Free fatty acids and the metabolic syndrome in patients with obstructive sleep apnoea.

Obesity and metabolic syndrome (MS) occur frequently in patients with obstructive sleep apnoea syndrome (OSAS). We hypothesised that circulating free fatty acids (FFAs) are elevated in OSAS patients independently of obesity. This elevation may contribute to the development of MS in these patients. We studied 119 OSAS patients and 119 controls. Participants were recruited and studied at sleep unit of our institution (Hospital Universitari Son Dureta, Palma de Mallorca, Spain) and were matched for sex, age and body mass index (BMI). The occurrence of MS was analysed by clinical criteria. Serum levels of FFAs, glucose, triglycerides, cholesterol, high-density lipoprotein-cholesterol, aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, C-reactive protein and 8-isoprostanes were determined. Prevalence of MS was higher in OSAS than in the control group (38 versus 21%; p=0.006). OSAS patients had higher FFAs levels than controls (mean±sd 12.2±4.9 versus 10.5±5.0 mg·dL(-1); p=0.015). Among subjects without MS, OSAS patients (OSAS+ MS-) showed higher levels of FFAs than controls (OSAS- MS-) (11.6±4.7 versus 10.0±4.4 mg·dL(-1); p=0.04). In a multiple regression model, after adjustment for age, sex, BMI and the presence of MS, FFAs were significantly associated with apnoea/hypopnoea index (p=0.04). This study shows that FFAs are elevated in OSAS and could be one of the mechanisms involved in the metabolic complications of OSAS.

Effects of CPAP on oxidative stress and nitrate efficiency in sleep apnoea: a randomised trial.

BACKGROUND: Previous studies have presented contradictory data concerning obstructive sleep apnoea syndrome (OSAS), lipid oxidation and nitric oxide (NO) bioavailability. This study was undertaken to (1) compare the concentration of 8-isoprostane and total nitrate and nitrite (NOx) in plasma of middle-aged men with OSAS and no other known co-morbidity and healthy controls of the same age, gender and body mass index; and (2) test the hypothesis that nasal continuous positive airway pressure (CPAP) therapy attenuates oxidative stress and nitrate deficiency. METHODS: A prospective, randomised, placebo controlled, double-blind, crossover study was performed in 31 consecutive middle-aged men with newly diagnosed OSAS and 15 healthy control subjects. Patients with OSAS were randomised to receive sham CPAP or effective CPAP for 12 weeks. Blood pressure, urinary catecholamine levels and plasma 8-isoprostane and NOx concentrations were obtained before and after both treatment modalities. RESULTS: Patients with OSAS had significantly higher 8-isoprostane levels (median (IQR) 42.5 (29.2-78.2) vs 20.0 (12.5-52.5) pg/ml, p = 0.041, Mann-Whitney test) and lower NOx levels (264 (165-650) vs 590 (251-1465) micromol/l, p = 0.022) than healthy subjects. Body mass index, blood pressure and urinary catecholamines were unchanged by CPAP therapy, but 8-isoprostane concentrations decreased (38.5 (24.2-58.7) pg/ml at baseline vs 22.5 (16.2-35.3) pg/ml on CPAP, p = 0.0001) and NOx levels increased (280 (177-707) vs 1373 (981-1517) micromol/l, p = 0.0001) after CPAP. CONCLUSIONS: OSAS is associated with an increase in oxidative stress and a decrease in NOx that is normalised by CPAP therapy.

CPAP decreases plasma levels of soluble tumour necrosis factor-alpha receptor 1 in obstructive sleep apnoea.

