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The aim of this study was to investigate the presence of subclinical cardiac dysfunction in recovered coronavirus disease 2019 (COVID-19) patients, who were stratified according to a previous diagnosis of pulmonary embolism (PE) as a complication of COVID-19 pneumonia. Out of 68 patients with SARS-CoV-2 pneumonia followed up for one year, 44 patients (mean age 58.4 ± 13.3, 70% males) without known cardiopulmonary disease were divided in two groups (PE+ and PE−, each comprising 22 patients) and underwent clinical and transthoracic echocardiographic examination, including right-ventricle global longitudinal strain (RV-GLS), and RV free wall longitudinal strain (RV-FWLS). While no significant differences were found in the left- or right-heart chambers’ dimensions between the two study groups, the PE+ patients showed a significant reduction in RV-GLS (−16.4 ± 2.9 vs. −21.6 ± 4.3%, p < 0.001) and RV-FWLS (−18.9 ± 4 vs. −24.6 ± 5.12%, p < 0.001) values compared to the PE- patients. According to the ROC-curve analysis, RV-FWLS < 21% was the best cut-off with which to predict PE diagnosis in patients after SARS-CoV-2 pneumonia (sensitivity 74%, specificity 89%, area under the curve = 0.819, p < 0.001). According to the multivariate logistic regression model, RV-FWLS < 21% was independently associated with PE (HR 34.96, 95% CI:3.24–377.09, p = 0.003) and obesity (HR 10.34, 95% CI:1.05–101.68, p = 0.045). In conclusion, in recovered COVID-19 patients with a history of PE+, there is a persistence of subclinical RV dysfunction one year after the acute phase of the disease, detectable by a significant impairment in RV-GLS and RV-FWLS. A reduction in RV-FWLS of lower than 21% is independently associated with COVID-related PE.

Left ventricular hypertrophy (LVH) is a well established cardiovascular risk factor, accounting for an increase in cardiovascular morbid-mortality, although how much the magnitude and the kind of LVH could affect cardiovascular outcomes is in large part unknown. We speculate that mild LVH in absence of left ventricular (LV) chamber dilation, could play a protective role towards functional capacity, clinical outcome, cardiovascular and total morbi-mortality in conditions in which LV systolic function is generally reduced. Accordingly to many epidemiological observations, the availability of extra-quote of systolic function could lead to a significative improvement in the final outcome of some kinds of heart patients, as those undergoing bypass-grafting, where the stress for heart and cardiovascular system is always high. We suppose that the functional reserve available for patients with LVH could make the difference with respect to other patients undergoing myocardial revascularization. Similarly, the availability of a contractile reserve warranted by LVH could ensure a little gain in the outcome for patients after other major cardiovascular events (such as myocardial infarction or other heart surgery as surgical valve replacement). However, our hypothesis only involves mild LVH without LV chamber dilation, that is the initial stage of "non-dilated concentric" LVH and "non-dilated eccentric" LVH according to the new four-tiered classification of LVH based on relative wall thickness and LV dilation. Support for our hypothesis derives from the well-known protective role of systolic function that is a major factor in almost all cardiovascular diseases, where LV ejection fraction (LVEF) has shown to significantly improve quality of life, as well as morbidity and mortality. The knowledge that mild LVH in absence of LV chamber dilation is not as harmful in such conditions as believed at present could make avoidable some drugs prescription in some stages of the disease. Furthermore, it may allow a better evaluation of the risk profile of patients with LVH undergoing some cardiovascular major events like bypass grafting, myocardial infarction or surgical heart valve replacement.

Background: Left atrial volume (LAV) and function are connected to the left ventricular (LV) haemodynamic patterns. To define the changes of LAV and functions to counterbalance age-related LV diastolic impairment, this study was undertaken. Methods: 2D-Left Atrial Speckle Tracking Echocardiography (2D-LASTE) was used to define both LAV and functions in an aged healthy population (group II) respect to adult healthy controls (group I). Results: Results showed an increasing of left atrial volume indices (LAVI) (maximum, minimum, pre-a) in old subjects in comparison with those obtained in adult healthy controls. On the contrary, LAVI passive emptying unchanged and LAVI passive fraction reduced with advanced age. Finally, LAVI active emptying increased with advancing age to compensate the age-dependent left ventricular diastolic dysfunction. The values of global systolic strain (S); systolic strain rate (SrS); early diastolic strain rate (SrE), and late diastolic strain rate (SrA) were also calculated. With reference to the function, our study confirmed that LA conduit function deteriorates with age while booster pump increases respect to adult controls and reservoir phase is maintained. Conclusions: The echocardiographic findings obtained with conventional and tissue Doppler confirmed the connection between LA functions and volumes and age-related LV dysfunction. Conclusively, 2D-LASTE appears to be a reliable tool to evaluate the role of LA to compensate the derangement of left ventricle happening with ageing.

Pneumonia in the elderly is a common and severe problem. In this review we analyze the state of the art for pneumonia in the elderly. Several aspects are discussed: i) how common is the disease; signs and symptoms in the elderly; ii) the elderly must always be hospitalized and which is the best place - Intensive Care Unit or medical ward?; iii) the role of comorbidities; iv) etiology and pathogenesis; medical treatment - when and how to start; v) antibiotic resistance; vi) antibiotics in hospital acquired and ventilator related pneumonia; vii) assisted non-invasive ventilation; viii) the treatment in the terminally ill elderly patient.

