Storia e medicina di genere

La salute non è un campo neutrale. Il concetto di diversità, declinato sui temi del sesso e del genere, è uno degli strumenti della riflessione clinica, ma anche di quella bioetica - quando discute, in particolare, del principio di uguaglianza. Il tema ha una storia medica recente. Proviamo rapidamente, attraverso un riesame della letteratura, a verificare se, in prospettiva storica, questa affermazione di ‘contemporaneità’ sia effettivamente condivisibile

Effects of blood transfusion on exercise capacity in thalassemia major patients

Anemia has an important role in exercise performance. However, the direct link between rapid changes of hemoglobin and exercise performance is still unknown.To find out more on this topic, we studied 18 beta-thalassemia major patients free of relevant cardiac dysfunction (age 33.5±7.2 years,males = 10). Patients performed a maximal cardiopulmolmonary exercise test (cycloergometer, personalized ramp protocol, breath-by-breath measurements of expired gases) before and the day after blood transfusion (500 cc of red cell concentrates). After blood transfusion, hemoglobin increased from 10.5±0.8 g/dL to 12.1±1.2 (p<0.001), peak VO2 from 1408 to 1546mL/min (p<0.05), and VO2 at anaerobic threshold from 965 to 1024mL/min (p<0.05). No major changes were observed as regards heart and respiratory rates either at peak exercise or at anaerobic threshold. Similarly, no relevant changes were observed in ventilation efficiency, as evaluated by the ventilation vs. carbon dioxide production relationship, or in O2 delivery to the periphery as analyzed by the VO2 vs. workload relationship. The relationship between hemoglobin and VO2 changes showed, for each g/dL of hemoglobin increase, a VO2 increase = 82.5 mL/min and 35 mL/min, at peak exercise and at anaerobic threshold, respectively. In beta-thalassemia major patients, an acute albeit partial anemia correction by blood transfusion determinates a relevant increase of exercise performance, observed both at peak exercise and at anaerobic threshold

Lifestyle and Stress Management in Women During COVID-19 Pandemic: Impact on Cardiovascular Risk Burden

CoV-19/SARS-CoV-2 (coronavirus 2019/severe acute respiratory syndrome coronavirus 2) is a virus that has caused a pandemic with high numbers of deaths worldwide. To contain the diffusion of infection, several governments have enforced restrictions on outdoor activities on the population. Today, we are witnessing the so-called “second wave” COVID-19 (coronavirus disease 2019) with an increasing number of cases similar to the one reported at the beginning of the current year. It is plausible that further restrictions will be applied to contain the “second wave” of infections. The present commentary evaluated the effects of stress on lifestyle during the COVID-19 pandemic in women. We briefly suggest practical recommendations for women to reduce stress and recovery for a healthy lifestyle after quarantine. Quarantine is associated with stress and depression, which lead to unhealthy lifestyle, including unhealthy diet, smoking, alcohol, and reduced physical activity. Women are more likely to suffer from depression and stress and quarantine has acted as a trigger. The prolongation of the COVID-19 pandemic around the world requires decisive action to correct the unhealthy lifestyle that has developed in recent months

Echocardiographic assessment of congenital mitral stenosis.

To assess the severity and precise anatomy of congenital mitral stenosis (MS), 17 patients with congenital left ventricular inflow obstruction were studied by M-mode and two-dimensional echocardiography (2DE) and by cardiac catheterization. In six patients MS was an isolated lesion and in 11 it was combined with other cardiovascular malformations. The diagnosis was confirmed at operation or autopsy in 15 patients. Twenty normal subjects of the same age and sex were selected as controls. M-mode amplitude and speed of diastolic closure (E-F slope) of the anterior mitral valve leaflet were determined in all patients. Mitral valve areas were traced after careful short-axis 2DE scans in 15 patients. Supravalvar, valvar, or subvalvar obstruction was evaluated in patients with surgical or autopsy documentation. Analysis of M-mode echocardiograms showed a reduction of E-F slope in all patients compared to normal control subjects but a poor correlation between E-F slope and hemodynamic data (mitral valve areas or pressure gradients). Diastolic fluttering of either or both mitral valve leaflets was found in 12 patients. It is concluded that M-mode echocardiography may be useful for qualitative assessment of congenital MS, even in the presence of associated heart defects, but less useful in evaluating its severity. Analysis of 2DE revealed good correlation between mitral valve areas as calculated with 2DE and with the Gorlin formula at cardiac catheterization, despite the complexity of the congenital mitral lesion. Anatomic varieties of congenital left ventricular inflow obstruction, such as stenosing supravalvar mitral ring or parachute deformity of the mitral valve, were recognized at 2DE.(ABSTRACT TRUNCATED AT 250 WORDS

Echocardiography combined with cardiopulmonary exercise testing for the prediction of outcome in idiopathic pulmonary arterial hypertension

