Association between serological evidence of past Coxiella burnetii infection and atherosclerotic cardiovascular disease in elderly patients.

Q fever, caused by Coxiella burnetii, may cause vascular complications, but the role that this infection may play in the development of atherosclerotic cardiovascular disease remains unknown. This study examined the association between Q fever serology and cardiovascular disease in a region where Q fever is endemic. A case-control study was conducted in the Hospital Universitario de Burgos (Spain) between February 2011 and June 2012. A total of 513 samples were tested, from 454 hospitalized patients ≥65 years old, of whom 164 were cases (patients with prevalent or incident coronary heart, cerebrovascular or peripheral artery, disease) and 290 controls (patients without cardiovascular disease). Serum IgG antibody phase II titres against Q fever were determined by immunofluorescence assay. Seropositivity (titres ≥1:256) was detected in 84/164 (51.2%) cases and in 109/290 (37.6%) controls (p = 0.005; OR, 1.7; 95% CI, 1.1-2.5). This ratio increases when adjusted for sex, hypertension, dyslipidaemia, smoking, diabetes and atrial fibrillation (OR, 2.6; 95% CI, 1.5-4.7). The geometric mean titre (GMT) for C. burnetii phase II assay was higher in cases than in controls (p = 0.004). We found no significant relationship between cardiovascular disease and C. pneumoniae, and Cytomegalovirus seropositivity (both determined by the IgG ELISA method). In conclusion, serological evidence of past Q fever is associated with atherosclerotic cardiovascular disease in elderly patients in an endemic region.

Absceso hepático amebiano autóctono. Presentación de un caso / Indigenous amebic liver abscess. Presentation of a case

No disponible

No disponible

Afectación pulmonar en la esclerosis tuberosa / Pulmonary involvement in tuberous sclerosis

No disponible

Leiomiosarcoma multicéntrico en paciente VIH / Multicentric leiomyosarcoma in patient with AIDS

No disponible

[Cardiovascular and hormonal factors associated with the lack of nocturnal fall in blood pressure among individuals aged over 55]. / Factores cardiovasculares y hormonales asociados a la falta de descenso nocturno de la presión arterial en sujetos mayores de 55 años.

BACKGROUND: Usually, there is a physiological fall in nocturnal blood pressure among all individuals, both hypertensive and normotensive individuals. The lack of nocturnal blood pressure (BP) fall may be associated with the risk of developing cardiovascular complications in hypertensive patients. Cardiovascular and hormonal factors associated with the lack of nocturnal blood pressure fall was studied in individuals aged over 55, those most exposed to this kind of complications. METHODS: A total of 108 individuals aged over 55 and with a wide range of BP (59 normotensive and 49 light-moderate hypertensive with no previous treatment) were studied. Two groups were established: dipper and non-dipper, with a fall over 10% in nocturnal SBP and DBP or not, respectively. Patients included in the study underwent serum hormonal measurements (renin, aldosterone, endoteline-1, atrial natriuretic peptide, free epinephrine and norepinephrine), continuous blood pressure monitoring for 24 hours (CBPM) and echocardiography with measurement of left ventricular mass (LVM), cardiac output, and peripheral vascular resistances (PVR) (determined in function of mean blood pressure and cardiac output). RESULTS: Fifty-one individuals were dipper and 57 were non-dipper. Significantly higher cholesterol (p < 0.05) and free norepinephrine (p < 0.001) levels among dipper compared with non-dipper individuals were observed. Non-dipper individuals had PVR significantly higher than dipper individuals (p < 0.05). Values of diurnal BP, other hormonal measurements, and CBPM did not differ significantly between the two groups. CONCLUSIONS: Non-dipper individuals aged over 55 have lower circulating free norepinephrine values and higher peripheral vascular resistances than dipper individuals, irrespective of diurnal blood pressure values. The left ventricular mass does not differ significantly between the two groups.

Factores cardiovasculares y hormonales asociados a la falta de descenso nocturno de la presión arterial en sujetos mayores de 55 años / Cardiovascular and hormonal factors associated with the lack of nocturnal fall in blood pressure among individuals aged over 55

Fundamento. Normalmente la presión arterial (PA) desciende durante la noche de forma fisiológica en todos los sujetos, tanto hipertensos como normotensos. La ausencia de descenso nocturno (condición no dipper) puede asociarse con el riesgo de desarrollar complicaciones cardiovasculares en pacientes hipertensos. Estudiamos en sujetos mayores de 55 años, los más expuestos a estas complicaciones, los factores cardiovasculares y hormonales asociados a la falta de descenso de la presión arterial nocturna. Métodos. Se seleccionaron 108 sujetos mayores de 55 años y con amplio rango de PA (59 normotensos y 49 hipertensos ligeros-moderados sin tratamiento previo). Se establecieron dos grupos: dipper y no dipper, según hubiera descenso superior al 10 por ciento de PA sistólica y PA diastólica nocturna o no. A los pacientes incluidos en el estudio se les realizó determinaciones hormonales en sangre (renina, aldosterona, endotelina-1, péptido natriurético atrial, adrenalina y noradrenalina libres), monitorización continua de la presión arterial durante 24 horas (MAPA) y ecografía cardíaca con determinación del índice de la masa ventricular izquierda (IMVI), gasto cardíaco y resistencias vasculares periféricas (RVP) (determinadas en función de la presión arterial media y el gasto cardíaco). Resultados. En la muestra a estudio 51 sujetos fueron dipper y 57 no dipper. Se apreciaron unos niveles de colesterol (p < 0,05) y de noradrenalina libre (p < 0,001) significativamente superiores en sujetos dipper en comparación con los no dipper. Los no dipper tuvieron unas RVP significativamente más elevadas que los dipper (p < 0,05). Los valores de PA diurna, resto de valores hormonales y el IMVI no variaron significativamente entre los dos grupos. Conclusiones. Los sujetos mayores de 55 años no dipper presentan menores valores de noradrenalina libre circulante y mayores resistencias vasculares periféricas que los dipper, independientemente de los valores diurnos de presión arterial. La masa ventricular izquierda no varía significativamente entre los dos grupos. (AU)