Norepinephrine Remains Increased in the Six-Minute Walking Test after Heart Transplantation

OBJECTIVE:

We sought to evaluate the neurohormonal activity in heart transplant recipients and compare it with that in heart failure patients and healthy subjects during rest and just after a 6-minute walking test.

INTRODUCTION:

Despite the improvements in quality of life and survival provided by heart transplantation, the neurohormonal profile is poorly described.

METHODS:

Twenty heart transplantation (18 men, 49±11 years and 8.5±3.3 years after transplantation), 11 heart failure (8 men, 43±10 years), and 7 healthy subjects (5 men 39±8 years) were included in this study. Blood samples were collected immediately before and during the last minute of the exercise.

RESULTS:

During rest, patients’ norepinephrine plasma level (659±225 pg/mL) was higher in heart transplant recipients (463±167 pg/mL) and heathy subjects (512±132), p<0.05. Heart transplant recipient’s norepinephrine plasma level was not different than that of healthy subjects. Just after the 6-minute walking test, the heart transplant recipient’s norepinephrine plasma level (1248±692 pg/mL) was not different from that of heart failure patients (1174±653 pg/mL). Both these groups had a higher level than healthy subjects had (545±95 pg/mL), p<0.05.

CONCLUSION:

Neurohormonal activity remains increased after the 6-minute walking test after heart transplantation.     

The effects of iron deficiency anemia on p wave duration and dispersion

OBJECTIVES:

The association between P wave dispersion and iron deficiency anemia has not been documented in the literature. In this study, we evaluated P wave dispersion in patients with iron deficiency anemia and the possible relationships between P wave dispersion and other echocardiographic parameters.

INTRODUCTION:

The iron status of an individual may play an important role in cardiovascular health. Anemia is an independent risk factor for adverse cardiovascular outcomes. P wave dispersion is a simple electrocardiographic marker that has a predictive value for the development of atrial fibrillation. Apart from cardiovascular diseases, several conditions, such as seasonal variation, alcohol intake and caffeine ingestion, have been demonstrated to affect P wave dispersion.

METHODS:

The study included 97 patients who had iron deficiency anemia and 50 healthy subjects. The cases were evaluated with a clinical examination and diagnostic tests that included 12‐lead electrocardiography and transthoracic echocardiography.

RESULTS:

Compared to the control group, patients with iron deficiency anemia showed significantly longer maximum P wave duration (Pmax) (91.1±18.0 vs. 85.8±6.7 msec, p = 0.054), P wave dispersion (PWD) (48.1±7.7 vs. 40.9±5.6 msec, p<0.001), mitral inflow deceleration time (DT) (197.5±27.9 vs. 178.8±8.9 msec, p<0.001) and isovolumetric relaxation time (IVRT) (93.3±9.2 vs. 77.4±8.2 msec, p<0.001); they also showed increased heart rate (85.7±16.1 vs. 69.0±4.4, p<0.001) and frequency of diastolic dysfunction (7 (7.2%) vs. 0). Correlation analysis revealed that PWD was significantly correlated with IVRT, DT, heart rate, the presence of anemia and hemoglobin level.

CONCLUSIONS:

Iron deficiency anemia may be associated with prolonged P wave duration and dispersion and impaired diastolic left ventricular filling.     

Effect of physiological overload on pregnancy in women with mitral regurgitation

OBJECTIVES:

to evaluate the structural and functional heart abnormalities in women with mitral regurgitation during pregnancy.

INTRODUCTION:

Women with mitral regurgitation progress well during pregnancy. However, the effects on the heart of the association between pregnancy and mitral regurgitation are not well established.

METHODS:

This is a case–control, longitudinal prospective study. Echocardiograms were performed in 18 women with mitral regurgitation at the 12th and 36th week of pregnancy and on the 45th day of the puerperium. Twelve age‐matched healthy and pregnant women were included as controls and underwent the same evaluation as the study group.

