Is mesalazine treatment effective in the prevention of diverticulitis? A review.

Diverticulitis is the most severe form of Diverticular disease (DD). An effective treatment strategy for its prevention has not yet been defined. This review aimed to provide a viewpoint on the role of mesalazine, also note as 5-aminosalicylic acid (5-ASA), in the prevention of diverticulitis. A systematic electronic search of relevant articles was performed using PubMed, Embase, Scopus, and Cochrane. Randomized controlled trials (RCTs), open trials, and retrospective studies, published between January 1999 and January 2020, were identified. Twelve eligible studies that analyzed primary or secondary outcomes of diverticulitis were included. The population included patients with symptomatic uncomplicated diverticular disease (SUDD), or patients with a history of diverticulitis. All studies compared 5-ASA to placebo, rifaximin, or other treatments. Two studies, including 359 patients, assessed the efficacy of 5-ASA in preventing the first appearance of diverticulitis in patients with SUDD. Of these, one showed that 5-ASA was effective, and one did not. Ten studies, including 2.995 patients, assessed the efficacy of 5-ASA treatment in preventing the recurrence of diverticulitis in patients with a history of diverticulitis. Four studies showed that 5-ASA had a certain degree of efficacy. All four RCTs demonstrated that 5-ASA did not significantly reduce the rate of diverticulitis recurrence. In a retrospective trial, 5-ASA was less effective than rifaximin in preventing diverticulitis recurrence. In an open trial, there was no difference between 5-ASA and probiotic treatment. Overall, there is currently conflicting evidence regarding the efficacy of 5-ASA treatment in the prevention of diverticulitis and further RCTs are needed.

Using the cytokinesis-block micronucleus cytome assay to evaluate chromosomal DNA damage in chronic renal patients undergoing bicarbonate haemodialysis and haemodiafiltration.

INTRODUCTION: Chronic Renal Failure (CRF) patients are considered to show genomic instability and are associated with a high risk of both cardiovascular diseases and cancer. We explored DNA damage due to two dialysis treatments in 20 patients undergoing bicarbonate haemodialysis (BD), 20 undergoing haemodiafiltration (HDF) and 40 healthy subjects. METHODS: The cytokinesis-block micronucleus (MN) assay was performed on peripheral blood lymphocytes to evaluate genetic damage. RESULTS: A higher frequency of MN in the dialysis groups compared with controls was found. The results do not show a relationship between genetic instability and the type, frequency and duration of haemodialysis. The average BD and HDF treatment time was respectively 3.8 ± 6.3 and 3.7 ± 3.9 yrs. CAT and scintigraphy was independently correlated with high levels of MN. CONCLUSIONS: Overall, the frequency of MN in CRF patients undergoing dialysis therapy was observed to be higher. Further studies need to be performed on a larger number of patients and for a longer period.

Interactions between commonly used left and right ventricular function indexes in stable patients.

AIM: Aim of this study was to better understand interactions between left ventricular (LV) and right ventricular (RV) systolic and diastolic function echocardiographic indexes in stable cardiovascular diseased patients and in subjects with cardiovascular risk factors. METHODS: The study enrolled 683 stable patients who were submitted to standard transthoracic echocardiography with evaluation of left ventricular ejection fraction (LVEF) (Simpson biplane method), LV and RV systolic peak on Doppler tissue imaging (LVSys and RVSys), tricuspid annulus plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and multiparameter evaluation of LV and RV diastolic function utilizing E and A peak, their ratio, E peak deceleration time, E' and A' peak on Doppler tissue imaging, their ratio, and E/E' ratio. RESULTS: Part of the considered indexes had interactions but only LVEF and TAPSE were related to all the others (LVEF P<0.001 with all the considered parameters; TAPSE P<0.001 with all parameters except with PASP=0.003). Unexpectedly TAPSE seems to have, such as LVEF, a pivotal position among LV and RV function. CONCLUSION: The study demonstrates the existence of interactions between LV and RV function indexes; these results may be considered as a piece of evidence in favor of heart seen as a single structure.

Links between metabolic syndrome and cardiovascular autonomic dysfunction.

