RESUMEN
Resistant Hypertension (RHT) is associated with a higher risk of Obstructive Sleep Apnoea (OSA). OSA and aortic stiffness (AS) measured by Pulse Wave Velocity (PWV) are independent risk factors for cardiovascular events. We assessed, in a cross-sectional study, the association between AS measured by PWV and OSA severity in patients with RHT. All patients were submitted to polysomnography, PWV measure and 24 h ABPM. Bivariate analysis compared patients with and without moderate/severe OSA. Multivariate analysis was performed to assess the independent correlates of moderate/severe OSA. A total of 376 patients were included, 31% were men with a mean age of 63 ± 10 years. Moderate/severe OSA was diagnosed in 214 patients (57%), 63 patients (17%) presented AS. Uncontrolled ABPM (true RHT) was found in 215 patients (57.2%) and among them 113 were diagnosed with moderate/severe OSA. Evaluating AS in patients with mild, moderate and severe apnoea, we observed a progressive increase in PWV (8.19 ± 1.55, 8.51 ± 1.84, 8.67 ± 1.68, respectively). Classifying them in 2 groups: (1) without apnoea/mild apnoea and (2) moderate/severe apnoea, we found higher values in group 2 (8.21 ± 1.52 m/s vs. 8.60 ± 1.75 m/s, p = 0.02), especially among true RHT patients (8.28 ± 1.62 vs. 8.81 ± 1.86, p = 0.029), women (8.13 ± 1.49 vs. 8.55 ± 1.73, p = 0.036), and uncontrolled nocturnal systolic BP (8.49 ± 1.63 vs. 8.58 ± 1.78, p = 0.04). In conclusion, in this RHT cohort, although with borderline results, the more severe the apnoea, the greater the arterial stiffness, mainly among women, true RHT and patients with an adverse nocturnal BP profile.
Asunto(s)
Hipertensión , Apnea Obstructiva del Sueño , Rigidez Vascular , Masculino , Humanos , Femenino , Persona de Mediana Edad , Anciano , Análisis de la Onda del Pulso , Estudios Transversales , Hipertensión/complicaciones , Hipertensión/diagnóstico , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/diagnósticoRESUMEN
The prevalence of sarcopenia in hospitalized people living with HIV is underdiagnosed, as assessment instruments are not always available. This study aimed to identify factors related to sarcopenia, correlating their anthropometric and clinical markers in hospitalized people living with HIV. This was an observational cross-sectional clinical study, carried out from September 2018 through October 2019. Handgrip strength, muscle mass index, calf circumference and gait speed test were evaluated in recruited patients within three days of hospital admission. The sample consisted in 44 patients, mostly men (66%), black (68%), young adults (41.65±12.18 years) and immunodeficient (CD4 cell count 165 cells/mm3 [34.25-295.5]). Sarcopenia was present in 25% of the sample. Calf circumference showed a significant correlation with CD4 cell count and viral load (p<0.05) while handgrip strength and gait speed test did not. Calf circumference>31cm and gait speed test>0.8m/s reduced the chance of sarcopenia by 60% (OR=0.396 [-1.67 to -0.18]; p<0.05) and 98% (OR=0.02 [-8.16 to 0.13]; p<0.05) respectively. Calf circumference>31cm and gait speed test>0.8m/s are associated with a reduced chance of sarcopenia in hospitalized HIV patients.
