Association of low serum 25-hydroxyvitamin D levels and high arterial blood pressure in the elderly.

BACKGROUND: Vitamin D and calcium metabolism are involved in vascular smooth muscle cell proliferation, endothelial function and blood pressure (BP) regulation. Their physiopathology has been a matter of intensive clinical investigation with variable and sometimes contradictory results. Vitamin D insufficiency is highly prevalent in the general population, particularly among the elderly. We evaluated the association between serum 25(OH)-D levels and arterial BP in this population. METHODS: An epidemiological cross-sectional study was designed to analyse the prevalence of hypovitaminosis D ('D'AVIS' study) in our reference area. The study was performed on a representative random sample of the population over 64 years of age obtained from five primary health care areas. A medical record, arterial BP and biological analysis: serum 25(OH)-D, iPTH, creatinine, urea, calcium, albumin were obtained. RESULTS: A total of 237 subjects (53% women), aged between 64 and 93 (mean 71.7 +/- 5.3), were evaluated. The mean serum 25(OH)-D levels were 17.21 +/- 7.57 ng/ml (interval 5-54; 86% had <25 ng/ml). The mean BP was 138.8 +/- 14/80 +/- 7.4 mmHg, and 46% were on antihypertensive treatment. A significant negative association was observed between serum 25(OH)-D levels and systolic (r = -0.153, P = 0.018) and diastolic BP (r = -0.152, P = 0.019). This association persisted after controlling for possible confounders in the multivariate analyses. CONCLUSIONS: Low serum 25(OH)-D levels were inversely and independently associated with BP. Supplemental measures to prevent hypovitaminosis D in this population would be important, not only to protect the skeletal system but also for the possible beneficial effects on the cardiovascular system and the BP regulation.

Safety of Switching Nevirapine Twice Daily to Nevirapine Once Daily in Virologically Suppressed Patients.

BACKGROUND: The strategy of switching nevirapine (NVP) twice daily to once daily was evaluated. METHODS: Forty-eight-week randomized, open, multicenter trial. Stable HIV-infected patients on NVP twice daily for >12-18 weeks with alanine aminotransferase (ALT) <2.5, the upper normal limit were randomized to continue their regimen or switch to NVP 400 mg once daily. Primary end point was the proportion of ALT/aspartate transaminase (AST) > or =grade 3. RESULTS: Two hundred eighty-nine patients were included, mean CD4 620 cells per microliter. Noninferiority was demonstrated in the per protocol analysis, with 97.9% (once daily) and 99.3% (twice daily) of patients event free (difference, 1.4%; 95% confidence interval, -1.95% to 5.4%), whereas 81.8% vs. 93.8% were event free by intent-to-treat switch = toxicity analysis (difference, 12%; 95% confidence interval, 4.6% to 19.4%). Only 4 patients (3 once daily, 1 twice daily) had NVP-related grade 3/4 ALT/AST increases, but in 2 of them (once daily), transaminases decreased despite continuation with NVP. Two other once daily patients presented grade 3/4 ALT/AST increase due to well-documented acute hepatitis A virus or hepatitis C virus infection. Grade 2 ALT/AST increases occurred in 11.2% (once daily) vs. 10.3% (twice daily) of patients (P = 0.80). A larger number of once daily patients were lost to follow-up/violated protocol (15% vs. 5%). CONCLUSIONS: In patients on standard twice daily NVP-containing regimens for at least 12-18 weeks, per protocol analysis showed that switching to once daily NVP was not inferior to continued twice daily NVP in terms of the predefined noninferiority margin of 10% for hepatotoxicity.

Hipovitaminosis D asociada a exposición solar insuficiente en la población mayor de 64 años / Hypovitaminosis D associated to low sun exposure in the population over 64 years old

Fundamento y objetivo: Identificar los factores relacionados con la hipovitaminosis D en la población ambulatoria mayor de 64 años sin factores de riesgo conocidos de hipovitaminosis D. Sujetos y método: Se ha realizado un estudio transversal de ámbito poblacional en personas mayores de 64 años procedentes de las áreas básicas de salud del área de referencia del hospital. Se realizó una encuesta con varios ítems (capacidad funcional, exposición solar, paseos, alimentación) y se determinaron parámetros analíticos. Resultados: Se evaluó a 239 personas, cuya edad media (desviación estándar) era de 72 (5,4) años. El 95% presentaba un índice de Barthel mayor de 90. La concentración sérica media de 25-hidroxicolecalciferol ­25(OH)D3­ fue de 17 (7,5) ng/ml y la de paratirina intacta, de 60 (26) pg/ml. La prevalencia de hipovitaminosis D fue del 87%. El 70,3% presentó insuficiencia ­25(OH)D3 entre 11 y 25 ng/ml­ y el 16,7% deficiencia ­25(OH)D3 # 10 ng/ml­. La ingesta de vitamina D y calcio fue inferior a lo recomendado. La principal fuente de vitamina D fue el pescado azul. Las personas con deficiencia tenían un menor índice de Barthel, edad media superior, vivían en pisos, tenían una ingesta menor de calcio, menor exposición solar y menor hábito de pasear al sol. Los valores más elevados de fosfatasa alcalina y paratirina intacta se hallaron en las personas con deficiencia. Las variables asociadas independiente y significativamente con la situación de deficiencia fueron el índice de Barthel igual o menor de 90, no tomar el sol y vivir en un piso. Conclusiones: Se evidencia una elevada prevalencia de hipovitaminosis D durante los meses de invierno, que se asocia a un menor grado de autonomía funcional, a un escaso hábito de exposición solar y a vivir en un piso, en los mayores de 64 años residentes en nuestra comunidad