BACKGROUND: Type 2 diabetes (T2D) might occur within metabolic syndrome (MbS). One of the complications of T2D is an impaired (imp) cardiovascular autonomic function (CAF). AIMS: In subjects with T2D and age ≤ 55 years, the prevalence of impCAF and its relationship with BMI, waist, HbA(1c) values, MbS, hypertension, and family history of T2D and/or hypertension were analysed. METHODS: 180 subjects consecutively undergoing a day hospital for T2D were studied. The IDF criteria were used to diagnose MbS. To detect impCAF, 5 tests for the evaluation of CAF were performed with Cardionomic (Meteda, Italy). Univariate and multivariate analyses were performed. RESULTS: The prevalence of impCAF and MbS were 33.9% and 67.8%, respectively. Among diabetics with impCAF, 86.9% had MbS. ImpCAF was significantly associated with MbS, overweight, and HbA(1c) > 7%. Both logistic (P = 0.0009) and Poisson (P = 0.0113) models showed a positive association between impCAF and MbS. The degree of ImpCAF showed a positive linear correlation with BMI and HbA(1c) values. CONCLUSIONS: The study demonstrates that glycaemic control and overweight influence CAF and that T2D + MbS is more strongly associated with impCAF than isolated T2D. We suggest that MbS not only increases the cardiovascular risk of relatively young subjects with T2D but is also associated with impCAF.

Nateglinide provides tighter glycaemic control than glyburide in patients with Type 2 diabetes with prevalent postprandial hyperglycaemia.

AIMS: Postprandial hyperglycaemia in patients with Type 2 diabetes mellitus has been linked to the development of cardiovascular disease. This study compared the effects of mealtime (thrice-daily) nateglinide with once-daily glyburide on postprandial glucose levels in patients with Type 2 diabetes and postprandial hyperglycaemia. METHODS: Patients with Type 2 diabetes aged ≥ 21 years with 2-h postprandial glucose levels ≥ 11.1 mmol/l, HbA(1c) of 6.5-8.5% (48-69 mmol/mol) and BMI of 22-30 kg/m(2) were randomized to 6 weeks' double-blind treatment with nateglinide 120 mg three times daily prior to meals, or glyburide 5 mg once daily before breakfast. The primary endpoint was the baseline-adjusted change in plasma glucose from preprandial (fasting plasma glucose) to 2-h postprandial glucose levels (2-h postprandial glucose excursion) at 6 weeks. RESULTS: Patients were randomized to nateglinide (n = 122) or glyburide (n = 110). The treatment groups were similar in terms of age, gender, BMI, fasting plasma glucose, 2-h postprandial glucose and HbA(1c). At endpoint, nateglinide recipients had significantly greater reductions than those receiving glyburide in both the 2-h (-2.4 vs. -1.6 mmol/l; P = 0.02) and 1-h (-1.7 vs. -0.9 mmol/l; P = 0.016) postprandial glucose excursions. Adverse events, most commonly symptomatic hypoglycaemia, were reported in 26% of recipients of glyburide and 22% of recipients of nateglinide. Episodes of suspected mild hypoglycaemia were reported in 24% of recipients of glyburide and 10% of recipients of nateglinide. CONCLUSIONS: Nateglinide leads to greater reductions in postprandial glucose excursions and is associated with a lower risk of hypoglycaemia than glyburide in this selected population of patients with Type 2 diabetes.

[Biological risk in non-clinical biological and chemical laboratories]. / II rischio biologico nei laboratori biologici e chimici non sanitari.

The D.Lgs 626/94, regarding the improvement of workers safety in the workplace, introduces the necessity of the biological hazards assessment. In case of not sanitary chemical and biological laboratories, workers are subject to biological hazards due to potential exposure, because many biological agents could be present in the samples to be analysed, and also for deliberated use of micro organisms. However the assessment of the air and surfaces monitoring results in such environment is still difficult without Guidelines that indicate levels of acceptable exposure and contamination, and reference limits in order to judge "safe" the environment. The following report describes a microbiological monitoring into the Laboratories of HERA SpA and wants to underline the need to produce Guidelines dedicated to these particular workplaces environment, in order to standardize air quality sampling procedures and results assessment.

Homocysteine in chronic renal failure in relation to renal anemia and to oxidative stress parameters 4-hydroxynonenal and malondialdehyde.

Homocysteine serum levels were measured in patients with end-stage renal disease in relation to severity of renal anemia and oxidative stress parameters such as 4-hydroxynonenal (HNE) and malondialdehyde (MDA). The predialytic homocysteine serum levels of the patients are five times as high as in healthy controls. It was found that homocysteine does not correlate to hemoglobin concentration and to oxidative stress, but rather to parameters of nutrition status such as albumine concentration and protein catabolic rate. The homocysteine accumulation represents a cardiovascular risk factor which is statistically independent of oxidative stress, but dependent on nutrition or energy status in patients with chronic renal failure.

