Impaired aldosterone response to the saline infusion test in patients with resistant hypertension and obstructive sleep apnea

Background In this cross-sectional study, we sought associations among severity of obstructive sleep apnea (OSA), renin-angiotensin-aldosterone system and blood pressure patterns in patients with resistant hypertension.Material and methods In 65 patients with resistant hypertension we measured the apnea-hypopnea index (AHI) by a portable sleep recorded system and aldosterone and plasma renin activity (PRA) in response to saline infusion test. We also collected data on cardiovascular events, dyslipidemia, chronic kidney disease, and diabetes and performed 24-hour blood pressure monitoring (ABPM).Results Baseline PRA, aldosterone and aldosterone-to-renin ratio were within normal range but aldosterone level in response to saline infusion was increased above normal upper limit. In ABPM, 68% of patients had an altered pattern of blood pressure (non-dipping or reverse dipping). AHI was inversely correlated with PRA and positively with weight, BMI, plasma aldosterone, aldosterone to renin ratio, and aldosterone after saline load but not with blood pressure. Patients with severe OSA (AHI > 30) in comparison to those with mild OSA (AHI 5–15) had significantly higher PRA and aldosterone (baseline and after saline load) but comparable values of blood pressure. We did not find significant impact of OSA severity on the frequency of abnormal blood pressure patterns. Frequencies of diabetes, abnormal lipid profiles, ischemic heart disease, myocardial infarction, and stroke increased with increases in severity of OSA.Conclusions Despite of normal basal PRA and aldosterone concentration, patients with resistant hypertension and OSA had impaired response to saline load and a rate of this impairment depended on the severity of OSA.Background In this cross-sectional study, we sought associations among severity of obstructive sleep apnea (OSA), renin-angiotensin-aldosterone system and blood pressure patterns in patients with resistant hypertension.Material and methods In 65 patients with resistant hypertension we measured the apnea-hypopnea index (AHI) by a portable sleep recorded system and aldosterone and plasma renin activity (PRA) in response to saline infusion test. We also collected data on cardiovascular events, dyslipidemia, chronic kidney disease, and diabetes and performed 24-hour blood pressure monitoring (ABPM).Results Baseline PRA, aldosterone and aldosterone-to-renin ratio were within normal range but aldosterone level in response to saline infusion was increased above normal upper limit. In ABPM, 68% of patients had an altered pattern of blood pressure (non-dipping or reverse dipping). AHI was inversely correlated with PRA and positively with weight, BMI, plasma aldosterone, aldosterone to renin ratio, and aldosterone after saline load but not with blood pressure. Patients with severe OSA (AHI > 30) in comparison to those with mild OSA (AHI 5–15) had significantly higher PRA and aldosterone (baseline and after saline load) but comparable values of blood pressure. We did not find significant impact of OSA severity on the frequency of abnormal blood pressure patterns. Frequencies of diabetes, abnormal lipid profiles, ischemic heart disease, myocardial infarction, and stroke increased with increases in severity of OSA.Conclusions Despite of normal basal PRA and aldosterone concentration, patients with resistant hypertension and OSA had impaired response to saline load and a rate of this impairment depended on the severity of OSA

Coexistence of Parry-Romberg syndrome with homolateral segmental vitiligo

Parry-Romberg syndrome or progressive facial hemiatrophy was first described by Caleb Parry in 1825 and Moritz Romberg in 1846. This disorder is characterized by slowly progressing acquired unilateral hemifacial atrophy, which affects subcutaneous tissue together with the muscles and underlying bones. The pathogenesis and precise incidence of the syndrome remain unclear. Immune-mediated processes and disturbed central regulation, leading to the hyperactivity of the sympathetic nervous system, are primarily considered in the pathogenesis of this disorder. Parry-Romberg syndrome and localized scleroderma are considered to be interrelated as both of them have a similar clinicopathological appearance. We report the case of a 46-year-old man affected by both progressive atrophy of the left side of the face and homolateral, segmental vitiligo in the left side of the trunk and face

