Association of hyperuricemia with conventional cardiovascular risk factors in elderly patients.

The relationship between serum uric acid (UA) and cardiovascular risk profile was investigated in 557 outpatients (415 women) aged 60 years and older. Patients were grouped according to a UA cutoff level of 5.5 mg/dL. Prevalence of obesity, hypertension, and impaired glucose metabolism was increased in women with higher UA, who had higher body mass index (37.7±6.9 vs 33.1±5.9 kg/m(2) , P<.001), waist circumference, and serum glucose and triglyceride concentrations than women with lower UA levels. Conversely, men with higher UA levels showed lower high-density lipoprotein cholesterol and higher left ventricular mass than men with lower UA levels. Estimated glomerular filtration rate was reduced in patients with high UA levels of both sexes (65±17 vs 72±16 mL/min/1.73 m(2) , P<.001, for women; 70±16 vs 76±15 mL/min/1.73 m(2) , P<.03, for men). Grouping patients by sex-specific median UA concentrations produced similar results. These data indicate that, even in the elderly, UA clusters in a sex-specific fashion with features of metabolic syndrome and signs of target organ damage.

Relative fat-free mass deficiency and left ventricular adaptation to obesity: the Strong Heart Study.

BACKGROUND: Relative fat-free mass (FFM) deficiency (RFFMD) can also occur in obesity, but the impact on left ventricular (LV) mass is unknown. METHODS: We assessed relations among reduced FFM, obesity and LV mass in a population with high prevalence of obesity. Echocardiograms were performed in 2625 participants (1694 women, 1199 non-obese) of the Strong Heart Study cohort, free of prevalent cardiovascular disease and kidney failure. FFM was estimated by bioelectric impedance and analyzed in the non-obese subpopulation in relation with sex, BMI and waist-to-hip ratio (WHR). RFFMD was estimated in the obese subpopulation as the percent of observed/predicted FFM<20th percentile of the non-obese distribution. RESULTS: RFFMD was more frequent in women than men. LV mass indices (by either height(2.7) or FFM) were greater in obese with than in those without RFFMD, even after adjusting for sex and diabetes (both p<0.0001). The greater LV mass index in obesity with RFFMD was related mostly to increased LV diastolic dimension paralleling increased stroke index and cardiac index, in the presence of normal ejection fraction. RFFMD remained associated with greater LV mass index (p<0.0001) even independently of older age, greater BMI, higher systolic and lower diastolic blood pressure (all p<0.007), with negligible effect of sex, waist/hip ratio and diabetes. CONCLUSION: In obese SHS participants, RFFMD is associated with higher levels of LV mass, an effect related to adiposity more than central fat distribution and typical of female gender. Biological mechanisms of this association have to be better explored.

Lifestyle educational program strongly increases compliance to nonpharmacologic intervention in hypertensive patients: a 2-year follow-up study.

The authors investigated the efficacy of a lifestyle educational program, organized in small group meetings, in improving the outcome of a nonpharmacologic intervention. One hundred and eighty-eight hypertensive patients with stable blood pressure (BP) levels and drug therapy in the previous 6 months were randomly divided into educational care (EC) and usual care (UC) groups. They were followed at 3-month intervals up to 2 years. In addition to the visits in an outpatient clinic, patients in the EC program participated in small group meetings in order to improve their knowledge of the disease and reinforce their motivation for treatment. At baseline, EC and UC groups were similar for age, sex, body mass index (BMI), blood pressure (BP) levels, and pharmacologic treatment. Patients in the EC group had significantly reduced total energy, total and saturated fats, and sodium intake. Physical activity was significantly increased in the EC group as well. At the end of the 1-year follow-up, BMI (P<.001), visceral fat (P<.001), and BP (P<.001) were significantly lower in the EC group compared with the UC group. Pharmacologic treatment during the study was similar for all classes of drugs apart from diuretics whose dose was higher in the UC group at the end of the study.

Bullying, agresores, victimas y testigos del maltrato entre iguales / Bullying, aggressors, victims and witnesses of peer abuse

Estudio descriptivo por encuesta autoadministrada (junio 2007). Muestra: 616 alumnos de edades comprendidas entre 12 y 18 años de 14 Instituciones Educativas de Bahía Blanca, Puan y Benito Juarez. Análisis Estadístico: Prueba CHI Cuadrado de Homogeneidad de proporciones...

Immunophenotype of sporadic and familial adenomatous polyposis associated fundic gland polyps: a mucin and MIB1 study.

