Uncontrolled hypertension in older patients: markers and associated factors to masked and white-coat effect

Background Hypertension is the main risk factor for cardiovascular diseases, affecting more than half the elderly population. It is essential to know if they have proper control of hypertension. The aim of this study was to identify the associated factors to masked uncontrolled hypertension and false uncontrolled hypertension in older patients. Methods Two-hundred seventy-three individuals (70.1 ± 6.7 years-old) had blood pressure (BP) measured at the office and by ambulatory BP monitoring (ABPM), with the definition of controlled group (C), individuals with high office BP and adequate ABPM, called white-coat effect group (WCE), uncontrolled (UC), and subjects with appropriate office BP and elevated ABPM denominated masked effect group (ME). Age, body mass index, diabetes, pulse pressure (PP) and BP dipping during sleep were evaluated (Kruskal-Wallis test and logistic regression models). Results Age was higher in UC than in C and ME (P < 0.01), and 24-h ABPM PP was lower in C (48 ± 7 mmHg) and WCE (51 ± 6 mmHg) than in UC (67 ± 12 mmHg) and ME (59 ± 8 mmHg) (P < 0.01). Sleep systolic BP dipping was lower in ME than in C (P = 0.03). Female gender was associated with a greater chance of being of ME group, which showed a higher PP and lower BP dipping during sleep. Conclusions In older individuals, office BP measurements did not allow the detection of associated factors that would permit to differentiate WCE from UC group and C from ME group. ABPM favored the identification of a higher PP and a lower BP dipping during sleep in the masked effect and uncontrolled groups.     

Increased apoptosis and expression of tumor necrosis factor-alpha caused by infection of cultured human monocytes with dengue virus

Dengue (DEN) virus is responsible for one of the most significant viral diseases in tropical countries. Monocytes/macrophages (Mo/Mphi) are the major target cells for DEN virus. To determine the effects of the interaction between DEN virus and Mo/Mphi, human monocyte cultures were infected with DEN virus type 2. Apoptosis and production of tumor necrosis factor-alpha (TNF-alpha) and nitric oxide were measured in control and infected cultures. Virus was taken up by phagocytosis, but no membrane-coated pits at the virus attachment sites were observed. Increased number of apoptotic cells and increased production of TNF-a were observed in infected monocyte cultures. No increase in production of nitric oxide was observed. These results may be related to early primary viral infection, in which virus could induce apoptosis in monocytes, but monocytes may contribute to host defense mechanisms against virus by viral phagocytosis, phagocytosis of infected apoptotic cells, and the release of proinflammatory cytokines.     

CD133+ cell content does not influence recovery time after hematopoietic stem cell transplantation

BACKGROUND: Infusion of an adequate dose of CD34+ mononuclear hematopoietic stem cells (HSCs) is the single most important variable to assure success in hematopoietic grafting. CD133+ HSCs constitute the CD34+ subgroup with higher differentiation potential. The number of granulocyte–colony‐stimulating factor (G‐CSF)‐mobilized CD133+ HSCs administered during hematopoietic grafting and its relationship with the number of days needed to regain hematopoiesis was determined. STUDY DESIGN AND METHODS: Thirty‐eight patients with malignant hematologic diseases who received an autologous (n = 15) or allogeneic (n = 23) HSC transplant were prospectively evaluated. G‐CSF was administered for 5 days at 10 µg/kg/day. Hematopoietic progenitors were recovered from peripheral blood on day 5 by leukopheresis. CD34+ and CD133+/CD34+ cell populations were quantified by flow cytometry; the number of days to hematologic recovery was documented. RESULTS: A median dose of 4.56 × 10⁶/kg CD34+ HSCs (range, 1.35 × 10⁶‐14.6 × 10⁶) was recovered and transplanted; of these grafted cells, a median 3.25 × 10⁶ were also CD133+ (range, 1.25 × 10⁶‐14.3 × 10⁶). In the autologous group, the median number of days to reach a platelet (PLT) count of 20 × 10⁹/L or greater was 12, and 15 days to obtain a neutrophil count of 0.5 × 10⁹/L or greater; in the allogeneic group 13 and 16 days, respectively, were required (p > 0.05). A median 76.5% of G‐CSF–mobilized CD34+ HSCs coexpressed the CD133+ antigen (range, 23.1‐97.9). CONCLUSIONS: A higher number of CD133+/CD34+ HSCs in the graft was not clearly associated with a shorter neutrophil or PLT recovery time in either allogeneic or autologous recipients.     