[Reconstructive surgery in a case of aneurysm of the ascending aorta and aortic valve insufficiency]. / Chirurgia ricostruttiva in un caso di aneurisma dell'aorta ascendente ed insufficienza valvolare aortica.

The authors report the case of a young patient with an aneurysm of the ascending aorta and moderate aortic incompetence, who underwent a conservative operation at our institution. Dilatation of the sinotubular junction, particularly at the level of the non-coronary sinus of the aortic valve with loss of coaptation between the corresponding leaflet and the two coronary leaflets, was identified at the time of surgery as major cause of valve insufficiency. During surgery, the dilated ascending aorta and pathologic aortic sinus were replaced with a 26 Hemashield prosthesis tailored according to the David guidelines. An intraoperative post-repair transesophageal echo exam showed that the aortic valve appeared to be working competently. The post-operative course was uneventful and at one year, an echographic check of the aortic valve showed that it was fully competent, with normal leaflet motion. Conservative surgery can be a good option in selected patients with ascending aortic aneurysm and aortic valve insufficiency.

Early and intermediate-term (10-year) results of surgery for univentricular atrioventricular connection ("single ventricle").

One hundred sixteen patients with "single ventricle" underwent 147 operations between 1967 and July 1982, with an actuarial survival rate (hospital deaths are included in all actuarials) at 10 years of 66%. One hospital death (2%) occurred after 45 primary "classic" shunting operations, and the 10-year actuarial survival was 85%. There were no hospital deaths after atrial septectomy or pulmonary artery banding, and the 10-year actuarial survival rate after these as initial procedures was 76% and 74%, respectively. Thirteen of 36 patients (36%) who underwent ventricular septation between 1967 and November 1, 1983, died in hospital. Among the 13 with the ideal morphologic characteristics of double inlet left ventricle without major associated cardiac anomalies, and without the need for valve replacement or a valved extracardiac conduit, there were no hospital deaths and a late survival rate of 77% (confidence limits 59 to 90%). Sixteen of 73 patients (22%), including those with tricuspid atresia, undergoing the Fontan-type procedure between 1967 and November 1, 1983, died in hospital. Multivariate analysis indicates that cardiac morphologic patterns other than tricuspid atresia are risk factors for hospital death in this group. The 10-year actuarial survival rate among the 73 patients was 71%, but only 1 death (associated with reoperation) occurred more than 2 months after operation. Ninety-seven percent of all surviving patients are in New York Heart Association functional class I or II, as are 100% of those who underwent septation and 96% of those who underwent the Fontan-type procedure.

Duration of residual B-cell function in maturity-onset diabetes.

In order to evaluate factors influencing the duration of residual B-cell function in maturity-onset diabetics we investigated 104 patients (age 60 +/- 11 years) with a mean duration of disease of 11.3 +/- 8.7 years by measuring fasting C-peptide (FCP) and fasting blood glucose levels (FBG), C-peptide increment after a standardized breakfast and both mean diurnal plasma glucose (MBG) and mean diurnal C-peptide levels (MCP). C-peptide levels were found to be reciprocally dependent on both the age at onset (positively) and, conversely, on the duration of diabetes (y = 0.75 + 0.026x1-0.049x2; R = 0.52, t1 = 2.76, t2 = -4.08). In particular, the present B-cell secretory capacity appears to be lower the younger the patients were at onset, thus suggesting that inherent impairment of B-cell capacity may play a crucial role in determining age at onset of type II diabetes and thus the duration of their residual B-cell function. Moreover, by analyzing separately the data from patients treated with insulin and oral agents respectively, we found that the influence of the duration of the disease on the rate on B-cell exhaustion is unrelated to the mode of treatment even though B-cell capacity at onset appears to be more severely reduced in insulin-treated subjects who, apart from anything else, were younger at onset.(ABSTRACT TRUNCATED AT 250 WORDS)

Double-blind study of the analgesic effect of indoprofen (K 4277).

In a double-blind study, indoprofen was superior to placebo in decreasing pain in patients with primary and metastatic cancer and with neuralgia. A single oral dose of 200 mg was more active than a 100-mg dose. The preferences of patients proved to be a more sensitive parameter in this study than scores of pain intensity, pain relief, and other related measurements (SPID, TOTPAR, and Peak PID).