Corin-ul, peptidul natriuretic atrial şi hipertensiunea

La ora actuală este sugerată sau dovedită importanţa a numeroase substanţe (hormoni, enzime, molecule active biologic, markeri ai injuriei miocardice, ai afectării funcţiei cardiace etc.) pentru evoluţia clinică şi managementul afecţiunilor. Prezenta lucrare face referire la biomarkeri noi, cu accent pe moleculele potenţial utile pentru care există nişte date privind rolul clinic

Hipertrofia ventriculară stângă–generalităţi fiziopatologice

Articolul prezintă o trecere în revistă a literaturii de ultimă oră în problema hipertrofi ei ventriculare stângi şi a abordării acesteia în calitate de factor de risc cardiovascular, cu oferirea datelor statistice, descrierea succintă a metodelor de bază de diagnostic, a mecanismelor fi ziopatologice şi genetice de evoluare a acestui proces din unul adaptiv spre unul maladaptiv

Unele aspecte cronoterapice în hipertensiunea arterială

Cronobiologia este știința care studiază relația organismelor vii cu timpul. Prin intermediul ceasurilor biologice sunt dictate ritmurile biologice ce reglează orice aspect al funcționării unui organism, atât in normă, cât și în patologie. Articolul prezent este o scurta inițiere în cronobiologie în general, cu accente asupra aspectelor cronofarmacologice în hipertensiunea arterială, asupra rolului patternului circadian de non-dipper în stabilirea riscului cardiovascular. Este prezentată o revistă a studiilor clinice, inclusiv celor mai recente, ce au abordat problema cronoterapiei în hipertensiunea arterială. Concluzia pertinentă a studiilor și metaanalizelor prezentate ține de necesitatea utilizării mai pe larg a monitorizării ambulatorii a tensiunii arteriale pentru stabilirea patternului circadian al tensiunii arteriale și pentru ajustarea tratamentului antihipertensiv, inclusiv sunt aduse dovezi în favoarea administrării serale (bedtime) a medicamentelor antihipertensive

Disfuncţia erectilă – o condiţie cardiovasculară?

Disfunctia erectilă este defi nită actualmente ca o patologie de origine vasculară, rămânând în acelaşi timp o condiţie clinică de un interes pluridisciplinar. Mecanisme comune – disfuncţia endotelială şi infl amaţia – stau la baza afectării vasculare, atât în bolile cardiovasculare, cât şi în disfuncţia erectilă, acestea fi ind legate prin relaţii cauzative bilaterale. Articolul abordează aspecte statistice, fi ziopatologice, terapeutice, oferă informaţii utile despre stratifi carea riscului cardiac al pacienţilor cu disfuncţie erectilă

Hipertensiunea sistolică izolată la vârstnici

Pacienţii vârstnici trebuie să benefi cieze de tratament medicamentos antihipertensiv în vederea reducerii morbidităţii şi mortalităţii cardiovasculare, indiferent dacă aceştea au hipertensiune sistolo-diastolică sau hipertensiune sistolică izolată. Acest lucru a fost demonstrat într-un număr mare de studii randomizate, care au inclus pacienţi cu vârsta de peste 60 de ani. Tratamentul medicamentos poate fi iniţiat cu diuretice tiazide, antagonişti de calciu, antagonişti ai receptorilor de angiotensină, inhibitori ai enzimei de conversie şi b-blocante, în conformitate cu recomandările generale din ghid

Canine granulomatous meningoencephalitis: a case report and review of the literature

Canine granulomatous meningoencephalomyelitis (GME) is a subtype of a large group of idiopathic central nervous system diseases with a relatively high incidence (up to 25%) among dogs with central nervous system affection (Tipold, 1995). Neurological presentation of GME can vary from focal to multifocal, or ocular form. Histologically, GME is characterized by focal, disseminated or perivascular mononuclear cells spreading in the white matter and meninges (Coates and Jeffery, 2014). The aim of the current case report is to describe the pathological findings and to discuss the diagnostic features of this disease. Therefore, we should further emphasize the importance of this disease in current veterinary practice

Evaluation of carbohydrate and lipid metabolism dynamics in chronic HCV diabetic patients treated with direct antiviral agents

Although Hepatitis C virus (HCV) infection has become a curable disease, the aftermath of the infection remains an important aspect to be evaluated. HCV infection is well known for its extrahepatic manifestations, mostly the tight relationship between HCV, type 2 diabetes mellitus (T2DM) and dyslipidemia. Not only HCV increases the risk of T2DM, but it also affects its control in diabetic patients, increasing the risk of diabetes related complications. Furthermore, HCV hijacks the lipid metabolism resulting in abnormalities in circulating lipids which can lead to multiple complications, such as increased atherosclerotic risk and hepatic steatosis. Objectives. The aim of this study was to evaluate the dynamics of the parameters of carbohydrate and lipid metabolism in HCV-infected diabetic patients compared to non-diabetic patients after viral eradication. Material and methods. This is a prospective study conducted on 100 patients with chronic HVC infection who obtained viral clearance after interferon-free treatment. 58 patients had type 2 diabetes mellitus and 42 were nondiabetic. We evaluated serum total cholesterol, triglycerides, blood glucose and glycosylated hemoglobin in both groups at treatment initiation and 1 year after. Continuous variables were expressed as mean values ± standard deviation or median, categorical variables were represented as relative or absolute frequencies. Characteristics were compared using the Mann-Whitney method or the two-sample Student's T-test method for continuous variables, Chi-square and Fischer's test for categorical variables. A p value < 0.05 was considered statistically significant. Outcomes. The study analyzed and compared lipid and glycemic profiles of diabetic and non-diabetic HVC patients before and after viral cure. Conclusions. 1 year after treatment initiation the changes in lipid metabolism seem to persist, carbohydrate metabolism seems to remain unchanged, with no differences between diabetic and non-diabetic patients

Effects of granulocyte-colony stimulating factor on bone marrow morphology following cyclophosphamide induced neutropenia in rats

Granulocyte-colony stimulating factor is a glycoprotein that stimulates synthesis of granulocytes, especially of neutrophiles. It can be used to correct myelosupression associated with long-term chemotherapy or in the treatment of neutropenia. The aim of our study was to assess the effects of G-CSF on bone marrow after cyclophosphamide induced neutropenia in rats. The study was conducted on 24 female Wistar rats divided in 3 experimental groups; the control group, group of cyclophoshamide treated animals and the group of animals that were treated with Granulocyte-colony stimulating factor after neutropenia induction with cyclophosphamide. Cytological exam of bone marrow aspirates and histological exam from sternal bone marrow were realized using routine techniques. Examination of the aspirates taken from the femoral bone marrow and of the histological sections taken from the sternum showed a dramatic reduction in the number of myeloid precursors in individuals of group 2 which have been subjected to cyclophosphamide-induced myelosuppression, while the administration of G-CSF to the individuals of group 3 induced marked proliferation of the myeloid precursor cells, correcting the myelosuppressive effect of the cyclophosphamide In conclusion, G-CSF can be used for the stimulation and mobilization of myeloid progenitor cells from the bone marrow

Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.

INTRODUCTION: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. METHODS: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. RESULTS: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. CONCLUSION: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events