[Sodium, potassium and arterial hypertension: what's new?] / Sodium, potassium et hypertension artérielle: quoi de neuf?

High blood pressure is a public health problem, causing high morbidity and mortality. Its prevalence could exceed 1.5 billion of cases by 2025. High-salt diets have been recognized for several years as a major contributor to elevated blood pressure, with a curvilinear relationship between salt load and increased systolic and diastolic values. On the contrary, potassium is considered as protective, with lower blood pressure values in populations consuming a lot of fruits and vegetables. The World Health Organisation has established recommendations, with a target consumption of less than 218 mmol and more than 90 mmol per day, of salt and potassium, respectively. In this review article, we cover the most recent evidence allowing to sustain those recommendations.

L'hypertension artérielle est un problème de santé publique entraînant une grande morbi-mortalité. Sa prévalence pourrait dépasser 1,5 milliard de cas en 2025. L'alimentation riche en sel est reconnue depuis plusieurs années comme un pourvoyeur important d'augmentation de la tension artérielle, avec une relation curvilinéaire entre la charge en sel et la hausse des valeurs systoliques et diastoliques. Au contraire, le potassium est considéré comme protecteur, avec des valeurs tensionnelles inférieures dans les populations consommant beaucoup de fruits et légumes. L'OMS a établi des recommandations, avec comme cible moins de 218 mmol (5 g) et plus de 90 mmol (3,5 g) par jour de sel (NaCl) et de potassium, respectivement. Dans cet article, nous revoyons les évidences récentes permettant de soutenir ces recommandations.

[Recent developments in internal medicine]. / Développements en médecine interne hospitalière.

Whilst the practice of hospital based internal medicine is often carried out in tight collaboration with clinical specialities, in particular for deciding on the indication of interventional and diagnostic procedures, it is important to remain objective with respect to the indications and benefits of these acts. This is the case in areas such as cardiovascular medicine and nephrology. Recent studies also have the potential to modify current guidelines for the management of arterial hypertension and hypercholesterolemia. This article discusses some of these selected subjects.

Si la pratique de la médecine interne hospitalière est souvent menée en étroite collaboration avec certaines spécialités cliniques, en particulier pour décider de certains gestes interventionnels et procédures diagnostiques, il est important de rester objectif quant aux indications et avantages de ces actes. C'est le cas dans des domaines tels que la médecine cardiovasculaire et la néphrologie. Des études récentes ont également le potentiel de modifier les lignes directrices actuelles pour la prise en charge de l'hypertension artérielle et de l'hypercholestérolémie. Cet article traite de certains de ces sujets sélectionnés.

AMH concentration is not related to effective time to pregnancy in women who conceive naturally.

This study determined whether anti-Müllerian hormone (AMH) concentration influences the time necessary to conceive a live-born child--effective time to pregnancy (eTTP)--in a population of women who conceived naturally. This is an observational study of 87 women with a planned spontaneous pregnancy resulting in a live birth. eTTP was assessed retrospectively by a questionnaire and AMH was measured in a frozen serum sample from first trimester of pregnancy. eTTP was correlated with age (r=-0.24, P=0.02), but not with AMH (r=-0.10) or body mass index (r=0.05). With logistic regressions, the only variable that affected the probability of pregnancy within 3 or 6 months was age, irrespective of whether an AMH concentration limit of 1.0 ng/ml or 2.0 ng/ml was chosen. In conclusion, this study suggests that there is no relationship between AMH concentration and eTTP and therefore speaks against determining AMH in women who are not infertile for the purpose of predicting their chances of pregnancy. The findings are concordant with previous reports describing AMH as a quantitative but not a qualitative marker of ovarian reserve and therefore does not reflect a woman's ability to become pregnant. Anti-Müllerian hormone (AMH) is secreted by small growing ovarian follicles and reflects a woman's ovarian reserve - the number of primordial follicles at a given time. AMH concentrations has been extensively studied in infertile women but there are only scarce data on AMH in non-infertile women. Our objective was to determine whether AMH concentrations influence the time necessary to conceive a live-born child - also called effective time to pregnancy (eTTP) - in a population of women who conceived naturally. We conducted an observational study between 2007 and 2009 in which we assessed eTTP retrospectively in 87 women who had delivered a live-born child and measured AMH in a frozen blood sample collected during the first trimester of pregnancy. The results of our study show, as expected, a decrease of AMH concentrations as age increases but no relationship between AMH and eTTP. In conclusion, our study results suggest AMH concentrations do not influence the time necessary to conceive a live-born child spontaneously and therefore speak against determining AMH in women who are not infertile for the purpose of predicting their chances of pregnancy. Our findings are concordant with previous reports describing AMH as a quantitative but not a qualitative marker of ovarian function that does therefore not reflect a woman's ability to become pregnant.

Procalcitonin levels during pregnancy, delivery and postpartum.

AIMS: To determine the normal value ranges of procalcitonin (PCT) in women with uncomplicated pregnancies. METHODS: This prospective cohort study was conducted between May 2009 and February 2010 among 60 women without signs of clinical infection (31 vaginal deliveries, 29 cesarean sections) attending the maternity unit of the University of Geneva Hospitals. Sequential follow-up of PCT levels was performed at 24-28 weeks (n=7), 36-40 weeks (n=60), at delivery (n=59), and at days 2-3 (n=58) and 10 (n=53) postpartum using a sensitive PCT assay with a functional sensitivity of 0.06 µg/L. RESULTS: Median levels of PCT were: 24-28 weeks: 0.043 µg/L (range 0.010-0.080); 36-40 weeks: 0.061 µg/L (range 0.010-0.110); at delivery: 0.068 µg/L (range 0.010-0.170); days 2-3: 0.200 µg/L (range 0.030-5.00); and day 10: 0.060 µg/L (range 0.020-0.120). At days 2-3 postpartum, three women had a PCT level between 0.25 µg/L and 0.5 µg/L and two women had a level higher than 0.5 µg/L. CONCLUSIONS: This study provides reference values for PCT during the third trimester, at delivery and at the immediate postpartum period. A cut-off PCT level of 0.25 µg/L can be used during the third trimester, at delivery, and at the immediate postpartum period to rule out infection.