Left Ventricular Diastolic Function in Essential Hypertensive Patients: Influence of Age and Left Ventricular Geometry

PURPOSE - To evaluate diastolic dysfunction (DD) in essential hypertension and the influence of age and cardiac geometry on this parameter. METHODS - Four hundred sixty essential hypertensive patients (HT) underwent Doppler echocardiography to obtain E/A wave ratio (E/A), atrial deceleration time (ADT), and isovolumetric relaxation time (IRT). All patients were grouped according to cardiac geometric patterns (NG - normal geometry; CR - concentric remodeling; CH- concentric hypertrophy; EH - eccentric hypertrophy) and to age (<40; 40 - 60; >60 years). One hundred six normotensives (NT) persons were also evaluated. RESULTS - A worsening of diastolic function in the HT compared with the NT, including HT with NG (E/A: NT - 1.38±0.03 vs HT - 1.27±0.02, p<0.01), was observed. A higher prevalence of DD occurred parallel to age and cardiac geometry also in the prehypertrophic groups (CR). Multiple regression analysis identified age as the most important predictor of DD (r²=0.30, p<0.01). CONCLUSION - DD was prevalent in this hypertensive population, being highly affected by age and less by heart structural parameters. DD is observed in incipient stages of hypertensive heart disease, and thus its early detection may help in the risk stratification of hypertensive patients

Visceral Leishmaniasis in Renal Transplant Recipients: Epidemiological, Clinical, Diagnostic and Therapeutic Aspects. Expertise From 30 Cases

Univ Fed Sao Paulo, Div Nephrol, Sao Paulo, BrazilHosp Alianca Casamater, Renal Transplant Unit, Piau, BrazilUniv Fed Piaui, Gen Clin Dept, Div Nephrol, Teresina, BrazilUniv Fed Sao Paulo, Div Nephrol, Sao Paulo, BrazilWeb of Scienc

The Risk Factors for and Effects of Visceral Leishmaniasis in Graft and Renal Transplant Recipients

Background. the aim of this study was to identify the risk factors for visceral leishmaniasis (VL) in renal transplant recipients and to analyze the impacts of this disease on graft success and patient health.Methods. This retrospective, case-control study examined 120 renal transplant patients in a VL endemic area. the treatment group included patients (n=20) who developed VL after transplantation, and the control group (n=100) was composed of renal transplant recipients without VL. This study evaluated socioeconomic, demographic, clinical, and laboratory variables. Bivariate analysis and multiple logistic regressions were performed to identify potential risk factors.Results. the average time between transplantation and Leishmania infection in the treatment group was 29.4 months. Seventeen (85%) patients were cured and 3 (15%) died. in 95% of the cases, a myelogram was used for initial identification of Leishmania forms. the significant risk factors for VL in renal transplant recipients were cytomegalovirus infection after transplantation (odds ratio [OR], 5.29; 95% confidence interval [CI], 1.27-21.97) and living with cats (OR, 5.74; 95% CI, 1.15-28.76). Bacterial infection after transplantation (OR, 3.00; 95% CI, 0.96-9.37) and unpaved streets in the neighborhood (OR, 2.14; 95% CI, 0.71-6.43) tended to increase the risk of VL, whereas a negative Rh factor tended to protect against VL (OR, 0.26; 95% CI, 0.06-1.02).Conclusion. Cytomegalovirus infection after transplantation and living with cats increased the risk of VL in renal transplant recipients living in VL endemic areas.Kidney Transplant Units of the Federal University of São PauloFederal University of CearaGeneral Hospital of FortalezaFederal University of PiauiUniversidade Federal de São Paulo, Div Nephrol, São Paulo, BrazilHosp Alianca Casamater, Renal Transplant Unit, Piaui, BrazilUniv Fed Piaui, Gen Clin Dept, Div Nephrol, Teresina City, Piaui, BrazilHosp Israelita Albert Einstein, Renal Transplant Unit, São Paulo, BrazilHosp Geral Fortaleza, Renal Transplant Unit, Fortaleza, Ceara, BrazilUniv Fed Ceara, Div Nephrol, Barbalha, Ceara, BrazilUniv Fed Ceara, Div Nephrol, Renal Transplant Serv, Dr Joaquim Bezerra Unit,Sch Med, Crato, Ceara, BrazilUniv Fed Piaui, Infect Dis Hosp Dr Natan Portela, Teresina City, Piaui, BrazilUniversidade Federal de São Paulo, Div Nephrol, São Paulo, BrazilWeb of Scienc