Virginia Zouganeli

Factor XII (FXII) deficiency is a coagulation factor disorder inherited in an autosomal recessive manner that causes prolonged activated partial thromboplastin time (aPTT). Although it is clinically benign without additional bleeding risk, it has been associated with paradoxical thrombosis. We report the case of a 38-year-old woman who presented with cardiac arrest secondary to spontaneous coronary artery dissection (SCAD) in the absence of identifiable risk factors. Laboratory investigations revealed an isolated prolonged aPTT, which was corrected with mixing studies, and a severe FXII deficiency with activity levels < 1%. Molecular analysis identified two homozygous FXII gene variants: the 46C>T polymorphism and the c.619G>C (p.Ala207Pro) variant. The two variants are considered clinically benign, although the combination of both in a single individual has not been previously reported. The coexistence of FXII deficiency in this case may be of clinical and hypothesis-generating interest.

Background/Objectives: Extra virgin olive oil (EVOO) exhibits potent antioxidant and anti-inflammatory properties. Recent findings from our Institute indicate that its bioactive compounds enhance lipid metabolism, suggesting EVOO as a promising nutritional intervention for hyperlipidemic patients. This clinical study aimed to evaluate the effects of EVOO consumption on vascular endothelial function and hemodynamic parameters in hyperlipidemic individuals, while comparing two EVOO types differing in polyphenol content and dosage. Methods: This post hoc analysis included 70 participants: 50 patients with hyperlipidemia and 20 healthy controls. All participants consumed EVOO daily for four weeks. Hyperlipidemic patients were randomized into two subgroups: one receiving high-phenolic EVOO at a low dose and another receiving low-phenolic EVOO at a high dose, ensuring equivalent total polyphenol intake. Vascular endothelial function, assessed via near-infrared spectroscopy (NIRS), served as the primary endpoint, while arterial blood pressure and heart rate were secondary endpoints. Statistical analyses employed mixed linear models. Results: Hyperlipidemic patients exhibited significant improvements in endothelial function, with increased reperfusion rate (p = 0.010) and oxygen consumption rate (p < 0.001) compared to controls. Reductions in maximum hyperemia time (p = 0.004) and hyperemia recovery time (p < 0.05) further indicated enhanced vascular function. Diastolic blood pressure (p = 0.007) and heart rate (p = 0.004) decreased significantly. Among subgroups, high-phenolic EVOO at lower doses was more effective in reducing systolic blood pressure (p = 0.049) and improving reperfusion rate (p = 0.049). Conclusions: EVOO consumption improved endothelial function and hemodynamic parameters in hyperlipidemic patients, with high-phenolic EVOO demonstrating superior vascular benefits at lower doses.

Background/Objectives: Systemic lupus erythematosus (SLE) is associated with impaired functional capacity, persistent fatigue, and poor health-related quality of life despite advances in pharmacological therapy. Exercise training has been proposed as a non-pharmacological intervention, but its efficacy and safety remain incompletely defined. This systematic review aimed to evaluate the effects of exercise training on functional aerobic capacity and quality of life in adults with SLE. Methods: A comprehensive search of PubMed, EMBASE, Cochrane Library, and PEDro was conducted to identify randomized controlled trials published up to October 2022, in accordance with the PRISMA guidelines. Results: Twelve randomized controlled trials involving 619 participants were included. Exercise interventions were heterogeneous and comprised aerobics, resistance, combined programs, vibration training, home-based protocols, and counseling strategies, with durations ranging from 6 weeks to 12 months. Supervised aerobic and combined interventions consistently improved functional aerobic capacity, while quality of life benefits were reported across several domains, particularly physical health, vitality, and fatigue. Additional positive effects were observed on fatigue, depression, pain, sleep, insulin sensitivity, and self-care ability, without evidence of increased disease activity. Conclusions: Structured exercise is safe and can meaningfully enhance functional capacity and quality of life in patients with SLE, supporting its incorporation into multidisciplinary clinical management.

