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1.
Nutr Metab Cardiovasc Dis ; 31(4): 1044-1052, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33549437

RESUMO

BACKGROUND AND AIMS: Metabolic Syndrome (MS) has been related to an impairment in arterial structural and functional properties with heterogeneous results. In this paper we focused on the effects of MS on arterial carotid-femoral PWV and common carotid IMT in two different populations, one of hypertensive patients and one of healthy controls. METHODS AND RESULTS: We enrolled 816 consecutive HT and 536 healthy controls. Vascular structural (IMT) and functional (PWV) properties were evaluated. NCEP-ATP-III criteria were used for diagnosis of MS. MS was diagnosed in 26.9% and 6.9% in hypertensive and control subjects, respectively. PWV was similar in controls with and without MS (7.7 ± 1.9 vs 7.6 ± 1.1 m/s, p = 0.69), while IMT was higher in controls with than those without MS (0.64 ± 0.18 vs 0.57 ± 0.13 mm, p = 0.02). Hypertensives with MS were older (57.9 ± 12.2 vs 52.7 ± 14.1 years, p < 0.001) and showed higher PWV (9.0 ± 2.3 vs 8.4 ± 2.1 m/s, p = 0.001) and IMT (0.72 ± 0.22 vs 0.65 ± 0.17 mm, p < 0.001) than those without MS, however at the age-adjusted analysis only the difference in IMT was confirmed (p = 0.007). Regression models showed that MS was an independent determinant of IMT in both controls (ß = 0.08, p = 0.03) and hypertensives (ß = 0.08, p = 0.01), but not of PWV either in controls (ß = 0.006, p = 0.886 and ß = 0.04, p = 0.19, respectively). CONCLUSIONS: the main finding of our work is that MS is a significant determinant of IMT while this is not the case for PWV. This result have been confirmed both in hypertensive subjects and in healthy controls.


Assuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/fisiopatologia , Espessura Intima-Media Carotídea , Velocidade da Onda de Pulso Carótido-Femoral , Artéria Femoral/fisiopatologia , Hipertensão/diagnóstico , Síndrome Metabólica/diagnóstico , Rigidez Vascular , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Síndrome Metabólica/diagnóstico por imagem , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência
2.
Clin Interv Aging ; 15: 853-863, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606625

RESUMO

Purpose: There have been few recent studies regarding vascular aging and its relationship with left ventricular (LV) geometry. Moreover, the association of abnormal LV geometry with various kinds of vascular aging has not yet been systematically analyzed. Thus, this study aimed to further elucidate this relationship. Materials and Methods: In this study, 3363 older participants (43.6% male, aged 71.1±5.9 years; 56.4% female, aged 71.1±6.1 years) derived from the Northern Shanghai Study were enrolled. Vascular aging criteria included arteriosclerosis, defined as carotid-femoral pulse wave velocity >10 m/s or brachial-ankle pulse wave velocity >1800 cm/s, and peripheral atherosclerosis, defined as ankle-brachial index <0.9, carotid artery intima-media thickness (cIMT) greater than 0.9 mm, or carotid plaque indicating carotid artery abnormality. Micro-albuminuria was defined as urinary albumin-to-creatinine ratio >30 mg/g. Decreased estimated glomerular filtration rate (eGFR) was defined as eGFR <60 mL/min/1.73 m2. Results: When vascular aging parameters were respectively adjusted for age and sex, arteriosclerosis, micro-albuminuria, and peripheral atherosclerosis were significantly associated with concentric remodeling, eccentric LV hypertrophy (LVH), and concentric LVH (P<0.045) but not with decreased eGFR or abnormal cIMT and presence of plaque. Peripheral atherosclerosis was strongly associated with LV concentric geometry (LVCG) when considering other covariates (risk factors, diseases, and treatments) (P<0.012). Conclusion: Vascular aging parameters such as arteriosclerosis, micro-albuminuria, and peripheral atherosclerosis are significantly and independently associated with LVCG in community-dwelling older Chinese population, suggesting the importance of vascular aging during early clinical assessment of abnormal LV geometry change and serious cardiovascular events.


