Risk factors associated with valvular calcification in patients with chronic kidney disease. Analysis of NEFRONA study

INTRODUCTION

Patients with chronic kidney disease (CKD) are at high risk of cardiovascular morbidity and mortality. Subclinical cardiac structural alterations have prognostic value in these patients. The aim was to analyse the prevalence of valvular calcification, the evolution and the relationship with different risk factors.

MATERIAL AND METHODS

Part of the sample of the NEFRONA study was randomly selected. Aortic and mitral valve calcification were analysed in echocardiograms performed at the baseline visit and at 24 months.

RESULTS

We included 397 patients, the estimated basal glomerular filtrate (eGFR) was 33 ml/min with significant decrease to 30.9 ml/min. There was an increase in the area of carotid and femoral plaque, as well as an increase in patients with aortic and mitral calcification at 24 months. A positive association of mitral calcification at 24 months with age, ankle-brachial index (ABI) and calcium-phosphorus product (CaxP) at baseline visit was observed, without association with eGFR. Aortic calcification at 24 months was positively associated with age, phosphorous and total carotid plaque area at baseline, with no relationship to eGFR.

CONCLUSIONS

A significant prevalence of valvular calcification was observed in patients with CKD without known cardiovascular disease.Two-year progression was observed independently of the eGFR. Patients with higher risk of mitral valve calcification were those with older age, higher ABI and CaxP product. Patients with a higher risk of aortic calcification were those with older age, higher phosphorous levels and larger area of carotid plaque. Identifying these higher risk patients would help to avoid future cardiovascular events intensifying follow-ups.

[Risk factors associated with valvular calcification in patients with chronic kidney disease. Analysis of NEFRONA Study]

INTRODUCTION

Patients with chronic kidney disease (CKD) are at high risk of cardiovascular morbidity and mortality. Subclinical cardiac structural alterations have prognostic value in these patients. The aim was to analyse the prevalence of valvular calcification, the evolution and the relationship with different risk factors.

MATERIAL AND METHODS

Part of the sample of the NEFRONA study was randomly selected. Aortic and mitral valve calcification were analysed in echocardiograms performed at the baseline visit and at 24 months.

RESULTS

We included 397 patients, the estimated basal glomerular filtrate (eGFR) was 33ml/min with significant decrease to 30.9ml/min. There was an increase in the area of carotid and femoral plaque, as well as an increase in patients with aortic and mitral calcification at 24 months. A positive association of mitral calcification at 24 months with age, ankle-brachial index (ABI) and calcium-phosphorus product (CaxP) at baseline visit was observed, without association with eGFR. Aortic calcification at 24 months was positively associated with age, phosphorous and total carotid plaque area at baseline, with no relationship to eGFR.

CONCLUSIONS

A significant prevalence of valvular calcification was observed in patients with CKD without known cardiovascular disease.Two-year progression was observed independently of the eGFR. Patients with higher risk of mitral valve calcification were those with older age, higher ABI and CaxP product. Patients with a higher risk of aortic calcification were those with older age, higher phosphorous levels and larger area of carotid plaque. Identifying these higher risk patients would help to avoid future cardiovascular events intensifying follow-ups.

Anomalous right coronary artery origin with interarterial pathway-importance of morphological origin assessment and the role of percutaneous interventionism

Anomalies in coronary arteries (CA) are an important issue in cardiology and cardiovascular surgery. Specifically the anomalous origin of the right coronary artery (RCA) is of special importance because it is the most frequent anomaly. Clinical practice guidelines recommend the revascularization treatment in cases of interarterial pathway and documented myocardial ischemia and when hypoplasia, compression or obstruction is evident. We report two different cases of patients with anomalous origin of RCA and associated interarterial pathway. With them we want to highlight the different presentation forms of these patients and the different diagnostic alternatives available in each of the steps. In the patient with anomalous origin of the RCA and associated interarterial pathway, the first step after establishing the diagnosis is to rule out the presence of inducible ischemia. In those patients in whom ischemia induction tests are negative, the second step is to adequately assess the interarterial pathway, in order to rule out obstructions or compressions that also justify revascularization. In those cases in which all the tests are negative, the current evidence does not recommend revascularization, but adequate periodic follow-up is recommended. For this reason, we believe that the stress echocardiogram and exercise perfusion scintigraphy (based on availability and experience in each center) are fundamental because of their high sensitivity and specificity. We would also like to highlight the role that percutaneous interventionism can play in this type of clinical cases. Especially with patients of high surgical risk and in whom the percutaneous approach is feasible.

