Angiotensin-converting enzyme inhibitors and angiotensin-II-receptor antagonists modulate sodium handling based on endogenous lithium clearance.

BACKGROUND: Numerous studies based on assessment of lithium clearance demonstrated higher sodium reabsorption in renal proximal tubules in individuals with hypertension, overweight, obesity, metabolic syndrome, or diabetes. AIMS: We aimed to assess the influence of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin-II-receptor antagonists (ARB) treatment on sodium handling. METHODS: In a sample of 351Caucasian subjects without diuretic treatment with prevailing sodium consumption, we studied associations between renal sodium reabsorption in proximal (FPRNa) and distal (FDRNa) tubules assessed by endogenous lithium clearance and daily sodium intake measured by 24-hour excretion of sodium (UNaV), in the context of obesity and long-term treatment with ACE-I or ARB. RESULTS: In the entire study population, we found a strong negative association between FPRNa and ACE-I/ARB treatment (b = -19.5; SE = 4.9; P <0.001). Subjects with FPRNa above the median value showed a significant adverse association between FPRNa and age (b = -0.06; SE = 0.02; P = 0.003), with no association with ACE-I/ARB treatment (P = 0.68). In contrast, in subjects with FPRNa below the median value, we found a strongly significant adverse relationship between FPRNa and ACE-I/ARB treatment (b = -30.4; SE = 8.60; P <0.001), with no association with age (P = 0.32). CONCLUSIONS: ACE-I/ARB long-term treatment modulates FPRNa in the group with lower reabsorption, but not in that with higher than median value for the entire study population.

Brain Fog and Quality of Life at Work in Non-Hospitalized Patients after COVID-19.

Background: There is still a need for studies on the quality of life (QoL) at work among COVID-19 survivors. Therefore, we aimed to evaluate the association between the brain fog symptoms and the QoL at work in non-hospitalized patients with previous SARS-CoV-2 infection. Methods: Three hundred non-hospitalized patients (79.33% women; median age, 36 years; interquartile range, 30-48 years) were included in the final analysis. An anonymous neuropsychological questionnaire containing eight different questions on the presence of brain fog symptoms in four time intervals, i.e., pre-COVID-19 and 0-4, 4-12, and >12 weeks after infection, was retrospectively introduced to patients and staff of the University Hospital in Krakow. Additionally, a four-point Likert scale was used to evaluate QoL at work in four time periods. Included were participants aged ≥ 18 years in whom the diagnosis of COVID-19 was confirmed by the RT-PCR from nasopharyngeal swab and the first symptoms occurred no earlier than 3 months before the completion of the questionnaire. Results: Before SARS-CoV-2 infection, 28.00% (n = 84) of patients reported poor QoL at work. Within 4, 4-12, and >12 weeks after infection, a decrease in QoL was observed in 75.67% (n = 227), 65.00% (n = 195), and 53.66% (n = 161) of patients, respectively (p < 0.001). With increasing deterioration of the QoL at work, the number of brain fog symptoms increased, and patients with severe QoL impairment exhibited a median of five symptoms for <4, 4-12, and >12 weeks post-COVID-19. In the multivariable logistic regression model, predictors of the deterioration of the QoL at work depended on the time from COVID-19 onset; in the acute phase of the disease (<4 weeks), it was predicted by impairment in remembering information from the past (OR 1.88, 95%CI: 1.18-3.00, p = 0.008) and multitasking (OR 1.96, 95%CI: 1.48-2.58, p < 0.001). Furthermore, an impairment in the QoL at work 4-12 weeks and >12 weeks after COVID-19 was independently associated with age (OR 0.46, 95%CI: 0.25-0.85, p = 0.014 and OR 1.03, 95%CI: 1.01-1.05, p = 0.025, respectively), problems with multitasking (OR 2.05, 95%CI: 1.40-3.01, p < 0.001 and OR 1.75, 95%CI: 1.15-2.66, p = 0.009, respectively), answering questions in an understandable/unambiguous manner (OR 1.99, 95%CI: 1.27-3.14, p = 0.003 and OR 2.00, 95%CI: 1.47-2.36, p = 0.001, respectively), and, only for the >12 week interval, problems with remembering information from the past (OR 2.21, 95%CI: 1.24-3.92, p = 0.007). Conclusions: Certain brain fog symptoms, such as impaired memory or multitasking, are predictors of a poorer QoL at work not only during the acute phase of COVID-19 but also within more than 12 weeks after the onset of infection.

