Effect of an individualized physical training program on resting cortisol and growth hormone levels and fat oxidation during exercise in obese children

Objectives

The aim of this study was to characterize the resting levels of cortisol and growth hormone (GH), and the substrate profile during exercise of obese children before and after an individualized training program.

Patients and methods

Twenty-two obese children (13.1 ± 0.8 yrs) were included in the study. Twelve individuals (six boys and six girls; 31.1 ± 1.1 kg/m², VO_2peak = 1.92 ± 0.16 l/min) participated in a two-month endurance training program and 10 individuals (five boys and five girls; 30.9 ± 1.7 kg/m², VO_2peak = 1.98 ± 0.12 l/min) served as controls. Training was individualized and targeting at the point were fat oxidation was maximal (Lipox_max). Substrate oxidation was evaluated by indirect calorimetry. To determine plasma cortisol and GH concentrations, blood was collected at rest before and after the two-month period.

Results

Before the program, no significant differences were detected between the training group and the control group for any of the measured anthropometric, metabolic or hormonal variables. At the end of the two-month program, training group showed an increase in VO_2peak and fat oxidation during exercise. After the program, resting levels of GH and cortisol were significantly increased in the training group (+ 0.9 ± 0.3 ng/mL and + 55.4 ± 10.3 ng/mL respectively, p < 0.01). Following the two-month period, there was no change in any variables measured in control group.

Conclusion

The present data show that an individualized endurance training program targeting Lipox_max improves fat oxidation during exercise and increases resting levels of GH and cortisol.     

Body temperature circadian rhythm variability corresponds to left ventricular systolic dysfunction in decompensated cardiomyopathic hamsters

Background

A declining amplitude of body temperature circadian rhythm (BTCR) predicts decompensation or death in cardiomyopathic hamsters. We tested the hypothesis that changes in BTCR amplitude accompany significant changes in left ventricular (LV) size and function.

Methods and Results

Using intraperitoneal transmitters, we continuously monitored the temperature of 30 male BIO TO-2 Syrian dilated cardiomyopathic hamsters. Cosinor analysis was used to detect significant changes—defined as changes >1 standard deviation from the baseline amplitude for 3 consecutive days—in BTCR amplitude over each hamster’s lifespan. The Student t-test was used to compare BTCR variability and LV size and function (as assessed by 2D echocardiography) between baseline and the time that BTCR amplitude declined. All hamsters received 10 mg/kg furosemide daily. At the time of BTCR amplitude decline, functional parameters had changed significantly (P < .0001) from baseline: ejection fraction (0.31 ± 0.09% vs. 0.52 ± 0.08%), LV end-systolic volume (0.11 ± 0.03 vs. 0.05 ± 0.02 cm³), and LV end-diastolic volume (0.16 ± 0.04 vs. 0.10 ± 0.03 cm³).

Conclusions

In decompensated cardiomyopathic hamsters, a decline in BTCR amplitude was associated with progression of heart failure and cardiac decompensation. Variation in BTCR warrants further investigation because of its potential implications for the diagnosis and treatment of cardiovascular disorders.     

Study of the intronic polymorphism of the angiotensin 1 converting enzyme among coronary Tunisians

Background

The acute coronary syndromes (ACS) are classified among the major causes of mortality in the industrialized countries. The increased angiotensin I converting enzyme (ACEI) activity related to a genetic polymorphism constitutes a hereditary predisposition to these syndromes.

Aim

Evaluate the ACEI activity in Tunisian patients with coronary heart disease, and investigate the association between this activity and an intronic deletion of 287 pb on the intron 16 of the ACEI gene.

Patients and methods

Seventy-two coronary patients and 34 control subjects are recruited for our study. ACEI activity was measured by kinetic method. The intronic deletion was identified by PCR technique.

Results

An increased activity of ACEI was observed in patients compared with control subjects (84.38 ± 33.83 UI/L vs 59.06 ± 18.2 UI/L, P = 10⁻⁵). The molecular study showed a raised relative frequency of D/D genotype (51.4%) among patients, whereas among the witnesses, I/I genotype prevailed (62%). D/D genotype is always associated with highest ACEI activity for the patients and the control subjects.

Conclusion

The molecular studies and the biochemical investigations of the various parameters of cardiovascular risk (including the ACEI) direct towards a better treatment.     

