ABSTRACT
Objectives: To evaluate the role of autonomic nervous system in determining the appearance of diastolic ventricular dysfunction in patients with previously unrecognized and untreated essential hypertension
Methods: We studied 60 middle aged and pharmacologically untreated hypertensive subjects [45 men and 15 women] and 30 normotensive subjects [24 men and 6 women] as a control group [group I]. All patients were referred from outpatient clinic with blood pressure more than 140/90 mmHg as detected by ambulatory blood pressure monitoring with an ausculatory device. Echocardiography was done to assess left ventricular diastolic function. Exercise ECG test was done to exclude patients with ischaemic heart disease. Holter ECG monitor was done for all subjects to assess heart rate variability. Hypertensive patients were classified into two groups: group II: included 30 patients with diastolic dysfunction and group III: included 30 patients with normal ventricular systolic function
Results: In regard of age, gender, left ventricular mass index and left ventricular systolic function there was no significant difference between all groups of study [p = NS], but the hypertensive patients of group II had a significant decreased E/A ratio [p <0.05], a significant decrease in r-MSSD and p-NN50 [p < 0.05] and a significant increase in daytime and nighttime heart rate [p < 0.05] than subjects and patients of groups I and II. There was a significant correlation between vaeal dependent parameter [r-MSSD] and E/A ratio [r = 0.875, p < 0.05]. Stepwise logistic analysis revealed that no significant relation between age, gender and ambulatory systolic and diastolic blood pressure and the presence of left ventricular diastolic dysfunction in hypertensive patients
Conclusion: It is concluded that left ventricular diastolic dysfunction in hypertensive patients without left ventricle hypertrophy is related to reduced parasympathetic activity and this supports the use of non-pharmacologic treatments that increase vagal tone
ABSTRACT
A case of Strongyloides hyperinfection syndrome, associated with corticosteroid therapy is described here. A 69-year-old male patient was admitted with a minor stroke. A history of headache arid a markedly elevated ESR prompted a temporal artery biopsy, which was consistent with temporal arteritis. Treatment was started with prednisolone 60 mg per day and the patient was discharged for follow-up. He was readmitted with a dense hemiplegia arid high fever. Blood culture grew E.co/i. He rapidly deteriorated arid died with evidence of disseminated intravascular coagulation and acute respiratory distress syndrome. Wet smears of sputum were positive for larvae of Strongyloides sterco ru/is, suggesting generalised infection. The importance of early diagnosis arid therapy, and screening methods for detection of parasites in stool are discussed