BACKGROUND: Right ventricular (RV) function is a major determinant of exercise intolerance and outcome in idiopathic pulmonary arterial hypertension (IPAH). The aim of the study was to evaluate the incremental prognostic value of echocardiography of the RV and cardiopulmonary exercise testing (CPET) on long-term prognosis in these patients. METHODS: One hundred-thirty treatment-naïve IPAH patients were enrolled and prospectively followed. Clinical worsening (CW) was defined by a reduction in 6-minute walk distance plus an increase in functional class, or non elective hospitalization for PAH, or death. Baseline evaluation included clinical, hemodynamic, echocardiographic and CPET variables. Cox regression modeling with c-statistic and bootstrapping validation methods were done. RESULTS: During a mean period of 528 ± 304 days, 54 patients experienced CW (53%). Among demographic, clinical and hemodynamic variables at catheterization, functional class and cardiac index were independent predictors of CW (Model-1). With addition of echocardiographic and CPET variables (Model-2), peak O2 pulse (peak VO2/heart rate) and RV fractional area change (RVFAC) independently improved the power of the prognostic model (AUC: 0.81 vs 0.66, respectively; p=0.005). Patients with low RVFAC and low O2 pulse (low RVFAC + low O2 pulse) and high RVFAC+low O2 pulse showed 99.8 and 29.4 increase in the hazard ratio, respectively (relative risk -RR- of 41.1 and 25.3, respectively), compared with high RVFAC+high O2 pulse (p=0.0001). CONCLUSIONS: Echocardiography combined with CPET provides relevant clinical and prognostic information. A combination of low RVFAC and low O2 pulse identifies patients at a particularly high risk of clinical deterioration

SARS-CoV-2 spread in northern Italy. what about the pollution role

The recent epidemic of the new SARS-CoV-2 in the northern regions of Italy is putting the organization of the Italian health system under serious attack. The current emergency requires all possible efforts to stem the spread of the virus. In this context, it is clear that we have the urgent need to rely upon etiopathogenetic data, in order to do all possible efforts to block the epidemic. However, observing the trend of the infections in China and the geographic areas of the main outbreaks, it could be hypothesized that air pollution plays a role. In particular, it has been previously demonstrated, in specific populations, a role of particulate matter in worsening clinical presentation of virus infection in airways. Without prejudice to the ascertained virus spread by air droplets or contaminated surfaces, the factors that could have favored its spread remain to be investigated. Moreover, if these observations were to be confirmed, when the health emergency is resolved, it will be mandatory to redesign an economic-productive model in balance with the environment

“Quarantine during COVID-19 outbreak: changes in Diet and physical activity increase the risk of cardiovascular disease”

Aims. CoV-19/SARS-CoV-2 is a highly pathogenic virus that is causing a global pandemic 53 with a high number of deaths and infected people. To contain the diffusion of infection, 54 several Governments have enforced restrictions on outdoor activities or even collective 55 quarantine on the population. The present commentary briefly analyzes the effects of 56 quarantine on lifestyle, including nutrition and physical activity and the impact of new 57 technologies in dealing with this situation. 58 Data Synthesis. Quarantine is associated with stress and depression leading to unhealthy 59 diet and reduced physical activity. A diet poor in fruit and vegetables is frequent during 60 isolation, with a consequent low intake of antioxidants and vitamins. However, vitamins 61 have recently been identified as a principal weapon in the fight against the Cov-19 virus. 62 Some reports suggest that Vitamin D could exert a protective effect on such infection. 63 During quarantine, strategies to further increase home-based physical activity and to 64 encourage adherence to a healthy diet should be implemented. The WHO has just released 65 guidance for people in self-quarantine, those without any symptoms or diagnosis of acute 66 respiratory illness, which provides practical advice on how to stay active and reduce 67 sedentary behaviour while at home

Stratificazione del rischio negli infarti senza onde-Q: ruolo dell'ecocardiografia a riposo e da sforzo

To assess the relation between the extent of myocardial necrosis and the presence of myocardium at risk in myocardial infarction without Q waves (NQMI) we studied by echocardiography the prevalence of jeopardized myocardium in a group of NQMI stratified on the basis of left ventricular wall motion (akinesis, hypokinesis, normal kinesis). We have studied 60 consecutive patients with non-Q myocardial infarction. Patients were examined by 2D echo at rest (V-VI day from the acute episode) and during symptoms limited bicycle ergometric test (ExT) (XX-XXX day). Regional left ventricular wall motion was evaluated as normal or asynergic (severe hypokinetic, akinetic) and the ExT was considered positive in case of new asynergic areas or ECG criteria. 2D echo at rest was technically satisfactory in 56 patients, 19 showed almost an akinetic segment (Aci) 17 had hypokinetic areas (Ipo) and 20 had normal left ventricle kinesis (Norc). Wall motion abnormalities were localized more frequently in the apex and lateral areas. During exercise 2D echo was performed in 46 patients (82%) with 23 positive tests (50%). Stratifying the population on the basis of left ventricle wall motion we observed a major number of positive tests in the group of patients with normal wall motion in comparison with those with asynergic areas at rest (Norc 66.6%, Ipo 35.7%, Aci 42.6% p less than 0.05 Nore vs Ipo and Nore vs Aci) despite the same CAD extension. These data show the heterogeneity of the NQMI that likely includes patients with transmural (asynergy group) and subendocardial MI (normal kinesis group), the latter with a higher degree of myocardium at risk

The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women's Lifespan: An Updated Review

Physical inactivity (PI) represents a significant, modifiable risk factor that is more frequent and severe in the female population worldwide for all age groups. The physical activity (PA) gender gap begins early in life and leads to considerable short-term and long-term adverse effects on health outcomes, especially cardiovascular (CV) health. Our review aims to highlight the prevalence and mechanisms of PI across women's lifespan, describing the beneficial effects of PA in many physiological and pathological clinical scenarios and underlining the need for more awareness and global commitment to promote strategies to bridge the PA gender gap and limit PI in current and future female generations