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Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 "Delirium Day" project. Setting and participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.

BACKGROUND Children with cerebral palsy (CP) often present a loss of effectiveness of the plantarflexors/knee-extensors couple that leads to crouch gait. When treating a child with crouch gait by means of ankle foot orthoses, preserving or restoring push off power is a key issue. AIM To compare carbon-fiber spring (Carbon Ankle Seven® [CAFO], Ottobock® HealthCare, Duderstadt, Germany) and hinged ankle-foot orthoses (HAFO) effectiveness in improving functionality and walking ability in children with diplegic CP and crouch gait. DESIGN Randomized crossover trial. SETTING Hospital center. POPULATION Ten children with diplegic CP and crouch gait, 5 males and 5 females, aged 11 (4) years. METHODS The gait of each child was evaluated by means of instrumental gait analysis with both CAFO and HAFO, in a randomized order and after a 4-week adaptation period. The primary outcome measure was the change in ankle power generation. As secondary outcome measures, knee joint kinematics, stride length, walking speed, Observational Gait Scale, and preferred orthosis were considered. RESULTS The median of the energy produced in stance was superior with CAFO (+2.2 J/kg, IQR 4.7, P=0.006), and the energy absorbed inferior (-3.3 J/kg, IQR 4.3, P=0.011). No statistically significant difference was found for any other parameter. Preference of the children was equally distributed between the two orthoses. CONCLUSIONS No evident superiority of CAFO with respect to HAFO was found in improving gait performance of children with CP and crouch gait. Nevertheless, the results suggest the possibility that CAFO permits an energy saving and reduction of the more compromising deficits. CLINICAL REHABILITATION IMPACT The final choice of the participants indicates that CAFOs are preferred by older and heavier children, but the preference does not correlate with the performance of the orthoses during gait.

Summary Background Increased blood pressure is the biggest contributor to the global burden of disease and mortality. Data suggest that less than half of the population with hypertension is aware of it. May Measurement Month was initiated to raise awareness of the importance of blood pressure and as a pragmatic interim solution to the shortfall in screening programmes. Methods This cross-sectional survey included volunteer adults (≥18 years) who ideally had not had their blood pressures measured in the past year. Each participant had their blood pressure measured three times and received a a questionnaire about demographic, lifestyle, and environmental factors. The primary objective was to raise awareness of blood pressure, measured by number of countries involved, number of people screened, and number of people who have untreated or inadequately treated hypertension (defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or both, or on the basis of receiving antihypertensive medication). Multiple imputation was used to estimate the mean of the second and third blood pressure readings if these were not recorded. Measures of association were analysed using linear mixed models. Findings Data were collected from 1 201 570 individuals in 80 countries. After imputation, of the 1 128 635 individuals for whom a mean of the second and third readings was available, 393 924 (34·9%) individuals had hypertension. 153 905 (17·3%) of 888 616 individuals who were not receiving antihypertensive treatment were hypertensive, and 105 456 (46·3%) of the 227 721 individuals receiving treatment did not have controlled blood pressure. Significant differences in adjusted blood pressures and hypertension prevalence were apparent between regions. Adjusted blood pressure was higher in association with antihypertensive medication, diabetes, cerebrovascular disease, smoking, and alcohol consumption. Blood pressure was higher when measured on the right arm than on the left arm, and blood pressure was highest on Saturdays. Interpretation Inexpensive global screening of blood pressure is achievable using volunteers and convenience sampling. Pending the set-up of systematic surveillance systems worldwide, MMM will be repeated annually to raise awareness of blood pressure. Funding International Society of Hypertension, Centers for Disease Control and Prevention, Servier Pharmaceutical Co.

