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Biomedical subjects

E Rovira

Publications and source records attributed to E Rovira.

At least 19 recordsLinked to original sources
PubMed2001

Angiotensin II AT1 receptor gene polymorphism and microalbuminuria in essential hypertension.

The objective of this study was to analyze the relationship of polymorphisms of the angiotensin II AT1 receptor gene with microalbuminuria in a group of young adults with essential hypertension. Essential hypertensives, less than 50 years old, never previously treated with antihypertensive drugs, and in absence of diabetes mellitus were included. Office blood pressure (BP), 24-h ambulatory BP monitoring, urinary albumin excretion (UAE) measurements, and DNA analysis were performed. Polymorphisms of the angiotensin II AT1-receptor gene (A1166C and C573T) were studied by polymerase chain reaction and single-strand conformation polymorphism techniques. One hundred eighty-three patients, 49 (27%) microalbuminurics, were included. Office and ambulatory BP values were significantly higher in the microalbuminuria group. No differences in the presence of microalbuminuria were observed among the genotypes of either A1166C or C573T polymorphisms of the angiotensin II receptor AT1 gene, or in the allele frequency of the A1166C or the C573T polymorphism. LogUAE was significantly different among genotypes of the C573T polymorphism [CC 1.30(1.15-1.45), CT 1.14(1.00-1.28), and TT 0.94(0.68-1.20), P < .05]. Both office and ambulatory blood pressure and the TT/C573T genotype were independently related to logUAE, and, at the same BP values, UAE was lower in subjects with this genotype. We have found that the C573T polymorphism is on linkage disequilibrium with A1166C, as the 573T allele is closely linked to the presence of the 1166A allele, but not vice versa. Haplotype analysis among subjects with the AA genotype for the A1166C polymorphism confirms the influence of the TT genotype of the C573T polymorphism on the UAE in hypertensives. The C573T polymorphism of the angiotensin II receptor AT1 gene seems to be a genetic protective factor for UAE in a population of essential hypertensives.

Adult↗
PubMed2001

Polymorphism insertion/deletion of the ACE gene and ambulatory blood pressure circadian variability in essential hypertension.

OBJECTIVE: The objective of the present study was to analyze the influence of the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme on ambulatory blood pressure values and circadian variability in untreated patients with hypertension. MATERIAL AND METHODS: Ninety-nine essential hypertensive patients, less than 50 years old (mean age 39.5+/-7.0 years), previously untreated with antihypertensive drugs were included. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed with a Spacelabs (90202 and 90207) monitor, during a regular working day in unrestricted ambulatory conditions. The I/D polymorphism of the ACE was determined by PCR. RESULTS: The distributions of genotypes were in Hardy-Weinberg equilibrium: I=17 (17%), ID=41 (41.5%), DD=41 (41.5%). No significant differences were present among the groups in terms of age, sex, and biochemical and lipid profiles. The average of 24-h ambulatory blood pressure was slightly higher in patients with the DD genotype as compared with patients with the II and ID genotypes. This was the result of higher nighttime blood pressure values, because no differences in blood pressure were observed during daytime. The systolic blood pressure (SBP) day:night ratio, as an estimate of circadian variability, was significantly lower in subjects homozygous for the D allele than it was in patients carrying the I allele (1.13+/-0.09 vs. 1.17+/-0.08, P=0.014). The subjects in the lowest tertile of the SBP day:night ratio, exhibited a higher frequency of the D allele when compared with those in the middle tertile (0.74 vs. 0.59, P<0.05) or with those in the highest tertile (0.74 vs. 0.54, P<0.01). By using two-way ANOVA with repeated measures, significant differences in SBP variation over time were observed when comparing homozygous for the D allele with subjects carrying the I allele (F=2.11, P=0.002). CONCLUSIONS: Among the genotypes of the I/D polymorphism, subjects carrying DD genotype showed a blunted decline of the physiological nocturnal fall of blood pressure that was significant for SBP.

Adult↗
PubMed2000

[Factors associated with changes in microalbuminuria during antihypertensive treatment].

