Novedades cardiovasculares 2013/2014 / Cardiovascular news 2013/2014

Durante el año 2013 y los primeros meses de 2014 se han publicado numerosos estudios relevantes en el campo cardiovascular. Han aparecido nuevas guías para el manejo de la hipertensión arterial y para reducir el riesgo cardiovascular descendiendo el colesterol. También han aparecido nuevos datos sobre la gran eficacia hipolipidemiante de los anticuerpos monoclonales frente a PCSK-9, decepcionando, sin embargo, los ensayos clínicos dirigidos a elevar el colesterol-HDL con ácido nicotínico, los cuales no han demostrado una reducción de la tasa de complicaciones cardiovasculares. Tampoco en el campo de la hipertensión, la colocación de un stent en pacientes con hipertensión renovascular, o la denervación simpática en pacientes con hipertensión resistente, han demostrado ser eficaces para reducir la presión arterial. Con relación al tratamiento antitrombótico, los test farmacogenéticos no parecen útiles para mantener más tiempo en rango terapéutico a los pacientes anticoagulados con warfarina. A su vez, cada vez existen más evidencias de que en pacientes con enfermedad coronaria y fibrilación auricular, la antiagregación no añade beneficio a la anticoagulación y se asocia con un mayor riesgo de sangrado. Por último, una dieta de tipo mediterráneo podría prevenir la aparición de diabetes, mientras que la cirugía bariátrica podría ser una opción razonable para mejorar la enfermedad en pacientes obesos. Muchos de estos estudios tienen una aplicación práctica inmediata en el trabajo clínico diario (AU)

During 2013 and the first months of 2014, numerous studies have been published in the cardiovascular field. New guidelines have appeared for managing arterial hypertension and reducing cardiovascular risk by lowering cholesterol levels. New data have emerged on the considerable lipid-lowering efficacy of monoclonal antibodies against PCSK-9, in contrast, however, to the clinical trials directed towards raising HDL-cholesterol with nicotinic acid, which have not shown a reduction in the rate of cardiovascular complications. In the field of hypertension, neither stent placement in patients with renovascular hypertension nor sympathetic denervation in patients with resistant hypertension has been shown to be effective in reducing blood pressure. In terms of antithrombotic treatment, the pharmacogenetic tests do not seem useful for maintaining patients anticoagulated with warfarin within the therapeutic range for longer periods. Moreover, there is increasing evidence that, for patients with coronary artery disease and atrial fibrillation, antiplatelet therapy adds no benefit to anticoagulation therapy and is associated with a greater risk of bleeding. Lastly, a Mediterranean diet could prevent the onset of diabetes, while bariatric surgery could be a reasonable option for improving the disease in patients with obesity. Many of these studies have immediate practice applications in daily clinical practice (AU)

Cardiovascular news 2013/2014. / Novedades cardiovasculares 2013/2014.

During 2013 and the first months of 2014, numerous studies have been published in the cardiovascular field. New guidelines have appeared for managing arterial hypertension and reducing cardiovascular risk by lowering cholesterol levels. New data have emerged on the considerable lipid-lowering efficacy of monoclonal antibodies against PCSK-9, in contrast, however, to the clinical trials directed towards raising HDL-cholesterol with nicotinic acid, which have not shown a reduction in the rate of cardiovascular complications. In the field of hypertension, neither stent placement in patients with renovascular hypertension nor sympathetic denervation in patients with resistant hypertension has been shown to be effective in reducing blood pressure. In terms of antithrombotic treatment, the pharmacogenetic tests do not seem useful for maintaining patients anticoagulated with warfarin within the therapeutic range for longer periods. Moreover, there is increasing evidence that, for patients with coronary artery disease and atrial fibrillation, antiplatelet therapy adds no benefit to anticoagulation therapy and is associated with a greater risk of bleeding. Lastly, a Mediterranean diet could prevent the onset of diabetes, while bariatric surgery could be a reasonable option for improving the disease in patients with obesity. Many of these studies have immediate practice applications in daily clinical practice.

