Ecotoxicological and pathological research on Grampus griseus (Cuvier, 1812) (Risso's dolphins) is scarce both globally and in the Mediterranean Sea. This species has been classified as “Vulnerable” ...by the International Union for Conservation of Nature (IUCN) in the Mediterranean Sea.
To evaluate the presence of “persistent organic pollutants” (POPs), especially organochlorine compounds (OCs), in the animals, chemical analyses were performed on tissues and organs of Risso's dolphin stranded along the Italian coasts between 1998 and 2021. Toxic contaminants such as hexachlorobenzene (HCB), polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane and its metabolites (DDTs) were examined in the blubber, liver, muscle, and brain of 20 animals, and data was correlated with sex, age, and stranding locations.
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•Analysis of the concentrations of POPs in Grampus griseus stranded along the Italian coasts in the last 23 years•Highest recorded concentrations of HCB, DDTs and PCBs found in Risso's dolphins•Use of blubber of stranded individuals to assess toxicity levels in the Mediterranean Sea•Comparison with studies carried out on individuals stranded in other parts of the world•Increased knowledge about the toxicological status of this species in the Mediterranean Sea
Abstract Purpose Screening of Cushing Syndrome (CS) and Mild Autonomous Cortisol Secretion (MACS) in hypertensive patients is crucial for proper treatment. The aim of the study was to investigate ...screening and management of hypercortisolism among patients with hypertension in Italy. Methods A 10 item-questionnaire was delivered to referral centres of European and Italian Society of Hypertension (ESH and SIIA) in a nationwide survey. Data were analyzed according to type of centre (excellence vs non-excellence), geographical area, and medical specialty. Results Within 14 Italian regions, 82 centres (30% excellence, 78.790 patients during the last year, average 600 patients/year) participated to the survey. Internal medicine (44%) and cardiology (31%) were the most prevalent medical specialty. CS and MACS were diagnosed in 313 and 490 patients during the previous 5 years. The highest number of diagnoses was reported by internal medicine and excellence centres. Screening for hypercortisolism was reported by 77% in the presence of specific features of CS, 61% in resistant hypertension, and 38% in patients with adrenal mass. Among screening tests, the 24 h urinary free cortisol was the most used (66%), followed by morning cortisol and ACTH (54%), 1 mg-dexamethasone suppression test (49%), adrenal CT or MRI scans (12%), and late night salivary cortisol (11%). Awareness of referral centres with expertise in management of CS was reported by 67% of the participants, which reduced to 44% among non-excellence centres. Conclusions Current screening of hypercortisolism among hypertensive patients is unsatisfactory. Strategies tailored to different medical specialties and type of centres should be conceived.
Reduced myocardial mechano-energetic efficiency (MEE), estimated as stroke volume/heart rate ratio per g of left ventricular (LV) mass (LVM), and expressed in μl s
g
(MEEi), is a strong predictor of ...cardiovascular (CV) events, independently of LV hypertrophy and other confounders, including type II diabetes (DM). Decreased MEEi is more frequent in patients with diabetes. In the present analysis we evaluated the interrelation among MEEi, DM and metabolic syndrome (MetS) in the setting of arterial hypertension. Hypertensive patients from the Campania Salute Network, free of prevalent CV disease and with ejection fraction >50% (n=12 503), were analysed. Coexistence of MetS and DM was ordinally categorized into 4 groups: 8235 patients with neither MetS nor DM (MetS-/DM-); 502 without MetS and with DM (MetS-/DM+); 3045 with MetS and without DM (MetS+/DM-); and 721 with MetS and DM (MetS+/DM+). After controlling for sex, systolic blood pressure, body mass index, relative wall thickness (RWT), antihypertensive medications and type of antidiabetic therapy, MEEi was 333 μl s
g
in MetS-/DM-, 328 in MetS-/DM+, 326 in MetS+/DM- and 319 in MetS+/DM+ (P for trend <0.0001). In pairwise comparisons (Sidak-adjusted), all conditions, except MetS-/DM+, were significantly different from MetS-/DM- (all P<0.02). No statistical difference was detected between MetS-/DM+ and MetS+/DM-. Both MetS and DM are associated with decreased MEEi in hypertensive patients, independently to each other, but the reduction is statistically less evident for MetS-/DM+. MetS+/DM+ patients have the lowest levels of MEEi, consistent with the alterations of energy supply associated with the combination of insulin resistance with insulin deficiency.
•State of art of management and treatment of hypertension emergency/urgency in Italy.•Good knowledge of definition and treatment.•Fair quality of blood pressure measurement technique.•Lack of ...protocol or fast track for this problem.•Differences in terms of treatment and diagnosis across macro-areas.