BACKGROUND: The objective of the present study was to analyze the factors related with changes of microalbuminuria during antihypertensive treatment in patients with essential hypertension. METHODS: One hundred and six patients (57 men, mean age 40.8 [SD 6.6] years) never treated with antihypertensive treatment were included. At the beginning and after one year, blood pressure biochemical profile and urinary albumin excretion (UAE) were measured. After the initial evaluation, 53 patients received angiotensin converting enzyme inhibitors (ACEi) and 53 beta-blockers (BB). Hydrochlorothiazide was added to achieve the blood pressure target < 140/90 mmHg. RESULTS: The average of UAE was 32.1 (43.1) mg/24 h, and 41 (39%) patients had microalbuminuretics. After 12 months of treatment, a significative fall of systolic BP (-20.6 [8.03] mmHg, p < 0.001), and diastolic BP (-14.18 [10.34] mmHg, p < 0.001) were observed, whereas baseline glucose increases (3.08 [11.07] mg/dl, p = 0.006). The changes of UAE were only related with the baseline UAE values. Neither, age, sex, baseline diastolic BP and changes in diastolic BP were significantly related with the changes in UAE. In spite of similar mean BP reduction (medial BP 17.4 [10.9] vs 14.8 [10.4] mmHg), UAE only was reduced in patients treated with ACEi (LogUAE: 0.203 [0.872] mg/24 h; p < 0.04). In addition, in patients treated with BB a significative increase in baseline glucose (4.4 [12.3] mg/dl; p = 0.013) and uric acid (1.18 [4.18]; p = 0.031) were observed. CONCLUSIONS: In patients with essential hypertension, changes in microalbuminuria depends of the initial UAE values and the kind of antihypertensive treatment. ACEi produced higher UAE reduction and lower derangement of the glucose metabolism than BB.

Adrenergic beta-Antagonists↗
PubMed2000

Influence of the I/D polymorphism of the angiotensin-converting enzyme gene on the outcome of microalbuminuria in essential hypertension.

The objective of the present study was to analyze the influence of the I/D polymorphism of the ACE gene on the outcome of microalbuminuria in essential hypertensive patients who were receiving antihypertensive treatment. One hundred thirty-six essential hypertensive patients who were <50 years old and had never previously received treatment with antihypertensive drugs were included in the study. During a 3-year period, patients received nonpharmacological treatment consisting of moderate salt restriction and a low-calorie diet they were obese, with or without a regimen of antihypertensive drugs based on beta-blockers or ACE inhibitors. Hydrochlorothiazide was added when necessary to maintain the blood pressure goal of <135/85 mm Hg. At the beginning of the study and at yearly intervals, systolic and diastolic blood pressures (SBP and DBP, respectively), 24-hour urinary albumin excretion (UAE), renal function, and biochemical profile measurements were made. The insertion/deletion (I/D) polymorphism of the ACE gene was determined through the use of polymerase chain reaction. The variables used in the statistical analysis were the measurements at the start of the study and the increase or decrease detected during the follow-up, estimated as individual specific regression line slope values. At baseline, no differences in blood pressure or UAE values were observed among genotypes. Likewise, the genotype or allele frequency was not significantly different between normoalbuminurics and microalbuminurics. After the 3 treatment years, significant reductions in SBP, DBP, and UAE were found (SBP 151.6+/-17.3 reduced to 137.2+/-14.3 mm Hg, P<0.001; DBP 96.6+/-8.9 reduced to 84.5+/-9.8 mm Hg, P<0.001; UAE 36.7+/-71.5 reduced to 28.3+/-78.6 mg/24 h, P<0. 05). The slopes of these parameters over time did not differ significantly among genotypes. The slope of SBP was the main factor related to the slope of logUAE (P<0.003). A significant positive correlation coefficient between the SBP and logUAE slopes was observed for the DD patients (r=0.57, P<0.0001) but was absent in patients carrying the I allele (II r=-0.03, P=NS; I/D r=0.01, P=NS). Follow-up studies should be used to achieve a better understanding of the impact of candidate gene polymorphisms on the development of hypertension-induced organ damage. Assessment of the I/D polymorphism of the ACE gene may identify subjects who require a greatly lowered blood pressure to prevent organ damage and to reduce hypertension-associated complications and death.

Adult↗
PubMed1999

[Insertion/deletion polymorphism of the gene encoding for angiotensin-converting enzyme and microalbuminuria in essential arterial hypertension].

BACKGROUND: To assess the influence of insertion/deletion polymorphism in the ACE gene on the microalbuminuria in essential hypertension. PATIENTS AND METHODS: Seventy-nine patients with essential hypertension (37 males and 42 females) (mean age 39 [7] years, body mass index 28 [4] kg/m2), never treated with antihypertensive drugs were included in the study. Urinary albumin excretion (UAE) was assessed in two different days. Ambulatory blood pressure (BP) was assessed during 24 h period. Genotype ACE gene and gene frequencies were determined by an assay based on the polymerase chain reaction (PCR). RESULTS: The distribution of phenotypes was: II = 14 (17%), ID = 32 (40%) and DD = 33 (43%). The mean for UAE tended to be higher in the DD group (53.82 [88.4] mg/24 h) than ID (27.8 [39.6] mg/24 h) and II (23.8 [16.7] mg/24 h). Likewise, the average for UAE were higher in the DD group than in the II + ID group (26.6 [34.0] mg/24 h) (p = 0.06), although the differences did not achieved statistical significance. The relationship between log UAE and 24-hour mean BP was significantly higher in the DD group (r2 = 0.232; p = 0.005) than that observed in the other groups (r2 = 0.060; p = 0.101). CONCLUSIONS: In the present study with young patients with essential hypertension, in DD genotype, UAE seems to be higher and more dependent of BP levels than in the other hypertensives.