Effect of population aging on the international organ donation rates and the effectiveness of the donation process.

This study analyzed the effect of population aging on organ donation for transplants in 43 countries and on the effectiveness of the donation process by comparing the results between Spain and the United States. The percentage of the population aged 65 or over accounted for 33% of the difference in the donation rates between the countries and for 91% of the variation in the rates after age adjustment. However, the level of aging of the Spanish (16.5%) and American (12.3%) populations failed to account for the percentages of deceased donors 65 or over (28% vs. 10%), due to the different age-specific donation rates, much higher in Spain above 50 years. These differences lead to a higher effectiveness of the process in the United States (3.1 transplanted organs per donor vs. 2.5 in Spain), though at lower rates of transplant per million population (73 vs. 87). We conclude that older populations have a greater donation potential as donation rates are strongly associated with population aging. It should therefore be mandatory to adjust donation rates for age before making comparisons. Additionally, effectiveness decreases with older donors, so age should be considered when establishing standards relating to organ donation and effectiveness of the process.

[Epidemic rhabdomyolysis due to the eating of quail. A clinical, epidemiological and experimental study]. / Rabdomiólisis epidémica por ingestión de codornices. Estudio clínico, epidemiológico y experimental.

BACKGROUND: Few toxic outbreaks by quails ingestion have been described, none in Spain, and the toxic hasn't been identified. A toxic outbreak, by quails ingestion that ate Galeopsis ladanum seeds, is described and an animal model is developed. PATIENTS AND METHODS: A rhabdomyolysis outbreak by quails ingestion is studied clinical and epidemiologically. Quails crops were analyzed and 20 patients were studied. A murine model was developed. Alcaloid content in Galeopsis ladanum seeds and quail meat was measured. RESULTS: Twenty patients suffered from rhabdomyolysis (myalgia, increase of muscular enzymes and myoglobinuria) by ingestion of quails that ate Galeopsis ladanum seeds as it could be seen at their crops. Six patients needed hospital care but evolution was benign. Rats fed with quails that ate Galeopsis ladanum seeds had higher creatinkinase (CK) levels than controls rats (near significance, p = 0.0588). Several alcaloids, stachydrine included, was detected in seeds. Another alcaloid no identified was detected in quails meat. CONCLUSIONS: Quails that eat Galeopsis ladanum seeds are toxic for human beings, causing rhabdomyolysis. A plant alcaloid could be the toxic involved in the outbreak.

[Prevalence of human immunodeficiency virus infection in drug addicts assisted from 1991 to 1996 at a detoxification center in Castilla y Leon]. / Prevalencia de la infección por el virus de la inmunodeficiencia humana en drogodependientes atendidos desde 1991 a 1996 en un centro de desintoxicación de Castilla y León.

BACKGROUND: The Word Health Organization (WHO) has recommended epidemiologic surveillance of infection by the human immunodeficiency virus (HIV) in high risk populations. An important decrease has recently been observed in the prevalence of HIV infection in drug addicts in different regions in Spain with notable differences being found. The evolution of the prevalence of HIV infection in intravenous drug addicts initiating detoxication in Castilla and Leon was analyzed. METHODS: Six hundred forty-seven drug addicts (535 males and 112 females) were studied over 6 years (1991-1996) analyzing HIV seropositivity, demographic variables, drug use, age of initiation in drug consumption and route used. RESULTS: Most of the drug addicts were males (83%) with a mean age of initiation in the use of drugs of 19.6 years. Heroine was most frequently consumed in 95% of the patients. The mean length of consumption on admission was 8.6 years with no significant differences being observed in sexes. A relationship was observed between HIV infection and the lower age of initiation in drug usage with the greater the age of admission to detoxication the longer the time having consumed drugs. The prevalence of HIV infection significantly decreased in males and females from 36.8% in 1991 to 17.4% in 1996 (p < 0.0005), with this decrease being related to the change from the intravenous to the smoked route of drug intake. On multivariate analysis by logistic regression the odds ratio at one year of admission was significant (OR = 0.80), years of drug addiction (OR = 1.15), intravenous route (OR = 3.04) and female sex (OR = 2.75). CONCLUSIONS: A significant decrease has been observed in the prevalence of HIV infection in drug addicts in Castilla and León attending a therapeutic center for detoxication from 1991-1996.

