Abstract Background We aimed to evaluate the presence of nocturnal hypotension (NHP) in ischemic stroke (IS) survivors using ambulatory blood pressure (BP) monitoring (ABPM). Methods We included ...fifty consecutive patients presenting at our outpatient clinic for review and who had been discharged for IS in the previous six months. 24-h ABPM was performed with Spacelab 90207 monitor. NHP episodes were considered those values on which the mean arterial pressure (MAP) < 70 mm Hg. Patients were divided into two groups according to the presence or absence of NHP. Results We studied 31 men and 19 women, mean age 68 ± 11 years. Episodes of NHP were observed in 21 patients (42%). There were no significant differences with regard to clinical characteristics between groups. With regard to BP, patients with NHP had significantly lower mean 24-hour BPs, mean daytime BPs and mean nighttime BPs. Dipper pattern occurred more often in patients with NHP, although differences were only statistically significant in the diastolic BP values. Mean office readings were 142 ± 26/77 ± 13 mm Hg (149 ± 26 versus 133 ± 20; P = 0.06; 82 ± 12 versus 71 ± 12; P = 0.008). None of the patients showed office SBP < 90 mmHg and only four had office DBP < 60 mmHg. Conclusions Episodes of NHP in patients with recent IS are common and difficult to detect with clinical cuff measurements. It is necessary to redefine the target BP levels in secondary stroke prevention, possibly because we are subjecting our patients to increased risk of NHP and cerebral hypoperfusion.
BackgroundClinical heterogeneity, a hallmark of systemic autoimmune diseases (SADs) impedes early diagnosis and effective treatment, issues that may be addressed if patients could be grouped into a ...molecular defined stratification.MethodsWith the aim of reclassifying SADs independently of the clinical diagnoses, unsupervised clustering of integrated whole blood transcriptome and methylome cross-sectional data of 918 patients with 7 SADs and 263 healthy controls was undertaken. An inception cohort prospectively followed for 6 and 14 months was studied to validate the results in early cases and analyze if cluster assignment was modified with time.ResultsFour clusters were identifiedThree aberrant clusters were ‘acute phase inflammatory’, ‘T cell immunity’, and ‘interferon’, each including all diagnoses, were defined by genetic, clinical, serological and cellular features. A fourth cluster showed no specific molecular pattern, to which 74% of healthy controls clustered with patients. The inception cohort showed that most patients were either assigned always to the same cluster or moved from the healthy-like cluster to a single aberrant cluster resembling the relapsing-remitting dynamic of these diseases, showing that single aberrant molecular signatures characterize each individual patient.ConclusionsPatients with SADs share molecular signatures and can be therefore stratified into three disease clusters differentiating each patient into a specific molecular disease pathway. Such assignment is stable with time. These results have important implications for understanding disease progression and therapy design marking a paradigm shift in our view of SADs.AcknowledgmentThis work has been supported through a grant from the Innovative Medicines Initiative Joint Undertaking No. 115565 and in-kind and in-cash contributions from the EFPIA partners. G.B. is supported by the Instituto de Salud Carlos III (ISCIII, Spanish Health Ministry), through the Sara Borrell subprogram (CD18/00153). The authors would like to particularly express their gratitude to the patients, nurses and many others who helped directly or indirectly in the consecution of this study.
Abstract Background We aim to evaluate prospectively the long-term changes of blood pressure (BP) in stroke survivors using ambulatory BP monitoring (ABPM) and compare them with the clinic ...conventional measurements. Methods We studied 101 patients who were admitted within 24 h after stroke onset. To study the circadian rhythm of BP a continuous BP monitor (Spacelab 90207) was used. After six and twelve months follow-up a new ABPM was undertaken. Data were analyzed using the SSPS 12.0. Results We studied 62 males and 39 females, mean age: 70.9 ± 10.7 years. We included 88 ischemic strokes and 13 hemorrhagic strokes. In the acute phase mean 24 h BPs were 136 ± 19/78.6 ± 11.4 mm Hg. The normal diurnal variation in BP was abolished in 88 (87.1%) patients. After six months, 74 patients were assessed. Mean office readings were 137.5 ± 23.8/76.4 ± 11.4 mm Hg, and high systolic BPs and diastolic BPs were found in 37% and 11% of the subjects respectively. ABPM revealed a mean BP of 118.5 ± 20.1/70.3 ± 8.6 ( p < 0.0001). In 57 (76.9%), the normal BP pattern remained abolished ( p < 0.001). After one year, 63 patients were assessed. Mean office readings were 130.8 ± 26.3/77.6 ± 9.3 mm Hg, and high systolic BPs and diastolic BPs were found in 23.8% and 10% of the subjects respectively. Mean 24 h BPs were 117 ± 12.5/69.7 ± 7.2 ( p < 0.001). The normal diurnal variation in BP was now abolished in 47 (74.6%) patients ( p < 0.001). Conclusion Survivors of stroke, both hypertensive and non-hypertensive patients, present a chronic disruption of circadian rhythm of BP. Conventional clinical recordings are an unreliable method of controlling these patients and ABPM should be routinely performed in this population.