RESULTS:

Compared with controls, women with mitral regurgitation presented increased left cardiac chambers in all evaluations. Increasing left atrium during pregnancy occurred only in the mitral regurgitation group. At the end of the puerperium, women with mitral regurgitation showed persistent enlargement of the left atrium compared with the beginning of pregnancy (5.0 ± 1.1 cm vs 4.6 ± 0.9 cm; p<0.05). Reduced left ventricular relative wall thickness (0.13 ± 0.02 vs 0.16 ± 0.02; p<0.05) and an increased peak of afterload (278 ± 55 g/cm² vs 207 ± 28 g/cm²; p<0.05) was still observed on the 45th day after delivery in the mitral regurgitation group compared with controls.

CONCLUSIONS:

Pregnancy causes unfavorable structural alterations in women with mitral regurgitation that are associated with an aggravation of the hemodynamic overload.     

Impaired hemodynamic response to mental stress in subjects with prehypertension is improved after a single bout of maximal dynamic exercise

INTRODUCTION:

High blood pressure during mental stress in subjects with prehypertension is associated with blunted vasodilation in skeletal muscles, which might be improved by an acute bout of exercise.

OBJECTIVE:

To investigate the hemodynamic responses to mental stress before and after a bout of exercise in subjects with prehypertension.

METHOD:

Eighteen subjects with prehypertension and 16 with normotension underwent a mental stress test before and after a maximal cardiopulmonary exercise test on a treadmill. Blood pressure was measured by auscultation, and forearm blood flow was measured by venous occlusion plethysmography; from these measurements, the vascular conductance was calculated.

RESULTS:

Subjects with prehypertension had a higher mean blood pressure during mental stress (prehypertension 112±2 vs. normotension 101±3 mm Hg, p<0.05), and their vascular conductance did not increase (baseline 0.025±0.004 vs. mental stress 0.022±0.003 a.u., p>0.05). After the exercise bout, the mean blood pressure during mental stress was lower in subjects with prehypertension (before exercise 112±2 vs. after exercise 107±2 mm Hg, p<0.05), and vascular conductance increased (baseline 0.011±0.001 vs. mental stress 0.024±0.004 a.u., p<0.05).

CONCLUSION:

Subjects with prehypertension had elevated blood pressure and a blunted vasodilator response during mental stress, but their blood pressure was attenuated and their vasodilator response was normalized after a single bout of maximal dynamic exercise.     

Nutritional and metabolic status of HIV-positive patients with lipodystrophy during one year of follow-up

OBJECTIVES:

The aim of this prospective study was to compare changes in lipid metabolism and nutritional status after either 6 and 12 months of follow-up in subjects with lipodystrophy syndrome after traditional lifestyle therapy with or without fibric acid analogue intervention (bezafibrate and clofibrate).

METHODS:

Food intake, alterations in body composition and metabolic abnormalities were assessed in subjects with lipodystrophy syndrome at the beginning of the study. The nutritional status and metabolic alterations of the subjects were monitored, and the subjects received nutritional counseling each time they were seen. The subjects were monitored either two times over a period no longer than six months (Group A; n  =  18) or three times over a period of at least 12 months (Group B; n  =  35). All of the subjects underwent nutrition counseling that was based on behavior modification. The fibric acid analogue was only given to patients with serum triglyceride levels above 400 mg/dL.

RESULTS:

After six months of follow-up, Group A showed no alterations in the experimental parameters. After twelve months, there was a decrease in serum triglyceride levels (410.4 ± 235.5 vs. 307.7 ± 150.5 mg/dL, p< 0.05) and an increase in both HDLc levels (37.9 ± 36.6 vs. 44.9 ± 27.9 mg/dL, p<0.05) and lean mass (79.9 ± 7.8 vs. 80.3 ± 9.9 %, p< 0.05) in Group B.

CONCLUSION:

After one year of follow-up (three sessions of nutritional and medical counseling), the metabolic parameters of the subjects with lipodystrophy improved after traditional lifestyle therapy with or without fibric acid analogue intervention.     

Noninvasive measurement of cardiac performance in recovery from exercise in heart failure patients

OBJECTIVE:

To examine the association between cardiac performance during recovery and the severity of heart failure, as determined by clinical and cardiopulmonary exercise test responses.

METHODS:

As part of a retrospective cohort study, 46 heart failure patients and 13 normal subjects underwent cardiopulmonary exercise testing while cardiac output was measured using a noninvasive device. Cardiac output in recovery was expressed as the slope of a single exponential relationship between cardiac output and time; the recovery-time constant was assessed in relation to indices of cardiac function, along with clinical, functional, and cardiopulmonary exercise responses.

