Inherited and acquired predispositions for thrombosis in immunocompetent patients with cytomegalovirus-associated thrombosis.

BACKGROUND: Thrombosis is a rare complication of cytomegalovirus (CMV) infection in immunocompetent patients. The clinical circumstances of this complication have never been studied, to the best of our knowledge. AIM: We reviewed all reports on CMV-associated thrombosis in immunocompetent adults found in the literature, in search for thrombosis risk factors other than CMV. METHODS: Our search yielded 32 case reports and case series on CMV-associated thrombosis in immunocompetent adults. Reports on immunocompromised patients, infants and elderly patients were excluded. All reports were reviewed for other, acquired as well as inherited, predispositions for thrombosis. RESULTS: Reports on 39 immunocompetent adults were reviewed, mean age for which was 34.9+/-10.8years. Overall, 14 (35.9%) patients had one or more acquired predispositions for thrombosis; 16 (45.7%) of the 35 patients that were investigated for inherited thrombophilias had one or more inherited predispositions for thrombosis. Only 12 (34.3%) patients were found to have no acquired or inherited predispositions for thrombosis other than CMV. The most common (n=13; 33.3%) acquired predisposition for thrombosis was daily use of oral contraceptives. The most common (n=6; 17.1%) inherited predisposition for thrombosis was factor V Leiden mutation. CONCLUSIONS: Most immunocompetent adults with CMV-associated thrombosis have other acquired or inherited predispositions for thrombosis. Hence, addressing these predispositions in patients with CMV-associated thrombosis may be of great clinical importance.

Depressive symptoms and erectile dysfunction in men with coronary artery disease.

OBJECTIVES: To study the association between erectile dysfunction (ED) and depressive symptoms in men with coronary artery disease (CAD). A cross-sectional analysis of data obtained during a prospective study was carried out. METHODS: A cohort of men undergoing coronary angiography filled-out the sexual health inventory for males (SHIM) and the mental health inventory 5 (MHI5) questionnaires for detection and severity assessment of both ED and depressive symptoms. CAD documented by coronary angiography was defined as > or = 50% stenosis in at least one of the major epicardial coronary arteries. RESULTS: Overall, 242 men, with a mean age of 63.7 +/- 12.0 years, were included in the study. ED and depressive symptoms were found in 76% and 47.9% of men, respectively, whereas 94 (38.8%) men suffered from both. The prevalence of diabetes mellitus and the mean age were significantly higher, whereas the mean MHI5 scores were significantly lower, in the group with ED than that without. ED was associated independently with age (P <.0001) and depressive symptoms (P = .007), but not with the number of obstructed coronary arteries, history of diabetes mellitus, hypertension, or smoking. After controlling for age and diabetes mellitus, the scores of SHIM were positively correlated with MHI5 scores (r = .14; P = .03). CONCLUSIONS: These results validate the high prevalence of both ED and depressive symptoms in men with CAD. ED in men with CAD might be associated with age and depressive symptoms.

Elevated resting heart rate is associated with the metabolic syndrome.

BACKGROUND: Increased resting heart rate (RHR) may be associated with increased cardiovascular morbidity. Our aim was to explore the possibility that increased RHR is associated with the prevalence of the metabolic syndrome (MetS) in a sample of apparently healthy individuals and those with cardiovascular risk factors. METHODS: We performed a cross-sectional analysis in a large sample of apparently healthy individuals who attended a general health screening program and agreed to participate in our survey. We analyzed a sample of 7706 individuals (5106 men and 2600 women) with 13.2% of men and 8.9% of the women fulfilling the criteria for the MetS. The participants were divided into quintiles of resting heart rate. Multiple adjusted odds ratio was calculated for having the MetS in each quintile compared to the first. RESULTS: The multi-adjusted odds for the presence of the MetS increased gradually from an arbitrarily defined figure of 1.0 in the lowest RHR quintile (<60 beats per minute (BPM) in men and <64 BPM in women) to 4.1 and 4.2 in men and women respectively in the highest one (>or=80 BPM in men and >or=82 BPM in women). CONCLUSION: Raised resting heart rate is significantly associated with the presence of MetS in a group of apparently healthy individuals and those with an atherothrombotic risk. The strength of this association supports the potential presence of one or more shared pathophysiological mechanisms for both RHR and the MetS.

