Proteomic investigations into hypertension: what's new and how might it affect clinical practice?

Introduction: Hypertension is a multifactorial disease that has, thus far, proven to be a difficult target for pharmacological intervention. The application of proteomic strategies may help to identify new biomarkers for the early diagnosis and prompt treatment of hypertension, in order to control blood pressure and prevent organ damage. Areas covered: Advances in proteomics have led to the discovery of new biomarkers to help track the pathophysiological processes implicated in hypertension. These findings not only help to better understand the nature of the disease, but will also contribute to the clinical needs for a timely diagnosis and more precise treatment. In this review, we provide an overview of new biomarkers identified in hypertension through the application of proteomic techniques, and we also discuss the difficulties and challenges in identifying biomarkers in this clinical setting. We performed a literature search in PubMed with the key words 'hypertension' and 'proteomics', and focused specifically on the most recent literature on the utility of proteomics in hypertension research. Expert opinion: There have been several promising biomarkers of hypertension identified by proteomics, but too few have been introduced to the clinic. Thus, further investigations in larger cohorts are necessary to test the feasibility of this strategy for patients. Also, this emerging field would profit from more collaboration between clinicians and researchers.

Cholinergic alterations by exposure to pesticides used in control vector: Guppies fish (Poecilia reticulta) as biological model.

Spinosad and temephos are two of the most used pesticides in Mexico for the control of vector causing disease such as dengue, chikungunya and Zika. The aim of this study was to compare the neurotoxic effects of these two pesticides using guppy fish (Poecilia reticulata) as a model organism. Guppies were exposed for 7 and 21 days to technical grade temephos and spinosad at 1.0 and 0.07 g/L, respectively, (10 and 0.5 mg/L of active substance; concentrations recommended by the Ministery of Health of the State (Secretaría de Salud de Nayarit (SSN) Mexico)). Subsequently, acetylcholinesterase activity (AChE) and acetylcholine concentrations (ACh) in muscle tissue were determined. Temephos exposure decreased AChE activity and increased ACh concentration, whereas exposure to spinosad only increased ACh concentration. Though cholinergic alterations were more severe in fish exposed to temephos, both pesticides were equally lethal during the first seven days after exposure. Nonetheless, temephos was more lethal after 21 days.

Monitorización ambulatoria de la presión arterial y actividad física en pacientes hipertensos / Ambulatory blood pressure monitoring and physical activity in hypertensive patients. Circadian pattern and physical activity

Objetivo: Analizar la relación entre el patrón circadiano de la presión arterial ambulatoria de 24h y la actividad física habitual en sujetos hipertensos. Material y métodos: Estudio transversal en el que se incluyeron 552 pacientes hipertensos del estudio EVIDENT (edad media 61 ± 55 años; 49,5% mujeres). La presión arterial ambulatoria se valoró con un tonómetro radial (dispositivo-B pro) y la actividad física se evaluó con un acelerómetro Actigraph GT3X (counts/minuto) durante 7días. Resultados: Los pacientes con patrón circadiano dipper realizaban mayor actividad física habitual que los no dipper. Las medidas de la actividad física (counts/minuto) presentaron correlación negativa con el ratio noche/día de las presiones arteriales sistólica y diastólica (ρ = -0,227 y ρ = -0,205; p < 0,001), respectivamente. Esta asociación se mantuvo en la regresión lineal múltiple después de ajustar por factores de confusión (β = -0,016; p < 0,001). En la regresión logística, considerando el patrón circadiano como variable dependiente (1: dipper; 0: no dipper), la odds ratio del tercer tertil de counts/minuto respecto del primero fue de 2,80 (IC95%: 1,73-4,51; p < 0,001) después de ajustar por las variables de confusión. Conclusiones: La actividad física evaluada con acelerómetro se asoció con un mayor descenso nocturno de la presión arterial y, en consecuencia, un menor ratio noche/día de la presión arterial sistólica y diastólica en sujetos hipertensos

