Abstract: Introduction
Self-monitoring home blood pressure (BP) devices are currently recommended for long-term follow-up of hypertension and its management. Some of these devices are integrated with algorithms aimed at detecting atrial fibrillation (AF), which is common essential hypertension. This study was designed to compare the diagnostic accuracy of two widely diffused home BP monitoring devices in detecting AF in an unselected population of outpatients referred to a hypertension clinic because of high BP.
Methods
In 503 consecutive patients the authors simultaneously compared the accuracy of the Microlife® BP A200 Plus (Microlife) and the OMRON® M6 (OMRON) home BP devices, in detecting AF.
Results
Systolic and diastolic BP as well as heart rate (HR) values detected by the two devices were not significantly different. Pulse irregularity was detected in 124 and 112 patients with the OMRON M6 and Microlife BP A200 Plus devices, respectively. Simultaneous electrocardiogram (ECG) recording revealed that pulse irregularity was due to AF in 101 patients. Pulse irregularity detected by the OMRON M6 device corresponded to AF in 101, to supraventricular premature beats in 18, and to frequent premature ventricular beat in five patients, respectively. Pulse irregularity detected by the Microlife BP A200 Plus device corresponded to AF in 93, to supraventricular premature beats in 14, and to ventricular premature beats in five patients. The sensitivity for detecting AF was 100%, the specificity was 92%, and diagnostic accuracy 95% for the OMRON M6 and 100%, 92%, and 95 for the Microlife BP A200 Plus, respectively. AF was newly diagnosed by ECG recordings in 47 patients, and was detected in all patients by the OMRON device, and in 42 patients by the Microlife device.
Conclusion
These results indicate that OMRON M6 is more accurate than Microlife BP A200 Plus in detecting AF in patients with essential hypertension. Widespread use of these devices in hypertensive patients could be of clinical benefit for the early diagnosis and treatment of this arrhythmia and related consequences.
Abstract: Obesity is frequently characterized by a reduced vitamin D bioavailability, as well as insulin-resistance and a chronic inflammatory response. We tested the hypothesis of an independent relationship between serum concentrations of 25-hydroxyvitamin D (25[OH]D) and several circulating inflammatory markers in a cohort of severely obese individuals. Cross-sectional study was carried out among obese patients undergoing a clinical evaluation before bariatric surgery in our University Hospital. Serum 25(OH)D, fasting and post load glucose and insulin, high-sensitive C-reactive protein (hs CRP), fibrinogen, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), leptin, adiponectin and lipid profile were collected. Insulin-resistance was assessed by insulin sensitivity index (ISI). Total body fat (FAT kg), total percent body fat (FAT%) and truncal fat mass (TrFAT) were assessed with dual-energy X-ray absorptiometry. A total of 147 obese subjects (89 women, 37.8 ± 7.1 years) with mean body mass index (BMI) of 43.6 ± 4.3 kg/m(2) were enrolled. Patients in the lowest tertile of 25(OH)D were significantly more obese with a higher amount of TrFAT, more insulin-resistant, and had higher levels of fasting and post-challenge glucose (p < 0.05 for all). In a multivariate regression analysis, serum 25(OH)D was inversely related to significant levels of hs CRP, IL-6 and TNF-α after accounting for age, gender, season of recruitment, BMI, FAT kg and TrFAT (p < 0.01 for all). In extremely obese subjects, 25(OH)D serum concentrations are inversely associated with several biomarkers of systemic inflammation, regardless of the total quantity of fat mass.
Abstract: In athletes exercise training induces autonomic nervous system (ANS) adaptations that could be used to monitor the training status. However, the relationship between training and ANS in athletes has been investigated without regard for individual training loads. We tested the hypothesis that in long-distance athletes changes in ANS parameters are dose-response related to individual volume/intensity training load (TL) and could predict athletic performance. Spectral analysis of HR and systolic arterial pressure (SAP) variability and baroreflex sensitivity (BRS), by the sequences technique, was investigated in 8 recreational athletes during a 6-months training period culminating with a marathon. Individualized TL responses were monitored by a modified Training Impulses (TRIMPi) method, which was determined in each athlete using the individual HR and lactate profiling determined during a treadmill test. Monthly TRIMPi steadily increased during the training period. All the ANS parameters were significantly and very highly correlated to the dose of exercise with a second-order regression model (r(2) ranged from 0.90 to 0.99; P < 0.001). Variance, high-frequency oscillations of HRV and BRS resembled a bell-shaped curve with a minimum at the highest TRIMPi, whereas low-frequency oscillations of HR and SAP variability and the LF/HF ratio rembled an U-shaped curve with a maximum at the highest TRIMPi. The LF component of HRV assessed at the last recording session was significantly and inversely correlated to the time needed to complete the nearing marathon. These results suggest that in recreational athletes ANS adaptations to exercise training are dose-related on individual basis, showing a progressive shift toward a sympathetic predominance and that LF oscillations in HRV at peak training load could predict athletic achievement in this athletes population Key words: heart rate variability, baroreflex sensitivity, training load, performance.
