RESUMO
We tested the capacity of the Sysmex UF-1000i system to detect yeasts in urine by screening a total of 22 132 urine samples received for culture in our microbiology laboratory during 1 year. We also analyzed different dilutions of previously filtered urine inoculated with a strain of Candida albicans. With clinical samples, a single cut-off point of 50 yeast-like cells (YLCs)/µL detected candiduria ≥10 000 colony forming units (CFU)/mL and >100 000 CFU/mL with a sensitivity of 87.3%/95.4%, a specificity of 97%, a negative predictive value of 95.9%, and a positive predictive value of 9.3%/5.7%. With the simulated samples, a linear relationship was observed between the dilution factor and the number of cells detected by UF-1000i. This instrument appears to be able to reliably rule out candiduria of a magnitude of at least 10 000 CFU/mL and facilitate urine sample screening, thereby providing fast results. The Sysmex UF1000i system can be adapted for candiduria screening by the use of an appropriate YLCs/µL cut-off point that takes account of the prevalence of candiduria in the population.
Assuntos
Micologia/métodos , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia , Urina/microbiologia , Leveduras/isolamento & purificação , Adulto , Idoso , Automação Laboratorial , Candidíase/diagnóstico , Candidíase/microbiologia , Contagem de Colônia Microbiana/métodos , Contagem de Colônia Microbiana/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Micologia/estatística & dados numéricos , Micoses/diagnóstico , Micoses/microbiologia , GravidezRESUMO
Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden, FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes has been investigated in many studies. We performed a pooled analysis of case-control and cohort studies investigating in adults the association between each variant and VTE, published on Pubmed, Embase or Google through January 2010. Authors of eligible papers, were invited to provide all available individual data for the pooling. The Odds Ratio (OR) for first VTE associated with each variant, individually and combined with the others, were calculated with a random effect model, in heterozygotes and homozygotes (dominant model for FVL and PT20210A; recessive for C677T MTHFR). We analysed 31 databases, including 11,239 cases and 21,521 controls. No significant association with VTE was found for homozygous C677T MTHFR (OR: 1.38; 95 % confidence intervals [CI]: 0.98-1.93), whereas the risk was increased in carriers of either heterozygous FVL or PT20210 (OR = 4.22; 95 % CI: 3.35-5.32; and OR = 2.79;95 % CI: 2.25-3.46, respectively), in double heterozygotes (OR = 3.42; 95 %CI 1.64-7.13), and in homozygous FVL or PT20210A (OR = 11.45; 95 %CI: 6.79-19.29; and OR: 6.74 (CI 95 % 2.19-20.72), respectively). The stratified analyses showed a stronger effect of FVL on individuals ≤ 45 years (p value for interaction = 0.036) and of PT20210A in women using oral contraceptives (p-value for interaction = 0.045). In this large pooled analysis, inclusive of large studies like MEGA, no effect was found for C677T MTHFR on VTE; FVL and PT20210A were confirmed to be moderate risk factors. Notably, double carriers of the two genetic variants produced an impact on VTE risk significantly increased but weaker than previously thought.
Assuntos
Fator V/genética , Predisposição Genética para Doença , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Protrombina/genética , Tromboembolia Venosa/genética , Estudos de Casos e Controles , Humanos , Fatores de RiscoRESUMO
OBJECTIVES: To report a clonal outbreak of ST17 vancomycin-resistant Enterococcus faecium (VREfm) carrying Tn1546 (vanA) in a haemo-oncology ward of a tertiary teaching hospital in the south of Spain (January-September 2009). PATIENTS AND METHODS: Twenty-two VREfm strains from 13 patients were characterized by PFGE, multiple-locus variable-number tandem-repeat analysis (MLVA) and multilocus sequence typing (MLST). Genes encoding antibiotic resistance and putative virulence traits and the Tn1546 backbone were investigated by PCR. Plasmid characterization included determination of size (S1-PFGE) and replication modules (PCR, hybridization and sequencing). Patient clinical records were analysed retrospectively. RESULTS: A single ST17 E. faecium clone (MT-7 MLVA type) carrying esp and hyl plus a 30 kb Inc18-like::Tn1546 (IS1216) plasmid was identified. Ampicillin resistance was linked to PBP5 showing mutations at positions 24, 27, 34, 66, 68, 85, 100, 144, 172, 177, 204, 216, 324, 462, 466', 470, 485, 496, 499, 525, 546, 558, 582, 586, 629, 632, 642 and 667. Other resistance genes identified were erm(B), ant(6')-Ia and aph(3')-IIIa. Fluoroquinolone resistance was attributable to ParC (Arg-61 â Gly and Ser-80 â Arg) and GyrA (Ser-83 â Arg) mutations. CONCLUSIONS: A nosocomial outbreak caused by an ST17 (CC17) E. faecium clone harbouring Esp and Hyl and a 30 kb Inc18-like::Tn1546 plasmid among haemo-oncology patients is reported. The failure of early infection control practices indicates an undetected reservoir and the ability of this strain to persist over long periods. The potential spread of epidemic clones and broad host plasmids carrying vancomycin resistance in Spain is of concern since it might contribute towards a higher rate of VREfm infection.
