Lower is better: ezetimibe and PCSK9 inhibition join the mainstream of lipid‑lowering therapy

The focus of 2013 cholesterol guidelines to prevent atherosclerotic cardiovascular disease (ASCVD) released by American College of Cardiology (ACC) and American Heart Association (AHA) is the administration of high intensity statin therapy to specific four groups of patients, which were found to benefit the most from such therapy. They no longer promote achieving specific LDL-C goals with a combination therapy involving statins and other drugs, as advocated by the former ATP-III guidelines as well as current guidelines of European Atherosclerosis Society, International Atherosclerosis Society or National Lipid Association. Such approach has been dictated by the strict reliance on randomized controlled trials as the only acceptable level of evidence. However, since publication of the 2013 ACC/AHA guidelines, cardiovascular benefits of ezetimibe added to statin therapy have been established. Moreover, the advent of PCSK9 inhibitors, providing a powerful supplement and/or alternative to statin therapy, further complicates the therapeutic horizon in dyslipdiemias. It is very likely that a new set of ACC/AHA guidelines will be published in 2016, with a return of specific LDL-C and Non-HDL-C goals of therapy as well as integration of drugs other than statins. As the treatment of dyslipidemias becomes more complex, the need for the subspecialty of clinical lipidology to be officially recognized becomes more evident.

Antibiotic resistance: current issues and future strategies

The antibiotic resistance (antimicrobial resistance – AMR) and the particular emergence of multi-resistant bacterial strains, is a problem of clinical relevance involving serious threats to public health worldwide. From early this decade, a lot of studies have demonstrated a significant increase in the rates of antibiotic resistance by bacterial pathogens responsible for nosocomial and community infections all over the world. The AMR leads to a reduced drug efficacy in the treatment options available and therefore, to an increase in mortality rates. The original causes of the phenomenon are: environmental factors which favor a mutation of the genetic bacterial inheritance, thereby inhibiting the active ingredient of the antibiotics; unsuitable administering of antibiotics in veterinary, incorrect taking both in hospitals and at home and, lately, lack of investments in the development of new drugs. The alarming epidemiological data prompted the World Health Organization (WHO) in 2011 to coin the slogan "No action today, no cure tomorrow" in order to immediately implement a new strategy to improve the use of available drugs and to accelerate the introduction of new ones through a new phase of research involving private and public institutions. The European Union has stressed that the surveillance is considered an essential factor for an effective response to this problem but it has also highlighted that the results produced have been lower than expectations because of serious shortcomings such as lack of methodological standards, insufficient data sharing and no coordination among European countries. In Italy the situation is much more troubling; in fact, according to the Ministry of Health, 5000-7000 yearly deaths are deemed due to nosocomial infections, with an annual cost of more than 100 million €.These figures explain how the fight against infections is far from being won. The purpose of this review is to analyze the basic causes of the recurrence of the phenomenon, to explain the steps taken by the most important international organizations to face AMR and finally to suggest a possible way to search for new classes of antibiotics.

Childhood obesity in Italian primary schools: eating habits, physical activity and perception of weight by parents

Childhood obesity is the worst not infectious disease in the world with few clinical treatment options. The purpose of this review is to analyze the epidemiological differences related to childhood obesity in the age group of 6-11 years, both in the United States and Italy which are the most affected by this disease. Among the main causes, three were analyzed: eating habits, physical activity and the perception of the body weight of children by their parents. The review also reports a series of targeted measures adopted by specialized physicians whose main aim is to fight and reduce, in the shortest period possible, the prevalence of childhood obesity. Overeating, often unaware of energy dense foods and beverages, and a sedentary lifestyle habits as well the increase of body weight. The wrong timing of meals, jumping breakfast, eating few fruit and vegetables all day long and drinking sugary and/or carbonated drinks are more frequent and deep-rooted habits among children. To correct these habits and promote a healthy eating it is necessary to plan targeted interventions.