RESULTS:

The recovery time constant was delayed in patients with heart failure compared with normal subjects (296.7±238 vs. 110.1±27 seconds, p <0.01), and the slope of the decline of cardiac output in recovery was steeper in normal subjects compared with heart failure patients (p<0.001). The slope of the decline in cardiac output recovery was inversely related to peak VO₂ (r = -0.72, p<0.001) and directly related to the VE/VCO₂ slope (r = 0.57, p<0.001). Heart failure patients with abnormal recovery time constants had lower peak VO₂, lower VO₂ at the ventilatory threshold, lower peak cardiac output, and a heightened VE/VCO₂ slope during exercise.

CONCLUSIONS:

Impaired cardiac output recovery kinetics can identify heart failure patients with more severe disease, lower exercise capacity, and inefficient ventilation. Estimating cardiac output in recovery from exercise may provide added insight into the cardiovascular status of patients with heart failure.     

Trends in ischemic heart disease and stroke death ratios in brazilian women and men

OBJECTIVE:

Cardiovascular diseases are the main cause of death in women and men in Brazil, but the trends for the death ratios for ischemic heart disease and stroke in women and men remain unknown.

METHOD:

In this study, the trends for the death ratios among women and men who were over 30 years of age were analyzed from 1980 to 2005. Data were collected for both the Brazilian population and the metropolitan area of São Paulo. Estimates of the population size and data for mortality were then obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. The risk for death was adjusted using a direct method.

RESULTS:

Death rates due to cardiovascular disease, ischemic heart disease, and stroke have declined in both Brazil and the metropolitan region of São Paulo. A linear regression analysis revealed a similar trend for ischemic heart disease and demonstrated a male/female ratio of 1.653 ± 0.001 (r = 0.228; p = 0.262) in Brazil and 1.763 ± 0.008 (r = 0.863; p<0.001) in São Paulo. Comparisons between the slopes of the linear regressions showed an increased ischemic heart disease ratio in men/women in São Paulo in comparison to those in Brazil (p<0.0001). The linear regression showed an increasing trend for the male/female stroke ratio of 1.252 ± 0.004 (r = 0.776; p<0.0001) in Brazil and 1.331 ± 0.006 (r = 0.580; p = 0.002) in São Paulo. Comparisons between the regressions for the stroke ratio were similar for men/women in São Paulo compared to Brazil (p = 0.244).

CONCLUSION:

We observed an increased trend in the ratio for ischemic heart disease death in men compared to women. Improvements in the control of risk factors and treatments for both men and women are mandatory to reduce the number of ischemic heart disease‐related deaths in Brazil.     

Nutritional Status is Related to Fat-Free Mass, Exercise Capacity and Inspiratory Strength in Severe Chronic Obstructive Pulmonary Disease Patients

INTRODUCTION:

Being overweight or obese is associated with a higher rate of survival in patients with advanced chronic obstructive pulmonary disease (COPD). This paradoxical relationship indicates that the influence of nutritional status on functional parameters should be further investigated.

OBJECTIVE:

To investigate the impact of nutritional status on body composition, exercise capacity and respiratory muscle strength in severe chronic obstructive pulmonary disease patients.

METHODS:

Thirty-two patients (nine women) were divided into three groups according to their body mass indices (BMI): overweight/obese (25 ≤ BMI ≤ 34.9 kg/m², n=8), normal weight (18.5 ≤ BMI ≤ 24.9 kg/m², n=17) and underweight (BMI <18.5 kg/m², n=7). Spirometry, bioelectrical impedance, a six-minute walking distance test and maximal inspiratory and expiratory pressures were assessed.

RESULTS:

Airway obstruction was similar among the groups (p=0.30); however, overweight/obese patients had a higher fat-free mass (FFM) index [FFMI=FFM/body weight² (mean±SEM: 17±0.3 vs. 15±0.3 vs. 14±0.5 m/kg², p<0.01)], exercise capacity (90±8 vs. 79±6 vs. 57±8 m, p=0.02) and maximal inspiratory pressure (63±7 vs. 57±5 vs. 35±8 % predicted, p=0.03) in comparison to normal weight and underweight patients, respectively. In addition, on backward multiple regression analysis, FFMI was the unique independent predictor of exercise capacity (partial r=0.52, p<0.01).