Diplegia is a specific subcategory of the wide spectrum of motion disorders gathered under the name of cerebral palsy. Recent works proposed to use gait analysis for diplegia classification paving the way for automated analysis. A clinically established gait-based classification system divides diplegic patients into 4 main forms, each one associated with a peculiar walking pattern. In this work, we apply two different deep learning techniques, namely, multilayer perceptron and recurrent neural networks, to automatically classify children into the 4 clinical forms. For the analysis, we used a dataset comprising gait data of 174 patients collected by means of an optoelectronic system. The measurements describing walking patterns have been processed to extract 27 angular parameters and then used to train both kinds of neural networks. Classification results are comparable with those provided by experts in 3 out of 4 forms.

OBJECTIVE: Serum uric acid (SUA) has been associated to incident hypertension and increased risk of cardiovascular diseases. Our aims were to compare the haemodynamic characteristics of normotensives, undiagnosed hypertensives, controlled and uncontrolled hypertensive subjects, and to evaluate if SUA level could also been associated to a different control of blood pressure in pharmacologically treated patients. DESIGN AND METHOD: During the last population survey of the Brisighella Heart Study we identified 146 new cases of arterial hypertension and 394 treated but uncontrolled hypertensive patients. Thus we compared their haemodynamic characteristics with those of age- (58 ± 14 years old) and sex-matched normotensive (N. 324) and controlled hypertensive (N. 470) subjects. Then, by logistic regression analysis, we evaluated which factors were associated to a worse blood pressure control under pharmacological treatment. RESULTS: Pulse Wave Velocity (PWV) was significantly higher (p

Objective: In this study anxiety and depressive disorders were evaluated in patients admitted to an emergency department (ED) or to a medical department (MD). Methods: The General Health Questionnaire-30 (GHQ-30) was administered to screen all patients (n = 719) consecutively admitted to an ED (n = 556) and to MD (n = 163) in a 120 day period. All GHQ-30 positive (score>4) underwent the Mini International Neuropsychiatric Interview, a structured interview to diagnose mental disorders according to DSM-IV criteria. Results: Subjects positive to GHQ-30 were 264 (47%) in ED and 88 (54%) in MD. A mental disorder was diagnosed in 233 ED patients (42%) and in 77 MD patients (47%) (p = 0.70). The most frequent disorders were anxiety disorders in ED patients (18.1%) and depressive disorders in MD patients (21%) (p = 0.04). Conclusions: Anxious patients more frequently seek attention at ED, whereas patients with depressive disorders are more often observed in medical units. The improvement of quality of care, the waste of healthcare resources through unnecessary medical care, and the well known efficacy of appropriate treatments in patients with anxiety and depressive disorders make the diagnosis of these patients particularly important.

Essential hypertension (EH) has been associated with abnormal sympathetic outflow particularly during mental stress. However data were unclear because of associated pharmacological drugs often taken by patients. The aim of this study is to ascertain abnormalities of sympathetic during mental stress in patients with untreated EH. We studied 7 untreated patients with established criteria for EH, and 10 sex and age matched healthy subjects. Patients with EH underwent an extensive laboratory screening excluding secondary causes of hypertension. Subjects underwent sitting microneurographic recording of muscle sympathetic activity (MSNA) from peroneal nerve, heart rate (HR) and blood pressure (BP) during resting state and mental stress (3-min of paced auditory serial arithmetic test -PASAT) and a cold test (two minutes immersion of a hand in ice water). The pharmacological treatment for EH was usually started after the microneurographby evaluation. As expected EH patients showed increased resting BP compared to controls but MSNA was not significantly increased although showed a tendency toward the increase. During mental stress BP was increased compared to controls but HR and MSNA did not show a significant difference. Sympathetic and cardiovascular parameters did not differ during cold test. Our data confirmed the higher BP reactivity in EH patients but this was not due to increased MSNA. However these data are preliminary and a larger cohort of patients must be recruited before drawing a definite conclusion.