Assuntos
Espessura Intima-Media Carotídea/normas , Hipertensão/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Remodelação Ventricular/fisiologia , Idoso , Índice Tornozelo-Braço , Artérias Carótidas/fisiopatologia , China/epidemiologia , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Vida Independente , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/fisiopatologia , Estudos Prospectivos , Análise de Onda de Pulso , Fatores de Risco
3.
BMC Med Genet ; 21(1): 144, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631253

RESUMO

BACKGROUND: Autosomal dominant hypertension with brachydactyly type E syndrome caused by pathogenic variants in the PDE3A gene was first reported in 2015. To date, there are only a few reports of this kind of syndrome. Other patients still lack a genetic diagnosis. CASE PRESENTATION: Whole-exome sequencing was performed in an 18-year-old female proband with a clinical diagnosis of hypertension with brachydactyly syndrome. Quantitative real-time PCR was used to identify pathogenic copy number variations (CNVs). After bioinformatics analysis and healthy control database filtering, we revealed a heterozygous missense PDE3A variant (c.1346G > A, p.Gly449Asp). The variant was absent in the ExAC database and located in a highly evolutionarily conserved cluster of reported PDE3A pathogenic variants. Importantly, this variant was predicted to affect protein function by both SIFT (score = 0) and PolyPhen-2 (score = 1). After Sanger sequencing, the variant was determined to be absent in the healthy parents of the proband as well as 800 ethnically and geographically matched healthy controls. CONCLUSION: We present a report linking a de novo PDE3A variant to autosomal dominant hypertension with brachydactyly type E syndrome.


Assuntos
Braquidactilia/genética , Nucleotídeo Cíclico Fosfodiesterase do Tipo 3/genética , Genes Dominantes , Hipertensão/congênito , Mutação/genética , Sequenciamento Completo do Exoma , Adolescente , Braquidactilia/diagnóstico por imagem , Éxons/genética , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/genética , Masculino , Linhagem , Síndrome
4.
Angiology ; 71(10): 920-933, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32696658

RESUMO

The objectives of this study are to (1) examine the "10-year cardiovascular risk" in the common carotid artery (CCA) versus carotid bulb using an integrated calculator called "AtheroEdge Composite Risk Score 2.0" (AECRS2.0) and (2) evaluate the performance of AECRS2.0 against "conventional cardiovascular risk calculators." These objectives are met by measuring (1) image-based phenotypes and AECRS2.0 score computation and (2) performance evaluation of AECRS2.0 against 12 conventional cardiovascular risk calculators. The Asian-Indian cohort (n = 379) with type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), or hypertension were retrospectively analyzed by acquiring the 1516 carotid ultrasound scans (mean age: 55 ± 10.1 years, 67% males, ∼92% with T2DM, ∼83% with CKD [stage 1-5], and 87.5% with hypertension [stage 1-2]). The carotid bulb showed a higher 10-year cardiovascular risk compared to the CCA by 18% (P < .0001). Patients with T2DM and/or CKD also followed a similar trend. The carotid bulb demonstrated a superior risk assessment compared to CCA in patients with T2DM and/or CKD by showing: (1) ∼13% better than CCA (0.93 vs 0.82, P = .0001) and (2) ∼29% better compared with 12 types of risk conventional calculators (0.93 vs 0.72, P = .06).


Assuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Insuficiência Renal Crônica/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Hipertensão/complicações , Índia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/complicações , Estudos Retrospectivos , Medição de Risco
5.
High Blood Press Cardiovasc Prev ; 27(5): 379-388, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32705504