Evaluation of blood pressure control by ambulatory blood pressure monitoring and study of factors associated with poor blood pressure control in 300 treated hypertensive type 2 diabetic patients

Hypertension is frequently associated with type 2 diabetes and is often difficult to control.

Aim

Evaluate the frequency of controlled hypertension in our type 2 diabetic patients with known and treated hypertension and determine the factors associated with poor blood pressure control.

Subjects and methods

Prospective study concerning 300 type 2 diabetic patients with a known and treated hypertension, sex-ratio: 0.64, mean age: 61.2 ± 9.1 years (37–86). All subjects underwent physical examination, biological investigations and a 24 hours ambulatory blood pressure monitoring (ABPM).

Results

Hypertension was well controlled in 70 patients (23.3%). The concordance rate between clinical measure of blood pressure and ABPM was 70.3%. Subjects with uncontrolled hypertension were older (61.8 ± 8.9 vs 59.1 ± 9.3 years, P < 0.05), more frequently of male sex (sex-ratio: 0.77 vs 0.34, P < 0.01), smokers (36.4 vs 21.7%, P < 0.05) and with abdominal adiposity (P < 0.05). Duration of diabetes, body mass index and the frequency of peripheral neuropathy, retinopathy and coronary insufficiency were not different between the two groups. Diabetic nephropathy was more frequent (29.8 vs 16.1%, P < 0.05) in the group with uncontrolled hypertension. Loss of circadian blood pressure rhythm was noted in 239 patients (79.6%) and it was more frequently observed in patients with uncontrolled hypertension (84 vs 66%, P < 0.001).

Conclusion

Our type 2 diabetic patients had a poorly controlled hypertension. Close monitoring of blood pressure with adjustment of antihypertensive treatment are necessary to improve cardiovascular prognosis of our patients.     

Dépistage de l’ischémie myocardique par l’échocardiographie de stress à la dobutamine chez le diabétique de type 2 à haut risque cardiovasculaire au Sénégal

Introduction

Diabetes is a major risk factor for coronary artery disease witch may develop insidiously. Several non-invasive methods are used to detect silent myocardial ischaemia, especially in diabetic patients at high cardiovascular risk. We project to screen, by dobutamine stress echocardiography, silent myocardial ischaemia in type 2 diabetics in Senegal.

Methodology

We randomly recruited in hospital in Senegal type 2 diabetics aged at least 40 years and a dobutamine stress echocardiography was performed in those selected according to the French Society of Cardiology and the French Language Association for the Study of Diabetes and Metabolic Diseases.

Results

Dobutamine stress echocardiography was performed in 79 diabetics at high cardiovascular risk, including 56 women. The average age was 58.8 ± 11.8 years. The exam was positive in 67.1% of cases (53/79), with a predominance of motion abnormalities in anterior territory (83%). Cardiovascular risk factors associated with positivity of test were microalbuminuria (p = 0.0001), inactivity (p = 0.0001), dyslipidemia (p = 0.0002), arterial hypertension (p = 0.001), smoking (0.003) and male sex (p = 0.004).

Conclusion

In Africa, dobutamine stress echocardiography has the advantage of its accessibility and its feasibility. Early detection of silent myocardial ischaemia in diabetics at high risk could optimize their care.     

Associated factors for sleep apnea in heart failure

Objective

Genesis of sleep apnoea syndrome (SAS) in chronic heart failure (CHF) is not well known. The aim of our study was to find associated factors to SAS in heart failure (HF) and to look for differences between central sleep apnea (CSA) and obstructive sleep apnea (OSA).

Patients and methods

We realised a cross-sectional and retrospective study. Thirty patients with stable heart failure under medical optimal therapy were included. Polygraphy, echocardiography and cardiopulmonary exercise were systematically performed.

Results

Men were predominant (80%) in the group. Mean age, left ventricular ejection fraction (LVEF) were respectively 64.1 ± 13.8 years and 40 ± 9.8%. SAS was present in 60% of patients (33.3% were classified as central sleep apnoea [CSA] and 26.7% as obstructive sleep apnoea [OSA]). Body mass index, blood pressure and left ventricular pressures estimated by the E/Ea ratio were significantly higher in the group with SAS (P < 0.05) compared to the non SAS group. New York Heart Association class was significantly higher (P = 0.04) and the predicted peak VO₂ was significantly lower in CSA patients compared to OSA patients.