CONCLUSIONS:

Severe chronic obstructive pulmonary disease (COPD) patients who were overweight or obese had a greater FFM, exercise capacity and inspiratory muscle strength than patients with the same degree of airflow obstruction who were of normal weight or underweight, and higher FFM was independently associated with higher exercise capacity. These characteristics of overweight or obese patients might counteract the drawbacks of excess weight and lead to an improved prognosis in COPD.     

Relationship between depression and apolipoproteins A and B: a case-control study

OBJECTIVE:

To investigate the relation between major depressive disorder and metabolic risk factors of coronary heart disease.

INTRODUCTION:

Little evidence is available indicating a relationship between major depressive disorder and metabolic risk factors of coronary heart disease such as lipoprotein and apolipoprotein.

METHODS:

This case–control study included 153 patients with major depressive disorder who fulfilled the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV), and 147 healthy individuals. All participants completed a demographic questionnaire and Hamilton rating scale for depression. Anthropometric characteristics were recorded. Blood samples were taken and total cholesterol, high‐ and low‐density lipoproteins and apolipoproteins A and B were measured. To analyze the data, t‐test, χ² test, Pearson correlation test and linear regression were applied.

RESULTS:

Depression was a negative predictor of apolipoprotein A (β = −0.328, p<0.01) and positive predictor of apolipoprotein B (β = 0.290, p<0.05). Apolipoprotein A was inversely predicted by total cholesterol (β = −0.269, p<0.05) and positively predicted by high‐density lipoprotein (β = 0.401, p<0.01). Also, low‐density lipoprotein was a predictor of apolipoprotein B (β = 0.340, p<0.01). The severity of depression was correlated with the increment in serum apolipoprotein B levels and the decrement in serum apolipoprotein A level.

CONCLUSION:

In view of the relationship between apolipoproteins A and B and depression, it would seem that screening of these metabolic risk factors besides psychological interventions is necessary in depressed patients.     

Memantine Prevents Cardiomyocytes Nuclear Size Reduction in the Left Ventricle of Rats Exposed to Cold Stress

OBJECTIVES

Memantine is an N-methyl-d-aspartate (NMDA) glutamate receptor antagonist used to treat Alzheimer’s disease. Previous studies have suggested that receptor blockers act as neuroprotective agents; however, no study has specifically investigated the impact that these drugs have on the heart. We sought to evaluate the effects of memantine on nuclear size reduction in cardiac cells exposed to cold stress.

METHOD

We used male EPM-Wistar rats (n=40) divided into 4 groups: 1) Matched control (CON); 2) Memantine-treated rats (MEM); 3) Rats undergoing induced hypothermia (IH) and 4) Rats undergoing induced hypothermia that were also treated with memantine (IHM). Animals in the MEM and IHM groups were treated by oral gavage administration of 20 mg/kg/day memantine over an eight-day period. Animals in the IH and IHM groups were submitted to 4 hours of hypothermia in a controlled environment with a temperature of − 8°C on the last day of the study.

RESULTS

The MEM group had the largest cardiomyocyte nuclear size (151 ± 3.5 μm³ vs. CON: 142 ± 2.3 μm³; p<0.05), while the IH group had the smallest mean value of nuclear size. The nuclear size of the IHM group was preserved (125 ± 2.9 μm³) compared to the IH group (108 ± 1.7 μm³; p<0.05).

CONCLUSION

Memantine prevented the nuclear size reduction of cardiomyocytes in rats exposed to cold stress.     

The Association between Plasma D-dimer Levels and Community-Acquired Pneumonia

BACKGROUND:

Plasma D-dimer levels are directly related to the intra- and extra-vascular coagulation that occurs in acute and chronic lung damage in patients with community-acquired pneumonia (CAP).

OBJECTIVES:

This study examines the relationship between the severity of community-acquired pneumonia and D-dimer levels. In addition, the study examines the correlations among community-acquired pneumonia, the radiological extent of the disease and mortality.