Assuntos
Infecção Hospitalar/epidemiologia , Elementos de DNA Transponíveis , Surtos de Doenças , Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Neoplasias Hematológicas/complicações , Plasmídeos , Adulto , Análise por Conglomerados , Infecção Hospitalar/microbiologia , Eletroforese em Gel de Campo Pulsado , Enterococcus faecium/classificação , Enterococcus faecium/genética , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Repetições Minissatélites , Dados de Sequência Molecular , Tipagem Molecular , Reação em Cadeia da Polimerase , Análise de Sequência de DNA , Espanha/epidemiologia , Resistência a Vancomicina , Fatores de Virulência/genéticaRESUMO
A 13-month prospective multicenter study including 44 hospitals was carried out to evaluate the epidemiology of Candida parapsilosis complex candidemia in Spain. Susceptibility to amphotericin B, flucytosine, fluconazole, itraconazole, voriconazole, posaconazole, anidulafungin, caspofungin, and micafungin was tested by the microdilution colorimetric method. A total of 364 C. parapsilosis complex isolates were identified by molecular methods: C. parapsilosis (90.7%), Candida orthopsilosis (8.2%), and Candida metapsilosis (1.1%). Most candidemias (C. parapsilosis, 76.4%; C. orthopsilosis, 70.0%; C. metapsilosis, 100%) were observed in adults. No C. orthopsilosis or C. metapsilosis candidemias occurred in neonates. C. parapsilosis was most frequent in adult intensive care unit (28.8%), surgery (20.9%), and internal medicine (19.7%) departments; and C. orthopsilosis was most frequent in hematology (28.6%), pediatrics (12.0%), and neonatology (11.5%) departments. The geographic distribution of C. orthopsilosis and C. metapsilosis was not uniform. According to CLSI clinical breakpoints, all C. orthopsilosis and C. metapsilosis isolates were susceptible to the nine agents tested. Resistance (MICs > 1 mg/liter) was observed only in C. parapsilosis: amphotericin B, posaconazole, itraconazole, and caspofungin (0.3% each), anidulafungin (1.9%), and micafungin (2.5%). Applying the new species-specific fluconazole and echinocandin breakpoints, the rates of resistance to fluconazole for C. parapsilosis and C. orthopsilosis increased to 4.8% and 0.3%, respectively; conversely, for C. parapsilosis they shifted from 1.9 to 0.6% (anidulafungin) and from 2.5 to 0.6% (micafungin). Our study confirms the different prevalence of C. parapsilosis complex candidemia among age groups: neither C. orthopsilosis nor C. metapsilosis was isolated from neonates; interestingly, C. metapsilosis was isolated only from adults and the elderly. The disparity in antifungal susceptibility among species could be important for therapy.
Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/genética , Candidemia/epidemiologia , Candidemia/microbiologia , Candidíase/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/classificação , Candida/classificação , Candida/isolamento & purificação , Candidíase/microbiologia , Criança , Pré-Escolar , Farmacorresistência Fúngica , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Espanha/epidemiologia , Especificidade da Espécie , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Liver steatosis in chronic hepatitis C (CHC) is related to viral and metabolic factors and likely to genetic factors. The aim of this study was to know if hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR)-C677T polymorphisms are associated with liver steatosis in nonalcoholic patients with CHC. PATIENTS AND METHOD: In 54 consecutive patients with CHC, alcohol consumption less than 40g/week, and no other causes of liver disease, a liver biopsy was performed. All variables were obtained at the time of biopsy. MTHFR-C677T was also performed in 128 healthy subjects, with age and gender similar to the patients. RESULTS: Liver steatosis was found in 33 patients (61%), 30 of them having a mild degree. Hyperhomocysteinemia was more prevalent in patients with steatosis (61% vs 24%; p=0.008) and overweight tended to be more prevalent in the same patients (61% vs 33%; p=0.05). All patients with virus C genotype 3 had steatosis. Viral load, liver inflammatory and fibrosis score were not different in patients with and without steatosis. MTHFR-C677T polymorphism was similar in controls and cases and in cases with and without steatosis. A multiple logistic regression showed that hyperhomocysteinemia was associated with liver steatosis after adjustment for age and sex (OR: 3.94; 95% CI: 1.09-14.29), and adjustment for overweight (OR: 4.43; 95% CI: 1.27-15.51). CONCLUSIONS: In nonalcoholic patients with CHC mild liver steatosis is frequent, and is associated with hyperhomocysteinemia. An association between steatosis and MTHFR-C677T polymorphism was not found.
Assuntos
Fígado Gorduroso/complicações , Hepatite C Crônica/complicações , Hepatite C Crônica/genética , Hiper-Homocisteinemia/complicações , Hiper-Homocisteinemia/genética , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Mutação , Polimorfismo Genético , Adulto , Fígado Gorduroso/genética , Feminino , Humanos , MasculinoRESUMO
The microbiology laboratory should be a safe, efficient, and comfortable place for those working there, and a pleasant place for visitors. According to the ISO 15189 standard, it should be spacious enough for the workload to be carried out without jeopardizing quality or the safety of the persons present, whether workers or visitors, and provide optimal comfort to all occupants. In addition, the setup should respect the privacy of patients, and provide controlled access to the different laboratory areas and a safe place for storing clinical samples, manuals, and reagents. In the design of the facilities, the needs of specialists, technicians, and other personnel must converge, without forgetting patients, their relatives, and other visitors. The clinical microbiology laboratory has certain characteristics that make it different from other diagnostic laboratories. Its main activity involves isolation, propagation, and handling of pathogenic microorganisms that pose a risk to the laboratory personnel. To minimize this risk, the laboratory must meet a certain level of biosafety. Moreover, correct interpretation of microbiological cultures depends on the capacity of the laboratory to avoid or minimize the presence of contaminants; hence, proper handling of samples and cultures (aseptic conditions, biosafety cabinet) is mandatory. A number of documents and regulations, from very general to highly specific (biosafety), affect the design of the microbiology laboratory. The aim of this report is to establish the minimum requirements and recommendations for designing clinical microbiology laboratories, based on a review of current regulations. It is contemplated as an aid to microbiology specialists who are designing or planning to reform their laboratories.
Assuntos
Laboratórios/organização & administração , Técnicas MicrobiológicasRESUMO
BACKGROUND AND OBJECTIVE: Women with polycystic ovary syndrome (PCOS) exhibit frequently risk factors that predispose to cardiovascular disease. Hyperhomocysteinemia is an independent risk factor for this disease. The aim of this study was to know whether young women with PCOS have increased homocysteine levels. We also analyzed their possible relation with folate and vitamin B12 levels. PATIENTS AND METHOD: Thirty nine patients with PCOS were studied; (age: mean [standard deviation] 28.9 [5.8] years), and 39 healthy women similar in age. We evaluated in all of them: smoking, menstrual cycles, hirsutism, body mass index, metabolic syndrome and levels of homocysteine, lipids, glucose, creatinine, folate, vitamin B12, follicle-stimulating hormone (FSH), luteinizing hormone (LH) and androstendione. RESULTS: Menstrual cycles, hirsutism, androstendione, LH levels and LH/FSH were higher, as we expected, in patients with PCOS. Moreover, patients had increased homocysteine (9.1 [2.1] vs 6.4 [1.8] micromol/L; p < 0.001) and glucose levels (99 [13] vs 88 [10] mg/dl; p < 0.001), a higher frequency of abnormal fasting glycemia (> 110 mg/dl) (23% vs 2.5%; p =.01) and lower folate levels (7.6 [3.7] vs 10.2 [3.6] ng/ml; p = 0.02). A multiple linear regression showed a negative association between homocysteine and folate levels (r2 = 0.05; p =.02). CONCLUSIONS: Homocysteinemia is increased in women with PCOS, and it is negatively associated with folate levels.
