Wine consumption in the Mediterranean diet: old concepts in a new sight

The term “Mediterranean diet” is widely employed to indicate the typical diet of the Countries located on the Mediter- ranean sea coast. A growing body of scientific literature pointed out the healthy effects of this diet. In recent years we investigated about the protective effects of a regular and moderate wine consumption. As we know, alcoholic and non alcoholic wine constituents are responsible of different effects by means of molecular and cell mechanisms. Among the non alcoholic components, polyphenols (for example resveratrol and quercetin) were deeply investigated. The aim of this review is to underline the effects of a moderate and regular wine drinking in the context of the Mediterranean diet in light of the interactions between wine and important dietary factors such as olive oil, fruit and vegetables

Physiopathologica, epidemiologica, clinical and therapeutic aspects of exercise-associated hyponatriemia

Exercise-associated hyponatremia (EAH) is dilutional hyponatremia, a variant of inappropriate antidiuretic hormone secretion (SIADH), characterized by a plasma concentration of sodium lower than 135 mEq/L. The prevalence of EAH is common in endurance (6 hours in duration), in which both athletes and medical providers need to be aware of risk factors, symptom presentation, and management. The development of EAH is a combination of excessive water intake, inadequate suppression of the secretion of the antidiuretic hormone (ADH) (due to non osmotic stimuli), long race duration, and very high or very low ambient temperatures. Additional risk factors include female gender, slower race times, and use of nonsteroidal anti-inflammatory drugs. Signs and symptoms of EAH include nausea, vomiting, confusion, headache and seizures; it may result in severe clinical conditions associated with pulmonary and cerebral edema, respiratory failure and death. A rapid diagnosis and appropriate treatment with a hypertonic saline solution is essential in the severe form to ensure a positive outcome

Sirtuins and Aging: is there a Role for Resveratrol?

Prolonged human life duration is consequently associated with a higher incidence of chronic diseases. Aging is a very complex process in which genetic, environmental and cellular pathways are involved. Along with aging, longevity has been linked with Sirtuins. Sirtuin enzymes are a family of highly conserved protein deacetylases that have been linked with calorie restriction and aging by modulating energy metabolism, genomic stability and stress resistance. Aim of this brief review is to describe Sirtuins’ influence on the conditions that worsen the physiological aging. We will also report the beneficial effects of the polyphenol resveratrol on these molecules and the possible therapeutical perspectives

Iponatriemia ed esercizio fisico

L’iponatriemia associata ad esercizio fisico (EAH) è una evenienza degli sport di resistenza che può esitare in gravi manifestazioni cliniche quali l’edema cerebrale o l’insufficienza respiratoria. L’EAH è una iponatriemia diluizionale, variante della secrezione inappropriata di ADH (SIADH), caratterizzata da una concentrazione plasmatica di sodio inferiore a 135 mEq/l. Il sesso femminile e la durata delle competizioni si associano a più elevato rischio di iponatremia. L’incidenza di iponatriemia, infatti, aumenta con la durata dell’attività in special modo dopo 4-8 ore dall’inizio della gara. Le donne sembrano presentare un rischio maggiore rispetto agli uomini. I meccanismi fisiopatologici che ne sono alla base comprendono l’aumentata perdita di sodio con la sudorazione e l’eccessivo introito di fluidi ipotonici durante e dopo l’evento sportivo. Nella genesi dell’EAH sembra avere un ruolo determinante l’inadeguata secrezione di AVP mediata da stimoli non osmotici, tra i quali l’IL-6. Accorgimenti per la prevenzione dell’iponatremia comprendono l’educazione degli atleti ad un consumo adeguato di fluidi e il monitoraggio delle variazioni del peso corporeo. In seguito all’identificazione dello squilibrio elettrolitico è necessaria una restrizione idrica e un trattamento con infusione di soluzione ipertonica al 3% soprattutto nei casi di iponatremia severa. L’efficacia degli antagonisti dei recettori V2 necessita di ulteriori approfondiment

Marked elevation of transaminases and pancreatic enzymes in severe malnourished male with eating disorder