RESUMO

INTRODUCTION: Structural and functional properties of the left ventricle (LV) wall have been reported to be altered in hypertension, even at early stages of the disease. Abnormal adipokine levels affect blood pressure regulation. Hypo-adiponectinaemia and hyper-leptinaemia were reported in hypertension. AIM: To evaluate the effects of valsartan versus amlodipine on LV deformation also, on plasma adiponectin and leptin levels in hypertensive individuals. METHODS: LV strain was measured by two-dimensional speckle tracking echocardiography, plasma levels of adiponectin and leptin was determined in 30 healthy individuals served as control group and in 200 hypertensive patients before and after treatment for 6 months with either valsartan 160 mg or amlodipine 10 mg. RESULTS: Compared to control group longitudinal strain was significantly affected in hypertensive patients, adiponectin was significantly lower while TNF-α, hs-CRP and leptin levels were significantly higher in hypertensive group. A significant improvement in LV functions, along with a decrease in leptin and increase in adiponectin levels in valsartan group compared to amlodipine group. CONCLUSIONS: Our results indicate that valsartan is superior to amlodipine when it comes to affecting the hormonal function of human adipose tissue. Valsartan has a beneficial effect on LV deformation and function presented in GLS.


Assuntos
Adipocinas/sangue , Anlodipino/uso terapêutico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Ecocardiografia , Hipertensão/terapia , Valsartana/uso terapêutico , Função Ventricular Esquerda/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos , Adiponectina/sangue , Adulto , Anlodipino/efeitos adversos , Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Bloqueadores dos Canais de Cálcio/efeitos adversos , Egito , Feminino , Humanos , Hipertensão/sangue , Hipertensão/diagnóstico por imagem , Hipertensão/fisiopatologia , Leptina/sangue , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do Tratamento , Fator de Necrose Tumoral alfa/sangue , Valsartana/efeitos adversos
7.
Sci Rep ; 10(1): 7708, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32382106

RESUMO

To analyze longitudinal changes in peripapillary retinal nerve fiber layer (pRNFL) thicknesses over time in the fellow eyes of patients with unilateral retinal vein occlusion (RVO). A total of 47 patients with unilateral RVO and 47 healthy controls were enrolled. The mean and sectoral pRNFL thicknesses were measured using spectral domain-optical coherence tomography at 1 year intervals, and followed for 3 years. Linear mixed models were performed to calculate and compare the reduction rates of pRNFL thicknesses over time. The mean pRNFL thickness decreased significantly during the 3-year follow-up, with a significant decrease over time in both groups. The reduction rate in mean pRNFL thicknesses was -0.41 µm/year in the control group and -0.68 µm/year in the fellow eyes of RVO group, and the decrease was significantly higher in the fellow eyes of RVO group than in the control group (p < 0.001). Using a multivariate linear mixed model, age (estimate: -0.41, p = 0.011) and hypertension (HTN) (estimate: -6.51, p = 0.014) were significantly associated with the reduction in mean pRNFL thicknesses in fellow eyes of RVO group. The fellow eyes of RVO patients showed a greater reduction in pRNFL thickness over time than normal controls. Age and HTN should be considered as factors to decrease the pRNFL thickness over time in fellow eyes of RVO group.


Assuntos
Fibras Nervosas/patologia , Retina/diagnóstico por imagem , Oclusão da Veia Retiniana/patologia , Vasos Retinianos/diagnóstico por imagem , Idoso , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/patologia , Pressão Intraocular/fisiologia , Macula Lutea/diagnóstico por imagem , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/metabolismo , Retina/metabolismo , Retina/patologia , Células Ganglionares da Retina/metabolismo , Células Ganglionares da Retina/patologia , Oclusão da Veia Retiniana/diagnóstico por imagem , Vasos Retinianos/patologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia
9.
PLoS One ; 15(5): e0233166, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32407418

RESUMO

Retinal fundus photography provides a non-invasive approach for identifying early microcirculatory alterations of chronic diseases prior to the onset of overt clinical complications. Here, we developed neural network models to predict hypertension, hyperglycemia, dyslipidemia, and a range of risk factors from retinal fundus images obtained from a cross-sectional study of chronic diseases in rural areas of Xinxiang County, Henan, in central China. 1222 high-quality retinal images and over 50 measurements of anthropometry and biochemical parameters were generated from 625 subjects. The models in this study achieved an area under the ROC curve (AUC) of 0.880 in predicting hyperglycemia, of 0.766 in predicting hypertension, and of 0.703 in predicting dyslipidemia. In addition, these models can predict with AUC>0.7 several blood test erythrocyte parameters, including hematocrit (HCT), mean corpuscular hemoglobin concentration (MCHC), and a cluster of cardiovascular disease (CVD) risk factors. Taken together, deep learning approaches are feasible for predicting hypertension, dyslipidemia, diabetes, and risks of other chronic diseases.


