No abstract

Acromegaly is associated with increased cardiovascular mortality; however, little is known about the early atherosclerotic changes occurring in such patients. Endothelial function, in the form of flow-mediated dilation (FMD) of the brachial artery, and intima-media thickness (IMT) of the carotid artery were measured by B-Mode ultrasound in: 1) 18 patients with active acromegaly; 2) 12 subjects cured from acromegaly; 3) 18 subjects without acromegaly, each of them matched to an acromegalic patients for age, sex, risk factors and treatments; and 4) 10 healthy subjects. Results are expressed as median plus (25th, 75th) percentile. In active acromegalic patients, FMD was 5.7 (3.9, 7.7)%, significantly lower than in both healthy subjects (P < 0.01) and matched controls (P < 0.01). No difference between groups was observed for endothelium-independent vasodilation. Acromegalic patients had also higher IMT than healthy controls (P < 0.05), whereas no difference was observed with matched controls. In cured acromegalic patients, FMD was 9.2 (7.7, 10.5)%, significantly lower (P < 0.01) than in healthy controls but higher (P < 0.01) than in active patients. No difference in IMT was observed between active and cured patients. In conclusion, patients with acromegaly have functional and morphological vascular alteration that seems, at least in part, dependent on the GH excess itself.

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Peripheral arterial disease (PAD) is a predictor of cardiovascular risk. However, it is unknown whether PAD severity in uences in ammatory status and endothelial function, which play a major role in atherosclerosis. Accordingly, we measured brachial artery ow-mediated dilation (FMD), and plasma levels of several in ammatory markers in 15 control subjects, and 19 asymptomatic and 19 symptomatic PAD patients. Each symptomatic patient was matched to an asymptomatic patient for age, sex, risk factors, presence of cardiovascular disease, and pharmacological treatments. Asymptomatic patients had similar in ammatory pro les as controls, but lower median FMD (11.7% vs 8.5% , p < 0.01). Compared with asymptomatic patients, symptomatic patients had higher median C-reactive protein (1.5 mg=l vs 6.0 mg=l, p < 0.05) and interleukine-6 (1.5 pg=ml vs 3.5 pg=ml, p < 0.05), and lower FMD (8.5% vs 5.1% , p < 0.01). In the 38 PAD patients, the ankle=brachial pressure index correlated positively with FMD (p < 0.01), and negatively with C-reactive protein (p < 0.05), soluble intercellular adhesion molecule-1 (p < 0.05) and soluble vascular cell adhesion molecule-1 (p < 0.05). Thus, in PAD, endothelial function and in ammatory status are related to the severity of the circulatory impairment. This nding may contribute to the explanation of the increasingly poor prognosis with increased PAD severity.

Background Homocysteine assessment has been proposed as a potential predictive biomarker for the severity of COVID‐19 infection. The purpose of this review was to analyze the correlation between the prevalence of MTHFR C677 T gene polymorphism and COVID‐19 incidence and mortality worldwide. Methods Data regarding MTHFR C677 T gene mutation were obtained from the interrogation of the Genome Aggregation Database (genomAD), which is publicly available from the web“ https://gnomad.broadinstitute.org .” COVID‐19 cases, including prevalence and mortality, were obtained from“ https://www.worldometers.info/coronavirus ” 27 August 2020. Results There is a clear trend toward the worldwide prevalence of MTHFR 677 T and COVID‐19 incidence and mortality. The prevalence of MTHFR 677 T allele in the Latino population, and the incidence and mortality for COVID‐19 was higher for this ethnic group than that reported for most other populations globally. Statistical analysis showed a relatively strong correlation between C677 T and death from coronavirus. Conclusions Genetic polymorphism of MTHFR C677 T may modulate the incidence and severity of COVID‐19 pandemic infection.

No abstract

Small bowel obstruction (SBO) is a common condition requiring urgent attention that may involve surgical treatment. Imaging is essential for the diagnosis and characterization of SBO because the clinical presentation and results of laboratory tests may be nonspecific. Ultrasound is an excellent initial imaging modality for assisting physicians in the rapid and accurate diagnosis of a variety of pathologies to expedite management. In the case of SBO diagnosis, ultrasound has an overall sensitivity of 92% (95% CI: 89–95%) and specificity of 93% (95% CI: 85–97%); the aim of this review is to examine the criteria for the diagnosis of SBO by ultrasound, which can be divided into diagnostic and staging criteria. The diagnostic criteria include the presence of dilated loops and abnormal peristalsis, while the staging criteria are represented by parietal and valvulae conniventes alterations and by the presence of free extraluminal fluid. Ultrasound has reasonably high accuracy compared to computed tomography (CT) scanning and may substantially decrease the time to diagnosis; moreover, ultrasound is also widely used in the monitoring and follow-up of patients undergoing conservative treatment, allowing the assessment of loop distension and the resumption of peristalsis.

Septic shock is a medical emergency that represents one of the most important underlying causes for presentation to the Emergency Department. Sepsis is defined as organ dysfunction, life-threatening event caused by a deregulated inflammatory host response to infection, with a mortality risk ranging from 10 to 40%. Early sepsis identification is the cornerstone of management and diagnostic imaging can play a pivotal role in this clinical context. The choice of imaging modality depends on several factors, associated with the clinical condition and the presence or absence of localising signs and symptoms. The diagnostic accuracy of contrast-enhanced total-body CT has been well established during septic shock, allowing for a rapid, panoramic, and detailed study of multiple body areas, simultaneously. The aim of this article is to illustrate the controversial CT hypoperfusion complex in patients with septic shock, characterised by the following imaging features: decreased enhancement of the viscera; increased mucosal enhancement; luminal dilation of the small bowel; mural thickening and fluid-filled loops of the small bowel; the halo sign and flattening of the inferior vena cava; reduced aortic diameter; peripancreatic oedema; abnormal parenchymal perfusion; and other controversial findings that are variably associated with each other and reversible during the early stages. Increasing physicians’ awareness of the significance of these findings could prompt alternative approaches to the early assessment and management of septic shock. In this perspective, CT imaging represents a useful tool for a complete, rapid and detailed diagnosis of clinically suspected septic shock, which can be used to improve patient outcomes.