The sensitivity of the IRMA method is limited by the specific activity (SA) of the conventionally employed radioisotropic label and high sensitivity radioimmunoassay should theoretically be attained by the use of short-lived radiometallic nuclides. Our group have achieved radiolabeling of high SA IgG by using the radiometal, gallium-67 (67Ga) with a short half-life (T1/2 = 78 h) and deferoxamine (DF), a bifunctional chelating agent bound through a multispacer (dialdehyde starch, DAS) as the linker (J Nucl Med 32:825, 1991). In the present work, the application of the approach is attempted by employing a two-site IRMA for human growth hormone (hGH); the monoclonal antibody to hGH (MAB2) is bound to DF via DAS and the coupled DF-DAS-MAB2 is radiolabeled with 67Ga. The 67Ga-DF-DAS-MAB2 of high SA (4,884 MBq/mg versus 370-518 MBq/mg calculated for radioiodinated MAB2) was thus used for the two site 'sandwich' 67Ga-IRMA. Excellent correlation with the 125I-IRMA was registered, and higher detection capability obtained by using 67Ga over the 125I in the hGH IRMA offered a good basis for the exploitation of short-lived radio-nuclides in the IRMA system.

alking. Healthy young subject were asked to mimic voluntarily nterior pelvic tilt during gait analysis sessions. Materials andmethods: Six healthy young adults (29±3 years ld) performed a gait analysis along a 12 meters walkway bareoot. After that, they were asked to mimic anterior pelvic tilt, Fig . Data were collected with Vicon Mx system with 8 cameras, two MTIOR6-5 forceplatformsandWave surfaceEMGsystem. Spatioemporal parameters, kinematic, kinetic and surface EMG of four ait cycles were analyzed, comparing self placed barefoot gait with oluntary anterior pelvic tilt one. Digital video acquisitions were lso performed. Results: Videoobservation:duringvoluntary anteriorpelvic tilt, he trunk tilted forward, the upper limbs tilted backward, the foot ontact was flat or on toe, Fig. 1. Kinematic: in comparison with barefoot gait the main diferences were the ankle plantar-flexion at foot contact, the nticipation of ankle plantar-flexion during late stance, a reduced aximum of knee flexion during swing, an increased hip flexion nd, of course, the requested increased anterior pelvic tilt. Kinetic: double bump and reduction of ankle dorsal-flexion oment, increased ankle power absorption and generation during arly stance, and reduced ankle power generation in late stance as observed, Fig. 2. Spatio-temporal parameters: the cadence increased from 24±5.11 steps/min to 145±14.4 steps/min; the stride time ecreased from 0.96±0.040 s to 0.84±0.078 s and consequently alking speed increased from 1.34±0.11 m/s to 1.57±0.26 m/s. he other spatio-temporal variables did not differ. EMG: triceps enveloped surface EMG diagram showed anticipaion of triceps activation during voluntary tilt, Fig. 3. Discussion: Voluntary anterior pelvic tilt facilitated the forward rojection of the upper bodywith the association of a not requested oewalking like behaviour. The kinematic, kinetic, spatio-temporal nd EMG parameters showed a pattern similar with the gait of toealkers. From the results of this work it is possible to hypothesize hat anterior pelvic tilt could be considered one of the elements acilitating toe walking. The whole body biomechanical configuation contributes to the aetiology of gait strategies. The selected daptive solution for balancing thepelvis could constrain alsodistal egments configurations.

This work is aimed at comparing mucinous colorectal adenocarcinomas (MUC) and non-mucinous colorectal adenocarcinomas (non-MUC), and at verifying the existence of two different subgroups of MUC, in terms of clinicopathological features, chromosomal alterations, and outcome, in a geographical area where mucinous colorectal cancer resulted as being very frequent. One hundred and fifty-six unselected patients who underwent curative colorectal resection for sporadic colorectal cancer over a 4-year period were evaluated for histological classification as to MUC and non-MUC subtype, for microsatellite instability (MSI) using six microsatellite markers, and for the presence of p27, Fhit, and cyclooxygenase-2 (Cox-2). Molecular data, immunohistochemical results, recurrence frequency, and patient survival were analyzed statistically in relation to histological subtypes. MUC accounted for 38.5% of all colorectal carcinomas. Compared to non-MUCs, MUCs were more frequently located in the proximal colon (p