[Intracranial epidural abscess in a newborn secondary to skin catheter]

Intracranial epidural abscesses are uncommon lesions, being more frequents in older children and adults. They commonly arise as a result of direct extension of a preexisting infection and rarely present with focal deficit. We present a case of a 11-days old preterm infant who developed an intracranial epidural abscess as a result of an infected scalp vein catheter. The diagnosis was made on the basis of the cranial ultrasound and CT scan images. An identified strain of Enterococcus faecium was cultured from all the samples. The patient underwent a right frontal craniotomy with drainage of the abscess and a 2-week total course of intravenous antibiotics was administrated. CT scan imaging 3 week after the procedure demonstrated no evidence of residual lesion. When present, a scalp vein catheter, in absence of others predisponing factors, must be considered as an etiologic agent for an intracranial epidural abscess in this age-group.

Hypertrophic pulmonary osteoarthropathy in acquired immunodeficiency syndrome. Case report and review

We describe a case of hypertrophic pulmonary osteoarthropathy (HPOA) in an adult patient with acquired immunodeficiency syndrome (AIDS). This is the ninth case of HPOA associated with AIDS in adults, reported in the literature. The presence of pulmonary tuberculosis was also suspected, based on clinical grounds. Cases of clubbing associated with AIDS infection are reviewed.

[Changes in bone mass and in glucose homeostasis in subjects with high spontaneous fluoride intake]

This paper reports metabolic data of 24 women and two men, 44-66 years old, ex-residents in an area of endemic fluorosis close to Bahía Blanca city. Fasting fluoremias of these subjects (0.5 to 9.2 microM) and daily urinary fluoride excretion (> 60 mumoles/day) are characteristics of zones with endemic fluorosis. Bone mineral density (BMD) at the lumbar spine (L2-4 1330 +/- 41 mg/cm2) and femoral neck (1045 +/- 10 mg/cm2) were significantly above average of normal subjects of the same age and sex. A significant correlation was observed between the daily excretion of fluoride and BMD L2-4 (r = 0.43, P < 0.05). The Area Under the Curve of insulin during a standard glucose tolerance test showed an inverse relationship with fluoremia. This observation coincides with experiments published elsewhere indicating that fluoride intake at concentrations 5 microM or greater, inhibits the secretion of insulin.

The Cuban National Cancer Registry: 1986-1990

In Cuba, the illness that produces most deaths among 1-64-year-olds is cancer. Over 65, it is the second cause of death after heart diseases. A National Cancer Registry was created 1964. Its main goals are to register all malignant neoplasms diagnosed in the country, to study this disease from the statistical and epidemiological point of view and to aid in the health control and planning of cancer fighting resources. This paper presents the results based on cases registered from 1986 to 1990. More than 50% of incidence and mortality caused by cancer is confined to the five major primary sites: lung, prostate, colon, breast and cervix. World population standardised rates by 100,000 inhabitants for the period 1986-1990 were 218.2 in males and 183.7 in females for incidence and 138.4 in males and 95.1 in females for mortality. Cancer incidence distribution by provinces shows two major regions: western-central, where higher risks of lung, breast, prostate and colon cancers are found, and eastern where very high risk of cervix cancer is observed. Although an improvement of the information quality indexes has been reported by the National Cancer registry in the studied period of time, quality of the data remained very poor according to the international standards. However, the results obtained by the National Cancer Registry seem to be a valuable tool to evaluate the cancer burden and, in particular, to control and eventually modify the tasks of the National Cancer Control Program in Cuba.

Open randomized comparison of itraconazole versus terbinafine in onychomycosis

BACKGROUND

Onychomycoses are among the most frequent nail diseases. The principal agents are dermatophytes. Itraconazole and terbinafine are two effective and systemic antimycotics. Previous trials have shown, that treatment schedules with effective concentrations for 3 months cause drug deposits in nail plates that persist 6 months after the end of the treatment.

METHODS

A comparative, open, prospective study was carried out with random assignment of patients. The first group included 27 patients under treatment with 200 mg of itraconazole once daily for 3 months. The second group included 26 patients treated with 250 mg of terbinafine for 3 months. Both series of patients were followed for 6 additional months.

