The goals of global vaccination are to control,eliminate,or eradicate infectious diseases in a sustainable way that strengthens public health systems.Although the use of vaccines is essential for the control of epidem...The goals of global vaccination are to control,eliminate,or eradicate infectious diseases in a sustainable way that strengthens public health systems.Although the use of vaccines is essential for the control of epidemics,the vaccines against coronavirus disease 2019(COVID-19)proved to be inadequate to end the pandemic and thus are considered incomplete.These vaccines failed to prevent infection,so their primary purpose has been shifted to prevent severe disease and reduce hospitalizations and deaths.Therefore,we believe that all the strategies available to reduce transmission,hospitalizations and deaths due to COVID-19 will be put in place.It is reported that uncontrolled inflammation and thrombosis are the principal mechanisms for aggravation and death in patients with COVID-19.Unlike corticosteroids that should not be administered at the beginning of the symptoms for their immunosuppressive action,which could worsen the evolution of the disease,the usefulness of non-steroidal anti-inflammatory drugs in the early at-home treatment of the disease is becoming evident.展开更多
We report the clinical case of a 40-year-old Italian woman, who soon after her booster vaccination with mRNA-1273 after the two previous vaccinations with BNT162b2, developed severe headache, high fever, and Musculo-s...We report the clinical case of a 40-year-old Italian woman, who soon after her booster vaccination with mRNA-1273 after the two previous vaccinations with BNT162b2, developed severe headache, high fever, and Musculo-skeletal pain. She went to the emergency department, where computerized tomography (CT) scans of chest and brain were performed, resulting in both negative for pathologic findings. On the contrary, white blood count was strongly lowered and D-dimer severely elevated. She improved after treatment with enoxaparin and the blood analyses returned in the normal range after ten days. This case supports the hypothesis that COVID-19 vaccines could increase blood clotting in some predisposed subjects. Therefore, we believe that robust and well-designed clinical trials, considering the evaluation of D-dimer levels, should be performed to eliminate any doubts on this issue.展开更多
Berberine(BBR) is a natural alkaloid isolated from the Coptis Chinensis.While this plant has been used in Ay-urvedic and Chinese medicine for more than 2500 years,interest in its effects in metabolic and cardiovascula...Berberine(BBR) is a natural alkaloid isolated from the Coptis Chinensis.While this plant has been used in Ay-urvedic and Chinese medicine for more than 2500 years,interest in its effects in metabolic and cardiovascular disease has been growing in the Western world in the last decade.Many papers have been published in these years reporting beneficial effects in carbohydrate and lip-id metabolism,endothelial function and the cardiovascu-lar system.In this review,we report a detailed analysis of the scientific literature regarding this topic,describing the effects and the underlying mechanisms of BBR on carbohydrate and lipid metabolism,endothelial function and the cardiovascular system.展开更多
AIM:To test the efficacy of a proprietary nutraceutical combination in reducing insulin resistance associated with the metabolic syndrome(MetS).METHODS:Sixty-four patients with MetS followed at a tertiary outpatient c...AIM:To test the efficacy of a proprietary nutraceutical combination in reducing insulin resistance associated with the metabolic syndrome(MetS).METHODS:Sixty-four patients with MetS followed at a tertiary outpatient clinic were randomly assigned to receive either placebo or a proprietary nutraceutical combination(AP)consisting of berberine,policosanol and red yeast rice,in a prospective,double-blind,placebo-controlled study.Evaluations were performed at baseline and after 18 wk of treatment.The homeostasis model assessment of insulin resistance(HOMAIR)index was the primary outcome measure.Secondary endpoints included lipid panel,blood glucose and insulin fasting,after a standard mixed meal and after an oral glucose tolerance test(OGTT),ow-mediated dilation(FMD),and waist circumference.RESULTS:Fifty nine patients completed the study,2 withdrew because of adverse effects.After 18 wk there was a signif icant reduction in the HOMA-IR index in the AP group compared with placebo(ΔHOMA respectively-0.6 ± 1.2 vs 0.4 ± 1.9;P < 0.05).Total and low density lipoprotein cholesterol also significantly decreased in the treatment arm compared with placebo(Δlow density lipoprotein cholesterol-0.82 ± 0.68 vs-0.13 ± 0.55 mmol/L;P < 0.001),while triglycerides,high density lipoprotein cholesterol,and the OGTT were not affected.In addition,there were significant reductions in blood glucose and insulin after the standard mixed meal,as well as an increase in FMD(ΔFMD 1.9 ± 4.2 vs 0 ± 1.9 %;P < 0.05)and a significant reduction in arterial systolic blood pressure in the AP arm.CONCLUSION:This short-term study shows that AP has relevant beneficial effects on insulin resistance and many other components of MetS.展开更多