Objective; To analyze the relationship between the circadian pattern of 24hour ambulatory blood pressure and regular physical activity in hypertensive patients. Material and methods: A cross-sectional study that included 552 hypertensive patients from EVIDENT study (mean age 61 ± 55 years, 49.5% women) was performed. Ambulatory blood pressure was measured with a radial tonometer (pro-B device) and physical activity was assessed with an accelerometer Actigraph GT3X (counts/min) for 7 days. Results: Patients with dipper circadian pattern performed more regular physical activity than non-dipper patients. The measures of physical activity (counts/min) showed negative correlation with the night/day systolic and diastolic blood pressures ratio (ρ = -.227 and ρ = -.205, P < .001), respectively. This association remained in the multiple linear regression after adjusting for confounders (β = -.016, P < .001). In the logistic regression, considering the circadian pattern as the dependent variable (1: dipper, 0: no dipper), the odds ratio for third tertile of counts/minute, compared to the first one was 2.80 (95% CI: 1.73-4.51, P < .001) after adjusting for confounding variables. Conclusions: Physical activity assessed by accelerometer was associated with increased nocturnal blood pressure and, consequently, a lower night/day systolic and diastolic blood pressure ratio in hypertensive patients

Relationship between electrocardiographic left ventricular hypertrophy criteria and vascular structure and function parameters in hypertensive patients.

The objective of this study was to determine the electrocardiographic left ventricular hypertrophy (LVH) criterion that best correlated with vascular structure and function parameters in hypertensive patients. A cross-sectional study involving 347 hypertensive patients was performed. The mean age of the subjects was 54.9±11.8 years, and 61% were male. Electrocardiography was used to detect LVH based on the evaluation of 10 criteria, and we defined the voltage-duration product (VDP) complex criterion. The vascular structure was evaluated according to carotid intima-media thickness (C-IMT), and vascular function was evaluated according to pulse wave velocity (PWV), the ambulatory arterial stiffness index (AASI), the home arterial stiffness index, and the peripheral (PAIx) and central (CAIx) augmentation indices. LVH according to at least some electrocardiographic criteria was recorded in 29.10% of the patients (34.10% of females; 25.90% of males). The vascular structure and function parameters showed higher values in the hypertensive patients with LVH. The criterion most closely correlated with C-IMT was Lewis-VDP (r=0.257); with PWV and AASI, the criterion was the Framingham-adjusted Cornell voltage (r=0.228 and r=0.195, respectively); and with CAIx and PAIx, the criterion was Novacode (r=0.226 and r=0.277, respectively). In the multivariate analysis, the association of the vascular structure and function parameters, the VDP complex (multiple linear regression) and the presence of LVH (logistic regression) disappeared after adjusting for age, sex and antihypertensive drugs. The relationship between the electrocardiographic criteria used to detect LVH in hypertensive patients and the vascular structure and function parameters were fundamentally conditioned by age and antihypertensive drug treatment.

[Mild cognitive impairment: early detection and new perspectives]. / Deterioro cognitivo leve: deteccion temprana y nuevas perspectivas.

INTRODUCTION. Along past years, interest in mild cognitive impairment (MCI) research and its early detection has been increased. Unlike first theories, international current proposals suggest that MCI is a syndrome characterized by an impairment in one or more cognitive functions without interfering in daily functional abilities and it is also accompanied by a concern because of the cognitive change. Although early MCI detection is usually made by cognitive screening tests, most of them do not seem to correctly detect MCI, but dementia. AIM. To expose an analysis of the cognitive screening tests more suitable for clinical MCI detection, according to current researches. DEVELOPMENT AND CONCLUSIONS. There are three kind of cognitive screening tests: general cognitive screening tests, specific cognitive screening tests and MCI-subtype cognitive screening test. We observe that most of the tests don't follow current MCI criteria. In this respect we propose to jointly apply tests, as well as the necessity of a carefully test choice to effectively detect MCI in clinical practice.

[Usefulness of self-expanding biodegradable prosthesis in the treatment of refractory benign stenosis: a case series study]. / Utilidad de las prótesis autoexpandibles biodegradables en el tratamiento de estenosis benignas refractarias. Estudio de una serie de casos.