Metabolic syndrome in adults: relation with diet and other lifestyle factors

Metabolic syndrome is a constellation of risk factors that has the potential of developing into cardiovascular disease or increase the susceptibility to it. It is present worldwide with now even developing countries getting overwhelmed by its burden. With a shift towards unhealthy diet coupled with sedentary lifestyle, development of metabolic syndrome is on the rise even among young adults. One of the main causes of this problem is faulty diet, so any means to reduce the incidence of the syndrome involves the modification of the existing diets rich in saturated fat, sodium and cholesterol. This review focusses on efficacy of different dietary patterns for combating the syndrome along with other lifestyle risk factors. It also highlights newer advancements in the field of Metabolic Syndrome, which can serve as potential strategies to combat it. Public health interventions targeting adults, therefore, should center on prevention through education, modification of diet and lifestyle, and focusing on environment, so that these changes are acceptable and sustainable.

Ledipasvir/sofosbuvir: the fixed dose combination in the new era of treatment for HCV

Interferon-based treatment is not suitable for many patients with hepatitis C virus (HCV) infection because of contraindications, other reasons for ineligibility and side-effects. The fixed dosed combination ledipasvir/sofosbuvir (LDV / SOF) is the first approved regimen that doesn’t require administration with interferon or ribavirin. LDV / SOF is also the first single-pill approved for the treatment of chronic HCV genotype 1 in both treatment-naïve and treatment-experienced patients. The results of the phase III studies demonstrate the combination has been very well tolerated and SVR rates consistently above 90%. Objective of this review is to present clinical evidence of efficacy and safety of the combination LDV / SOF in different subgroups of patients with HCV.

Sofosbuvir: an all-around drug in hepatitis C treatment new era – The first phase

Chronic hepatitis C virus (HCV) infection is a slowly progressive disease affecting more than 185 million people worldwide. For many years, the combination of pegylated interferon (Peg-IFN) plus ribavirin (RBV) has been the backbone of treatment for patients infected with HCV. More than two years ago, the first generation direct-acting antiviral agents (DAAs) – the protease inhibitors boceprevir and telaprevir – were approved for treatment of genotype 1 patients, doubling the cure rate. The new DAAs that have been developed, are effective for multiple genotypes, improve rates of sustained viral response with fewer side effects, simplify dosing and drug-drug interactions, and in some patients, offer the promise of interferon-free and/or ribavirin-free therapy. These new agents include the recently approved second generation protease inhibitor, the HCV NS5B polymerase inhibitor sofosbuvir and the NS3/4A protease inhibitor simeprevir as well as several other agents that are currently in later phases of development. With sofosbuvir-based regimens, successful interferon-free treatment is now available across all genotypes. In fact sofosbuvir is very effective in combination with Peg-interferon and ribavirine or with ribavirine alone or with other direct anti-viral agents. The following assessment evaluates the evidence on the clinical effectiveness and harms of sofosbuvir for the treatment of chronic hepatitis C.

Friendship and Cancer

Friendships are a powerful healing force for physical and mental illness. The study of the role of friendship for cancer patients has been relatively neglected and academic evidence-based studies are lacking. A literature review of research was performed linking cancer with friendships and social support (other than that provided by family members or members of medical staff). Some studies report the importance of friendships formed amongst young children and often in a school context; fewer studies have focused on friendships amongst adults with cancer. Direct links between friendships formed and/or maintained amongst cancer patients and their precise effects on an individual’s battle with cancer have yet to be explored.

Aging, inflammation and depressive behavior: a review

One of the most common co-morbidities of cerebrovascular disorders is neuroinflammation, a hallmark and decisive contributor to many central nervous system (CNS) diseases. Although neuropathological conditions differ in etiology and in the way in which the inflammatory response is mounted, cellular and molecular mechanisms of neuroinflammation are probably similar in aging, hypertension, depression and cognitive impairment or after cerebral insult such as stroke. Moreover, a number of highly prevalent risk factors such as hypertension, diabetes and atherosclerosis are increasingly understood to act as “silent contributors” to neuroinflammation – not only establishing the condition as a central pathophysiological mechanism, but also constantly fuelling it. Mild, but continuous neuroinflammation can provide the ground for disorders such as cerebral small vessel disease (cSVD) and subsequent dementia. Acute neuroinflammation, often in the context of traumatic or ischemic CNS lesions, aggravates the acute damage and can lead to depression, post-stroke dementia and neurodegeneration. All of these sequelae impair recovery and provide the ground for further cerebrovascular events.