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Plasma ADMA levels were significantly higher in the ERA patients. A statistically significant negative effect of ADMA levels on CFR value was observed. The effect of ADMA levels on IMT is not significant.

Rheumatoid arthritis (RA) is associated with enhanced atherosclerosis and impaired endothelial function early after the onset of the disease and cardiovascular (CV) disease represents one of the leading causes of morbidity and mortality. It is well known that disease modifying antirheumatic drugs (DMARDs) are able to improve the course of the disease and the quality of life of these patients, but little is known about the effects of DMARDs on CV risk and endothelial dysfunction. Our goal was to examine the effects of long‐term therapy with DMARDs on endothelial function and disease activity in early RA (ERA). Twenty‐five ERA patients (mean age 52 ± 14.6 years, disease duration 6.24 ± 4.10 months) without evidence of CV involvement were evaluated for disease activity score (DAS‐28), 2D‐echo derived coronary flow reserve (CFR), common carotid intima‐media thickness (IMT) and plasma asymmetric dimethylarginine (ADMA) levels at baseline and after 18 months of treatment with DMARDs (10 patients with methotrexate and 10 with adalimumab). DMARDs significantly reduced DAS‐28 (6.0 ± 0.8 vs. 2.0 ± 0.7; P < 0.0001) and improved CFR (2.4 ± 0.2 vs. 2.7 ± 0.5; P < 0.01). Common carotid IMT and plasma ADMA levels did not show significant changes. The present study shows that DMARDs, beyond the well known antiphlogistic effects, are able to improve coronary microcirculation without a direct effect on IMT and ADMA, clinical markers of atherosclerosis. Treatment strategies in ERA patients with high inflammatory activity must be monitored to identify beneficial effects on preclinical markers of vascular function.

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Echocardiography is the most common diagnostic method for assessing cardiac function but some limitations affect this technique. Until now, visual assessment of wall motion and thickening has allowed only a subjective evaluation of myocardial function and requires long-term training. Recently, new echocardiographic techniques have been introduced to evaluate myocardial mechanics. Tissue Doppler imaging (TDI) technique is limited by angle-dependency such that only deformation along the ultrasound beam can be derived from velocities, while myocardium deforms simultaneously in three dimensions. Speckle tracking echocardiography (STE) is a more recent technique that provides a global approach to left ventricular myocardial mechanics, giving information about the three spatial dimensions of cardiac deformation. In this editorial, we describe the physical and pathophysiological concepts of STE, discussing the differences compared to TDI and underlining the pitfalls of this new technique.

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Urinary tract infections (UTIs) are a common cause of bacteraemia in the elderly and are associated with a high probability of hospitalization. Despite the impact of UTIs on health status and quality of life, a limited number of studies have evaluated their aetiology in this population. This study aimed to evaluate the microbial aetiology and pattern of susceptibility of bacteria causing UTIs in the elderly. For this purpose, a retrospective cohort study of elderly residents (n5472, aged .65 years) in 14 nursing homes in Milan (Italy) and its province was performed. Globally, 393 micro-organisms from 328 samples were isolated: Escherichia coli was the most prevalent (44.8 %), followed by Proteus mirabilis (20.4 %), Providencia spp. (8.9 %), Klebsiella spp. (6.4 %) and Pseudomonas aeruginosa (4.6 %). Enterococci were the most frequently isolated Grampositive organisms (7.4 %). Almost all Enterobacteriaceae were susceptible to nitrofurantoin, carbapenems and amikacin. Extended-spectrum b-lactamases were detected in 42.1 % of isolates. The most active antibiotics against P. aeruginosa were colistin, amikacin and piperacillin/ tazobactam. All Gram-positive organisms were susceptible to glycopeptides and linezolid, and 90 % were susceptible to nitrofurantoin. Fluoroquinolones showed a limited activity against all the tested micro-organisms. Escherichia coli remains the major micro-organism responsible for UTIs in older people, although to a lesser extent than in a younger population. The high rates of resistance observed in this study make careful use of antibiotics advisable to limit further development of resistance.