RESUMEN
Because of recent papers on "Cugini's syndrome", as a new nosographic cardiovascular entity, the writer of this article has seen of medical interest to interview Prof. Cugini in person for a better elucidation of this syndrome. It must be stressed that the syndrome we are dealing with has been identified by reviewing Cugini's investigations carried out in Italy between 1997-1999 on subjects considered to be normotensive at the casual Riva-Rocci sphygmomanometry but unexplicably showing initial signs of hypertensive organ damage. The syndrome consists of the binomium "Minimal change hypertensive retinopathy/Pre-hypertension", in that the apparently normotensive subjects were seen to be characterized by a minimally accentuated reflex of retinal arterioles, as it occurs in I Stage of Keith-Wagener-Barker classification for hypertensive retinopathy, being neither "truly normotensive" nor "truly hypertensive". As a matter of fact, these subjects were classified by Prof. Cugini as "pre-hypertensive" in that the 24-h values of their blood pressure (BP), measured via Ambulatory Blood Pressure monitoring (ABPM), were invariably below the upper reference limits given at that time by WHO, but, notwithstanding that, their systolic (S) and diastolic (D) daily average was significantly higher than in "true normotensive" subjects. Furthermore, at the chronobiometric analysis of the ABPM, these pre-hypertensive subjects resulted to have a well-phased BP circadian rhythm and an amplified oscillation in their 24-h BP values. Interestingly, Prof. Cugini documented that the clinical condition of "Pre-hypertension" could be also found in putatively normotensive subjects with an initial hypertensive damage of other target organs, suggesting that the "Cugini's syndrome" could be intended more extensively via the binomium, i.e., "Minimal change hypertensive cardiovascular damage/Pre-hypertension". Having statistically found a significant difference in BP 24-h mean values between "true normotensives" and "pre-hypertensives", it can be inferred that Prof. Cugini used the term "Pre-hypertension" to taxonomically indicate a para-physiological hemodynamic status characterized by an increase in BP 24-h mean values, quantifiable and documentable via ABPM, staying in between normotension and hypertension, describing with a large anticipation of time the "normal-high" grade of the classification reported years later in 2003 by JNC in its VII Report on arterial hypertension. Moreover, it is important to stress at the time of Cugini's studies the Stage I of hypertensive retinopathy was considered to be an initial sign of damage already indicative of a high BP regimen. But, even more important, it is to remark that at the time of Cugini's studies the term "Pre-hypertension" was used just to indicate a presumable stage of predisposition to develop hypertension in subjects with a positive familiarity for high BP. Therefore, Prof. Cugini transposed the meaning of the term "Pre-hypertension" from a merely putative preclinical asymptomatic status to an objective clinical symptomatic status documentable via the daily average of BP values, being associated with documentable signs of initial tensive target organ damage in subjects "falsely normotensive". With this connotation, the Cugini's syndrome shows the following indications: 1. in the presence of a minimal sign of hypertensive organ damage in subjects considered to be normotensive at the casual sphygmomanometry, it is mandatory to perform the ABPM with the suspicion not only of an "odd-hour hypertension" or a "non-dipping phenomenon" but also of a "pre-hypertension"; 2. in the presence of a pre-hypertension diagnosed at the ABPM, it is mandatory to perform an accurate investigation of cardiovascular organs susceptible to hypertensive damage with the suspicion of a Cugini's syndrome. Further studies are needed to verify whether or not the Cugini's syndrome needs to be preventively cured and which drugs have to be eventually used. A non-pharmacological treatment of life-style seems to be necessary.