[High prevalence without reactivation of herpes virus 6 in subjects with chronic fatigue syndrome]. / Alta prevalencia sin reactivación del herpesvirus humano-6 en sujetos con síndrome de fatiga crónica.

INTRODUCTION: Chronic fatigue syndrome (CFS) is a disorder of unknown etiology. Some viruses have been associated with CFS etiology, specially herpesviruses, enteroviruses and retroviruses. Some studies suggest an association between human herpesvirus-6 (HHV-6) and CFS. In order to know if there is an active HHV-6 infection in CFS patients we studied the immunologic and virologic status of HHV-6. MATERIALS AND METHODS: Twenty patients with CFS were studied. IgG and IgM anti HHV-6 were determined by indirect immunofluorescence assay. DNA from serum and peripheral blood mononuclear cells (PBMC) were studied by dot- and Southern-blotting and nested-PCR to detect HHV-6 DNA. HHV-6 RNA from PBMC were amplified by RT(retrotranscription)-PCR. RESULTS: Ten patients (50%) had IgG anti-HHV-6 in serum but none had IgM anti-HHV-6. Dot-blotting of DNA from 200 microliters of serum and Southern-blotting of 10 micrograms of PBMC DNA were negative. Nested-PCR from sera were negative. Nested-PCR with 1 microgram PBMC DNA were positive in 8 out 20 (40%) and with 5 micrograms PBMC DNA were positive in 16 out of 20 (80%). No viral RNA were detected in PBMC. CONCLUSIONS: There is a high proportion of CFS patients infected with HHV-6 but with low viral load. Results do not support HHV-6 reactivation in CFS patients.

[The rapid specific characterization of clinical isolates of the genus Mycobacterium by the polymerase chain reaction and restriction enzyme analysis]. / Caracterización específica rápida de aislados clínicos del género Mycobacterium mediante reacción en cadena de la polimerasa y análisis de enzimas de restricción.

BACKGROUND: Typing at species level of Mycobacterium is usually performed by microbiological and biochemical methods that require a long time and/or sufficient amount of bacteria. Molecular biology can avoid these problems using different techniques. METHODS: A colony growth of the following mycobacteria has been analyzed: M. tuberculosis, M. kansasii, M. avium, M. intracellulare, M. gordonae, M. phlei, M. aurum, M. fortuitum, M. flavescens, M. marinum, M. xenopi, M. nonchromogenicum, M. terrae and M. chelonei. Strains were grown in Löwenstein-Jensen medium. DNA was obtained by proteolytic digestion and fenol extraction. The 16S rRNA gen was amplified by polymerase chain reaction (PCR) and the amplification was digested by HaeIII, HpaII, RsaI and AluI restriction enzymes. Restriction fragment patterns were analyzed by agarose gel electrophoresis and UV transillumination. RESULTS: The combination of the patterns obtained with HpaII and RsaI was sufficient to generate 13 different combined ones. The patterns of M. intracellulare and M. avium were the same. CONCLUSIONS: PCR and restriction enzyme analysis is an useful method for typing at species level of clinical isolates of mycobacteria.

High prevalence of HHV-6 DNA in peripheral blood mononuclear cells of healthy individuals detected by nested-PCR.

The aim of the study was the evaluation of human herpesvirus-6 (HHV-6) infection rate and semiquantification of viremia in healthy people. Healthy blood donors were studied. Human herpesvirus-6 IgG and IgM antibody titers were measured by indirect immunofluorescence assay. Human herpesvirus-6 DNA amplification (nested-PCR) was performed in peripheral blood mononuclear cells (PBMC) and in serum. Seventeen of 50 (34 percent) individuals were positive for IgG anti-HHV-6 and the titers ranged from 1:40 to 1:160. None of 30 individuals was positive for IgM anti-HHV-6, suggesting no recent infection nor reactivation. Human herpesvirus-6 DNA was detected by nested-PCR amplification in peripheral blood mononuclear cells but not in sera. When 1 microgram DNA was amplified, HHV-6 DNA was detected in 8 of 20 individual (40%), but in 18 of 20 (90%) when 5 micrograms DNA were amplified. It is concluded that HHV-6 is present in a high proportion of the healthy population but in minimal amounts, and although it can be detected in 1.4 x 10(5) PBMC, 7 x 10(5) cells are necessary to detect most cases. No reactivation was observed in healthy people.

