Pneumatosis intestinalis (PI) is a rare condition due to the presence of gas within the bowel wall; it is mainly caused by endoscopic procedures, infections and other gastrointestinal diseases. Oncological therapies have been reported to be a cause of PI as well, but their role is not clearly defined. This systematic review investigates the concurrency of PI and antitumor therapy in cancer patients, considering both solid tumors and onco-hematological ones. We performed a literature review of PubMed, Embase and the Web of Science up to September 2021 according to the PRISMA guidelines. A total of 62 papers reporting 88 different episodes were included. PI was mainly reported with targeted therapies (sunitinib and bevacizumab above all) within the first 12 weeks of treatment. This adverse event mostly occurred in the metastatic setting, but in 10 cases, it also occurred also in the neoadjuvant and adjuvant setting. PI was mostly localized in the large intestine, being fatal in 11 cases, while in the remaining cases, symptoms were usually mild, or even absent. A significant risk of PI reoccurrence after drug reintroduction was also reported (6/18 patients), with no fatal outcomes. Potential pharmacological mechanisms underlying PI pathogenesis are also discussed. In conclusion, although uncommonly, PI can occur during oncological therapies and may lead to life-threatening complications; therefore, consideration of its occurrence among other adverse events is warranted in the presence of clinical suspicion.

Purpose: To perform a systematic umbrella review with meta-analysis to evaluate the certainty of evidence on mortality risk associated with digoxin use in patients with atrial fibrillation (AF) with or without heart failure (HF). Methods: We systematically searched MEDLINE, Embase, and Web of Science databases from inception to 19 October 2021. We included systematic reviews and meta-analyses of observational studies investigating digoxin effects on mortality of adult patients with AF and/or HF. The primary outcome was all-cause mortality; secondary outcome was cardiovascular mortality. Certainty of evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool and the quality of systematic reviews/meta-analyses by the A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR2) tool. Results: Eleven studies accounting for 12 meta-analyses were included with a total of 4,586,515 patients. AMSTAR2 analysis showed a high quality in 1, moderate in 5, low in 2, and critically low in 3 studies. Digoxin was associated with an increased all-cause mortality (hazard ratio [HR] 1.19, 95% confidence interval [95%CI] 1.14–1.25) with moderate certainty of evidence and with an increased cardiovascular mortality (HR 1.19, 95%CI 1.06–1.33) with moderate certainty of evidence. Subgroup analysis showed that digoxin was associated with all-cause mortality both in patients with AF alone (HR 1.23, 95%CI 1.19–1.28) and in those with AF and HF (HR 1.14, 95%CI 1.12–1.16). Conclusion: Data from this umbrella review suggests that digoxin use is associated with a moderate increased risk of all-cause and cardiovascular mortality in AF patients regardless of the presence of HF. Trial registration: This review was registered in PROSPERO (CRD42022325321).

Vaccination against SARS-CoV-2 has been demonstrated to be safe during gestation. Nevertheless, there are no robust data investigating the entity of maternal antibodies’ transmission through the placenta to the newborn and the persistence of the antibodies in babies’ serum. The objective of this study is to assess the maternal antibody transmission and kinetics among newborns in the first months of life. Women having received one or two doses of anti-SARS-CoV-2 mRNA-vaccines during pregnancy at any gestational age, and their newborns, were recruited and followed-up over 9 months. Ninety-eight women and 103 babies were included. At birth, we observed a significant positive correlation between maternal and neonatal serum anti-SARS-CoV-2 antibody levels and a significant negative correlation between the time since last dose and antibody levels in mothers with two doses. Over the follow-up, the birth antibody level significantly decreased in time according to the received doses number at 3, 6, and 9 months. During the follow-up, we registered 34 dyad SARS-CoV-2 infection cases. The decreasing trend was slower in the SARS-CoV-2 infection group and among breastfed non-infected babies. Antibodies from maternal anti-SARS-CoV-2 vaccination are efficiently transferred via the placenta and potentially even through breast milk. Among newborns, antibodies show relevant durability in the first months of life.