Assuntos
Aprendizado Profundo , Dislipidemias/diagnóstico , Fundo de Olho , Hiperglicemia/diagnóstico , Hipertensão/diagnóstico , Retina/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Doença Crônica , Estudos Transversais , Dislipidemias/diagnóstico por imagem , Feminino , Humanos , Hiperglicemia/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Curva ROC , Fatores de Risco , Adulto Jovem
10.
Stroke ; 51(6): 1682-1689, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32390549

RESUMO

Background and Purpose- Cerebrovascular disease contributes to age-related cognitive decline, but the mechanisms underlying this phenomenon remain incompletely understood. We hypothesized that vascular risk factors would lead to cognitive impairment through the disruption of brain white matter network efficiency. Methods- Participants were 19 346 neurologically healthy individuals from UK Biobank that underwent diffusion MRI and cognitive testing (mean age=62.6). Global efficiency, a measure of network integration, was calculated from white matter networks constructed using deterministic diffusion tractography. First, we determined whether demographics (age, sex, ethnicity, socioeconomic status, and education), vascular risk factors (hypertension, hypercholesterolemia, diabetes mellitus, smoking, body mass index), and white matter hyperintensities were related to global efficiency using multivariate linear regression. Next, we used structural equation modeling to model a multiple regression. The dependent variable was a latent cognition variable using all cognitive data, while independent variables were a latent factor including all vascular risk factors (vascular burden), demographic variables, white matter hyperintensities, and global efficiency. Finally, we used mediation analysis to determine whether global efficiency explained the relationship between vascular burden and cognition. Results- Hypertension and diabetes mellitus were consistently associated with reduced global efficiency even after controlling for white matter hyperintensities. Structural equation models revealed that vascular burden was associated with cognition (P=0.023), but not after adding global efficiency to the model (P=0.09), suggesting a mediation effect. Mediation analysis revealed a significant indirect effect of global efficiency on cognition through vascular burden (P<0.001), suggesting a partial mediation effect. Conclusions- Vascular burden is associated with reduced global efficiency and cognitive impairment in the general population. Network efficiency partially mediates the relationship between vascular burden and cognition. This suggests that treating specific risk factors may prevent reductions in brain network efficiency and preserve cognitive functioning in the aging population.


Assuntos
Envelhecimento , Bancos de Espécimes Biológicos , Disfunção Cognitiva , Complicações do Diabetes , Imagem de Tensor de Difusão , Hipertensão , Modelos Neurológicos , Idoso , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Complicações do Diabetes/diagnóstico por imagem , Complicações do Diabetes/fisiopatologia , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Reino Unido/epidemiologia
11.
J Cardiovasc Magn Reson ; 22(1): 34, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393281

