The effect of multifactorial lifestyle interventions on cardiovascular risk factors: a systematic review and meta-analysis of trials conducted in the general population and high risk groups.

Cardiovascular diseases (CVDs) are the leading cause of premature mortality and disability accounting for one third of all deaths worldwide with considerable impacts on economics and on the quality of life. The evidence suggests that a multifactorial lifestyle intervention might have a role in the CVDs risk reduction, especially in the risk populations, nonetheless the effects on modifiable CVDs risk factors have not been completely explored. Our work aimed at evaluating the impact of multifactorial lifestyle interventions on cardiovascular risk modification, both in the general and risk population. A systematic review and meta-analysis of the randomized controlled trials (RCTs) were performed by including articles published up to April 16th, 2016. RCTs were selected if they had investigated the impact of multifactorial lifestyle interventions on lipids, blood pressure, BMI and waist circumference, smoking and physical activity. Changes in the level of modifiable risk factors from baseline were evaluated. Search resulted in 19,847 studies, of which 36 were included in the analysis. Compared to a usual care, the multifactorial lifestyle intervention is able to lower the blood pressure, total cholesterol, BMI and waist circumference, at both 6 and 12months, and to increase physical activity at 12months. Better results were obtained in primary prevention and in moderate and high risk groups. Multifactorial lifestyle interventions clearly represent a valid tool for reducing the cardiovascular risk factors and should be implemented in the risk groups and in primary prevention.

Current usefulness of aspiration cytology (FNAC) in the head and neck diagnosis.

BACKGROUND: Fine Needle Aspiration Cytology (FNAC) is a well established and widely used method for both a preliminary and sometime final non-invasive pathologic diagnosis. FNAC is a simple and inexpensive diagnostic tool and should represent the standard of care in developing and resource-poor countries while maintaining its diagnostic usefulness in developed and advanced ones. METHODS: The concordance between preoperative FNAC and final histology was evaluated in 168 patients operated on at the Otorhinolaryngology Unit, "A. Murri" Hospital, Fermo (Italy), from January 2012 to October 2016, including thyroid cases, salivary glands and cervical masses. RESULTS: The percentages of correct diagnosis provided by FNAC were good in all groups of pathologies and in accordance with the mean data of the literature. In particular the kappa statistic for the degree of agreement between FNAC and definitive histology (good > 0.6 and excellent > 0.8) was 0.74 for the thyroid, 0.83 for the parotid and 0.71 for both the submandibular and the cervical masses. DISCUSSION: Thy 3 group is still the most challenging for a successful FNAC diagnostic prediction. Especially in the developed and advanced countries, both the immediate review of the smear with its repetition, if needed, and the aspiration performed under CT/MRI guidance, when necessary, seem to further empower FNAC diagnostic resolution and should be pursued. Being routinely used for more than 40 years, FNAC is still a valuable and cost-effective tool to distinguish between cases that don't need any treatment, cases to be treated medically and those that require surgical excision. In the Authors' opinion every institution should periodically review its data in order to monitor and assess the accuracy of its diagnostic activity.

Knowledge, attitudes and behaviors of the Italian population towards Neisseria meningitidis, Streptococcus pneumoniae and HPV diseases and vaccinations: A cross-sectional multicentre study.

OBJECTIVES: This study addressed knowledge of Streptococcus pneumoniae, Neisseria meningitidis and human papillomavirus (HPV), and attitudes and behaviours towards vaccines against them. STUDY DESIGN: This is a cross-sectional, multicentre study. METHODS: Data were collected through a questionnaire administered to 530 adults who accessed four Departments of Prevention of the Italian National Health Service in 2013. RESULTS: Less than 50% of people gave the right answer to all the questions concerning the three diseases, but 96.2%, 94% and 92.7% agreed with the importance of vaccination against N. meningitidis, S. pneumoniae and HPV, respectively, and 58.4% expressed own willingness to have their children vaccinated with N. meningitidis B vaccine. The attitude towards vaccination was more positive in women for N. meningitidis and in people having children for HPV. Furthermore, individuals giving correct answers to all knowledge items were more in favour of both HPV and S. pneumoniae vaccination. A total of 68.8%, 82.6% and 84.5% of respondents vaccinated their own children against N. meningitidis C, S. pneumoniae and HPV, respectively. About 50% of the respondents reported paediatricians' or other health professionals' recommendations as the main reason for vaccination. CONCLUSIONS: Vaccinations may be promoted through actions aimed at increasing citizens' knowledge. Health professionals should be educated to actively provide information on vaccinations in a clear, comprehensive and effective way.

[Primary aorto-enteric fistula]. / Fistola aorto-enterica primitiva.