There is increasing evidence that inflammation plays an important role in the development of cardiovascular complications in patients with obstructive sleep apnoea (OSA). No previous works have studied levels of soluble tumour necrosis factor-alpha receptor (sTNFR)-1 in patients with OSA. The aims of the present study were to examine serum levels of sTNFR-1 and the effect of nasal continuous positive airway pressure (CPAP) in patients with OSA. A prospective, randomised, placebo-controlled crossover study was performed. In total, 30 consecutive newly diagnosed OSA patients (apnoea/hypopnoea index 43.8+/-27.0 events x h(-1)) and 15 healthy obese patients were selected. Urinary levels of norepinephrine and epinephrine, as well as plasma sTNFR-1, tumour necrosis factor (TNF)-alpha, interleukin (IL)-6 and leukotriene (LT)B(4) levels were obtained at baseline and after 3 months of CPAP or sham CPAP. Nocturnal urinary levels of norepinephrine, epinephrine and sTNFR-1 (1,053+/-269 versus 820+/-166 pg x mL(-1)) were significantly higher in OSA patients. There were no significant differences in plasma levels of IL-6, LTB(4), or TNF-alpha between the two study groups. There were no significant differences in blood pressure, urinary catecholamine levels, or plasma IL-6, LTB(4) and TNF-alpha levels after both treatment modalities. However, after 3 months of effective CPAP usage, sTNFR-1 levels were significantly reduced (1,053+/-269 versus 899+/-254 pg x mL(-1)). Obstructive sleep apnoea patients have higher levels of soluble tumour necrosis factor-alpha receptor 1 than individuals without OSA; soluble tumour necrosis factor-alpha receptor 1 levels are lowered by continuous positive airway pressure therapy. These findings further corroborate a potential role of inflammation in the natural history of obstructive sleep apnoea.

[Determining cardiac output by carbon dioxide rebreathing in patients with sleep apnea-hypopnea syndrome]. / Determinación del gasto cardíaco mediante reinhalación de CO2 en pacientes con síndrome de apneas-hipopneas durante el sueño.

The objective of the present study was to determine the relation between resting cardiac output in patients with sleep apnea-hypopnea syndrome but without arterial hypertension or heart failure as measured indirectly by the carbon dioxide rebreathing method and left ventricular function evaluated by transthoracic echocardiography. We also compared the variability and reproducibility of the measurements obtained by the equilibrium and exponential methods. In patients with sleep apnea-hypopnea syndrome there was a modest but significant association between resting cardiac output and left ventricular shortening fraction (r=0.690; P<.001) and left ventricular ejection fraction (r=0.690; P<.001). In addition, mean (SD) cardiac output obtained by the equilibrium method showed a lower coefficient of variability (0.21 [0.08]) than that of the exponential method (0.16 [0.09]) (P<.01) as well as a narrower reproducibility interval.

Determinación del gasto cardíaco mediante reinhalación de CO2 en pacientes con síndrome de apneas-hipopneas durante el sueño / Determining cardiac output by carbon dioxide rebreathing in patients with sleep apnea-hypopnea syndrome

El objetivo del presente estudio ha sido relacionar la medida indirecta del gasto cardíaco por reinhalación de anhídrido carbónico en reposo en pacientes con síndrome de apneas-hipopneas durante el sueño sin hipertensión arterial ni insuficiencia cardíaca, con la función ventricular izquierda valorada mediante ecocardiografía transtorácica. También se comparan la variabilidad y la reproducibilidad de las medidas obtenidas por el método del equilibrio y por el método exponencial. En pacientes con síndrome de apneas-hipopneas durante el sueño se evidencia una relación moderada pero significativa del gasto cardíaco en reposo (método de equilibrio) con las fracciones de acortamiento (r = 0,690; p < 0,001) y de eyección del ventrículo izquierdo (r = 0,690; p < 0,001). Además, el gasto cardíaco obtenido por el método de equilibrio mostró un menor coeficiente de variabilidad que por el obtenido por el método exponencial (0,21 ± 0,08 frente a 0,16 ± 0,09; p < 0,01), así como un menor intervalo de reproducibilidad

The objective of the present study was to determine the relation between resting cardiac output in patients with sleep apnea-hypopnea syndrome but without arterial hypertension or heart failure as measured indirectly by the carbon dioxide rebreathing method and left ventricular function evaluated by transthoracic echocardiography. We also compared the variability and reproducibility of the measurements obtained by the equilibrium and exponential methods. In patients with sleep apnea-hypopnea syndrome there was a modest but significant association between resting cardiac output and left ventricular shortening fraction (r=0.690; P<.001) and left ventricular ejection fraction (r=0.690; P<.001). In addition, mean (SD) cardiac output obtained by the equilibrium method showed a lower coefficient of variability (0.21 [0.08]) than that of the exponential method (0.16 [0.09]) (P<.01) as well as a narrower reproducibility interval

Broncodilatadores de acción corta: ¿qué lugar les reservamos? / No disponible

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Utilidad de la ecoendoscopia para la resección endoscópica de los tumores carcinoides duodenales / Utility of echoendoscopy for endoscopic resection of duodenal carcinoid tumors

