Prevalence and predictors of left ventricular hypertrophy in patients with hypertension and normal electrocardiogram

Background: Electrocardiography (ECG) has low sensitivity for detecting left ventricular hypertrophy (LVH), while echocardiography cannot be routinely performed. Design/methods: In this study we evaluate the prevalence of LVH and diastolic dysfunction in hypertensive patients with normal ECG. We excluded patients with cardiovascular (CV) diseases, diabetes, chronic kidney disease, or presenting ECG-LVH or other ECG anomalies. The enrolled 440 hypertensive patients underwent echocardiographic examination (Acuson Sequoia 512); LV mass was indexed by body surface area (LVMI) and LVH was defined as LVMI >125 g/m2 in men and >110 g/m2 in women. Diastolic function was evaluated by mitral inflow and tissue Doppler imaging (TDI). Results: The prevalence of LVH was 8.18% (95% confidence interval [CI] 5.97–11.1%). Multiple regression analysis showed that the only variable independently associated with LVH was duration of hypertension (p<0.001). The receiver operating characteristic (ROC) curve showed that duration of hypertension was a powerful predictor of LVH, with an area under the curve (AUC) of 0.878 and p<0.0001. Further, in patients with LVH the mean difference of LVMI from the cut-off value for LVH was 12.3 9.19 g/m2. Diastolic dysfunction, defined as early diastolic myocardial velocity (Em) <0.08 m/s, was detected only in 3.2% of patients. Conclusions: The prevalence of LVH among hypertensive patients with normal ECG, free of diabetes and of CV diseases is low; moreover, patients with echocardiographic LVH presented LVMI values that identified mild LVH. Few cases of impaired diastolic function were registered. We suggest that in hypertensive patients with such characteristics the echocardiographic examination should be reserved to those who present with higher duration of hypertension

MALIGNANT TUMOR-LIKE GAASTRIC LESION DUE TO CANDIDA ALBICANS IN A DIABETIC PATIENT TREATED WITH CYCLOSPORIN: A CASE REPORT AND REVIEW OF THE LITERATURE

The gastrointestinal tract of healthy individuals is colonized by hundreds of saprophytes and mycetes, especially in the candida species, are habitual ones. Under certain conditions, the fungal flora may overgrow, resulting in lesion of the digestive mucosa which rarely, can have a local diffusion and/or spread to the lympho-hematogenous system. Mycotic infections of the stomach can sometimes look like benign gastric ulcers. here, we present the case report of a woman, aged 64, who presented with type II diabetes mellitus and psoriasis, on chronic treatment with cyclosporin A and with endoscopic evidence of an ulcerated, vegetating gastric lesion secondary to Candida Albicans infection. Although strongly sugestive of malignancy, it completely healed after cyclosporin withdrawal and the administration of oral antifungal drugs

Serum levels of soluble CD30 in adult patients affected by atopic dermatitis and its relation to age, duration of disease and Scoring Atopic Dermatitis index.

The value of CD30 and the soluble circulating fragment of CD30 (sCD30) for atopic dermatitis (AD) remains unclear. In particular, little is known about the effects of age, duration of disease and Scoring Atopic Dermatitis index (SCORAD) on the levels of serum sCD30 in patients affected by AD. In the present study, we have analysed serum sCD30 levels of adult patients affected by AD. The study's population includes 18 non-smoking outpatients, with a diagnosis of AD. As a control group we studied 18 non-atopic subjects from laboratory staff, matched for sex and age. These subjects had no history of AD, urticaria or seasonal or perennial rhinitis or asthma, and had negative skin prick test to a panel of allergens. The sCD30 serum levels were clearly higher in patients affected by AD (14.2+/-9.0 IU/ml) than in healthy subjects (1.2+/-0.8 IU/ml) (p<0.001). No differences were observed between males and females affected by atopic dermatitis, regarding age, duration of disease and SCORAD. Significant correlations were found between serum levels of sCD30 levels and age (r=-0.55; 95% confidence interval (CI) for r (Fisher's z transformed)=-0.81 to -0.12; p=0.01), duration of the disease (months) (r=-0.64; 95% CI for r (Fisher's z transformed)=-0.85 to -0.24; p=0.004) and SCORAD (r=-0.74; 95% CI for r (Fisher's z transformed)=-0.89 to -0.42; p=0.004). As demonstrated by the close correlation with age, duration of disease and SCORAD, serum levels of sCD30 appear to be an additional marker for the follow-up of AD

Predicting efficacy and toxicity in the era of targeted therapy: focus on anti-EGFR and anti-VEGF molecules