Conclusion

High left ventricular pressures estimated by the E/Ea are significantly associated with SAS in heart failure. CSA patients tend to have a worse functional state than OSA patients.     

Usefulness of tricuspid annular displacement (TAD) to identify right ventricular dysfunction in normotensive patients with acute pulmonary embolism

Background

Echocardiographic criteria of right ventricular dysfunction (RVD) in acute pulmonary embolism (PE) differ among published studies. Assessment of RV systolic function remains difficult because of the RV's complex shape. We aimed to evaluate RV systolic function with TAD in patients (pts) with acute PE. TAD (QLAB, Philips Medical Imaging) was based on a tissue-tracking algorithm that is ultrasound beam angle independent for automated detection of tricuspid annular displacement.

Design

Prospective and observational study.

Methods

All adults’ pts who were diagnosed with PE from December 2008 to December 2009 at Princess Grace Hospital, Monaco were eligible for this study after exclusion of history of heart failure. We evaluated 36 consecutive pts with PE (18 male, mean age 62.7 years), which underwent echocardiography, plasma BNP titration during the first day after admission, and a second echocardiography obtained within 48 hours before discharge.

Results

TAD value were significantly lower in pts with abnormal RV function by echocardiogram (15.9 ± 0.3 vs. 12.7 ± 0.2 ; P = 0.026). Pts with a normal BNP (< 80 pg/ml) had an elevated TAD (16.4 ± 0.2 vs. 11.2 ± 0.3 mm ; P < 0.0001). At discharge, echocardiographic data were obtained from 33 pts (mean: 8.3 ± 3.5 days). RV end diastolic diameter, RV to LV diameter, pulmonary arterial systolic pressure, mean pulmonic valve acceleration time, RV FAC, Sa and TAD were significantly improved. There was no difference between TAD among pts with echocardiographic RVD at baseline vs. pts without RVD (14.9 ± 3.7 vs. 16.1 ± 2.9 mm ; P = 0.3). Four pts who deteriorated during short-term observation had substantially lower TAD values than those with uncomplicated courses (7.7 ± 0.4 mm vs. 14.6 ± 0.2 mm ; P = 0.001). In conclusion, impaired TAD was associated with decreased RV systolic function in pts with acute PE. To identify the clinical meaning of decreased TAD, larger trials with longer follow-up periods are needed.     

Increase in epicardial fat volume is associated with greater coronary artery calcification progression in subjects at intermediate risk by coronary calcium score: a serial study using non-contrast cardiac CT

Objective

Epicardial fat volume (EFV) is related to calcified coronary plaques. However, it is unknown whether baseline EFV or changes in EFV affect the progression of coronary artery calcification over time.

Methods

We identified 375 consecutive asymptomatic subjects with an intermediate risk of developing coronary artery disease, who underwent serial non-contrast CT at least 3–5 years apart. Subjects were divided into tertiles of CCS progression (% increase) between the 2 scans. Subjects from the upper tertile (High Progressors) were matched by age and gender to 81 subjects from the lower tertile (Low Progressors). All subjects underwent serial measurements of CCS and EFV. Relationships between EFV and CCS progression, and change in plaque number were examined.

Results

At baseline, there was no difference in EFV, and EFV indexed to body surface area (EFVi) between the groups. At follow-up, EFV, EFVi and percent increase in EFVi-change were higher in High Progressors than Low Progressors (EFV, 102 ± 38 cm³ vs. 90 ± 35 cm³, p = 0.03; EFVi, 50 ± 16 cm³/m² vs. 46 ± 15 cm³/m², p = 0.03; percent increase in EFVi-change, 15 ± 22% vs. 7 ± 20%, p = 0.02). On multivariate analysis, after adjusting for conventional risk factors, EFVi increase ≥ 15% [odds ratio (OR) 2.3, p < 0.05], log (baseline CCS) [OR 0.3, p < 0.0001] and scan interval time [p = 0.003, OR 1.0] were predictive of being a High Progressor. EFVi increase ≥ 15% (β = 3.0, p = 0.02) and hypertension (β = 3.1, p = 0.01) were independent predictors of number of new calcified plaques on follow-up.

Conclusion

Increase in EFV is associated with greater progression of coronary artery calcification in intermediate-risk subjects.     