Abstract: ABSTRACT: Coeliac disease is a chronic inflammatory disease of the gut with increased risk of gastrointestinal malignancy. Although enteropathy T-lymphoma is the most common neoplasm in patient affected by coeliac disease, an increased frequency of small bowel carcinoma has been described. We present a case of jejunal carcinoma in a patient suffering for coeliac disease in which gastrointestinal and extraintestinal symptoms of disease developed although he was treated with a gluten-free diet.
Abstract: Riportiamo diverse ipotesi sulle possibili correlazioni immunologiche tra la malattia di Crohn e la celiachia. Sono entrambe patologie infiammatorie croniche dell’intestino che si manifestano in individui geneticamente suscettibili che possono associarsi a molteplici alterazioni cliniche extraintestinali. Nella malattia celiaca, come nel Crohn, l’insufficiente apoptosi cellulare può indurre un’eccessiva concentrazione di classi cellulari T attivate e determinare l’infiammazione cronica specie a livello della lamina propria. E’ possibile che determinati micronutrienti ed antigeni microbici possano essere assorbiti nella mucosa intestinale evocando la risposta infiammatoria tipica del Morbo di Crohn che è, comunque, simile al comportamento immunologico della malattia celiaca. Questi legami sarebbero in grado, in una mucosa fortemente iperattiva quale è quella del Crohn, di innescare una reazione immunologica molto simile alla Malattia Celiaca. Ulteriori studi sono necessari per analizzare e comprovare questa possibile associazione.
Crohn’s disease and coeliac disease are both chronic inflammatory disorders of the gut appearing in genetically susceptible individuals and associated with multiple clinical extraintestinal manifestations. In coeliac disease, as in Crohn’s disease, reduced cell apoptosis may induce an excessive concentration of activated T cells and promote chronic inflammation. Micronutrients and bacterial antigens can be adsorbed to the gut mucosa, evoking the typical inflammatory response of Crohn’s disease, which is similar in many aspects to that of coeliac disease. This review outlines the similarities and differences in the immunological mechanisms of Crohn’s and celiac disease.
Abstract: ABSTRACT
La malattia celiaca può essere correlata con disfunzioni del sistema nervoso autonomo e alterazioni
endoteliali. Questa patologia potrebbe alterare le prestazioni degli atleti. Lo scopo del nostro studio
è di valutare se la celiachia altera il sistema nervoso autonomo o l'endotelio. Abbiamo studiato 11
soggetti affetti da malattia celiaca non trattati rispetto ad un gruppo di controllo in buona salute (13
soggetti). La neuropatia autonoma è stata valutata tramite misure standardizzate dei riflessi
cardiovascolari (lying-to-standing, manovra di Valsalva, deep breathing, sustained handgrip). La
funzione endoteliale è stata studiata misurando la vasodilatazione indotta da flusso a livello
dell’arteria brachiale.
I pazienti celiaci hanno mostrato una tolleranza più bassa alla posizione ortostatica, connessa con
uno squilibrio latente di equilibrio simpatico-vagale e una prevalenza relativa della componente
parasimpatica della funzione autonoma. Tuttavia, questi risultati non sono risultati statisticamente
significativi nel confronto con il gruppo di controllo. Non sono state evidenziate differenze
statistiche per le alterazioni endoteliali fra i due gruppi.
Questo studio non è riuscito a confermare una correlazione significativa tra la malattia celiaca e
alterazioni autonomiche o endoteliali, tuttavia non possiamo escludere un ruolo della disfunzione
autonomica nella genesi di sintomi sistemici in alcuni celiaci. Gli atleti celiaci sintomatici
dovrebbero essere valutati per le disfunzioni del sistema nervoso autonomo.
ABSTRACT
Coeliac disease may be related to autonomic nervous system dysfunctions and endothelialalterations. This disease could be an important factor in athlete’s performances. The aim of our
study was to investigate whether autonomic nervous system or endothelium were altered in
untreated and unselected coeliac disease patients.
Eleven untreated and consecutive coeliac disease patients compared with a healthy, asymptomatic
control group (13 people) were evaluated. Extrinsic autonomic neuropathy was assessed by
standardized measurement of cardiovascular reflexes (lying-to-standing, Valsalva manoeuvre, deep
breathing, and sustained handgrip). Doppler measurement of flow-mediated dilation was conducted
as a screening tool for endothelial dysfunction.
Coeliac patients showed a lower tolerance to orthostatic position, associated with a latent
disequilibrium of sympathetic-vagal balance, a relative prevalence of parasympathetic component
of the autonomic function. However, these results were not statistically significant when compared
with control group. Endothelial alterations didn’t show any statistical difference between groups.
This study failed to confirm a significant correlation between autonomic dysfunction and
endothelial coeliac disease, yet we could not exclude a role of autonomic dysfunction in the genesis
of systemic symptoms in some coeliacs. Some symptomatic athletes suffering from coeliac disease
should be evaluated for autonomic dysfunctions.
