Cryptococcal meningoencephalitis. Case report and review of Italian literature

A case of cryptococcal meningoencephalitis, as presented by a hypertensive hydrocephalus, is described. To our knowledge, this is the 24th case described in Italy since 1953. The diagnosis was made with ventricular fluid examination: the patient was successfully treated with amphotericin B and 5-fluorocytosine, thus avoiding the risks of surgical treatment of hydrocephalus. Early diagnosis and proper therapy are necessary in order to decrease the high lethality of cryptococcosis.     

Effects of sino-aortic denervation on spectral characteristics of blood pressure and pulse interval variability: a wide-band approach

Sino-aortic denervation (SAD) is employed in cats to evaluate the baroreflex influence on blood pressure (BP) and pulse interval (PI) spectral components from 0·00008 to 0·9 Hz as assessed by FFT wide-band spectra and their 1/f modelling; and the linear coupling between BP and PI and between systolic and diastolic BP as assessed by coherence analysis. Specific procedures have been developed to obtain an effective smoothing of spectra and coherence functions. SAD induced an increase in BP powers from 0·03 to 0·0006 Hz and a power reduction of most of the remaining BP components; a reduction of PI powers at all frequencies; marked deviations of BP spectra from the 1/f trend; a reduction of the coherence between BP and PI from 0·12 to 0·5 Hz and a coherence enhancement at lower frequencies. These findings indicate that the arterial baroreflex modulates both fast and slow spectral components of BP and PI; homogeneously enhances PI fluctuations at all frequencies; produces differentiated effects on BP fluctuations along the frequency axis; and at low frequencies exerts the buffering action on BP through strategies which reduce the BP-PI linear link.     

The trough:peak ratio and the smoothness index in the evaluation of control of 24 h blood pressure by treatment in hypertension

The duration and homogeneity of the antihypertensive effect of a drug are commonly quantified by computation of the trough:peak ratio (T/P) from 24 h ambulatory blood pressure recordings [i.e. the ratio of the reduction in blood pressure at the end of the interval between doses (trough) and the reduction in blood pressure at the time of the maximal effect of a drug (peak)]. Although it is widely employed, this index has a lot of limitations: it makes use of only a small portion of a 24 h blood pressure recording; individual T/P values do not have a normal distribution, unless responders at peak are selected; it bears no relation to 24 h blood pressure variability; peak changes in blood pressure are affected by a placebo effect and thus T/P needs correction for effects of placebo; peak and trough changes in blood pressure are reproducible over time but T/P is not; and, finally, it was shown in the SAMPLE study that T/P is not correlated to changes in left ventricular mass induced by treatment, and thus has a limited clinical value.     

Stiff left atrial syndrome after low‐dose radiotherapy for right breast cancer: The need for invasive hemodynamics at exercise

Stiff left atrial (LA) syndrome is a distinct phenotype of heart failure with preserved ejection fraction, characterized by predominant high LA pressure. We describe the case of a middle‐aged woman who developed exertional breathlessness during low‐dose radiotherapy for right breast cancer and who was eventually found to be affected by stiff LA syndrome. Invasive hemodynamics allowed the recognition of pathognomonic tall V waves in the wedge position during exercise, in spite of inconclusive noninvasive investigations.     

Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper—accessibility,clinical use and cost effectiveness of ABPM in Latin America in year 2020

Accurate office blood pressure measurement remains crucial in the diagnosis and management of hypertension worldwide, including Latin America (LA). Office blood pressure (OBP) measurement is still the leading technique in LA for screening and diagnosis of hypertension, monitoring of treatment, and long‐term follow‐up. Despite this, due to the increasing awareness of the limitations affecting OBP and to the accumulating evidence on the importance of ambulatory BP monitoring (ABPM), as a complement of OBP in the clinical approach to the hypertensive patient, a progressively greater attention has been paid worldwide to the information on daytime and nighttime BP patterns offered by 24‐h ABPM in the diagnostic, prognostic, and therapeutic management of hypertension. In LA countries, most of the Scientific Societies of Hypertension and/or Cardiology have issued guidelines for hypertension care, and most of them include a special section on ABPM. Also, full guidelines on ABPM are available. However, despite the available evidence on the advantages of ABPM for the diagnosis and management of hypertension in LA, availability of ABPM is often restricted to cities with large population, and access to this technology by lower‐income patients is sometimes limited by its excessive cost. The authors hope that this document might stimulate health authorities in each LA Country, as well as in other countries in the world, to regulate ABPM access and to widen the range of patients able to access the benefits of this technique.