The introduction of perfluoro-based contrast agents such as SonoVue together with sensitive realtime scanning modes such as cadence contrast pulse sequences (CPS) have made possible significant advances in the management of patients with pathology affecting large vessels. This has been particularly valuable in aortic graft procedures where the lack of nephrotoxicity allows multiple repeat studies for follow-up of leaks. It has also proved valuable in situations where the flow is very slow and undetectable on conventional Doppler

Ultrasound (US) plays a secondary role to computed tomography (CT) in the diagnostic assessment of traumatic lesions involving abdominal organs, especially in the case of major trauma (Becker et al. 1998; Boioli et al. 1993; Brown et al. 1998; Harris et al. 2001; Mirvis 2000; Sherck et al. 1984; Shuman 1997). Because US has a relatively limited panoramic capacity, it does not detect lesions of hollow internal organs reliably. On the whole it has a lower sensitivity and specificity than CT in the diagnosis of parenchymal damage to the liver, kidney and spleen.

Rebound insomnia is a transient intense worsening of sleep usually appearing within 3 days from the abrupt discontinuation of benzodiazepines (mainly short-acting), following long term use and abuse of these hypnotics. Zolpidem is an imidazopyridine, that binds selectively at ω1-receptor subtypes within the GABAA receptor supramolecular complex. It has a rapid onset of action and short-elimination half-life; it reduces the latency of sleep and prolongs the duration of sleep in patients with insomnia, without any major effects on sleep stages and rebound effects upon discontinuation. The present multicentre trial (three Italian centres) was aimed at assessing the symptoms/signs of rebound insomnia after discontinuation of either zolpidem or triazolam. A double-blind, randomized, parallel group trial of 20-day duration was carried out in 22 patients suffering from either transient insomnia, or short-term (situational stress) insomnia, or patients who were poor sleepers. The trial consisted of three periods: a 3-day run-in period with placebo, a 14-day active treatment period (zolpidem 10 mg od or triazolam 0.25 mg od), a 3-day withdrawal period with placebo. There were statistically significant [p = 0.0064 for Total Sleep Time (TST) and p = 0.0051 for Sleep Efficiency (SE%)] differences between triazolam- and zolpidem-treated patients during the first withdrawal night versus baseline: TST decreased to 34.5 min after triazolam but increased to 43.8 min after zolpidem, and a similar evolution was shown on SE% (a decrease of 6.3 per cent after triazolam and an increase of 9.9 per cent after zolpidem). Also the Wake-time After Sleep Onset (WASO) showed a statistically significantly (p = 0.0083) different pattern, during the first withdrawal night, remaining decreased after zolpidem (37.5 min) but suddenly increasing after triazolam (17.3 min). Also the subjective time to fall asleep changed with a statistically significant difference (p = 0.042), being increased after triazolam (8.6 min) and decreased after zolpidem (20.8 min). The results of the study demonstrate the presence of clear rebound insomnia after triazolam discontinuation, whereas such a drawback is absent with zolpidem. This allows the abrupt discontinuation of zolpidem without any need for a tapering procedure and without any risk of pharmacological dependence.