Prevalence of thyroid disease in patients with obstructive sleep apnea

Objectives

Studies have suggested that ethnicity and environment may influence thyroid disease. We aim in this study to determine the prevalence of thyroid disease among Saudi (Arab) patients with laboratory-diagnosed obstructive sleep apnea (OSA) and the characteristics and predictors of thyroid disease associated with OSA.

Methods

Serum thyroid-stimulating hormone (TSH) and free-thyroxine (FT4) levels were measured in all patients referred to the sleep disorders center for an overnight sleep study. The levels were measured within 4 weeks of the sleep study. Type I attended polysomnography (PSG) was performed for all patients.

Results

During the study period, 271 patients with OSA and a mean age of 48.7 ± 14.1 yr, a body mass index (BMI) of 37.7 ± 9.6 kg/m² and an AHI of 55.2 ± 37/hr as well as 76 non-OSA patients with a mean age of 40.8 ± 14.9 yr, a BMI of 33.7 ± 8.9 kg/m² and an AHI of 3.8 ± 3.1/hr underwent thyroid function tests. In the OSA patients, the prevalence of newly diagnosed clinical hypothyroidism was 0.4%, and the prevalence of newly diagnosed subclinical hypothyroidism was 11.1%. In the non-OSA patients, the prevalence of newly diagnosed clinical hypothyroidism was 1.4%, and the prevalence of newly diagnosed subclinical hypothyroidism was 4%. There were no cases of clinical or subclinical hyperthyroidism in the studied group. Female gender was the only predictor of clinical hypothyroidism.

Conclusion

In the OSA patients, the prevalence of newly diagnosed clinical hypothyroidism was low; however, subclinical hypothyroidism was common among patients with OSA.     

The prognostic use of serum concentrations of cardiac troponin-I,CK-MB and myoglobin in patients with idiopathic dilated cardiomyopathy

Objective

To examine the association between survival and serum concentrations of cTnI, CK-MB, and myoglobin in patients with idiopathic dilated cardiomyopathy (IDC).

Background

It has been suggested that elevated circulating biomarkers of myocardial damage such as cardiac troponin-I (cTnI), creatine kinase MB (CK-MB) and myoglobin are independent risk factors for mortality in patients with heart failure, and recent studies, although limited, showed that there was a potential association between cTnI and the prognosis of patients with dilated cardiomyopathy (DCM).

Methods

A cohort study was undertaken in 310 patients with IDC. Standard demographic information, transthoracic echocardiography, and routine blood tests were obtained shortly after hospital admission. Outcome was assessed with all-cause mortality.

Results

Among the 310 patients studied, 61 (19.7%) died during a mean follow-up of 2.2 years. There was a significant difference in the all-cause mortality rate between patients with serum cTnI >0.05 ng/mL and with cTnI ≤0.05 ng/mL (37.5% vs 15%, log-rank χ² = 18.423, P < 0.001). After adjustment for other factors associated with prognosis at baseline, serum cTnI >0.05 ng/mL, QRS duration, NYHA functional class and systolic blood pressure predicted all-cause mortality in patients with IDC. There was no association between circulating CK-MB and myoglobin levels and all-cause mortality in the studied IDC patients.

Conclusion

Serum concentrations of cTnI but not CK-MB or myoglobin are an independent predictor of all-cause mortality in patients with IDC.     

Outcome in AN adult patients: a 13-year follow-up in 484 patients

Background

To study the long-term prognosis of anorexia nervosa (AN), 484 adult AN patients were followed on a mean duration of 13 years.

Results

The mortality rate was 1.2%. Eight factors were linked to the lack of recovery at 2 years: low BMI at discharge, low energy and fat intakes, high drive for excessive exercising, high score for perfectionism, for interpersonal distrust and for anxiety, use of tube-feeding and adhesion to treatment (P < 0.02). Four factors explained the risk of the binge/purging form at 2 years: having had binge-eating disorder and overweight before AN, having had purging episodes within the first 2 years of AN; having had very high energy intakes through meals and being not treated by tube-feeding. During the 13-year follow-up, very few binge/purging patients turned out to have the restrictive form. Two main factors explained 67% of the variance of menses recovery: having a BMI > 18.5 kg/m²; and having no physical hyperactivity. The recovery rate increased with the elapsing of relapse-free time (P = 0.02). After a 13.5-year follow-up, 292 out of the 484 patients were recovered (60.3%), 25.8% had a relatively good outcome, 6.4% a bad outcome and 6.4% a severe outcome. Very few factors were identified as predictors of a good outcome (binge-eating/purging subtype, personality disorder).     

