Physical activity, high density lipoprotein cholesterol and other lipids levels, in men and women from the ATTICA study

BACKGROUND: Physical activity has long been associated with reduced risk of coronary heart disease (CHD). In this work we evaluated the effect of physical activity on lipid levels, in a sample of cardiovascular disease free people. METHODS: The ATTICA study is a population – based cohort that has randomly enrolled 2772 individuals, stratified by age – gender (according to the census 2001), from the greater area of Athens, during 2001–2002. Of them, 1376 were men (45 ± 12 years old, range: 18 – 86) and 1396 women (45 ± 13 years old, range: 18 – 88). We assessed the relationship between physical activity status (measured in kcal/min expended per day) and several lipids, after taking into account the effect of several characteristics of the participants. RESULTS: 578 (42%) men and 584 (40%) women were classified as physically active. Compared to sedentary physically active women had significantly lower levels of total serum cholesterol (p < 0.05), LDL (p < 0.05) and oxidized LDL cholesterol (p < 0.05), triglycerides (p < 0.05), apolipoprotein B (p < 0.05), and higher levels of HDL cholesterol (p < 0.05) and apolipoprotein A1 (p < 0.05). Similar associations were observed in men, but the benefits did not reach statistical significance. However, when we adjusted for age, smoking habits and body mass index, physical activity was only significantly associated with higher HDL-cholesterol (p < 0.05) and apolipoprotein A1 (p < 0.05) levels, in women, but not in men. CONCLUSIONS: Substantial independent increases in HDL-cholesterol and apolipoprotein A1 concentrations were observed in women, but not in men, in a Mediterranean cohort

Infections in a surgical intensive care unit of a university hospital in Greece

SummaryObjectivesWe aimed to evaluate the clinical and microbiological characteristics of the patients who developed an infection in our surgical intensive care unit (SICU).MethodsThis was a prospective study of all patients who sustained an ICU-acquired infection from 2002 to 2004.ResultsAmong 683 consecutive SICU patients, 123 (18.0%) developed 241 infections (48.3 infections per 1000 patient-days). The mean age of patients was 66.7±3.8 years, the mean APACHE II score (acute physiology and chronic health evaluation) on SICU admission was 18.2±2.4, and the mean SOFA score (sepsis-related organ failure assessment) at the onset of infection was 8.8±2. Of the study patients, 51.2% were women. Infections were: bloodstream (36.1%), ventilator-associated pneumonia (VAP; 25.3%, 20.3/1000 ventilator-days), surgical site (18.7%), central venous catheter (10.4%, 7.1/1000 central venous catheter-days), and urinary tract infection (9.5%, 4.6/1000 urinary catheter-days). The most frequent microorganisms found were: Acinetobacter baumannii (20.3%), Pseudomonas aeruginosa (15.7%), Candida albicans (13.2%), Enterococcus faecalis (10.4%), Klebsiella pneumoniae (9.2%), Enterococcus faecium (7.9%), and Staphylococcus aureus (6.7%). High resistance to the majority of antibiotics was identified. The complication and mortality rates were 58.5% and 39.0%, respectively. Multivariate analysis identified APACHE II score on admission (odds ratio (OR) 4.63, 95% confidence interval (CI) 2.69–5.26, p=0.01), peritonitis (OR 1.85, 95% CI 1.03–3.25, p=0.03), acute pancreatitis (OR 2.27, 95% CI 1.05–3.75, p=0.02), previous aminoglycoside use (OR 2.84, 95% CI 1.06–5.14, p=0.03), and mechanical ventilation (OR 3.26, 95% CI: 2.43–6.15, p=0.01) as risk factors for infection development. Age (OR 1.16, 95% CI 1.01–1.33, p=0.03), APACHE II score on admission (OR 2.53, 95% CI 1.77–3.41, p=0.02), SOFA score at the onset of infection (OR 2.88, 95% CI 1.85–4.02, p=0.02), and VAP (OR 1.32, 95% CI 1.04–1.85, p=0.03) were associated with mortality.ConclusionsInfections are an important problem in SICUs due to high incidence, multi-drug resistance, complications, and mortality rate. In our study, APACHE II score on admission, peritonitis, acute pancreatitis, previous aminoglycoside use, and mechanical ventilation were identified as risk factors for infection development, whereas age, APACHE II score on admission, SOFA score at the onset of infection, and VAP were associated with mortality