Post-occlusive reactive hyperemic response of skin microcirculation among extremely obese patients in the short and long term after bariatric surgery.

OBJECTIVE: To assess changes of post-occlusive reactive hyperemic response in skin microcirculation among extremely obese patients 10 days and 6 months after bariatric surgery for patients with and without hypertension. METHODS: Skin blood flow was measured using PeriFlux laser Doppler fluxmetry. Data were analyzed in the entire group and two subgroups: with and without hypertension. RESULTS: Data from 88 patients (mean age 42.1 ± 11.2 years, 40.5% men) were analyzed. Six months after bariatric surgery, the time to reach peak flows had been shortened (2.4 ± 1.7 vs 2.1 ± 1.0 seconds, P < .05) and the area of hyperemia had increased (1027 ± 791 vs 1386 ± 699 AU*s, P < .05). The total power of post-occlusive reactive hyperemic after occlusion had been augmented mainly with power intensification of endothelial and myogenic origin. Post-occlusive reactive hyperemic parameters had changed mainly in the subgroup with hypertension. Variations of anthropometric parameters, metabolic characteristic, and adipokines mainly influenced on studied hyperemic flow parameters variations after the intervention in multiple regression analysis. CONCLUSION: Cutaneous post-occlusive reactive hyperemic reactivity in time and frequency domains improved 6 months after bariatric surgery, and improvements in microvascular function were observed mainly in patients with hypertension. Variations of anthropometric parameters, metabolic characteristics, and adipokines had influence on hyperemic flow reactivity.

Personality traits and hypertension-mediated organ damage. / Cechy osobowosci a powiklania narzadowe nadcisnienia tetniczego.

OBJECTIVES: Arterial hypertension may lead to the development of organ changes. This study compares different personality traits in hypertensive patients with and without left ventricular hypertrophy and arterial stiffness. METHODS: The study group consisted of 93 subjects (47 males and 46 females) with primary hypertension. Left ventricular mass index (LVMI) and pulse wave velocity (PWV) were evaluated and used as markers of cardiac and vascular damage. Personality traits of each patient were assessed using three psychometric tools: NEO-FFI, DS14 and EAS. RESULTS: Patients with increased PWV scored significantly lower than individuals with normal PWVin the following scales: NEO-FFI Neuroticism (18 vs. 27.5; p = 0.018), DS14 Negative affectivity (11.5 vs. 17; p = 0.035) and EAS Fear (10 vs. 13; p = 0.004). Subjects with left ventricular hypertrophy (increased LVMI values) presented lower levels of openness to experience (measured by the NEO-FFI) than persons with normal LVMI values (23 vs. 26; p = 0.027). CONCLUSIONS: These findings suggest that there are significant differences in personality traits between hypertensive patients with and without vascular and cardiac damage.

Sense of coherence and hypertensive target organ damage. / Poczucie koherencji a powiklania narzadowe nadcisnienia tetniczego.

OBJECTIVES: This study was designed to compare the level of sense of coherence in hypertensive patients with arterial stiffness or leftventricular hypertrophy and in hypertensive individuals without such health complications. METHODS: The study group consisted of 93 participants. All of them were asked to undergo the following procedures: clinical assessment, echocardiography (to diagnose hypertensive cardiac damage), pulse wave velocity measurement (to assess vascular damage) and psychological testing (to measure their level of comprehensibility, manageability, meaningfulness, and sense of coherence). RESULTS: Patients with hypertensive vascular damage (high pulse wave velocity) had higher levels of comprehensibility and sense of coherence than other hypertensive subjects. At the same time, there were no significant differences in the level of sense of coherence (and all of its dimensions) between individuals with and people without hypertensive left ventricular hypertrophy. CONCLUSIONS: The findings of this study suggest, that the sense of coherence may not be strongly associated with good somatic health. They may also contribute to the discussion about diagnostic usefulness of the SOC-29 method as a single tool. We believe that the level of sense of coherence should be taken into consideration in further studies on the development of hypertensive TOD.

