Predictors of Increased Left Ventricular Filling Pressure in Dialysis Patients with Preserved Left Ventricular Ejection Fraction

Aim

To study the left and right ventricular function and to assess the predictors of increased left ventricular (LV) filling pressure in dialysis patients with preserved LV ejection fraction.

Methods

This study included 63 consecutive patients (age 57 ± 14 years, 57% women) with end-stage renal failure. Echocardiography, including tissue Doppler measurements, was performed in all patients. Based on the median value of the ratio of transmitral early diastolic velocity to early myocardial velocity (E/E’ ratio), patients were divided into 2 groups: the group with high filling pressure (E/E’>10.16) and the group with low filling pressure (E/E’≤10.16).

Results

Compared with patients with low filling pressure, the group of patients with high filling pressure included a higher proportion of diabetic patients (41% vs 13%, P = 0.022) and had greater LV mass index (211 ± 77 vs 172 ± 71 g/m³, P = 0.04), lower LV lateral long axis amplitude (1.4 ± 0.3 vs 1.6 ± 0.3 cm, P = 0.01), higher E wave (84 ± 19 vs 64 ± 18cm/s, P < 0.001), lower systolic myocardial velocity (S’:8.6 ± 1.5 vs 7.0 ± 1.3 cm/s, P < 0.001), and lower diastolic myocardial velocities (E’: 6.3 ± 1.9 vs 9.5 ± 2.9 cm/s, P < 0.001; A’: 8.4 ± 1.9 vs 9.7 ± 2.5 cm/s, P = 0.018). Multivariate analysis identified LV systolic myocardial velocity – S’ wave (adjusted odds ratio, 1.909; 95% confidence interval, 1.060-3.439; P = 0.031) and age (1.053; 1.001-1.108; P = 0.048) as the only independent predictors of high LV filling pressure in dialysis patients.

Conclusions

In dialysis patients with preserved left ventricular ejection fraction, reduced systolic myocardial velocity and elderly age are independent predictors of increased left ventricular filling pressure.Cardiovascular disorders are the main cause of mortality and morbidity in patients with end-stage renal failure who are in regular hemodialysis programs (1,2). The left ventricular (LV) hypertrophy is a common finding in these patients. It reflects a physiological response to pressure and volume overload (3) and positively correlates with cardiovascular mortality (4). LV hypertrophy is frequently associated with LV dilatation and reduced systolic function (5). An increased incidence of atherosclerotic cardiovascular events in these patients has also been reported (6). Systolic dysfunction and LV hypertrophy have been identified as the best predictors of outcome in dialysis patients (4,7,8). However, the conventional systolic dysfunction appears in the late stages of the chronic renal failure (9).In contrast to conventional echocardiography, tissue Doppler imaging of the myocardial velocities overcomes the load dependence of diastolic parameters (10). The ratio of transmitral early diastolic velocity (E) to early myocardial velocity (E’) (E/E’ ratio) has been shown to be an accurate method of the LV filling pressure estimation (8) and the best predictor of LV diastolic filling in various cardiac pathologies (11,12), thereby serving as one of the best predictors of outcome in heart failure patients (13-15) and patients with end-stage renal disease (16).The aims of this study were to investigate the left and right ventricular function in patients with end-stage renal disease and preserved LV ejection fraction and to assess the predictors of increased LV filling pressure in these patients.     

Phytochemical composition,anti-inflammatory activity and cytotoxic effects of essential oils from three Pinus spp.

Context: Inflammation and cell differentiation lead to a number of severe diseases. In the recent years, various studies focused on the anti-inflammatory and anticancer activity of essential oils (EOs) of numerous plants, including different Pinus species.

Objective: The phytochemical composition, anti-inflammatory and cytotoxic activity of EOs from needles and twigs of Pinus heldreichii Christ (Pinaceae) and P. peuce Griseb., and from needles, twigs and cones of P. mugo Turra were determined.

