Latest insights into the hot question of proton pump inhibitor safety \u2013 a narrative review

Proton pump inhibitors (PPIs) are among the most widely prescribed medications worldwide and their use is continuously increasing. Although they have been shown to combine high therapeutic efficacy and good safety profile in many studies, in last years we have witnessed the publication of many articles reporting the possible association of long-term PPI therapy with important unexpected adverse events and these observations have created alarmism in both patients and physicians. However, the majority of these studies are observational, retrospective and prone to residual confounding. Also, the odds ratio values are generally comprised between 1 and 2 and therefore devoid of strong clinical relevance. As it is unlikely that prospective randomized trials will be ever done to reinforce these associations, we can only attempt to distinguish clear- from unclear-defined adverse events from the available literature. Nowadays we can reasonably exclude cardiovascular diseases, community-acquired pneumonia, all-cause mortality, dementia and bone fractures from PPI-related adverse events. However, physicians should be aware of the existence of possible risks when treating their patients, especially the elderly and frail ones, with long-term PPIs, which should be prescribed only to persons with defined indications and at lowest dose and duration

Malformazioni congenite delle alte vie aeree: aspetti clinici e diagnostici

Le anomalie congenite a carico delle alte vie aeree, pur essendo rare, rappresentano un capitolo importante della patologia respiratoria del bambino. Alcune di queste anomalie sono incompatibili con la vita, mentre altre possono passare inosservate nelle settimane, nei mesi o negli anni successivi alla nascita. Spesso il loro esordio clinico è confuso con quello di altre patologie e, quando non sono diagnosticate e trattate adeguatamente, possono rappresentare un pericolo di vita per il bambino. Dal punto di vista clinico tali anomalie hanno in comune lo “stridore”, che è il sintomo tipico di un’ostruzione parziale delle alte vie aeree. Lo stridore non è una diagnosi, ma un sintomo che impone una diagnosi differenziale che comprende varie malformazioni congenite delle vie aeree. La storia clinica, l’esame obiettivo e la diagnostica per immagini possono fornire utili informazioni riguardanti le malformazioni congenite, ma l’esame endoscopico delle vie aeree è fondamentale per una corretta diagnosi. Tutti i medici che si occupano di patologia respiratoria in età pediatrica dovrebbero conoscere adeguatamente gli aspetti embriologici, anatomo-fisiologici e clinici delle malformazioni congenite delle vie aeree per la messa in atto di pronte e adeguate strategie diagnostiche e terapeutiche presso i centri specialistici

Compact Superconducting High Gradient Quadrupole Magnets for the Interaction Regions of High Luminosity Colliders

Recent developments in the high luminosity e(+)e(-) colliders are based on a collision scheme with a large Piwinski angle, a vertical beta function beta(y) much smaller than the bunch length, and a crab waist transformation. This scheme is being adopted in the SuperB asymmetric collider, to be built in Italy, with a design peak luminosity of 10(36) cm(-2) sec(-1). A crucial role is played by the quadrupole doublets QD0/QF1, which are placed close to the interaction point and generate gradients close to 100 T/m. The available space for the doublets is very small, causing the magnets to be operated with a high engineering current density (2000 A/mm(2)). Starting from the helical coil concept, an advanced design of the quadrupole has been developed. The paper discusses the basic design concepts and the development of a coil model aimed at assessing the design criteria and demonstrating the feasibility of the quadrupole. The successful test of the coil model opens the way to new compact superconducting high gradient quadrupole magnets for the interaction regions of high luminosity colliders

Colorectal Cancer in Inflammatory Bowel Diseases: Epidemiology and Prevention: A Review

Simple Summary Colorectal cancer (CRC) is one of the most serious potential complications of inflammatory bowel diseases (IBDs). The aging of patients affected by IBDs makes this issue a challenge that will increasingly be faced by clinicians in clinical practice, especially in light of the poorer prognosis for CRC in this group of people when compared with the general population. In this review, we summarize the current epidemiology, risk factors and various prevention strategies proposed for CRC in patients with IBDs. Colorectal cancer (CRC) is currently the third most frequent form of malignancy and the second in terms of mortality. Inflammatory bowel diseases (IBDs) are recognized risk factors for this type of cancer. Despite a worldwide increase in the incidence of CRC, the risk of CRC-related death in IBD patients has declined over time, probably because of successful surveillance strategies, the use of more effective drugs in the management of remission and improved indications to colectomy. This notwithstanding, CRC 5-year survival in patients with IBD is poorer than in the general population. This review provides a summary of the epidemiological features, risk factors and various prevention strategies proposed for CRC in IBD patients. Moreover, there is a special focus on reporting and highlighting the various prevention strategies proposed by the most important international scientific societies, both in terms of chemoprevention and endoscopic surveillance. Indeed, in conducting the analysis, we have given attention to the current primary, secondary and tertiary prevention guidelines, attempting to emphasize unresolved research and clinical problems related to this topic in order to improve diagnostic strategies and management