METHODS:

The Pneumonia Severity Index was used to classify patients into five groups. Patients were treated at home or in the hospital according to the guidelines for community-acquired pneumonia. Blood samples were taken from the antecubital vein with an injector and placed into citrated tubes. After they were centrifuged, the samples were evaluated with the quantitative latex method.

RESULTS:

The study included 60 patients who had been diagnosed with community-acquired pneumonia (mean age 62.5 ± 11.7) and 24 healthy controls (mean age 59.63 ± 6.63). The average plasma D-dimer levels were 337.3 ± 195.1ng/mL in the outpatient treatment group, 691.0 ± 180.5 in the inpatient treatment group, 1363.2 ± 331.5 ng/mLin the intensive care treatment group and 161.3 ± 38.1ng/mL in the control group (p<0.001). The mean D-dimer plasma level was 776.1 ± 473.5ng/mL in patients with an accompanying disease and 494.2 ± 280.1 ng/mL in patients without an accompanying disease (p<0.05).

CONCLUSIONS:

Plasma D-dimer levels were increased even in community-acquired pneumonia patients who did not have an accompanying disease that would normally cause such an increase.     

Longitudinal study of Cystatin C in healthy term newborns

OBJECTIVE:

The purpose of this study was to determine the levels of Cystatin C in healthy term newborns in the first month of life.

INTRODUCTION:

Cystatin C may be a suitable marker for determining the glomerular filtration rate because it is not affected by maternal renal function.

METHODS:

Cohort study. Inclusion: term newborns with appropriate weight; mother without renal failure or drugs that could affect fetal glomerular filtration rate. Exclusion: malformations; hypertension or any condition that could affect glomerular filtration rate. Cystatin C (mg/L) and creatinine (mg/dl) were determined in the mother (Mo) and in the newborn at birth (Day‐0), 3^rd (Day‐3), 7^th(Day‐7) and 28^th(Day‐28) days. Statistics: one way ANOVA and Pearson''s correlation tests. Sample size of 20 subjects for α  =  5% and a power test  =  80% (p<0.05).

RESULTS:

Data from 21 newborns were obtained (mean ± standard deviation): MoCystatin C = 1.00±0.20; Day‐0 Cystatin C 1.70±0.26; Day‐3 Cystatin C = 1.51±0.20; Day‐7 Cystatin C = 1.54±0.10; Day‐28 Cystatin C = 1.51±0.10.MoCystatin C was smaller than Day‐0 Cystatin C (p<0.001), while MoCreatinine was not different from Day‐0 Creatinine. Cystatin C only decreased from Day‐0 to Day‐3 (p = 0.004) but newborns Creatinine decreased along the time. Correlations were obtained between MoCystatin C and MoCreatinine (p = 0.012), as well as Day‐3 (p = 0.047) and Day‐28 (p = 0.022) Cystatin C and Creatinine values.

CONCLUSION:

Neonatal Cystatin C values were not affected by MoCystatin C and became stable from the 3^rd day of life.     

Influence of preoperative serum N-terminal pro-brain type natriuretic peptide on the postoperative outcome and survival rates of coronary artery bypass patients

BACKGROUND:

The N-terminal fragment of pro-brain type natriuretic peptide (NT-proBNP) is an established biomarker for cardiac failure.

OBJECTIVE:

To determine the influence of preoperative serum NT-proBNP on postoperative outcome and mid-term survival in patients undergoing coronary artery bypass grafting (CABG).

METHODS:

In 819 patients undergoing isolated CABG surgery preoperative serum NT-proBNP levels were measured. NT-proBNP was correlated with various postoperative outcome parameters and survival rate after a median follow-up time of 18 (0.5–44) months. Risk factors of mortality were identified using χ², Mann–Whitney test, and Cox regression.

