Data on cognitive impairment in patients with Long-COVID remain controversial. The study analyzed in patients followed for Long-COVID the frequency and risk factors for cognitive impairment (defined by a Montreal Cognitive Assessment [MoCA] score < 24 points), its associations with subjectively reported cognitive and psychological symptoms, and the evolution of cognitive impairment and cognitive symptoms over time. At a mean interval of 259 days from COVID-19, the mean MoCA score recorded among 118 individuals was 25.5, with 32.2

The primary objective of this article is to provide an overview of studies in humans that evaluate and compare the effects of heated tobacco products (HTPs) with those of conventional cigarette smoking on cardiovascular and respiratory diseases. To address this research question, a scoping review methodology was employed. A comprehensive literature search was conducted in the PubMed, Scopus, Web of Science, and Cochrane Library databases to identify relevant articles published between January 2014 and March 2025. Two reviewers independently screened all articles. This process resulted in the identification of 34 articles deemed appropriate to the aims of this scoping review. Despite the heterogeneity of the available data, the current evidence suggests that HTPs are associated with a lower harmful impact on the cardiovascular and respiratory systems as compared to conventional cigarettes. However, considering the relatively recent introduction of HTPs, in contrast to the long latency periods typically required for the development of smoking-related chronic diseases, as well as the evolving design and composition of these products, it is not surprising that definitive conclusions regarding their clinical, and public health impact bring up the need to be integrated by long-term evidence derived from independently conducted studies.

Aim of the study was to define the patterns and determinants of symptom persistence in Long-COVID. The study population was represented by a multicenter cohort of patients with persisting symptoms after SARS-CoV-2 infection. Data collection included demographics, comorbidities, characteristics of acute infection, vaccination, reinfection, plus 30 different symptoms. The associations between covariates and persistence were assessed in multivariable logistic regression models. The study evaluated, at a mean interval of 453 days from acute SARS-CoV-2 infection, symptom persistence in 755 patients who had Long-COVID symptoms at a mean interval of 223 days from COVID-19. At second evaluation, 423 (56.0

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), encompasses a spectrum of liver diseases characterized by hepatic steatosis, the presence of at least one cardiometabolic risk factor, and no other apparent cause. Metabolic syndrome (MetS) is a cluster of clinical conditions associated with increased risk of cardiovascular disease, type 2 diabetes, and overall morbidity and mortality. This narrative review summarizes the changes in the management of people with MetS and NAFLD/MASLD from screening to therapeutic strategies that have occurred in the last decades. Specifically, we underline the clinical importance of considering the different impacts of simple steatosis and advanced fibrosis and provide an up-to-date overview on non-invasive diagnostic tests (i.e., imaging and serum biomarkers), which now offer acceptable accuracy and are globally more accessible. Early detection of MetS and MASLD is a top priority as it allows for timely interventions, primarily through lifestyle modification. The liver and cardiovascular benefits of a global and multidimensional approach are not negligible. Therefore, a holistic approach to both conditions, MetS and related chronic liver disease, should be applied to improve overall health and longevity.

Purpose:Some studies have suggested that therapeutic interventions able to mitigate the acute phase of COVID-19 can also reduce the risk of Long-COVID and its severity, but the issue is still controversial. Methods:We examined in a national cohort of patients followed in Long-COVID centers the risk of persistent symptoms according to administration in acute COVID-19 of four drug classes: antivirals, IL-6 inhibitors, monoclonal neutralizing antibodies and systemic corticosteroids. Final risk estimates for 26 symptoms were expressed as adjusted odds ratios calculated in multivariable logistic regression models that included as covariates demographics, comorbidities, BMI, smoking, severity of acute disease, hospitalization, level of respiratory support, SARS-CoV-2 vaccination and treatments administered during acute infection. Results:The final population included 1534 adult patients (mean age 60.3 years, 67.0% hospitalised during acute COVID-19). Treatments administered during acute phase included systemic steroids (52.8%), antivirals (20.7%, mostly remdesivir), IL-6 inhibitors (9.4%) and neutralizing antibodies (3.9%). After a mean interval of 338 days from acute COVID-19, 1181 patients (77.0%) presented persisting symptoms. For the drug classes considered, some protective associations were found in univariate analyses, that were however not maintained adjusting for confounders in multivariate analyses. Systemic corticosteroids and IL-6 inhibitors showed some negative associations with isolated symptoms. Conclusions:Some drug classes showed a protective effect that was however not confirmed in multivariable analyses, underlining the importance of adjusting for a comprehensive number of covariates. Clinicians should consider the possibility that systemic corticosteroids and IL-6 inhibitors administered during acute COVID-19 may prolong the persistence of particular symptoms.

