New insights on ocular surface disease in patients with atopic dermatitis treated with dupilumab.

Our study sought to describe ocular surface alterations at baseline and after 4 months of dupilumab treatment in patients with severe AD. Our findings highlight that all 25 patients showed ocular surface alterations prior to dupilumab treatment. Dupilumab may cause the worsening of clinical or subclinical pre-existing ocular alterations belonging to the spectrum of AKC.

An Italian pilot study of a psycho-social intervention to support family caregivers' engagement in taking care of patients with complex care needs: the Engage-in-Caring project.

BACKGROUND: The raising of disability and chronic illness burden among European population is calling for a new paradigm of care, focused on primary health care interventions. Engage-In-Caring is a novel multicomponent intervention clearly dedicated to improve family caregiver engagement in the care of patients with complex care needs, by supporting them to develop a stronger consciousness of their role, needs and skills. METHOD: Engage-In-Caring intervention's efficacy and feasibility have been evaluated through a single arm pre-post observational pilot study settled in Rome. A qualitative phase, consisting of literature analysis of caregivers' unmet needs and a final revision from an experts' group, led to the structuration of the intervention, following the Caregiver Health Engagement Model (CHE-Model). Afterwards, a quantitative phase allowed understanding the feasibility of the intervention through Kruskal-Wallis test on a sample of 47 caregivers. RESULTS: Results showed a reduction of the physical burden (Chi Squared = 6,483; p = .01) perceived by the caregivers and increase of the health literacy (Chi Squared = 3,560; p = .059) after the intervention. CONCLUSIONS: Feasibility tests on caregivers of patients with complex care needs are promising: this pilot study suggests a first effectiveness evidence, particularly concerning aspects related to burden perception and improvements in health literacy. Randomised controlled trials on larger samples are needed.

First Report of Shoot Blight, Canker, and Gummosis Caused by Neoscytalidium dimidiatum on Citrus in Italy.

In September 2008, a new disease was noticed in eastern Sicily, Italy in a 2-year-old regrafted citrus orchard with approximately 1,500 plants of sweet orange (Citrus sinensis (L.) Osbeck cv. Tarocco Scirè) on sour orange rootstock. Symptoms on the sweet orange scion consisted of blight of vigorously growing shoots and a sooty canker on shoots and rootstock trunks, resulting in shoot dieback to the cankered area. Masses of black fungal spores appeared under the bark and on the canker surface. Abundant gummosis was frequently associated with the affected tissues. Of the 1,500 plants surveyed, 12% were infected. A Scytalidium-like fungus was isolated consistently from symptomatic tissues on 2% potato dextrose agar (PDA). Conidia were ellipsoid to ovoid, hyaline, with an acutely rounded apex, truncate base, initially aseptate, becoming brown and two-septate at maturity, (10-) 12 to 13 (-14) × (4-) 5 (-6) µm. Mycelium was branched with septate, brown hyphae that disarticulated into 0- to 1-septate phragmospores (toruloid state). Genomic DNA was extracted from mycelia of single-conidial isolates cultivated on malt extract agar. Primers V9G and ITS4 were used to amplify the nuclear rRNA operon spanning the 3' end of 18S rRNA gene, the internal transcribed spacers, the 5.8S rRNA gene, and a part of the 5' end of the 28S rRNA gene (1,2). Both PCR primers were used to sequence directly the entire amplicon. DNA sequences of two isolates (CBS 124887 and 124888) were deposited in GenBank (Accession Nos. GQ330902 and GQ330903, respectively). These sequences were 100% identical in more than 545 nt to GenBank Accession Nos. AY213688 and FJ648577. On the basis of morphological characters and molecular data, the fungal isolates were identified as Neoscytalidium dimidiatum (Penz.) Crous & Slippers (2,3). Pathogenicity tests were conducted on five 2-year-old potted plants of sweet orange cv. Tarocco Scirè and lemon cv. Femminello Zagara Bianca, both grafted on sour orange. Eight 5-cm mycelial plugs of a single-conidial isolate were placed in wounds made with a sterile blade in the inner bark of plant stems and branches. Inoculation wounds were wrapped with Parafilm. The same number of plants inoculated with sterile PDA plugs served as controls. Inoculated plants were maintained in a growth chamber at 25 ± 1°C and 90 to 95% relative humidity. After 2 weeks, all inoculated plants developed gummosis originating from the inoculation point. Shoot blight and death of the entire plant were observed within 6 months on all inoculated plants. No differences were observed among the two citrus species. Control plants remained healthy. N. dimidiatum was reisolated from the infected plants and identified as described. To our knowledge, this is the first record of a disease caused by N. dimidiatum on citrus in Italy. The pathogen has been previously observed to infect freeze-damaged limbs of citrus in California, inducing a disease named Hendersonula branch wilt (4). This pathogen on citrus is important mainly as a wound-invading pathogen, therefore posing a serious threat to regrafted citrus orchards. References: (1) R. Cheewangkoon et al. Persoonia 21:77, 2008. (2) P. W. Crous et al. Stud. Mycol. 55:235, 2006. (3) E. Punithalingam and J. M. Waterston. No 274 in: Descriptions of Pathogenic Fungi and Bacteria. CMI, Kew, Surrey, UK, 1970. (4) J. O. Whiteside. Page 29 in: Compendium of Citrus Diseases. The American Phytopathological Society, St. Paul, MN, 1988.