The coronary patient six months after cardiac rehabilitation: rehabilitation evaluation research (RER study)

Aims of the study

The aims of the study are to elaborate and test, in a coronary population admitted in a cardiac rehabilitation (CR) department, an evaluative method 6 months after a cardiac rehabilitation programme, with emphasis on modified cardiac risk factors.

Patients and methods

Every coronary patient admitted in the CR department in Machecoul between 2007 October and 2009 October, who's home were not over 50 km far away and without mental inability, were included. At the start of the programme, he was suggested to complete the training course by a phone interview at 3 months and a multidisciplinary consult at 6 months. It used dietary and physical activity questionnaires, and a 6-minute walk test (6mnWT).

Results

Two hundred and two patients were included (mean age 63,4 ± 10 years, 93% men), 17% after an acute coronary syndrome, 23% after angioplasty and 75% after coronary artery bypass graft. The cardioprotective dietary score increased from 7.8 ± 4.3 to 12.7 ± 3 (on a scale from –17 to +19) and the physical activity score from 15.4 ± 7.7 to 19.5 ± 4.8 (on a scale from 5 to 40). The 6mnWT increased in CR (from 431 ± 90 m to 511 ± 91 m) and was maintained at 6 months (513 ± 88 m). The European recommendation goals were achieved by 76% of patients for LDL (< 1 g/L), 64% for blood pressure (< 140/90), 82% for a BMI less than 30 and 36% a BMI less than 25, 67% central obesity (< 102 cm by men and 88 cm by women) and 82% for no smoking. Four non-fatal cardiac events and seven vascular events were reported by a mean delay of 190 ± 30 days.

Conclusion

A six monthly evaluation of CR programme can be used in a cardiac rehabilitation department routinely activity.     

Hypertension artérielle du sujet noir âgé de 50 ans et plus a Lomé : aspects épidémiologiques et évaluation du risque cardiovasculaire (Étude prospective et longitudinale de 1485 patients)

Introduction

High blood pressure is public health problems whose assumption of responsibility especially remains difficult at the old subject. Generally it is associated with the other cardiovascular risk factors. We assigned for objectives to determine the prevalence of High blood pressure in the old subject in specialized milieu and to evaluate the cardiovascular risk among these patients.

Methodology

It is about a longitudinal exploratory study undertaken on 1485 hypertensive of 50 years old and more, selected among 1999 patients received in three health professional trainings of the commune of Lomé, of June 1, 2004 to June 30, 2007. Information had been collected using a card of investigation. Classifications of high blood pressure were those of the JVCVII and the European Society of Cardiology. The data analysis had been made by computer tools.

Results

The prevalence high blood pressure was of 74.29%. We had noted a female prevalence (63.8%) with a sex ratio of 0,57 and one middle age of 62.08 ± 9.3 years. Dyspnea (45.9%), chest pains (16.2%) and palpitations (13.2%) were the principal found symptoms. The various listed risk factors were: the dyslipidemy (58.1%), obesity (36.12%), alcoholism (16.7%) and the diabetes (10.6%). The complications were of order cardiac (87.81%), eyepieces (79.8%), renal (19.86%), neurological (4.92%) and arterial (0.99%). The cardiovascular risk was very high at 58.05% of the patients. The rate of lethality was of 1.9%.

Conclusion

High blood pressure is the cardiovascular risk factor most frequent in our country as from 50 years. Its assumption of responsibility passes by information, the education of the population and requires the mobilization of all the social components.     

Accessory pathway ablation in children: indications and results

Introduction

Radiofrequency ablation of accessory pathways (AP) has become a first-line treatment, except in young children where the indications are discussed because of radiation risks and complications of catheterization. The purpose of the study was to evaluate the indications and results of radiofrequency AP ablation in children and teenagers.

Methods

Electrophysiological study (EPS) was performed in 145 patients aged from 5 to 18 years (13.5 ± 3) with a preexcitation syndrome (PS).