RESULTS:

NT-proBNP levels >430 ng/ml and >502 ng/ml predicted hospital and overall mortality (p<0.05), with an incidence of 1.6% and 4%, respectively. Kaplan–Meier analysis revealed decreased survival rates in patients with NT-proBNP >502 ng/ml (p = 0.001). Age, preoperative serum creatinine, diabetes, chronic obstructive pulmonary disease, low left ventricular ejection fraction and BNP levels >502 ng/ml were isolated as risk factors for overall mortality. Multivariate Cox regression analysis, including the known factors influencing NT-proBNP levels, identified NT-proBNP as an independent risk factor for mortality (OR = 3.079 (CI = 1.149-8.247), p = 0.025). Preoperative NT-proBNP levels >502 ng/ml were associated with increased ventilation time (p = 0.005), longer intensive care unit stay (p = 0.001), higher incidence of postoperative hemofiltration (p = 0.001), use of intra-aortic balloon pump (p<0.001), and postoperative atrial fibrillation (p = 0.031)

CONCLUSION:

Preoperative NT-proBNP levels >502 ng/ml predict mid-term mortality after isolated CABG and are associated with significantly higher hospital mortality and perioperative complications.     

Acute effect of phosphodiesterase type 5 inhibitor on serum oxidative status and prolidase activities in men with erectile dysfunction

OBJECTIVES:

To investigate the acute effect of phosphodiesterase type 5 (PDE5) inhibitor on erectile dysfunction by evaluating serum oxidative status and prolidase activity.

METHODS:

Serum samples of 36 patients with erectile dysfunction and 30 control cases were analyzed for total antioxidant status, total oxidant status, and prolidase activity, before and after the administration of tadalafil citrate.

RESULTS:

Before and after tadalafil citrate administration, serum total antioxidant status, total oxidant status, and prolidase were 1.1±0.0 vs. 1.6±0.0 µmol H₂O₂ Eq/L, 10.3±1.1 vs. 6.9±1.2 µmol H₂O₂ Eq/L, and 236.4±19.5 vs. 228.2±19.2 U/L, respectively (p<0.0001 for all).

CONCLUSIONS:

Evaluation of serum oxidative status and prolidase activity confirmed the beneficial acute effects of PDE5 inhibitor in patients with erectile dysfunction.     

Protective effect of sildenafil citrate on contralateral testis injury after unilateral testicular torsion/detorsion

OBJECTIVES:

This study was designed to investigate prevention of contralateral testicular injury with sildenafil citrate after unilateral testicular torsion/detorsion.

METHODS:

Thirty‐seven adult male rats were divided into four groups: sham operated (group 1, n  =  7), torsion/detorsion + saline (group 2, n  =  10), torsion/detorsion + 0.7 mg of sildenafil citrate (group 3, n  =  10) and torsion/detorsion + 1.4 mg of sildenafil citrate (group 4, n  =  10). Unilateral testicular torsion was created by rotating the right testis 720° in a clockwise direction for 2 h in other groups, except for group 1, which was served as sham group. After torsion (2 h) and detorsion (2 h) periods, rats were killed.

RESULTS:

The level of reduced glutathion (GSH) (p<0.05) and the activities of catalase (p<0.01) and glutathione peroxidase (p<0.05) in the contralateral testis from group 2 were significantly lower and nitric oxide (NO) (p<0.05) level in the contralateral testis were significantly higher than those of group 1. Administration of low‐dose sildenafil citrate (group 3) prevented the increases in malondialdehyde and NO levels and decreases in glutathione peroxidase activities and GSH values induced by testicular torsion. However, administration of high‐dose sildenafil citrate (group 4) had no effect on these testicular parameters (p>0.05). Histopathological changes were detected in groups 2, 3 and 4.

CONCLUSION:

These results suggest that biochemically and histologically torsion/detorsion injury occurs in the contralateral testis following 2‐h torsion and 2‐h detorsion and that administration of low‐dose sildenafil citrate before detorsion prevents ischemia/reperfusion cellular damage in testicular tissue.     

Sleep in Infants with Congenital Heart Disease

OBJECTIVES:

To investigate hypoxia and sleep disordered breathing in infants with congenital heart disease.

METHODS:

Prospective study. In-hospital full polysomnography was performed on 14 infants with congenital heart disease, age 7 ±1 months, and in 7 normal infants, age 10 ±2 months. Congenital heart disease infants were classified as acyanotic (n=7) or cyanotic (n=7).