Assuntos
Hiper-Homocisteinemia/epidemiologia , Síndrome do Ovário Policístico/epidemiologia , Adulto , Biomarcadores , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Hiper-Homocisteinemia/sangue , Hormônio Luteinizante/sangue , Síndrome do Ovário Policístico/sangueRESUMO
Among the new technologies for the detection of subclinical atherosclerosis, ankle-brachial index, carotid ultrasonography, computed tomography detection of coronary calcifications and high-resolution nuclear magnetic resonance are those of greatest clinical usefulness. These explorations are especially useful for patients with an intermediate cardiovascular risk, or a 10-20% risk according to the National Cholesterol Education Program-Adult Treatment Panel III or 3-4% according to the SCORE project. This is because they allow the identification of high-risk patients who need a more intense treatment. In addition, high-sensitivity C-reactive protein concentrations may be considered as a new marker for the evaluation of cardiovascular risk. In this article, the current state of knowledge about these explorations and the guidelines of the main scientific societies are reviewed, and the practical conclusions of the working group are provided.
Assuntos
Arteriosclerose/diagnóstico , Proteína C-Reativa/análise , Doenças Cardiovasculares/epidemiologia , Mediadores da Inflamação/sangue , Algoritmos , Arteriosclerose/sangue , Arteriosclerose/epidemiologia , Arteriosclerose/fisiopatologia , Biomarcadores , Pressão Sanguínea , Artéria Braquial/fisiopatologia , Calcinose/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/epidemiologia , Humanos , Guias de Prática Clínica como Assunto , Radiografia , Reprodutibilidade dos Testes , Medição de Risco , Sociedades Médicas , Artérias da Tíbia/fisiopatologia , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/ultraestrutura , Túnica Média/diagnóstico por imagem , Túnica Média/ultraestrutura , UltrassonografiaRESUMO
BACKGROUND: Carotid intima-media thickness (CIMT) is a surrogate marker of cardiovascular morbility. Hyperhomocysteinemia, which is an independent cardiovascular risk factor, is associated with low folate levels. The aim of this study was to evaluate the effect of folic acid treatment on the evolution of CIMT in patients with coronary disease and homocysteinemia > or =9 micromol/l. METHODS: In 137 consecutive patients with coronary disease treated with statins and normal vitamin B12 values, a randomized treatment with open-label folic acid 2.5 mg/day (group A) or not (group B) was performed during 3 years. CIMT was evaluated by two-dimensional ultrasonography baseline and at the final of the study. RESULTS: Clinical, biochemical parameters and CIMT were similar in both groups of patients. Homocysteine levels decreased (12.4+/-3.4 vs. 10.3+/-2.4 micromol/l; p<0.001) in group A, but not in group B. CIMT did not change neither in group A (0.71+/-0.23 vs. 0.69+/-0.20 mm; p=0.34) nor in group B (0.74+/-0.23 vs. 0.72+/-0.29 mm; p=0.39). In 12 patients of group A with methylenetetrahydrofolate reductase (MTHFR) 677TT mutation a decrease of CIMT was found (0.83+/-0.35 vs. 0.72+/-0.27 mm; p=0.02), but a multiple linear regression only showed a trend to the association between CIMT changes and MTHFR 677TT (p=0.051), probably due to the small number of patients with this mutation. CONCLUSIONS: Long-time treatment with folic acid in patients with coronary disease and normal values of vitamin B12 decreases homocysteine levels. A CIMT decrease is observed in treated patients with MTHFR 677TT mutation.
