Infectious Diseases and Basal Ganglia Calcifications: A Cross-Sectional Study in Patients with Fahr's Disease and Systematic Review.

Background: It is unclear whether patients with basal ganglia calcifications (BGC) should undergo infectious disease testing as part of their diagnostic work-up. We investigated the occurrence of possibly associated infections in patients with BGC diagnosed with Fahr's disease or syndrome and consecutively performed a systematic review of published infectious diseases associated with BGC. Methods: In a cross-sectional study, we evaluated infections in non-immunocompromised patients aged ≥ 18 years with BGC in the Netherlands, who were diagnosed with Fahr's disease or syndrome after an extensive multidisciplinary diagnostic work-up. Pathogens that were assessed included the following: Brucella sp., cytomegalovirus, human herpesvirus type 6/8, human immunodeficiency virus (HIV), Mycobacterium tuberculosis, rubella virus, and Toxoplasma gondii. Next, a systematic review was performed using MEDLINE and Embase (2002-2023). Results: The cross-sectional study included 54 patients (median age 65 years). We did not observe any possible related infections to the BGC in this population. Prior infection with Toxoplasma gondii occurred in 28%, and in 94%, IgG rubella antibodies were present. The positive tests were considered to be incidental findings by the multidisciplinary team since these infections are only associated with BGC when congenitally contracted and all patients presented with adult-onset symptoms. The systematic search yielded 47 articles, including 24 narrative reviews/textbooks and 23 original studies (11 case series, 6 cross-sectional and 4 cohort studies, and 2 systematic reviews). Most studies reported congenital infections associated with BGC (cytomegalovirus, HIV, rubella virus, Zika virus). Only two studies reported acquired pathogens (chronic active Epstein-Barr virus and Mycobacterium tuberculosis). The quality of evidence was low. Conclusions: In our cross-sectional study and systematic review, we found no convincing evidence that acquired infections are causing BGC in adults. Therefore, we argue against routine testing for infections in non-immunocompromised adults with BGC in Western countries.

Genotypes, superantigen gene profiles, and presence of exfoliative toxin genes in clinical methicillin-susceptible Staphylococcus aureus isolates.

We compared genotype and virulence gene profiles for strains from carriers with autologous invasive infection (n = 56), nasal isolates from matched carriers (n = 108), and invasive strains from noncarriers (n = 34). Superantigen gene profiles and presence of exfoliative toxin genes A and D were associated with clonal complex rather than with invasive disease.

Non-invasively measured structural and functional arterial characteristics and coronary heart disease risk in middle aged and elderly men.

BACKGROUND: In cardiovascular (CV) epidemiology, interest increases in studying etiologic and prognostic implications of early structural or functional changes of the large arteries. Examples of such measurements are pulse wave velocity (PWV), carotid intima-media thickness (CIMT) and augmentation index (AIx). PWV and CIMT are established markers of CV risk whereas the role of AIx as indicator of risk has not fully been established. Therefore, our aim was to relate AIx to CV risk and to compare the magnitude of relations of PWV, CIMT and AIx to CV risk. METHODS: Two hundred and ninty-nine men free from cardiovascular disease (mean age 59.2 years), participated in this cross-sectional study. Cardiovascular risk profile was determined and 10-year coronary heart disease risk was estimated using the Framingham risk score (FRS). PWV, CIMT and AIx were measured and data were analyzed using linear regression models. RESULTS: PWV and CIMT were strongest related to FRS whereas AIx showed the weakest relation. Ten-year coronary heart disease risk increased 6.24%, 95% confidence interval (CI) [5.11;7.37] per standard deviation (S.D.) increase in PWV, 6.39% [5.24;7.54] per S.D. increase in CIMT and 2.50% [1.19;3.80] per S.D. increase in AIx. CONCLUSION: In middle aged and elderly men AIx is related to CV risk. However, compared with AIx, PWV and CIMT seem better markers of cardiovascular risk.

Noninvasive arterial measurements of vascular damage in healthy young adults: relation to coronary heart disease risk.