BACKGROUND: The use of self-expanding biodegradable prosthesis treatment of refractory benign stenosis is still undefined. OBJECTIVE: To determine the utility and safety of biodegradable polydioxanone prostheses as treatment of gastrointestinal tract refractory benign strictures. METHODS: Consecutive patients diagnosed with refractory benign stricture of gastrointestinal tract following Kochman's criteria were included. The type of stenosis were anastomotic (n = 5), peptic (n = 1), post-radiotherapy (n = 1) and they were located in proximal esophagus-hypofarynge (n = 2), esophagus medium (n = 1), distal esophagus (n = 2) and rectum (n = 2). The prosthesis was placed under endoscopic and fluoroscopic control under conscious sedation with propofol. RESULTS: Seven patients (8 prosthesis) were included. Mean patient age was 49 years-old (range: 37-70). Insertion prosthesis was successful in all cases. Distal migration of prosthesis was observed in both rectal stenosis and was the indication of a second prosthesis placement in one case. At the end of follow-up (median follow-up 30 weeks for esophageal stricture, 33 weeks for rectal stricture) 5 patients remained asymptomatic. Eighty per cent of patients with esophageal stenosis showed partial and transient re-stenosis due to hyperplastic reaction during the degradation of the prosthesis, with transient dysphagia in two patients resolved medically. Complete prosthesis degradation was confirmed by endoscopy in all cases. CONCLUSIONS: The use of self-expanding biodegradable polydioxanone prosthesis is a safe and utile therapeutic option for refractory benign gastrointestinal stenosis.

El aumento de la velocidad de la onda de pulso no se asocia con la elevación de la presión arterial central en hipertensos con enfermedad renal / The increase in the speed of the pulse wave is not hypertensive patients with kidney disease

Objetivo: Analizar la relación entre la velocidad de la onda de pulso (VOP) y la presión arterial central valorada con el índice de aumento (IA) en personas hipertensas con enfermedad renal. Métodos: Se incluyeron 406 hipertensos con función renal normal y 72 con enfermedad renal. La rigidez arterial se estimó con la VOP y con el IA. Se siguieron los criterios de la Guía Europea de Hipertensión de 2007para valorar la existencia o no de enfermedad renal. Resultados: La VOP fue 8,98 ± 2,15 y 10,17 ± 3,01 m/s (p <0,05) y el IA 30,06 ± 12,46% y 30,23 ± 12,56% (p >0,05)en hipertensos con función renal normal y con enfermedad renal, respectivamente. El análisis de regresión múltiple reveló la función renal como determinante importante de VOP, pero no del IA. Conclusión: En hipertensos con enfermedad renal la VOP está aumentada, pero no el IA. Consideramos que el IA no es una medida fiable de la rigidez arterial en hipertensos con enfermedad renal (AU)

Objective: To analyze the relationship between pulse wave velocity (PWV) and central blood pressure evaluated by augmentation index (AIx) in hypertensive patients with kidney disease. Methods: 406 hypertensive patients with normal renal function and 72 with kidney disease. Arterial stiffness was estimated with the PWV and the AIx. We followed the 2007 European Guidelines of Hypertension criteria to assess the presence or absence of kidney disease. Results: PWV was 8.98 ±2.15 and 10.17 ± 3.01 m/s (p <0.05) and AIx 30.06% ± 12.46and 30.23% ± 12.56 (p >0.05) in hypertensive patients with normal renal function and kidney disease, respectively. Multiple regression analysis showed the renal function as an important determinant of PWV, but not AIx. Conclusion: In hypertensive patients with renal disease PWV is increased, but not the AIx. We believe that the AIx is not a reliable measure of arterial stiffness in hypertensive patients with kidney disease (AU)

Diferencias de la ecuación CKD-EPI con la de MDRD para la estimación del filtrado glomerular en pacientes hipertensos / Differences in the CKD-EPI equation with MDRD for the estimation of glomerular filtration in hypertensive patients

Objetivo: Analizar las concordancias en el filtrado glomerular(FG) estimado con las ecuaciones de CKD-EPI y MDRDIDMS en una cohorte de pacientes hipertensos. Métodos: Se incluyeron 478 hipertensos consecutivamente, edad media57,58 años (DE = 12,34), el 68,3% hombres. La estimación del FG se realizó con las ecuaciones de MDRD-IDMS y CKD-EPI, valorando las concordancias entre ellas. Resultados: La estimación de FG con CKD-EPI fue 4,37 ml/min/1,73 m2 (IC 95%, 3,73-4,19) superior al MDRD-IDMS en global y por sexos (hombres3,99; mujeres 5,04). En menores de 65 años la diferencia fue mayor, 6,55 ml/min/1,73 m2 (IC 95%, 5,95-7,15), tanto en hombres(6,07) como en mujeres (6,48). Sin embargo, en mayores de 65 años no se encontró diferencia significativa. El coeficiente de correlación intraclase fue 0,904 (IC 95%, 0,886-0,919), en hombres 0,897 y en mujeres 0,917, y el índice kappa fue 0,848(IC 95%, 0,795-0,889), en hombres 0,845 y en mujeres 0,852.Conclusión: La ecuación de CKD-EPI estima un FG más alto en mayores de 65 años y reclasifica hacia estadio 1 a hipertensos catalogados en estadio 2 por MDRD-IDMS (AU)