RESULTS

Both groups were similar in age, sex, and history of onychomycosis. Trichophyton rubrum was the main isolated agent in all patients. The percentage of diseased nails was similar in both groups affecting predominantly the first toenail. Treatment was highly effective and differences between groups were not significant. The rate of adverse events was 21% in the itraconazole group and 47% in the terbinafine group.

CONCLUSIONS

Itraconazole and terbinafine are two drugs of choice in dermatophytic onychomycosis.

Evidence for the participation of protein kinase C and 3',5'-cyclic AMP-dependent protein kinase in the stimulation of muscle cell proliferation by 1,25-dihydroxy-vitamin D3

Treatment with 1,25-dihydroxy-vitamin D3 (1,25(OH)2D3) (1-12 h, 10(-10) M) stimulates DNA synthesis in proliferating myoblasts, with an early response at 2-4 h of treatment followed by a maximal effect at 10 h. To investigate the mechanism involved in the mitogenic action of the hormone we studied the possible activation of intracellular messengers by 1,25(OH)2D3. The initial phase of stimulation of [3H]thymidine incorporation into DNA by the sterol was mimicked by the protein kinase C activator tetradecanoylphorbol acetate (TPA) in a manner which was dose dependent and specific as the inactive analog 4 alpha-phorbol was without effect. Maximal responses to TPA (100 nM) were obtained at 4 h. Staurosporine, a protein kinase C inhibitor, blocked the effect of 1,25(OH)2D3 on myoblast proliferation at 4 h. In addition, a fast (1-5 min) elevation of diacylglycerol levels and membrane-associated protein kinase C activity was observed in response to 1,25(OH)2D3. The adenylate cyclase activator forskolin (20 microM) and dibutyryl-cAMP (50 microM) increased DNA synthesis reproducing the second 1,25(OH)2D3-dependent stimulatory phase at 10 h. Inhibitors of protein kinase A blocked the increase in muscle cell DNA synthesis induced by 1,25(OH)2D3 at 10 h. Significant increases in cyclic AMP levels were detected in myoblasts treated with the sterol for 1-10 h. The calcium channel antagonist nifedipine (5-10 microM) abolished both the effects of 4-h treatment with 1,25(OH)2D3 or TPA and 10-h treatment with 1,25(OH)2D3 or dibutyryl-cAMP. Similar to the calcium channel agonist Bay K8644, 1,25(OH)2D3 stimulated myoblast 45Ca uptake and its effects were blocked by nifedipine.(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental Chagas disease in a South American primate (Cebus sp)

Two year old Cebus sp monkeys were infected with the Argentine strain of T. cruzi by the conjuctival route employing metacyclic forms of the parasite, obtained from dejecta of T. infectans. Both animals developed parasitemia detected by xenodiagnosis, without any overt acute disease, and with serological conversion. After 9-10 months of infection, both animals developed significant ECG abnormalities. One animal died spontaneously and the other was sacrificed. At necropsy, both animals presented significant megacolon. Severe thinning of the intestinal wall was observed without inflammatory lesions and with preservation of the parasympathetic plexus. Histologic studies revealed fibrotic lesions in the myocardium. In this organ, lymphocytic infiltrates were found in infrequent and small foci, but no pseudocytic forms containing parasities were observed. These observations suggest that the Cebus monkey may be a useful experimental model for some major aspects of chronic Chagas disease in man.

The effect of a single large dose of cyclophosphamide on erythropoiesis and iron metabolism in mice

The effects of a single large dose (350 mg/kg) of cyclophosphamide on erythropoiesis and iron metabolism was studied in BALB/ep mice. These effects include erythropoietic depression lasting 7–10 days followed by a phase of recovery. The depressant action of the drug on erythrocyte production is accompanied by other metabolic effects on iron and hemoglobin metabolism.The erythroid aplasia develops faster and is more profound in spleen than in bone marrow. Radioactive iron injected 8 h after cyclophosphamide is cleared by bone marrow and liver with values above normal and released very slowly. These effects were not observed in the spleen. Differences in iron handling among the diverse sectors of iron stores suggest interference by this drug on the mechanism of hemoglobin breakdown and iron metabolism and an inhomogeneity of the reticuloendothelial system.