PURPOSE: There is an increasing interest in noninvasive measurements of early structural or functional changes in large arteries such as pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and augmentation index (AIx). These measurements may be applied in etiologic or prognostic research. The role of the AIx as a marker of cardiovascular risk has not fully been established. Our aim was to study whether AIx is related to coronary heart disease (CHD) risk and to compare the strength of the relations of AIx, PWV, and CIMT with cardiovascular risk in healthy young adults. METHODS: Our study included 224 men and 273 women (mean age 28 years, range 27-30 years) from the Atherosclerosis Risk in Young Adults (ARYA) study. Cardiovascular risk profile was determined and CHD risk was estimated using the Framingham risk score. AIx, PWV and CIMT were measured using standard methods. Data were analyzed in strata of gender using linear regression models. RESULTS: In men, PWV and CIMT were most strongly related to CHD risk. The increase in CHD risk per standard deviation increase in measurement was 0.24%/m/s, 95% CI (0.01;0.33) and 0.32%/mm, 95% CI (0.08;0.55), whereas the AIx was not significantly related to CHD risk (0.09 %/% 95% CI [-0.15;0.33]). In women, AIx, PWV, and CIMT were weakly but significantly related to CHD risk; there was no clear difference between the measurements. CONCLUSION: In young men, PWV and CIMT are better measures of CHD risk than AIx. In women, AIx, PWV and CIMT estimate CHD risk equally well.

Alcohol consumption and augmentation index in healthy young men: the ARYA study.

BACKGROUND: Light-to-moderate alcohol consumption is associated with a decreased risk of ischemic cardiovascular disease, whereas increased alcohol intake is related to hypertension and intracerebral hemorrhage. We studied the effect of alcohol consumption on the augmentation index (AIx), a measure of arterial wave reflection in a population of healthy young men. METHODS: Three hundred twenty-nine men (mean age 28 years) from the Atherosclerosis Risk in Young Adults study (ARYA-study) were studied. The level of alcohol consumption and risk factors for cardiovascular disease were determined. The AIx was estimated by radial applanation tonometry using a Sphygmocor device. The relation between alcohol intake level and AIx was determined using linear regression models. RESULTS: There was a positive graded relation between alcohol intake and AIx. Subjects who did not drink, who drank 1 to 2 glasses/d, or who drank > or =3 glasses of alcohol/d had, respectively, a -0.6% (95% confidence interval [CI] -4.2, 3.0), 0.2% (95% CI -2.6, 2.9), and 3.4% (95% CI 0.2, 6.7) difference in AIx compared with very light drinkers (<1 glass/d). After adjustment for current smoking, body mass index and HDL-cholesterol, those consuming >3 glasses/d had a 3.29% (95% confidence interval CI 0.01, 6.7) higher AIx compared with those consuming <1 glass/d. CONCLUSIONS: In a population of healthy young men, the heaviest drinkers had a significantly higher AIx. This finding supports the evidence that increased alcohol consumption is related to vascular damage at young age.

Average blood pressure and cardiovascular disease-related mortality in middle-aged women.

BACKGROUND: The aim of this study was to assess which average blood pressure (BP) component (ie, systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP], or mean arterial pressure [MAP]), is most strongly related to cardiovascular disease (CVD)-related mortality and to evaluate whether the strength of the relation varies with follow-up time. METHODS: This was a prospective cohort study. The studied cohort comprised a population of postmenopausal women (n = 7813) between the ages of 49 and 66 years of age, of whom four BP measurements were available, obtained at four different time points. Average BP, ie, the mean of the four measurements divided by the standard deviation, was entered in Cox proportional hazards models to facilitate direct comparison. Hazard ratios (HR) were calculated adjusted for age, body mass index, presence of diabetes mellitus, smoking habit, and use of BP-lowering medication. In addition analyses were repeated in strata of follow-up time (10, 15, and 20 years). RESULTS: During a mean follow-up of 13.1 years, 463 CVD-related deaths occurred. For SBP and MAP the highest HR for CVD mortality were found; however, the confidence intervals (CI) overlapped (SBP: HR = 1.43, 95% CI = 1.30 to 1.58; DBP: HR = 1.35, 95% CI = 1.23 to 1.50; PP: HR = 1.30, 95% CI = 1.19 to 1.42; MAP: HR = 1.43, 95% CI = 1.30 to 1.58). Analyses in strata of follow-up time did not show a difference in strength of the associations with increasing follow-up time. CONCLUSIONS: In this prospective follow-up study of postmenopausal women, SBP and MAP seemed to be strongest related with CVD-related death; however the CI of the HR overlapped.