceptor modulation in both time and frequency domains and the cardiovascular autonomic profile in pSS patients compared to healthy controls. Autonomic symptoms were quantified by the Composite Autonomic Symptom Scale (COMPASS31) three-item questionnaire. The EULAR Sjogren's syndrome patient reported index (ESSPRI) questionnaire evaluated the magnitude of pSS clinical symptoms, i.e., fatigue, pain, and sicca symptoms. Electrocardiogram, beat-by-beat arterial pressure (AP) and respiratory activity were continuously recorded in 17 pSS patients and 16 healthy controls, while supine and during 75 degrees head-up tilt. In seven patients and seven controls, muscle sympathetic nerve activity (MSNA) was measured. Spectrum analysis of RR variability provided markers of cardiac vagal modulation (HFRR nu) and sympatho-vagal balance [low frequency (LF)/high frequency (HF)]. The power of LF (0.1 Hz) oscillations of systolic arterial pressure (SAP) variability (LFSAP) evaluated the vasomotor response to sympathetic stimulation. Compared to controls, pSS patients scored higher in total COMPASS31 (p < 0.0001) and all ESSPRI subdomains (fatigue, p = 0.005; pain, p = 0.0057; dryness, p < 0.0001). Abnormal scialometry (<1.5 ml/15 min) and Schirmer tests (<5 mm/5 min) were found in pSS patients and salivary flow rate was negatively associated with ESSPRI dryness (p = 0.0014). While supine, pSS patients had lower SEQ(cBRs) index of cardiac baroreceptor sensitivity, higher HFRRnu (p = 0.021), lower LF/HF (p = 0.007), and greater MSNA (p = 0.038) than controls. No differences were observed in LFSAP between groups. During orthostatic challenge, although LFSAP increased similarly in both groups, MSNA was greater in pSS patients (p = 0.003). At rest pSS patients showed lower cBR control and greater parasympathetic modulation. Furthermore, greater sympathetic nerve activity was observed in pSS patients while supine and in response to gravitational challenge. We hypothesized that such enhanced sympathetic vasoconstrictor activity might reflect an attempt to maintain blood pressure in a setting of likely reduced vascular responsiveness

Chronic widespread pain in spondyloarthritis

The pain associated with spondyloarthritis (SpA) can be intense, persistent and disabling. It frequently has a multifactorial, simultaneously central and peripheral origin, and may be due to currently active inflammation, or joint damage and tissue destruction arising from a previous inflammatory condition. Inflammatory pain symptoms can be reduced by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in the mechanisms that regulate central pain, as in the case of the chronic widespread pain (CWP) that characterises fibromyalgia (FM). The importance of distinguishing SpA and FM is underlined by the fact that SpA is currently treated with costly drugs such as tumour necrosis factor (TNF) inhibitors, and direct costs are higher in patients with concomitant CWP or FM than in those with FM or SpA alone. Optimal treatment needs to take into account symptoms such as fatigue, mood, sleep, and the overall quality of life, and is based on the use of tricyclic antidepressants or selective serotonin reuptake inhibitors such as fluoxetine, rather than adjustments in the dose of anti-TNF agents or disease-modifying drugs

Chirurgia refrattiva: cheratotomia radiale

Vengono sintetizzati i vari tipi di interventi in corso per la chirurgia refrattiva ed in particolare si considera la cheratotomia radiale con le sue indicazioni e le sue complicanze. Detta chirurgia è indicata solo in quei casi in cui nè gli occhiali nè le lenti a contatto risolvono soddisfacentemente il problema dell'ametrope e cioè tali mezzi non sono compatibili con la loro vita

Effetti di un beta-bloccante (Oxprenololo) nel trattamento dei glaucomi congeniti (On the ocular hypotensive action of topical oxprenolol in congenital glaucoma)

Gli Autori hanno condotto un'indagine clinico- sperimentale al fine di valutare l'azione ipotonizzante oculare di un beta-bloccante (Oxprenololo) dato per via locale in occhi affetti da glaucoma congenito. Il farmaco si è dimostrato efficace momentaneamente e nel tempo nel ridurre la pressione oculare non dando luogo ad effetti collaterali locali o sistemici

Il muco congiuntivale

Gli AA. descrivono il ruolo svolto dal muco congiuntivale e la sua composizione chimica; vengono anche analizzate le metodiche di studio e le problematiche tutt'ora aperte

Azione dell’Acetazolamide sulla pressione arteriosa sistemica ed oftalmica (Effects of the administration of acetazolamide on the systemic and ophthalmic blood pressure)

Gli AA. hanno ritenuto interessante procedere alla determinazione dei rapporti intercorrenti tra il tono oculare, pressione arteriosa omerale ed oftalmica dopo somministrazione di Acetazolamide al fine di meglio comprendere un'eventuale componente vascolare nell'azione ipotonizzante oculare del farmaco e gli effetti sistemici indesiderati accusati dai pazienti. Gli AA. concludono che il parallelo decremento della pressione arteriosa oftalmica e del tono oculare non fa che ridurre lo squilibrio di gradiente a livelli inferiori mentre per un risultato positivo non si dovrebbero osservare riduzioni della pressione arteriosa sistemica ed in particolare oftalmica

Bakterizide Wirksamkeit und Wirkungen auf das Polymer eines thermischen Langzeitdesinfektionsgerät, rasterelektronenmikroskopische Untersuchungen

Gli AA. hanno valutato al microscopio elettronico a scansione l'efficacia battericida e l'influenza sul polimero di un asettizzatore termico a "ciclo lungo". Le lenti sottoposte a questo trattamento non hanno messo in evidenza residui biologici mentre il polimero sembra aver subito alterazioni morfo-strutturali simili a quelle delle lenti contaminate e non trattate termicamente. Si può quindi dedurre un effetto di degradazione del polimero da parte di sostanze biologiche mentre non si può per ora avvalorare un effetto termico (55° per 60') a breve o lungo termine sul polimero, richiedendo ciò ulteriori indagini. I risultati preliminari evidenziano come per ottenere un'efficace azione di disinfezione delle lenti non sia necessario raggiungere elevate temperature di esercizio, con conseguente marcato stress per il polimero, ma che temperature di 55°C per un tempo di 60' possono essere sufficienti in quanto già dette temperature potrebbero essere critiche specie se si integrano alle alterazioni indotte dai materiali biologici

Soluzioni per contattologia

Viene valutato quanto sia indaginoso formulare una soluzione per contattologia per le notevoli problematiche che si aprono: isotonia, pH e conservante che deve possedere numerose caratteristiche. Vengono esaminati i principali disinfettanti in commercio e descritte le caratteristiche delle soluzioni detergenti, comprese le enzimatiche, le conservanti, le umettanti e quelle per il risciacquo

Sui possibili effetti sistemici dell’Oxprenololo 1% collirio in pazienti con affezioni cardio-vascolari (On the possible side effects after topical administration of 1% oxprenolol in patients with cardiovascular diseases)

Gli AA. hanno condotto un'indagine clinico- sperimentale al fine di valutare gli effetti sistemici di un Beta-bloccante (Oxprenololo) dato per via locale in occhi sani alla concentrazione dell'1% ed in soggetti con patologia cardiovascolare. Il farmaco si è dimostrato ben tollerato dai pazienti e con scarsi efffetti sulla pressione arteriosa massima e minima, la frequenza cardiaca e l'elettrocardiogramma