Aorto-enteric fistula, i.e. communication between the aorta and the digestive tract, is a clinical condition that usually appears in patients who have already been submitted to aneurismectomy. Primary fistula, in patients not submitted to surgical treatment, is uncommon. The authors describe a case of primary aorto-enteric fistula which was diagnosed and operated on early, with a favourable outcome. The critical analysis of the authors' experience and the literature data stress that an early diagnosis and suitable therapy can reduce mortality.

Factors affecting Department of Defense patient satisfaction in a military emergency department.

This descriptive, correlational study was conducted to explore factors (nurses and staff, doctors, waiting and convenience issues, and tests and treatments) and specific interpersonal behaviors affecting Department of Defense patient satisfaction in a military emergency department (ED). Data from a random sample of 534 patients using a mail-back questionnaire (N = 178) revealed that military patients who perceived the staff to have treated them courteously, taken their problems seriously, and paid attention to them during their stay were more satisfied with their military ED encounter. Patient satisfaction, expressed as likelihood to recommend the facility, was independent of major demographic characteristics such as age and sex. Our findings suggest that a patient's perception of the ED encounter, particularly the interactions between the patient and staff, ultimately influence satisfaction. Significant improvements in patient satisfaction might be realized if quality improvement efforts focus on providing ED staff specific training in interpersonal interactions.

Squamous cell tumors and ocular prostheses.

Conjunctival squamous cell carcinoma is an infrequent tumor. It has been reported to occur in association with actinic damage and chronic irritation. To the authors' knowledge, however, this tumor has not been reported secondary to poorly fitting ocular prostheses. Two patients were studied in whom conjunctival squamous cell carcinoma had developed. In both instances, the patient had been enucleated and fitted with an ocular prosthesis more than 40 years before tumor development. Histopathologic evaluation of each tumor revealed its squamous cell origin. In one of the patients, the tumor was found to be metastatic to the ipsilateral parotid gland, an uncommon finding. The authors attempted to identify risk factors that may have contributed to the development of these tumors. Aside from the poor fit of the prostheses, neither patient had significant risk factors for the development of conjunctival squamous cell carcinoma. It is concluded that a new, sanguineous conjunctival discharge or focal eyelid swelling after years of prosthetic wear may not be due to mechanical irritation alone. The onset of these symptoms, especially years after the initial fitting of an ocular prosthesis, should prompt a thorough investigation of its cause.

Herpes simplex blepharoconjunctivitis presenting as complete acquired ankyloblepharon.

PURPOSE: A 90-year-old woman was referred to us with a 1-month history of progressively worsening blepharoconjunctivitis. She had a complete acquired ankyloblepharon of the right lids, which resulted in the appearance of a right upper lid abscess on computed tomography. METHODS: Blepharotomy with separation and debridement of the lid margins was performed. RESULTS: Cultures were positive only for herpes simplex virus, type II. CONCLUSIONS: Herpes simplex blepharoconjunctivitis may take many clinical forms. Our patient's severe manifestations led to the clinical and radiologic appearance of preseptal cellulitis with a right upper lid abscess.

Traumatic cataract and Wieger's ligament.

The objective of this study was to determine the relationship between posterior subcapsular contusion cataract and Wieger's ligament. Two clinical cases of traumatic cataract, occurring in young patients, were analyzed. In neither case was there evidence of penetrating or perforating injuries to the globe. During cataract extraction a smooth oval defect in the posterior capsule was observed; however, there was no evidence of intraoperative capsular damage. The outline of the defect was consistent with the border of Wieger's ligament. It appears that blunt trauma avulsed this region of lens capsule, resulting in these findings.

Plasmacytoma of the eye and orbit.

BACKGROUND: Plasmacytomas of the ocular and adnexal tissue are rare. The variation in their clinical manifestations and potential association with multiple myeloma are not well appreciated. METHODS: We reviewed the clinical features and laboratory data of five cases of plasmacytoma involving the eye and orbit. RESULTS: Plasmacytomas involved the conjunctiva in one case, the orbit in three cases, and the iris in one case. Plasmacytoma was the solitary plasma cell neoplasm in a patient with a conjunctival lesion and another patient with an orbital lesion. Two other patients who developed plasmacytomas of the orbit and iris, respectively, had a known history of multiple myeloma. An orbital plasmacytoma preceded the onset of systemic plasma cell neoplasia in the final patient. CONCLUSION: Plasmacytomas of the eye and orbit are rare. They may or may not be associated with multiple myeloma.

Effect of Lisuride on serum prolactin levels during puerperium.

A new semisynthetic ergot derivative, Lisuride, has been administered to 40 women who wanted to have lactation inhibited. Purpose of the study was to evaluate the drug's effect on serum PRL levels. Treatment was carried out for 7 days with daily doses of 300 or 600 microgram. Lisuride lowered PRL levels, and the decrease was significantly more marked for the 600 microgram dose.