Minerva medica
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The treatment landscape of advanced non-small cell lung cancer (NSCLC) patients has dramatically changed over the past 10 years, particularly thanks to the advent and development of several tyrosine kinase inhibitors (TKI) targeting oncogenic drivers. Among them, patients bearing anaplastic lymphoma kinase (ALK) translocations, which are causative of 3-5% of all advanced NSCLC, have seen dramatically improved their clinical outcomes moving life expectancy at 5 years from less than 5% to 50%. In fact, multiple ALK inhibitors (ALKi) entered in the therapeutic algorithm of ALK+ patients, multiplying their treatment opportunities. ⋯ In such wide variety of options, we reviewed the preclinical and clinical efficacy data of brigatinib, its pharmacological and safety profile, like also actual and potential future applications in the ALK+ NSCLC scenario. Through a spurious exercise of an indirect comparison with other available 2G ALKi, we tent to summarize the required knowledge to properly choose the best drug at the right time. Furthermore, we reviewed available data on molecular resistance mechanisms and putative therapeutic applications in other contexts, such as ROS1+ NSCLC patients or EGFR+ ones progressing to osimertinib.
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Inflammatory bowel diseases (IBD) may be complicated by extraintestinal manifestations (EIM). Both conditions may be implicated in the overall increase of cardiovascular (CV) risk profile of the patients. The study aimed to assess CV risk in IBD patients with EIMs in relation to the stages of both diseases. ⋯ The active phase of IBD or EIM or both may promote endothelial dysfunction in patients, thus increasing their CV risk profile. Patients in remission phase showed endothelial function similar at controls.
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Hypertension and hypotension are strictly related phenomena, that frequently coexist within the spectrum of cardiovascular autonomic dysfunction, especially at advanced age. Indeed, antihypertensive treatment may predispose to orthostatic and postprandial hypotension, while intensive blood pressure lowering may be responsible for systemic hypotension. Over recent years, systemic and orthostatic hypotension have emerged as important although often neglected risk factors for adverse outcomes, paralleling the widely recognized arterial hypertension. ⋯ Balancing low and high blood pressure requires accurate diagnostic assessment of blood pressure values and patients' hypotensive susceptibility, which allow for the development of customized treatment strategies based on individual hypo/hypertensive risk profile. The present review illustrates the complex interrelationship between hypotension and hypertension and discusses the relevant prognostic role of these conditions. Additionally, it provides an overview on hypotension detection and treatment in patients with hypertension, focusing on customized diagnostic and therapeutic strategies.
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According to 2018 ESC Guidelines for syncope, the first aim in ED evaluation is to identify patients with underlying acute diseases, at higher risk of short-term adverse events; in the meantime, emergency physicians should also identify cases of hypotensive syncope elicited by non-severe concurrent conditions, as they mostly do not require hospitalization. After excluding these cases, ESC GL state that patients should be managed with initial evaluation and risk stratification, providing several tables and flow-charts to do it. To optimize ED management, we propose to combine these two phases, as in the clinical practice they occur at the same, with the following simplified paths: patients with only clinical features suggestive of reflex syncope should be discharged, with a fast-track to an outpatient Syncope Unit only in case of severe syncope; patients with orthostatic syncope could be discharged with measures to prevent recurrences or be managed in an ED Observation Unit (EDOU) in case of fluid loss or other causes of volume depletion; patients with major clinical or ECG criteria suggestive of cardiogenic syncope should be admitted, for diagnostic or therapeutic purposes; patients with undetermined syncope or minor clinical or ECG criteria suggestive of cardiogenic syncope should be managed in an EDOU. ESC GL give focus to this novel care pathway, but they do not provide clear details on the organizational aspects; accordingly, this document proposes resources and protocols for managing patients in EDOU, as a first part of the functional path of the outpatient Syncope Unit.
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The aim of this open supplement study was to evaluate the effects of Pycnogenol® in comparison with controls on symptoms of post-COVID-19 syndrome and in improving endothelial function, microcirculation, inflammatory markers and oxidative stress over 3 months in symptomatic subjects recovering from COVID-19. ⋯ In conclusion, Pycnogenol® may offer a significant option for managing some of the signs and symptoms associated with post-COVID-19 syndrome. This pilot evaluation offers some potential rationale for the use of Pycnogenol® in this condition that will have significant importance in the coming years.