RESULTS:

Nutritional status, assessed by the Gomez classification and expressed as % weight for age, was 70 ±7, 59 ±11 and 94 ±16 in the acyanotic, cyanotic congenital heart disease and control infants, respectively (p<0.001). The respiratory disturbance index (AHI, events per hour) was [median (25–75%)]: 2.5 (1.0–3.4), 2.4 (1.5–3.1) and 0.7 (0.7–0.9) in acyanotic, cyanotic CHD infants and controls, respectively (p=0.013). Almost all congenital heart disease infants (11 out of 14) and only one control infant had an AHI >1 event/hour. The minimum oxygen saturation was 79% (74–82), 73% (57–74) and 90% (90–91) in the acyanotic, cyanotic congenital heart disease infants and controls, respectively (p <0.001). The arousal index (events/hour) was similar among the three groups at 8.4 ±2.4, 10.3 ±8.7 and 6.5 ±3, respectively (p=0.451).

CONCLUSIONS:

Infants with congenital heart disease frequently present with sleep-disordered breathing associated with oxygen desaturations but not arousals. Therefore, sleep may represent a significant burden to infants with congenital heart disease.     

Outcome of children hospitalized with community-acquired pneumonia treated with aqueous penicillin G

OBJECTIVE:

To describe the evolution and outcome of children hospitalized with community‐acquired pneumonia receiving penicillin .

METHODS:

A search was carried out for all hospitalized community‐acquired pneumonia cases in a 37‐month period. Inclusion criteria comprised age ≥2 months, intravenous penicillin G use at 200,000 IU/kg/day for ≥48 h and chest x‐ray results. Confounders leading to exclusion included underlying debilitating or chronic pulmonary illnesses, nosocomial pneumonia or transference to another hospital. Pneumonia was confirmed if a pulmonary infiltrate or pleural effusion was described by an independent radiologist blind to the clinical information. Data on admission and evolution were entered on a standardized form.

RESULTS:

Of 154 studied cases, 123 (80%) and 40 (26%) had pulmonary infiltrate or pleural effusion, respectively. Penicilli was substituted by other antibiotics in 28 (18%) patients, in whom the sole significant decrease was in the frequency of tachypnea from the first to the second day of treatment (86% vs. 50%, p = 0.008). Among patients treated exclusively with penicillin G, fever (46% vs. 26%, p = 0.002), tachypnea (74% vs. 59%, p = 0.003), chest indrawing (29% vs. 13%, p<0.001) and nasal flaring (10% vs. 1.6%, p = 0.001) frequencies significantly decreased from admission to the first day of treatment. Patients treated with other antimicrobial agents stayed longer in the hospital than those treated solely with penicillin G (16±6 vs. 8±4 days, p<0.001, mean difference (95% confidence interval) 8 (6–10)). None of the studied patients died.

CONCLUSION:

Penicillin G successfully treated 82% (126/154) of the study group and improvement was marked on the first day of treatment.     

Clinical characteristics and risk factors for peripartum cardiomyopathy

Background

Peripartum cardiomyopathy (PPCM) is a potentially fatal form of heart failure and the recognition of its risk factors is important for prevention and treatment.

Objective

To explore the clinical characteristics and the risk factors for PPCM.

Methods

Echocardiographic was used to examine the left ventricular ejection fraction (LVEF). Blood level of troponin I (cTNI), high sensitive C-reaction protein (hs-CRP), NT-proBNP was measured. All PPCM occurred within weeks following delivery.

Results

Fifty-two PPCM patients and 52 normal delivery subjects (control group) were included in this study. Compared with the control group, PPCM patients were older, with a higher level of blood pressure, and a higher rate of suspected respiratory infection. The level of leucocytes, hs-CRP, cTNI and NT-proBNP in PPCM patients were higher than in the control. Multivariate logistic regression analysis showed that elevated plasma hs-CRP (OR =1.86, p<0.05), respiratory infection (OR = 2.87, p<0.01), and hypertension (OR =1.68, p < 0.05) were independent risk factors for PPCM. During the follow up of 21.6±5.4 d, one patient (1.9%) died probably of heart failure but other patients remained well.

Conclusion

Hypertension, respiratory infection, and elevated plasma hs-CRP seem to be associated with the pathogenesis of peripartum cardiomyopathy in this patient population.     

