Factores relacionados con la presencia de disfunción eréctil en pacientes con síndrome de apnea obstructiva del sueño / Factors related with the presence of erectile dysfunction in patients with obstructive sleep apnea

Fundamento y objetivo: El síndrome de apnea obstructiva del sueño (SAOS) puede contribuir al desarrollo de disfunción eréctil (DE) a través de múltiples mecanismos. El objetivo fue identificar los factores que están relacionados con la presencia de DE en estos pacientes. Pacientes y método: Estudio transversal en varones diagnosticados de SAOS. Se recogieron variables demográficas, índice de apneas-hipopneas (IAH), comorbilidad, fármacos, presión arterial, escala Epworth, exploración física, electrocardiograma, índice tobillo-brazo, analítica sanguínea y de orina. La presencia de DE se valoró mediante el cuestionario IIEF-5. Resultados: Se incluyeron 142 pacientes, con una edad media (desviación estándar) de 53 (11) años. La prevalencia de DE fue del 69%. Encontramos diferencias significativas en el IAH entre los pacientes con DE leve y grave (41 [21] frente a 63 [18]; p=0,023). La DE se asoció a la hipertensión arterial [HTA] (odds ratio [OR] 3,56; intervalo de confianza del 95% [IC 95%] 1,64-7,72), hipercolesterolemia (OR 7,19; IC 95% 2,39-21,68), diabetes mellitus tipo 2 (OR 3,07; IC 95% 1,02-9,48) y cardiopatía isquémica (OR 1,51; IC 95% 1,33-1,70), así como al tratamiento con antihipertensivos (OR 4,05; IC 95% 1,76-9,31), hipolipidemiantes (OR 9,71; IC 95% 2,21-22,72), antidiabéticos (OR 3,21; IC 95% 0,69-14,89), antiagregantes y anticoagulantes (OR 6,44; IC 95% 1,45-28,64). Tras el análisis de regresión logística, la DE se asoció con la edad (OR 1,11; IC 95% 1,05-1,16) y la hipercolesterolemia (OR 4,87; IC 95% 1,49-15,96). Conclusiones: Los pacientes con SAOS tienen una alta prevalencia de DE, principalmente en SAOS grave. Los factores que influyen en la presencia de la DE en pacientes con SAOS son fundamentalmente la edad y la hipercolesterolemia. Otros factores que pueden estar relacionados son la HTA, el mal control metabólico, la cardiopatía isquémica y el consumo de antihipertensivos, estatinas y antidiabéticos (AU)

Background and objective: Obstructive sleep apnea (OSA) syndrome can contribute to the development of erectile dysfunction (ED) through multiple mechanisms. The aim was to identify factors influencing the presence of ED in these patients. Patients and methods: Cross sectional study in men diagnosed with OSA by polysomnography. We obtained information about demographic variables, apnea-hypopnea index (AHI), comorbidity, blood pressure, drugs, Epworth Sleepiness Scale, physical examination, electrocardiogram, ankle-brachial index and blood and urine analysis. The presence of ED was assessed by questionnaire IIEF-5. Results: We included 142 patients, mean age was 53 (11) years. The prevalence of ED was 69%. We found significant differences in AHI between patients with mild and severe ED (41 [21] vs 63 [18], P=.023). ED was associated with hypertension (odds ratio [OR]=3.56 [1.64-7.72]), hypercholesterolemia (OR=7.19 [2.39-21.68]), diabetes mellitus type 2 (OR=3.07 [1.02-9.48]) and ischemic heart disease (OR=1.51 [1.33-1.70]); and treatment with antihypertensive (OR=4.05 [1.76-9.31)], lipid-lowering drugs (OR=9.71 [2.2-22.72]), anti-diabetic drugs (OR=3.21 [0.69-14.89]), antiplatelet and anticoagulant agents (OR=6.44 [1.45-28.64]). After logistic regression analysis, only age (OR=1.11 [1.05-1.16]) and hypercholesterolemia (OR=4.87 [1.49-15.96]) were associated with ED. Conclusions: Patients with OSA have a high prevalence of ED, mainly in severe OSA. Factors influencing the presence of ED in patients with OSA are primarily age and hypercholesterolemia. Other factors that may be related include hypertension, poor metabolic control, ischemic heart disease, and treatment with antihypertensive, lipid-lowering and anti-diabetic drugs (AU)

[Factors related with the presence of erectile dysfunction in patients with obstructive sleep apnea]. / Factores relacionados con la presencia de disfunción eréctil en pacientes con síndrome de apnea obstructiva del sueño.