Asunto(s)
Hipertensión , Enfermedades de la Retina , Humanos , SíndromeRESUMEN
OBJECTIVE: To prevent iodine deficiency disorders, the World Health Organization, United Nations Children's Fund, and International Council for the Control of Iodine Deficiency Disorders established that for a given population median urinary iodine concentrations (UIC) must be 100-199 microg/L in clinically healthy subjects and 150-249 microg/L in clinically healthy pregnant women. We evaluated whether in the urban area of Rome, Italy, where a salt iodination program (30 mg/kg) was introduced since 2005, an increased demand of iodine during pregnancy is guaranteed. METHODS: During 2006, 51 pregnant women at first trimester of a physiologic gestation were consecutively enrolled on presentation to evaluate UIC in morning spot urine samples. As controls, 100 age-matched clinically healthy non-pregnant women were evaluated. RESULTS: The median UICs were 182 microg/L (range 85-340 microg/L) and 74 microg/L (range 17-243 microg/L), respectively, in the control and pregnant groups. This difference was highly significant (P < 0.001). In particular, the UIC was found to be lower than adequate in 4% of control women compared with 92% of pregnant women. This difference of occurrences was highly significant (P < 0.001). CONCLUSION: This observational study demonstrated that, despite the adequate supplementation of iodine intake, most pregnant women appear not to be protected against iodine deficiency. If confirmed in larger case studies, this finding claims the attention of relevant professionals to monitor iodine nutrition during gestation, assuming that ordinary supplementation of iodine intake seems to be sufficient only in non-gestational conditions.
Asunto(s)
Yodo/administración & dosificación , Yodo/deficiencia , Fenómenos Fisiologicos Nutricionales Maternos/fisiología , Necesidades Nutricionales , Estado Nutricional , Adulto , Estudios de Casos y Controles , Femenino , Alimentos Fortificados , Humanos , Yodo/orina , Embarazo , Complicaciones del Embarazo/prevención & control , Cloruro de Sodio Dietético/administración & dosificaciónRESUMEN
OBJECTIVE: The scope of this study is to detect whether or not the entropy (E) circadian rhythm (CR) is maintained preserved in sinusal R-R intervals (SRRI), its loss being the expression of a transition to an indeterministic chaos in heart rate variability (HRV). METHODS: The E of SRRI was estimated in 14 type I diabetic pregnant women (DPW) in the first trimester of an apparently uncomplicated gestation (7 patients - mean age = 30.3 +/- 4.1 y - without clinical and laboratory evidence of cardiac autonomic neuropathy, and 7 patients - mean age = 30.7 +/- 3.6 y - with positive tests for a cardiac dysautonomia). The E CR was studied via the single cosinor method, and summarized via the population-mean cosinor method. RESULTS: The E CR was found not to be preserved in both the investigated type I DPW, despite the occurrence of the SRRI CR. CONCLUSIONS: The loss of the E CR confirms that in type I DPW there is a transition to an indeterministic disorder in HRV due to the lack of an autocorrelated periodic chaos in cardiac pacing. Such an unphysiological neurovegetative regulation suggests a new silent cardiac dysautonomic syndrome, that we intend to call "minimum delirium cordis syndrome" (MDCS). Can the MDCS be regarded as a condition of cardiovascular risk? To answer this question, it seems justified to suggest that the study of the E CR should be added to the routine tests that are presently applied to clinical analysis of the Holter ECG, being the classic tests of linear analysis not methodologically suitable for detecting the indeterministic chaos of the MDCS.
Asunto(s)
Ritmo Circadiano/fisiología , Sistema de Conducción Cardíaco/fisiopatología , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Embarazo en Diabéticas/fisiopatología , Adulto , Electrocardiografía Ambulatoria , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Embarazo , Primer Trimestre del Embarazo/fisiología , SíndromeRESUMEN
1. The aim of the present study was to investigate the effects of a short (1 day) fast by testing biohumoral variables associated with the human circadian rhythm. 2. Fifteen clinically healthy male volunteers (32 +/- 8 years old) participated in the study. Subjects were fed a control diet for 7 days. The last day was a control day and the following 8th day was the fasting day. Each subject was asked to collect urine seven times over a 24 h period. Chemical and hormonal variables were measured in each fractionated urine specimen. The time- qualified urinary excretion rates were biometrically analysed using conventional and chronobiological methods. 3. During fasting, significant incremental changes were detected in the urinary excretion rates of potassium, aldosterone, 17-hydroxycorticosteroids and adrenaline and significant decremental changes were detected in the excretion rates of sodium, chloride, creatinine, urea nitrogen, uric acid, 17-ketosteroids, noradrenaline and dopamine. The circadian rhythmicity of the variables was well preserved and remained almost stable throughout the fasting phase. 4. Fasting affected the mean oscillatory levels and oscillatory amplitudes of variables, suggesting that nutrients may have played roles as tonic and phasic modulators on the mechanisms that physiologically regulate ircadian rhythmicity.