The treatment of solid malignancies includes various target drugs, such as monoclonal antibodies and tyrosine kinase inhibitors, which exert their effect alone or in combination with chemotherapy. The main part of these molecules have a target on proteins of EGFR and VEGF pathways. The particular toxicity profile and the financial impact, deriving from the application of these agents in cancer treatment, prompted a lot of researches to define predictive factors of their efficacy. Various biomarker were identified among the components of the targeted pathways. However just few studies allowed to identify specific factors to predict the toxicity of these drugs. In this review EGFR and VEGF-related pathways are described, most relevant clinical findings about target therapy applications are exposed and the clinical impact of predictive factors of efficacy and toxicity are discussed

25-hydroxy vitamin D levels in healthy premenopausal women: Association with bone turnover markers and bone mineral density

BACKGROUND:Vitamin D deficiency is very common in elderly people while there are very few reports on its incidence, determinants and metabolic consequences in young subjects. RESULTS:In 608 young healthy premenopausal women participating in the BONTURNO study, levels of 25-hydroxyvitamin D [25(OH)D] below 20 ng/ml were found in almost a third of the women. Its levels were inversely (P<0.001) related with age and body mass index (BMI kg/m(2)) and directly with sunlight exposure during the summer time, and latitude: i.e. the higher the latitude over Italy, the higher the 25(OH)D level. In women on contraceptive pill the mean 25(OH)D level was significantly increased even when the data were adjusted for age, BMI and sun exposure. 25(OH)D levels, adjusted for age and BMI, were significantly and positively related with serum C-telopeptide of type 1 collagen, serum phosphate and spine bone mineral density (BMD) and negatively with serum PTH, serum magnesium, serum bone alkaline phosphatase (bone AP). CONCLUSION:Vitamin D deficiency is rather common in young otherwise healthy Italian women and particularly among those living in the Southern part of the country. The most close determinants of vitamin D deficiency were BMI and sunlight exposure. Vitamin D insufficiency is associated with low spine BMD and increased bone AP even in young individuals

RELATIONSHIP BETWEEN SERUM URIC ACID AND AORTIC STIFFNESS IN UNTREATED HYPERTENSIVE SUBJECTS

Recent studies have reported an association between serum uric acid (SUA) and reduced arterial elasticity. However, in these studies arterial elastic properties have been assessed chiefly by measuring brachial-ankle pulse wave velocity (PWV) or peripheral PWV and only sometimes by using aortic PWV. Moreover, the relationships between SUA and arterial stiffness have never been statistically adjusted for albuminuria. Furthermore, the studies exploring the influence of uric acid on aortic distensibility in subjects with arterial hypertension yielded conflicting results. The aim of our study was to evaluate the relationships between SUA and aortic stiffness in a group of essential hypertensive patients, attending our Hypertension Centre. We enrolled 222 untreated hypertensive patients (mean age: 44 ± 10 years; 60 % males), without cardiovascular complications and without severe renal insufficiency. In all subjects routine blood chemistry, including SUA determination (by uricase/peroxidase method) and albumin excretion rate (AER) assay were obtained. Moreover, measurement of carotid-femoral pulse wave velocity (c-f PWV), by an automatic computerised method (Complior) and 24-h ambulatory blood pressure (BP) monitoring were performed. Patients with c-f PWV > 12 m/sec (n = 44) showed SUA levels significantly higher than those with lower values of PWV (5.9 ± 1.2 vs 5.3 ± 1.1 m/sec; p = 0.002). This difference held after correction by ANCOVA for age, gender, mean arterial pressure (MAP), body mass index, and serum creatinine (p = 0.02), but not after further adjustment for AER. Univariate analysis of correlation disclosed a significant association of SUA with c-f PWV (r = 0.23; p = 0.001). This correlation lost statistical significance when AER was added in a multiple regression model including, as covariates, age, gender, MAP, serum creatinine, metabolic syndrome and SUA. The results of our study show that, in essential hypertensive subjects, a positive relationship between SUA and aortic stiffness exists This association may be mediated by endothelial dysfunction, as suggested by the loss of its statistical significance, after adjustment for albumin excretion rate

ASSOCIATION OF SERUM URIC ACID WITH AORTIC STIFFNESS IN UNTREATED HYPERTENSIVE SUBJECTS.

