May Measure Month 2022 in Italy: A Focus on Fixed-dose Combination, Therapeutic Adherence, and Medical Inertia in a Nationwide Survey.

INTRODUCTION: Hypertension is the main risk factor for cardiovascular diseases (CVD). Notably, only about half of hypertensive patients manage to achieve the recommended blood pressure (BP) control. Main reasons for the persistence of uncontrolled BP during treatment are lack of compliance on the patients' side, and therapeutic inertia on physicians' side. METHODS: During the global BP screening campaign "May Measure Month" (MMM) (May 1st to July 31st, 2022), a nationwide, cross-sectional, opportunistic study endorsed by the Italian Society of Hypertension was conducted on volunteer adults ≥ 18 years to raise awareness of the health issues surrounding high BP. A questionnaire on demographic/clinical features and questions on the use of fixed-dose single-pills for the treatment of hypertension was administered. BP was measured with standard procedures. RESULTS: A total of 1612 participants (mean age 60.0±15.41 years; 44.7% women) were enrolled. Their mean BP was 128.5±18.1/77.1±10.4 mmHg. About half of participants were sedentary, or overweight/obese, or hypertensive. 55.5% individuals with complete BP assessment had uncontrolled hypertension. Most were not on a fixed-dose combination of antihypertensive drugs and did not regularly measure BP at home. Self-reported adherence to BP medications was similar between individuals with controlled and uncontrolled BP (95% vs 95.5%). CONCLUSIONS: This survey identified a remarkable degree of therapeutic inertia and poor patients' involvement in the therapeutic process and its monitoring in the examined population, underlining the importance of prevention campaigns to identify areas of unsatisfactory management of hypertension, to increase risk factors' awareness in the population with the final purpose of reducing cardiovascular risk.

Untreated masked hypertension and carotid atherosclerosis: a meta-analysis.

AIM: Masked hypertension (MH) is recognized as a clinical entity with an unfavorable cardiovascular prognosis; a limited number of reports, however, investigated the impact of this condition on subclinical vascular damage. We performed a meta-analysis aimed at evaluating the association of MH with subclinical carotid atherosclerosis in initially untreated subjects. DESIGN: Studies were identified by the following search terms: "masked hypertension", "isolated clinic normotension", "white coat normotension", "carotid artery", "carotid atherosclerosis", "carotid intima-media thickness", "carotid damage" and "carotid thickening". Full articles published in English language reporting data from studies performed in untreated adult individuals were considered. RESULTS: Overall, 2752 untreated subjects (1039 normotensive, 497 MH and 766 hypertensive individuals) of both genders were included in five studies (sample size range 18-222 for MH participants). Common carotid intima-media thickness (IMT) showed a progressive increase from normotensive (681 ± 24 µm) to MH (763 ± 57 µm) (standardized mean difference, SMD: 0.51 ± 0.19, 95% CI 0.13-0.89, p < 0.01) and to sustained hypertensive subjects (787 ± 58 µm) (SMD: 0.33 ± 0.07, 95% CI 0.20-0.46, p < 0.01). The statistical difference between MH and NT became borderline after correction for publication bias. A sensitivity analysis showed that the final result was not substantially affected by a single study effect. CONCLUSIONS: Our findings support the view that MH subjects tend to have a higher risk of developing early carotid atherosclerosis than their true normotensive counterparts. From a practical perspective, the ultrasound search of preclinical carotid disease may improve cardiovascular risk stratification and decision making strategies in these subjects.

Adult scoliosis: age-related deformity and surgery.

PURPOSE: We retrospectively analyzed our results in thoracolumbar and lumbar adolescent idiopathic scoliosis treated during adulthood. METHODS: Fifty-two thoracolumbar and 30 lumbar idiopathic scoliosis surgically treated were reviewed. Mean follow-up was 9.5 ± 6.6 years. All the subjects were analyzed by visual analog scale, Oswestry Disability Index (ODI), and SF-36 scores before and after surgery and at follow-up. The scoliotic curve, thoracic kyphosis, lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT), sacral slope, and C7 plumb line were measured. For the statistical analysis, multivariate multiple regression models were formulated, considering as significative a P < 0.05. RESULTS: A statistically significant clinical and radiological amelioration was noted after surgery and at final follow-up. According to the logistic regression model, ODI was related to lumbar lordosis and spino-pelvic parameters at follow-up. The only determinant of failure was age. CONCLUSIONS: Spino-pelvic recovery is easier in patients aged less than 60 years with PI < 55° and PT < 25°.

Vertebral body recollapse without trauma after kyphoplasty with calcium phosphate cement.

Traditionally, immobilization and external bracing has been recommended for patients with type A traumatic and non-osteoporotic fractures that do not present neurological deficits or significant instability. Nevertheless, several authors have recently suggested the possibility to treat thoraco-lumbar and lumbar vertebral compression post-traumatic fractures using standalone balloon kyphoplasty with osteoconductive filler materials, such as calcium phosphate (CPC). Maestretti and Huang have demonstrated the advantages of this technique showing an almost immediate return to daily activities without the inconvenience of wearing a brace, pain reduction, minimal operative risks and maintenance of stability, therefore proposing this as a first-choice technique in young patient needing rapid spine stability. The authors present a case of vertebral body recollapse after kyphoplasty with calcium phosphate cement (CPC) in a 47-year-old man with an A1.2 post-traumatic L1 compression fracture.

Cervicothoracic postarachnoiditic hydrosyringomyelia secondary to pedicular hook dislocation: case report.

BACKGROUND: Pedicular hook dislocation is a rare complication of spinal instrumentation. We report on the first case of hydrosyringomyelia secondary to intracanalar hook displacement after scoliosis surgery. CASE DESCRIPTION: A 15-year-old girl presented to our institution with a 7-month history of persistent neck and occipital pain as well as numbness of the lower extremities and previous dorsolumbar instrumentation with dorsal pedicular hooks and lumbar screws. Magnetic resonance imaging showed intramedullary cystic cavity from C5 to T7, isointense to cerebrospinal fluid (CSF) on T1- and T2-weighted images. Computed tomographic scan showed intracanalar displacement of the left hook. On admission, the patient presented with mild weakness of the lower extremities, hypalgesia below the level of T4, and urinary disturbance. The patient underwent surgical hook removal, T4 laminectomy, and midline dural opening: the arachnoid membrane was found to be thick and adhered to the dura and dorsolateral spinal cord. The arachnoid scarring was dissected, and the cord was untethered. A small posterior-median myelotomy was performed, and a syringosubarachnoid catheter was placed into the subarachnoid space to restore CSF flow. CONCLUSIONS: Late intracanalar displacement of spinal devices is an event that may complicate spinal instrumentation for scoliosis. This case highlights the importance of correct spinal device positioning and that of careful follow-up after instrumentation to detect complications early. We also discuss the pathogenetic pathway of the postarachnoiditic syringomyelia in this case.