Asunto(s)
Infecciones por VIH , Sarcopenia , Anciano , Estudios Transversales , Evaluación Geriátrica , Infecciones por VIH/complicaciones , Fuerza de la Mano , Humanos , Masculino , Fuerza Muscular , Prevalencia , Sarcopenia/diagnóstico , Sarcopenia/epidemiología , Adulto JovenRESUMEN
Refractory hypertension (RfHT) is an extreme phenotype of resistant hypertension (RHT) and is considered uncontrolled blood pressure (BP) despite the use of five or more antihypertensives. The objective of this study was to characterize the prevalence and clinical profile of RfHT patients in a historical cohort of patients with RHT at two different times: before and after the introduction of spironolactone. First, this cross-sectional study evaluated 1048 RHT patients (72.3% females, mean [SD] age: 61.2 [11.3] years) referred to a hypertension clinic (prespironolactone period). All patients were submitted to a standard protocol including clinical and complementary exams. Second, the analysis evaluated patients after the introduction of spironolactone (postspironolactone period). Statistical analysis included bivariate comparisons between patients with RHT and patients with RfHT and logistic regressions to assess the independent correlations of RfHT. A total of 146 patients (13.9%) remained refractory despite the use of at least five antihypertensives (prespironolactone period). After the introduction of spironolactone, the prevalence increased to 17.6%. For any criterion, RfHT patients were younger and more obese. In the initial period, current smoking and left ventricular hypertrophy were independently correlated with RfHT. Furthermore, after spironolactone use, RfHT patients had lower aortic stiffness and peripheral artery disease (PAD), pointing to a lower cardiovascular risk despite the lack of BP control. Younger age and lower prevalence of PAD correlated independently with RfHT. In conclusion, there was a high prevalence of RfHT, especially in younger and obese patients, and spironolactone use seemed to reduce cardiovascular risk despite the lack of BP control.
Asunto(s)
Hipertensión , Antihipertensivos/farmacología , Antihipertensivos/uso terapéutico , Presión Sanguínea , Estudios Transversales , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Espironolactona/farmacología , Espironolactona/uso terapéuticoRESUMEN
ABSTRACT The prevalence of sarcopenia in hospitalized people living with HIV is underdiagnosed, as assessment instruments are not always available. This study aimed to identify factors related to sarcopenia, correlating their anthropometric and clinical markers in hospitalized people living with HIV. This was an observational cross-sectional clinical study, carried out from September 2018 through October 2019. Handgrip strength, muscle mass index, calf circumference and gait speed test were evaluated in recruited patients within three days of hospital admission. The sample consisted in 44 patients, mostly men (66%), black (68%), young adults (41.65 ± 12.18 years) and immunodeficient (CD4 cell count 165 cells/mm3 [34.25-295.5]). Sarcopenia was present in 25% of the sample. Calf circumference showed a significant correlation with CD4 cell count and viral load (p < 0.05) while handgrip strength and gait speed test did not. Calf circumference > 31 cm and gait speed test > 0.8 m/s reduced the chance of sarcopenia by 60% (OR = 0.396 [−1.67 to −0.18]; p < 0.05) and 98% (OR = 0.02 [−8.16 to 0.13]; p < 0.05) respectively. Calf circumference > 31 cm and gait speed test > 0.8 m/s are associated with a reduced chance of sarcopenia in hospitalized HIV patients.
Asunto(s)
Humanos , Masculino , Anciano , Adulto Joven , Infecciones por VIH/complicaciones , Sarcopenia/diagnóstico , Sarcopenia/epidemiología , Evaluación Geriátrica , Prevalencia , Estudios Transversales , Fuerza de la Mano , Fuerza MuscularRESUMEN
The COVID-19 outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global major concern. In this review, we addressed a theoretical model on immunopathogenesis associated with severe COVID-19, based on the current literature of SARS-CoV-2 and other epidemic pathogenic coronaviruses, such as SARS and MERS. Several studies have suggested that immune dysregulation and hyperinflammatory response induced by SARS-CoV-2 are more involved in disease severity than the virus itself.Immune dysregulation due to COVID-19 is characterized by delayed and impaired interferon response, lymphocyte exhaustion and cytokine storm that ultimately lead to diffuse lung tissue damage and posterior thrombotic phenomena.Considering there is a lack of clinical evidence provided by randomized clinical trials, the knowledge about SARS-CoV-2 disease pathogenesis and immune response is a cornerstone to develop rationale-based clinical therapeutic strategies. In this narrative review, the authors aimed to describe the immunopathogenesis of severe forms of COVID-19.