The association of cigarette smoking with several severe and very severe diseases (oncological, cardiovascular, respiratory) which have dramatic epidemiological, medical, and financial impact, is a well-known public threat. Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent diseases in Italy, posing significant public health challenges. Tobacco smoking, a primary risk factor for COPD and a common asthma trigger, remains a critical preventable public health issue. While universally acknowledged that quitting smoking drastically reduces the risk of smoking-related health issues, a significant portion of smokers and patients find quitting challenging or undesirable, hence a need for new ways to deal with it. A worth considering alternative might be the switch to electronic cigarettes (e-cig), and heat-not-burn/heated tobacco products (HnB/HTP). Emerging evidence suggests potential benefits in asthma and COPD management when transitioning from traditional smoking to e-cigs or HnB devices. However, the effectiveness of these products in facilitating smoking cessation is still debated, alongside concerns about their role in promoting smoking initiation among non-smokers. Internists are among the physicians who most frequently assist patients with smoking-related diseases, and in this perspective they cannot avoid paying attention to the progressive diffusion of smoking products alternative to the traditional cigarette, and to the controversies with respect to their use. In this context, the Italian Society of Internal Medicine, also recognizing a growing need for clarity for healthcare providers, has undertaken a comprehensive analysis of existing literature to offer an informed perspective on the health impact of e-cigs and HnB/HTP on asthma and COPD.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Sleep-disordered breathing is a highly prevalent disorder with negative impact on healthcare systems worldwide. This condition has detrimental effects on cardiovascular health and quality of life, and is frequently associated with a variety of comorbidities, including cardiovascular disease, heart failure, diabetes and atrial fibrillation. Nevertheless, it remains frequently undiagnosed and undertreated, especially in specific populations. Studies on sleep-disordered breathing have been conducted mainly on male patients, and the prevalence and severity of this disorder in women are underestimated. Recently, some clinical and laboratory evidence has highlighted the epidemiological and pathophysiological differences between men and women with sleep-disordered breathing. In this review, we discuss sex-related mechanisms of sleep-disordered breathing in frequently associated disorders, to improve clinical understanding of this condition and to simplify the practical application of targeted interventions. The aim is to improve prognosis among female patients and guarantee a better quality of life and a reduction in healthcare costs.

Long-COVID symptoms remain incompletely defined due to a large heterogeneity in the populations studied, case definitions, and settings of care. The aim of this study was to assess, in patients accessing care for Long-COVID, the profile of symptoms reported, the possible clustering of symptoms and cases, the functional status compared to pre-infection, and the impact on working activity. Multicentre cohort study with a collection of both retrospective and prospective data. Demographics, comorbidities, severity and timing of acute COVID, subjective functional status, working activity and presence of 30 different symptoms were collected using a shortened version of the WHO Post COVID-19 Case Report Form. The impact on working activity was assessed in multivariable logistic regression models. Clustering of symptoms was analysed by hierarchical clustering and the clustering of cases by two-step automatic clustering. The study evaluated 1297 individuals (51.5

BACKGROUND:There are conflicting evidence on the association between atrial fibrillation (AF) pattern, such as persistent/permanent (Pers/Perm) and paroxysmal (PAF) AF and risk of ischemic events. We investigated if left atrial diameter (LAd) may affect the risk of cardiovascular outcomes according to AF pattern.METHODS:Prospective multicenter observational including 1,252 non-valvular AF patients (533 PAF and 719 Pers/Perm AF). Study endpoints were cardiovascular events (CVEs), major adverse cardiac events (MACE) and CV death. LA anteroposterior diameter (LAd) was obtained by transthoracic echocardiography.RESULTS:Pers/Perm AF patients had a higher proportion of LAd above median than PAF (≥44 mm, 59.5% vs 37.5% respectively, P < .001). In a mean follow-up of 42.2 ± 31.0 months (4,315 patients/year) 179 CVEs (incidence rate [IR] 4.2%/year), 133 MACE (IR 3.1%/year), and 97 CV deaths (IR 2.2%/year) occurred. Compared to patients with LAd below median, those with LAd above the median had a higher rate of CVEs (log-rank test, P < .001), MACE (log-rank test P < .001), and CV death (log-rank test P < .001). Multivariable Cox regression analysis showed that LAd above the median was associated with CVEs, (HR 1.569, 95% CI 1.129-2.180, P = .007) MACE (HR 1.858, 95% CI 1.257-2.745, P = .002) and CV death (HR 2.106, 95% CI 1.308-3.390, P = .002). The association between LAd and outcomes was evident both in PAF and Pers/Perm AF patients. No association between AF pattern and outcomes was found.CONCLUSION:LAd is a simple parameter that can be obtained in virtually all AF patients and can provide prognostic information on the risk of CVEs, MACE and CV death regardless of AF pattern.