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Nine non-obese males with non-insulin-dependent diabetes mellitus (NIDDM) were evaluated before and after 3 and 12 months (6 patients) treatment with the second generation hypoglycemic sulfonylurea: gliclazide. They underwent an oral glucose tolerance test, intravenous glucose and arginine tests measuring plasma insulin and C-peptide responses. Pre-hepatic insulin production and insulin delivery to peripheral tissues were calculated by deconvolution techniques and hepatic extraction of insulin estimated. An improvement was observed in the beta-cell function of the patients on gliclazide treatment: reduction of fasting plasma glucose associated with a progressive increase in C-peptide level but insulin levels decreased at 12 months, suggesting an increase in hepatic insulin extraction at this time. In the same way, while plasma glucose values after oral and i.v. glucose were greatly reduced at 3 and 12 months treatment, insulin did not change but C-peptide levels increased significantly at 12 month treatment. While the prehepatic insulin secretion rate increased progressively on gliclazide during all glucose challenges, the fractional hepatic insulin extraction fell after 3 and increased at 12 month treatment, with opposite changes in insulin delivered to peripheral tissues. Thus the insulinogenic effect of gliclazide could be masked during long-term administration by a concomitant effect of gliclazide which increases hepatic extraction of insulin. The maintenance of the responsiveness to the non-glucose secretagogue, arginine, as evaluated by the C-peptide levels, before and after correction of hyperglycemia, suggested improvement of beta-cell sensitivity to glucose after sulfonylurea treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal tolerability of a guided incremental dose schedule of sulphinpyrazone was evaluated in an open study of 2-month duration, performed in twenty-one cardiovascular elderly azotemic patients (thirteen males, eight females; mean age: 79 years, S.D.: 7·3 years). Starting dosage was 200 mg per day; daily dosage was then increased, every 4 days, by 200 mg or kept constant for another 4 days, according to each patient's basal renal function, up to the maintenance dose: 800 mg/day. Eighty-one per cent of the patients followed a successful incremental pathway, 9% kept a constant daily dosage of 200 mg for 8 days, reaching then the maintenance daily dose without any problems. Nine per cent withdrew at 200 mg/day because renal function deteriorated at two consecutive visits. Renal function of the patients who completed the study significantly improved (two-way ANOVA, p < 0·01). General tolerability was good. The proposed incremental dose schedule of sulphinpyrazone can be successfully used in the treatment of cardiovascular elderly azotemic patients.

Serum and tonsillary tissue levels of cefroxadine, a new broad-spectrum cephalosporin, proving to be effective in several infections, particularly in the ENT ones, were measured in patients scheduled for tonsillectomy. Twenty patients (12 males, 8 females) aged between 11 and 25 years (mean 18.0 years) were given cefroxadine for 2 days (500 mg every 12 h), and on the 3rd day 500 mg of the drug was given before surgical operation. Tonsillar tissues were taken 2 h after dosing and blood samples before, 1, 2, 4 and 6 h after the drug administration in 8 out of 20 enrolled patients. Cefroxadine concentrations were measured according to microbiological methods. Cefroxadine tonsillary levels were 1.13 +/- 1.73 micrograms/g, approaching the MIC for sensitive bacteria. The time course of plasma levels is superimposable to previous studies. These findings suggest a rapid penetration of cefroxadine in tonsillar tissue and seem to confirm the clinical efficacy of the drug in ENT infections.

Two-hundred-and-three female patients (mean age: 58 yrs; SD: 8.2 yrs) suffering from osteoarthritis entered this late phase IV multicentre, stratified according to previous therapy (e.g. ketoprofen, naproxen, aspirin, indomethacin or indoprofen), randomized, double-blind, between within-patient trial of 2-week duration. Each patient received either diclofenac SR 100 mg/day (D), piroxicam 20 mg/day (P), or placebo (P1 by oral route. Clinical evaluation (functional class; pain assessment; osteoarthritic condition; joint motility and stiffness) was performed at entry, as well as after the first and the second week. Patient compliance and reported signs and symptoms were recorded after the first week and at the end of the trial. Patient preference, as regards previous therapy, and global evaluation (both by the physicians and the patients) were checked at the end of the trial. The clinical evaluation showed a superiority of D and P over P1. No difference was seen between the two active drugs. Placebo effect was very strong. Global evaluation was significantly in favour of D and P. Patient compliance was extremely good (greater than or equal to 95%). Diclofenac was preferred to naproxen, aspirin and indomethacin, while piroxicam and placebo were preferred only to aspirin. The tolerability of the two active drugs was good and comparable. A significantly lower number of patients complaining of unwanted effects (u.e.) was detected in the placebo group. The number of patients withdrawn for u.e. was similar in the three trial groups.