RESUMO

BACKGROUND: The clinical application of cardiovascular magnetic resonance (CMR) T2 and T2* mapping is currently limited as ranges for healthy and cardiac diseases are poorly defined. In this meta-analysis we aimed to determine the weighted mean of T2 and T2* mapping values in patients with myocardial infarction (MI), heart transplantation, non-ischemic cardiomyopathies (NICM) and hypertension, and the standardized mean difference (SMD) of each population with healthy controls. Additionally, the variation of mapping outcomes between studies was investigated. METHODS: The PRISMA guidelines were followed after literature searches on PubMed and Embase. Studies reporting CMR T2 or T2* values measured in patients were included. The SMD was calculated using a random effects model and a meta-regression analysis was performed for populations with sufficient published data. RESULTS: One hundred fifty-four studies, including 13,804 patient and 4392 control measurements, were included. T2 values were higher in patients with MI, heart transplantation, sarcoidosis, systemic lupus erythematosus, amyloidosis, hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and myocarditis (SMD of 2.17, 1.05, 0.87, 1.39, 1.62, 1.95, 1.90 and 1.33, respectively, P <  0.01) compared with controls. T2 values in iron overload patients (SMD = - 0.54, P = 0.30) and Anderson-Fabry disease patients (SMD = 0.52, P = 0.17) did both not differ from controls. T2* values were lower in patients with MI and iron overload (SMD of - 1.99 and - 2.39, respectively, P <  0.01) compared with controls. T2* values in HCM patients (SMD = - 0.61, P = 0.22), DCM patients (SMD = - 0.54, P = 0.06) and hypertension patients (SMD = - 1.46, P = 0.10) did not differ from controls. Multiple CMR acquisition and patient demographic factors were assessed as significant covariates, thereby influencing the mapping outcomes and causing variation between studies. CONCLUSIONS: The clinical utility of T2 and T2* mapping to distinguish affected myocardium in patients with cardiomyopathies or heart transplantation from healthy myocardium seemed to be confirmed based on this meta-analysis. Nevertheless, variation of mapping values between studies complicates comparison with external values and therefore require local healthy reference values to clinically interpret quantitative values. Furthermore, disease differentiation seems limited, since changes in T2 and T2* values of most cardiomyopathies are similar.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Transplante de Coração , Hipertensão/diagnóstico por imagem , Imagem por Ressonância Magnética , Infarto do Miocárdio/diagnóstico por imagem , Cardiomiopatias/epidemiologia , Cardiomiopatias/fisiopatologia , Diagnóstico Diferencial , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Resultado do Tratamento
12.
J Clin Neurosci ; 78: 259-263, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32340844

RESUMO

INTRODUCTION: Asymptomatic intracranial atherosclerotic stenosis (AICAS) is a common cause of stroke. Elderly women were more likely than men to develop AICAS, although it indicated that a lifelong exposure to estrogen could lower the risks of cardiovascular disease (CVDs). OBJECTIVE: The present study aims to ascertain whether postmenopausal time is a risk factor of AICAS. Fostering a correct perception of menopause is of great significance for the overall well-being of the elderly women. METHODS: All participants received a questionnaire, physical examination, laboratory testing and transcranial Doppler. The menopausal population (n = 701) was divided into three groups by tertiles of postmenopausal time. Two-tailed testing and trend test were used to reveal the relationship between postmenopausal time and newly discovered AICAS. Other potential risk factors were also analyzed to ascertain whether there was a relation between postmenopausal time and the newly discovered ICAS. RESULTS: Both mean age and mean postmenopausal time were gradually increased from G0 to G2. The same trend occurred in hypertension, diabetes mellitus, total cholesterol, triglyceride, C-reactive protein and serum homocysteine. Adjusting for various confounding factors, postmenopausal time was not a risk factor for newly discovered AICAS. Multifactor analysis and stratifying analysis showed no correlation between newly discovered AICAS and postmenopausal time. CONCLUSIONS: Postmenopausal time is not an independent risk factor of AICAS. No relationship was detected between postmenopausal time and newly discovered AICAS, while vigorous control of body weight, blood pressure/glucose/lipids and smoke cessation are vital for preventing the occurrence of AICAS.


Assuntos
Doenças Assintomáticas , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/fisiopatologia , Pós-Menopausa/fisiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Ultrassonografia Doppler Transcraniana/tendências , Adulto Jovem
13.
Am J Trop Med Hyg ; 102(6): 1205-1207, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32314685

