A methodological look at the controversy about the influence of salt intake on cardiovascular risk.

Comment on: Reduced dietary salt for the prevention of cardiovascular disease. [Cochrane Database Syst Rev. 2011] Reduced dietary salt for the prevention of cardiovascular disease: a meta-analysis of randomized controlled trials (Cochrane review). [Am J Hypertens. 2011

Forage mixture productivity and silage quality from a grass/legume intercrop in a semiarid Mediterranean environment

In semiarid environments of the Mediterranean region, intercropping is a sustainable agricultural system of long standing. In this area, the pea (Pisum sativum L.) is one of the most commonly grown legume crops. Little information is available on the quality of silages to be obtained from forage mixtures of pea intercropped with cereals or annual grasses. In this study, two experiments were conducted over the course of two growing seasons in Sicily (Italy) with the aim to determine the biomass production of forage crop mixtures and assess, only in the second experiment, the silage quality of grass and legumes. Four cereals and one annual grass species were grown in pure stand and in mixture with pea, and their main agronomic traits were determined. The land equivalent ratio (LER), competitive ratio, and aggressivity index were also calculated. A number of parameters were considered to assess the quality of silage obtained from fermented biomasses derived from pea–ryegrass (Lolium multiflorum Lam. var. Westerwoldicum) intercropping. In the first experiment, the best performance between the intercrops was recorded for the pea–wheat mixture. The total LER calculated for fodder yields was always greater than 1, indicating crop yield advantages ranging from 2.0% to 47.0%. In the second experiment, the pea–ryegrass mixture appeared to respond well, depending on plant arrangement and seeding ratio factors: the ratios 50:50 and 100:50 showed the greatest crop yield advantages, of 12.0% and 11.0%, respectively. All silages revealed a very good suitability of a pea–ryegrass intercropping system with high-quality silage production in the Southern Mediterranean region

NT pro BNP plasma level and atrial volume are linked to the severity of liver cirrhosis.

BACKGROUND AND AIMS: Plasma levels of NT-pro-BNP, a natriuretic peptide precursor, are raised in the presence of fluid retention of cardiac origin and can be used as markers of cardiac dysfunction. Recent studies showed high levels of NT pro BNP in patients with cirrhosis. We assessed NT pro-BNP and other parameters of cardiac dysfunction in patients with cirrhosis, with or without ascites, in order to determine whether the behaviour of NT pro BNP is linked to the stage of liver disease or to secondary cardiac dysfunction. METHODS: Fifty eight consecutive hospitalized patients mostly with viral or NAFLD-related cirrhosis were studied. All underwent abdominal ultrasound and upper GI endoscopy. Cardiac morpho-functional changes were evaluated by echocardiography and NT-pro-BNP plasma levels determined upon admission. Twenty-eight hypertensive patients, without evidence of liver disease served as controls. RESULTS: Fifty eight cirrhotic patients (72% men) with a median age of 62 years (11% with mild arterial hypertension and 31% with type 2 diabetes) had a normal renal function (mean creatinine 0.9 mg/dl, range 0.7-1.06). As compared to controls, cirrhotic patients had higher NT pro-BNP plasma levels (365.2±365.2 vs 70.8±70.6 pg/ml; p<0.001). Left atrial volume (LAV) (61.8±26.3 vs 43.5±14.1 ml; p = 0.001), and left ventricular ejection fraction (62.7±6.9 vs. 65.5±4%,; p = 0.05) were also altered in cirrhotic patients that in controls. Patients with F2-F3 oesophageal varices as compared to F0/F1, showed higher e' velocity (0.91±0.23 vs 0.66±0.19 m/s, p<0.001), and accordingly a higher E/A ratio (1.21±0.46 vs 0.89±0.33 m/s., p = 0.006). CONCLUSION: NT-pro-BNP plasma levels are increased proportionally to the stage of chronic liver disease. Advanced cirrhosis and high NT-pro-BNP levels are significantly associated to increased LAV and to signs of cardiac diastolic dysfunction. NT pro-BNP levels could hence be an useful prognostic indicators of early decompensation of cirrhosis

Rapid left ventricular filling in untreated hypertensive subjects with or without left ventricular hypertrophy

In this study, independent contribution of age, HR, BMI, casual and ambulatory blood pressure, LVM and LVEF in evaluating diastolic filling have been investigated in 34 never-treated hypertensive patients and in 15 healthy normotensive subjects. All the subjects were free from coronary artery disease, valvular disease, heart failure, renal disease and psychiatric problems. All the hypertensive subjects (never treated) were subgrouped according to presence or absence of LVH. The PFR decreased significantly and tPFR increased significantly in hypertensive patients in comparison with normotensive subjects and they did not change in the presence vs absence of LVH. The PFR was inversely correlated with BMI, age, 24-h mean SBP and with 24-h DBP. In multiple regression analysis, PFR decreased with BMI, age, 24-h mean SBP and DBP but not with LVMI. These results suggest that BMI, age and 24-h mean blood pressure were the major determinants of PFR abnormalities in hypertensive patients

Left ventricular diastolic filling alterations in subjects with mitral valve prolapse: a Doppler echocardiographic study

