Case report of exercise and statin-fibrate combination therapy-caused myopathy in a patient with metabolic syndrome: contradictions between the two main therapeutic pathways

ABSTRACT: BACKGROUND: Lifestyle modifications including exercise are beneficial and fundamentally part of the therapy of metabolic syndrome, although in most of the cases medical interventions are also required to reach the target values in the laboratory parameters. Statin and fibrate combination therapy is considered to be safe and effective in dyslipidaemia and metabolic syndrome. However, increased physical activity can enhance the statin and fibrate-associated myopathy. Myositis and the rare but life-threatening rhabdomyolysis are causing a conflict between exercise and statin-fibrate therapy, which is yet to be resolved. CASE PRESENTATION: We present a case of a 43-year-old Caucasian man with metabolic syndrome who had the side-effect of exercise and drug-associated myositis. The patient had only transient moderate complaints and rhabdomyolysis could be avoided with the one-month creatine kinase control, a test which is not recommended routinely by the new guidelines. CONCLUSIONS: We would like to turn the spotlight on the possible complications of statin-fibrate therapy and exercise, when strict follow-up is recommended. In this condition high number of patients can be affected and the responsibility of general practitioners is accentuated

A konstitutív hem-oxigenáz enzim (HO-2) ösztrogének által szabályozott expressziójának és a keringési rendszer védelmi mechanizmusában betöltött szerepének vizsgálata patkányban = Regulation of the constitutive heme-oxigenase enzime (HO-2) expression by estrogenes, and its role in cardiovascular defense: in vivo actions of 17beta-estradiol and raloxifene

Szervezetünkben két vazoaktív gáz képződik: a nitrogénmonoxid (NO) és szénmonoxid (CO). Mindkét gázt különböző izoenzimek képzik, az NO szintázok és a CO-t a hem-oxigenáz (HO) izoenzimek. Az NO és CO fontos szerepet tölt be a normál vazodilátor tónus fenntartásában. Az NO enzimregulációval kapcsolatban számos adat található a szakirodalomban. Ezzel szemben a HO enzim szabályozás még kevésbé tanulmányozott terület. Kíséreteinkben in vivo és in vitro rendszereket alkalmaztunk. Kimutattuk, hogy a HO izoenzimek expresszióját az endogén ösztrogének szabályozzák. A HO enzim expresszió a kardiovaszkuláris szövetekben nagyobb nőstényekben, mint hímekben és ovariektomizált nőstényekben. Ugyanakkor a HO enzim expressziója függ a nemi ciklustól is: ösztrusz fázisban kifejezettebb, mint diösztruszban. Csökkent HO enzimexpresszió esetén megnövekszik a hajlam a vazokonstrikcióra, illetve a vaszkuláris endotélium diszfunkcióra. A HO és NO szintáz enzimrendszerek szinergistaként viselkednek a vaszkuláris integritás fenntartásában. Kiegészítő kísérleteinkben rámutattunk, hogy olyan gyulladásos folyamatokban, mint a kísérletes Crohn betegség a HO enzimrendszer aktivációja kulcsfontosságú szerepet tölt be a bél nyálkahártya védelmében. A Crohn betegség gyógyításában használatos 5-amino szalicilsav hatásmechanizmusában a HO rendszer aktivációjának is számottevő jelentősége van. | Two known endogenous vasoactive gases exist in the body: nitric oxide (NO) and carbon monoxide (CO). Both gases are synthesized by specific isoenzyme systems, i.e. by NO synthases and heme-oxygenase (HO) enzymes. Under physiological circumstances, NO and CO play crucial role in the maintenance of the normal vasodilator tone. There are numerous data in the literature in conjunction with the regulation of NO isoenzymes. In contrast less is known on HO enzyme regulatory pathways. We performed in vivo and in vitro studies. It was shown that the expression of HO isoenzymes is up-regulated by endogenous estrogens in cardiovascular tissues. An increased expression of HO isoenzymes was demonstrated in female rats compared to males and ovariectomized females. Moreover, we found an estrus cycle-dependent HO expression: in the estrus phase HO is overexpressed, while in the diestrus phase HO is down-regulated. The decreased expression of HO leads to augmented vasoconstrictive response, and suspectibility of vascular endothelial dysfuction. HO and NO isoenzymes are in synergistic interaction in the maintenance of microvascular integrity. In our additional experiments, we found that the activation of the HO enzyme system has important anti-inflammatory role in the development of colonic mucosal injury in a model of Crohn disease. Such known agent as 5-amino salicylic acid (used in the treatment of inflammatory bowel diseases) acts through the mediation of HO enzyme up-regulation