Results

AP ablation was indicated in 66 children (group 1); others represent the group I. Group I was older and less frequently asymptomatic. All children with a spontaneous malignant form had an ablation. Group 1 has a faster conduction through the AP than group 2. The induction of reentrant tachycardia (RT), atrial fibrillation and the presence of a malignant form is more common in group 1. Failures or reappearances of WPW after ablation were frequent (20, 26%) related to a younger age (15 ± 3 vs 17 ± 4) (< 0.05). In group 2, one 18-year-old teenager with untreated RT died before ablation. Asymptomatic children are well with disappearance of PS in two. Medically treated symptomatic children are well.

Conclusion

If spontaneous malignant forms, symptoms with drugs or practice of competitive sport are indications of AP ablation, it is recommended to wait for adolescence in other children.     

Fibrose rétropéritonéale idiopathique : évolution à long terme du pronostic rénal dans une série rétrospective multicentrique de 30 cas

Purpose

Idiopathic retroperitoneal fibrosis (IRF) is an inflammatory disorder, affecting the aorta and the surrounding vessels and tissues. The prognosis is mainly driven by the risks of chronic kidney disease and relapse. Our aim was to assess the prevalence of chronic kidney disease at follow-up.

Methods

We retrospectively reviewed the medical records of patients diagnosed for IRF in Seine-Saint-Denis (France) between 1987 and 2011. We collected informations about presentation, radiologic findings and follow-up. Diagnosis of IRF was confirmed when all the following criteria were met: infiltration of the infrarenal aorta or iliac vessels, absence of aneurysmal dilation, lack of clinical suspicion of malignancy.

Results

Thirty patients were identified, with a male/female ratio of 4.9. Mean age was 55 ± 13 years old. The mean creatinine clearance was 66 mL/min/1.73 m² and the mean CRP was 45 ± 36 mg/L. In 24 (80%) patients, the location of IRF was periaortic and periiliac. Eleven patients (37%) underwent a diagnostic biopsy, and 14 (47%) required an ureteral procedure. A mean follow-up of 63 months was available for 29 patients: 69% relapsed, 7 developed chronic renal disease (24%), and one died of urinary sepsis. Older age (P = 0.023), diabetes (P = 0.007), and initial renal insufficiency (P = 0.05) were associated with a risk of chronic renal insufficiency.

Conclusion

The high frequency of relapses and chronic renal disease emphasizes the need of close follow-up in patients diagnosed with IRF.     

Correlation of TIMI risk score with angiographic extent and severity of coronary artery disease in non-ST-elevation acute coronary syndromes

Aim of study

To determine whether the TIMI risk score correlates with the angiographic extent and severity of coronary artery disease in patients with non-ST-elevation acute coronary syndrome undergoing cardiac catheterization.

Patients and method

We conducted a retrospective review of 239 medical records of patients who underwent coronary angiography secondary to non-ST-elevation acute coronary syndrome between 2002 and 2006. Patients were classified into three groups according to TIMI risk score: TIMI scores 0 to 2 (group 1: n = 121), 3 to 4 (group 2: n = 100), and 5 to 7 (group 3: n = 18). We compared the coronary angiography findings of the three groups.

Results

Patients of group 1 had a greater likelihood of normal or non significant CAD than patients of group 2 (36.3 % vs 13 %, P < 0.001) and than patients of group 3 (36.3 % vs 0 %, P = 0.002). One-vessel disease was found more often in patients with TIMI score 0 to 2 than in patients with TIMI score 5 to 7 (28.9 % vs 0 %; P = 0.01), and in patients with TIMI score 3 to 4 than in those with score 5 to 7 (35 % vs 0 %, P = 0.006). However, 1-vessel disease was found in patients of group 1 as often as in patients of group 2. The frequency of two-vessel disease was similar whatever the level of TIMI score was low, intermediate or high. Three-vessel or left main disease was more likely found in patients of group 3 than in patients of group 2 (66.7 % vs 26 %; P = 0.01), and than patients of group 1 (66.7 % vs 13.2 %; P < 0.001). Chronic coronary occlusions and coronary calcifications were also more likely found in patients with TIMI score 5 to 7.

Conclusion

In patients with non-ST-elevation acute coronary syndrome undergoing cardiac catheterization, the TIMI risk score correlated with the extent and severity of coronary artery disease.     

Adult celiac disease with thrombosis: a case series of seven patients. Role of thrombophilic factors

Purpose

Thrombotic events may occur in celiac disease. In this study, we analyzed clinical features and risk factors for thrombosis in seven patients who had celiac disease and thrombosis.