We report a case of a 45 year old Caucasian malnourished male with an history of eating disorder who developed severe liver and pancreatic damage and multiorgan disfunction. At admission to our department, his body mass index (BMI) was 11.1. Biochemical evaluation showed elevated serum levels of transaminases (AST= 2291 U/L, ALT= 1792 U/L), amylase (3620 U/L), lipase (4102 U/L), CPK= 1370 U/L, LDH= 2082 U/L. No other cause of acute liver and pancreatic damage was evidenced. Haematological disorders (anemia, thrombocytopenia, leukopenia) found on admission seem related to bone marrow hypoplasia and to gelatinous marrow transformation described in severe state of malnutrition. Although a moderate increase in liver and pancreatic enzymes are a common finding in malnourished patients, only a small number of reports describes severe liver injury and multiorgan dysfunction. After a few days of treatment (hydration and nutritional support) a marked decrease of serum transaminases, lipase, amylase, CPK, LDH occurred, despite a transient increase in these levels secondary to refeeding syndrome. The association of chronic malnutrition and a decrease in systemic perfusion may be responsible for multiorgan dysfunction. In our patient the high levels of transaminases and pancreatic enzymes were the most important biochemical abnormalities normalized after refeeding

Dynamic treatment effect phenotyping through functional survival analysis

In recent years, research interest in personalised treatments has been growing. However, treatment effect heterogeneity and possibly time-varying treatment effects are still often overlooked in clinical studies. Statistical tools are needed for the identification of treatment response patterns, taking into account that treatment response is not constant over time. We aim to provide an innovative method to obtain dynamic treatment effect phenotypes on a time-to-event outcome, conditioned on a set of relevant effect modifiers. The proposed method does not require the assumption of proportional hazards for the treatment effect, which is rarely realistic. We propose a spline-based survival neural network, inspired by the Royston-Parmar survival model, to estimate time-varying conditional treatment effects. We then exploit the functional nature of the resulting estimates to apply a functional clustering of the treatment effect curves in order to identify different patterns of treatment effects. The application that motivated this work is the discontinuation of treatment with Mineralocorticoid receptor Antagonists (MRAs) in patients with heart failure, where there is no clear evidence as to which patients it is the safest choice to discontinue treatment and, conversely, when it leads to a higher risk of adverse events. The data come from an electronic health record database. A simulation study was performed to assess the performance of the spline-based neural network and the stability of the treatment response phenotyping procedure. In light of the results, the suggested approach has the potential to support personalized medical choices by assessing unique treatment responses in various medical contexts over a period of time

Protein oxidation in chronic kidney disease

An imbalance between oxidative processes and antioxidant systems has been widely demonstrated in chronic kidney diseases (CKD). In this study we enrolled 26 healthy subjects, 27 patients with CKD on conservative treatment (CT-CKD) with various degrees of renal failure, and 31 CKD subjects in haemodialysis treatment (HD-CKD), evaluated before and after a standard haemodialysis session. In each group we measured protein carbonyl groups (PC) as an index of protein oxidation, lipid peroxidation (TBARS) and two plasma markers of leukocyte activation, elastase and myeloperoxidase (MPO). In CT-CKD subjects the PC level was significantly higher than in normal controls, and it was negatively correlated with creatinine clearance. In HD-CKD patients the PC concentration was significantly increased also in comparison with CT-CKD. An increase in TBARS was present both in CT-CKD and in HD-CKD patients, but in HD-CKD patients TBARS were lower than in CT-CKD. Elastase was increased in both CKD groups, while MPO was not different among control and patient groups. In HD-CKD patients the HD session was followed by a further increase in PC, as well as by an increase in elastase and MPO, whereas TBARS did not change. Protein oxidation accelerates the glycation processes and seems to be connected with the chronic inflammatory state detectable in renal failure, although we did not observe any significant correlation between PC level and leukocyte activation markers

COVID-19 in Low- and Middle-Income Countries (LMICs): A Narrative Review from Prevention to Vaccination Strategy

The management of the COVID-19 pandemic represents a challenging process, especially for low- and middle-income countries (LMICs) due to the serious economic and health resource problems it generates. In this article, we assess COVID-19 situation in LMICs and outline emerging problems and possible solutions. The prevention and control of COVID-19 would be based on focused tests exploiting those systems (e.g., GeneXpert®) already used in other scenarios. This would be less stressful for the healthcare system in LMICs. Avoiding close contact with people suffering from acute respiratory infections, frequent handwashing, and avoiding unprotected contact with farm or wild animals are recommended infection control interventions. The appropriate use of personal protective equipment (PPE) is required, despite its procurement being especially difficult in LMICs. Patients’ triage should be based on a simple and rapid logarithm to decide who requires isolation and targeted testing for SARS-CoV-2. Being able to estimate which patients will develop severe disease would allow hospitals to better utilize the already limited resources more effectively. In LMICs, laboratories are often in the capital cities; therefore, early diagnosis and isolation become difficult. The number of ICU beds is often insufficient, and the equipment is often old and poorly serviced. LMICs will need access to COVID-19 treatments at minimal prices to ensure that all who need them can be treated. Year-to-date, different vaccines have been approved and are currently available. The main obstacle to accessing them is the limited ability of LMICs to purchase significant quantities of the vaccine