Adult↗
PubMed1999

[Ambulatory arterial pressure and left ventricular hypertrophy in untreated hypertensive patients].

BACKGROUND: The study was designed to evaluate blood pressure (BP) values related to left ventricular hypertrophy (LVH) in a group of never treated middle-aged hypertensive subjects. PATIENTS AND METHOD: Non-invasive ambulatory blood pressure monitoring (ABPM) and echocardiography were performed in 149 hypertensive patients (25-50 years old) with diastolic blood pressure (DBP) 90-114 mmHg. LVH was considered when left ventricular mass (LVM) was > 134 g/m2 in males and > 110 g/m2 in females. RESULTS: 43% of patients had LVH. Patients with LVH had higher clinic and ambulatory BP values. The greatest differences were in mean 24-h SBP (p = 0.001) and in 24-h DBP (p = 0.006). With respect to LVH, there were no differences between dippers and non-dippers, males or females, and circadian or BP variability. LVM was positively correlated with clinical DBP (p = 0.24), 24 h SBP (p = 0.41), pulse pressure (PP) (p = 0.36) and absolute BP variability (p = 0.23). Multiple regression analysis confirmed that 24-h SBP and sex where positively associated with LVH independent of others factors. The existence of 24-h SBP > 150 mmHg dramatically increased the risk of LVH (odds ratio [OR] = 9.2; CI 95%: 2.8-29.3; p = 0.002). CONCLUSIONS: The present study indicates that in never treated middle-aged essential hypertensive patients the principal factor related to the presence of LVH is the value of systolic blood pressure throughout a 24-h period.

Adult↗
PubMed1999

Treatment of community-acquired pneumonia in outpatients: randomized study of clarithromycin alone versus clarithromycin and cefuroxime.

OBJECTIVE: To evaluate the efficacy of clarithromycin alone in comparison with the combination of clarithromycin and cefuroxime in the treatment of nonhospitalized patients with community-acquired pneumonia (CAP) in a Mediterranean population. METHODS: CAP was defined as the acute onset of fever (>38 degrees C) with pulmonary opacity on chest roentgenogram. The American Thoracic Society (ATS) criteria (1993) were used to decide on patient hospitalization. Ninety subjects, of whom 53 (59%) were men, with a mean age (+/-SD) of 38+/-15 years, were randomized: 45 received clarithromycin 500 mg b.i.d. orally for 14 days (CL group), and 45 received clarithromycin plus cefuroxime 500 mg b.i.d. orally for 7 days (CLCE group). Patients were monitored with clinical, radiological, and laboratory controls at 3 and 21 days. There were no significant differences between the two groups with regard to demographic, clinical, physical and laboratory data. RESULTS: The mean time to defervescence was 2.4+/-1.4 and 2.4+/-1.5 days, respectively. Chest roentgenogram clearance was complete in all cases, without statistically significant differences in the time to resolution between both arms. Side effects were mild (no significant differences between groups): 5 patients in the CL group and 3 in the CLCE group showed gastrointestinal symptoms. Two patients (2.2%), both in the CLCE group, needed hospital admission during follow-up, but all 90 patients showed an excellent outcome. A causative agent was determined in 25 cases (28%). Legionella pneumophila, Streptococcus pneumoniae, and Mycoplasma pneumoniae were the most frequent pathogens. CONCLUSION: Empirical treatment of outpatient CAP with clarithromycin can be considered adequate in the Mediterranean area, independently of the microbiological etiology. ATS criteria for admitting patients with CAP are appropriate in this population.

Adult↗
PubMed1998

[Outbreak of asthma caused by soybean dust allergy. Clinical and immunologic study of the affected patients].