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Diseño y análisis de estudios de casos y controles / Disign and analysis of case-control studies

En este artículo se revisan las principales medidas asociados a los estudios de casos y controles. Se describen los métodos de diseño y de análisis estadístico de este tipo de estudio y se ejemplifican estos procedimientos mediante software estándar como EpiInfo y EpiTable. Por último, se presenta la corrección necesaria en el caso de que la exposición al factor de riesgo se mide con un test de sensibilidad y especificidad conocida (AU)

Mediciones en epidemiología. Medidas de frecuencia, de asociación y de impacto potencial / Measures in Epidemiology. Frequency, association and impact measures

En este artículo se revisan las principales medidas de frecuencia, asociación e impacto de uso frecuente en los estudios epidemiológicos en relación con los distintos niveles de actuación de la investigación epidemiológica: descriptivo, conocimiento etiológico e intervención. Por último, se describen los principales sesgos presentes en este tipo de estudios (AU)

Diseño y análisis de estudios de cohortes / Design and analysis of cohort studies

En este artículo se revisan las principales medidas asociados a los estudios de cohortes. Se describen los métodos de diseño y de análisis estadístico de este tipo de estudio y se ejemplifican estos procedimientos mediante software estándar como EpiInfo y EpiTable. Por último, se presenta la corrección necesaria en el caso de que la exposición al factor de riesgo se mide con test de sensibilidad y especificidad conocida (AU)

Diseño y análisis de estudios de prevalencia / Design and analysis of prevalence studies

En este artículo se revisan las principales medidas asociados a los estudios de sección cruzada o de prevalencia. Se describen los métodos de diseño y de análisis estadístico de este tipo de estudio y se ejemplifican estos procedimientos mediante software estándar como EpiInfo y EpiTable (AU)

[Late postoperative amiodarone pulmonary toxicity]. / Toxicidad pulmonar por amiodarona en el post-operatorio tardío.

Amiodarone is an effective antiarrhytmic drug and it is used to treat supraventricular or ventricular rhythm disturbances. Nevertheless it is not free from side effects. Acute amiodarone-induced pulmonary toxicity is one of them. We referred a 55-year-old man who started on amiodarone after a mitral valva replacement. Afterwards he had acute respiratory failure and diffuse ill-defined opacities. The diagnosis was confirmed by detection of lots of foamy macrophages in the bronchoalveolar lavage fluid. Relief of symptoms and arterial blood gases improvement was achieved when he started on corticosteroids and amiodarone treatment was stopped.

Toxicidad pulmonar por amiodaroma en el post-operatorio tardío / Late postoperative amiodarone pulmonary toxicity

La amiodarona es un fármaco antiarrítmico muy utilizado para el control de arritmias ventriculares y supraventriculares. No obstante, no está exenta de efectos secundarios, entre los que se encuentra la toxicidad pulmonar aguda. Presentamos el caso de un varón de 55 años que después de una cirugía de sustitución de la válvula mitral, comienza tratamiento con amiodarona y posteriormente desarrolla insuficiencia respiratoria e infiltrados alveolointersticiales bilaterales difusos. El diagnóstico se confirmó con la detección de lipófagos en las muestras del lavado bronco alveolar. Comenzó un tratamiento con corticoides sistémicos y se retiró el tratamiento con amiodarona. Con ello se detectó una mejoría clínica y gasométrica progresiva (AU)

[Listeria monocytogenes meningitis in the adult in Spain. Report of 10 cases and review of the literature]. / Meningitis por Listeria monocytogenes en el adulto en España. Presentación de 10 casos y revisión de la literatura.