Insulin resistance is a clinical condition characterized by a decrease in sensitivity and responsiveness to the metabolic actions of insulin, so that a given concentration of insulin produces a less-than-expected biol...Insulin resistance is a clinical condition characterized by a decrease in sensitivity and responsiveness to the metabolic actions of insulin, so that a given concentration of insulin produces a less-than-expected biological effect. As a result, higher levels of insulin are needed to maintain normal glucose tolerance. Hyperinsulinemia, indeed, is one of the principal characteristics of insulin resistance states. This feature is common in several pathologic conditions, such as type 2 diabetes, obesity, and dyslipidemia, and it is also a prominent component of hypertension, coronary heart disease, and atherosclerosis. The presence of endothelial dysfunction, related to insulin resistance, plays a key role in the development and progression of atherosclerosis in all of these disorders. Insulin resistance represents the earliest detectable abnormality in type 2 diabetes, and is one of the major underlying mechanisms of hypertension and cardiovascular diseases. Its early detection could be of great importance, in order to set a therapeutic attack and to counteract the higher risk of diabetes and cardiovascular diseases.展开更多
AIM:To evaluate efficacy and tolerability of the combination valsartan plus hydrochlorothiazide(160 mg and 25 mg daily,respectively) in young-middle aged males with high-normal blood pressure(BP) or firstdegree arteri...AIM:To evaluate efficacy and tolerability of the combination valsartan plus hydrochlorothiazide(160 mg and 25 mg daily,respectively) in young-middle aged males with high-normal blood pressure(BP) or firstdegree arterial hypertension with evidence of target organ damage.METHODS:Twenty males with high-normal BP or first-degree hypertension associated with left ventricular concentric remodeling and/or increased aortic stiffness were enrolled.BP at rest and during exercise,and echocardiographic parameters of the left ventricle(LV),were evaluated at baseline and after 3 mo of treatment.The effects of treatment on aortic stiffness,metabolic parameters,renal and erectile function were also assessed.RESULTS:BP was significantly reduced by treatment both at rest(P < 0.001) and during exercise(P < 0.001),and 85% of patients achieved BP normalization(< 130/85 mmHg).Doppler echocardiography showed a significant reduction of LV mass(P < 0.005).LV hypertrophy was identified in 70% of subjects at baseline and in 5% after 3 mo of treatment.The ratio of early(E) to late(A) trans-mitral diastolic flow velocity increased,(P < 0.05),the relative wall thickness decreased(P < 0.05) and the left ventricular relaxation time shortened(P < 0.005).The left atrial diameter(P < 0.05) and the aortic diameter(P < 0.05) and stiffness(P < 0.005) also decreased.CONCLUSION:The full-dose combination of valsartan plus hydrochlorothiazide produced optimal BP control with regression of target organ damage,already after 3 mo,without relevant side effects.展开更多
We report the long-term follow-up of 3 cases of severe idiopathic pulmonary arterial hypertension,in whom tadalafil plus sitaxentan combination therapy improved the clinical condition and exercise performance without ...We report the long-term follow-up of 3 cases of severe idiopathic pulmonary arterial hypertension,in whom tadalafil plus sitaxentan combination therapy improved the clinical condition and exercise performance without any relevant adverse event.展开更多
The world pandemic due to coronavirus disease 2019,known as COVID-19,embodies a high rate of disease transmission that causes a critical hospitalization overload.As of May 15,2020,the disease has been the cause of mor...The world pandemic due to coronavirus disease 2019,known as COVID-19,embodies a high rate of disease transmission that causes a critical hospitalization overload.As of May 15,2020,the disease has been the cause of more than 4 million infections and more than 280000 deaths all over the world.At the beginning,we underestimated the disease;now,we have sufficient information and it is clear that it is not just a respiratory disease.In fact,if a prompt treatment is not initiated,the disease may evolve towards an abnormal immune response and cytokine storm with an important thrombophilic pattern.Therefore,we think that while waiting for certainties to be established by evidence-based medicine,it is not ethical to not try off-label therapies for some of the well-known drugs,as they could have some efficacy based on their mechanisms of action.展开更多
