Low HDL cholesterol concentration is associated with increased intima-media thickness independent of arterial stiffness in healthy subjects from families with low HDL cholesterol

BACKGROUND: Low high-density lipoprotein cholesterol (HDL-C) is associated with increased risk for developing coronary artery disease. Cardiovascular disease is characterized by increased intima-media thickness (IMT) and arterial stiffness, but the effect of low HDL on these measurements has not been reported. MATERIALS AND METHODS: We studied 18 apparently healthy subjects from families with low HDL-C and 18 control subjects, which were pair-matched to maximize statistical power. Intima-media thickness was assessed using ultrasound examination of the carotid arteries. Arterial stiffness was measured using applanation tonometry on the radial artery and pulse-wave analysis to obtain central aortic pulse-pressure waveform, from which the augmentation index, a measure of global large artery stiffness, was calculated. RESULTS: Low HDL subjects (age 41 +/- 3 years, BMI 26.6 +/- 1.0 kg m(-2) had significantly lower HDL-C than the control subjects (age 41 +/- 3 years, BMI 26.5 +/- 1.0 kg m-2; 1.00 +/- 0.05 vs. 1.49 +/- 0.09 mmol L-1, low HDL vs. control subjects, P < 0.0001). Subjects with low HDL-C had significantly thicker mean IMTs than the control subjects (0.77 +/- 0.03 vs. 0.70 +/- 0.02 mm, low HDL vs. control subjects, P < 0.01). The maximal (0.99 +/- 0.04 vs. 0.89 +/- 0.03 mm, P < 0.01), far wall (0.76 +/- 0.04 vs. 0.69 +/- 0.02 mm, P < 0.05) and carotid bulb (1.11 +/- 0.06 vs. 0.97 +/- 0.04 mm) IMTs were also significantly increased, whereas the mean common carotid and the internal artery IMT were not. The age-related increase in mean IMT was more pronounced in the low HDL subjects than the control subjects (P < 0.01 for difference between elevations of age vs. IMT slopes). There were no differences in central pressure augmentation, the augmentation index, peripheral or central blood pressures between the groups. CONCLUSIONS: A low HDL-C concentration is associated with thickening of carotid IMT independent of other risk factors in healthy affected members of low HDL families.     

Effect of a kinin antagonist on renal function and haemodynamics during alterations in sodium balance in conscious normotensive rats

1. To evaluate whether sodium intake can modulate the action of endogenous kinins on renal function and haemodynamics, a receptor antagonist of bradykinin was infused in conscious normotensive rats maintained on either a normal or a low sodium diet. 2. The antagonist inhibited the hypotensive effect of exogenously administered bradykinin. It did not change the vasodepressor effect of acetylcholine, dopamine or prostaglandin E2. 3. The antagonist did not affect mean blood pressure, glomerular filtration rate, renal blood flow or urinary sodium excretion, in rats on sodium restriction. It did not change mean blood pressure, glomerular filtration rate or urinary sodium excretion, but decreased renal blood flow, in rats on a normal sodium intake. 4. The kallikrein-kinin system has a role in the regulation of renal blood flow in rats on a normal sodium diet.     

Toxicidad retiniana por antipalúdicos: frecuencia y factores de riesgo

ObjectiveTo study the frequency of retinal toxicity and associated risk factors in a cohort of patients treated with antimalarials and seen at a tertiary level hospital.Material and methodsRetrospective study of 40 patients treated with antimalarials, who were referred to ophthalmology for the study of retinal toxicity during 2011. Data collection included type of antimalarial prescribed, daily and cumulative doses, presence of rheumatic disease, corticosteroid use, associated diseases and ophthalmologic examination. Retinal toxicity was confirmed if two of the following tests were altered: fundus examination, visual field with a macular pattern, changes in spectral domain optical coherence tomography and full-field electroretinography.ResultsToxic retinopathy was detected in 13.1% of patients (95% confidence interval 5-21%) and a trend for a higher risk was observed in case of chloroquine (CQ) treatment. Among the patients with retinopathy, the mean cumulative dose was 229 g for CQ and 111 g for Hydroxychloroquine (HCQ), and the mean daily dose of CQ was 250 mg and 333 mg for HCQ. Arterial hypertension had a statistically significant effect on retinopathy development.ConclusionsToxic retinopathy defined by ophthalmological evaluation was detected in 13.1% of patients. A trend for a higher risk was observed in case of chloroquine treatment.     