BACKGROUND AND OBJECTIVE: Obstructive sleep apnea (OSA) syndrome can contribute to the development of erectile dysfunction (ED) through multiple mechanisms. The aim was to identify factors influencing the presence of ED in these patients. PATIENTS AND METHODS: Cross sectional study in men diagnosed with OSA by polysomnography. We obtained information about demographic variables, apnea-hypopnea index (AHI), comorbidity, blood pressure, drugs, Epworth Sleepiness Scale, physical examination, electrocardiogram, ankle-brachial index and blood and urine analysis. The presence of ED was assessed by questionnaire IIEF-5. RESULTS: We included 142 patients, mean age was 53 (11) years. The prevalence of ED was 69%. We found significant differences in AHI between patients with mild and severe ED (41 [21] vs 63 [18], P=.023). ED was associated with hypertension (odds ratio [OR]=3.56 [1.64-7.72]), hypercholesterolemia (OR=7.19 [2.39-21.68]), diabetes mellitus type 2 (OR=3.07 [1.02-9.48]) and ischemic heart disease (OR=1.51 [1.33-1.70]); and treatment with antihypertensive (OR=4.05 [1.76-9.31)], lipid-lowering drugs (OR=9.71 [2.2-22.72]), anti-diabetic drugs (OR=3.21 [0.69-14.89]), antiplatelet and anticoagulant agents (OR=6.44 [1.45-28.64]). After logistic regression analysis, only age (OR=1.11 [1.05-1.16]) and hypercholesterolemia (OR=4.87 [1.49-15.96]) were associated with ED. CONCLUSIONS: Patients with OSA have a high prevalence of ED, mainly in severe OSA. Factors influencing the presence of ED in patients with OSA are primarily age and hypercholesterolemia. Other factors that may be related include hypertension, poor metabolic control, ischemic heart disease, and treatment with antihypertensive, lipid-lowering and anti-diabetic drugs.

beta-Adrenoceptor and GRK3 expression in human lymphocytes is related to blood pressure and urinary albumin excretion.

OBJECTIVE: The objective of our work was to analyze if changes in the expression of beta-adrenoceptors (beta-ARs) and G-protein-coupled receptor kinases (GRKs) in human lymphocytes - a practical surrogate for myocardial or vascular cells - are related to the hypertensive state and its clinical consequences. METHODS: Real-time quantitative RT-PCR was employed to evaluate the expression of the three beta-ARs (beta1, beta2, beta3) and three GRKs (GRK2, GRK3, GRK5) in human lymphocytes obtained from both normotensive and hypertensive patients, some of whom had been treated with blockers of the renin-angiotensin system. Office blood pressure, 24-h ambulatory blood pressure, urinary albumin excretion and serum biochemical profile were also recorded. RESULTS AND CONCLUSIONS: beta1-AR expression levels were higher in circulating lymphocytes from hypertensive patients (2-DeltaDeltaCt = 2.135 +/- 0.4252*, vs. control group), but this difference was not observed when these patients were treated with blockers of the renin-angiotensin system. beta1-AR levels directly correlated (r2 = 0.5711, P = 0.0185) with urinary albumin excretion in microalbuminuric patients, which relates alterations of this receptor to cardiovascular risk. An inverse correlation was observed between the expression levels of beta2-AR and diastolic blood pressure (r2 = 0.2078, P = 0.0031), suggesting that beta2-AR levels in lymphocytes mirror their expression in vascular cells, in which beta2-AR-mediated relaxation regulates vascular resistance. mRNA levels for GRK3 were inversely correlated with systolic and diastolic blood pressure (day, night and 24 h), which suggests a protective role for GRK3 in the regulation of human blood pressure, as supported by previous findings in transgenic mice.

Factors related to the occurrence of microalbuminuria during antihypertensive treatment in essential hypertension.

