Objectives: The primary objective of this review is to analyze the effects on body weight of discontinuing therapy with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or tirzepatide in patients treated for obesity. In recent months, there has been a considerable increase in the utilization of GLP-1 RAs and GIP/GLP-1 RAs. However, the paucity of available data regarding their medium- to long-term safety remains a salient concern. Of particular significance is the observation of the weight curve following their suspension, a subject that has received scant attention to date. Methods: For this, a bibliographic search was carried out in three electronic databases: PubMed, Cochrane Library and Google Scholar. The following filters were applied: in the last 10 years, Randomized Controlled Trial, Adult: 19+ years. The review was restricted to randomized controlled trials to reduce bias and ensure the high quality of the studies examined. A total of 427 references were identified, 178 articles were read in full, and 13 articles were included in the analysis. Results and Conclusions: The analysis showed a rapid regain of weight after cessation of therapy, regardless of the duration of the treatment with GLP-1 RA or GIP/GLP-1 RA. This rebound is likely to substantially mitigate the metabolic benefits attained through weight loss. Given the efficacy of these drugs, it is essential for future research to focus on elucidating the optimal duration of these treatments or identifying techniques or schemes that involve a reduction in dosages to prevent weight regain.

Background: Malnutrition in patients hospitalized in internal medicine wards is highly prevalent and represents a prognostic factor of worse outcomes. Previous evidence suggested the prognostic role of the nutritional status in patients affected by the coronavirus disease 2019 (COVID-19). We aim to investigate the nutritional risk in patients with COVID-19 hospitalized in an internal medicine ward and their clinical outcomes using the Nutritional Risk Screening 2002 (NRS-2002) and parameters derived from bioelectrical impedance analysis (BIA). Methods: Retrospective analysis of patients with COVID-19 aimed at exploring: 1) the prevalence of nutritional risk with NRS-2002 and BIA; 2) the relationship between NRS-2002, BIA parameters and selected outcomes: length of hospital stay (LOS); death and need of intensive care unit (ICU); prolonged LOS; and loss of appetite. Results: Data of 90 patients were analyzed. Patients at nutritional risk were 92% with NRS-2002, with BIA-derived parameters: 88% by phase angle; 86% by body cell mass; 84% by fat-free mass and 84% by fat mass (p-value ≤ 0.001). In ROC analysis, NRS had the maximum sensitivity in predicting the risk of death and need of ICU and a prolonged hospitalization showing moderate-low specificity; phase angle showed a good predictive power in terms of AUC. NRS-2002 was significantly associated with LOS (β 12.62, SE 5.79). In a multivariate analysis, blood glucose level and the early warning score are independent predictors of death and need of ICU (OR 2.79, p ≤ 0.001; 1.59, p-0.029, respectively). Conclusion: Present findings confirm the clinical utility of NRS-2002 to assess nutritional risk in patients with COVID-19 at hospital admission and in predicting LOS, and that bioimpedance does not seem to add further predictive value. An early detection of nutritional risk has to be systematically included in the management of COVID-19 patients hospitalized in internal medicine wards.

The aim of this study was to investigate the predictive value of bioimpedance phase angle (PA) on selected clinical outcomes in patients hospitalized in internal-medicine wards. This was a retrospective observational study of 168 patients admitted to the internalmedicine service (52.9% women, 47.1% men), with a mean (± SD) age of 73.9 ± 15.9 y. Anthropometric examination, laboratory tests, and bioelectrical impedance analysis were performed. Bioimpedance-derived PA was the study's parameter. Length of hospital stay, prospective all-cause hospital readmission, mortality, and falls were the clinical endpoints. Across the four PA quartile groups, age was incrementally higher (P ≤ 0.001). Multivariate linear regression models showed that PA quartile 1 was significantly associated with length of hospital stay (β, SE) in both crude and adjusted models-respectively, β (SE) = 6.199 (1.625), P ≤ 0.001, and β = 2.193 (1.355), P = 0.033. Over a 9-mo follow-up period, the hazard ratios for readmission, in-hospital falls, and mortality were associated with the lowest phase angle (PA quartile 1 versus quartiles 2-4)-respectively, 2.07 (95% confidence interval [CI], 1.28-3.35), 2.36 (95% CI, 1.05-5.33), and 2.85 (95% CI, 1.01-7.39). Associations between narrow PA and outcomes continued to be significant after adjustments for various confounders. In internal-medicine wards, bioimpedance-derived PA emerged as a predictor of length of hospital stay, hospital readmission, falls, and mortality. The present findings suggest that in the hospital setting, PA assessment could be useful in identifying patients at higher risk who need specific nutritional support.