Az izolált septum pellucidum hiány praenatalis diagnosztikája ultrahang- és mágneses rezonancia képalkotó vizsgálattal

Összefoglaló. A septoopticus dysplasia, vagy más néven De Morsier-szindróma egy ritka, az agy középvonali képleteit érintő rendellenesség, mely a septum pellucidum hiányával, hypophysis-diszfunkcióval, látóideg-hypoplasiával és mentális visszamaradottsággal jár együtt. A septum pellucidum hiánya önmagában is előfordulhat izolált formában, de ennek septoopticus dysplasiától való praenatalis elkülönítése jelentős diagnosztikai kihívást jelent. Az izolált septum pellucidum hiány a kevés, rendelkezésünkre álló irodalmi adat alapján ártalmatlan anatómiai variáció. Esetbemutatásunkban a magas mágneses térerővel végzett magzati mágneses rezonancia (MR) képalkotó vizsgálat segítette az izolált septum pellucidum hiány septoopticus dysplasiától való elkülönítését azáltal, hogy lehetővé tette a látóidegek és a chiasma pontosabb megítélését, valamint az esetleges egyéb agyi rendellenességek kizárását. A szülés utáni kétéves követési periódus alatt a gyermek normális szomatomentális fejlődést mutatott mindennemű hormonális és vizuális eltérés nélkül. Esetbemutatásunk megerősíti, hogy a septum pellucidum izolált hiánya önmagában lehet egy tünetmentes anatómiai variáció, melynek praenatalis diagnosztikai algoritmusában a vizuális traktus és az agyszerkezet pontosabb megítélése kapcsán a magas mágneses térerővel végzett magzati MR-vizsgálat kulcsfontosságú szerepet játszik, és lehetőséget biztosíthat a septoopticus dysplasia praenatalis kizárására. Orv Hetil. 2020; 161(52): 2195-2200. Summary. Septo-optic dysplasia is characterized as a midline anomaly with agenesis of the septum pellucidum, optic nerve hypoplasia and pituitary dysfunction. The septal agenesis can occur in isolated form, but its prenatal differentiation from septo-optic dysplasia can be challenging. The isolated agenesis of septum pellucidum is an asymptomatic anatomical variation, based on the few literature data available. We report a case where prenatally performed high magnetic field magnetic resonance imaging helped the differential diagnosis by visualizing and assessing thickness of the optic nerves and chiasma. The development of the infant was followed for 24 months and showed no abnormalities. Our case report confirms that isolated agenesis of the septum pellucidum is probably an asymptomatic variation and the visualization of the optic nerves with high magnetic field fetal MRI could be a crucial point of the differential diagnosis and provide possibility to exclude septo-optic dysplasia in utero. Orv Hetil. 2020; 161(52): 2195-2200

A mánia a hangulat hipertóniája? Hasonlóságok és különbségek a bipoláris betegség és a hipertónia között

A possibly shared pathophysiological background between bipolar disorders and essential hypertension is suggested by the several similarities and overlaps between their genetic background, underlying biological disturbances (including partially shared neuroanatomical and neurochemical correlates), concomitant personality and temperamental characteristics, precipitating factors, comorbidity and treatment response. In this paper we outline and extend our previously published hypothesis discussing the similar origins of these two biphasic/bidirectional phenomena

The impact of currently recommended antihypertensive therapy on depression and other psychometric parameters: preliminary communication.