Renal tolerability of four different dose schedule of sulphinpyrazone (S) was evaluated in a bi-centre, 2-week long open study performed in fifty-six cardiovascular patients of both sexes (47 males, 9 females; mean age 64 yrs) at different risk as regards serum uric acid levels. Each patient was allocated, according to his/her baseline values of serum uric acid or serum creatinine to four different sulphinpyrazone incremental dosage schedules. Renal function and other biochemical assessments (liver function; blood lipids; blood glucose) were assessed at the entry, after the 1st and the 2nd week. Reported signs and symptoms were collected at the 1st and the 2nd week, too. Renal function did not show any statistically and clinically significant impairment during the whole trial. General tolerability, both objective and subjective was particularly good. Only one patient was withdrawn because of reasons unrelated to the ongoing treatment. Sulphinpyrazone can be safely administered also in patients at risk as regards uric acid levels if the proposed therapeutic program is adopted.

Hypertensive disorders are the most common medical complications in the peripartum period associated with a substantial increase in morbidity and mortality. Hypertension in the peripartum period may be due to the continuation of pre-existing or gestational hypertension, de novo development of pre-eclampsia or it may be also induced by some drugs used for analgesia or suppression of postpartum haemorrhage. Women with severe hypertension and hypertensive emergencies are at high risk of life-threatening complications, therefore, despite the lack of evidence-based data, based on expert opinion, antihypertensive treatment is recommended. Labetalol intravenously and methyldopa orally are then the two most frequently used drugs. Short-acting oral nifedipine is suggested to be used only if other drugs or iv access are not available. Induction of labour is associated with improved maternal outcome and should be advised for women with gestational hypertension or mild pre-eclampsia at 37 weeks’ gestation. This position paper provides the first interdisciplinary approach to the management of hypertension in the peripartum period based on the best available evidence and expert consensus.

Background/objectives: The aim of the present study was to validate a short questionnaire on habitual dietary salt intake, to quickly and easily identify individuals whose salt consumption exceeds recommended levels. Subjects/methods: A total of 1131 hypertensive subjects participating in the MINISAL-SIIA study were included in the analysis. Anthropometric indexes, blood pressure, and 24-h urinary sodium excretion (NaU) were measured. A fixed-sequence questionnaire on dietary salt intake was administered. Results: NaU was significantly associated with scores, with a linear association across categories (p for trend 85 mmol/day) and “very high NaU” (NaU > 170 mmol/day) was 86 and 35%, respectively. The score of the questionnaire had a significant ability to detect both “high NaU”—with a specificity of 95% at the score of 10 points—and “very high NaU”—with a specificity of 99.6% at score of 13 points. Conclusions: The main results of the study indicates that a higher score of this short questionnaire is distinctive of habitual high salt consumption in hypertensive patients.