Background/Objectives: Hyperlipidemia is a major risk factor for cardiovascular disease and atherosclerosis. Polyphenols found in polyphenol-rich extra virgin olive oil (EVOO) have been shown to possess strong antioxidant, anti-inflammatory, and cardioprotective properties. The present study aimed to assess the effects of two types of EVOO with different polyphenol content and dosages on the lipid profile of hyperlipidemic patients. Methods: In this single-blind, randomized clinical trial, 50 hyperlipidemic patients were randomized to receive either a higher-dose, lower-phenolic EVOO (414 mg/kg phenols, 20 g/day) or a lower-dose, higher-phenolic EVOO (1021 mg/kg phenols, 8 g/day), for a period of 4 weeks. These doses were selected to ensure equivalent daily polyphenol intake in both groups (~8.3 mg of total phenols/day), based on chemical analysis performed using NMR spectroscopy. The volumes used (8–20 g/day) reflect typical daily EVOO intake and were well tolerated by participants. A group of 20 healthy individuals, separated into two groups, also received the two types of EVOO, respectively, for the same duration. Primary endpoints included blood levels of total blood cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, lipoprotein-a (Lpa), and apolipoproteins A1 and B. Measurements were performed at baseline and at the end of the 4-week intervention. Linear mixed models were performed for the data analysis. Results: The higher-phenolic, lower-dose EVOO group showed a more favorable change in total blood cholesterol (p = 0.045) compared to the lower-phenolic, higher-dose group. EVOO intake was associated with a significant increase in HDL (p < 0.001) and reduction in Lp(a) (p = 0.040) among hyperlipidemic patients in comparison to healthy individuals. Conclusions: EVOO consumption significantly improved the lipid profile of hyperlipidemic patients. Higher-phenolic EVOO at lower dosages appears to be more effective in improving the lipid profile than lower-phenolic EVOO in higher dosages.

Campylobacter jejuni, a common cause of gastroenteritis worldwide, has also been associated with rare extraintestinal infections, including myocarditis. We report a unique case of a 24-year-old male who presented with febrile diarrhea and acute chest pain. Diagnostic investigations revealed elevated cardiac troponin levels, normal electrocardiography findings, and myocardial inflammation on cardiac magnetic resonance imaging, confirming the diagnosis of acute myocarditis. Stool cultures identified Campylobacter jejuni as the causative agent. The patient was managed with supportive care, including hydration and electrolyte replacement, and a three-day course of azithromycin (500 mg daily). He achieved a full recovery and was discharged after eight days, with subsequent follow-up demonstrating the complete resolution of myocardial dysfunction. This case emphasizes the need to consider Campylobacter jejuni-related myocarditis in the differential diagnosis of young patients presenting with chest pain and diarrhea, along with an overview of its diagnostic and therapeutic challenges.

Endothelial dysfunction and inflammation are common pathophysiological characteristics of chronic heart failure (CHF). Endothelial progenitor cells (EPCs) are recognized as useful markers of vascular damage and endothelial repair. The aim of this study was to investigate the effects of a cardiac rehabilitation program on EPCs and inflammatory profile in CHF patients of different severity. Forty-four patients with stable CHF underwent a 36-session cardiac rehabilitation program. They were separated into two different subgroups each time, according to the median peak VO₂, predicted peak VO₂, VE/VCO₂ slope, and ejection fraction. EPCs, C-reactive protein (CRP), interleukin 6 (IL-6), interleukin 10 (IL-10), and vascular endothelial growth factor (VEGF) were measured. Flow cytometry was used for the quantification of EPCs. Mobilization of EPCs increased and the inflammatory profile improved within each severity group (p < 0.05) after the cardiac rehabilitation program, but there were no statistically significant differences between groups (p > 0.05). A 36-session cardiac rehabilitation program has similar beneficial effects on the mobilization of EPCs and on the inflammatory profile in patients with CHF of different severity.

Heart failure (HF) is a major public health issue worldwide with increased prevalence and a high number of hospitalizations. Patients with chronic HF and either reduced ejection fraction (HFrEF) or mildly reduced ejection fraction (HFmrEF) present vascular endothelial dysfunction and significantly decreased circulating levels of endothelial progenitor cells (EPCs). EPCs are bone marrow-derived cells involved in endothelium regeneration, homeostasis, and neovascularization. One of the unsolved issues in the field of EPCs is the lack of an established method of identification. The most widely approved method is the use of monoclonal antibodies and fluorescence-activated cell sorting (FACS) analysis via flow cytometry. The most frequently used markers are CD34, VEGFR-2, CD45, CD31, CD144, and CD146. Exercise training has demonstrated beneficial effects on EPCs by increasing their number in peripheral circulation and improving their functional capacities in patients with HFrEF or HFmrEF. There are two potential mechanisms of EPCs mobilization: shear stress and the hypoxic/ischemic stimulus. The combination of both leads to the release of EPCs in circulation promoting their repairment properties on the vascular endothelium barrier. EPCs are important therapeutic targets and one of the most promising fields in heart failure and, therefore, individualized exercise training programs should be developed in rehabilitation centers.