Long-Term Adherence in Overweight Patients with Obstructive Sleep Apnea and Hypertension-A Pilot Prospective Cohort Study.

Obstructive sleep apnea (OSA) is associated with increased cardiovascular risk, sedentarism, depression, anxiety and impaired quality of life. The long-term effectiveness of positive airway pressure (PAP) is insufficiently studied and limited by poor patient compliance. The aim of this pilot prospective cohort study was to evaluate long-term adherence in overweight patients with moderate-severe OSA and hypertension and to analyze changes in weight, sleepiness and quality of life. We performed a prospective study that included overweight patients with moderate-severe OSA and hypertension who had not undergone previous PAP therapy. All subjects received a standard physical examination, education regarding lifestyle changes and free PAP therapy for 2 months. After five years, the patients were invited to participate in a telephone-based interview regarding PAP compliance and completed standard questionnaires assessing adherence to medication, physical activity, diet, anxiety and quality of life (QoL). Only 39.58% of the patients were adherent to PAP 5 years (58.42 ± 3.70 months) after being diagnosed with moderate-severe OSA. Long-term PAP use results in sustained weight loss; improved blood pressure control, sleepiness and QOL; and lower anxiety and depression scores. PAP compliance was not associated with a higher level of daily physical activity or a healthier diet.

Markers of insulin resistance in a case of Launois-Bensaude syndrome.

Launois-Bensaude syndrome (benign symmetric lipoma-tosis) is a rare disease characterized by symmetric fat deposits localized in the cervical region, shoulders and proximal parts of upper and lower limbs. We present the case of a 63-year-old male who presented the typical location of fatty masses and a history of chronic alcoholism associated with elements defining the metabolic syndrome. The biological profile indicated high-atherogenic mixed dyslipidemia, high basal insulinemia (30 microU/ml), and multiple markers of insulin resistance (Reaven index, lipid accumulation product, homeostatic model, insulin sensitivity index, and modified glycemic curve following oral glucose load). The particularity of the presented case is the discordance between the severity of metabolic disturbances and their clinical expression, raising the question whether this patient's cardiometabolic risk is increased or rather lowered by the association of benign symmetric lipomatosis.

[Resolution of inflammation--pharmacological aspects]. / Rezolutia inflamatiei--implicatii farmacologice.

Inflammation is a fundamental biologic process evolutionally preserved by a germ line code. The interplay of the epigenetic with the environment directs the code to temporally distinct inflammatory responses, which can be acute or chronic. The aim of this study is to present new aspects regarding the resolution of inflammation. Acute inflammation normally resolves by mechanisms still somewhat elusive. Current evidence suggests that an active coordinated program initiated the first few hours after the inflammatory response begins and its failure lead to chronic inflammation. This process is essential for appropriate host responses, tissue protection and the return to homeostasis. Prostaglandins and leukotrienes are lipid mediators that play important roles in host defense and acute inflammation. Granulocytes promote the switch of arachidonic acid-derived prostaglandins and leukotrienes to lipoxins, active antiinflammatory and pro-resolution mediators. The apoptosis of the neutrophils coincides with the biosynthesis of resolvins and protectins from omega-3 polyunsaturated fatty acids and releases anti-inflammatory and reparative cytokines. This information could lead to new treatments for inflammatory diseases.

Correlations between C-reactive protein and metabolic syndrome or other associated diseases.

The aim of the paper is to present few aspects about the implication of the C-reactive protein (CRP) in the metabolic syndrome. High-sensitivity (hs) CRP is a marker of subclinical inflammation and it is a mediator of atherosclerotic disease. A recent study indicates a possible dose-effect relationship between waist circumference and hs-CRP levels. Elevated level of hs-CRP was associated with risk of developing metabolic syndrome (MS). However, cross-sectional studies have reported increased concentration of these inflammatory markers in both MS and over type 2 diabetes mellitus (DM) and prospective studies have found strong, graded relations between hs-CRP and incident diabetes. A growing number of large-scale studies are finding positive correlations of CRP with cardiovascular disease and these correlations are independent of smoking. The studies show that it is an association between chronic inflammation and depressive symptoms.