The objective of the study was to assess the factors related to the occurrence of microalbuminuria during the follow-up of a young adult group with essential hypertension that had not been previously treated. Normo-albuminuric essential hypertensives, <50 years old, who had not been previously treated with antihypertensive drugs and who did not have diabetes mellitus were included. After the initial evaluation, patients were treated using only nonpharmacological measures (n=62), beta-blockers (n=38), ACE inhibitors (n=64), calcium channel blockers (n=8), and several classes (n=15). Measurements were taken for office blood pressure, biochemical profile, and 24-hour urinary albumin excretion at the beginning of the study and were measured yearly during an average of 2.7+/-1.2 years of follow-up. Among the 187 patients included, 22 (11,7%) developed microalbuminuria (progressors, 4.4/100 patients/y). No differences were present between progressors and those who remained normo-albuminuric (nonprogressors) in terms of age, gender, body mass index, disease duration, blood pressure values, biochemical profile, familial history of diabetes or hypertension, smoking habits, or the presence of EKG left ventricular hypertrophy. The group with the lowest progression rate was the patients treated with ACE inhibitors (n=5; 2.9/100 patients/y), followed by the diet group (n=5; 3.3/100 patients/y) and the beta-blockers group (n=5; 4.1/100 patients/y). When we excluded patients treated with calcium channel blockers or those who changed over time between different classes of treatment, no significant differences in the incidence of microalbuminuria were observed among the groups. Progressors showed higher slopes of fasting glucose (4.78+/-11.4 versus 0.50+/-6.8 mg/y, P<0.02) and uric acid (0.58+/-0.93 versus 0.05+/-1.10 mg/y, P<0.03) compared with the slopes of nonprogressors. Both the slopes for glucose and systolic blood pressure over time were associated independently with the slope of the logarithm of urinary albumin excretion when adjusted for age, gender, and treatment groups. Cox proportional hazard model for progression of microalbuminuria showed that baseline urinary albumin excretion (risk ratio [RR]=1.06; confidence interval [CI] 95%, 1.01 to 1.11), slope for systolic blood pressure (RR=1.11; CI 95%, 1.03 to 1.20), and slope for glucose (RR=1.08; CI 95%, 1.03 to 1.14) were independently associated to the development of microalbuminuria. In conclusion, in a group of young adults with essential hypertension that had not been previously treated, the main factors influencing the occurrence of microalbuminuria during antihypertensive treatment were the values of microalbuminuria at baseline and the slopes for systolic blood pressure and fasting glucose.

[Tuberculous spondylodiskitis (Pott's disease): Experience in a general hospital]. / Espondilodiscitis tuberculosa o enfermedad de Pott: experiencia en un hospital general.

BACKGROUND: Pott's disease (PD) is an uncommon extra-pulmonary form of tuberculosis. Dissimilar data about location, diagnosis and treatment from various hospitals and different countries are reported. PATIENTS AND METHOD: We present our experience with Pott's disease at our institution between January 1993 to December 1999, retrospectively, based on clinical bacteriological and pathological research. We found the medical records of 14 patients diagnosed as having PD at our hospital. The following information was obtained: age, sex, symptoms and sings at presentation, PPD tuberculin skin test, imaging techniques, mycobacterium cultures and smear, histopathologic study, treatment and clinical outcome. RESULTS: The number of microbiological diagnosed tuberculosis during the study period was of 1,400 (4 cases per 1,000 admissions). From them, 1,047 cases (74.8%) were pulmonary and 353 cases (25.2%) extra-pulmonary. We found the medical records of 14 patients diagnosed as having PD at our hospital. There was a diagnostic delay between 2 and 720 days. In 5 cases, cultures were positive (1.4% extra-pulmonary). The following information was obtained: age, sex, symptoms and signs at presentation, PPD tuberculin skin test, imaging techniques, mycobacterium cultures and smear, histopathologic study, treatment and clinical outcome. The mean age of the patients was 58 years. Pain and dorsal location were more frequent (8/14). In 6 cases, tuberculosis was diagnosed at other sites. Tuberculin skin test was positive in 7 ases (50%). The diagnosis was confirmed by positive cultures from biopsies in 5 from 8 cases performed and the histology was compatible in 8 from 11 cases performed. Diskitis was presented in 10 cases, soft tissue abscess in 9 cases (psoas abscess in 2); epidural compression in 9 cases and surgery was necessary in 9 cases (diagnostic in 3). CONCLUSIONS: Pott's disease is a rare entity even among HIV-patients in whom extrapulmonar disease has increased. Dorsal location, diskitis and advanced forms of the disease that deserve surgical treatment are frequent.