Asunto(s)
Betacoronavirus/inmunología , Infecciones por Coronavirus/inmunología , Síndrome de Liberación de Citoquinas/inmunología , Neumonía Viral/inmunología , Síndrome de Dificultad Respiratoria/inmunología , Factores de Edad , Enzima Convertidora de Angiotensina 2 , Animales , Formación de Anticuerpos , Betacoronavirus/patogenicidad , Trastornos de la Coagulación Sanguínea/etiología , COVID-19 , Comorbilidad , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Humanos , Inmunidad Innata , Inflamación/inmunología , Pulmón/patología , Linfopenia/inmunología , Ratones , Coronavirus del Síndrome Respiratorio de Oriente Medio/inmunología , Pandemias , Peptidil-Dipeptidasa A/fisiología , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Factores de Riesgo , SARS-CoV-2 , Síndrome Respiratorio Agudo Grave/inmunología , Índice de Severidad de la Enfermedad , Factores Sexuales , Internalización del VirusRESUMEN
Abstract The COVID-19 outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global major concern. In this review, we addressed a theoretical model on immunopathogenesis associated with severe COVID-19, based on the current literature of SARS-CoV-2 and other epidemic pathogenic coronaviruses, such as SARS and MERS. Several studies have suggested that immune dysregulation and hyperinflammatory response induced by SARS-CoV-2 are more involved in disease severity than the virus itself. Immune dysregulation due to COVID-19 is characterized by delayed and impaired interferon response, lymphocyte exhaustion and cytokine storm that ultimately lead to diffuse lung tissue damage and posterior thrombotic phenomena. Considering there is a lack of clinical evidence provided by randomized clinical trials, the knowledge about SARS- CoV-2 disease pathogenesis and immune response is a cornerstone to develop rationale-based clinical therapeutic strategies. In this narrative review, the authors aimed to describe the immunopathogenesis of severe forms of COVID-19.(AU)
Asunto(s)
Humanos , Neumonía Viral/inmunología , Infecciones por Coronavirus/inmunología , Betacoronavirus/efectos de los fármacos , Trombosis/etiología , Citocinas/efectos adversosRESUMEN
ABSTRACT Objective The study aimed to verify the relationship between handgrip strength measurement and classic anthropometric values in HIV positive outpatients. Methods This was a cross-sectional study that enrolled HIV-positive outpatients treated at the Gaffrée and Guinle University Hospital, aged between 20 and 60 years and considered to be well-nourished or moderately malnourished, according to the Global Subjective Analysis. The patients' bilateral handgrip strength were assessed (Jamar dynamometer), and classic anthropometry variables (weight, height, body mass index, arm muscle area, arm fat area, arm muscle circumference, and triceps skin fold) were measured. The Kolmogorov-Smirnov test, t-test, bivariate correlation and regression analysis were used (SPSS 21® software), with a significance level of 5%. Results A total of 242 patients were assessed. According to the Global Subjective Analysis, 218 (90.1%) patients were classified as well nourished (Global Subjective Analysis-A) and 24 (9.9%) as moderately malnourished (Global Subjective Analysis-B). The average dominant hand handgrip strength with standard deviation was 30.5±9.5kgf and 24.1±6.1kgf for Global Subjective Analysis-A and Global Subjective Analysis-B patients, respectively. Handgrip values were not influenced by age. The handgrip strength showed in both genders a significant correlation with weight, body mass index, and with anthropometric parameters related to lean body mass (arm muscle circumference and arm muscle area), but without correlation with the non-lean mass parameter (arm fat area). The handgrip strength of the dominant hand was a predictor of the following variables associated with lean body mass, i.e., arm muscle circumference and arm muscle area (R2=0.194, t=7.7, p<0.001, and R2=0.192, t=7.6, p<0.001, respectively). However, handgrip strength was not a predictor of arm fat area. Conclusion Measurement of handgrip strength was a useful method for nutritional assessment in outpatients with HIV due to a significant relationship with anthropometric parameters associated with lean body mass.
