European journal of internal medicine
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Eur. J. Intern. Med. · Mar 2024
ReviewMetabolic Bariatric surgery in People with Obesity aged ≥65 Years.
Obesity management guidelines recommend metabolic bariatric surgery for individuals with body mass index (BMI) ≥35 kg/m2, regardless of the presence of any obesity-related comorbidity; and for individuals with BMI 30-34.9 kg/m2 with metabolic diseases. Older age is not in itself a contraindication for bariatric surgeries, which can be performed after careful selection and assessment, to decrease the risks of postoperative complications. ⋯ Laparoscopic Roux-en-Y-gastric bypass and sleeve gastrectomy have been the preferred bariatric procedures for older adults with obesity, as for younger patients. This review summarizes the safety and efficacy of bariatric surgery for individuals aged ≥65 years with obesity, and the efforts that have been invested to improve the perioperative and long-term consequences.
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Eur. J. Intern. Med. · Mar 2024
Relation of plasma neuropeptide-Y with myocardial function and infarct severity in acute ST-elevation myocardial infarction.
Acute myocardial infarction is associated with the release of the co-transmitter neuropeptide-Y (NPY). NPY acts as a potent vasoconstrictor and is associated with microvascular dysfunction after ST-elevation myocardial infarction (STEMI). This study comprehensively evaluated the association of plasma NPY with myocardial function and infarct severity, visualized by cardiac magnetic resonance (CMR) imaging, in STEMI patients revascularized by primary percutaneous coronary intervention (PCI). ⋯ High plasma levels of NPY, measured 24h after STEMI, were independently associated with lower LVEF, decreased GLS, larger IS as well as presence of MVO, indicating plasma NPY as a novel clinical risk marker post STEMI.
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Eur. J. Intern. Med. · Mar 2024
The interplay between subclinical hypothyroidism and poor sleep quality: A systematic review.
The relationship between subclinical hypothyroidism (SHYPO) and sleep disturbances is still poorly investigated. This systematic review aims to critically appraise the existing literature to provide more insights in understanding whether SHYPO favors sleep disturbances or it is the sleep disturbance per se that affects the hypothalamus-pituitary-thyroid axis regulation. ⋯ Overall, the existing literature data suggest a link between SHYPO and sleep disturbances, but further studies on larger populations of patients with homogeneous study designs and outcomes are warranted.
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Eur. J. Intern. Med. · Mar 2024
Serum potassium abnormalities, renin-angiotensin-aldosterone system inhibitor discontinuation, and clinical outcomes in patients with chronic cardiovascular, metabolic, and renal conditions: A population-based analysis.
Renin-angiotensin-aldosterone system inhibitors (RAASIs) play a crucial role in the treatment of several chronic cardiovascular conditions. Nonetheless, hyperkalemia, a frequent side effect, often leads to the discontinuation of RAASIs. The implications of hyperkalemia-driven changes in RAASI medications are poorly understood. ⋯ In this large, observational study, hyperkalemia was linked to a greater likelihood of discontinuing RAASIs. Down-titration of RAASI was independently associated with unfavorable clinical outcomes such as hospitalization and specially mortality. Although the observational nature of the study, these findings underscore the importance of preventing circumstances that may lead to RAASI down-titration, such as hyperkalemia, as well as preventing hospitalizations and mortality, to ensure RAASI benefits.