Assuntos
Estenose das Carótidas/tratamento farmacológico , Ácido Fólico/uso terapêutico , Túnica Íntima/patologia , Túnica Média/patologia , Idoso , Análise de Variância , Doenças das Artérias Carótidas/tratamento farmacológico , Doenças das Artérias Carótidas/prevenção & controle , Estenose das Carótidas/prevenção & controle , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Homocisteína/efeitos dos fármacos , Homocisteína/metabolismo , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Probabilidade , Prognóstico , Valores de Referência , Medição de Risco , Método Simples-Cego , Resultado do Tratamento , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/efeitos dos fármacos , Túnica Média/diagnóstico por imagem , Túnica Média/efeitos dos fármacos , Ultrassonografia DopplerRESUMO
Streptococcus agalactiae infective endocarditis Streptococcus agalactiae is an unusual cause of infectious endocarditis. We describe the clinical characteristics, therapy and evolution of this infection in four patients diagnosed between 1996 and 2003. All four cases had native valve involvement and vegetations. All the patients had severe aortic failure and three of them also developed heart failure. Valve replacement surgery was performed in all four cases. Mortality was 50%. Infectious endocarditis due to S. agalactiae is very aggressive. Early surgery should be considered to prevent valve destruction and serious complications.
Assuntos
Endocardite Bacteriana/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/isolamento & purificação , Adulto , Idoso , Antibacterianos/uso terapêutico , Insuficiência da Valva Aórtica/etiologia , Terapia Combinada , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Feminino , Insuficiência Cardíaca/etiologia , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Espanha/epidemiologia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/cirurgiaRESUMO
BACKGROUND AND OBJECTIVE: An increase homocysteine values, which is an independent risk factor for atherotrombotic disease, can be produced with antiepileptic treatment. The aims of this study were: 1) to assess the frequency and determinant factors of hyperhomocysteinemia in adult patients receiving antiepileptic drugs, and 2) to know the effect of different doses of folic acid. PATIENTS AND METHOD: Ninety eight patients and 100 healthy controls similar in age and gender were studied. Eighty six patients were treated with hepatic enzyme inductors (diphenylhydantoine and/or phenobarbital and/or primidone and/or carbamazepine), 5 received non inductors (valproate) and 7 were treated with both in combination. Thirty eight patients were randomized to receive in an open and concurrent way folic acid, 0.2 mg (n = 18) or 5.2 mg (n = 20) daily for 3 months. RESULTS: Homocysteine values were increased in patients in relation with controls (mean [SD]12.2 [6.7] 95% confidence interval [CI],10.0-13.5 vs 8.8[2.2] 95% CI, 8.3-9.2 micromol/l; p < 0.001). Hyperhomocysteinemia was found in 28 patients and 4 controls (28.6% vs 4.0%; p < 0.001). In a multivariate analysis hyperhomocysteinemia was positively associated with treatment with antiepileptic inductors and negatively with folate values and female gender. Homocysteine values decreased after treatment with folic acid at high and low doses (p < 0.001 for both groups), and the values observed in the latter group were similar to those in healthy controls. CONCLUSIONS: Hyperhomocysteinemia is frequent in patients treated with antiepileptic drugs. Treatment with hepatic enzyme inductors and low folate values are predictors of hyperhomocysteinemia. Administration of folic acid, even at very low doses, produces a significant decrease of homocysteinemia in these patients.