RESUMO Objetivo Este estudo buscou verificar a relação entre a mensuração da força de preensão manual e os valores das medidas antropométricas clássicas em pessoas vivendo com HIV em acompanhamento ambulatorial. Métodos O estudo foi transversal, com inclusão de pessoas vivendo com HIV atendidas no Hospital Universitário Gaffrée e Guinle, entre 20 e 60 anos e consideradas bem nutridas ou desnutridas moderadas, de acordo com Análise Subjetiva Global. Foi mensurada a força de preensão manual bilateralmente (dinamômetro Jamar®) e realizada antropometria clássica: peso, estatura, índice de massa corporal, área muscular do braço, área gordurosa do braço, circunferência muscular do braço e dobra cutânea tricipital. Através do software SPSS 21®, foram utilizados o teste de Kolmogorov-Smirnov, teste t, correlação bivariada e análise de regressão, com nível de significância de 5%. Resultados Foram analisados 242 pacientes. Conforme análise de objetivo geral, 218 (90,1%) pacientes foram classificados como bem nutridos (Análise Subjetiva Global-A), e 24 (9,9%), como desnutridos moderados (Análise Subjetiva Global-B). O valor médio com o desvio-padrão da força de preensão manual da mão dominante foi de 30,5±9,5kgf e 24,1±6,1kgf para pacientes Análise Subjetiva Global-A e Análise Subjetiva Global-B, respectivamente. Os valores da força de preensão manual não foram influenciados pela idade. A força de preensão manual apresentou correlação significativa com o peso, com o índice de massa corporal e com parâmetros antropométricos relacionados à massa corporal magra (circunferência muscular do braço e área muscular do braço), mas sem correlação com parâmetro não relacionado à massa magra (força de preensão manual) em ambos os sexos. A força de preensão manual da mão dominante foi preditora das variáveis relativas à massa magra circunferência muscular do braço e área muscular do braço (R2=0,194, t=7,7; p<0,001; e R2=0,192, t=7,6; p<0,001, respectivamente). Contudo, a força de preensão manual não foi preditora da área gordurosa do braço. Conclusão A mensuração da força de preensão manual foi um bom método para avaliação nutricional em pacientes ambulatoriais vivendo com HIV com significativa relação com parâmetros antropométricos associados à massa corporal magra.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Evaluación Nutricional , VIH , Fuerza MuscularRESUMEN
Moderately increased albuminuria, defined as urinary albumin excretion rate (UAER) between 30 and 300-mg/24-h is a well-known cardiovascular risk factor, especially in diabetic and hypertensive patients. This study aim to analyze the prognostic value of baseline UAER in a still understudied group, patients with resistant hypertension (RHT). This is a prospective observational study, which had enrolled 1048 outpatients with RHT, who were submitted to a clinical-laboratory assessment and ambulatory blood pressure monitoring (ABPM) during the follow-up. Primary endpoints were a composite of fatal and non-fatal cardiovascular events, all-cause mortality and cardiovascular mortality. Survival analysis by multiple Cox regression assessed the associations among endpoints, baseline UAER, glomerular filtration rate (GFR), and ABPM control. After a mean 7.5 years follow-up, 233 patients died, 120 from cardiac death; 215 cardiovascular events occurred, 90 strokes and 116 coronary diseases. UAER above 30-mg/24-h increased above 40% the risk of fatal and non-fatal cardiovascular events, and of all-cause mortality. At these UAER levels, secondary outcomes were associated to increased risk of stroke and risk of end-stage renal disease, but did not affect coronary events. Both the GFR below 60-mL/min and uncontrolled ABPM were related to nearly two-fold raised risk of fatal and non-fatal cardiovascular events, when coupled with UAER above 30-mg/24-h. In conclusion, moderately increased albuminuria predicts cardiovascular events and all-cause mortality in RHT, and its prognostic impact is enhanced in association with a GFR under 60-mL/min and uncontrolled baseline ABPM.