BACKGROUND: Fundic Gland Polyps (FGPs) are small sessile (2-5 mm) usually multiple polyps arising in the gastric, acid-secreting mucosa, described both in a sporadic form, prevalently in middle aged females, and associated with familial adenomatosis coli (FAP)-Gardner's syndrome and their attenuated variants (syndromic form). AIMS: We performed an immunohistochemical study on 5 syndromic (4 cases without and 1 case with dysplasia) and 28 sporadic FGPs, using monoclonal antibodies (MoAbs) against normal epitopes of fundic mucosa (Ck20, the surface gastric mucin M1, EMA, ChA), H. pylori and HLA-DR(Ia) antigens, CEA and mucin epitopes, and the Ki67 (MIB1) proliferation antigen, in order to establish the immunophenotype of FGPs; find any possible differences between sporadic and syndromic polyps. RESULTS: Ck20 and M1 were positive on surface and foveolar epithelium of controls, whereas sporadic and syndromic FGPs showed an enhanced deep positivity below foveolar necks ("foveolar metaplasia"); EMA was strongly positive on parietal cells, highlighting intracytoplasmic canaliculi. Chromogranin-positive cells in FGPs were alike controls, except for a sporadic case with micronodular hyperplasia. Ck7, as expected, was negative in controls, whereas the 5 syndromic FGPs and 25 of 28 sporadic FGPs showed a diffuse superficial and deep expression. H. pylori anti-serum gave negative results on all cases, and only 3 sporadic FGPs showed epithelial expression of HLA-DR(Ia). Syndromic FGPs were CEA negative, whereas 32% of sporadic FGPs expressed it. FGPs showed a neoexpression of the mucin oncofetal epitopes syalil-Tn (3/5 syndromic, 82% sporadic) CA19.9 and CA50 (4/5 syndromic, 14% sporadic). MIB1-labelling index of surface (30.5%) and deep (37.1%) compartments of the 4 syndromic FGPs without dysplasia was enhanced, with high statistical significance (p < 0.0001) both in comparison to controls (16.9% superficial stain only) and sporadic FGPs (15.8% surface, 19.5% deep labeling indexes). Moreover, the MIB1 labeling-index of the syndromic case with dysplasia (60.8% surface, 56.6% deep labeling indexes) was further enhanced in comparison with the other 2 syndromic cases. CONCLUSIONS: Sporadic and syndromic FGPs showed a neoexpression of Ck7, CEA, and mucin epitopes. As these markers are normal antigens of fetal stomach, FGPs showed a fetal, "immature" immunophenotype. The only difference we found between syndromic and sporadic polyps was a statistically significant enhanced MIB1-labelling index expression by syndromic FGPs, further enhanced in the syndromic FGP with dysplasia.

Sporadic fundic gland polyps: clinico-pathologic features and associated diseases.

BACKGROUND: Fundic gland polyps have been described either in association with genetic polyposis syndromes of the colon, or in a sporadic form. In the first case they are diagnosed during family screening in asymptomatic subjects, while sporadic FGP patients often complain of upper gastrointestinal symptoms. So far, no great attention has been paid to the clinical presentation of these patients, so we undertook a clinico-pathologic study to further delineate: the clinical presentation at 1st examination; the associated gastrointestinal conditions; a possible role of omeprazole; Helicobacter pylori (H. pylori) colonization, the presence of intestinal metaplasia and dysplasia. METHODS: We followed-up for a 9-year period with endoscopies a case series of 70 patients with sporadic FGPs, recording endoscopic data, symptoms, associated gastrointestinal conditions, previous therapies, histopathological findings. RESULTS: The prevalence of the present series was 0.36%. The patient prevalence and number of polyps by age classes rose in women (maximum value in perimenopausal age), while was constant in males. We observed a frequent association between FGPs and esophageal conditions (34%), namely hiatus hernia-reflux esophagitis, significantly higher than in our endoscopic population (15%). Five patients had an isolated colonic adenoma. Only one patient had received long term omeprazole therapy. H. pylori was negative in all 70 FGPs, and in 15 samples of antral mucosa. No metaplastic or dysplastic lesions were seen. CONCLUSION: Sporadic FGP patients frequently complain of epigastric pain, burning, dyspepsia, probably related to the frequently associated esophageal pathology, namely reflux esophagitis-hiatus hernia (34%). Prevalence of FGPs and polyps number are linked to female sex (maximum rise for both values in perimenopausal age). No link with omeprazole therapy was seen. FGPs patients appear to be protected from H. pylori colonization and ultimately from the development of intestinal metaplasia-dysplasia-gastric cancer. Nonetheless, they are apparently more prone to colonic adenomas. So, every sporadic FGP patient should undergo colonic surveillance.

Prevalence of Helicobacter pylori infection and intestinal metaplasia in subjects who had undergone surgery for gastric adenocarcinoma in Northwest Italy.

AIM: To investigate the seroprevalence of Helicobacter pylori (H pylori) infection and its more virulent strains as well as the correlation with the histologic features among patients who had undergone surgery for gastric cancer (GC). METHODS: Samples from 317 (184 males, 133 females, mean age 69+/-3.4 years) consecutive patients who had undergone surgery for gastric non-cardia adenocarcinoma were included in the study. Five hundred and fifty-five (294 males, 261 females, mean age 57.3+/-4.1 years) patients consecutively admitted to the Emergency Care Unit served as control. Histological examination of tumor, lymph nodes and other tissues obtained at the time of surgery represented the diagnostic "gold standard". An enzyme immunosorbent assay was used to detect serum anti-H pylori (IgG) antibodies and Western blotting technique was utilized to search for anti-CagA protein (IgG). RESULTS: Two hundred and sixty-one of three hundred and seventeen (82.3%) GC patients and 314/555 (56.5%) controls were seropositive for anti-H pylori (P<0.0001; OR, 3.58; 95%CI, 2.53-5.07). Out of the 317 cases, 267 (84.2%) were seropositive for anti-CagA antibody vs 100 out of 555 (18%) controls (P<0.0001; OR, 24.30; 95%CI, 16.5-35.9). There was no difference between the frequency of H pylori in intestinal type carcinoma (76.2%) and diffuse type cancer (78.8%). Intestinal metaplasia (IM) was more frequent but not significant in the intestinal type cancer (83.4% vs 75.2% in diffuse type and 72.5% in mixed type). Among the patients examined for IM, 39.8% had IM type I, 8.3% type II and 51.9% type III(type III vs others, P = 0.4). CONCLUSION: This study confirms a high seroprevalence of H pylori infection in patients suffering from gastric adenocarcinoma and provides further evidence that searching for CagA status over H pylori infection might confer additional benefit in identifying populations at greater risk for this tumor.