Estrogen-induced improvement in coronary flow responses during atrial pacing in relation to endothelin-1 levels in postmenopausal women without coronary disease

Ioannis Kallikazaros, Costas Tsioufis, Panagiotis Zambaras, Ioannis Skiadas, Marina Toutouza, Dimitrios Tousoulis, Christodoulos Stefanadis, Pavlos ToutouzasCardiology Department and University Cardiology Clinic, Hippokration Hospital of Athens, GreeceBackground: The cardioprotective role of hormonal replacement therapy remains in doubt, but interest is increasing in the vascular effects of estrogens especially in coronary circulation.Methods: Coronary blood flow (CBF) was measured in 24 postmenopausal women (age 55 &plusmn; 3 years), whose coronary arteries appeared angiographically normal, during incremental atrial pacing (AP) before and 20 minutes after intracoronary administration of either 75 ng/mL 17-&beta; estradiol (treated group, n = 18) or 0.9% saline (controls, n = 6).Results: Before estrogen, no differences in the coronary vasomotor responses at AP between the two groups (p = NS) could be detected. After estrogen, in the treated group, at the peak of the second AP, the coronary artery diameter decreased by 0.17 mm (p &lt; 0.005) while the CBF increased by 61 mL/min (p &lt; 0.05). These changes differed significantly from thoseobserved at the peak of first AP (p &lt; 0.001 for both cases). In contrast, in the control group no such changes were observed. The endothelin-1 (ET-1) levels in the coronary sinus were significantly reduced after estrogen infusion, which was negatively correlated with the degree of coronary artery constriction (r = &minus;0.40, p = 0.03) and positively correlated with the increase in CBF (r = 0.54, p = 0.01).Conclusions: In postmenopausal women without coronary artery disease, the intracoronary estrogen infusion mediates a greater increase in CBF and is positively correlated with the reduction of the coronary sinus ET-1 levels at the peak of AP.Keywords: estrogens, coronary blood flow, endothelin-1, coronary intervention

Increasing frequency of gram-positive cocci and gram-negative multidrug-resistant bacteria in spontaneous bacterial peritonitis

&lt;sec id=”liv12152-sec-0001”&gt; BackgroundSpontaneous bacterial peritonitis (SBP) is historically caused by Gram-negative bacteria (GNB) almost exclusively Enterobacteriaceae. Recently, an increasing rate of infections with Gram-positive cocci (GPC) and multidrug-resistant (MDR) microorganisms was demonstrated. &lt;sec id=”liv12152-sec-0002”&gt; AimsTo assess possible recent changes of the bacteria causing SBP in cirrhotic patients. &lt;sec id=”liv12152-sec-0003”&gt; MethodsWe retrospectively recorded 47 cases (66% males) during a 4-year-period (2008-2011). &lt;sec id=”liv12152-sec-0004”&gt; ResultsTwenty-eight (60%) patients had healthcare-associated infections while 15 (32%) received prophylactic quinolone treatment. GPC were found to be the most frequent cause (55%). The most prevalent organisms in a descending order were Streptococcus spp (n=10), Enterococcus spp (n=9), Escherichia coli (n=8), Klebsiella pneumonia (n=5), methicillin-sensitive Staphylococcus aureus (n=4) and coagulase-negative Staphylococcus spp (n=3). Nine of the isolated bacteria (19%) were MDR, including carbapenemase-producing K. pneumonia (n=4), followed by extended-spectrum beta-lactamase-producing E. coli (n=3) and Pseudomonas aeruginosa (n=2). MDR bacteria were more frequently isolated in healthcare-associated than in community-acquired infections (100% vs 50%, P=0.006), in patients receiving long-term quinolone prophylaxis (67% vs 24%, P=0.013) and in those with advanced liver disease as suggested by higher MELD score (28 vs 19, P=0.012). More infections with GNB than GPC were healthcare-associated (81% vs 42%, P=0.007). Third-generation cephalosporin resistance was observed in 49% and quinolone resistance in 47%. &lt;sec id=”liv12152-sec-0005”&gt; ConclusionsGPC were the most frequent bacteria in culture-positive SBP and a variety of drug-resistant microorganisms have emerged. As a result of high rates of resistance in currently recommended therapy and prophylaxis, the choice of optimal antibiotic therapy is vital in the individual patient