This paper describes an unusual type of abnormal coloration caused by the fungal species Phoma glomerata (P. glomerata) detected in samples of commercially available mozzarella cheese produced from cow’s milk. The presence of this fungus in dairy and cheese products has already been reported by other authors, along with other fungal contaminants; however, it has never been associated to specific alterations of cheeses. This is the first report of a macroscopic alteration of a soft cheese due to P. glomerata. Mozzarella cheese from four packages (two sealed and two already opened, three of which with evident macroscopic alterations) was analyzed by means of ISO methods for the detection of the main bacterial and fungal contaminants of cheese products. Culture tests carried out according to the ISO 21527-1:2008 method revealed presence of P. glomerata (from 1,100 CFU/g to 45,000 CFU/g). In addition, in both the previously opened packages, Acremonium spp. (100 CFU/g), Alternaria spp. (100 CFU/g), Pseudomonas fluorescens (25,000 CFU/g) and Pseudomonas putida (2,400 CFU/g) were also isolated. In sample N°4, contamination by P. glomerata was present, but in the absence of macroscopic changes. These results show that P. glomerata is able to contaminate mozzarella cheese, causing macroscopically visible alterations of the product; this may have serious consequences in terms of sales. With regard to the possible effects on human health, further studies are needed in order to assess the toxic effect of the fungus. As a result of the episode described, the Italian health authorities issued a RASFF (Rapid Alert System for Food and Feed) early warning notice, a key E.U. tool to ensure the cross-border flow of information in order to react swiftly when risks to public health are detected in the food chain.

Esophageal achalasia is a motility disorder characterized by impaired relaxation of the lower esophageal sphincter and dilatation of the distal two-thirds of the esophagus. This condition may be a non-frequent reason of extrinsic compression of left atrium. In turn, this can be a cause of some hemodynamic changes such as chest discomfort, dyspnea or reduced exercise tolerance, systemic hypotension and tachycardia. We describe a case of a patient with esophagus achalasia compressing the left atrium and inducing hemodynamic compromise. The diagnostic methods, as chest X-ray, computed tomography (CT), manometry, and 2D-Trans-Thoracic Echocardiography (TTE) demonstrated the esophagus dilation, the impaired relaxation of the lower esophageal sphincter, and its compression on the left atrium. Three-D Trans-Thoracic Echocardiography (3D-TTE) was firstly performed also. This last examination pointed out better than 2D-TTE the extrinsic compression of the left atrium due to the esophagus dilatation. Therefore, 3D-TTE is a true improvement for the echocardiographic diagnosis of the left atrial compression induced by esophageal achalasia.

AIM: This study was undertaken to evaluate the hepatic effects of silybum marianum on non alcoholic fatty liver disease (NAFLD). METHODS: In 72 patients affected by NAFLD, main metabolic, hepatic and anti-inflammatory parameters were assayed after 3 mo of a restricted diet and before silymarin treatment (twice a day orally). The brightness of liver echography texture (hepatorenal ratio brightness) was also defined at same time. These evaluations were repeated after 6 mo of treatment. RESULTS: Serum levels of some metabolic and anti-inflammatory data nonsignificantly lowered after 6 mo of silymarin. On the contrary, Steato test, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase were significantly (P < 0.001) reduced. Instead, the AST/ALT ratio unchanged. Finally, the hepatorenal brightness ratio, as an index of hepatic steatosis, significantly (P < 0.05) dropped. CONCLUSION: The obtained results indicate that silymarin appears to be effective to reduce the biochemical, inflammatory and ultrasonic indices of hepatic steatosis. Some parameters indicative of early stage of atherosclerosis were also lowered.

BACKGROUND: To point out a possible correlation between left atrial volume index (LAVI) and left ventricular (LV) diastolic time interval to better define LV diastolic dysfunction, this study was performed. METHODS: In 62 hypertensive-hypertrophic patients without LV systolic dysfunction, LV volumes, myocardial mass index, ejection fraction% (EF%) and LAVI were measured by two-dimensional echocardiography. Instead, tissue Doppler echocardiography (TDE) was used to measure myocardial performance index (MPI) and its systo-diastolic time intervals, such as: iso-volumetric contraction time (IVCT); iso-volumetric relaxation time (IVRT); ejection time. LAVI, TDE-MPI and time intervals where also measured in 15 healthy controls, to obtain the reference values. RESULTS: Results shown a significant increase of LV volumes in hypertensives in comparison to the control group (p < 0.05). LV mass index also augmented (p < 0.001). Instead, EF% not significantly changed in hypertrophic patients in comparison with healthy controls. LAVI raised in hypertensives wih left ventricular hypertrophy, whereas IVCT resulted within the normal limits. On the contrary, IVRT significantly raised. Accordingly, MPI resulted higher in controls. CONCLUSION: LAVI, MPI and its time intervals appear as reliable tools to non-invasively individualize LV diastolic dysfunction in systemic hypertension, in absence of mitral valve disease.

Nowadays, the importance of practicing physical activity (PA) during pregnancy is widely known and recommended thanks also to several guidelines. Nonetheless, fewer than 15% of pregnant women reach these recommendations. Given the above, the implementation of adapted physical activity (APA) intervention emerges among the possible strategies that allow pregnant women to perform the right dose of PA. Childbirth preparation classes (CPCs), offered by the national healthcare system, can represent an ideal setting for the promotion of PA during pregnancy and the implementation of APA programs. The aim of this study was to co-design an intervention of APA tailored for pregnant women to be included in the CPCs and to evaluate the feasibility and efficacy in terms of PA levels and physical performance