Antioxidant activity of oregano, parsley, and olive mill wastewaters in bulk oils and oil-in-water emulsions enriched in fish oil.

The antioxidant activity of oregano, parsley, olive mill wastewaters (OMWW), Trolox, and ethylenediaminetetraacetic acid (EDTA) was evaluated in bulk oils and oil-in-water (o/w) emulsions enriched with 5% tuna oil by monitoring the formation of hydroperoxides, hexanal, and t-t-2,4-heptadienal in samples stored at 37 degrees C for 14 days. In bulk oil, the order of antioxidant activity was, in decreasing order (p < 0.05), OMWW > oregano > parsley > EDTA > Trolox. The antioxidant activity in o/w emulsion followed the same order except that EDTA was as efficient an antioxidant as OMWW. In addition, the total phenolic content, the radical scavenging properties, the reducing capacity, and the iron chelating activity of OMWW, parsley, and oregano extracts were determined by the Folin-Ciocalteau, oxygen radical absorbance capacity, ferric reducing antioxidant power, and iron(II) chelating activity assays, respectively. The antioxidant activity of OMWW, parsley, and oregano in food systems was related to their total phenolic content and radical scavenging capacity but not to their ability to chelate iron in vitro. OMWW was identified as a promising source of antioxidants to retard lipid oxidation in fish oil-enriched food products.

High-throughput methods to assess lipophilic and hydrophilic antioxidant capacity of food extracts in vitro.

Assays comprising three probes for different mechanisms of antioxidant activity in food products have been modified to allow better comparison of the contributions of the different mechanisms to antioxidant capacity (AOC). Incorporation of a common format for oxygen radical absorbance capacity (ORAC), ferric reducing antioxidant power (FRAP), and iron(II) chelating activity (ICA) assays using 96-well microplates provides a comprehensive and high-throughput assessment of the antioxidant capacity of food extracts. The methods have been optimized for aqueous extracts and validated in terms of limit of quantification (LoQ), linearity, and precision (repeatability and intermediate reproducibility). In addition, FRAP and ORAC assays have been validated to assess AOC for lipophilic extracts. The relative standard deviation of repeatability of the methods ranges from 1.2 to 6.9%, which is generally considered to be acceptable for analytical measurement of AOC by in vitro methods. Radical scavenging capacity, reducing capacity, and iron chelating properties of olive mill wastewaters (OMWW), oregano, and parsley were assessed using the validated methods. OMWW showed the highest radical scavenging and reducing capacities, determined by ORAC and FRAP assays, respectively, followed by oregano and parsley. The ability to chelate Fe (2+) was, in decreasing order of activity ( p > 0.05) parsley congruent with oregano > OMWW. Total phenol content, determined by the Folin-Ciocalteu method, correlated to the radical scavenging and reducing capacities of the samples but not to their chelating properties. Results showed that the optimized high-throughput methods provided a comprehensive and precise determination of the AOC of lipophilic and hydrophilic food extracts in vitro.

Are the beneficial cardiovascular effects of simvastatin and metformin also associated with a hormone-dependent mechanism improving insulin sensitivity?