INTRODUCTION: Recent studies have reported an association between serum uric acid (SUA) and reduced arterial elasticity. However, in these studies arterial elastic properties have been assessed chiefly by measuring brachial-ankle pulse wave velocity (PWV) or peripheral PWV and only sometimes by using aortic PWV, that is considered the gold standard for measuring arterial stiffness. Moreover, the studies exploring the influence of SUA on aortic distensibility in subjects with arterial hypertension yielded conflicting results. AIM: The purpose of our study was to evaluate the relationships between SUA and aortic stiffness in a group of essential hypertensive patients. METHODS: We enrolled 222 untreated hypertensive subjects (mean age: 44 ± 10 years; 60 % males), free from cardiovascular complications and without severe renal insufficiency. In all subjects SUA determination and albumin excretion rate (AER) assay were obtained. Moreover, measurement of carotid-femoral pulse wave velocity (c-f PWV), by an automatic computerised method (Complior) was performed. RESULTS: Patients with c-f PWV [12 m/s (n = 44) showed SUA levels significantly higher than those with lower values of PWV (5.9 ± 1.2 vs 5.3 ± 1.1 m/s; p = 0.002). This difference held after correction by ANCOVA for various confounding factors (p = 0.02), but not after further adjustment for AER. Univariate analysis of correlation disclosed a significant association of SUA with c-f PWV (r = 0.23; p = 0.001). This correlation lost statistical significance when AER was added in a multiple regression model including, as covariates, age, gender, mean arterial pressure, serum creatinine, metabolic syndrome and SUA. CONCLUSIONS: The results of our study showed that, in hypertensive subjects, a positive relationship between SUA and aortic stiffness exists This association may be mediated by endothelial dysfunction, as suggested by the loss of its statistical significance, after adjustment for AER

Heat Shock Protein-60 and Risk for Cardiovascular Disease

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. There is growing evidence that molecular chaperones, many of which are heat shock proteins HSPs, are involved in CVD pathogenesis. In this review we focus on HSP60, the human mitochondrial chaperone that also displays extramitochondrial and extracellular functions. HSP60 is typically cytoprotective but a number of stress conditions determine its conversion to a potentially toxic molecule for cells and tissues. We present illustrative examples of specific subtypes of CVD where HSP60 is implicated in the initiation and/or progression of disease. The data not only indicate a pathogenic role for HSP60 but also its potential as a biomarker with applications for diagnosis, assessing prognosis and response to treatment, as well as for preventing and treating CVD

PREVALENCE OF DIASTOLIC DYSFUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND CHRONIC KIDNEY DISEASE

Introduction: In patients with arterial hypertension and chronic kidney disease (CKD), the prevalence of diastolic heart failure (HF-PEF) is probably very high. However, in these patients the diagnosis is difficult, especially because the signs and symptoms suggestive of HF-PEF are very common in CKD; in these cases the detection of left ventricular structural and functional alterations (as reported in the 2012 ESC guidelines on heart failure), assumes a decisive role for the diagnosis of HF-PEF. Aim: To evaluate the prevalence of patients with diastolic dysfunction according to ESC guidelines 2012 in a population of Hypertensive patients with CKD. Methods: We studied 466 hypertensive patients with mean age of 62.3 ± 12.6 years (M/F = 262/204) suffering from chronic kidney disease (stages 3-4-5 KDIGO), with a mean value of GFR equal to 26.8 ± 15.1 mL/min/1.73 m2. The criteria for exclusion from the study were: EF\50 %, other cardiovascular diseases that could cause heart failure. Were considered with diastolic dysfunction, all patients with a value of Em (evaluated with tissue Doppler imaging at lateral mitral annulus) less than 10 cm/s. Results: We found a value of Em \10 cm/s in 331/466 patients (71 %). In order to determine the role of CKD to explain the very high prevalence of diastolic dysfunction, we selected 160 hypertensive patients with overlapping features to the previous group with regard to age, sex, BMI, etc. In this population the prevalence of diastolic dysfunction was 43.7 %. Conclusions: Our findings demonstrate a very high prevalence of diastolic dysfunction in the studied population; it is possible to assume that a large proportion of these patients had HF-PEF or is at high risk for its development. The finding of a lower prevalence of diastolic dysfunction in a hypertensive population supports the hypothesis of a decisive role of CKD in determining diastolic dysfunction and HF-PEF

REPORT OF A CASE OF MALIGNANT TUMOR-LIKE GASTRIC LESION BY CANDIDA IN A DIABETIC TREATED WITH CYCLOSPORINE FOR PSORIASIS AND REVIEW OF THE LITERATURE

Mycotic infection of the alimentary canal are rare and usually involve the upper digestive tract. Mycetes, especially of Candida family, are habitual saprophytes in the digestive tract of healthy individuals. Under certain conditions, fungal flora may overgrowth, resulting in lesions of the digestive mucosa, which, rarely, might evolve to local diffusion and/or systemic lympho-hematogenous spreading. In the stomach, sometimes, mycotic infections may appear like benign gastric ulcers. we described a case of woman, aged 64, affected by psoriasis, in chronic treatment with cyclosporine and type 2 diabetes mellitus, a well-known immunosoppressive condition, with endoscopic evidence of ulcerated vegetating gastric lesion, strongly suggestive for malignancy, due to Candida albicans infection, and completely healed after cyclosporine withdrawal and administration of oral antifungal drugs