Impact of combined therapy with alpha-lipoic and ursodeoxycolic acid on nonalcoholic fatty liver disease: double-blind, randomized clinical trial of efficacy and safety.

BACKGROUND AND PURPOSE: Nonalcoholic fatty liver disease (NAFLD) is one of the causes of a fatty liver, occurring when fat is deposited (steatosis) in the liver not due to excessive alcohol use. It is related to insulin resistance and the metabolic syndrome. The purpose of the present study was to evaluate the impact of combination therapy with alpha-lipoic acid (ALA) and ursodeoxycholic acid (UDCA) on NAFLD. METHODS: Alpha-lipoic acid 400 mg/day plus UDCA 300 mg/day (ALAUDCA) was investigated in patients over a period of 12 months using a randomized, placebo (PLA)-controlled study with four parallel groups. Serum concentration of gamma-glutamyl transpeptidase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin and platelets (PLT) were measured at the beginning and at the end of the treatment. Moreover, the AST/ALT ratio and the NAFLD fibrosis score were examined. RESULTS: A total of 120 patients were randomly assigned to the four groups. ALA and UDCA were safe and well tolerated in the oral daily administration only. AST, ALT, GGT (p < 0.001) showed a significant difference between ALAUDCA and other three groups. Besides, NAFLD fibrosis score underlined a significant reduction (p < 0.04) in the ALAUDCA group, while AST/ALT ratio presented a moderate decline (p > 0.05). CONCLUSION: ALAUDCA therapy reduced AST, ALT, GGT values and improved NAFLD fibrosis score and AST/ALT ratio, especially in patients who were on a hypocaloric diet. These findings will be useful in patient selection in future clinical trials with ALAUDCA in long-term studies.

[Cardiac arrythmias in the elderly]. / Aritmie cardiache in età geriatrica.

The prescription of antiarrhythmic therapy in the elderly depends on the characteristics of clinical symptoms and on the potential morbidity and mortality. Some cardiac arrhythmias may cause bothersome symptoms but do not affect the long-term prognosis. However, other dysrhythmias with mild or no symptoms may be associated with a poor prognosis.

[Non-invasive ventilation in acute respiratory failure. A case report]. / Insufficienza respiratoria acuta trattata con ventilazione meccanica non invasiva.

This is a case of 89 years old patient suffering by chronic obstructive pulmonary disease and affected by acute respiratory failure characterized by hypoxemia and hipercapnia. It is interesting because, comparing oxygen therapy and non invasive ventilation, the best results were reached with the last technique, in an elder patient.

[Prevalence of depression in a geriatric population with metabolic syndrome]. / Prevalenza della depressione in una popolazione geriatrica con sindrome metabolica.

Metabolic Syndrome (Metabolic Syndrome, MS) is associated with many other diseases in the elderly. We have studied a possible correlation between this disorder and depression in a Geriatric Centre. The study was conducted on a random sample of 30 geriatric patients, then divided into 2 groups according to clinical and instrumental diagnostic investigations: 15 patients affected MS according to the criteria of NCEP ATP III, and 15 controls without MS. Then it's administered the Geriatric Depression Scale (GDS). Elaboration of the results it appears statistically significant correlation (t=2.05, p=0.0495) between MS and depression in the elderly.

[Relationship between atrial fibrillation and other cardiovascular risk factors in Alzheimer's disease. New prevention opportunities]. / Fibrillazione atriale e fattori di rischio vascolari nella malattia di Alzheimer. Nuove opportunità di prevenzione.

Dementia is one of the most frequent neurological disorders in the elderly. Several vascular risk factors such as atrial fibrillation have been found to be associated with vascular dementia and Alzheimer's disease. Early interventions at reducing atrial fibrillation may have a strong impact on future incidence and prevalence of cognitive impairment.

[Adverse drug reactions: a common cause of hospitalization of the elderly]. / Reazioni avverse ai farmaci negli anziani.

Aging is associated with various physiological changes and multiple diseases which alter the pharmacological response to a drug in elderly patient. Moreover, elderly people are more sensitive to frequently used drugs like NSAIDs, benzodiazepines, opioids, etc. There is an urgent need to develop better preventive strategies to reduce the burden of adverse drug reactions.