RESUMO

The initial cases of novel coronavirus disease-19 (COVID-19) in a country are of utmost importance given their impact on healthcare providers, the country's preparedness response, and the initial molding of the public perception toward this pandemic. In Bhutan, the index case was a 76-year-old immunocompromised man who had traveled from the United States and entered Bhutan as a tourist. He presented initially with vague gastrointerestinal symptoms and later a cough. His atypical presentation led to a delay in diagnosis, but ultimately he was isolated and tested. On confirming the diagnosis of COVID-19, the patient was isolated in a separate hospital with a dedicated medical care team. All contacts were traced and quarantined. The patient's respiratory status deteriorated despite broad-spectrum antivirals, antibiotics, and intensive supportive care. He required intubation and was given a trial of intravenous immunoglobulin to modulate his likely aberrant immune response. Subsequently, the patient's clinical status improved, and after 8 days of hospitalization, he was transferred out of the country, where he recovered. This was a learning experience for the treating medical staff, the government, and the people of Bhutan.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico por imagem , Hiperlipidemias/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Idoso , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Butão , Busca de Comunicante , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/patologia , Humanos , Hiperlipidemias/tratamento farmacológico , Hiperlipidemias/imunologia , Hiperlipidemias/patologia , Hipertensão/tratamento farmacológico , Hipertensão/imunologia , Hipertensão/patologia , Hospedeiro Imunocomprometido , Imunoglobulinas Intravenosas/uso terapêutico , Pulmão/efeitos dos fármacos , Pulmão/patologia , Pulmão/virologia , Masculino , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Pneumonia Viral/patologia , Tomografia Computadorizada por Raios X , Viagem , Resultado do Tratamento , Ultrassonografia , Estados Unidos
14.
Am J Trop Med Hyg ; 102(6): 1208-1209, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32314699

RESUMO

The early shortage of novel coronavirus disease (COVID-19) tests in the United States led many hospitals to first screen for common respiratory pathogens, and only if this screen was negative to proceed with COVID-19 testing. We report a case of a 56-year-old woman with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) coinfection with group A Streptococcus. The initial testing strategy resulted in delays in both diagnosis and implementation of appropriate precautions. Underlined is the importance of testing for both SARS-CoV-2 and other common respiratory pathogens during the current pandemic.


Assuntos
Betacoronavirus/patogenicidade , Dor Crônica/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico por imagem , Anticorpos Monoclonais Humanizados/uso terapêutico , Azitromicina/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/isolamento & purificação , Ceftriaxona/uso terapêutico , Chicago , Dor Crônica/imunologia , Dor Crônica/patologia , Dor Crônica/terapia , Coinfecção , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Oxigenação por Membrana Extracorpórea , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Hipertensão/imunologia , Hipertensão/patologia , Hipertensão/terapia , Pulmão/efeitos dos fármacos , Pulmão/patologia , Pulmão/virologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Infecções Estreptocócicas/imunologia , Infecções Estreptocócicas/patologia , Infecções Estreptocócicas/terapia , Streptococcus pyogenes/efeitos dos fármacos , Streptococcus pyogenes/isolamento & purificação , Streptococcus pyogenes/patogenicidade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Sci Rep ; 10(1): 6541, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32300160

RESUMO

The purpose of this study was to investigate changes in peripapillary microvasculature using optical coherence tomography angiography (OCTA) in systemic hypertension (HTN) patients. This was a cross-sectional study. Based on the duration of HTN, seventy-eight HTN patients were divided into two groups. (HTN group 1: <10 years, 38 eyes; HTN group 2: ≥10 years, 40 eyes) and 90 control subjects. All subjects underwent 6 × 6 mm OCTA scan centered on the optic nerve head. We analyzed peripapillary vessel density (VD) and perfusion density (PD) in superficial capillary plexus among three groups. The average ganglion cell-inner plexiform layer (GC-IPL) and retinal nerve fiber layer (RNFL) thicknesses of HTN group 2 were thinner than those of the control group (p = 0.016, and 0.035, respectively). HTN group 2 showed lower peripapillary VD and PD than the control group. However, there were no differences between HTN group 1 and the control group in OCT and peripapillary OCTA parameters. In HTN patients, the peripapillary VD, PD and GC-IPL, RNFL thicknesses correlated significantly. OCTA showed that the peripapillary VD and PD were lower in HTN patients with a duration ≥10 years compared with those of normal controls. Peripapillary microvasculature was correlated with the RNFL and GC-IPL thicknesses. HTN duration should therefore be considered when evaluating peripapillary microvasculature using OCTA.


