Hipertensión por hiperaldosteronismo: más lesión cardiaca,mayor riesgo cardiovascular

Introduction and objectives

Primary hyperaldosteronism is the most common cause of secondary hypertension. Elevated aldosterone levels cause heart damage and increase cardiovascular morbidity and mortality. Early diagnosis could change the course of this entity. The objective of this report was to study the clinical characteristics, cardiac damage and cardiovascular risk associated with primary hyperaldosteronism.

Methods

We studied 157 patients with this diagnosis. We analyzed the reason for etiological investigation, and the routinely performed tests, including echocardiography. We used a cohort of 720 essential hypertensive patients followed in our unit for comparison.

Results

Compared with essential hypertensive patients, those with hyperaldosteronism were younger (56.9 [11.7] years vs 60 [14.4] years; P<.001), had higher blood pressure prior to the etiological diagnosis (136 [20.6] mmHg vs 156 [23.2] mmHg), more frequently had a family history of early cardiovascular disease (25.5% vs 2.2%; P<.001), and had a higher prevalence of concentric left ventricular hypertrophy (69% vs 25.7%) and higher cardiovascular risk. Specific treatment resulted in optimal control of systolic and diastolic blood pressures (from 150.7 [23.0] mmHg and 86.15 [14.07] mmHg to 12.69 [15.3] mmHg and 76.34 [9.7] mmHg, respectively). We suspected the presence of hyperaldosteronism because of resistant hypertension (33.1%), hypokalemia (38.2%), and hypertensive crises (12.7%). Only 4.6% of these patients had been referred from primary care with a suspected diagnosis of hyperaldosteronism.

Conclusions

Hyperaldosteronism should be suspected in cases of resistant hypertension, hypokalemia and hypertensive crises. The diagnosis of hyperaldosteronism allows better blood pressure control. The most prevalent target organ damage is left ventricular hypertrophy.Full English text available from:www.revespcardiol.org/en.     

ICU患者院内获得性肺部感染38例分析

目的探讨ICU患者院内获得性肺部感染发生的特征及防治办法。方法回顾性分析ICU患者226例临床资料。结果本组发生院内肺部感染38例(16.8%)。感染与昏迷程度、年龄、住院时间、基础疾病及医疗操作有一定关系。结论加强重症监护室消毒、加强无菌观念、减少医源性操作造成的感染及抗生素的合理应用等是控制院内肺部感染的重要措施。     

替加环素治疗高龄老年院内获得性肺炎的疗效及安全性分析

目的观察替加环素治疗高龄老年院内获得性肺炎(HAP)耐药鲍曼不动杆菌感染的临床疗效与安全性。方法筛选2014年6月-2015年8月我院老年病科应用替加环素治疗多重或泛耐药鲍曼不动杆菌感染的高龄HAP病例,收集患者临床相关资料,总结分析其临床、细菌学疗效及药物安全性。结果共30例合格病例被纳入研究,分为两组:替加环素单药治疗组6例,临床有效3例,细菌清除1例。替加环素为基础联合其他抗生素治疗组24例,临床有效15例,死亡1例;细菌清除10例。临床总有效率为60%,细菌清除率36.7%。治疗前后患者肝肾功能无明显变化,治疗过程中出现恶心、欲吐不良反应1例。结论替加环素能有效改善高龄HAP耐药鲍曼不动杆菌感染患者的临床疗效,临床可尝试选用替加环素进行治疗,但同时需密切观察其不良反应。     

Bacteriological testing and recurrence prevention efforts in the diagnosis and treatment of nursing- and healthcare-associated pneumonia and aspiration pneumonia: A questionnaire survey of hospitals across Japan

Background

Clinical practice guidelines for nursing- and healthcare-associated pneumonia (NHCAP) were developed for pneumonia caused by drug-resistant bacteria and pneumonia in elderly patients, particularly aspiration pneumonia. The identification of pathogenic bacteria and implementation of efforts to prevent the recurrence of aspiration pneumonia are very important in clinical practice. This study examined the extent to which clinicians have established bacteriological testing and recurrence prevention efforts for NHCAP and aspiration pneumonia.

Basic and clinical aspects of gastrointestinal pain

The gastrointestinal (GI) tract is a system of organs within multicellular animals which facilitates the ingestion, digestion, and absorption of food with subsequent defecation of waste. A complex arrangement of nerves and ancillary cells contributes to the sensorimotor apparatus required to subserve such essential functions that are with the exception of the extreme upper and lower ends of the GI tract normally subconscious. However, it also has the potential to provide conscious awareness of injury. Although this function can be protective, when dysregulated, particularly on a chronic basis, the same system can lead to considerable morbidity. The anatomical and molecular basis of gastrointestinal nociception, conditions associated with chronic unexplained visceral pain, and developments in treatment are presented in this review.     