Objective: Chronic kidney disease (CKD) is a condition with high cardiovascular mortality associated with emerging risk factors, including sarcopenia. Several mechanisms can affect muscle mass, such as vitamin D deficiency, low protein intake, physical inactivity, metabolic acidosis, and inflammation leading to a worsening of cardiovascular outcomes and cognitive function. We aimed to evaluate the prevalence of sarcopenia in CKD patients on conservative and replacement therapy and the associations between sarcopenia and markers of atherosclerosis, endothelial dysfunction, psychological and cognitive function. Methods: We enrolled CKD patients (stage 3/5 KDIGO [Kidney Disease: Improving Global Outcomes]) and hemodialysis, peritoneal dialysis, and post-kidney transplant patients. Clinical, laboratory and instrumental assessments, including bioimpedance analysis, hand-grip strength, intima media thickness, flow-mediated dilation, and epicardial adipose tissue, were performed in addition to analysis of psychological and cognitive status by the Montreal Cognitive Assessment, Mini-Mental State Examination, and Geriatric Depression Scale. Results: A total of 77 patients (43 male) with a mean age of 69.6 9.85 y were studied. According to validated criteria (using bioimpedance analysis and hand-grip strength), the prevalence of sarcopenia was 49.4%. Sarcopenic patients had higher values of intima media thickness (P= 0.032) and epicardial adipose tissue (P= 0.012) and lower flow-mediated dilation (P= 0.002), total cholesterol (P = 0.005), and high-density lipoprotein cholesterol (P= 0.008) with respect to non-sarcopenic patients. We found higher Geriatric Depression Scale scores (P= 0.04) in sarcopenic patients, whereas we did not find differences between the two groups in Mini-Mental State Examination and Montreal Cognitive Assessment score. Conclusion: Sarcopenia is highly prevalent in CKD/end stage renal disease patients and is associated with changes in early systemic indices of atherosclerosis and endothelial dysfunction, known as markers of worse prognosis. (C) 2018 Elsevier Inc. All rights reserved.

BACKGROUND Recent studies suggested that the visceral fat could exert a predictive role in the pathogenesis of dementia. The aims of the present study were to evaluate: i) possible differences between groups with different epicardial adipose tissue (EAT) thickness on the included variables; ii) the possible predictive role of the EAT levels on cognitive functioning. METHODS 65 community-dwelling subjects were enrolled and divided into two groups: EAT < 7 mm (n = 36); EAT > 7 mm (n = 29). The metabolic profile was assessed through the evaluation of the biochemical parameters whereas the EAT thickness was measured through the transthoracic echocardiography. The Mini Mental State Examination (MMSE) was also administered. RESULTS The two EAT groups reported several significant differences, included on the MMSE scores. The multiple linear regression analysis showed that the EAT thickness levels and the hypertension had a predictive effect on the MMSE scores. CONCLUSIONS These preliminary findings support the association between EAT thickness levels and cognitive impairment.

Chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) are characterized by increased oxidative stress, but the impact of the coexistence of COPD and AF on systemic oxidative stress is unclear. We performed a cross-sectional study including 157 outpatients to investigate the Nox2-related oxidative stress in patients with AF and COPD. COPD was defined by an FEV1/FVC <0.70. Oxidative stress was measured by sNox2-dp, a marker of Nox2 activation, and urinary isoprostanes. We divided patients into four groups: Group 0: hypertension (n = 49, controls); Group 1: COPD (n = 42); Group 2: AF (n = 33); and Group 3: COPD and AF (n = 33). Mean age was 68.3 +/- 11.0 years, and 46.5% were women. Patients with COPD or AF showed increased levels of sNox2-dp as compared with group 0; sNox2-dp further increased in patients with COPD + AF. In these patients, sNox2-dp was higher than in those with COPD (p < 0.001) or AF (p = 0.003). At multivariable logistic regression analysis, chronic kidney disease, COPD, and AF were associated with sNox2-dp above median. Similar results were observed for urinary isoprostanes. We hypothesize that the coexistence of COPD in AF patients may be associated with an increased systemic oxidative stress by the upregulation of Nox2.

