Aortic stenosis (AS) is the most prevalent valvular heart disease in Western countries and it is especially associated with older age. With its progressive course, AS leads to ventricular hypertrophy, impaired diastolic and systolic function, and symptomatic deterioration. The natural history of AS is closely linked to the extent of myocardial and extracardiac damage in association with the patients comorbidities. Diagnosis relies primarily on transthoracic echocardiography, which assesses valve morphology, quantifies stenosis severity, and evaluates cardiac remodeling. However, discordant grading is frequent, necessitating advanced imaging to clarify the severity and the mechanism of the stenosis and stratify risk. Treatment is predominantly interventional, as no medical therapy is able to stop disease progression. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are the two treatment options. Special clinical scenarios-such as cardiogenic shock or concomitant cardiac amyloidosis-pose additional diagnostic and therapeutic challenges and require individualized, multidisciplinary management. Overall, contemporary AS care increasingly integrates multimodality imaging, refined risk stratification, and tailored interventional strategies to optimize outcomes.
To assess the long-term (4 year) outcomes of staged (phacoemulsification ≥ 6 months prior to trabeculectomy) or combined (phacotrabeculectomy) surgical approaches in patients with uncontrolled glaucoma. Patients who underwent trabeculectomy alone (with phacoemulsification at least 6 months before trabeculectomy - staged approach) and simultaneous phacotrabeculectomy (combined approach) were included in this retrospective chart review study. Surgical success was defined as complete (without medication) or qualified (with medication) according to 3 criteria of upper limits: intraocular pressure (IOP) > 21 mmHg (criterion A), > 18 mmHg (B), > 15 mmHg (C). Mean IOP values were compared between groups at each follow-up. A total of 72 patients (staged n = 35, combined n = 37) were included. No differences in baseline characteristics were observed between groups. The mean age was 72.3 years, almost three-quarters were diagnosed with primary open-angle glaucoma (73.6
Congenital cytomegalovirus (cCMV) is the most common congenital infection and a leading cause of non-genetic sensorineural hearing loss and neurodevelopmental disability in newborns. Despite its clinical burden, routine CMV screening in pregnancy has not been recommended so far due to the lack of effective treatment to prevent transplacental transmission. In December 2023, the Italian National Institute of Health, on behalf of the Ministry of Health, has issued a new recommendation supporting universal CMV serological screening during pregnancy. This recommendation is based on the results of a systematic review of the literature, including randomized controlled trials, observational studies, and systematic reviews. Recent high-quality evidence demonstrates that valacyclovir significantly reduces vertical transmission when administered during early primary maternal infection. In addition, cost-effectiveness analyses support universal screening in settings with moderate-to-high CMV seroprevalence among childbearing age women. Based on this evidence, the updated Italian guideline recommends CMV serological screening at the first antenatal visit within the first trimester, with monthly testing until 24 weeks in seronegative women, and targeted information on CMV prevention to all pregnant women. This article summarizes the evidence and decision-making process behind this new national recommendation and highlights its potential relevance to other countries currently considering the implementation of a similar screening policy.
Five modifiable cardiovascular risk factors-hypertension, diabetes, smoking, hypercholesterolemia, and obesity-account for approximately 50% of the global burden of cardiovascular disease. Recent data from the Global Cardiovascular Risk Consortium show that the absence of diabetes and smoking is associated with the lowest risk in terms of life expectancy and years lived free from cardiovascular disease. A systolic blood pressure below 130 mmHg, lower non-HDL cholesterol levels, and normal body weight are associated with a later onset of cardiovascular disease and a more modest increase in life expectancy. The absence of hypertension is correlated with the greatest number of years lived free from cardiovascular events. Smoking is confirmed as one of the most influential risk factors in terms of its impact on health and longevity. Individuals who eliminate hypertension and smoking in midlife gain the greatest number of additional years of life free from cardiovascular disease and all-cause mortality, respectively. Male sex emerges as a traditional, non-modifiable risk factor independent of modifiable risk factors. Finally, even the absence of all the risk factors considered remains associated with a residual lifetime probability of developing cardiovascular disease.
