Il rischio cardiovascolare e la concentrazione plasmatica del colesterolo LDL: il ruolo dei Servizi Sanitari Regionali

Cardiovascular risk and increased plasma LDL cholesterol concentration: the role of the Regional Health ServiceThe relevance of hypercholesterolemia, as a risk factor for cardiovascular (CV) disease, requires urgent actions to detect and assist high-risk citizens/patients, thus reducing and/or avoiding future complications. This goal could be achieved through more widespread awareness of the problem within the Health System of the Veneto Region, joint efforts between clinical laboratories and clinicians in transmitting and interpreting informative laboratory reports, and deeper integration of hospital and community health services. Data from recent studies, recommendations of scientific societies and political-institutional guidelines helped in determining the number of patients in the Veneto Region, which may be suffering from clinical or biochemical conditions that impact on CV risk. These include hypercholesterolemia, which is particularly addressed in this paper, with special emphasis on FH (familial hypercholesterolemia), a chronic disease associated with very high CV risk

Human cytomegalovirus infection in an as yet unexplored at-risk category of subjects: elderly subjects facing acute ischemic stroke

Background: Human cytomegalovirus (HCMV) is an important opportunistic pathogen leading to severe diseases in “at-risk” categories of individuals upon the symptomatic reactivation of the virus belonging to specific genotypes. In this respect, it has been postulated that envelope glycoproteins (g) N and O could have a key role as virulence factors, most likely in combined patterns. Several data is accumulating about HCMV reactivations in non-immunocompromised adults with critical illness that may impair clinical outcomes. The interplay between HCMV and immune surveillance is also supposed to become more vulnerable in advanced age; here, subclinical reactivations may drive expanded anti-HCMV immune responses. Accordingly, it is reasonable to expect cases of HCMV reactivation in elderly patients facing an acute life-threatening disease such as ischemic stroke. Materials/methods: We have performed an observational prospective study in a cohort of 105 elderly patients admitted to the Stroke Care Units of Parma University-Hospital for major acute ischemic stroke. Plasma samples from patients tested positive for anti-HCMV IgG, collected at 10±2 days from hospital admission, were analyzed for the presence of viral DNA by Real-Time PCR; gN and gO genotyping was performed by RFLP in case of positive DNAemia. Results: HCMV DNA was detected in the range of few hundred copies/mL in 11.7% of the analyzed samples. The gN and gO genotypes were characterized in 77.7% of the positive samples for HCMVDNAemia. In particular, the gN3 genotype was found to predominate (57.1%); with regard to gO, the recurrent genotypes were gO1 (57.1%) and gO2 (42.9%). Furthermore, these data suggest that combined gN3-gO1 and gN3-gO2 genotypes could be the recurring virulence factor patterns associated with viral DNAemia. Conclusions: This study focused for the first time on the role of HCMV infection in acute ischemic stroke. Overall, the results suggest that HCMV tends to escape immune surveillance in some elderly patients in this clinical setting. The quite low viral genome copies could be associated with localized, rather systemic, viral reactivations and involved specific HCMV envelope genotype combinations. The impact of these data will be evaluated with respect to clinical outcomes and HCMV-specific T cell responses of the studied population

Il rischio cardiovascolare e la concentrazione plasmatica del colesterolo LDL: il ruolo dei Servizi Sanitari Regionali

Cardiovascular risk and increased plasma LDL cholesterol concentration: the role of the Regional Health ServiceThe relevance of hypercholesterolemia, as a risk factor for cardiovascular (CV) disease, requires urgent actions to detect and assist high-risk citizens/patients, thus reducing and/or avoiding future complications. This goal could be achieved through more widespread awareness of the problem within the Health System of the Veneto Region, joint efforts between clinical laboratories and clinicians in transmitting and interpreting informative laboratory reports, and deeper integration of hospital and community health services. Data from recent studies, recommendations of scientific societies and political-institutional guidelines helped in determining the number of patients in the Veneto Region, which may be suffering from clinical or biochemical conditions that impact on CV risk. These include hypercholesterolemia, which is particularly addressed in this paper, with special emphasis on FH (familial hypercholesterolemia), a chronic disease associated with very high CV risk

A primary-care interventional model on the diverticular disease: Searching for the optimal therapeutic schedule

Introduction In routine colonoscopy, diverticulosis is the most commonly found feature, but only a minority of these cases show symptoms of diverticular disease. From June 2014 to December 2014, we enrolled prospectively 178 patients affected by symptomatic uncomplicated diverticular disease (Male/Female = 0.47, mean age 71.7 ± 11.5 y, range 41 to 95 y) from 15 General Pratictioners patient files. All patients were symptomatic; in all cases, diagnosis was been confirmed by a colonoscopy performed at least 1 year before. Patients with acute diverticulitis were excluded. On the basis of the predominant symptoms (abdominal complaints or constipation), patients were addressed to 4 different therapeutic approaches using mesalamine, rifaximine, probiotics (in a consortium of different species of Lactobacillus and Bifidobacterium), and fibers (Plantago Ovata Husk). All treatments lasted 3 months. Results: Sixty-three patients were enrolled in group A (rifaximine), 43 in group A1 (rifaximine + fibers + probiotics), 23 in group B (mesalamine), and 31 in group B1 (mesalamine + fibers). Analysis of variance suggested a statistically significant difference (P < 0.003) among groups at the end of the observation period, with Groups A1 and B1 showing a higher number of bowel movement per week. Global linear measurement confirmed the role of treatment as a significant factor (F = 2.858; P = 0.039) associated with body mass index (F = 6.972; P < 0.009). Conclusions: In accordance with the baseline clinical presentation, the supplementation of fiber and/or probiotics is associated with a statistically significant improvement in the clinical pattern of symptoms in patients with diverticular disease in a primary-care/family physician setting