Assuntos
Angiofluoresceinografia , Hipertensão/diagnóstico por imagem , Hipertensão/patologia , Microvasos/diagnóstico por imagem , Microvasos/patologia , Disco Óptico/irrigação sanguínea , Disco Óptico/diagnóstico por imagem , Tomografia de Coerência Óptica , Feminino , Humanos , Macula Lutea , Masculino , Pessoa de Meia-Idade , Disco Óptico/patologia , Células Ganglionares da Retina/patologia
16.
Sci Rep ; 10(1): 7109, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32346001

RESUMO

Epicardial adipose tissue (EAT) is associated with cardiovascular risk. The longitudinal change in EAT volume (EATv) and density (EATd), and potential modulators of these parameters, has not been described. We prospectively recruited 90 patients with non-obstructive coronary atherosclerosis on baseline computed tomography coronary angiography (CTCA) performed for suspected coronary artery disease to undergo a repeat research CTCA. EATv in millilitres (mL) and EATd in Hounsfield units (HU) were analysed and multivariable regression analysis controlling for traditional cardiovascular risk factors (CVRF) performed to assess for any predictors of change. Secondary analysis was performed based on statin therapy. The median duration between CTCA was 4.3years. Mean EATv increased at follow-up (72 ± 33 mL to 89 ± 43 mL, p < 0.001) and mean EATd decreased (baseline -76 ± 6 HU vs. -86 ± 5 HU, p < 0.001). There were no associations between baseline variables of body mass index, age, sex, hypertension, hyperlipidaemia, diabetes or smoking on change in EATv or EATd. No difference in baseline, follow-up or delta EATv or EATd was seen in patients with (60%) or without baseline statin therapy. In this select group of patients, EATv consistently increased and EATd consistently decreased at long-term follow-up and these changes were independent of CVRF, age and statin use. Together with the knowledge of strong associations between EAT and cardiac disease, these findings may suggest that EAT is an independent parameter rather than a surrogate for cardiovascular risk.


Assuntos
Tecido Adiposo , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana , Hipertensão , Pericárdio , Sistema de Registros , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/fisiopatologia , Idoso , Índice de Massa Corporal , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Feminino , Seguimentos , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pericárdio/diagnóstico por imagem , Pericárdio/fisiopatologia , Estudos Prospectivos , Estudos Retrospectivos
17.
Am J Trop Med Hyg ; 102(6): 1198-1202, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32333544

RESUMO

Patients with novel coronavirus disease (COVID-19) typically present with bilateral multilobar ground-glass opacification with a peripheral distribution. The utility of point-of-care ultrasound has been suggested, but detailed descriptions of lung ultrasound findings are not available. We evaluated lung ultrasound findings in 10 patients admitted to the internal medicine ward with COVID-19. All of the patients had characteristic glass rockets with or without the Birolleau variant (white lung). Thick irregular pleural lines and confluent B lines were also present in all of the patients. Five of the 10 patients had small subpleural consolidations. Point-of-care lung ultrasound has multiple advantages, including lack of radiation exposure and repeatability. Also, lung ultrasound has been shown to be more sensitive than a chest radiograph in detecting alveolar-interstitial syndrome. The utilization of lung ultrasound may also reduce exposure of healthcare workers to severe acute respiratory syndrome-coronavirus-2 and may mitigate the shortage of personal protective equipment. Further studies are needed to evaluate the utility of lung ultrasound in the diagnosis and management of COVID-19.


Assuntos
Asma/diagnóstico por imagem , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Adulto , Idoso , Asma/patologia , Asma/terapia , Asma/virologia , Betacoronavirus/genética , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Feminino , Humanos , Hipertensão/patologia , Hipertensão/terapia , Hipertensão/virologia , Pulmão/efeitos dos fármacos , Pulmão/patologia , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Obesidade/patologia , Obesidade/terapia , Obesidade/virologia , Oxigênio/uso terapêutico , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Ultrassonografia
18.
Circ J ; 84(3): 524-528, 2020 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-32023564

RESUMO

BACKGROUND: Although it has been discussed which measures against atherosclerotic diseases should be started in childhood, the current situation in Japan is unclear.Methods and Results:We conducted a health management survey of all 12-year-old children in a local town for 20 years. The body mass index tended to decrease over time. Although the serum low-density lipoprotein cholesterol level did not change, the levels of serum high-density lipoprotein cholesterol and serum triglycerides significantly increased over time. CONCLUSIONS: The serum triglyceride levels in school children increased significantly, probably through lifestyle changes, and the health management system should be reviewed.