Hypertensive emergencies (HE) and urgencies (HU) are frequent causes of patients referral to Emergency Department (ED) and the approach may be different according to local clinical practice. Our aim was to explore awareness, management, treatment and counselling after discharge of HE and HU in Italy, by mean of an on-line survey. The young investigator research group of the Italian Society of Hypertension developed a 23-item questionnaire spread by e-mail invitation to the members of Italian Scientific societies in the field of Hypertension. 665 questionnaires were collected from EDs, Emergency and Urgency Medicine, Cardiology or Coronary Units, Internal Medicines, Intensive care, Stroke units. Symptoms considered suspicious of acute organ damage were: chest pain (89.0%), visual disturbances (89.8%), dyspnoea (82.7%), headache (82.1%), dizziness (52.0%), conjunctival haemorrhages (41.5%), tinnitus (38.2%) and epistaxis (34.4%). Exams more frequent prescribed were: electrocardiogram (97.2%), serum creatinine (91.4%), markers of cardiomyocyte necrosis (66.2%), echocardiography (65.1%). The use of intravenous or oral medications to treat HEs was 94.7% and 3.5%, while for HUs 24.4% and 70.8% respectively. Of note, a surprisingly high percentage of physicians (22 % overall, 24.5% in North Italy) used to prescribe sublingual nifedipine. After discharge, home blood pressure monitoring and general practitioner re-evaluation were more frequently suggested, while ambulatory blood pressure monitoring and hypertension specialist examination were less prescribed. The differences observed across the different macro-areas, regarded prescription of diagnostic test and drug administration. This survey depicts a complex situation of shades and lights in the real-life management of HE and HU in Italy.
The genetic structure and population connectivity of the Mediterranean endemic speckled skate Raja polystigma were investigated in 10 population samples (N = 232) at 7 exonprimed nuclear ...microsatellites and at 3 mitochondrial DNA sequence markers. The phylogeographic and population genetic analyses revealed that R. polystigma in the western and central Mediterranean represents a near-panmictic population, with a subtle but significant mitochondrial divergence of the Adriatic deme. Nuclear genotypes revealed that 2.5% of the total individuals exhibited an admixed ancestry with the sibling species R. montagui (spotted ray). Individuals with admixed ancestry were detected along with purebred individuals in the Algerian, southern Tyrrhenian, Sicilian and Adriatic R. polystigma population samples, but they were absent or rare in Sardinian and northern Tyrrhenian ones. Since the 2 species co-occur in the southwestern Mediterranean, we suggested that this area may act as a secondary hybrid zone.
OBJECTIVE:Hypertensive emergencies (HE) and urgencies (HU) are frequent causes of patients referral to Italian Emergency Department (ED), however the diagnostic and therapeutic approach may differ ...across the Italian country. The aim of the study GEAR (Gestione delle Emergenze e urgenze in ARea critica) was to explore awareness, management, treatment and counselling after discharge of HE and HU in Italy, by mean of on-line survey.
DESIGN AND METHOD:The young investigator research group of the Italian Society of Hypertension developed a 23-items questionnaire spread by e-mail invitation to the members of Italian Scientific societies involved in the field of Emergency Medicine and Hypertension.
RESULTS:665 questionnaires were collected59.7% from EDs, 22% from Emergency and Urgency Medicine wards, 8.7% from Cardiology or Coronary Units, 5.7% from Internal Medicines and 3.9% from Intensive care or Stroke units. The definition of HE and HU was correctly identified by 81.2% and 89.3% of the responders respectively. The symptoms considered suspicious of acute organ damage werechest pain (89.0%), visual disturbances (89.8%), dyspnoea (82.7%), headache (82.1%), dizziness (52.0%), conjunctival haemorrhages (41.5%), tinnitus (38.2%), epistaxis (34.4%). Appropriate cuffs, for different arm sizes, were not widely available in all units94% had standard cuffs, 57% small and 75.6 % large cuffs, extra-large only 38.5%. The exams more frequent prescribed to evaluate target organ damage were electrocardiogram (97.2%), serum creatinine (91.4%), markers of cardiomyocyte necrosis (66.2%), echocardiography (65.1%). HEs were treated by 94.7% of the physicians by intravenous medications and by 3.5% by oral drugs, while HUs were treated by intravenous drugs in 24.4% of the cases and by oral drugs in 70.8%. When patients were discharged from ED, 87.5 % of the responders recommended home blood pressure monitoring, 87.5% general practitioner re-evaluation, while ambulatory blood pressure monitoring and hypertension specialist examination were less frequently recommended.
CONCLUSIONS:This survey depicts a complex situation of shades and lights in the real-life management of HE and HU in Italy. Strong unmet needs clearly emerged, especially for educational initiatives, standardized treatment protocols and interrelationship with the chronic care system.
Reduction of left ventricular mass index (LVMi) during antihypertensive treatment is less likely to occur in obese subjects. The aim of the study was to assess whether weight loss influences ...reduction of LVMi in treated, obese, hypertensive patients.