Background and objective: To identify the factors related to hypovitaminosis D in the population over 64 years of age without known risk factors of hypovitaminosis D. Subjects and method: It was a cross-sectional population study in individuals over 64 year-old attending basic healthcare areas in our hospital's area of reference. A survey was conducted to assess various items (functional capacity, exposure to sun, walks, eating habits). Blood samples taken from each participant were analyzed. Results: A total of 239 individuals ­mean age (standard deviation): 72 (5.4) years­ were evaluated. 95% of the participants scored > 90 on the Barthel index. Mean serum 25-hydroxyvitamin D3 ­25(OH)D3­ concentration was 17 (7.5) ng/ml and intact parathormone was 60 (26 pg/ml). The prevalence of hypovitaminosis D was 87%, including 70.3% with insufficiency (25(OH)D3 between 11 and 25 ng/ml) and 16.7% with deficiency (25(OH)D3 # 10 ng/ml). The intake of vitamin D and calcium were below recommended levels. The principal source of vitamin D was oily fish. Participants with deficiency scored lower on the Barthel index, had a higher mean age, lived in flats, had less exposure to sun, and used to walk less in sun-hours. Higher levels of alkaline phosphatase and intact parathormone were found in participants with deficiency. The variables independently and significantly associated with vitamin D deficiency were a Barthel score # 90, scant exposure to sun and living in a flat. Conclusions: There is a high prevalence of hypovitaminosis D in the population aged over 64 years in our area, which is associated with lower functional capacity, scant exposure to sun and living in flats

Prevalence of Bartonella henselae in cats in Catalonia, Spain.

Bartonella henselae, an emerging pathogen bacterium, is the main causative agent of the cat scratch disease. While the first clinical descriptions were associated with immunosupressed patients, it is now more frequently observed in patients with normal immune status (endocarditis and bacteremia). Cats were found to be the only known reservoir of B. henselae. In this paper, we report the results obtained in the first study made to investigate the prevalence of B. henselae bacteremia and antibodies in domestic cats in Catalonia, Spain. Serum samples from 115 cats were tested for antibodies to B. henselae by immunofluorescent antibody testing, and 29.6% had a titer >or= 1:64. Seven B. henselae strains were isolated using standard culture techniques and amplification by a polymerase chain reaction and subsequent sequencing was performed on the intergenic spacer region between the 16 and 23S ribosomal RNA genes. Of all factors concerning the studied bacteremia rate (age, sex, habitat, presence of antibodies, contact with animals, parasites), only the presence of antibodies to B. henselae was statistically significant.

An outbreak of norovirus infection in a long-term-care unit in Spain.

BACKGROUND: Norovirus belongs to the Caliciviridae family and causes outbreaks of infectious enteritis by fecal-oral transmission. In Spain, there have been few outbreaks reported due to this virus. We describe an outbreak on a long-term-care hospital ward. METHODS: Cases were classified as probable, confirmed, and secondary. Stool cultures were performed. Polymerase chain reaction detection of norovirus was also performed. RESULTS: The outbreak occurred from December 7 to 28, 2001, involving 60 cases (32 patients, 19 staff members, 8 patients' relatives, and 1 relative of a staff member). Most (82%) of the cases were female. The most frequently involved ages were 20 to 39 years for staff members and 70 to 89 years for patients. The incubation period of secondary cases in patients' families had a median of 48 hours (range, 1 to 7 days). Clinical symptoms included diarrhea (85%), vomiting (75%), fever (37%), nausea (23%), and abdominal pain (12%). Median duration of the disease was 48 hours (range, 1 to 7 days). All cases resolved and the outbreak halted with additional hygienic measures. Stool cultures were all negative for enteropathogenic bacteria and rotaviruses. In 16 of 23 cases, the norovirus genotype 2 antigen was detected. CONCLUSION: This outbreak of gastroenteritis due to norovirus genotype 2 affected patients, staff members, and their relatives in a long-term-care facility and was controlled in 21 days.