Assuntos
Aterosclerose/epidemiologia , Dislipidemias/epidemiologia , Hipertensão/epidemiologia , Obesidade Pediátrica/epidemiologia , Fatores Etários , Aterosclerose/diagnóstico , Biomarcadores/sangue , Pressão Sanguínea , Índice de Massa Corporal , Criança , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Dislipidemias/sangue , Dislipidemias/diagnóstico , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/fisiopatologia , Japão/epidemiologia , Masculino , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/fisiopatologia , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Triglicerídeos/sangue
19.
J Neurol Neurosurg Psychiatry ; 91(4): 388-391, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32034114

RESUMO

OBJECTIVE: To determine if vascular risk factor (VRF), that is, smoking, arterial hypertension (HT), dyslipidaemia and diabetes, have an effect on multiple sclerosis (MS) pathology as measured by MS typical brain lesions, we have compared brain MRIs from patients with MS with and without VRF age-matched and sex-matched. METHODS: Brain MRIs from five centres were scored for the presence of Dawson's fingers (DF) and juxtacortical lesions (JCL). A regression model was built to predict the effect of each individual VRF on DF and JCL, considering age and disease duration. RESULTS: 92 MS cases without VRF and 106 MS with one or more VRF (80 ever-smokers, 43 hypertensives, 25 dyslipidaemics and 10 diabetics) were included. Ever-smoking associated with a higher burden of DF (Exp(B)=1.29, 95% CI 1.10 to 1.51, p<0.01) and JCL (Exp(B)=1.38, 95% CI 1.21 to 1.57, p<0.01). No other VRF had an impact on DF. Dyslipidaemia associated with increased JCL (Exp(B)=1.30, 95% CI 1.10 to 1.56, p<0.01) but HT did not associate with any of the outcomes. CONCLUSIONS: Individual VRF appear to affect MS-specific lesions differently. An increase in MS lesions was mainly seen in smokers; however, this VRF is most likely to be present from onset of MS, and other VRF effects may be partly mitigated by treatment. Our findings support that treating VRF and cessation of smoking may be important in the management of MS.


Assuntos
Encéfalo/patologia , Esclerose Múltipla/patologia , Substância Branca/patologia , Adulto , Encéfalo/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Fumar , Substância Branca/diagnóstico por imagem
20.
J Clin Neurosci ; 72: 169-173, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31911108

RESUMO

To investigate the differences in the epidemiological and clinical characteristics of patients with intracerebral hemorrhage (ICH) treated at our institution over the last few decades. Two chronological cohorts with ten-year-interval were established and epidemiological and clinical data were retrospectively collected from patients with ICH, and data were analyzed using SPSS 13.0. The time windows for the two cohorts were from January 1, 2010 to December 31, 2014 (2010-2014 cohort) and January 1, 2000 to December 31, 2004 (2000-2004 cohort). 1598 patients with ICH were enrolled: 360 patients in the 2000-2004 cohort and 1238 patients in the 2010-2014 cohort. ICH often occurred in patients aged from 45 to 75 years, without a sex bias, accounting for 69.6% of patients. Hypertension (60.7%) was still the main risk factors. Meanwhile, the risk factors of smoking (28.9%) and drinking (23.3%) were often present in male patients but not female patients (p ≤ 0.001). The incidence of pulmonary infection, the main complication during hospitalization, was 40.8% in the 2000-2004 cohort and 61.8% in the 2010-2014 cohort (p ≤ 0.001). Moreover, the incidence of gastrointestinal hemorrhage was 12.5% in the 2000-2004 cohort and 6.0% in the 2010-2014 cohort (p ≤ 0.001). The epidemiological and clinical features have changed over the past 10 years. The mortality was reduced but still high, as evidenced by the increased hospitalization rate of patients with ICH. Current preventions and therapeutic strategies for ICH are effective, but more strategies must be developed to improve the outcome of ICH and decrease the incidence of pulmonary infection.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Adulto , Idoso , Hemorragia Cerebral/fisiopatologia , Estudos de Coortes , Feminino , Hospitalização/tendências , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Fumar/fisiopatologia
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