C-reactive protein velocity following antibiotics in patients with chronic obstructive pulmonary disease exacerbation and community acquired pneumonia.

INTRODUCTION: Distinguishing community acquired pneumonia (CAP) from chronic obstructive pulmonary disease (COPD) exacerbation is a challenging task, since fever, productive cough, dyspnea, and leukocytosis are all common features of both conditions. Moreover, chest X-ray might not be sensitive enough. It is therefore quite common for physicians to prescribe unnecessary antibiotics for COPD exacerbation, leading to resistant bacteria and other related adverse affects. AIM: To study whether CRP levels upon admission and the delta in CRP levels following initiation of antibacterial treatment, could provide an efficient tool for distinguishing CAP from COPD exacerbation. METHODS: The study group included 36 COPD exacerbation and 49 CAP patients, admitted to a single Internal Medicine department during the years 2004-2006. All patients were treated with cephalosporins and macrolides upon admission. RESULTS: CRP levels upon admission were significantly higher among CAP patients than among COPD exacerbation patients (111.5+/-104.4 vs. 34.9+/-28.6 mg/l, p<0.0001). CRP levels on the second day of hospitalization, following antibiotic administration to all patients, made a sharp incline in 36.7% of CAP patients compared to only 5.9% of COPD exacerbation patients (p=0.005), and remained unchanged in 61.8% of COPD patients compared to 16.3% of CAP patients (p=0.0006). CONCLUSIONS: CRP levels upon admission and the delta in CRP levels following initiation of antibacterial treatment could provide an efficient tool for distinguishing CAP from COPD exacerbation.

Cytomegalovirus-associated splenic infarcts in a female patient with Factor V Leiden mutation: a case report.

INTRODUCTION: Cytomegalovirus-associated thrombosis has rarely been reported in the medical literature, and if so, mainly in immunocompromized patients. CASE PRESENTATION: We report the case of a 36-year-old Caucasian woman with acute cytomegalovirus infection presenting with spontaneous splenic infarcts. Trans-esophageal echocardiography did not show any vegetations or mural thrombi. The patient was also found to be heterozygous for the Factor V Leiden mutation. Anticoagulation treatment was considered but ruled out since cytomegalovirus was the obvious trigger for thrombosis in this patient. To the best of our knowledge, this is only the third report to date of cytomegalovirus-associated splenic infarcts. CONCLUSION: This case report serves as additional evidence for the role of cytomegalovirus in thrombosis.

Screening for erectile dysfunction and associated cardiovascular risk factors in Israeli men.

BACKGROUND: Erectile dysfunction is associated with treatable cardiovascular risk factors; therefore, screening for erectile dysfunction and its cardiovascular risk factors is of clinical importance. OBJECTIVES: To detect erectile dysfunction cases and assess their severity among military personnel. METHODS: The Sexual Health Inventory for Men questionnaire was handed out to military personnel aged 25-55 years during routine examinations. RESULTS: A total of 19,131 men with a mean age of 34.0 +/- 7.1 years participated in routine physical examinations during the years 2001-2005. More than half of them (n=9956, 52%) completed the SHIM questionnaire. No significant differences were found between those who completed the SHIM questionnaire and those who did not, in terms of mean age, mean body mass index, and prevalence of cardiovascular risk factors. One out of every four men (25.2%) suffered from erectile dysfunction, which was mild in 18.9%, mild to moderate in 4.4%, moderate in 1.1%, and severe in 0.7%. Even though treatable cardiovascular risk factors were quite prevalent in the study group (45.2% of them suffered from dyslipidemia, 25.6% smoked, 4.2% suffered from essential hypertension, and 1.6% from diabetes mellitus), erectile dysfunction was significantly associated with age and diabetes mellitus alone (P<0.0001). CONCLUSIONS: There is a high prevalence of erectile dysfunction and associated treatable cardiovascular risk factors in Israeli men aged 25-55, especially those with diabetes.

