Vitamin D deficiency is a common health problem worldwide, in particular among older people. Vitamin D regulates and modulates the physiology and function of multiple human systems, including the skeletal muscle. The effect of vitamin D on the muscle has been widely investigated, suggesting that this hormone can stimulate the proliferation and differentiation of skeletal muscle fibers, maintaining and improving muscle strength and physical performance. Older persons have a higher prevalence of low Vitamin D levels as a consequence of low dietary intake and reduced ultraviolet irradiation of the skin. Therefore, older people with vitamin D deficiency might be at risk of sarcopenia, a geriatric syndrome characterized by the progressive loss of skeletal muscle mass and strength often complicated by adverse events, such as falls, disability hospitalization and death. Several randomized clinical trials have been conducted to investigate the effect of oral vitamin D supplementation in older patients to prevent or treat sarcopenia, but results are still controversial. In this narrative review we summarize the biological, clinical and epidemiological evidence supporting the hypothesis of a causal association between Vitamin D deficiency and an increased risk of sarcopenia in older people.

Background: The COVID-19 lockdown had a profound effect on everyday life, including sleep health. This systematic review and meta-analysis evaluated changes in quantitative sleep parameters during the first lockdown compared with pre-lockdown in the general population. Methods: A search in scientific databases was performed to identify eligible observational studies from inception to 8 February 2023. We performed a random effects meta-analysis of those studies reporting (a) means of sleep duration, time in bed (TIB), and sleep timing (bedtime and wake-up time); (b) the percentages of atypical sleep duration before and during the lockdown; (c) the percentages of change in sleep duration and sleep timing. Results: A total of 154 studies were included. A small increase in sleep duration (0.25 standardized mean difference, 95% CI 0.180–0.315) was found, with 55.0% of the individuals reporting changes, predominantly an increase (35.2%). The pooled relative risk for sleeping more than 8/9 h per night was 3.31 (95% IC 2.60–4.21). There was a moderately significant delay in sleep timing and a surge in napping. Conclusion: An increase in sleep duration and napping, and delayed sleep timing were observed. High-quality studies should evaluate whether these parameters have now become chronic or have returned to pre-lockdown values.

Background: Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion. Herein, we assessed clinical, serological and histopathological findings of a single-center, large cohort of CD patients diagnosed and followed-up over forty years. Methods: From January 1980 to December 2020, 1547 CD patients (1170 females; age range: 8–81 years; F:M ratio = 3.1:1) were diagnosed in an Italian tertiary referral center. Comorbidities and complications were recorded at diagnosis and during follow-up. Results: CD diagnoses quadrupled after 2000. The most frequent phenotype was the non-classical CD (63.3%), and the most prevalent histotype was Marsh 3C (44.7%). Gastrointestinal manifestations, detectable in 51% of patients, were diarrhea (24.3%), bloating (28%) and aphthous stomatitis (19.7%). The most common CD-associated disorder was osteopenia (59.9%), predominant in females (64.3%); extraintestinal manifestations included anemia (35.8% iron-deficiency; 87% folic acid malabsorption), cryptogenic hypertransaminasemia (27.9%), and recurrent miscarriages (11.5%). Thyroiditis (26.9%), type 1 diabetes mellitus (2.9%), and dermatitis herpetiformis (1.4%) were the most common CD-related autoimmune disorders. Six patients had inflammatory bowel disease. Complications and mortality rate occurred in 1.8% and 1.9%, respectively. Conclusions: This single-center, large cohort analysis confirmed that CD presentation changed over the years, with an increase of non-classical and subclinical clinical phenotypes.

Background: Cardiac arrest with refractory ventricular fibrillation (rVF) represents a dramatic medical emergency. Despite recent advances, its treatment is challenging and burdened by limited evidence. This systematic review and meta-analysis aims at establishing whether alternative defibrillation strategies (ADS), i.e. double sequential external defibrillation (DSED) or vector-change defibrillation (VCD), improve survival among patients with rVF compared to standard defibrillation (SD). Methods: Randomized clinical trials (RCTs), prospective and retrospective studies were included if: (1) compared ADS with SD in rVF; (2) conducted on patients ≥ 18 years old; (3) reported survival to hospital admission. English-language papers from MEDLINE, Google Scholar, Cochrane Library, World Health Organization, EMBASE and CINAHL, published from inception to December 2022, were retrieved. The risk of bias was assessed following the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the revised Cochrane risk of bias tool for randomized trials, as appropriate. A random-effects meta-analysis was performed to estimate the pooled Odds Ratio (pOR) with 95% Confidence Interval (95%CI) of ADS and survival to hospital admission. Furthermore, a subgroup analysis was performed to compare SD with each type of ADS. The protocol was registered on PROSPERO (CRD42022379049). Results: Eight studies (2 RCTs, 5 retrospective and 1 case-control study) were retrieved for qualitative and quantitative analyses. The study population included 1405 patients (ADS = 493 vs. SD = 912) with a pooled mean age of 61.9 ± 1.1 years; among them, 277 (19.7%) were female. The random-effect meta-analysis did not show differences in survival to hospital admission among ADS vs. SD (pOR = 1.12, 95%CI: 0.62-2.01). The subgroup analysis confirmed that neither DSED (pOR = 1.20, 95%CI: 0.56-2.58) nor VCD (pOR = 1.66, 95%CI: 0.10-27.02) were associated with improved survival to hospital admission. Main limitations were: i) few numbers of studies included with small sample size; and ii) female under-representation. Conclusion: The present manuscript did not show any difference on survival to hospital admission between the considered defibrillation strategies in rVF. This result highlights the need for further ad hoc clinical trials assessing the actual role of ADS.