Asunto(s)
Albuminuria , Hipertensión/orina , Anciano , Anciano de 80 o más Años , Monitoreo Ambulatorio de la Presión Arterial , Brasil/epidemiología , Femenino , Tasa de Filtración Glomerular , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Pronóstico , Estudios ProspectivosRESUMEN
BACKGROUNDS AND AIMS: Involuntary weight loss and muscle mass loss among HIV-positive patients are only detectable in late stages, leading poor life quality. The reduction of adductor pollicis muscle thickness (APMT) can be easily and earlier uncovered in those cases. The purpose was to estimate APMT and compare it with immunological and anthropometric parameters of HIV-infected people. METHODS: A crosssectional study was carried out in an University Hospital including 103 HIV-infected outpatients by subjective global assessment (SGA). Data were compared to APMT for the whole sample and between gender in univariate analysis. Besides that, simple correlation and multiple linear regression were done to check the APMT relation with gender, age, weight body, body mass index, arm circumference, CD4, CD8 and viral load. RESULTS: The APMT average values of the dominant hand (16.2 ± 4.2 mm) and non-dominant hand (14.8 ± 4.3 mm) were lower than in the healthy population. Through stratified analysis by gender, it was found significant difference in weight, arm muscle circumference, arm muscle area, triceps skinfold thickness and arm fat area (p < 0,01 for each). In any age group, men had significantly higher dominant and non-dominant APMT values than women (p < 0.001). Although the fair correlation among cited variables and APMT of both hands, there were no correlation and no difference between the genders in regards to immunological markers (CD4, CD8 and viral load). In a prediction model to APMT values, gender was determinant in multiple linear regression. CONCLUSIONS: In a well-nourished HIV sample by SGA with adequate CD4 counts, APMT measures of both hands were lower than in healthy people. In both hands, APMT were positively correlated with weight and male, regardless of other anthropometric data and immunologic factors.
Asunto(s)
Antropometría , Infecciones por VIH/diagnóstico , Músculo Esquelético/patología , Atrofia Muscular/diagnóstico , Adiposidad , Adulto , Anciano , Anciano de 80 o más Años , Peso Corporal , Brasil , Recuento de Linfocito CD4 , Estudios de Casos y Controles , Estudios Transversales , Femenino , Infecciones por VIH/inmunología , Infecciones por VIH/patología , Infecciones por VIH/fisiopatología , Hospitales Universitarios , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Músculo Esquelético/fisiopatología , Atrofia Muscular/patología , Atrofia Muscular/fisiopatología , Evaluación Nutricional , Estado Nutricional , Tamaño de los Órganos , Valor Predictivo de las Pruebas , Extremidad Superior , Carga Viral , Adulto JovenRESUMEN
INTRODUCTION: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the inability of antidiuretic hormone (ADH) suppression, compromising the mechanisms of water excretion and urinary concentration. It manifests as hyponatremia and its symptoms, especially neurological. There are many causes that trigger such disease, notably: central nervous system disorders, malignant neoplasm, drugs and others. CASE REPORT: A 65 years female hypertensive patient presented clinical and laboratory manifestations of hyponatremia due to SIADH. It happened twice under use of herbal medication for osteoarthritis treatment. DISCUSSION: The drug-related hyponatremia can be triggered by direct effect of the drug or by association with SIADH. The clinical manifestations presented could have been related to psychiatric condition and may have severe outcome if not properly diagnosed. The association of an herbal medicine to SIADH could be confirmed after a new episode of hyponatremia related to Harpagophytum procumbers reintroduction. Our literature review did not find this herbal medicine associated with SIADH, so far. CONCLUSION: SIADH may be caused by herbal medicine described from now on their association in the literature.
