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COVID-19 is causing a global pandemic with a high number of deaths and infected people. To contain the diffusion of COVID-19 virus, Governments have enforced restrictions on outdoor activities or even collective quarantine on the population. One important consequence of quarantine is a change in lifestyle: reduced physical activity and unhealthy diet. 2019 guidelines for primary prevention of cardiovascular disease indicate that “Adults should engage in at least 150 minute per week of accumulated moderate-intensity or 75 minute per week of vigorous-intensity aerobic physical activity (or an equivalent combination of moderate and vigorous activity) to reduce ASCVD risk.” During quarantine, strategies to further increase home-based physical activity and to follow a healthy diet should be implemented. Quarantine carries some long-term effects on cardiovascular disease, mainly related to unhealthy lifestyle and anxiety. Following quarantine a global action supporting healthy diet and physical activity is mandatory to encourage people to return to good lifestyle.

The cardiovascular risk assessment must be carried out during all the different phases of life because the cardiovascular risk and the related prevention actions are dynamic and constantly evolving. As patients age, they change their exposure to various risk factors and accumulate comorbidities by changing their subjective cardiovascular risk, so it is necessary to undertake personalized early and preventive diagnostic actions. The main approach to asymptomatic vascular disease is based on primary prevention with the adoption of a healthy lifestyle. Indeed, lifestyle influences most of the traditional risk factors. In recent years, important differences between the sexes regarding cardiovascular risk factors have emerged and in particular, risk factors specific for female sex have been identified. Women are more likely to be categorized into lower risk categories for cardiovascular disease and, as a result, receive less lifestyle counseling than men, as well as less intensive prevention. This narrative review aims to analyze CVD risk prevention in asymptomatic atherosclerosis with a look at new emerging factors. In the end, we quickly analyzed the effects of the recent pandemic on lifestyle and cardiovascular risk and the potential negative effects in the long term.

The present letter to editor comments the manuscript “Energy Drink-Associated Cardiomyopathy after Excessive Consumption: A Case Report. J Teh Univ Heart Ctr 2021;16(3):119-122” presenting some comments on consumption of energy drinks and cardiac damages.

A pathologic condition, as perihilar cholangiocarcinoma, can impair the functional mechanisms that regulate the normal lymph flow in the hilar or perihilar lymphatics through a direct neoplastic lymph nodes involvement or a simple condition of lymphatic congestion.3 Besides, in the hepatic hilum, we have not observed a fibrous sheet equivalent to that described in the rectum anatomy, which could define an anatomic space for a preferred early neoplastic involvement and offer a clear landmark for a correct dissection.

When this conservative treatment is not efficacious and the general conditions advice against a more invasive procedure, in the presence of a leak involving less than half of the circumference of the anastomosis, but without signs of undrained mediastinal infectious collections, a treatment based on cervical exclusion of the esophageal transit can be considered.

[...]we recall attention to the different development of the portal venous collaterals that can accompany an enlarged spleen and sustain important splenorenal or spleno-retroperitoneal shunts.

[...]it can be involved by secondary neoplastic implants, caused by seeding from the primary rectal tumor, or by spillage from lymphatic channels engorged with neoplastic cells.3,4 Besides important modifications observed after radiotherapy in vascular and nervous apparatuses of the mesorectum jeopardize its arterial supply and lymphatic drainage for the rectal stump.2 From this point of view, cases with recurrent rectal cancers but operated with total mesorectal excision can be considered different from those with only incomplete mesorectal resection.

Considering all these features these neo-generated organs deserve to be considered tertiary lymphatic structures.2,3 This process, observed independently from the presence of LN metastases, can be associated with intratumoral lymphocytic infiltration and it is generally considered as a tissue immune response to persistent antigenic stimuli.2-4 A corresponding neogenesis of lymphatic structures was observed in other cancers (breast, lung, skin melanoma, and so forth), and with minor number, also in inflammatory diseases of the colon.2 In our experience, based on histological examinations of surgical specimens, this immunological activity was demonstrated only in the regional lymphatic district. Because of its complexity, this topic requires further research; maybe tomorrow this colon cancer feature will be considered among the prognostic signs.5

The heterotopic mesenteric ossification, also known as myositis ossificans, is a rare form of heterotopic ossification, a metaplastic phenomenon where new bone is formed in the mesenteric base, generally after abdominal trauma (surgical or other). The pathophysiology of heterotopic mesenteric ossification is unknown; clinical presentation is not specific, with vague abdominal symptoms, uncertain radiological findings, and often regular laboratory exams. No consensus exists on the best possible approach, although it might well be both medical and surgical. We reviewed the clinical history of a 28-year-old man with a recent motor vehicle accident who was admitted to our surgical unit with symptoms consistent with a small bowel obstruction; after surgery, a diagnosis of myositis ossificans was surprisingly made.