Methods

We retrospectively studied 87 patients with adult celiac disease and identified seven cases of thrombosis. We searched if risk factors for thrombosis were identified and tested retrospectively antiphospholipid antibodies on the serum.

Results

In our study, the global prevalence of thrombosis was 8 %, and 5.7 % for spontaneous thrombosis, with venous thrombosis (n = 5) or arterial thrombosis (n = 1) or both (n = 2). The seven patients consisted in six women and one man with a mean age of 44.8 years at time of thrombosis. Thrombotic events occurred before the diagnosis of celiac disease in four cases. In three cases, venous thrombosis was in unusual sites: portal (n = 2), splenic vein thrombosis (n = 1). In six cases, we identified risk factors for thrombosis, which could be linked to celiac disease: hyperhomocysteinemia (n = 1), protein C and S deficiency due to vitamin K deficiency (n = 3) and antiphospholipid antibodies (n = 2).

Conclusion

Such risk factors for thrombosis should be identified in patients in adult celiac disease in order to correct them and add a thromboembolic prophylaxis.     

Pneumocystis jirovecii pneumonia in non-HIV infected patients: a study of 41 cases

Background

The increasing use of immunosuppressive and cytotoxic therapies leads to a growing number of opportunistic infections especially Pneumocystis jirovecii pneumonia (PCP). The purpose of our study was to describe the population involved, and to assess clinical, biological, and mortality data.

Methods

We collected retrospectively the whole medical file of all PCP cases diagnosed in non-HIV infected patients, in two French University Hospitals in the last decade (1999–2009). Diagnosis was made on standard coloration and/or immunofluorescence analysis of bronchoalveolar lavage fluid (BAL).

Results

Forty-one patients were included in the study, mean age 56 (±12.5) years, sex ratio 0.71 men/woman. Underlying diseases were as follow: 12 patients (29%) were renal transplant recipients, 13 (32%) were treated for solid cancers, and 16 (39%) suffered from various diseases (three allogenic bone-marrow transplantation, 11 hematological malignancies, one pulmonary transplantation, one vasculitis). Twelve patients died (i.e. 29%). Median lymphocyte count was 542/mm³. More than 85% patients received corticosteroids at a median cumulative 6-month dose of 2700 mg. Seven patients (17%) had a PCP prophylaxis. Clinical worsening at day 5 (P < 0.003), poor control of the underlying disease (P < 0.015), WHO performans status superior than 2 (P < 0.025), high temperature (P < 0.04), and high oxygen flow (P < 0.042) were linked to a poor prognosis.

Discussion/Conclusion

The prognosis factors found are mostly linked to the patients’ clinical severity. We would like to highlight: first, near to 30% mortality rate, secondly, a lack of prophylaxis in 34 patients, reflecting the difficulty to define PCP's risk in non HIV-infected patients.     

Chronic kidney disease and myocardial infarction: epidemiological, clinical, therapeutic and prognostic characteristics (about 231 cases)

Aims of the study

To study the epidemiologic, clinical, therapeutic and prognostic characteristics of the myocardial infarction (MI) in patients with chronic kidney disease (CKD). To identify the impact of CKD in hospital, mid- and long-term survival after myocardial infarction. To determine the predictive factors of hospital and midterm MACCE in patients with CKD.

Patients and methods

The study population was 231 patients with a myocardial infarction admitted alive from January 2005 to December 2006. The population was divided into two groups. Group 1: glomerular filtration rate (GFR) ≥60 ml/min: 112 patients; group 2: GFR < 60 ml/min: 119 patients.

Results

Patients with CKD had more history of stroke and arterial hypertension. They had received less medical therapies and urgent reperfusion. In multivariate analysis, CKD was a predictive factor of hospital (P = 0.016), at 6 months (P = 0.003), at 1 year (P = 0.004) and at 2 years MACCE (P = 0,015). The predictive factors of hospital MACCE in group 2 were: use of vasopressors (P = 0.001) and primary angioplasty (P = 0.043). In patients with CKD, only surgical coronary revascularization was MACCE predictive factor (P = 0.03).

Conclusion

Baseline renal function is a powerful predictor of short- and long-term events after myocardial infarction. Our results confirm the need to include the renal function in the evaluation of the level of risk among patients admitted with acute myocardial infarction.