Potential role of statins in the intracerebral hemorrhage and subarachnoid hemorrhage

Statins are used in primary and secondary prevention of cardiovascular episodes. Most of recent studies regard ischemic stroke. There are more emerging results of studies suggesting usefulness of these drugs in the other types of stroke e.g. intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Searching for new methods of treatment is important, because both ICH and SAH lead to poor prognosis and severe psychomotor disability. The unquestionable role of inflammatory factors in the pathogenesis of these disorders justifies considering statin treatment. Previous results are contradictory, thus in present study we review results of studies and try to explain the potential pathomechanism of statin use in hemorrhagic strokes

The emotional stress and risk of ischemic stroke

Stroke is the second leading cause of death worldwide, and the leading cause of acquired disability in adults in most regions. There have been distinguished modifiable and non-modifiable risk factors of stroke. Among them the emotional stress was presented as a risk factor. The aim of this review was to present available data regarding the influence of acute and chronic mental stress on the risk of ischemic stroke as well as discussing the potential pathomechanisms of such relationship. There is an evident association between both acute and chronic emotional stress and risk of stroke. Several potential mechanisms are discussed to be the cause. Stress can increase the cerebrovascular disease risk by modulating symphaticomimetic activity, affecting the blood pressure reactivity, cerebral endothelium, coagulation or heart rhythm. The emotional stress seems to be still underestimated risk factor in neurological practice and research. Further studies and analyses should be provided for better understanding of this complex, not fully known epidemiological problem

Management of hypertension in selected acute conditions associated with an increased activation of the sympathetic nervous system

Autonomiczny układ nerwowy odgrywa kluczową rolę w utrzymaniu homeostazy układu krążenia poprzez wpływ na obwodowy opór naczyniowy, pojemność minutową serca, funkcję nerek. Dysfunkcja w obszarze autonomicznego układu nerwowego, objawiająca się chroniczną wzmożoną aktywacją współczulną, pełni istotną rolę w patogenezie nadciśnienia tętniczego i jego powikłań narządowych. Stany nagłego wzmożenia aktywności współczulnej, przebiegające z natychmiastowym wzrostem ciśnienia tętniczego, mogą stanowić bezpośrednie zagrożenia życia. W obecnej pracy przedstawiono wskazówki dotyczące postępowania z nadciśnieniem tętniczym w wybranych przypadkach przebiegających ze wzmożoną aktywnością współczulną — guza chromochłonnego, nagłego odstawienia klonidyny, narkomanii oraz stresu okołooperacyjnego.The autonomic nervous system plays a key role in cardiovascular homeostasis by affecting the peripheral vascular resistance, cardiac output, renal function. Dysfunction in the autonomic nervous system, manifested by chronic increased sympathetic activation, plays an important role in the pathogenesis of hypertension and target organ damage. Sudden conditions of enhancement sympathetic activity, running with an immediate increase in arterial pressure, may pose a direct threat to life. The present work provides guidelines for the management of hypertension in some selected cases associated with an increased activity of the sympathetic — pheochromocytoma, sudden clonidine withdrawal, drug addiction, perioperative stress

A comparative analysis of the level of aggression between female and male judokas society

 Aim: The comparison the level of aggression of women and men in the judo population, against the background of the average aggression of the Polish societyMaterial and Methods: A group of 77 former and still practicing judokas (30 women and 47 men) were tested using a questionnaire to determine the aggression level of "Aggression Questionnaire" Buss, Perry, Amity Institute in Polish adaptation.Results: Women had lower levels of physical aggression than men. Reduced feelings of hostility among women and men made the judo environment different from the average Polish population.Conclusions: Only the lower level of physical aggression in women is discriminating against the judo environment. The lower level of sense of hostility is a significant distinctive for the entire judo community