Background:Tinnitus is a common symptom in audiology and neurologypatients. Controversial data have been reported in the literature about the prevalence of tinnitus in hypertensive patients, whereas its relationship with the extent of blood pressure (BP) control has not been substantially explored.Objective:The aim of this study was to determine the prevalence of tinnitus in hypertensive patients, and the impact of different antihypertensive drugs on the incidence of tinnitus in these patients.Methods:This prospective, single-blind, observational study was conducted at the Hypertension Clinic, St. Orsola-Malpighi Hospital, Bologna, Italy. Patients aged 18 to 75 years with uncontrolled hypertension and receiving antihypertensive therapy were enrolled. Patients were asked to complete a standardized questionnaire to assess the presence, frequency, and duration of tinnitus and the apparent effect of their antihypertensive treatment on it. Patients considered by the investigator to have tinnitus, regardless of their audiologic condition, underwent a complete clinical cardiovascular examination, including supine systolic BP (SBP) and diastolic BP measurement and standard 12-lead electrocardiography. Twelve-hour ambulatory BP monitoring was also performed, and patients were asked to record, using patient diaries, times of the onset and resolution of tinnitus that occurred during those 12 hours. From these data, correlations between the onset of tinnitus and BP were calculated.Results:A total of 476 patients participated in the study (283 men, 193 women). Of these, 84 (17.6%) patients reported occasional or prolonged spontaneous tinnitus, whereas 392 (82.4%) reported no tinnitus. The incidence of tinnitus was significantly higher in patients receiving diuretics (72/265 [27.2%]) compared with those receiving angiotensin lI receptor blockers (5/37 [13.5%]), α-blockers (12/55 [21.8%]), or 3-hydroxy-3-methylglutaryl coenzyme A reduc tase inhibitors (9/73 [12.3%]) (all, P < 0.05). Mean (SD) SBP was significantly higher in patients without tinnitus compared with those with it (143.2 [11.1 ] vs 140.6 [10.3] mm Hg; P < 0.005). In 10 (11.9%) patients with tinnitus, the onset was correlated with a sudden decrease in SBP (

Introduction: Blood pressure (BP) control is poorly achieved in hypertensive patients, worldwide. Aim: We evaluated clinic BP levels and the rate of BP control in hypertensive patients included in observational studies and clinical surveys published between 2005 and 2011 in Italy. Methods: We reviewed the medical literature to identify observational studies and clinical surveys on hypertension between January 2005 and June 2011, which clearly reported information on clinic BP levels, rates of BP control, proportions of treated and untreated patients, who were followed in different clinical settings (mostly in general practice, and also in outpatient clinics and hypertension centres). Results: The overall sample included 158 876 hypertensive patients (94 907 women, mean age 56.6 +/- 9.6 years, BMI 27.2 +/- 4.2 kg/m(2), known duration of hypertension 90.2 +/- 12.4 months). In the selected studies, average SBP and DBP levels were 145.7 +/- 15.9 and 87.5 +/- 9.7 mmHg, respectively; BP levels were higher in patients followed in hypertension centres (n = 10 724, 6.7%; 146.5 +/- 17.3/88.5 +/- 10.3 mmHg) than in those followed by general practitioners (n = 148 152, 93.3%; 143.5 +/- 13.9/84.8 +/- 8.9 mmHg; P < 0.01). More than half of the patients were treated (n = 91 318, 57.5%); among treated hypertensive patients, only 31 727 (37.0%) had controlled BP levels. Conclusion: The present analysis confirmed inadequate control of BP in Italy, independently of the clinical setting. Although some improvement was noted compared with a similar analysis performed between 1995 and 2005, these findings highlight the need for a more effective clinical management of hypertension.

Epistaxis, that is a relatively frequent occurrence of hemorrhage from the nose, is reported in up to 60% of the population with peak incidences in subjects under the age of ten (" essential" epistaxis, usually linked to an altered vasomotor regulation) and, with even greater entity, over the age of 60. The cause of nosebleeds can generally be divided into two categories, local and systemic factors, although it should be remembered that a significant number of nosebleeds occur with no obvious cause. Actually, according to the common observation the epistaxis prone subject is an elderly with hypertension associated to some degree of vascular alteration. The statins essentially exert a competitive inhibition of 3-hydroxy-3 methyl glutaryl coenzyme A (HMG-CoA) reductase that results in cholesterol synthesis inhibition. In the last years, however, there has been a growing evidence that these drugs exert a number of vascular actions that are independent of lipid lowering and result in a vasoprotective effect. Due to their favourable influence on the vascular wall, and the consequent possible modulatory effect on blood pressure, a possible utility of statins in preventing many cases of nosebleed is hypothesized, to our knowledge for the first time.