Taiwanese female vegetarians have lower lipoprotein-associated phospholipase A2 compared with omnivores

Purpose

Many studies supported that vegetarians have a lower risk of cardiac diseases and mortality, partly due to better blood pressure and serum cholesterol profiles. However, the inflammatory markers, especially lipoprotein-associated phospholipase A2 (Lp-PLA2), have not been well-studied. This study aimed to compare inflammatory markers and conventional risk factors between vegetarians and omnivores.

Materials and Methods

One hundred and seventy-three vegetarians and 190 omnivores were studied. Fasting blood samples were obtained to compare levels of glucose, total cholesterol, triacylglycerol, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, homocysteine, Lp-PLA2 activity, and high-sensitivity C-reactive protein (hs-CRP).

Results

Vegetarians had higher serum levels of the following markers: hs-CRP (1.8 ± 3.4 vs. 1.2 1.8 mg/L, respectively; p = 0.05), homocysteine (9.39 ± 3.22 vs. 7.62 ± 2.41 µmol/L, respectively; p < 0.01), and triacylglycerol (96.91 ± 59.56 vs. 84.66 ± 43.24 mg/dL, respectively; p < 0.05). Vegetarians also had lower levels of Lp-PLA2 (18.32 ± 7.19 10-3 µmol/min/mL vs. 20.22 8.13 10-3 µmol/min/mL; p < 0.05), total cholesterol (180.62 ± 36.55 mg/dL vs. 192.73 ± 36.57 mg/dL; p < 0.01), LDL cholesterol (118.15 ± 32.8 vs. 126.41 ± 34.28 mg/dL; p < 0.05), and HDL cholesterol (55.59 ± 13.30 vs. 62.09 ± 14.52 mg/dL, p < 0.01). Multivariate analyses demonstrated that a vegetarian diet increases the chances for high serum hs-CRP and low Lp-PLA2 activity.

Conclusion

In addition to lower total cholesterol, LDL-cholesterol, and HDL-cholesterol, Taiwanese female vegetarians have lower serum Lp-PLA2 activity but higher levels of hs-CRP, homocysteine, and triacylglyerol. It might be due to geographic differences of vegetarian diets, and further studies are needed.     

Pulse Oximetry Wave Variation as a Noninvasive Tool to Assess Volume Status in Cardiac Surgery

OBJECTIVE:

To compare variations of plethysmographic wave amplitude (ΔPpleth) and to determine the percent difference between inspiratory and expiratory pulse pressure (ΔPp) cutoff values for volume responsiveness in a homogenous population of postoperative cardiac surgery patients.

INTRODUCTION:

Intra-thoracic pressure variations interfere with stroke volume variation. Pulse pressure variations through arterial lines during mechanical ventilation have been recommended for the estimation of fluid responsiveness. Pulse oximetry may offer a non-invasive plethysmographic method to evaluate pulse pressure; this may be useful for guiding fluid replacement.

METHODS:

Controlled, prospective study in cardiac surgery patients under controlled ventilation. Simultaneous digital recordings of arterial pressure and plethysmographic waves were performed. ΔPp, systolic pressure (ΔPs), ΔPpleth, and systolic component (ΔSpleth) were calculated. A ΔPp ≥ 13% identified fluid-responsive patients. Volume expansion was performed in responsive subjects. Systolic and amplitude components of pressure and plethysmographic waves were compared.

RESULTS:

In 50 measurements from 43 patients, ΔPp was correlated with (Ppleth (r=0.90, p<0.001), (Ps (r=0.90, p<0.001), and (Spleth (r=0.73, p<0.001). An aArea under ROC curve (AUC) identified the fluid responsiveness thresholds: (Ppleth of 11% (AUC = 0.95±0.04), (Ps of 8% (AUC=0.93±0.05), and (Spleth of 32% (AUC=0.82±0.07). A (Ppleth value ≥ 11% predicted (Pp ≥ 13% with 100% specificity and 91% sensitivity. Volume expansion, performed in 20 patients, changed (Pp, (Ppleth, (Ps and (Spleth significantly (p<0.008).

CONCLUSIONS:

ΔPpleth is well correlated with ΔPp and constitutes a simple and non-invasive method for assessing fluid responsiveness in patients following cardiac surgery.