In addition to lipid-lowering and cardiovascular protective actions, statins may have beneficial effects on insulin sensitivity. The objective of the present study was to evaluate the effect of simvastatin therapy on insulin resistance and on leptin, adiponectin, and C-reactive protein (CRP) levels, as compared to metformin, in overweight pre-diabetic subjects. Forty-one subjects with BMI >25 kg/m(2) and impaired fasting glucose or impaired glucose tolerance were randomized to take simvastatin, 20 mg/day (N = 20) or metformin, 1.7 g/day (N = 21) for 16 weeks. Blood samples for the determination of metabolic, hormonal, and inflammatory parameters were obtained at baseline and after each treatment. After metformin therapy, significant reductions in mean BMI and waist circumference were observed, and after simvastatin treatment LDL and triglyceride levels were significantly reduced. Insulin resistance determined by the homeostasis model assessment decreased only with metformin. Independently of the type of medication, a significant decrease in CRP levels was detected from baseline to the end of the study. CRP showed a mean reduction of 0.12 +/- 0.04 mg/dL (P = 0.002) over time. No change in leptin or adiponectin levels was induced by any therapy. The data suggest that a low dose of simvastatin does not affect insulin resistance in overweight pre-diabetic subjects and has no effect on leptin or adiponectin levels. Further studies including a larger sample size, higher doses of statins, and a placebo control group are necessary to confirm the present data.

Are the beneficial cardiovascular effects of simvastatin and metformin also associated with a hormone-dependent mechanism improving insulin sensitivity?

In addition to lipid-lowering and cardiovascular protective actions, statins may have beneficial effects on insulin sensitivity. The objective of the present study was to evaluate the effect of simvastatin therapy on insulin resistance and on leptin, adiponectin, and C-reactive protein (CRP) levels, as compared to metformin, in overweight pre-diabetic subjects. Forty-one subjects with BMI >25 kg/m² and impaired fasting glucose or impaired glucose tolerance were randomized to take simvastatin, 20 mg/day (N = 20) or metformin, 1.7 g/day (N = 21) for 16 weeks. Blood samples for the determination of metabolic, hormonal, and inflammatory parameters were obtained at baseline and after each treatment. After metformin therapy, significant reductions in mean BMI and waist circumference were observed, and after simvastatin treatment LDL and triglyceride levels were significantly reduced. Insulin resistance determined by the homeostasis model assessment decreased only with metformin. Independently of the type of medication, a significant decrease in CRP levels was detected from baseline to the end of the study. CRP showed a mean reduction of 0.12 ± 0.04 mg/dL (P = 0.002) over time. No change in leptin or adiponectin levels was induced by any therapy. The data suggest that a low dose of simvastatin does not affect insulin resistance in overweight pre-diabetic subjects and has no effect on leptin or adiponectin levels. Further studies including a larger sample size, higher doses of statins, and a placebo control group are necessary to confirm the present data.

Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review

Fetuses of mothers with gestational diabetes mellitus are at increased risk to develop perinatal complications mainly due to macrosomia. However, in view of the marked heterogeneity of this disease, it seems difficult to set guidelines for diagnosis and treatment. This complicates the choice of assigning patients either to diet or to insulin therapy. Also of concern is how much benefit could be expected from insulin therapy in preventing fetal complications in these patients. In a systematic review of the literature assessing the efficacy of insulin in preventing macrosomia in fetuses of mothers with gestational diabetes, we found six randomized controlled trials comparing diet alone to diet plus insulin. The studies included a total of 1281 patients (644 in the diet plus insulin group and 637 in the diet group), with marked differences among trials concerning diagnostic criteria, randomization process and treatment goals. Meta-analysis of the data resulted in a risk difference of -0.098 (95 percentCI: -0.168 to -0.028), and a number-necessary-to-treat of 11 (95 percentCI: 6 to 36), which means that it is necessary to treat 11 patients with insulin to prevent one case of macrosomia. This indicates a potential benefit of insulin, but not significantly enough to set treatment guidelines. Because of the heterogeneous evidence available in the literature about this matter, we conclude that larger trials addressing the efficacy of these two therapeutic modalities in preventing macrosomia are warranted

Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review.