Psychometric properties of an informant personality questionnaire (the HAP) in a sample of older adults in the Netherlands and Belgium

In geriatric psychiatry, informant reports are often important due to cognitive problems and related impaired insight and judgment. Informant questionnaires to identify personality traits among older adults are sparse. The Dutch informant personality questionnaire (the HAP) is especially developed to address this need. The objective of this study is the psychometric evaluation of the HAP among older adults in the Netherlands and Belgium. We investigated the internal consistency, gender differences, the test–retest and inter-rater reliability, the factorial structure, and the concurrent validity. Informants completed the HAP ratings of nursing home residents (n?=?385) and elderly psychiatric patients (n?=?204). The internal consistency of the scales is good. Medium gender differences on three scales were found in the population Psychiatry. The inter-rater and test–retest reliability are good to excellent. There are significant similarities between a number of HAP scales and dimensions of the Big Five. The congruence between the factor structures in both samples is very high. We labeled the three factors externalizing/antagonistic, internalizing/neurotic, and compulsive. The HAP meets the need for validated and reliable informant instruments for personality assessment among older adults in geriatric psychiatry. The content scales of the questionnaire address traits of the premorbid personality. Therefore, the HAP might be useful for personality assessment and selecting treatment options in mental healthcare and can be applied in scientific research in the area of personality aspects in late life.     

Plasmodium berghei HAP2 induces strong malaria transmission-blocking immunity in vivo and in vitro

Fertilization in Plasmodium is a complex process that occurs in the gut of the female Anopheles mosquito upon uptake of a bloodmeal. It requires the emergence of the gametocyte from the RBC and release of eight flagellate male gametes from each male cell, and subsequent fertilization of a similarly emerged immotile extracellular female macrogamete. Previous studies have demonstrated that antibodies against male gamete surface proteins ingested from the blood of an infected and immunized host inhibit parasite transmission. Gene disruption studies in Plasmodium berghei and complimentary studies on the green alga Chlamydomonas have shown that a conserved male gamete sterility gene, HAP2, is essential for fusion of male and female gametes. Genetic disruption of the HAP2 locus revealed that parasite fertilization is prevented, yet hap2 KO male gametes still retained the ability to form tight pre-fusion membrane attachments with females.We demonstrate that heterologous expression of the P. berghei HAP2 protein in Escherichia coli, and subsequent immunization of rabbits, has produced anti-sera that react specifically with recombinant HAP2, and with the native protein on the male gamete. Additionally, anti-HAP2 sera reduces in vitro formation of ookinetes by up to 81%, and, using standard membrane feeding assays, reduces oocyst burden within the mosquito host by up to 81.1%, and prevalence of in vivo infection by up to 34%. Inhibition is dose dependent. These results indicate that HAP2 should be considered as a potential target for any future anti-malarial transmission-blocking vaccine.     

锶磷灰石烧结体修复颌骨缺损的实验研究

目的　用不同比例的元素锶 (Sr)替代羟磷灰石 (HA)中的部分钙元素 ,通过动物实验研究该种复合人工骨在颌骨缺损修复中的应用。方法　将 32只新西兰大白兔 (简称新白 )分为 4组 ,在兔的下颌角造成约 2 m m×12 mm× 4mm的缺损 ,用不同浓度 (10 % ,5 % ,0 % )的含锶 HA块分别予以修复 ,于 2周 ,1月 ,3月 ,6月时随机处死一组进行尸解、组织学、扫描电镜观察以评价其骨修复能力。结果　掺锶羟基磷灰石复合人工骨几乎不引起排斥反应 ,术后早期即随材料的降解 ,新生骨引导进入降解间隙 ,并逐渐诱导未分化细胞转化为成骨细胞 ,随时间延长其成骨量明显较纯羟基磷灰石组为多 ,同时发现 5 %的锶磷灰石烧结体其成骨能力较 10 %者好。结论　掺锶羟基磷灰石较纯羟基磷灰石有更好的组织相容性、骨引导能力及生物降解率 ,并可能具备一定程度的骨诱导能力 ;掺锶羟基磷灰石的骨形成能力与其浓度并不成正相关。     

70岁以上老年食管癌患者术后获得性肺炎的危险因素和预防

目的 探讨70岁以上老年食管癌患者术后获得性肺炎的危险因素和预防措施.方法 总结分析2009-2012年208例高龄食管癌患者术后发生获得性肺炎的临床资料;Logistic多因素回归分析寻找相关危险因素.结果 术后获得性肺炎的发病率为25.9％,在获得性肺炎发生的可能相关因素Logistic多因素回归分析中,吸烟、低肺功能、术后非硬膜外镇痛、术中喉返神经的损伤、吻合口瘘是食管癌术后获得性肺炎的危险因素.结论 对于高龄患者应做好术前评估及围手术期的处理,减少食管癌术后并发症能有助于减少术后获得性肺炎的发生.     

COPD患者医院获得性肺炎临床分析

目的:分析我院住院慢性阻塞性肺疾病(COPD)患者医院获得性肺炎(HAP)特点,并分析有效临床处理方式。方法:回顾性分析2007年1月～2011年12月资料完整的496例COPD患者,全部COPD患者均进行痰细菌学检查,并对呼吸衰竭、年龄、咳嗽反射、心力衰竭、广谱抗菌素应用时间、气管插管/切开、机械通气和重症监护室(ICU)住院时间等9个候选因素进行二项Logistic回归分析。结果:COPD患者中HAP患病率21.98%(109/496),HAP病死率19.27%(21/109)。致病菌123株中以耐药肺炎克雷伯菌(21.14%)和铜绿假单胞菌(20.33%)最常见。结论:COPD患者HAP发生较高,主要致病菌是肺炎克雷伯菌和铜绿假单胞菌。HAP的发生与呼吸衰竭、年龄、应用广谱抗菌素、气管插管/切开、机械通气和ICU住院时间密切相关。选择合适的抗菌药物,加强ICU管理和早期防治是降低HAP发生的关键。