Atypical presentation of acute idiopathic megacolon in a 14-year-old patient

In clinical practice the term "megacolon" is used to indicate a marked dilatation of the cecum and the sigmoid colon (>12 and 6.5 cm, respectively) (1). From a clinical standpoint, a megacolon can be classified as chronic or acute depending on its clinical presentation. Chronic megacolon typically refers to a congenital disorder in which the enteric nervous system (ENS) supplying the colon does not develop properly, thereby leaving the distal segments of the viscus without myenteric and submucosal ganglia (i.e. Hirschsprung's disease) (2). Other cases of non-aganglionic chronic megacolon can be secondary to variety of conditions such as Chagas' disease and neurodegenerative diseases (e.g. Parkinson's and Alzheimer's diseases), leading to or associated with ENS abnormalities (3). The acute form of megacolon, also referred to as Ogilvie's syndrome, is characterized by a predominant involvement of the cecum and right colon usually affecting elderly patients undergoing surgery (e.g. orthopedic procedures) or taking medications altering gut motility (e.g. opioids or antidepressants) (4). Some forms of acute megacolon, however, can be idiopathic in origin since no underlying etiology can be identified. Patients with acute idiopathic megacolon usually have a longstanding history of constipation, often accompanied by laxative abuse, and their clinical presentation is characterized by abdominal distension and severe pain with radiological evidence of stool impacted in the colon and rectum (1, 4). The case herein reported represents an unusual form of acute idiopathic megacolon characterized by massive descending and sigmoid colon distension complicated with a volvulus in a 14-year-old boy with no Hirschsprung's disease. In addition, just to increase the peculiarity of this case report, the patient had an unremarkable clinical record, and never suffered from chronic constipation in the past

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Evolving concept of cardioprotection in myocardial infarction: from SMILE-1 to SMILE-5.

The renin–angiotensin–aldosterone system (RAAS) is a central regulator of cardiovascular (CV) and renal function and plays a key role in the pathophysiology of various CV and renal diseases. Clinical data has demonstrated that ACE inhibitors are very effective at reducing blood pressure in a large proportion of patients with hypertension (HBP), when given alone or in combination. ACE inhibitors improve the clinical prognosis of patients with congestive heart failure (CHF) and AMI, particularly when complicated by overt left ventricular (LV) dysfunction, although their efficacy maybe limited in postmyocardial patients with preserved LV function. Among the different ACE inhibitors, the efficacy of zofenopril has been proven in a wide population of patient and in the different studies. The SMILE project was a large clinical programme aimed at investigating the efficacy of zofenopril for the treatment of patients with AMs with HBP and coronary heart disease, in particular AMI

Serenoa repens + selenium + lycopene vs tadalafil 5 mg for the treatment of lower urinary tract symptoms secondary to benign prostatic obstruction: a Phase IV, non-inferiority, open-label, clinical study (SPRITE study)

Objective: To compare in a randomised, open-label, non-inferiority clinical study, the efficacy and tolerability of Serenoa repens (SeR) + selenium (Se) + lycopene (Ly) (SeR-Se-Ly) therapy vs tadalafil 5 mg in men with lower urinary tract symptoms (LUTS). Patients and methods: From May 2015 to January 2017, 427 patients were enrolled in 21 different centres (International Standard Randomised Controlled Trial Number Register [ISRCTN] 73316039). Inclusion criteria included: age between 50 and 80 years, International Prostate Symptom Score (IPSS) ≥12, maximum urinary flow rate (Qmax) ≤ 15 mL/s, and post-void residual (PVR) <100 mL. Patients were randomised into two groups in a 2:1 ratio: Group A (SeR-Se-Ly, 1 tablet daily for 6 months) and Group B (tadalafil 5 mg, 1 tablet daily for 6 months). The primary endpoint of the study was the non-inferior variation in the IPSS and Qmax in Group A vs Group B after 6 months of treatment. Results: In all, 404 patients completed the full protocol. When comparing both therapies, Group A was statistically not inferior to Group B considering the median change in IPSS (−3.0 vs −3.0; P < 0.01), IPSS quality of life (−2.0 vs −2.0; P < 0.05), and Qmax (2.0 vs 2.0 mL/s; P < 0.01). We found statistically significant differences in the increase of at least 3 points in Qmax (38.2% vs 28.1%; P = 0.04) and of at least 30% of Qmax (39.2% vs 27.3%; P < 0.01) in Group A compared to Group B. The percentage of patients with an increase of at least 3 points in the IPSS and a decrease of at least 25% of the IPSS was not statistically different between the two groups. For adverse events, four patients in Group A (1.44%) and 10 in Group B (7.81%) (P < 0.05) reported side-effects. Conclusion: We have shown that treatment with SeR-Se-Ly was not inferior to tadalafil 5 mg for improving IPSS and Qmax in men with LUTS