Reduction of 24-h blood pressure variability in extreme obese patients 10 days and 6 months after bariatric surgery depending on pre-existing hypertension.

Bariatric surgery is considered as a first line treatment in extreme obese patients to achieve a reduction in health risks. However, after surgical procedure obese patients with normal blood pressure (BP) levels still present residual risk, which may be partly related to lack of correction of BP profile and variability. AIM: To evaluate short (10 days) and mid-term (6 months) changes of mean values, profile and variability of BP after bariatric surgery in extremely obese patients with and without hypertension. MATERIALS & METHODS: A follow-up of cross-sectional study was conducted in 90 obese patients (aged 41.7 ±â€¯11.3, BMI = 46.7 ±â€¯5.7 kg/m2), who met the eligibility criteria and underwent bariatric surgery. Each patient underwent 24-h ambulatory BP monitoring with profile and variability estimation before, 10 days and 6 months after the intervention. RESULTS: Sixty-seven (74.4%) patients had hypertension. Significant decrease from baseline in mean values of systolic and diastolic BP in 10 days (p < .005) and 6 months (p < .005) follow-up were observed only in patients with hypertension. Moreover, only hypertensive subjects revealed significant reduction (p < 0,05) from baseline in 24-h systolic and diastolic BP weighted standard deviation and average real variability after surgical procedure. No changes were found in dipping status. CONCLUSIONS: Bariatric surgery not only decreased BP levels, but also contributed to reduction in BP variability in early period after intervention mainly in patients with pre-existing hypertension.

Arterial stiffness is not increased in patients with short duration rheumatoid arthritis and ankylosing spondylitis.

Patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have increased cardiovascular (CV) morbidity and mortality. Arterial stiffness is an independent predictor of CV events. The aim of the study was to assess arterial stiffness and inflammatory markers in patients with short duration chronic arthritis. We assessed carotid-femoral pulse wave velocity (PWV), augmentation index (AIx), traditional CV risk factors and inflammatory and endothelial markers in 71 chronic arthritis patients (RA and AS) and in 29 healthy controls. We did not find differences in PWV (for RA, AS and controls, respectively: 10 [8.8-10.9] versus 10.7 [9.1-11.8] versus 9.2 [8.3-11.4] m/s; p = .14) and AIx (for RA, AS and controls, respectively: 24.3 ± 11.5 versus 5.7 ± 12.4 versus 10 ± 12.8%; p = .22). Both groups of arthritis patients had active disease with significantly elevated inflammatory markers compared to controls. There were no correlations between endothelial and inflammatory markers and parameters of arterial stiffness in arthritis patients. When analyzing arthritis patients according to median of PVW, there were no significant differences in inflammatory and endothelial markers. We found that in patients with short duration active RA and AS arterial stiffness was not increased and furthermore, there was no association between markers of systemic inflammation and arterial stiffness.

[Falls during hospitalization--prevalence and consequences]. / Upadki w trakcie hospitalizacji--czestosc wystepowania i konsekwencje.

A systematic growth in the number of the elderly among hospitalized patients, including the number of patients in the oldest age group, is being observed over the last few years. A stay in hospital conditions is connected with deterioration of their fitness, reduction of their independence. It also entails the risk of hallucination, falls and hospital-acquired infections. The present analysis concerns 60 patients who fell during their hospitalization in the Internal Diseases and Geriatrics Unit of University Hospital in Krakow in 2012 and 2013 (in the total of 6,061 patients admitted to the Unit in this period), which was recorded in the registry of adverse events. An attempt at characterization of this group was made on the basis of medical record, assessment of fall circumstances and its consequences. This was followed by an attempt at tracing the later outcomes of these patients both during their stay in the unit as well as after the discharge from hospital (telephone contact with patient or with person indicated as contact). Analysis of the data (probably underevaluated due to the lack of unambiguous definition of a fall as well as a retrospective character of study) reveals a relation between falls in hospital and various degrees of body injuries, extended hospitalization time, increasing disability and, in some cases, even death. In the face of the observed growth in the number of hospitalized patients in advanced age, a clear definition and careful monitoring of falls as well as an attempt at an early identification of people at risk of falls may prove to be an effective means of their prevention.