Suppression of puberty with GnRH analogues in adolescents with Gender Dysphoria

Introduction: Gender Dysphoria (GD) is defined as a mismatch between biological sex characteristics and gender identity. The percentage of teenagers with doubts about their gender identity has dramatically increased over the past decade. The aim of the study: This article presents the positions of supporters and opponents regarding suppression of puberty with GnRH analogues in GD adolescents. Material and method: Standard criteria were used to review the literature data. The search of articles in the PubMed database was carried out using the following keywords: gender dysphoria, transsexualism, suppression of puberty. Description: Due to the extension of the time needed to shape gender identity, suppression of puberty seems to be a beneficial preventive measure for the development of sexual dysphoria. Adolescents avoid suffering associated with the development of unwanted sex. However, there are numerous concerns about the negative effects of puberty inhibition on bone development, neuropsychological development and future fertility. Summary: The safety and effectiveness of therapy that inhibits puberty is not properly grounded in scientific evidence. There is still a lack of research assessing the long-term effects of administering hormones that interfere with adolescent sexual development

The sustained increase of plasma fibrinogen during ischemic stroke predicts worse outcome independently of baseline fibrinogen level

Hyperfibrinogenemia at the beginning of ischemic stroke is associated with poor outcome. We hypothesized that the sustained increase of plasma fibrinogen during stroke predicts outcome independently of baseline fibrinogen concentration. We included 266 patients with first-ever ischemic stroke in whom plasma fibrinogen level was measured on days 1, 7, and 14. The sustained fibrinogen's increase was defined as the persistent elevation of fibrinogen's concentration on days 7 and 14 by at least 20 % compared to the level on day 1. The functional outcome on day 30 was assessed using modified Rankin Scale (mRS). Favorable outcome was defined as mRS 0-1. The sustained increase of fibrinogen was found in 17 % of patients. On multivariate logistic regression analysis adjusted for age, NIHSS score, baseline fibrinogen >2.66 mmol/L, presence of infection, and hyperglycemia, the sustained fibrinogen's level was associated with reduced chance of favorable outcome (OR: 0.17, 95 % CI: 0.06-0.48, P<0.01)

Improvement of survival in Polish stroke patients is related to reduced stroke severity and better control of risk factors : the Krakow Stroke Database

Introduction: In the last decade, the stroke mortality rate in Poland significantly decreased. We hypothesised that stroke severity, the major determinant of outcome, is lowered in Polish stroke patients. Material and methods: We compared the stroke severity in two cohorts of first-ever ischaemic stroke patients admitted within 24 h after stroke onset to the Department of Neurology, Jagiellonian University, Krakow in the years 1994-2000 and 2008-2012. To assess stroke severity we used the National Institute of Health Stroke Scale (NIHSS). We defined mild stroke as an NIHSS score ≤ 4. Results: We included 816 patients hospitalised in the years 1994-2000 and 569 patients hospitalised in the years 2008-2012. NIHSS score on admission was higher in the former (mean: 12.0 ±7.0 vs. 8.0 ±6.0, p < 0.01), and the frequency of mild stroke was higher in the latter (12.7% vs. 41.8%, p < 0.01). Although the frequency of hypertension (67.3% vs. 81.2%, p < 0.01), diabetes mellitus (20.8% vs. 26.4%, p = 0.02) and atrial fibrillation (20.7% vs. 26.2%, p = 0.02) was higher in patients hospitalised in the years 2008- 2012, the systolic and diastolic blood pressure values and the frequency of fasting hyperglycaemia were lower in this cohort. This cohort also less frequently suffered from hypercholesterolaemia (25.4% vs. 16.3%, p < 0.01). Conclusions: Reduced stroke severity is associated with better recognition and control of risk factors and explains the improvement of survival in Polish stroke patients

Psychological analysis of the level of aggression in the male judokas socjety

The phenomenon of aggression was the subject of research both in term of its negative effects, and as a desirable element in martial arts. Determination  the level of aggression of active and former players judo, and correlation between  aggression of judokas and sociodemographic  factors was the goal of this study. The test results indicated the unusual relationship of judokas aggression  with other determinants of social life and sporting career