[The influence of intermediate physical training on some non-enzyme antioxidants of oxidative stress, in moderate hypertension]. / Influenta antrenamentului fizic recuperator pe termen mediu asupra unor antioxidanti neenzimatici de stres oxidativ în HTA moderata.

A group of patients with moderate hypertension (149-150/90-99 mm Hg) performed physical exercise for 3 months; we determined the oxidative stress in blood samples, by calculating the level of some biochemical markers, non-enzyme antioxidants, glutathione (GSH), total -SH groups (G-STH), nonprotein -SH groups (G-SHNP), their G-SHT/G-SHNP ratio, uric acid, malondialdehyde (MDA) and comparing the results with the values obtained from a group of healthy subjects. We found an increased oxidative stress at the HTA patients, with initial (Vi) decreasing values of GSH and uric acid, and with higher values of MDA. After the 3 months (Vf) of physical training, the oxidative stress improved, with increasing GSH, uric acid and decreasing MDA, compared to normal subjects. The initial values of G-SHT, G-SHNP and their ratio, increased, but decreased after 3 months, with an inverse aspect to GSH. The clinical study proved that after 3 months of physical exercise, there wasn't any increased oxidative stress at the HTA patients; however, the oxidative stress is present, proved by the values of MDA, significantly higher compared to the normal subjects.

[Left cardiac dysfunction in COPD]. / Disfunctia cardiaca stânga in bronhopneumopatia obstructiva cronica.

The study of evaluation and rehabilitation of COPD patient (SERBOC) started in January 2004 in the 6th Medical Clinic of the Iasi Rehabilitation Hospital. One of its goals is to evaluate the left cardiac morphology and function in the chronic obstructive pulmonary disease. The inn-patients have been complexly approached by physical examination, chest X-ray, rest electrocardiogram, echocardiography and Holter monitoring. The stage result is that physical examination, chest X-ray and rest electrocardiogram fails in offering satisfactory information regarding left cardiac dysfunction; it is necessary to add Holter monitoring and especially echocardiography. The conventional and Doppler echocardiography performed in our clinic allowed the possibility to identify diastolic dysfunction in all 9 patients and systolic dysfunction in 7 of them.

[The effects of the physical training on the hypertensive patients with glycoregulation disorder]. / Efectele antrenamentului fizic la hipertensivii cu tulburari de glicoreglare.

UNLABELLED: The purpose of our clinical study was the evaluation of moderate physical training on hypertensive patients with the impaired glycoregulation, for a determinate period of time. METHODS: The study included 80 patients with moderate hypertension, divided in two groups: group B formed of 40 patients that followed an associated treatment (physical exercises 3-5 times/week, 45-60 min. for one training and antihypertensive drug therapy) and group C formed of 40 patients that followed only drug therapy for controlling blood pressure. The glycoregulation disorder was appreciated by determining a jeune glycemia to all the patients, the oral glucose tolerance test at the patients who were until 60 years old and for which there wasn't any evidence of glucose intolerance a jeune. The uniform pattern of OGTT values was considered due to insulin resistance and hyperinsulinism. We obtained the values of cholesterol, triglycerides, HDL-C, LDL-C and atherogenesis index. RESULTS: The patients with impaired glycoregulation had significant increased values of cholesterol (p = 0.03) and triglycerides (p < 0.001), decreased HDL-C (p = 0.004), compared to the patients without glycoregulation disorder. LDL-C didn't vary significantly (p = 0.2). The patients with impaired glycoregulation had the value of ventricular mass 254.46 +/- 38 g, compared to 239.52 +/- 41 g for the patients without glycoregulation disorder. In group B, we found 14 patients with impaired glycoregulation (35%) and 11 patients in group C (27.5%) with the same metabolic disorder. After 6 month, only 9 patients with glycoregulation disorder (22.5) were left in group B and also 10 patients (25%) with the same disorder in group C. CONCLUSION: Moderate physical exercise associated with antihypertensive therapy induced, besides the decrease of blood pressure values, a good control of lipids and glucose markers of metabolism.