Multimorbidity is known to impair Quality of Life (QoL) in patients in a primary setting. Poor QoL is associated with higher dyspnea perception. How multimorbidity and dyspnea perception are related to QoL needs clarification. The aim of the present study is to evaluate the mediating role of dyspnea perception in the relationship between multimorbidity and QoL in adults with and without airflow obstruction in a primary care setting. Seventeen general practitioners participated in the study: a total of 912 adult patients attending the practitioner’s surgery for a generic consultation completed a preliminary respiratory screening; 566 of them answered a respiratory questionnaire between January and June 2014, and 259 of the latter (148 M, aged 40–88) agreed to go through all the of procedures including spirometry, the IMCA and QoL (SF-36 through Physical Health “PCS” and Mental Health components) questionnaires, evaluation of comorbidities and the mMRC Dyspnea Scale. For screening purpose, a cut-off of FEV₁/FVC < 70% was considered a marker of airflow obstruction (AO). Of the sample, 25% showed airflow obstruction (AO). No significant difference in mMRC score regarding the number of comorbidities and the PCS was found between subjects with and without AO. Multimorbidity and PCS were inversely related in subjects with (p < 0.001) and without AO (p < 0.001); mMRC and PCS were inversely related in subjects with (p = 0.001) and without AO (p < 0.001). A mediation analysis showed that the relation between number of comorbidities and PCS was totally mediated by mMRC in subjects with AO and partially in subjects without AO. We conclude that the effect of multimorbidity on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in a primary care setting may be a useful indicator for evaluating a patient’s global health.

Asthma may have an impact on lung function decline but conflicting results are reported in forced expiratory volume in one second (FEV₁) decline. We aimed to describe the changes in FEV₁ in lifelong non-smoking adult asthmatic outpatients during a 10-year follow-up comparing years 1–5 (1st period) with years 6–10 (2nd period) to assess factors affecting these changes. A total of 100 outpatients performed spirometry every 3 months during a 10-year survey. FEV₁/Ht³ slope values of the 2nd period reduced significantly respect to the 1st period (p < 0.0001). FEV₁ slopes of years 1–5 and 6–10 were inversely associated with FEV₁ at enrolment (p = 0.02, p = 0.01, respectively). Reversibility and variability FEV₁ showed a significant effect on the 1st period slopes (p = 0.01 and p < 0.04, respectively). Frequent exacerbators in the 1st year had steeper FEV₁/Ht³ slopes in the 1st period (p = 0.01). The number of subjects using higher doses of ICS was significantly lower at the 10th years respect to the 5th and the 1st year (p < 0.001, p = 0.003, respectively). This study shows that FEV₁ decline in treated adult asthmatics non-smokers, over 10-year follow-up, is not constant. In particular, it slows down over time, and is influenced by FEV₁ at enrolment, reversibility, variability FEV₁ and exacerbation score in the 1st year.

For some decades several scientists have claimed the formation of the Shroud body image by the radiative hypotheses. These proposals have as a start the emission, by the corpse wrapped in the burial linen, of proton or electromagnetic radiation with the wavelengths of the far ultraviolet. From a theological point of view, these hypotheses must be discarded. In fact, the above proposal foresees a transcendental beginning, followed in compliance with the natural laws, hoping to find a result that justifies their initial hypothesis. The Miracles are done only by God, the Omnipotent. Also for Thomas Aquinas, a Doctor of the Church, the Divine intervention is instant. Therefore a description of these transcendental events, step by step, it is impossible. In line with Theology there is also the Ockham’s thought. It is not a physical law but a philosophical razor that still enjoys great consideration in the scientific world. Used in the case of Shroud Body Image Formation, the “Ockham’s razor” does not agree with the radiative hypotheses. The same occurs with the Religion. In fact, reading The Gospels, The Act of Apostles and The Letter, we must accept the initial absence of image.

Background: Vitamin D has been implicated in several biological pathways involved in atrial remodeling, yet its association with incident atrial fibrillation (AF) remains uncertain across epidemiological studies. Objectives: The objective was to evaluate the association between circulating vitamin D levels and the risk of incident AF through a systematic review and meta-analysis of prospective studies using a harmonized continuous analytical framework. Methods: A systematic review and meta-analysis of prospective cohort studies was performed. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled using the generic inverse variance method. To improve comparability across studies, effect estimates were harmonized to a common continuous contrast corresponding to a 1-standard-deviation (1-SD) difference in circulating vitamin D levels. Estimates were then oriented such that higher values reflected lower vitamin D status and higher AF risk. Random-effects models were used as the primary analytical approach. Sensitivity analyses included leave-one-out testing and an additional pooled analysis incorporating a threshold-based study after approximate rescaling to the continuous 1-SD framework. Results: Five prospective studies were eligible for quantitative assessment. In the primary continuous harmonized analysis, including the four studies with directly reported or more reliably rescaled continuous estimates, lower vitamin D status was associated with a higher risk of incident AF (HR 1.08, 95% CI 1.05–1.11), with no statistical heterogeneity (I² = 0%). In a sensitivity analysis including the HUNT study after approximation of its threshold-based estimate to the continuous 1-SD framework, the pooled association remained statistically significant (HR 1.08, 95% CI 1.05–1.11), with low heterogeneity (I² = 7%). The direction of effect remained stable across sensitivity analyses. Conclusions: Lower circulating vitamin D levels were associated with a modestly higher risk of incident AF in prospective studies. The most internally consistent quantitative signal emerged from analyses conducted within a common continuous 1-SD framework. Inclusion of a threshold-based study through approximate rescaling did not materially alter the pooled estimate, although this step relied on additional assumptions. These findings support an observational association but do not establish causality or justify vitamin D supplementation specifically for AF prevention.

(1) Background: To detect early airway obstruction in an adult primary care setting. (2) Methods: Seventeen general practitioners (GP) were involved. A total of 912 patients consulting their GPs over 40 years were recruited: 583 of them (323M) agreed to perform/undergo all the procedures: respiratory questionnaire, mMRC questionnaire, and spirometry. We identified four subgroups: physician COPD patients; physician asthma patients; asthma-COPD overlap syndrome patients; and no respiratory diagnosis subjects, on the basis of physician diagnosis. For screening purposes, an FEV₁/FVC < 70% was considered a marker of airway obstruction (AO). (3) Results: Prevalence rates of COPD, A, and ACOS were 12.5%, 7.8%, and 3.6%, respectively. In the overall sample 16.3% showed airway obstruction: 26% mild, 56% moderate, 17% severe, and 1% very severe. In obstructed subjects, those reporting neither respiratory symptoms nor a physician’s respiratory diagnosis were 60% level I; 43% level II; 44% level III; and none level IV. Wheezing (p < 0.001), sputum (p = 0.01), older age (p < 0.0001), and male gender (p = 0.002) were the best predictors of airway obstruction. (4) Conclusions: A high prevalence of AO was found. In AO we found a high prevalence of subjects without respiratory symptoms or respiratory chronic diagnosis. Airway obstruction was predicted by the presence of wheezing, sputum, older age, and male gender.

Aortic dissection is often reported in association with carotid or other vessel dissection. We report a case of 75-year old patient who underwent surgical treatment for aortic dissection in 2001. A routine carotid doppler shows bilateral carotid dissection even though the repaired aortic arch is normal.