Risk factors associated with colonic diverticulosis among patients from a defined geographic area

Background

Only a few data regarding colonic diverticulosis are available in Italy. We examined the frequency of colonic diverticulosis and its associations with risk factors in a homogeneous Northern Sardinian population undergoing colonoscopy for any reason in the last decades.

Methods

This was a retrospective single-center study. Medical records of patients undergoing colonoscopy for any indication between 1995 and 2013 were reviewed. Demographic information including age, gender, geographic area (urban, rural), marital status, smoking habit, occupation, body mass index, and comorbidities were collected. Presence, number, and extension of diverticula were assessed by colonoscopy. The diagnosis of diverticulosis was defined by the presence of more than five diverticula.

Results

A total of 4458 records were collected (39.8 % males). Analysis by birth cohorts showed a significant progressive age-related increase in the prevalence of diverticulosis. The average prevalence was 18.9 % without significant variation across the 19-year observation period. In 101 (12.1 %) subjects diverticula were single or few. Seventy-one percent of diverticula were located predominantly in the left side, 2 % in the right side, and 14.3 % were spread throughout the colon. There was a significant association with obesity but not with smoking habits, marital status, or urban versus rural environment. A strong association was observed between the presence of diverticulosis and cardiovascular and other gastrointestinal and lung disease (p < 0.0001). These associations were also confirmed by the logistic regression analysis.

Conclusions

In this endoscopic study, colonic diverticulosis in Northern Sardinia showed prevalence similar to other series in Western countries, and it was predominantly left sided and age related.

     

Fibrose hépatique congénitale. A propos d’un cas observé au centre hospitalier et universitaire de Cocody (Abidjan-Côte d’Ivoire)

Congenital hepatic fibrosis is an uncommon desease. She is often associated with renal polykystosis. She has various clinical presentation but she is mostly reaveled by portal hypertension signs.The diagnostic can be made by ultrasound, but the realisation of a biopsy for histological diagnostic is necessarry. We are reporting a case of congenital hepatic fibrosis of a one year old child     

Effet hypotenseur d’un extrait aqueux de <Emphasis Type="Italic">Zanthoxylum zanthoxyloides</Emphasis> (Lam.) Waterman (Rutaceae)

The aqueous extract from Zanthoxylum zanthoxyloides (FAZ) [Lam.] Waterman (Rutaceae) contained sterols and polyterpens, polyphenols, flavonoids, quinon and alkaloids. The richness of this extract into phytochimic components is compatible with the full traditional use of this medicinal plant. The toxicological study of FAZ has permitted to determine respectively by Miller and Tainter’s method and Dragsted and Land’s method a LD50 of 4,168±462mg/kg of body weight (b.w) and 5,500±875mg/kg b.w. These values showed that this natural extract is not toxic. For doses ranging from 2.7 × 10^?4 and 5.5 × 10^?1 g/kg b.w, this aqueous extract induced a dose-dependent sustained hypotension similar to that induced by acetylcholine 5.6 × 10^?7 g/kg b.w to 5.5 × 10^?4 g/kg b.w. It reduced the hypertension induced by adrenalin at 2.5 × 10^?5 g/kg b.w. These results showed that the aqueous extract from FAZ is a hypotensive substance. They justified the traditional use of this plant in the management of arterial hypertension. The partial inhibition of hypotension effect induced by FAZ caused by atropine, competitive antagonist of muscarinic cholinomimetic receptor, suggested the presence of two types of actives components in the aqueous extract: 1) muscarinic and cholinomimetic activity; 2) and non cholinomimetic activity.     