Materials and methods: For separation and identification of the EOs, gas chromatography/flame ion detector (GC/FID) and GC/mass spectrometry were performed. The amount of secreted IL-6 in a lipopolysaccharide (LPS)-stimulated macrophage model was quantified (concentration of oils: 0.0001–0.2%, 3?h incubation). Cytotoxicity on the cancer cell lines HeLa, CaCo-2 and MCF-7 were determined using a MTT (Thiazolyl Blue Tetrazolium Bromide) assay (concentration of oils: 0.001–0.1%, 24?h incubation).

Results: The most prominent members in the oils include: δ-3-carene, α-pinene and linalool-acetate (P. mugo); α-pinene, β-phellandrene and β-pinene (P. peuce); limonene, α-pinene and (E)-caryophyllene (P. heldreichii). EOs showed significant cytotoxic effects on cancer cell lines (IC₅₀ 0.007 to >0.1%), with a reduction in cell viability with up to 90% at a concentration of 0.1%, and anti-inflammatory activity (IC₅₀ 0.0008–0.02%) with a reduction of IL-6 secretion with up to 60% at a concentration of 0.01%.

Discussion and conclusion: The EOs of needles and twigs from P. peuce and P. heldreichii as well as of needles, twigs and cones of P. mugo can be considered as promising agents for anticancer and anti-inflammatory drugs.     

Epidemiology of hepatitis B virus infection in Albania

AIM： To assess the prevalence and socio-demographic distribution of hepatitis B virus （HBV） infection in Albania. METHODS： Blood samples from 410 unselected schoolboys, 666 students, 500 military personnel, 1286 casual blood donors, 378 voluntary blood donors and 640 pregnant women （total 3880 non-vaccinated residents of rural and metropolitan areas from all over Albania; 2354 （60.7%） male and 1526 （39.3%） female; mean age of 26.3 years） were tested during 2004-2006 for hepatitis B surface antigen （HBsAg） and antibodies to hepatitis B virus （anti-HBs） by ELISA. RESULTS： The HBsAg and anti-HBs prevalence were 9.5% and 28.7%, respectively. The highest HI3sAg prevalence was evident in the younger age group, such as in schoolchildren （11.8%） and the military （10.6%）. Consequently, the anti-HBs prevalence increased with age, from 21.2% in schoolchildren （mean age： 15.7 years）, to 36.3% in pregnant women （mean age： 26.3 years） and 29.7% in voluntary blood donors （mean age： 40.1 years）. There were no significant differences between males and females. CONCLUSION： Despite the estimated two-fold reduction of HBsAg prevalence in the general population from about 18%-19% to 9.5%, Albania remains a highly endemic country （i.e. over 8% of HBsAg prevalence rate）.     

Sevoflurane anesthesia for magnetic resonance procedures in pediatrics

OBJECTIVE: To assess the efficacy and safety of sevoflurane anesthesia in children during magnetic resonance imaging procedures. MATERIAL AND METHODS: The patients were 105 ASA-I-II children, mean weight 13 +/- 10 Kg and mean age 2.9 years (range 1 day-10 years), twenty (20%) of whom were under 3 months old. Induction was gradual with 6% sevoflurane in a mixture of nitrous oxide and oxygen, followed by maintenance with 1-2% sevoflurane in the same mixture through a face mask or nasal tubes while the patient breathed spontaneously. All procedures were performed satisfactorily. Ten minutes after anesthesia, 88% of the patients were fully awake. None suffered prolonged sedation and no serious complications occurred during the study period. The most common side effects were transient decreases in oxygen saturation in 15 patients (14%), although none reached the critical level (SpO2 < 90%). Six of those patients were under 3 months old. After recovering from sedation, 13 patients (12%) suffered transient episodes of excessive agitation, usually 5 minutes after awakening. Five patients (4.8%) vomited in the recovery room. CONCLUSIONS: This study indicates that sevoflurane is safe and effective for sedating children, including newborn infants, who must undergo magnetic resonance imaging.     

Challenging predictions between affective temperaments,depression and anxiety in a Kosovo student community sample

Abstract

Objective: The relationship between temperament and mental health problems is seen very important as we hope to explain the trajectory of this interaction. The aim of this study was to test the validity of affective temperaments for predicting psychiatric morbidity, by explaining the relationships between temperament, anxiety and depression in a community sample.