Advances in antiretroviral therapy have transformed HIV-1 infection into a chronic condition, enabling people living with HIV-1 (PWH) to achieve life expectancies comparable to those of the uninfected population. Consequently, a range of co-morbidities, particularly an increased incidence of cardiovascular events, has becoming more evident. Among these, dyslipidemia stands out as a significant risk factor with a multifactorial pathogenesis. The aim of this narrative review is to highlight the multifactorial origins of dyslipidemia in PWH, to provide an overview of drug interactions between statins and antiretroviral therapy, and examine the unique anti-inflammatory and immunomodulatory properties of statins in this context. Some studies indicate a reduction of mortality and cardiovascular risk in PWH treated with statins. However, the benefit of statin therapy is variable and seems to be dependent on HIV-1 length exposure and type of antiretroviral drugs and seems to be lower in individuals without comorbidities or additional risk factors. Statins are often underdosed for the perceived risk of drug interactions. Beyond their lipid-lowering effects, statins exert additional benefits, including anti-inflammatory and immunomodulatory actions on vascular tissues, monocyte-macrophages, and lymphocytes. These effects have sparked interest in their potential applications beyond dyslipidemia treatment. Statins may provide a clinical benefit in PWH by lowering LDL cholesterol and modulating immunity and inflammation. However, there is a clinical need for HIV-1-specific LDL cholesterol targets given the excess cardiovascular risk in this population, as well as for the identification of high-risk subgroups that may benefit most from statin treatment.

Endoscopic investigations reveal that a significant majority of individuals taking NSAIDs exhibit acute hemorrhages and mucosal erosions within the gastroduodenal lining. Ketoprofen acid (KA) is a potent NSAID with established efficacy and cardiovascular tolerability, but its gastric tolerability is a recognized limitation. To mitigate this, ketoprofen lysine salt (KLS) was developed. This review evaluates the pharmacological advantages of KLS over KA. While both KA and KLS maintain similar potency, KLS offers distinct advantages. Firstly, KLS demonstrates superior gastrointestinal protection through enhanced antioxidant properties and upregulation of mucosal defenses, as evidenced by both in vitro and in vivo studies. Secondly, KLS exhibits significantly faster absorption, leading to a more rapid onset of analgesic effects; this is attributed to its increased solubility and faster achievement of therapeutic concentrations. In essence, KLS addresses the gastric tolerability issues of KA while providing a quicker onset of action, making it a valuable alternative for patients requiring NSAID therapy, particularly those with gastric sensitivities or in need of rapid pain relief.

Background: Data on atrial fibrillation (AF) and heart failure (HF) with preserved ejection fraction (HFpEF) are scarce. We investigated the association of HFpEF with all‐cause mortality in AF. Methods: We included 10 369 patients with AF on oral anticoagulants from the nationwide ongoing START (Survey on Anticoagulated Patients Register) registry. Patients were divided into 3 groups: (1) no HF, (2) HF with reduced EF/HF with mildly reduced EF (EF ≤50%), and HFpEF (EF >50%). Patients with HF should have had a clinical diagnosis or a history of HF hospitalization. The association between HF types and all‐cause mortality was investigated by Cox proportional hazards regression analysis to estimate hazard ratio (HR) and 95% CI for each factor. The Fine–Gray model and propensity score matching were used. Results: Mean age was 76.4±9.4 years and 45.8% were women. Overall, 2309 (22.2%) patients had HF, of whom 47.4% had HFpEF. During 720±576 days of follow‐up (20 747 patients/year), 727 deaths occurred (3.5 per 100 patient‐years). After propensity score matching, both HF with mildly reduced EF/HF with reduced EF and HFpEF were associated with all‐cause mortality (HR, 1.33; P =0.037 and HR, 1.49; P =0.004). HFpEF was associated with mortality in men (HR, 1.654; P =0.001) but not in women (HR, 1.243; P =0.175). In HFpEF, age≥75 years (HR, 2.247; P =0.003), chronic respiratory disease (HR, 2.109; P <0.001), anemia (HR, 1.482; P =0.035), paroxysmal AF (HR, 0.528; P =0.012), creatinine clearance<30 mL/min (HR, 1.791; P =0.018), direct oral anticoagulants (HR, 0.575; P =0.005), and renin‐angiotensin inhibitors (HR, 0.670; P =0.033) were associated with all‐cause mortality. Conclusions: HFpEF is frequent in patients with AF and associated with an increased mortality, especially in men. Comorbidities and treatments associated differently with mortality according to HF phenotype. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02219984.