Objective: The aim was to evaluate if bariatric surgery can affect the LT4 performance. The endpoints were the following: 1) difference between LT4 daily dose before and 1 year after surgery, 2) difference between LT4 dose per weight before and 1 year after surgery, 3) difference among LT4 preparations. Methods: The study period was between January 2018 and May 2022. Inclusion criteria were a) adults undergone bariatric surgery, b) with proven autoimmune hypothyroidism, c) on LT4 therapy before bariatric surgery, d) using any commercialized LT4 preparation. Excluded were patients a) proven to have or suspected for pre-surgical intestinal malabsorption, b) with other potential interfering factors on LT4 absorption; c) with heart, renal, and/or hepatic failure, d) with recent/current infection/inflammation, e) in pregnancy, f) with incomplete data about LT4 therapy. Results: According to the selection criteria, 40 patients were included. Both TSH and LT4 daily doses were not significantly different with respect to baseline values. On the contrary, the LT4 dose per weight was significantly increased, especially in RYGB patients. An increased LT4 dose per weight was observed with the reduction of weight. Conclusion: One year after bariatric surgery 1) the daily dose of LT4 remains unchanged, and 2) despite the significant weight reduction, LT4 dose per weight increases. Most data are referred to LT4 tablet and the performance of LT4 caps should be further investigated.

Metronidazole is an antibiotic commonly prescribed for anaerobic and protozoan infections. Despite its good safety profile, this drug frequently causes a series of well-known side effects (nausea and intestinal transit disorders, dysgeusia, headaches, and alcohol intolerance). However, there are few data in the literature, mainly case reports and case series, about the onset of peripheral neuropathy with a generally self-limiting course after drug withdrawal. Thus, we herein describe two cases of peripheral neuropathy due to treatment with metronidazole. A 69-year-old woman treated with a total of 55 g of metronidazole for diverticular disease and a 52-year-old male patient on a long course of antibiotic therapy for hepatic abscesses (a cumulative dose of 168 g) developed peripheral neuropathy. The suspicion of metronidazole side effects was raised after the exclusion of other causes. After the suspension of the drug, different degrees of improvement were observed. Metronidazole is an effective antibiotic for treating infections caused by anaerobic or protozoan pathogens, and it has a good pharmacological and economic safety profile. However, in the existing literature, prolonged therapy regimens (>4 weeks of treatment and/or 42 g cumulative dose) may increase the risk of developing neurological complications, in particular peripheral polyneuropathy.

In the early months of 2020, Europe was confronted by a pandemic that originated in China, which initially affected its territories in different ways. Parts of northern Italy were among the regions most affected. At the same time, Ticino, a small canton of Switzerland geographically wedged into Italian territory, had an incidence rate comparable to that of hard-hit Lombardy. Home to 350,000 inhabitants and separated from the rest of Switzerland by the Alps, Ticino had to face the first part of the pandemic with little available knowledge. The cantonal authorities decided to transform two active hospitals into COVID centres, concentrating all coronavirus patients there. Since the virus was new and there were no clear guidelines for managing it, the nutritional team on site had to reorganise to provide patient care, adapting their strategy to accommodate the evolution of the pandemic and growing medical knowledge. This paper explains how one of these teams developed a model to deal with the first wave of COVID, maintaining it during the second and current third wave of the pandemic.