Objective: To analyze the agreement in glomerular filtration rate (GFR) estimated with CKD-EPI and MDRD-IDMS equations in a cohort of hypertensive patients. Methods: We included consecutively 478 hypertensive patients, 57.58 (SD: 12.34)aged, 68.3% males. The estimation of GFR was performed with MDRD-IDMS and CKD-EPI equations and we analyzed the agreement between them. Results: The estimation of GFR with CKD-EPI was 4.37 (95%:3,73-4,19) mL/min/1,73 m2 higher than MDRD-IDMS, overall and by gender (males 3.99; females5.04). In patients under 65 years the difference was greater,6.55 (95%: 5,95-7,15) ml/min/1,73 m2 in both men 6.07 and women6.48. However, in over 65 years we found no significant difference. Intraclass correlation coefficient was 0.904 (95%CI:0,886-0,919), 0.897 men and 0.917 women and Kappa index0.848 (95% CI: 0.795-0.889), 0.845 men and 0.852 women. Conclusion: CKD-EPI equation estimated a higher FG in hypertensive patients under 65 years and reclassified in stage 1 patients classified in stage 2 by MDRD-IDMS (AU)

[Differences between the CKD-EPI and the MDRD equations when estimating the glomerular filtration rate in hypertensive patients]. / Diferencias de la ecuación CKD-EPI con la de MDRD para la estimación del filtrado glomerular en pacientes hipertensos.

OBJECTIVE: To analyze the agreement in glomerular filtration rate (GFR) estimated with CKD-EPI and MDRD-IDMS equations in a cohort of hypertensive patients. METHODS: We included consecutively 478 hypertensive patients, mean age 57.58 yr (SD: 12.34), 68.3% males. The estimation of GFR was performed with MDRD-IDMS and CKD-EPI equations and we analyzed the agreement between them. RESULTS: The estimation of GFR with CKD-EPI was 4.37 (95%:3.73-4.19) mL/min/1,73 m2 higher than MDRD-IDMS, overall and by gender (males 3.99; females 5.04). In patients under 65 years the difference was greater, 6.55 (95%:5.95-7.15) mL/min/1.73 m2 in both men 6.07 and women 6.48. However, we found no significant difference over 65 years. Intraclass correlation coefficient was 0.904 (95% CI:0.886-0.919), 0.897 men and 0.917 women and Kappa index 0.848 (95% CI :0.795-0.889), 0.845 men and 0.852 women. CONCLUSION: CKD-EPI equation estimated a higher GFR in hypertensive patients under 65 years and reclassified in stage 1 patients classified in stage 2 by MDRD-IDMS.

[The increase in the speed of the pulse wave is not associated with elevated central blood pressure in hypertensive patients with kidney disease]. / El aumento de la velocidad de la onda de pulso no seasocia con la elevación de la presión arterial centralen hipertensos con enfermedad renal.

OBJECTIVE: To analyze the relationship between pulse wave velocity (PWV) and central blood pressure evaluated by augmentation index (AIx) in hypertensive patients with kidney disease. METHODS: 406 hypertensive patients with normal renal function and 72 with kidney disease. Arterial stiffness was estimated with the PWV and the AIx. We followed the 2007 European Guidelines of Hypertension criteria to assess the presence or absence of kidney disease. RESULTS: PWV was 8.98 ± 2.15 and 10.17 ± 3.01 m/s (p <0.05) and AIx 30.06% ± 12.46 and 30.23% ± 12.56 (p >0.05) in hypertensive patients with normal renal function and kidney disease, respectively. Multiple regression analysis showed the renal function as an important determinant of PWV, but not AIx. CONCLUSION: In hypertensive patients with renal disease PWV is increased, but not the AIx. We believe that the AIx is not a reliable measure of arterial stiffness in hypertensive patients with kidney disease.