From the Campania Salute Network registry, we identified 1546 obese hypertensive patients (50 ± 9 years, 43% women) with more than 12 months follow-up. Echocardiographic reduction of LVMi was considered as achievement of normal values (<47 g/m2.7 in women or <50 g/m2.7 in men) or a reduction of ≥10% during follow-up. Weight loss was considered as ≥5% reduction in body weight, and occurred in 403 patients (26%) during a median follow-up of 50 months (IQrange:31–93). Median weight loss was 8.6% (IQrange:6.5–12). Patients with weight loss had higher baseline body mass index (p < 0.05), while there was no difference in age, sex, duration of hypertension, prevalence of diabetes, metabolic syndrome and average blood pressure during follow-up. During follow-up, 152 patients (9.8%) exhibited reduction of LVMi. Reduction of LVMi was more frequent (12.9% vs 9.1%, p < 0.030) in patients losing weight than in those who did not. In logistic regression analysis, weight loss was associated with reduction of left ventricular mass index (OR 1.51 95%CI 1.02–2.23, p = 0.039), independent of significant associations with younger age, lower average systolic blood pressure during follow-up, longer follow-up time and higher LVMi at baseline.
In treated obese hypertensive patients, weight loss during follow-up promotes significant reduction of LVMi, independent of baseline characteristics and blood pressure control.
•Reduction of LVMi during antihypertensive treatment is less likely to occur in obese subjects.•A moderate weight reduction in obese hypertensive patients is associated with reduction in LVMi, independent of BP control.•Weight loss facilitates reduction in LVMi and may contribute to improve prognosis in obese hypertensive subjects.
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•Microbiological investigations were performed on stranded sea turtles.•Thirteen different species of bacteria were yielded.•A betanodavirus was in four loggerhead turtles.•The first ...detection of L. garviae and Betanodavirus in sea turtles was reported.•The isolation of V. parahaemolytic suggests the role of turtles as carrier of human pathogen.
During 2014, six loggerhead turtles, Caretta caretta and one green turtle, Chelonia mydas, found stranded on the Tuscany coast of Italy, were examined for the presence of specific bacterial and viral agents, along with their role as carriers of fish and human pathogens. Thirteen different species of bacteria, 10 Gram negative and 3 Gram positive, were identified. Among them, two strains of Vibrio parahaemolyticus and one strain of Lactococcus garviae were recovered and confirmed by specific PCR protocols. No trh and tdh genes were detected in V. parahaemolyticus. The first isolation of L. garviae and the first detection of Betanodavirus in sea turtles indicate the possibility for sea turtles to act as carriers of fish pathogens. Furthermore, the isolation of two strains of V. parahaemolyticus highlights the possible role of these animals in human pathogens’ diffusion.
Circulating uric acid (UA) is positively associated with body mass index (BMI), blood glucose, blood pressure (BP), markers of inflammation, and altered lipid profile. UA has also anti-oxidative ...properties which might be beneficial for cardiovascular (CV) system. It is still debated whether or not UA is independently associated with increased CV morbidity and/or mortality.
We studied prognostic impact of UA in 8833 hypertensive adults (mean age 53 ± 12 yrs, 3857 women) from the Campania Salute Network, without prevalent CV disease and more than stage 3 CKD. We calculated standardized UA Z-score, adjusted for age, sex, glomerular filtration rate, and BMI. Low and high UA and UA Z-score quartiles were compared to the 2 middle quartiles assumed to be “normal”. Prevalence of obesity and diabetes was higher in low and high than in normal UA Z-score group (all p < 0.001). Systolic BP, left ventricular mass, carotid intima thickness were significantly higher and ejection fraction was reduced in the presence of high UA Z-score (all p < 0.001). Over 33-months average follow-up, incident major CV end-points (MACE) were not significantly different among low, normal and high UA or UA Z-score. In the latter analysis, however, incident MACE tended to be more frequent in the low than the high UA Z-score. Despite the results of multivariable analyses, the effect of less aggressive therapy in low UA Z-score cannot be excluded with certainty.
In treated hypertensive patients, high levels of UA normalized for major biological determinants do not independently predict CV outcome.
NCT02211365.
•Circulating uric acid (UA) should not be considered in terms of CV prevention without integration with its main determinants.•Raw UA values, tend to overestimate the CV risk profile of hypertensive patients with a trend toward higher risk.•High normalized UA represent the impact of a high CV risk profile and the attempt to offset the effect of oxidative stimuli.
Patients with hepatitis C virus (HCV) chronic infection may develop a great number of extrahepatic manifestations. Among these latter, mixed cryoglobulinemia (MC) represents the prototype of ...HCV-associated autoimmune-lymphoproliferative disorders. Other rheumatological manifestations of HCV chronic infection are Siögren syndrome, arthritis and CREST syndrome. Thyroid autoimmune disorders are among the most frequent manifestations of HCV chronic infections and are clinically relevant because of the association with thyroid dysfunctions and hypothyroidism. Autoimmune cytopenia is also reported in association with HCV infection. This paper reviews the association of HCV chronic infection with the above mentioned pathologies, and their immunopathogenesis.
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