Asunto(s)
Harpagophytum , Síndrome de Secreción Inadecuada de ADH/inducido químicamente , Fitoterapia/efectos adversos , Preparaciones de Plantas/efectos adversos , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Abstract Introduction: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the inability of antidiuretic hormone (ADH) suppression, compromising the mechanisms of water excretion and urinary concentration. It manifests as hyponatremia and its symptoms, especially neurological. There are many causes that trigger such disease, notably: central nervous system disorders, malignant neoplasm, drugs and others. Case Report: A 65 years female hypertensive patient presented clinical and laboratory manifestations of hyponatremia due to SIADH. It happened twice under use of herbal medication for osteoarthritis treatment. Discussion: The drug-related hyponatremia can be triggered by direct effect of the drug or by association with SIADH. The clinical manifestations presented could have been related to psychiatric condition and may have severe outcome if not properly diagnosed. The association of an herbal medicine to SIADH could be confirmed after a new episode of hyponatremia related to Harpagophytum procumbers reintroduction. Our literature review did not find this herbal medicine associated with SIADH, so far. Conclusion: SIADH may be caused by herbal medicine described from now on their association in the literature.
Resumo Introdução: A síndrome da secreção inapropriada do hormônio antidiurético (SIADH) consiste na incapacidade de supressão do hormônio antidiurético (ADH), comprometendo os mecanismos de excreção da água e concentração urinária. Possui como manifestações a hiponatremia e seus sintomas, sobretudo neurológicos. Há variadas causas que desencadeiam tal distúrbio, a se destacarem: distúrbios do sistema nervoso central, neoplasias malignas e drogas, dentre outros. Relato de Caso: Paciente feminina, 65 anos, hipertensa, apresentando manifestações clínicas e laboratoriais correspondentes à hiponatremia. O fato ocorreu em duas ocasiões em vigência de medicação fitoterápica para tratamento de osteoartrite. Discussão: A hiponatremia relacionada às drogas pode ser provocada pelo efeito direto do medicamento ou por desencadear SIADH. As manifestações clínicas apresentadas poderiam ter sido atribuídas a um quadro psiquiátrico, o que poderia ter desfecho grave, caso não diagnosticada corretamente. A associação de um fitoterápico à SIADH pôde ser confirmada após novo episódio de hiponatremia relacionado à reintrodução do Harpagophytum procumbers. Nossa revisão da literatura não encontrou este fitoterápico associado à SIADH, até o momento. Conclusão: SIADH pode ser ocasionada por medicamento fitoterápico doravante descrita sua associação na literatura.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Preparaciones de Plantas/efectos adversos , Harpagophytum , Síndrome de Secreción Inadecuada de ADH/inducido químicamente , Fitoterapia/efectos adversosRESUMEN
BACKGROUND: C-reactive protein (CRP) is a biomarker of systemic low-grade inflammation and a cardiovascular risk predictor in several clinical conditions. However, its prognostic value has never been examined in patients with resistant hypertension. METHODS: In a prospective study, 476 patients with resistant hypertension had CRP levels measured at baseline, together with other clinical laboratory variables, including ambulatory blood pressures (BPs). Primary end points were a composite of major fatal or nonfatal cardiovascular events, all-cause mortality, and cardiovascular mortality. Multiple Cox regression assessed the associations between CRP levels and end points. RESULTS: Median CRP was 3.8mg/l (interquartile range: 2.0-7.2mg/l). After a median follow-up of 9 years, 103 major cardiovascular events occurred, and 120 patients died, 62 from cardiovascular causes. Patients with CRP levels above the median value had a doubled excess risk of major cardiovascular events (95% confidence interval: 1.29-3.06; P = 0.002) and an 86% higher risk of cardiovascular death (95% confidence interval: 1.07-3.25; P = 0.029), after adjustments for potential confounders including traditional cardiovascular risk factors and ambulatory BP and dipping pattern. A high CRP equally predicted coronary (hazard ratio: 2.04; 95% confidence interval: 1.10-3.76; P = 0.023) and cerebrovascular events (hazard ratio: 2.72; 95% confidence interval: 1.30-5.67; P = 0.007). In interaction and sensitivity analyses, CRP levels were stronger predictors of worse cardiovascular outcomes in younger and obese patients, and in those with uncontrolled ambulatory BPs and with the nondipping pattern. CONCLUSIONS: In patients with resistant hypertension, elevated serum CRP levels is predictive of worse cardiovascular prognosis above and beyond other cardiovascular risk factors, including ambulatory BP levels and dipping patterns.