Hypertension and paroxysmal atrial fibrillation: a novel predictive role of high sensitivity C-reactive protein in cardioversion and long-term recurrence.

The role of inflammation in maintenance of paroxysmal atrial fibrillation (PAF) in patients with hypertension and no other heart disease has not been fully elucidated yet. We investigated the association of various inflammatory markers with cardioversion and recurrence of PAF in patients with hypertension. We studied 75 patients (44 male, mean age 67.9+/-9.9 years) with PAF (duration from onset of symptoms<24 h) secondary to hypertension. None had heart failure or any other ongoing inflammatory process. All patients received anticoagulation and intravenous amiodarone for cardioversion. High sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6) and tumour necrosis factor (TNF)-alpha were measured on admission and 48 h later. By 48 h from admission 61/75 patients (81.3%) regained sinus rhythm (cardioverted), whereas 14/75(18.7%) remained in AF (non-cardioverted). hsCRP, IL-6 and TNF-alpha serum levels on admission were similar between groups. hsCRP at 48 h was the most significant factor correlated with cardioversion outcome (OR: 0.06, 95% CI: 0.01-0.47, P=0.008). During a 1-year follow-up, AF recurred in 28/61(45.9%) patients. The strongest factor associated with AF recurrence was hsCRP at 48 h > or =2.27 mg l(-1) (hazard ratio: 6.2, 95% CI: 2.2-17.6, P=0.001). hsCRP at 48 h after admission correlates with cardioversion outcome and may predict long-term AF recurrence.

Circulating oxidized LDL levels, current smoking and obesity in postmenopausal women.

OBJECTIVE: The aim of the present study was to estimate circulating oxidized low-density lipoprotein (oxLDL) levels in postmenopausal women and evaluate their association with obesity and smoking status. DESIGN AND METHODS: The study included 135 postmenopausal women aged 52-75 years. Forty of them were overweight (BMI 32.4+/-6.4) and non-smokers (Group A), 40 non-overweight (BMI 22.6+/-1.8) and smokers (Group B) and 55 non-overweight (BMI 23.5+/-1.4) and non-smokers (Group C). oxLDL and antibodies against them (anti-oxLDL) were measured using ELISA. Serum total cholesterol, LDL, HDL and triglycerides were measured in an automated analyzer. RESULTS: Total cholesterol, LDL, HDL and oxLDL serum levels were significantly elevated in Group A as compared to Group B or C, as well as oxLDL in Group B in comparison to Group C (p<0.001). Triglycerides and anti-oxLDL were increased in Group A in comparison to Group C (p=0.043 and 0.023). Total cholesterol, LDL, triglycerides and anti-oxLDL did not differ between Groups B and C, while HDL was decreased in Group B as compared to Group C (p<0.001). A significant positive correlation was found between oxLDL and LDL in Group A (r=0.53, p<0.001) as well as in Group C (r=0.955, p

Elevation of serum N-terminal pro-brain natriuretic peptide after exercise is an index of myocardial damage or a cytoprotective reflection?

AIM: Recent investigations have suggested the occurrence of transient cardiac dysfunction and reversible myocardial injury in healthy individuals after heavy exercise. Our purpose was to examine if the release of N-terminal pro-brain natriuretic peptide (NT-proBNP) after intense exercise in obviously healthy participants may have cytoprotective and growth-regulating effects or may result from myocardial dysfunction/damage with changes in cTnT as a marker for myocardial cell necrosis during exercise. METHODS: In 43 highly-trained male athletes <35 years old, who were examined immediately after exercising as well as 2 days later, 21 age-matched male patients classified as stage-B according to ACC/AHA guidelines and 35 healthy age-matched males, we evaluated NT-proBNP and 3rd generation's cTnT by electrochemiluminescence immunoassay. All participants underwent a detailed cardiac protocol including echocardiography and electrocardiogram (ECG). RESULTS: In athletes, cTnT consistently remained <0.01 mg/L after exercising as well as after 2 days. NTproBNP immediately after exercising was 58.27+/-19.48 ng/L, without reaching pathological levels, decreasing 2 days later to 22.93+/-10.22 ng/L. Our patients maintained high levels of NTproBNP, as much as a six-fold increase with reference to the levels of our study's control group and with cTnT <0.01 mg/L. In the control group, cTnT and NTproBNP levels were statistically similar with those of the athletes 2 days after exercising. NT-proBNP as a biological marker can reliably discriminate pathological from physiological cardiac hypertrophy. CONCLUSION: A normal plasma concentration of NT-proBNP in consecutive routine check-up, before and after exercise, could minimize the possibility of cardiac dysfunction, whereas persistent elevated plasma concentrations warrant further cardiological evaluation.

Primary non-refluxing megaureter: need for conservative treatment.

PURPOSE: In the last two decades, many reports have confirmed the efficacy and safety of the conservative treatment of non-refluxing megaureter in asymptomatic patients and many cases of ureteral dilatation tend to resolve spontaneously. We report our experience on 108 patients with primary non-refluxing megaureter detected prenatally or diagnosed after birth and we discuss our results with long-term non surgical treatment. MATERIAL AND METHODS: All patients were evaluated by ultrasound (US), voiding cystourethrogram (VCUG) and MAG3 renography. Observation period ranged from 6-72 months (mean 29.1). RESULTS: Surgery was performed in 12 patients (11.1%) with severe hydroureteronephrosis. Complete resolution or significant improvement was noted in 80 cases (74%) and persisted in 16 cases (14.8%). In the group with spontaneous resolution the ureteral diameter was less than in patients without resolution. Megaureters grade 1 to 3 tended to resolve between 12 and 36 months of observation. CONCLUSION: Conservative management is the treatment of choice in primary non refluxing megaureter. The grade of hydroureteronephrosis is an important predictor factor and infants should be followed periodically with renal ultrasound and diuretic renography.

Bisalbuminemia from a clinical chemist's viewpoint: a case report and review of the recent literature.

Bisalbuminemia is a rare inherent or acquired abnormality characterized by the occurrence of 2 distinct albumin bands or a single widened albumin band, after electrophoretic screening of blood proteins. Despite the fact that the presence of 2 albumin bands in electrophoresis, representing normal and variant protein, is observed with a frequency of 0.00030.0010 in the average population, its role in various pathological states has not yet been clearly defined. Until now, the only disorders which have been directly linked with the presence of congenital bisalbuminemia are familial dysalbuminemic hyperthyroxinemia (Arg218AEHis and Arg218AE Pro mutations) and hypertriiodothyroninemia (Leu66AEPro mutation), while acquired types of bisalbuminemia have been reported after an overdose of beta-lactam antibiotics and as a consequence of severe pancreatitis. We present a case of bisalbuminemia in an adult man who was referred to our laboratory with a prolonged history of recurrent abdominal pain and review the recent literature in order to better familiarize clinicians as well as laboratory personnel with this entity. The biochemical parameters assessed did not show any alteration which could correlate the protein disorder with any distinct pathology.