Development of lens opacities with peculiar characteristics in patients affected by thalassemia major on chelating treatment with deferasirox (ICL670) at the Pediatric Clinic in Monza, Italy.

About the 11–14% of patients with thalassemia major (TM) treated with deferasirox (DFO) develops retinopathy and/or lens opacities with an unclear pathogenesis but with a clear age related pattern.[1][1],[2][2] Possible causes can be either iron overload itself or DFO toxicity, with variou

Metabolic syndrome, left ventricular hypertrophy and carotid atherosclerosis in hypertension: a gender-based study.

Background. The influence of gender on the association between metabolic syndrome (MS) and subclinical organ damage (OD) has been poorly investigated. The aim of this study was to investigate whether the risk of developing left ventricular hypertrophy (LVH) and carotid atherosclerosis is different in men and women with MS. Methods. A total of 3752 untreated and treated hypertensive patients (mean age 53.3 ± 12.6, 52.7% men) were considered for this analysis. All patients underwent standard ultrasonographic investigations searching for LVH and carotid atherosclerosis. The MS was defined according to ATP III criteria. Results. LVH was more prevalent in women and men with the MS compared with their counterparts (58% vs 34% and 48% vs 33%, respectively, p < 0.001). This was also the case for carotid plaque prevalence (61% vs 42% and 57% vs 44%, p < 0.001). The prevalence of OD was not different between men and women with MS, after adjusting for confounders. In multivariate analysis, abdominal obesity was the most important MS component independently related to LVH in both genders, followed by blood pressure. As for carotid plaques, blood pressure, hyperglycemia and hypertriglyceridemia turned out to be independent correlates regardless of gender. Conclusions. Our data indicate that MS is associated with a higher risk of LVH and carotid atherosclerosis irrespective of gender; these findings do not support a gender influence in the association between MS and subclinical OD. © 2013 Scandinavian Foundation for Cardiovascular Research

Infezioni associate al cateterismo vascolare: consensus sull'iter diagnostico microbiologico.

Autore: Gruppo di Studio sulla Diagnostica delle Infezioni da Catetere Vascolare

Prevalence of echocardiographic left-atrial enlargement in hypertension : a systematic review of recent clinical studies

Background Left atrial enlargement (LAE) is a marker of hypertensive heart disease associated with increased cardiovascular risk. We reviewed recent literature about the prevalence of LAE, as assessed by echocardiography, to update our information about the clinical relevance of this cardiac phenotype in human hypertension. Methods We performed a search of MEDLINE using the key words "left atrial enlargement," "left atrial dilatation," "left atrial size," "hypertension," "echocardiography, " and "atrial fibrillation" to identify relevant papers. We considered full articles published in English from January 1, 2000 to July 1, 2012 reporting studies involving adult individuals. Results We analyzed a total of 15 studies, including 10,141 untreated and treated subjects. LAE was defined according to 11 different criteria (4 studies applied two or three criteria), and its prevalence consistently varied among studies, from 16.0-83.0%, with a prevalence in the pooled population of 32%. A gender-based analysis of 9 studies (8,588 patients) showed the prevalence of LAE as being similar in women and men (OR, 1.23; 95% CI, 0.83-1.83; P = 0.30). Data provided by 10 studies (n = 9,354 patients) showed the prevalence of left-ventricular hypertrophy as being significantly higher in patients with LAE (68.2%) than in their counterparts without LAE (41.8%) (OR, 2.97; 95% CI, 2.68-3.29; P < 0.01).CONCLUSIONSOur analysis shows that LAE is present in a relevant fraction of the hypertensive population. Because LAE is an independent predictor of cardiovascular events, the accurate detection of this phenotype may improve the evaluation of risk in hypertensive patients

Left-ventricular hypertrophy and obesity : a systematic review and meta-analysis of echocardiographic studies

AIM: Left-ventricular hypertrophy (LVH) is a frequent complication in obese individuals; an updated review and meta-analysis focusing on this issue is lacking. Thus, we analysed the literature in order to provide a comprehensive information on the left-ventricular structural changes, as assessed by echocardiography, associated to obesity. DESIGN: A literature search using the keywords 'left ventricle', 'left-ventricular hypertrophy', 'cardiac hypertrophy', 'obesity', 'hypertension' and 'echocardiography' was performed in order to identify relevant papers. Full articles published in English language in the past 12 years reporting studies in adult obese individuals were considered. RESULTS: A total of 22 studies including 5486 obese individuals were considered. Overall, in the pooled obese population, prevalence of LVH, defined by 12 criteria, was 56.0% (range 20.0-85.0%). Data provided by 15 studies (n=4999 obese individuals), including 6623 non-obese controls, showed that the probability of having LVH was much higher in cases than in non-obese counterparts (odds ratio 4.19, 95% confidence interval 2.67-6.53, P<0.01). A meta-regression analysis (n=2214; 14 studies) showed a direct correlation between BMI and left-ventricular mass (P<0.01). Among obese patients with LVH (n=1930; 15 studies), eccentric hypertrophy was more frequent than the concentric phenotype (66 versus 34%; P<0.01). CONCLUSIONS: Our analysis shows that LVH is present in a consistent fraction of the obese population and that eccentric hypertrophy prevails over the concentric phenotype. As obesity-related LVH is a powerful risk factor for systolic/diastolic dysfunction, the prevention/treatment of obesity may have a strong, favourable impact on incident heart failure

What is the accuracy of clinic blood pressure measurement?

Background: In clinical practice, blood pressure (BP) is frequently measured at the end of the visit in patients sitting on one side of the bed and not on a chair according to guidelines. Methods: In 540 consecutive subjects with essential hypertension (EH) attending a hospital outpatient clinic, BP was measured in the following sequence: 1) patient seated on chair for at least 5 min, 2) patient supine, 3) patient seated on bed, and 4) patient standing for a few minutes. Results: We found that mean (+/-SEM) BP was 143.5/ 87.2 +/- 0.9/0.5, 153.4/89.7 +/- 1.010.5, 148.9/90.9 +/- 1-0/ 0.5, and 144.8/91.7 +/- 1.0/0.6 mm Hg, respectively (P < .05 v position 1 for all). In 14% of patients, either systolic BP (SBP) or diastolic BP (DBP) was above the conventional upper limits of normality in the seated-on-bed but not in the recommended seated-on-chair position ("false" high clinic BP), whereas SBP and DBP were "false" normal (below limit for bed-seated and above limit for chair-seated position) in only 6% and 2% of patients, respectively. Overall, SBP and DBP increments from the chair- to the bed-seated position were inversely related to the baseline chair-seated values; systolic increments were directly related to age, in particular in the subgroup of untreated EH (n = 70), and to body mass index. A gender-related difference was apparent, as female subjects had more pronounced increments in SBP (+ 7.4 +/- 0.8 v + 3.5 +/- 0.7 mm Hg) and DBP (+ 4.4 +/- 0.5 v 2.9 +/- 0.4 mm Hg) than did male subjects (P < .05 for both). Conclusions: Clinic SBP and DBP are overestimated in the bed-seated position at the end of the visit compared with the recommended chair-seated position in treated and untreated patients with EH, in particular in elderly obese women with mild hypertension. (C) 2005 American Journal of Hypertension, Ltd