Isolated trisomy 8 is not considered presumptive evidence of myelodysplastic syndrome (MDS) in cases without minimal morphological criteria. One reason given is that trisomy 8 (+8) can be found as a ...constitutional mosaicism (cT8M). We tried to clarify the incidence of cT8M in myeloid neoplasms, specifically in MDS, and the diagnostic value of isolated +8 in MDS. Twenty-two MDS and 10 other myeloid neoplasms carrying +8 were studied. Trisomy 8 was determined in peripheral blood by conventional cytogenetics (CC) and on granulocytes, CD3+ lymphocytes and oral mucosa cells by fluorescence in situ hybridization (FISH). In peripheral blood CC, +8 was seen in 4/32 patients. By FISH, only one patient with chronic myelomonocytic leukemia showed +8 in all cell samples and was interpreted as a cT8M. In our series +8 was acquired in all MDS. Probably, once discarded cT8M by FISH from CD3+ lymphocytes and non-hematological cells, +8 should be considered with enough evidence to MDS.
In the congenital hypothyroidism screening in populations with sufficient iodine intake, in the percentage of newborns with TSH values 5 mU/l must be less than 3%. This study is aimed at ascertaining ...the prevalence of iodine deficiency among the mothers and newborns in Castellon and Valencia and, secondly, to evaluate the bearing which the day on which the sample is taken and the use of iodized antiseptics may have.
The TSH value was studied in 91,853 newborns within the 2004-2006 period in Castellon and Valencia. The mean TSH values were compared considering the conditions defined by the WHO for analyzing the indicator: sampling at two days following birth and no use of antiseptics. The percentages of samples having TSH5 > mU/l.were calculated and compared.
Among the samples having fulfilled the requirements for the analysis of the indicator, the prevalence of newborns having TSH5 > mlU/ showed a decrease from 2004 (2.2% CI95%:1.8%-2.6%), 2005 (2%; CI95%:1.6%-2.3%) and 2006 (1.7%; CI95%: 1.4%-2%). The mean TSH in samples of under 2 days was significantly higher (2.19 mlU/L; Q1-Q3: 1.35-3.40 as compared to 1.36 mlU/L; Q1-Q3: 0.78-2.21) (p<0,001). Considering the samples taken 2 days after birth, the use of antiseptics determined a significantly higher mean TSH (1.54 mlU/L; Q1-Q3: 0.88-2.50 as compared to 1.23 mlU/L; Q1-Q3: 0.72-1.97) (p< 0,001).
The value of the newborn thyrotropinemia indicator in Castellon and Valencia is compatible with the WHO definition for populations having a proper iodine intake. Neonatal TSH screening is a good tool for monitoring the prevalence of iodine deficiency, but the point in time of the extraction must be suitable and the use of iodized perinatal antiseptics eliminated.
Aquest article presenta un model d’acció tutorial desenvolupat sobre estratègies d’acompanyament a l’estudiant basades en “coaching” i intel•ligència emocional, i un model experimental de tutories ...per parells de tutors en els que es celebren sessions conjuntes per tractar problemes comuns i compartir experiències dels tutelats. Els resultats obtinguts d’integració i eficiència en el procés d’ensenyança aprenentatge dels tutelats en aquest model inviten a estendre l’experiència a un grup de tutors major per després generalitzar-lo.
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