文摘The goals of global vaccination are to control,eliminate,or eradicate infectious diseases in a sustainable way that strengthens public health systems.Although the use of vaccines is essential for the control of epidemics,the vaccines against coronavirus disease 2019(COVID-19)proved to be inadequate to end the pandemic and thus are considered incomplete.These vaccines failed to prevent infection,so their primary purpose has been shifted to prevent severe disease and reduce hospitalizations and deaths.Therefore,we believe that all the strategies available to reduce transmission,hospitalizations and deaths due to COVID-19 will be put in place.It is reported that uncontrolled inflammation and thrombosis are the principal mechanisms for aggravation and death in patients with COVID-19.Unlike corticosteroids that should not be administered at the beginning of the symptoms for their immunosuppressive action,which could worsen the evolution of the disease,the usefulness of non-steroidal anti-inflammatory drugs in the early at-home treatment of the disease is becoming evident.
文摘We report the clinical case of a 40-year-old Italian woman, who soon after her booster vaccination with mRNA-1273 after the two previous vaccinations with BNT162b2, developed severe headache, high fever, and Musculo-skeletal pain. She went to the emergency department, where computerized tomography (CT) scans of chest and brain were performed, resulting in both negative for pathologic findings. On the contrary, white blood count was strongly lowered and D-dimer severely elevated. She improved after treatment with enoxaparin and the blood analyses returned in the normal range after ten days. This case supports the hypothesis that COVID-19 vaccines could increase blood clotting in some predisposed subjects. Therefore, we believe that robust and well-designed clinical trials, considering the evaluation of D-dimer levels, should be performed to eliminate any doubts on this issue.
文摘Berberine(BBR) is a natural alkaloid isolated from the Coptis Chinensis.While this plant has been used in Ay-urvedic and Chinese medicine for more than 2500 years,interest in its effects in metabolic and cardiovascular disease has been growing in the Western world in the last decade.Many papers have been published in these years reporting beneficial effects in carbohydrate and lip-id metabolism,endothelial function and the cardiovascu-lar system.In this review,we report a detailed analysis of the scientific literature regarding this topic,describing the effects and the underlying mechanisms of BBR on carbohydrate and lipid metabolism,endothelial function and the cardiovascular system.
文摘AIM:To test the efficacy of a proprietary nutraceutical combination in reducing insulin resistance associated with the metabolic syndrome(MetS).METHODS:Sixty-four patients with MetS followed at a tertiary outpatient clinic were randomly assigned to receive either placebo or a proprietary nutraceutical combination(AP)consisting of berberine,policosanol and red yeast rice,in a prospective,double-blind,placebo-controlled study.Evaluations were performed at baseline and after 18 wk of treatment.The homeostasis model assessment of insulin resistance(HOMAIR)index was the primary outcome measure.Secondary endpoints included lipid panel,blood glucose and insulin fasting,after a standard mixed meal and after an oral glucose tolerance test(OGTT),ow-mediated dilation(FMD),and waist circumference.RESULTS:Fifty nine patients completed the study,2 withdrew because of adverse effects.After 18 wk there was a signif icant reduction in the HOMA-IR index in the AP group compared with placebo(ΔHOMA respectively-0.6 ± 1.2 vs 0.4 ± 1.9;P < 0.05).Total and low density lipoprotein cholesterol also significantly decreased in the treatment arm compared with placebo(Δlow density lipoprotein cholesterol-0.82 ± 0.68 vs-0.13 ± 0.55 mmol/L;P < 0.001),while triglycerides,high density lipoprotein cholesterol,and the OGTT were not affected.In addition,there were significant reductions in blood glucose and insulin after the standard mixed meal,as well as an increase in FMD(ΔFMD 1.9 ± 4.2 vs 0 ± 1.9 %;P < 0.05)and a significant reduction in arterial systolic blood pressure in the AP arm.CONCLUSION:This short-term study shows that AP has relevant beneficial effects on insulin resistance and many other components of MetS.