Methods: This was a cross-sectional study. The present sample consisted of 960 participants (347 male, 622 female) with a mean age of M?=?28.4 (SD?=?10) randomly recruited. Affective temperaments were measured by the brief version of TEMPS-A, depression and anxiety measured with Beck Depression Inventory and Beck Anxiety Inventory.

Results: The Cronbach alpha reliability coefficients for affective temperaments were between .72 and .81, for BDI and BAI, were .88 and .90. The study found significant gender differences on depressive [t(959)?=?–4.2, p<.001], cyclothymic [t(957)?=?–4.6, p?<?.001] and anxious temperament [t(957)?=?–8.2, p?<?.001], females having higher scores than males, and reverse results on hyperthermic temperament [t(958)?=?2.1, p?<?.045], males having higher scores than females. No gender difference is found in irritable temperament [t(955)?=?–.581, p?<?.561]. Affective temperaments were found significant predictors for depression and anxiety. The combination of the depressive temperament and cyclothymic temperament explained the 32% variance of depression and the 25% variance of anxiety.

Conclusions: Study findings are consistent with some other studies and stress the importance of screening for effective temperament in order to early identify depression and anxiety. Further investigation is needed to understand what are other factors that influence the relationship between affective temperaments with depression and anxiety.     

Psychopathology and well‐being in civilian survivors of war seeking treatment: a follow‐up study

The goal of the current study was to examine types of exposure to traumatic events and affective and anxiety disorders of 81 civilian war survivors seeking treatment for war‐related stress almost one decade following the war in the area of former conflict. Furthermore, the study investigated changes in symptoms of mental health and in well‐being amongst these individuals during a treatment period of 6 months. The results indicated that civilian war survivors seeking treatment reported multiple war‐related traumatic events and high levels of psychiatric morbidity. Individuals assessed at follow‐up (n = 67) reported no change in post‐traumatic stress symptoms or psychological well‐being, but improvement in symptoms of depression, overall psychiatric distress and quality of life. The only significant difference between participants classified as achieving clinically significant improvement as compared with those who did not achieve such change was in less symptom severity of depression, post‐traumatic stress, general distress and higher psychological well‐being at the time of first assessment. Neither the assessment of initial diagnoses nor war or post‐war trauma types emerged as significantly different amongst the two groups. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? Civilian survivors of war seeking treatment report high levels of psychiatric morbidity. ? Treatment for survivors of war may require adaptations to evidence‐based treatments based on their culture and life circumstances in order to recover from PTSD and experience general emotional relief.     

The role of SLC2A1 mutations in myoclonic astatic epilepsy and absence epilepsy,and the estimated frequency of GLUT1 deficiency syndrome

The first mutations identified in SLC2A1, encoding the glucose transporter type 1 (GLUT1) protein of the blood–brain barrier, were associated with severe epileptic encephalopathy. Recently, dominant SLC2A1 mutations were found in rare autosomal dominant families with various forms of epilepsy including early onset absence epilepsy (EOAE), myoclonic astatic epilepsy (MAE), and genetic generalized epilepsy (GGE). Our study aimed to investigate the possible role of SLC2A1 in various forms of epilepsy including MAE and absence epilepsy with early onset. We also aimed to estimate the frequency of GLUT1 deficiency syndrome in the Danish population. One hundred twenty patients with MAE, 50 patients with absence epilepsy, and 37 patients with unselected epilepsies, intellectual disability (ID), and/or various movement disorders were screened for mutations in SLC2A1. Mutations in SLC2A1 were detected in 5 (10%) of 50 patients with absence epilepsy, and in one (2.7%) of 37 patient with unselected epilepsies, ID, and/or various movement disorders. None of the 120 MAE patients harbored SLC2A1 mutations. We estimated the frequency of SLC2A1 mutations in the Danish population to be approximately 1:83,000. Our study confirmed the role of SLC2A1 mutations in absence epilepsy with early onset. However, our study failed to support the notion that SLC2A1 aberrations are a cause of MAE without associated features such as movement disorders.