Deformidad ósea secundaria a un encondroma / Bone deformation secondary to enchondroma

Los encondromas son tumores benignos de cartílago hialinomaduro que crecen en las metáfisis de los huesos tubulares. Presentamos el caso de un varón de 4 años de edad que acudió a la consulta de pediatría por presentar desde hacía 3 meses una deformidad del antebrazo izquierdo, sin signos inflamatorios. El hallazgo clínico, junto con el estudio radiológico, donde se aprecia una voluminosa lesión osteolítica en el radio izquierdo, permitió el diagnóstico de encondroma con un elevado grado de certeza. Dado que puede ser el inicio de una enfermedad de Ollier con afectación de varios huesos y existe la posibilidad de transformación maligna, consideramos necesario mantener estas lesiones bajo control en un centro especializado (AU)

Enchondromas are benign tumors formed by mature hyaline cartilage that affect the tubular bones. We present the case of a 4-year-old boy who was brought to the outpatient pediatric clinic. He had developed a deformity in left forearm with no evidence of inflammation three months earlier. The clinical findings and the radiological study, which revealed the presence of a large osteolytic lesion in the left radius, led to the diagnosis of enchondroma, with a high degree of certainty. These lesions must be monitored at a specialized center as they can be an indication of the onset of Ollier’s disease and there is a possibility of malignant transformation (AU)

Framingham-Grundy, REGICOR y SCORE en la estimación del riesgo cardiovascular del paciente hipertenso. Concordancias y discrepancias (CICLO-RISK) / Framingham-Grundy, REGICOR and SCORE in cardiovascular risk estimation in hypertensive patients. Agreements and disagreements (CICLO-RISK)

Introducción y objetivos. Evaluar concordancias y discrepancias en la estimación del riesgo cardiovascular en pacientes hipertensos con las escalas Framingham-Grundy, REGICOR y SCORE. Pacientes y métodos. Diseño: estudio descriptivo transversal. Sujetos: 453 pacientes hipertensos de 30 a 74 años (60,5 % mujeres) seleccionados por muestreo aleatorio en dos centros de salud. Edad media: 63,69 años. Mediciones: edad, sexo, presión arterial, glucemia, lípidos, tabaquismo y riesgo cardiovascular calculado con las escalas Framingham-Grundy y REGICOR para estimar el riesgo coronario en 10 años, y SCORE para estimar el riesgo de muerte cardiovascular en 10 años. Resultados. Framingham: riesgo coronario medio, 14,26 % (IC95 %: 13,45 ÷ 15,07); varones, 18,16 %, y mujeres, 11,72 % (p < 0,05). REGICOR: riesgo coronario medio, 4,96 % (IC95 %: 4,67 ÷ 5,26); varones, 5,88 %, y mujeres, 4,36 % (p < 0,05). SCORE: riesgo de muerte cardiovascular, 2,94 % (IC95 %: 2,64-3,24); varones, 4,01 %, y mujeres, 2,24 % (p < 0,05). Hay correlación positiva intensa, entre 0,80 y 0,85 (p < 0,01), al comparar las tres escalas. Presentan riesgo cardiovascu lar alto-muy alto el 22,5 % con Framingham, el 0,7 % con REGICOR y el 17 % con SCORE (p < 0,05). La concordancia estimada con el Índice Kappa fue: Framingham y REGICOR, 0,045; Framingham y SCORE, 0,619, y SCORE y REGI COR, 0,063. Conclusiones. Encontramos una correlación positiva intensa entre las tres escalas, aunque la ecuación de REGICOR estima un riesgo cardiovascular entre dos y tres veces inferior a las otras dos. Sin embargo, hay importantes discrepancias a la hora de clasificar a los pacientes según niveles de riesgo, especialmente entre la ecuación de REGICOR con Framingham-Grundy y SCORE