Background and AimWestern societies, with growing prevalence, suffer from various metabolic diseases like obesity and hepatic steatosis, better defined as non-alcoholic fatty liver disease, or cardiovascular (CV) diseases that are strictly linked to each other. The association of their occurrence with the altered homeostasis of metals is an intriguing issue. Copper in particular was identified as key player in various metabolic derangements. On these bases, we aimed at investigating the possible association of serum copper levels with an indicator of early CV risk as the intima-media thickness (IMT) of carotid artery and its predictive value in a selected population of obese patients. MethodsWe performed a cross-sectional study recruiting 100 obese patients characterized by a low prevalence of comorbidities. Ultrasound investigation for hepatic steatosis and IMT evaluation were performed. Serum samples were collected and then analyzed through atomic absorption spectrometry to evaluate their copper content. Possible correlations between copper bioavailability and biochemical, clinical, and anthropometric characteristics of patients were sought. ResultsAge negatively predicted copper serum levels of patients (P=0.009). However, the most interesting finding is the negative prediction of IMT by the copper serum levels (t=-2.23, P=0.028, least absolute deviations regression). Factor analysis confirmed the aforementioned inverse correlation and highlighted the strong inverse correlation between smoking and copper serum levels. ConclusionOur data show that an altered copper bioavailability predicts early atherosclerosis as main CV risk in obese patients with hepatic steatosis detected by ultrasound, shedding some light in this pathological scenario.

To explore the relationship between thyroid hormones, Vitamin D (Vit.D) serum concentrations and metabolic syndrome (MetS) in euthyroid subjects.

OBJECTIVES:To evaluate i) the correlation between vitamin D (vit. D) serum concentrations and metabolic syndrome (MetS); ii) the efficacy of 6 months supplementation therapy with vit. D.METHOD:200 patients were enrolled. Blood analyses and anthropometric measurements were carried out. Patients with hypovitaminosis D received an oral supplement therapy.RESULTS:81% of the sample shows vit. D levels < 30 ng/mL. Rate of MetS was significantly higher in vit. D deficiency group than in vit D insufficiency (p = 0.009) and sufficiency (p = 0.002) groups. Vit. D shows a significant negative correlation with both waist circumference (WC) (ρ - 0.202 p = 0.004) and glycaemia values (FBG) (ρ -0.185 p = 0.009). After the supplementation therapy in a group of 60 subjects a significant increase in vit. D levels (p = 0.001) and a significant reduction in WC values (p = 0.001) were observed.CONCLUSIONS:MetS, WC and FBG appeared to be associated vit. D status and it is well-known that central obesity, with the inflammatory alterations thereto correlated that determine insulin resistance, can be considered the "primum movens" for the development of MetS.

Background : Physical training should represent the primary therapeutic approach to prevent cardiovascular disease, overall in the subjects with metabolic syndrome (MetS). Few studies have been conducted to investigate the effects of spinning exercise on cardio-vascular weal. Despite this it has been emphasized that spinning puts strain on the cardiovascular system, questioning whether it can be recommended in the elderly. AIM: to assess whether a 6 months spinning training, combined with proper diet, is more effective than standard training programs and diet alone in improving metabolic abnormalities in elderly patients with MetS. DESIGN: Randomized clinical trial. SETTING: Rehabilitation Unit of the Department of Geriatric Sciences, Sapienza University of Rome POPULATION: elderly patients with MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) diagnostic criteria M ETHODS: Patients were randomly assigned to receive treatment with diet (group A, n=10), with diet and general gymnastics program (group B, n=10), with diet and spinning physical training program (group C, n= 10). The effects of interventions were assessed by differences in changes in components of  MetS and associated biomarkers between the three groups. RESULTS: Thirty patient were recruited at this study and all completed the 6 months protocol. During the study period we observed a significant reduction in  blood pressure (group C: systolic blood pressure p=0.03; diastolic blood pressure p=0.04 / group B: systolic blood pressure p=0.001), in lipid profile (group B: plasma total cholesterol pu003c0.0001; triglycerides pu003c0.0001 / group C: plasma total cholesterol p=0.04); in fasting blood glucose (group B: p=0.01; group C: p=0.008); in Homeostatic Model Assessment of Insulin Resistance (HOMA) (group B: p=0.01; group C: p=0.001); in waist circumference (group C: p=0.005; group A: p=0.022; group B: p=0.037). CONCLUSION: Our results confirm the effectiveness of spinning physical training combined with diet in the management of MetS. CLINICAL REHABILITATION IMPACT: The findings provide a preliminary evidence to support that spinning training may represent a useful and safe intervention in geriatric patients with multiple CV risk factors. The working group and the presence of an instructor may lead to increase the adherence to physical exercise.