文摘Insulin resistance is a clinical condition characterized by a decrease in sensitivity and responsiveness to the metabolic actions of insulin, so that a given concentration of insulin produces a less-than-expected biological effect. As a result, higher levels of insulin are needed to maintain normal glucose tolerance. Hyperinsulinemia, indeed, is one of the principal characteristics of insulin resistance states. This feature is common in several pathologic conditions, such as type 2 diabetes, obesity, and dyslipidemia, and it is also a prominent component of hypertension, coronary heart disease, and atherosclerosis. The presence of endothelial dysfunction, related to insulin resistance, plays a key role in the development and progression of atherosclerosis in all of these disorders. Insulin resistance represents the earliest detectable abnormality in type 2 diabetes, and is one of the major underlying mechanisms of hypertension and cardiovascular diseases. Its early detection could be of great importance, in order to set a therapeutic attack and to counteract the higher risk of diabetes and cardiovascular diseases.
文摘AIM:To evaluate efficacy and tolerability of the combination valsartan plus hydrochlorothiazide(160 mg and 25 mg daily,respectively) in young-middle aged males with high-normal blood pressure(BP) or firstdegree arterial hypertension with evidence of target organ damage.METHODS:Twenty males with high-normal BP or first-degree hypertension associated with left ventricular concentric remodeling and/or increased aortic stiffness were enrolled.BP at rest and during exercise,and echocardiographic parameters of the left ventricle(LV),were evaluated at baseline and after 3 mo of treatment.The effects of treatment on aortic stiffness,metabolic parameters,renal and erectile function were also assessed.RESULTS:BP was significantly reduced by treatment both at rest(P < 0.001) and during exercise(P < 0.001),and 85% of patients achieved BP normalization(< 130/85 mmHg).Doppler echocardiography showed a significant reduction of LV mass(P < 0.005).LV hypertrophy was identified in 70% of subjects at baseline and in 5% after 3 mo of treatment.The ratio of early(E) to late(A) trans-mitral diastolic flow velocity increased,(P < 0.05),the relative wall thickness decreased(P < 0.05) and the left ventricular relaxation time shortened(P < 0.005).The left atrial diameter(P < 0.05) and the aortic diameter(P < 0.05) and stiffness(P < 0.005) also decreased.CONCLUSION:The full-dose combination of valsartan plus hydrochlorothiazide produced optimal BP control with regression of target organ damage,already after 3 mo,without relevant side effects.
文摘We report the long-term follow-up of 3 cases of severe idiopathic pulmonary arterial hypertension,in whom tadalafil plus sitaxentan combination therapy improved the clinical condition and exercise performance without any relevant adverse event.
文摘The world pandemic due to coronavirus disease 2019,known as COVID-19,embodies a high rate of disease transmission that causes a critical hospitalization overload.As of May 15,2020,the disease has been the cause of more than 4 million infections and more than 280000 deaths all over the world.At the beginning,we underestimated the disease;now,we have sufficient information and it is clear that it is not just a respiratory disease.In fact,if a prompt treatment is not initiated,the disease may evolve towards an abnormal immune response and cytokine storm with an important thrombophilic pattern.Therefore,we think that while waiting for certainties to be established by evidence-based medicine,it is not ethical to not try off-label therapies for some of the well-known drugs,as they could have some efficacy based on their mechanisms of action.