INTRODUCTION: Ten new cases of Listeria monocytogenes meningitis (LMM) in the adult are here reported. Also, a review is made of reported cases by Spanish authors in the last 30 years, with an analysis of the predisposing conditions and mortality rate from this type of bacterial meningitis (BM) throughout the study period. METHODS: The reported cases met two criteria: CSF biochemistry consistent with BM and positive CSF and/or blood culture for Listeria monocytogenes. The bibliographic search of previously reported cases was made through Medline. Cases were divided into two periods: from 1974 to 1988, and from 1989 onwards. Predisposing conditions, therapy, and mortality were analyzed and compared between the two study periods. RESULTS: The features of the cases reported here did not differ from those in the cases reported so far, with the single feature of two HIV-positive patients. Of the analyzed cases, 73% had some predisposing condition. Thirty-eight and 39% of the total of patients and of patients with some predisposing conditions, respectively, died, with a statistically significant difference (p < 0.001) between those with and without predisposing conditions. Among the treated patients, 87% received either ampicillin or penicillin and the mortality rate among these patients was 30%. No differences regarding mortality was rate observed between the two study periods, the total of cases of between those treated with the aforementioned antibiotics. CONCLUSIONS: Patients with LMM commonly have a predisposing condition. The mortality rate in this type of BM is still high among those treated with ampicillin or penicillin, and a decrease in the mortality rate was not observed when the reported cases in Spain in the last 30 years were analyzed. The optimal therapy for this condition is still to be defined.

Meningitis por Listeria monocytogenes en el adulto en España. Presentación de 10 casos y revisión de la literatura / Listeria monocytogenes meningitis in the adult in Spain. Report of 10 cases and review of the literature

Introducción. Se presentan 10 nuevos casos de meningitis por Listeria monocytogenes (MLM) en adultos y, junto con ellos, se revisan los publicados por autores españoles en los últimos 30 años, analizando las enfermedades predisponentes y mortalidad de este tipo de meningitis bacteriana (MB) a lo largo del período de estudio. Métodos. Los casos presentados aquí reunían estos dos criterios: analítica de líquido cefalorraquídeo (LCR) compatible con MB y cultivo positivo de Listeria monocytogenes en LCR y/o sangre. La búsqueda de casos publicados previamente se hizo a través de Medline. Se dividieron los casos en dos períodos: de 1974 a 1988 y de 1989 en adelante. Se analizaron las enfermedades predisponentes, tratamiento y mortalidad, comparando ambos períodos. Resultados. Las características de los nuevos casos presentados no difieren de lo publicado hasta ahora, con la única particularidad de que dos de los 10 estaban infectados por el virus de la inmunodeficiencia humana (VIH). De los casos analizados, el 73 por ciento sufría alguna enfermedad predisponente. Falleció el 39 por ciento del total, y entre los que había información sobre enfermedad de base, el 40 por ciento, con diferencia significativa (p < 0,001) entre los que tenían alguna y los que no. De los pacientes tratados, lo fueron con ampicilina o penicilina el 87 por ciento, y entre éstos la mortalidad fue del 30 por ciento. No se halló diferencia en la mortalidad entre los dos períodos ni en el total de casos ni entre los tratados con los citados antibióticos. Conclusiones. Los pacientes con MLM presentan con mucha frecuencia una enfermedad predisponente. La mortalidad en este tipo de MB es alta aun entre los tratados con ampicilina o penicilina, no observándose una disminución de la mortalidad al analizar los casos publicados en España en los últimos 30 años. Está por definir el mejor tratamiento de esta enfermedad (AU)

Asma de difícil control: un reto diagnóstico y terapéutico / Difficult-to-control asthma: ad diagnostic and therapeutic challenge

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[Usefulness of induced sputum cytology in the study of central masses in elderly patients]. / Utilidad de la citología de esputo inducido en el estudio de masas centrales en ancianos.

OBJECTIVE: To analyze the diagnostic yield of cytology obtained by means of sputum induction in elderly patients with central masses. METHODS: A total of 23 patients older than 75 years with centrally located pulmonary masses identified by computerized tomography were studied. All patients collected three spontaneously produced sputum specimens and underwent three sputum-induction sessions. Induction was considered satisfactory when the patient expectorated within the following 15 minutes. All sputum specimens were processed by May-Grünwald-Giemsa and Papanicolau staining techniques. The definite diagnostic was considered that obtained by means of bronchial biopsy or chest percutaneous aspirative puncture (PAP). RESULTS: With sputum induction, 19 patients (83%) collected satisfactory specimens and in 14 cases cytology was positive for malignancy (sensitivity 74%) and negative in five. No false-positive cases were recorded and in no patient did complications occur in association with sputum induction. The analysis of agreement between induced sputum and definite diagnosis showed a kappa index of 0.66. CONCLUSIONS: Among elderly patients with central pulmonary masses, the cytology of induced sputum should be considered as the first diagnostic procedure because of its harmlessness, remarkable sensitivity and high histologic correlation.