Espondilodiscitis tuberculosa o enfermedad de Pott: experiencia en un hospital general / Tuberculous spondylodiskitis (Pott's disease): Experience in a general hospital

FUNDAMENTOS. La enfermedad de Pott es una manifestación infrecuente de tuberculosis extrapulmonar. Los datos sobre localización, diagnóstico y tratamiento son muy dispares según los centros y países. PACIENTES Y MÉTODO. Revisamos nuestra experiencia con la enfermedad de Pott durante un período de 7 años (1993-1999), de forma retrospectiva y basándonos en datos clínicos, bacteriológicos y microbiológicos. Encontramos 14 casos de enfermedad de Pott. Revisamos las siguientes variables: edad, sexo, signos y síntomas de presentación, reacción de la tuberculina (PPD), datos microbiológicos, histopatológicos, de extensión, tratamiento y evolución clínica. RESULTADOS. El número de casos de tuberculosis con diagnóstico microbiológico durante este período fue de 1.400 (4 casos por cada 1.000 ingresos). De ellos, 1.047 casos (74,8 por ciento) fueron pulmonares y 353 (25,2 por ciento) extrapulmonares. Encontramos 14 casos de enfermedad de Pott, cinco de ellos con cultivo positivo (un 1,4 por ciento extrapulmonares). La edad media de nuestros pacientes fue de 58 años. El tiempo de latencia hasta el diagnóstico varió entre 2 y 720 días. El dolor fue el síntoma de presentación más referido. La localización dorsal fue la más frecuente (8/14).Encontramos tuberculosis en otra localización en 6 casos y PPD en 7 pacientes (50 por ciento). En cinco de los 8 casos en que se realizó, el cultivo de punción-aspiración con aguja fina (PAAF) o biopsia fue diagnóstico, y la histología fue congruente en ocho de los 11 casos en que pudo llevarse a cabo. Asimismo, encontramos discitis en 7 casos, absceso a partes blandas en 9 pacientes (2 abscesos del psoas) y en 9 casos fue necesario realizar una intervención quirúrgica (en tres de los cuales fue diagnóstica). CONCLUSIONES. La enfermedad de Pott es una forma actualmente infrecuente de tuberculosis extrapulmonar en nuestro medio, incluso en pacientes infectados por el virus (AU)

Estudio de los factores relacionados con los cambios en la microalbuminuria durante el tratamiento antihipertensivo / Study of factors related with changes of microalbuminuria during antihypertensive treatment

Fundamento: Conocer los factores que determinan los cambios en la microalbuminuria (mAlb) durante el tratamiento antihipertensivo en pacientes con hipertensión arterial (HTA) esencial. Métodos: Se incluyeron 106 pacientes hipertensos esenciales (57 varones; edad media (DE) de 40,8 [6,6] años) no diabéticos y nunca tratados con fármacos antihipertensivos. Se determinaron valores de presión arterial, perfil bioquímico y excreción urinaria de albúmina (EUA) mediante inmunonefelometría en dos muestras de orina de 24 h. Los pacientes se asignaron al azar a recibir tratamiento, de forma que 53 pacientes se trataron con inhibidores de la enzima conversiva de la angiotensina (IECA), y 53 con bloqueadores beta (BB), manteniéndose durante 12 meses. En ambos grupos se añadió hidroclorotiazida cuando fue necesario para mantener cifras de presión arterial inferiores a 140/90 mmHg. Resultados: La EUA media fue de 32,1 (43,1) mg/24 h, 41 (39 por ciento) con mAlb > 30 mg/24 h. A los 12 meses se produjo un descenso significativo en la presión arterial sistólica (PAS) (-20,6 [18,03] mmHg, p < 0,001), presión arterial diastólica (PAD) (-14,18 [10,34] mmHg, p < 0,001) y un aumento de la glucemia (3,08 [11,07] mg/dl, p = 0,006). Los cambios en la EUA se relacionaron con los valores iniciales de EUA, y fueron independientes de la edad, sexo, PAD inicial, y cambios en la PAD. Aunque el descenso sobre la PAS y PAD no fue distinto en los pacientes tratados con IECA que con BB (PA media de -17,2 [10,9] frente a -14,8 [10,4] mmHg; p = NS), la EUA descendió significativamente sólo en el grupo de IECA (LogEUA: -0,203 [0,872] mg/24 h; p = 0,04). Adicionalmente, en los pacientes tratados con BB se produjo un aumento de glucemia (4,4 [12,3] mg/dl; p = 0,013) y ácido úrico (1,18 [4,18]; p = 0,031). Conclusiones: En pacientes con HTA esencial el descenso de la mAlb se relaciona principalmente con los valores basales de mAlb y con el tipo de tratamiento antihipertensivo, de forma que los IECA producen mayor descenso sobre la mAlb que los BB. (AU)