BACKGROUND: To study the clinical and immunological data of patients affected by a soybean asthma outbreak in Tarragona, Spain. PATIENTS AND METHODS: Characteristics of previous asthma, emergency rooms records and immediate outcome of 15 patients who attended emergency room departments the epidemic day were recorded. Functional respiratory studies, skin prick tests to aeroallergens, and prick tests, specific IgE and immunoblotting to soybean extracts were performed in all patients. RESULTS: Thirteen patients were sensitized to soybean proteins. All of them were atopic (most sensitized to house dust mites) and half had started asthma symptoms after their thirties. The epidemic crisis was particularly severe in patients over 50 years, daily chronic asthma, severe obstructive pattern and/or non receiving steroids. Four patients were admitted to intensive care units. Seven patients showed asthma exacerbations (late reactions) 24 h after the beginning of the epidemic crisis. Specific IgE against a 5-6 kD and a 15.5-17 kD soybean proteins was detected in the sera of 8 patients and 10 patients, respectively. CONCLUSIONS: The outbreak affected atopic patients exposed to soybean dust. The severity of the crisis was related with the previous severity of asthma. Besides the well known 5-6 kD allergenic soybean protein, the 15.5-17 kD protein seems also to be implicated in the sensitization of most of these patients.

Adult↗
PubMed1998

[Clinical manifestations of Stenotrophomas (Xanthomonas) maltophilia infection].

OBJECTIVE: Stenotrophomonas maltophilia (SM) is a gram-negative bacillus whose incidence like nosocomial pathogen has been incremented in the last years, especially in immunocompromised patients, subjected to invasive procedures and those receiving broad-spectrum antimicrobial therapy. METHOD: We report 15 isolations of SM between 1994-1996. RESULTS: The criteria for SM infection were fulfilled by 9 patients (60%), and 6 patients (40%) were colonized. The mean age of the patient was 60 +/- 12 years. Major predisposing factors in infections included venous catheterization (100%), prior surgery (86%), residence in ICU (80%), prior antibiotic therapy (80%) and intubation (66%). The most common underlying disease were heart disease (60%), treatment with immunosuppressors and/or steroids (46%) and chronic lung disease (46%). Ten cases (66%) had polymicrobial culture. The mortality rate was 40%. Risk factors associated with fatal outcome included the following: chronic lung disease (p = 0.043), nasogastric catheterization (p = 0.01), urinary tract catheterization (p = 0.02), intubation (p = 0.04) and the presence of pneumonia or sepsis by SM (p = 0.02). The most active agents were colistina (100%), cotrimoxazol (71%) and ceftazidima (53%). The isolates were highly resistant to first and second-generation cephalosporins (100%) tetracyclines (86%), aztreonam (91%) and imipenem (71%). CONCLUSION: SM cause a wide range of clinical syndromes and is more likely to cause infection or colonization in patients who have underlying disease. Due to its inherent multiple-antimicrobial resistance, it would appear its potential as a nosocomial pathogen will continue to increase. Therapy of patients should include cotrimoxazole.

Cross Infection↗
PubMed1997

Determination of water in ferrous lactate by near infrared reflectance spectroscopy with a fibre-optic probe.

Near infrared diffuse reflectance spectroscopy with a fibre-optic probe was used to determine the water content in ferrous lactate dihydrate. Spectra were recorded by immersing the probe in a beaker containing the ferrous lactate sample. Spectral data were processed by using two different multivariate calibration procedures, viz. stepwise multiple linear regression (SMLR) and partial least-squares regression (PLSR). The results provided by the two calibration procedures were similar and departed by less than 1.5% from the values obtained by Karl Fischer titration.

Ferrous Compounds↗
PubMed1997

[Dysfunction of a TIPS (transjugular intrahepatic porto-systemic shunt) and chylous ascites].

We reported a 66 year old woman diagnosed of cirrhosis secondary to VHC. A TIPS (transjugular intrahepatic portosystemic shunt) placement was used for the treatment of recurrent variceal hemorrhage and, a chyloperitoneum with hepatorenal syndrome developed after shunt occlusion. We discuss the pathological processes that might be responsible and the poor prognosis of this no reported complication.

Aged↗
PubMed1996

[Langerhans cell histiocytosis of lymph node].

Langerhans cell Histiocytosis or Histiocytosis X encompasses the syndromes of Letterer-Siwe disease, Hand-Schuller-Christian disease and eosinophilic granuloma. The localized disease usually consisted of isolated bone involvement as osteolytic areas. The isolated lymph node disease is uncommon. A case study of eosinophilic granuloma of lymph node in a 27 years-old woman who underwent several recurrences as lymphadenitis is presented. This case is presented in light of the cytologic, histologic and immunohistochemical findings of node-based eosinophilic granuloma and the favorable prognosis of this localized form treated with steroids.

Adult↗