[Monocytic dysfunction by opioid peptides in patients with major depression]. / Disfunción monocitaria mediada por opioides en pacientes con depresión mayor.

BACKGROUND: Patients with depression present immunodepression and it has been proposed that, in these patients, endogenous opioid peptides may be mediators between the dysfunction of the central nervous system and immune alterations. METHODS: The function and the surface markers of monocytes were studied in 15 patients with major unipolar depression and in 24 healthy controls by biological trials of phagocytosis of Candida albicans and latex particles and immunofluorescence with monoclonal antibodies. RESULTS: Most of the patients studied (86%) presented monocytic dysfunction characterized by diminished phagocytic activity and a decrease in the expression of intermediate filaments of vimentin of the cytoskeleton and membrane molecules (CR1, receptor for the Fc fraction of the IgG and HLA DR antigens). Incubation of the patients monocytes with naloxone led to the disappearance of monocytic alterations in most of the patients. CONCLUSIONS: Patients with major unipolar depression present a high opioid tone which has consequences in the function of the immune system.

Hepatitis B and C viral infections in patients with hepatocellular carcinoma.

The prevalence of hepatitis B and C virus infections was studied in 70 patients diagnosed as having hepatocellular carcinoma. In addition to viral serological markers, serum hepatitis B virus DNA and hepatitis C virus RNA were determined with a nested polymerase chain reaction assay. Twelve patients (17%) were HBsAg positive, 26 (37%) had antibodies to HBs, HBc or both and 32 (46%) were negative for all hepatitis B virus serological markers. Prevalence of the antibody to hepatitis C virus was 63% (44 patients). Hepatitis B virus DNA was detected in 24 of the 66 tested patients (36%). Twelve of these hepatitis B virus DNA-positive patients were HBsAg negative (seven were positive for antibody to HBs, antibody to HBc or both and five were negative for all hepatitis B virus serological markers). Hepatitis C virus RNA was found in 42 of 68 patients (62%). A high correlation (95%) existed between hepatitis C virus RNA and hepatitis C virus antibodies. Nevertheless, two patients without antibody to hepatitis C virus had serum hepatitis C virus RNA sequences. Coinfection by the two viruses was detected in nine subjects (14%), but no clinical differences were found between these and the rest of the patients. We conclude that nearly 90% (62 of the 70 patients studied) of cases of hepatocellular carcinoma in our geographical area are related to hepatitis virus infections (detected by serological or molecular studies). Hepatitis C is more prevalent than hepatitis B virus in patients with hepatocellular carcinoma, and the infection is still active when the tumor is diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Type 6 human herpes virus and chronic asthenic syndrome]. / Virus herpes humano tipo 6 y síndrome de astenia crónica.

Chronic asthenia syndrome has been associated with Epstein-Barr virus (EBV). To investigate the possible role in this syndrome of human herpesvirus type 6 (HHV-6), a new herpesvirus discovered in 1986, we performed a serological study of 44 patients diagnosed of chronic asthenia syndrome and 50 controls. Fifty healthy controls (34%) and 44 patients (54.5%) had positive serological tests for HHV-6. This difference was significant (p less than 0.05). The rate of positive serological studies for CMV and EBV was higher in healthy controls (n = 50) than in patients (n = 37) (96% vs 67.7% for CMV [p less than 0.001] and 92% vs 78.4% for EBV [non significant difference]). We conclude that HHV-6 may play a role in the pathogenesis of chronic asthenia syndrome. In our group of patients there were no significant differences in the presence of anti EBV capsid antibodies.