To assess left ventricular diastolic filling in mitral valve prolapse (MVP), we studied 22 patients with idiopathic MVP and 22 healthy controls matched for sex, age, body surface area and heart rate. A two-dimensional, M-mode and Doppler echocardiographic examination was performed to exclude any cardiac abnormalities. The two groups had similar diastolic and systolic left ventricular volumes, left ventricle mass and ejection fraction. Doppler measurements of mitral inflow were: E and A areas (the components of the total flow velocity-time integral in the early passive period of ventricular filling, E; and the late active period of atrial emptying, A), the peak E and A velocities (cm.s-1), acceleration and deceleration half-times (ms) of early diastolic rapid inflow, acceleration time of early diastolic flow (AT), total diastolic filling time (DFT) (ms), and the deceleration of early diastolic flow (cm.s-2). From these measurements were calculate: peak A/E ratio (A/E), E area/A area, the early filling fraction, the atrial filling fraction, AT/DFT ratio. All the Doppler measurements reported are the average of three cardiac cycles selected at end expiration. The mean peak A velocity, A/E velocity ratio, deceleration half time and atrial filling fraction were each significantly higher for subjects presenting a MVP (60 +/- 12 cm.s-1 vs 49 +/- 14, P < 0.008; 98 +/- 13% vs 64 +/- 12%, P < 0.0001; 120 +/- 36 ms vs 92 +/- 11, P < 0.002; 0.45 +/- 0.14 vs 0.36 +/- 0.08, P < 0.02

Methodological matters on an Alzheimer's dementia trial: is a double-blind randomized controlled study design sufficient to draw strong conclusions on treatment?

Letter to Edito

Liver injury, SARS-COV-2 infection and COVID-19: What physicians should really know?

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for coronavirus disease 2019 (COVID-19), which in males, especially in advanced age, can sometimes evolve into acute respiratory distress syndrome. In addition, mild to moderate alterations in liver function tests (LFTs) have been reported in the worst affected patients. Our review aims to analyse data on the incidence and prognostic value of LFT alterations, the underlying mechanisms and the management of pre-existing liver disease in COVID-19 affected patients

Treatment of hepatitis C: critical appraisal of the evidence

Chronic hepatitis C virus infection is currently the most common cause of end stage liver disease worldwide. Although the conclusions of the last National Institutes of Health Consensus Development Conferences on Hepatitis C have recently been published, several important issues remain unanswered. This paper reviews the available data using an evidence-based approach. Current evidence is sufficient to recommend IFN treatment for all patients with acute hepatitis. A later initiation of therapy yields the same likelihood of response as early treatment. A daily induction dose during month 1 is the best treatment option. The current gold standard of efficacy for treatment-naive patients with chronic hepatitis C is the combination of pegylated IFN and ribavirin. The overall sustained viral response rate to these regimens is 54 - 56% following a 48-week course of therapy. Patients with genotype 1 infection will have a 42 - 51% likelihood of response to 48weeks of therapy. Those with genotypes 2 or 3 infection will respond to 24weeks in 78 - 82% of cases. Debate continues regarding the optimal dose and duration of peginterferon (PEG-IFN), not only in patients infected with genotype 2 or 3 but also in those infected with genotype 1. The optimal dose of ribavirin has yet to be determined. Available data show the need to give the highest tolerable doses (1000-1200mg/day) to the difficult-to-treat patients (genotype 1, cirrhotics, obese), although there is a greater likelihood of intolerance. Genotypes 2 and 3 may receive 800mg/day, which is also the most appropriate lower dose for those patients who require dosage modification for anaemia or other side effects. Tolerability and compliance to therapy are still a problem, as approximately 15- 20% of patients within trials and > 25% in clinical practice withdraw from therapy. New PEG-IFNs are more effective than conventional IFN in improving liver histology. Monotherapy with PEG-IFN induces a marked reduction in staging in virological sustained responders, and to a lesser degree in relapsers, but provides no benefit to nonresponders after 24-48weeks of treatment. The use of maintenance therapy in virological nonresponders aiming to improve histology should be considered experimental and of unproven benefit. Pooling data from the literature suggests a slight preventive effect of IFN on hepatocellular carcinoma development in patients with HCV-related cirrhosis. The magnitude of this effect is low and the observed benefit may be due to spurious associations. The preventive effect is more evident among sustained responders to IFN

TRAUMA LUBANJE: ANALIZA OZLJEDA NA DREVNIM KOSTURIMA S ARHEOLOŠKIH NALAZIŠTA U SJEVEROZAPADNOJ LOMBARDIJI

Traumatic lesions are among the most important sources of data providing information associated to interpersonal violence within ancient populations. The investigation on weapon‑related traumas on human remains allows us to reconstruct the dynamic of the violent episodes. The purposes of this study are to describe the types of skull traumas discovered in several skeletons from medieval necropolis of the North West Lombardy (8th-16th) and to examine their presence and distribution. The injuries observed in our osteoarchaeological collection were in the form of depressed and penetrated traumas. The injuries were revealed on the middle aged and older men, but also on women and subadult. Fractures of skulls were analysed with macroscopical and radiological observations. In particular, CT investigations were essential to understand the extent of the injury and to hypothesis the cause.Traumatske lezije su među najvažnijim izvorima podataka za pružanje informacija povezanih s međuljudskim nasiljem u drevnim zajednicama. Istraživanje trauma nastalih upotrebom oružja na ljudskim ostacima omogućavaju nam rekonstruirati dinamiku nasilnih epizoda. Ciljevi ovog istraživanja su opisati vrste trauma lubanja otkrivenih na nekoliko kostura iz srednjovjekovne nekropole Sjeverozapadne Lombardije (8.–16. st.) i ispitati njihovu prisutnost i distribuciju. Ozljede uočene u našoj osteoarheološkoj zbirci su u obliku natučenih i ubodnih trauma. Ozljede su uočene na muškarcima srednje i starije dobi, ali i na ženama i djeci. Frakture lubanje analizirane su makroskopskim i radiološkim promatranjima. Konkretno, CT istraživanja su neophodna za razumijevanje opsega ozljede i hipoteze uzroka