AIMS: Current evidence on the psychological effects of antihypertensive medications is controversial. The aim of this study was to evaluate the effect of current antihypertensive medication on different psychometric parameters and on serum brain-derived neurotrophic factor (BDNF) level. METHODS: Psychometric, haemodynamic, arterial stiffness and laboratory parameters were evaluated before and 3 months after the initiation of antihypertensive medication in untreated hypertensive patients (HT, n=31), and once in healthy controls (CONT, n=22). Subjects completed the following psychometric tests: Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A), Symptom Checklist 90 Revised (SCL-90), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Big Five Inventory, Pain Vigilance and Awareness Questionnaire and Berkeley Expressivity Questionnaire. Amlodipine and/or perindopril compounds were preferred medications. Serum BDNF was measured with ELISA. RESULTS: Brachial systolic blood pressure, as well as pulse wave velocity were significantly improved in the HT group over the 3-month follow-up (153.3+/-15.9 mmHg vs. 129.5+/-10.0 mmHg and 8.2+/-1.4 m/s vs 7.5+/-1.6 m/s, respectively). Similarly, we found improvements in BDI (0.73 points) and in several Scl-90 subscales. Serum BDNF was not different between CONT and HT and did not change for therapy. CONCLUSIONS: Our results indicate that initiation of currently recommended antihypertensive medications in newly diagnosed patients may have a significant impact on psychological well-being of patients and could influence quality of life as well

Measurement of Arterial Stiffness: A Novel Tool of Risk Stratification in Hypertension

Cardiovascular diseases are the leading causes of morbidity and mortality in industrialized countries worldwide, despite highly effective preventive treatments available. As a difference continues to exist between the estimated and true number of events, further improvement of risk stratification is an essential part of cardiovascular research.Among hypertensive patients measurement of arterial stiffness parameters, like carotid-femoral pulse wave velocity (cfPWV) or brachial-ankle pulse wave velocity (baPWV) can contribute to the identification of high-risk subpopulation of patients. This is a hot topic of vascular research including the possibility of the non-invasive measurement of central hemodynamics, wave reflections and recently, 24-h arterial stiffness monitoring as well. This chapter discusses the past and the present of this area including the scientific achievements with cfPWV, baPWV and other measures, provides a short overview of methodologies and the representation of arterial stiffness parameters in guidelines

Integrated Central Blood Pressure-aortic Stiffness Risk Categories and Cardiovascular Mortality in End-stage Renal Disease

BACKGROUND: Our aim was to study the predictive power of integrated central blood pressure-aortic stiffness (ICPS) risk categories on cardiovascular (CV) mortality in end-stage renal disease (ESRD) patients. METHODS: This is a secondary analysis of a prospective study of 91 ESRD patients on hemodialysis therapy. At baseline, pulse wave velocity (PWV), central systolic blood pressure (cSBP) and central pulse pressure (cPP) were measured and patients were followed up for CV mortality for a median 29.5 months. Based on the shape of the association of each individual ICPS parameter with the CV outcome, patients were assigned ICPS scores: one point was given, if either the cSBP value was in the 3rd, or if the PWV or cPP was in the 2nd or 3rd tertiles (ICPS range: 0–3). We then evaluated the role of ICPS risk categories (average: 0–1, high: 2, very high: 3 points) in the prediction of CV outcomes using Cox proportional hazard regression analysis and compared its discrimination (Harrell’s C) to that of each of its components. RESULTS: We found a strong dose–response association between ICPS risk categories and CV outcome (high risk HR = 2.62, 95% CI: 0.82–8.43, p for trend = 0.106; very high risk HR = 10.03, 95% CI: 1.67–60.42, p = 0.02) even after adjustment for multiple potential confounders. ICPS risk categories had a modest discrimination (C: 0.622, 95% CI: 0.525–0.719) that was significantly better than that of cSBP (dC: 0.061, 95% CI: 0.006–0.117). CONCLUSIONS: The ICPS risk categories may improve the identification of ESRD patients with high CV mortality risk