Incidence,risk factors,and predictors of outcome of candidemia. Survey in 2 Italian university hospitals

In recent decades, Candida spp. emerged as the fourth most common cause of nosocomial bloodstream infections. The incidence of candidemia was 0.13 per 100 persons. Eighty-three cases (61%) of candidemia were due to Candida albicans and 53 (39%) to nonalbicans Candida spp. Twelve strains of Candida (9%) had shown in vitro resistance to fluconazole, 5 (4%) to itraconazole, 2 (1.5%) to voriconazole, 12 (9%) to 5-flucytosine, and 1 (0.7%) to amphotericin B. Multivariate logistic regression analysis of risk factors showed that length of hospitalization, presence of a central venous catheter, previous episodes of candidemia or bacteremia, parenteral nutrition, and chronic renal failure were variables independently associated with the development of candidemia. Multivariate logistic regression analysis of prognostic indicators showed that the independent variables associated with poor prognosis were inadequate initial therapy (P < .001) and high APACHE III score (P = .004). The inadequate initial therapy associated with mortality indicates the need for additional investigations to define high-risk patients for beneficial antifungal prophylaxis.     

Metabolic syndrome aggravates the increased endothelial activation and low‐grade inflammation in subjects with familial low HDL

Background. Inhibition of cytokine‐induced expression of adhesion molecules is one of the atheroprotective mechanisms of high‐density lipoprotein (HDL).

Aim. We investigated whether increased endothelial activation and low‐grade inflammation are present in Finnish subjects with familial low HDL, and which factors contribute to the inflammatory parameters.

Method. High‐sensitivity C‐reactive protein (hsCRP), soluble intercellular adhesion molecule‐1 (sICAM‐1), vascular cell adhesion molecule‐1 (sVCAM‐1), and sE‐selectin were measured in 91 subjects with low HDL‐cholesterol from 41 low‐HDL families and in 112 normolipidemic controls with comparable age‐ and gender distribution. Presence of the features of the metabolic syndrome (MetS) was recorded.

Results. sVCAM‐1, sICAM‐1, sE‐selectin, and hsCRP were significantly higher in low‐HDL subjects than in the controls (sVCAM‐1: 560±147?ng/mL versus 496±95?ng/mL, P = 0.001; sICAM‐1: 247±60?ng/mL versus 215±47?ng/mL, P<0.001; sE‐selectin: 52±20?ng/mL versus 44±16?ng/mL, P = 0.022; and hsCRP: 1.73±2.05?mg/L versus 0.85±1.10?mg/L, P<0.001). Low‐HDL subjects had increased body mass index (BMI) and waist, and elevated insulin and triglyceride levels. Adhesion molecules and hsCRP increased according to the number of the features of the MetS.

Conclusions. The presence of the MetS in subjects with familial low HDL‐cholesterol aggravates the low‐grade inflammation and endothelial activation, and ultimately may add to the higher susceptibility for atherosclerotic disease in these individuals.     

A candidate gene study in low HDL-cholesterol families provides evidence for the involvement of the APOA2 gene and the APOA1C3A4 gene cluster

In patients with premature coronary heart disease, the most common lipoprotein abnormality is high-density lipoprotein (HDL) deficiency. To assess the genetic background of the low HDL-cholesterol trait, we performed a candidate gene study in 25 families with low HDL, collected from the genetically isolated population of Finland. We studied 21 genes encoding essential proteins involved in the HDL metabolism by genotyping intragenic and flanking markers for these genes. We found suggestive evidence for linkage in two candidate regions: Marker D1S2844, in the apolipoprotein A-II (APOA2) region, yielded a LOD score of 2.14 and marker D11S939 flanking the apolipoprotein A-I/C-III/A-IV gene cluster (APOA1C3A4) produced a LOD score of 1.69. Interestingly, we identified potential shared haplotypes in these two regions in a subset of low HDL families. These families also contributed to the obtained positive LOD scores, whereas the rest of the families produced negative LOD scores. None of the remaining candidate regions provided any evidence for linkage. Since only a limited number of loci were tested in this candidate gene study, these LOD scores suggest significant involvement of the APOA2 gene and the APOA1C3A4 gene cluster, or loci in their immediate vicinity, in the pathogenesis of low HDL.