BACKGROUNDFew studies have been conducted to investigate the effects of spinning exercise on cardio-vascular weal.AIMTo assess whether a 6 months spinning training, combined with proper diet, is more effective than standard training programs and diet alone in improving metabolic abnormalities in middle-aged and older adults.DESIGNRandomized clinical trial.SETTINGRehabilitation Unit of our Department.POPULATIONPatients with Metabolic Syndrome (MetS) according to the National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria.METHODSPatients were randomly assigned to receive treatment with diet (group A, n = 10), with diet and general gymnastics program (group B, n = 10), with diet and spinning physical training program (group C, n = 10).RESULTSDuring the study period we observed a significant reduction in blood pressure (group C: systolic blood pressure p = 0.03; diastolic blood pressure p = 0.004 / group B: systolic blood pressure p = 0.001), in lipid profile (group B: plasma total cholesterol p = 0.001; triglycerides p = 0.001 / group C: plasma total cholesterol p = 0.04); in fasting blood glucose (group B: p = 0.01; group C: p = 0.008); in Homeostatic Model Assessment of Insulin Resistance (group B: p = 0.01; group C: p = 0.001); in waist circumference (group C: p = 0.005; group A: p = 0.02; group B: p = 0.04). No patients reported adverse events during follow-up.CONCLUSIONOur results confirm the effectiveness of spinning training combined with diet in the management of MetS.CLINICAL REHABILITATION IMPACTThe findings provide a preliminary evidence to support that spinning training may represent a useful and safe intervention also in middle-aged and older adults geriatric with multiple CV risk factors.

Frailty is a common geriatric syndrome that confers increased risk of adverse health outcomes. 1 Fried L.P. Tangen C.M. Walston J. et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 106: 3-5 Google Scholar , 2 Viscogliosi G. The metabolic syndrome: A risk factor for the frailty syndrome?. J Am Med Dir Assoc. 2016; 17: 364-366 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Because of its close association with functional disability, frailty has a devastating impact on individuals, families, and society as a whole. Thus, searching for modifiable risk factors for such conditions is a major challenge.

The influence of the surface chemistry of polyelectrolyte multilayers (PEMs) on the formation of lipid bilayers is studied here for PEMs with either polyallylamine hydrochloride (PAH) or polydiallyldimethylammonium chloride (PDADMAC) as a polycation as a top layer, and polystyrene sulfonate (PSS) as a polyanion. Small unilamellar vesicles (SUVs) composed of phosphatidyl choline and phosphatidyl serine at a 50 : 50 molar ratio are deposited on top of the PEM films. The assembly of the SUVs into bilayers is studied via a quartz crystal microbalance with dissipation (QCM-D) and fluorescence recovery after photobleaching (FRAP). SUV deposition on PDADMAC/PSS results in vesicle adsorption while on PAH/PSS under the same conditions a bilayer is formed mainly due to weak interactions between the quaternary amines of PDADMAC. FRAP measurements confirm that SUVs are not fused on top of PDADMAC/PSS. The effect of phosphate ions, in solution, on the formation of lipid bilayers is also analysed. X-ray photoelectron spectroscopy shows the complexation of phosphate salts to the primary amines of PAH and no interaction with the quaternary amines of PDADMAC. ζ-potential measurements show a potential close to 0 for the PAH/PSS multilayers in PBS while PDADMAC/PSS displays a potential of 25 mV. A model is presented for the formation of lipid bilayers on PAH/PSS PEMs taking into account the role of phosphate ions in decreasing the electrostatic interactions between SUVs and PEMs and the formation of hydrogen bonds between the phospholipids and the primary amines of PAH.