History repeating. The plague of 1630 in Milan and the COVID-19 pandemia

In western democracies, individual behaviour will be crucial to control the spread of COVID-19, as well as government actions [1] that unfortunately, except China, South Korea and Italy, followed by others,  seems to be generally unconvinced and, speculatively, late. Indeed human history has been marked by epidemics/pandemics which have affected, more or less, large geographical areas [2]. Italy, as well as the rest of Europe, has often been affected by these phenomena and, Lombardy, due to his position, was, as today by COVID-19, severely stroked in Italy that is, after China, the second most affected country [3]. This is also linked to the position of Lombardy and its capital, Milan, but this is beyond this brief comment. There are several differences between the past plagues and the actual COVID-19 pandemic and these must be sought in the increased ability to transmit diseases at-distance through the mobility of humans and goods [4], and in the catastrophic consequences of the breakdown of ecosystems, as told, a few years ago, by David Quammen in the book Spillover [5]

Epistemology of Natural Strategies for Cardiac Tissue Repair

Is there maintenance in complex biological systems or life is a continuous space-time drift? The emphasis that in the past years has been placed on tissue repair is, at least, misplaced since this property coincides with the same strategy that handles development and maintenance, a strategy that is broadly adaptive. It is not a mere philosophical question, since it deals with limited cellular resources; indeed, the evolution towards multicellularity is a form of adaptation to the environment that involves a high cost in terms of biological resources to handle differentiation, specialization, establishment of functional hierarchies, and development of a complex organisms. It is, therefore, evident that the availability of resources for other forms of adaptation in adult life, such as the re-generation process for maintenance or repair, is limited. In this opinion, I will discuss the epistemology of natural strategies for cardiac tissue repair, since, in the twentieth century, the increase in life expectancy in some geographic areas has given rise to diseases generally less frequent in the first three or four decades of life; thus, the morbidity and mortality related to cardiovascular disease has shown all the negative aspects of arterial and cardiac ageing bringing to the foreground the problem of cardiac damage and of its repair

Haemodynamic Response to a Standard Meal: Consideration on A Case of Significant Blood Pressure Peaks in a Diabetic Hypertensive Patient Treated with ARB and Comparison with Normal Age and Sex Matched Subjects

A standard meal is a stimulus that produces a response that consists in the redistribution of blood flow to the splanchnic district, potentially, affecting systemic blood pressure, this phenomenon was studied in animal models and in critic patient. Here we report a case of a diabetic hypertensive-in-treatment woman where two significant blood pressure peaks were recorded, during lunch and dinner, over an optimal 24/h blood pressure control. In the absence of previous normal reference values in the literature, we retrieved a series of n=10 age and sex matched subjects diagnosed normotensive on the mean of 24/h Ambulatory Blood Pressure Monitoring. We finally present our considerations on the normal response to a standard meal compared to what was found in the literature and in the present case, where an impaired control of resistance is hypothesised, and on the possible mechanisms supporting

PDE5 inhibitors, erectile dysfunction and beyond : How, sometimes, indications are the consequences of marketing strategies and/or serendipity

Phosphodiesterase inhibitors (PDE5i) have an established role in the treatment of erectile dysfunction (ED) and pulmonary arterial hypertension (PAH) but, at the same time, they represent a paradigmatic example of a class of drugs, originally tested for a clinical indication, shifted to another one, for the unexpected emergence of strong evidences opening towards a new market, at that time still to be defined, but with an enormous potential. Sildenafil, the primer of PDE5i drugs patented in 1996, was designed and thought as anti-hypertensive/anginal, early relocated for ED and approved for this in 1998 despite emerging evidences of a further possible use, albeit numerically limited, in PAH. The apparent lack of interest in other fields of application continue at least until 2004 when, possibly, due to the upcoming of 2 new PDE5i on the market, the request for PAH, supported by a trial, was finally submitted and obtained by FDA in 2005. It is noteworthy that in medicine, when a relevant cellular mechanism is identified and targeted with a new drug, the results are not always predictable and/or are in agreement with the interests of the market but serendipity can help. Thus development/marketing of drugs is a multifactorial phenomenon that includes, also, potential/effectiveness of the molecules, beliefs/curiosity of the researchers, doctor/patient expectations, and, first of all, the economical interest related to their economic exploitation. In this review we wanted to explore the potentials, if any, of PDE5i beyond ED, by searching the literature for off-label applications

The atherosclerosis of the sinus node artery is associated with an increased history of supra-ventricular arrhythmias : a retrospective study on 541 standard coronary angiograms

Background. The ischemic damage of the sinus node (SN) is a well known cause of cardiac arrhythmias and can be a consequence of any flow abnormality in the sinus node artery (SNA). Accordingly we aimed this retrospective study to: (1) evaluate the suitability of the standard coronary angiography to study the SNA and (2) determine if the percentage of subjects with a positive retrospective history of supra-ventricular arrhythmias (SVA) differs in patients with normal and diseased SNA ascertained at the time of coronary angiography. Methods and Results. Out of the 541 coronary angiograms reviewed the SNA was visible for its entire course in 486 cases (89.8%). It was found to arise from the right side of the coronary circulation in 266 cases (54.7%) slightly more often than from the left, 219 cases (45.1%). One patient had 2 distinct SNA arising from either side of the coronary circulation. For the second objective, we studied the 333 patients with: (a) coronary artery disease (CAD), (b) properly evaluable SNA and (c) complete clinical history available. In 51 (15.3%) a SNA disease was found, 41.2% of them had a positive SVA history, mainly atrial fibrillation (AF), whereas only 7.4% of patients with a positive history of SVA could be found in the non-SNA diseased. This difference was statistically significant (P < 0.001). Conclusions. (1) The evaluation of the SNA is feasible in clinical practice during a standard coronary angiography; (2) this may be relevant since angiographically detectable SNA disease was significantly associated with a positive history of SVA

Atrial fibrillation, an epiphenomenon of acute Stanford type-A aortic dissection with suspected intimo-intimal intussusception

Key Clinical Message Supraventricular arrhythmias can sometimes be only epiphenomena appearing during acute hypoxia, pneumonia, pulmonary embolism, and thrombosis. Indeed, atrial fibrillation is not rare in acute aortic dissection as it is estimated in about one half of patients and may be secondary to a perfusion deficit of the sinoatrial node artery