Relation of educational level to inflammation-sensitive biomarker level.

It is a well-established finding that cardiovascular morbidity varies among groups of different socioeconomic status. Inflammatory processes have been proposed as a possible mediator of this variance. Level of education is an important indicator of socioeconomic status, inversely related to levels of inflammatory biomarkers. Whether this association was significant in a subpopulation of highly educated individuals was questioned. This cross-sectional study enrolled attendees of an executive health screening program intended specifically for executive and high-wage personnel from September 2002 to November 2007. A detailed questionnaire, anthropometric measurements, and laboratory data were used to determine self-reported years of education and cardiovascular risk factors. Linear regression models included high-sensitivity C-reactive protein, fibrinogen, erythrocyte sedimentation rate, and white blood cell count as dependent variables and were adjusted for multiple potential confounders. Data for 8,998 subjects (5,757 men, 3,241 women) with a mean age of 44 years (range 18 to 84) were analyzed. More than two-thirds reported >or=14 years of schooling, and >2,900 reported >or=17 years of schooling. We found a statistically significant inverse association between number of school years and high-sensitivity C-reactive protein, fibrinogen, and erythrocyte sedimentation rate. Higher levels of education were associated with lower prevalences of diabetes and current smoking in both genders and lower prevalences of hypertension and dyslipidemia in women. In conclusion, level of education was inversely associated with inflammatory biomarkers and prevalence of cardiovascular risk factors, even within highly educated populations.

Platelet counts and platelet activation markers in obese subjects.

OBJECTIVE: In this work we studied the correlation between platelet count, platelet activation, and systemic inflammation in overweight, obese, and morbidly obese individuals. METHODS AND SUBJECTS: A total of 6319 individuals participated in the study. Complete blood counts, high sensitivity C-reactive protein (hs-CRP) serum levels, and body mass index (BMI) were measured during routine checkups. Platelet activation markers were studied among 30 obese (BMI = 41 +/- 8 kg/m(2)) and 35 nonobese (BMI = 24 +/- 3 kg/m(2)) individuals. Platelet activation status was evaluated by flow cytometry using specific antibodies against the activated platelet membrane glycoprotein IIb/IIIa, p-selectin (CD-62 p), and binding of Annexin-V to platelet anionic phospholipids. RESULTS: Overweight, obese, and morbidly obese females had significantly elevated platelet counts ( P < .0001) compared with normal-weight females. No significant elevation of platelet counts was observed in the male subgroups. A significant age adjusted correlation between BMI and platelet counts ( P < .0001) was found among females. This correlation was attenuated (P = .001) after adjustment for hs-CRP concentrations. The flow cytometry analysis of platelets showed no significant differences in activation marker expression between nonobese and obese individuals. DISCUSSION: Obesity may be associated with elevated platelet counts in females with chronic inflammation. Obesity is not associated with increased platelet activation.

Pure hypertriglyceridemia might be associated with erectile dysfunction: a pilot study.

INTRODUCTION: Unlike the association between erectile dysfunction (ED) and high levels of low-density lipoprotein (LDL) cholesterol, the association between ED and hypertriglyceridemia is still debatable. Aim. To study prevalence and severity of ED in young men with very high levels of triglycerides. MAIN OUTCOME MEASURES: Prevalence of ED, ED severity, total cholesterol levels, LDL cholesterol levels, and triglycerides levels. METHODS: Men who were enrolled went through routine health checks including full lipid profiling and completion of the Sexual Health Inventory for Men (SHIM) questionnaire. Very high levels of triglycerides were defined as >or=500 mg/dL. Very high levels of LDL cholesterol were defined as >or=190 mg/dL. Men with diabetes, ischemic heart disease, high-density lipoprotein (HDL) cholesterol >or=60 mg/dL, and mixed hyperlipidemias were excluded. RESULTS: Included were 88 men, aged 35.9 +/- 7.1 years (range: 25-51 years): 21 men with "pure" severe hypertriglyceridemia (triglyceride levels >or=500 mg/dL and non-HDL cholesterol or=190 mg/dL and triglycerides