Assuntos
Anticonvulsivantes/uso terapêutico , Ácido Fólico/uso terapêutico , Homocisteína/metabolismo , Hiper-Homocisteinemia/epidemiologia , Adulto , Idoso , Anticonvulsivantes/efeitos adversos , Feminino , Ácido Fólico/administração & dosagem , Humanos , Hiper-Homocisteinemia/induzido quimicamente , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND OBJECTIVE: To investigate whether hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) 677C --> T mutation are associated with venous thromboembolism in young Spanish adults. PATIENTS AND METHOD: One hundred adult patients younger than 50 years and 177 controls with similar age and gender. RESULTS: Hyperhomocysteinemia was present in 21% of the patients and 3.3% of the controls (p < 0.001), and MTHFR 677C --> T mutation was found in 25 and 14.7%, respectively (p = 0.03). Odds ratio (OR) for thromboembolism in hyperhomocysteinemic patients was 7.5 (95% CI, 2.9-19.2; p < 0.001), and in patients with MTHFR 677C --> T mutation the OR was 1.9 (95% CI, 1.1-3.5; p = 0.03). In a subgroup of 76 patients without other thrombogenic factors, thromboembolism persisted associated with hyperhomocysteinemia, yet an association with MTHFR 677C --> T mutation was not confirmed. CONCLUSIONS: Hyperhomocysteinemia, but not MTHFR 677C --> T mutation, is a risk factor for venous thromboembolism in young adults without other thrombogenic factors.
Assuntos
Homocisteína/sangue , Hiper-Homocisteinemia/complicações , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Tromboembolia/epidemiologia , Adulto , Feminino , Humanos , Masculino , Mutação , Fatores de Risco , Tromboembolia/etiologiaRESUMO
BACKGROUND: Apolipoprotein (apo) E polymorphism plays a role in the development of coronary disease, but their involvement in carotid atherosclerosis is controversial. The aim of this study was to evaluate the role of apo E polymorphism in the development of subclinical carotid atherosclerosis in patients with coronary disease. METHODS: In 226 consecutive patients with coronary disease, apo E genotypes were performed by PCR and restriction analysis. Intima-media thickness (IMT) and the presence of atherosclerotic plaques in carotid arteries were evaluated by two-dimension ultrasonography. RESULTS: Apo E allele frequencies were: 3=0.70, 4=0.22 and 2=0.08. The only patient with 2/4 genotype was excluded for the analysis. The patients were divided in three groups according to apo E genotype: E2 (2/2, 2/3), E3 (3/3) and E4 (4/4, 4/3). Patients of E4 group had higher values of low-density-lipoprotein (LDL) cholesterol and apo B than patients of E2 group (P< or =0.01). Carotid IMT mean was not different in E3 (0.81+/-0.21 mm), E4 (0.83+/-0.23 mm) and E2 groups (0.76+/-0.17 mm) (P=0.52). Mean differences of IMT in E3 group were not different from those of E2 or E4 groups after adjusting for age and gender in a first analysis, and for age, gender and LDL cholesterol levels in a second one. The number of plaques in apo E3 group was similar to that in apo E2 or apo E4 groups, after adjusting for the same variables. CONCLUSIONS: A relationship between subclinical carotid atherosclerosis and apo E polymorphism is not found in patients with coronary disease.
Assuntos
Apolipoproteínas E/fisiologia , Doenças das Artérias Carótidas/fisiopatologia , Doença das Coronárias/fisiopatologia , Idoso , Apolipoproteínas E/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético/genéticaRESUMO
BACKGROUND AND OBJECTIVE: Carotid intima-media thickness (IMT) is a marker of generalized atherosclerosis. Sequential evaluation of carotid IMT has permitted to know the factors involved in its progression. However, there are few studies about the influence of homocysteine in such progression. The aim of this work was to know the effect of homocysteine values on the evolution of carotid IMT in patients with coronary disease. PATIENTS AND METHOD: Carotid IMT (baseline and after 4 years of follow-up) was evaluated by a B-mode ultrasonography in 187 patients with coronary disease (166 males and 21 females; age: mean [standard deviation], 60 [7] years); 185 patients were treated with statins from the beginning of the study. RESULTS: Carotid IMT progression was confirmed in 59 patients (31.6%; 95% confidence interval [CI], 25.0-38.7%). Cardiovascular risk factors, basal biochemical parameters and methylenetetrahydrofolate reductase-C677T polymorphism were similar in patients with and without progression except for homocysteine values which were higher in the former (13.3 [5.3]; 95% CI, 12.0-14.6 vs 11.1 [3.5]; 95% CI, 10.5-11.7 (mol/l; p = 0.001). Biochemical changes at the end of the study were similar in both groups. In the multivariate analysis, IMT progression was associated with basal values of homocysteine (odds ratio [OR] 1.19; 95% CI, 1.07-1.31; p = 0.0008), female gender (OR 3.50; 95% CI, 1.17-10.50; p = 0.02), hypertension (OR 2.52; 95% CI, 1.14-5.59; p = 0.02) and basal high-density lipoprotein (HDL)-cholesterol values (OR, 0.94; 95% CI, 0.90-0.98; p = 0.009). CONCLUSIONS: The concentration of homocysteine is associated with the progression of carotid atherosclerosis in patients with coronary heart disease treated with statins.