Mobilization kinetics of CD133+ hematoprogenitor cells for hematopoietic grafting

BACKGROUND: Quantification of CD34+ mononuclear cells is the most important quality control measure for hematopoietic stem cell (HSC) transplantation. A fraction of CD34+ cells also express the CD133 antigen. These cells constitute a group of earlier, less-differentiated HSCs with a potentially higher capacity for engraftment. The correlation between total CD34+ peripheral HSCs and the fraction of these cells that coexpress CD133 was determined before and after automated collection by leukapheresis, as well as the effect of HSC CD133+ dose on hematopoiesis recovery.
STUDY DESIGN AND METHODS: Granulocyte–colony-stimulating factor mobilization of HSCs from the marrow to the peripheral blood (PB) of allogeneic and autologous donors was followed by automated collection through leukapheresis on the fifth day. Quantification of CD34+ and CD133+ cells was performed on PB before collection and in the hematopoietic graft (HG) by flow cytometry.
RESULTS: There was a significant correlation between CD133+ and CD34+ HSCs in the PB before collection and in the final product for grafting (r = 0.62 and 0.64; p < 0.01). CD34+ HSCs per µL in PB and the HG was the only variable that did not correlate (r = 0.18). CD34+/CD133+ correlation increased from 0.33 on PB to 0.94 on the leukapheresis product (p < 0.01). Time to recovery was not related to CD133+ HSCs infused.
CONCLUSION: There was a significant correlation of both number per µL and percentage of CD34+/CD133+ HSCs before and after collection for transplantation; number of CD133+ cells had no apparent clinical impact on time to hematopoiesis regeneration.     

Effect of estrogen on urethral function and nerve regeneration following pudendal nerve crush in the female rat

PURPOSE: We tested the hypothesis that estrogen promotes improvement in urethral function and nerve regeneration following bilateral pudendal nerve crush in ovariectomized female rats. MATERIALS AND METHODS: A total of 52 female rats underwent ovariectomy 6 days before bilateral pudendal nerve crush. Estrogen and sham capsules were subcutaneously implanted at the time of nerve crush in 16 and 14 of these rats, respectively, while 22 served as unoperated controls. Seven days following nerve crush urethral LPP testing was performed using urethane anesthesia. Spinal cord sections containing motoneurons of Onufrowicz's nucleus were subjected to in situ hybridization to detect the expression of beta(II) tubulin mRNA, a marker of the neuroregenerative response. RESULTS: Mean LPP +/- SEM was significantly decreased after pudendal nerve crush in sham treated animals compared to unoperated controls (32.1 +/- 6.8 vs 54.4 +/- 11.6 cm H2O). Rats with an estrogen implant had an LPP of 42.5 +/- 16.8 cm H2O, which was significantly greater than rats given sham implants and significantly less than unoperated controls. Rats that received an estrogen implant had increased beta(II) tubulin mRNA expression compared to those that received a sham implant. CONCLUSIONS: The results of this research suggest that estrogen given at the time of pudendal nerve crush promotes and facilitates the recovery of urethral function and an increase in the nerve regenerative response. Future studies will include the investigation of molecular pathways activated by estrogen in response to peripheral nerve injury.     

Control, elimination and eradication of viral immuno preventable diseases in Venezuela

Vaccination has demonstrated the capacity for the drastic decrease of the prevalence and incidence of several diseases of viral etiology and it has allowed their eradication. Among these human immuno preventable diseases are included poliomyelitis, measles, mumps, chicken pox, rubella, hepatitis A and B, influenza A and yellow fever. In residents, travelers to endemic areas and personal at risk, the vaccines to Japanese and equine encephalitis, rabies and adenovirus can be applied. Venezuela has not escaped from the positive impact in the epidemiology of these illnesses as a consequence of the organization and implementation of big national vaccination campaigns; however, and in spite of these efforts, important outbreaks of measles, yellow fever, chicken pox and hepatitis have occurred in the last few years. The tools to eliminate the majority of these viral diseases exist in Venezuela as well as in other countries, and are readily available, effective and relatively not expensive, but require on the whole of an effort of authorities and communities. The implementation of these strategies should have the support of the World Health Organization and the Panamerican Health Organization. This is a priority for the next few years if our aim is the eradication of these illnesses from Venezuela, the continent and the world.