Prevalence of proximal ascending aorta and target organ damage in hypertensive patients: the multicentric ARGO-SIIA project (Aortic RemodellinG in hypertensiOn of the Italian Society of Hypertension)

The aim of this study was to assess the prevalence of ascending aortic dilatation and to evaluate the possible association between proximal aorta dilatation and structural or functional markers of cardiac organ damage in hypertensive patients

Cypress pollen: an unexpected major sensitizing agent in different regions of Italy.

Abstract OBJECTIVES: In this multicenter survey, we assessed the impact of sensitization to cypress in atopic patients in Italy and determined whether cypress pollen concentration changed over time. METHODS: Allergists were required to collect the results of 100-200 consecutive skin prick tests (SPTs) performed during 2012. Seasonal symptoms were also recorded, as were airborne cypress pollen concentrations (data from the Italian Aerobiology Association) in 1998-2000 and 2010-2012. RESULTS: We examined 2258 atopic outpatients (56% females; age, 2-84 years) sensitized to at least 1 of the aeroallergens tested (Dermatophagoides species, grass, pellitory, olive, cypress, birch, Alternaria tenuis, and dog and cat dander). We found that 62.9%, 16.1%, and 32.7% of patients living in central, northern, and southern Italy, respectively, were sensitized to cypress (P < .0001). The cypress pollen concentration peak was delayed from February to March in 1998-2000 and 2010-2012 in all 3 regions, with a shift in pollination towards spring. Patients who were monosensitized to cypress reported mainly rhinitis (90.7%-97.6%) and conjunctivitis (38.1%-100%). In polysensitized patients, the prevalence of rhinitis, conjunctivitis, and asthma increased progressively (P < .0001) from southern to northern Italy. The same trend was observed for the prevalence of reported winter symptoms typical of cypress allergy (28%-65%). CONCLUSIONS: Today, cypress pollen is the most frequent sensitizing aeroallergen (assessed by SPT) in several areas of central Italy. Variations in the timing of the cypress pollination period may have favored this increased sensitization. Rhinitis and conjunctivitis are the predominant symptoms. The clinical impact of this allergy was poor in southern Italy and increased in central areas before reaching its peak in northern region

Omega-3 in Antiarrhythmic Therapy

The association between omega-3 (n-3 polyunsaturated fatty acids) and the clinical outcome of patients with cardiovascular diseases such as coronary heart disease is currently unclear, especially regarding its possible antiarrhythmic effects and the not quite understood mechanisms of action. In the last 15 years, several epidemiological studies have shown a lower incidence of sudden cardiac death with a diet rich in omega-3 or fish consumption. The antiarrhythmic properties related to omega-3 have been related to modulation of sodium-dependent ion channels or sodium-calcium exchangers of myocytes through a reduction of their excitability especially in ischaemic or damaged myocardial tissue. However, the results of experimental studies have not always been consistent. Although the role of omega-3 in preventing sudden cardiac death has been evaluated in several clinical trials that included patients with coronary artery disease (particularly in patients with post-myocardial infarction), the interpretation of such data must be treated with extreme caution. In particular, while a reduction in cardiac death was demonstrated by a meta-analysis of several randomized clinical trials, a reduced risk of sudden cardiac death has been described only in the GISSI-Prevenzione study, while in other studies the evidence that emerged is more controversial, with wide confidence intervals that support the possibility of heterogeneity in the distribution of the factors involved in the efficacy of treatment. Omega-3 is probably involved in the prevention of cardiovascular mortality through different mechanisms, and it is crucial to study its association with other drugs such as ACE inhibitors or calcium channel blockers. The study of antiarrhythmic drugs has been divided into prevention of supraventricular and ventricular arrhythmias. In these conditions, the role of omega-3 seems to be more pronounced in atrial tachyarrhythmias such as atrial fibrillation, but does not have a role in ventricular arrhythmias. In summary, the antiarrhythmic effect of omega-3 is not clearly evident and further studies are needed to investigate its beneficial effect in cardiac mortality compared with arrhythmic death

Cypress pollen: an unexpected major sensitizing agent in different regions of Italy.

In this multicenter survey, we assessed the impact of sensitization to cypress in atopic patients in Italy and determined whether cypress pollen concentration changed over time