Assuntos
Arteriosclerose/sangue , Arteriosclerose/complicações , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/complicações , Doença das Coronárias/complicações , Homocisteína/sangue , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We assessed the cardiovascular risk factors (CVRFs) in 116 stable liver transplant patients surviving for 5 years or more (median: 102 months). The prevalence of smokers was 29.3%, hypertension 49.1%, obesity 22.4%, hypercholesterolemia 34.5%, hypertriglyceridemia 11.2%, and hyperhomocysteinemia 57.8%. Diabetes was found in 21.5% of the patients, being more frequent in patients with hepatitis-C-virus infection (31.8% vs 15.3%; P=0.03). Patients on cyclosporine therapy had a higher prevalence of hypertension, hypercholesterolemia and hyperhomocysteinemia than those treated with tacrolimus. Multivariate analysis showed only an association between cyclosporine therapy and cholesterol concentrations (odds ratio:1.02; 95% confidence interval (CI): 1.00-1.03; P=0.01). The prevalence of hypertension, diabetes, hypercholesterolemia and hypertriglyceridemia was lower at the time of the study than at 1 and 3 years after transplantation ( P<0.05), probably related to steroid withdrawal. Comparing 87 patients' CVRFs with the general Spanish population, we found that the age-gender standardized prevalence ratio was not different: smoking 1.46 (95% CI: 0.88-1.76), obesity 1.16 (95% CI: 0.60-1.44), hypertension 1.55 (95% CI: 0.98-1.81), and hypercholesterolemia 0.64 (95%CI: 0.35-1.90). We conclude that the prevalence of CVRFs in liver transplant patients after 5 years or more is lower that found in the first years after the transplantation, and no different from that found within the Spanish population.
Assuntos
Doenças Cardiovasculares/etiologia , Transplante de Fígado , Adulto , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hiper-Homocisteinemia/epidemiologia , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Período Pós-Operatório , Prevalência , Fatores de Risco , Distribuição por Sexo , Fumar , Fatores de TempoRESUMO
BACKGROUND: A number of studies have suggested that infection with Chlamydia pneumoniae can play a role in development of atherosclerosis. The goal of this study was to know the prevalence of chronic C. pneumoniae infection, evaluated with IgG antibodies seropositivity, in Spanish patients with coronary disease and its association with inflammatory markers and cardiovascular risk factors. PATIENTS AND METHOD: In 176 patients with coronary disease IgG and IgM antibodies to C. pneumoniae were determined by enzyme immunoassay. In addition, fibrinogen and C-reactive protein values were measured as inflammatory markers. Controls were 55 healthy subjects whose age was not different from patients. Seropositivity for C. pneumoniae was considered when indices of IgG and/or IgM antibodies were higher than mean plus two standard deviations of control values. Three patients with seropositivity for IgM were excluded. RESULTS: In 126 patients and 2 controls a seropositivity against C. pneumoniae was proved (72.8% vs 4.2%; p < 0.001). Cardiovascular risk factors were not different in seropositive and seronegative groups of patients. Prevalence of hyperfibrinogenemia was higher in the former group (38.8% vs 19.1%; p = 0.01). The number of the patients with increased values of C-reactive protein was similar in both groups, although these values could be modified by treatment with statins. In multivariate analysis an association between seropositivity for C. pneumoniae and hyperfibrinogenemia was found (odds ratio [OR] = 2.42; 95% confidence interval, 1.07-5.48; p = 0.03) after adjusting for age, gender, smoking, hypertension, hypercholesterolemia and diabetes. CONCLUSIONS: Chronic infection with C. pneumoniae in patients with coronary disease is very prevalent, and it is associated with increased fibrinogen values.