N-domain isoform of Angiotensin I converting enzyme as a marker of hypertension: populational study.

The aim of this paper was to investigate the presence of the urinary 90 kDa N-domain ACE in a cohort of the population from Vitoria, Brazil, to verify its association with essential hypertension since this isoform could be a possible genetic marker of hypertension. Anthropometric, clinical, and laboratory parameters of the individuals were evaluated (n = 1150) and the blood pressure (BP) was measured. The study population was divided according to ACE isoforms in urine as follows: ACE 65/90/190, presence of three ACE isoforms (n = 795), ACE 90(+) (65/90) (n = 186), and ACE 90(-) (65/190) (n = 169) based on the presence (+) or absence (-) of the 90 kDa ACE isoform. The anthropometric parameters, lipid profile, serum levels of uric acid, glucose, and the systolic and diastolic BP were significantly greater in the ACE 90(+) compared with the ACE 90(-) and ACE 65/90/190 individuals. We found that 98% of individuals from the ACE 90(+) group and 38% from the ACE 65/90/190 group had hypertension, compared to only 1% hypertensive individuals in the ACE 90(-) group. There is a high presence of the 90 kDa N-domain ACE isoform (85%) in the studied population. The percentile of normotensive subjects with three isoforms was 62%. Our findings could contribute to the development of new efficient strategy to prevent and treat hypertension to avoid the development of cardiovascular disease.

Cerebrospinal fluid syndromes in HIV-positive patients with acute consciousness compromise

Revisamos as síndromes liquóricas de 100 pacientes HIV-positivos apresentando comprometimento agudo da consciência em pronto-socorro, as correlacionando com dados clínicos. As síndromes mais freqüentes foram: dissociaçäo proteino-citológica absoluta (21), viral (19), neurocriptococose (7), dissociaçäo proteino-citológica relativa (6) e séptica (4), hipoglicorraquia moderada (4 por cento), hipoglicorraquia severa (4 por cento), distúrbio hidroeletrolítico (3 por cento). Um quinto dos pacientes apresentou síndromes liquóricas consideradas suficientes para um diagnóstico ou uma conduta imediata. Os dados clínicos mais comuns foram infecciosos e neurológicos. Houve pouca correlaçäo entre os dados clínicos e as síndromes liquóricas. Comparado a dados de literatura, HIV-positivos tem menor chance de resultados decisivos no exame de líquor. Nós concluimos que, em pacientes HIV-positivos, que se apresentam com alteraçöes agudas da consciência, freqüentemente há resultados inespecíficos no líquor, o que deve ser julgado em funçäo de uma história clínica e exame físicos detalhados

Cerebrospinal fluid syndromes in patients with acute consciousness compromise

We reviewed the laboratory cards of 200 analysis of cerebrospinal fluid (CSF) performed to evaluate acute alterations of consciousness in adult patients attended in a neurological emergency room. 61 percent were men; the mean age was 46 years. The most common clinical data were infective and neurologic. The CSF was abnormal in 149 (74.5 percent) patients and the most common syndromes were: compressive (21 percent), hemorrhagic (11.5 percent), "viral"(8.5 percent), septic (7.5 percent), moderate hyperglycorrachia (6.5 percent), hidroelectrolytic disturbances (5.5 percent). There were some statistically significant correlations between CSF syndromes and clinical data: septic syndrome and fever and meningeal signs, hemorrhagic syndrome and headache and meningeal signs, CSF hydroelectrolytic disturbance syndrome and seizure, severe hyperproteinorrchia and headache, fever, meningeal signs and vomiting, moderate hyperproteinorrachia and age over 65 and male sex. We classified the abnormal results in two groups: 1 - sufficient for an immediate clinical decision; 2 - nonspecific. The former group was found in 27.5 percent of the patients and in 36.9 percent of the abnormal CSF results. In patients attending to neurologic emergency rooms with acute alterations of consciousness, the ecamination of the CSF frequently could contribute to an etiologic diagnosis. It must be performed after a rigorous clinical evaluation of the patient.