Introduction and objectives. To evaluate agreements and disagreements in cardiovascular risk estimation in hypertensive patients with Framingham-Grundy, REGICOR and SCORE scales. Patients and methods. Design: cross-sectional descriptive study. Subjects: 453 hypertensive patients, aged 30-74 years (60.5 % women) selected by random sampling in two health centres. Mean age was 63.69 years. Measurements: age, sex, blood pressure, glycaemia, lipids, smokers and cardiovascular risk calculated with Framingham-Grundy and REGICOR scales to estimate coronary risk in 10 years, and SCORE to estimate cardiovascular mortality risk in 10 years. Results. Framingham: mean coronary risk, 14.26 % (IC95 %: 13.45 ÷ 15.07); men, 18.16 %, and women, 11.72 % (p < 0.05). REGICOR: mean coronary risk, 4.96 % (IC95 %: 4.67 ÷ 5.26); men, 5.88 %, and women, 4.36 % (p < 0.05). SCORE: mean cardiovascular mortality risk, 2.94 % (IC95 %: 2.64-3.24); men, 4.01 %, and women, 2.24 % (p < 0.05). There is strong positive correlation, between 0.80 and 0,85 (p < 0.01), when we compare the three scales. The proportion of high and very high-risk patients was 22.5 % with Framingham, 0.7 % with REGICOR and 17 % with SCORE (p < 0.05). The agreement considered with Kappa index was: Framingham and REGICOR, 0.045; Framingham and SCORE, 0.619, and SCORE and REGICOR, 0.063. Conclusions. We found strong positive correlation between the three scales, although cardiovascular risk estimate with REGICOR is between two and three times lower than other two. Nevertheless, there are important disagreements when we classified the patients according levels risk, especially between REGICOR with Framingham-Grundy and SCORE

[Biochemical profile of primary hyperparathyroidism. Comparative study with hypercalciuric renal lithiasis]. / Perfil bioquímico del hiperparatiroidismo primario. Estudio comparativo con la litiasis renal hipercalciúrica.

Primary hyperparathyroidism (PH) is now considered a common condition. Its frequency and the deleterious long-term effects of hypercalcemia make a correct diagnosis mandatory. We attempted to evaluate the usefulness of the indexes of parathyroid function and hormone measurements more commonly used in the diagnosis of PH. To this end we studied 64 patients, distributed in three groups: group with PH, group with hypercalciuric renal lithiasis (HRL) and control group (CG). The results were evaluated with a test of comparison of means and a stepwise discriminating regression analysis. The 8 most useful measurements to differentiate PH from HRL and CG were serum calcium, corrected serum calcium, serum phosphorus, fasting calcium excretion (FCE), maximal tubular calcium reabsorption (MTCR), maximal tubular phosphate reabsorption (MTPR), osteocalcin, PTH half molecule (PTH-HM) and 1,25-dihydroxyvitamin D. The 3-variable and 4-variable groups with a highest discriminating ability were: serum calcium, FCE and PTH-HM, and serum calcium, FCE, PTH-HM and MTPR. We think that the measurement of these four variables is the most adequate strategy for the diagnosis of PH.

Treatment of gastric pyrosis with almagate in patients with and without endoscopically demonstrable duodenal ulcer. A multicentre clinical trial.

An open multicentre trial of a new clinical antacid, almagate (hydrated aluminium-magnesium hydroxycarbonate, Al2Mg6(OH)14(CO3)2 X 4H2O, Almax) has been made in 169 patients suffering from gastric pyrosis (heartburn). Clinical and endoscopical exploration revealed that 104 of the patients had an active duodenal ulcer and 60 of these (group II) were treated with antisecretory drugs (cimetidine or ranitidine) plus Almax and 44 (group III) with Almax alone. Endoscopic exploration in the remaining 65 patients (group I) failed to reveal the presence of an ulcer and they were also treated with Almax alone. In all groups Almax proved to be very effective and the majority of patients were symptom free by the end of the two week trial. 79.5% of the ulcer patients in group III required doses of 6-8 g/d whereas only 21.7% of those in group II with concomitant treatment with antisecretory drugs took more than 4 g/d. The nonulcer patients of group I also used lower doses and only 29.3% needed to reach 6-8 g/d. There was a significant increase in daily bowel movements in all groups which was considered to be advantageous by most patients. Overall tolerance was excellent and side effects (diarrhoea 7 cases, nauseas 5 cases and constipation 1 case) were few and transient and 84.2% of the patients expressed a clear preference for Almax over their previous antacid treatment.