Fetuses of mothers with gestational diabetes mellitus are at increased risk to develop perinatal complications mainly due to macrosomia. However, in view of the marked heterogeneity of this disease, it seems difficult to set guidelines for diagnosis and treatment. This complicates the choice of assigning patients either to diet or to insulin therapy. Also of concern is how much benefit could be expected from insulin therapy in preventing fetal complications in these patients. In a systematic review of the literature assessing the efficacy of insulin in preventing macrosomia in fetuses of mothers with gestational diabetes, we found six randomized controlled trials comparing diet alone to diet plus insulin. The studies included a total of 1281 patients (644 in the diet plus insulin group and 637 in the diet group), with marked differences among trials concerning diagnostic criteria, randomization process and treatment goals. Meta-analysis of the data resulted in a risk difference of -0.098 (95%CI: -0.168 to -0.028), and a number-necessary-to-treat of 11 (95%CI: 6 to 36), which means that it is necessary to treat 11 patients with insulin to prevent one case of macrosomia. This indicates a potential benefit of insulin, but not significantly enough to set treatment guidelines. Because of the heterogeneous evidence available in the literature about this matter, we conclude that larger trials addressing the efficacy of these two therapeutic modalities in preventing macrosomia are warranted.

Suicides and the third age.

The phenomenon of suicide represents a complex problem, the specific aspects of which should be examined by a multifactorial analysis, particularly in the elderly subjects. Although the research on risk factors continues to grow, only a limited knowledge is available on the biological changes increasing the risk for suicide. Similarly, limited information is at our disposal about the contributing psychosocial processes extending beyond the demographic factors. Although the best explored population is the elderly using primary care services, no proven interventions are known for the time being, although some efforts to test certain approaches reaching these older adults are under way. Apparently even more, continued efforts are needed to change the attitudes toward the mental illnesses and their treatments in general, in order to reach the older adults who are still outside of the health care services.

The prevalence of various arrhythmias in normotensive and hypertensive elderly patients.

The prevalence of the most frequent arrhythmias was studied in a geriatric day hospital. Patients older than 65 years have been considered, of them 118 were normotensive and 56 hypertensive subjects. Comparison of the two groups revealed no statistically significant difference either in the frequency of occurrence or in the type of arrhythmias. Dividing the hypertensive patients in the Lown's classes, only those of class 3 or over displayed a considerably higher frequency of arrhythmias than the normotensive subjects. The results demonstrate the age-dependent increase of the prevalence of arrhythmias in general, and the increased occurrence of complex ventricular types in the hypertensive subjects.

The leisure time and the third age: the experience of a geriatric day hospital.

Leisure time represents an important part of the so-called 'successful aging' and contributes to overcome the problems related to the reduction of the social roles, favoring a better subjective adaptation to old age. In this work we observed the elderly population frequenting our Day Hospital, by estimating the affective sphere (geriatric depression scale, GDS), the autosufficiency (activity of daily living, ADL; and instrumental activity of daily living, IADL) and the schooling years in correlation with the type and length of leisure time activities during the day. These data have been compared with those of the national statistics (ISTAT). The analyses revealed a very wide diffusion of the utilization of mass media and a large interindividual differentiation of the modes of using leisure time. The correlations between the indices of affectivity and autosufficiency show an effect on the types of leisure time activities, while the scholarity of the subjects has no influence on it. These results suggest considering leisure time as an indispensable part of the relational life of elderly subjects, having an important 'valency' for the affective sphere and the individual expectations and needs.

The care of elderly, terminally ill oncological patients in caregiving sanitary residences.

A panoramic survey is outlined regarding the care system of terminally ill oncologic patients with particular regard to the elderly. National and international experiences are considered offering a caregiving service out of hospital, in small dwelling centers being able to relieve the sufferings of the last days of life. The caregiving sanitary residences and hospices are inserted in a network of services for the elderly oncological patients, representing an adequate answer for the problems. In those structures there is a need of proper professional sanitary figures and standardized lodgings, which may be of importance in the maintenance of a good quality of life. In addition, this study emphasizes the caregiving activity of the family and the needs of the caregivers, as well as the proper instruction of them through courses of specialization. New figures should be inserted in the hospices, like the volunteers, the animators and spiritual assistants; their help is inevitably necessary to assure a better care during the last days of life.