Biomedical subjects
Heikki Kauma
Publications and source records attributed to Heikki Kauma.
Prevalence, characteristics and natural course of inappropriate sinus tachycardia.
AIMS: To study the prevalence, characteristics and natural course of inappropriate sinus tachycardia (IST). METHODS AND RESULTS: The prevalence and characteristics of IST were evaluated in a random sample of 604 middle-aged subjects. Seven of the subjects (1.16%) fulfilled the contemporary diagnostic criteria of IST. The systolic (147+/-11 mmHg vs. 130+/-13 mmHg, P<0.001) and diastolic ambulatory blood pressures (92+/-7 mmHg vs. 81+/-8 mmHg, P<0.001) were higher among the subjects with IST than among the controls. The other laboratory, echocardiographic and personality measurements, with the exception of the hostility score (10+/-2 vs. 8+/-3, P<0.001), revealed no differences between the groups. The natural course and prognosis of the disorder was assessed among the subjects fulfilling the IST criteria and nine previously diagnosed IST patients. During a mean follow-up of 6.0+/-2.4 years, none of the subjects developed any clinical or echocardiographic evidence of structural heart disease despite ongoing palpitations, and there was no significant reduction in the 24-h average HR (9+/-2 bpm vs. 89+/-8 bpm, P=0.204). CONCLUSION: The prevalence of IST in a middle-aged population was higher than previously assumed. Despite the chronic nature of the disorder, the prognosis of IST was benign. The causal relationship between IST and hypertension and/or hostile personality type remains speculative.
Blood culture Gram stain and clinical categorization based empirical antimicrobial therapy of bloodstream infection.
Early antimicrobial treatment has a great influence on the outcome of patients with blood stream infections (BSI). The study was designed to see if the simple practice of patient categorization (community acquired, nosocomial or infection in haematological unit) combined with Gram stain data could be used to guide empirical treatment of BSI in 1901 consecutive positive blood culture findings. There were considerable differences in the occurrence of common pathogens and their antimicrobial susceptibilities between patient categories especially for Gram-positive cocci. For example, second generation cephalosporins covered more than 70% cocci in clusters and over 80% of cocci in chains in community acquired infections whereas in hospital acquired infections the corresponding figures were only 47 and 44%. We conclude that Gram stain results of positive blood cultures along with the knowledge of where the infection was acquired, would allow early accurate targeting of antimicrobial therapy for BSI.
Paraoxonase-1 gene Leu-Met55 and Gln-Arg192 polymorphisms are not associated with carotid artery atherosclerosis in a population-based cohort.
BACKGROUND: Paraoxonase-1 (PON1) is an enzyme that prevents low-density lipoprotein (LDL) oxidation. The role of polymorphisms of PON1 determining early atherosclerotic changes is currently unclear. DESIGN: Cross sectional cohort study. METHODS: Nine hundred and ninety-nine subjects from a population-based cohort were screened. Intima-media thickness (IMT) was measured by ultrasonography. Leu-Met55 and Gln-Arg192 polymorphism were determined. RESULTS: No association between PON1 genotypes and IMT was found. This finding remained after adjusting for confounding factors. CONCLUSIONS: The PON1 Leu-Met55 and Gln-Arg192 polymorphisms are not major risk factors for atherosclerosis in the general Caucasian population.
Low plasma ghrelin is associated with insulin resistance, hypertension, and the prevalence of type 2 diabetes.
Experimental studies have suggested that ghrelin plays a role in glucose homeostasis and in the regulation of blood pressure (BP). We therefore assessed the hypothesis that a low ghrelin concentration may be a risk factor for type 2 diabetes and hypertension. We also characterized the effect of the ghrelin Arg51Gln and Leu72Met mutations on ghrelin concentrations in the population-based hypertensive (n = 519) and control (n = 526) cohorts of our OPERA (Oulu Project Elucidating Risk of Atherosclerosis) study. The fasting plasma ghrelin concentrations of 1,040 subjects were analyzed using the radioimmunoassay method. Insulin sensitivity was assessed using the quantitative insulin sensitivity check index (QUICKI). Ghrelin concentrations were negatively associated with fasting insulin (P < 0.001), systolic (P = 0.026) and diastolic BP (P = 0.018), and the prevalence of type 2 diabetes (P = 0.015) and insulin resistance (P < 0.001) in the multivariate models. In the control cohort, low ghrelin was associated with hypertension (BP >140/90 mmHg) (P = 0.031). The subjects with the ghrelin 51Gln allele had lower ghrelin concentrations than the Arg51Arg homozygotes (P = 0.001). We conclude that low ghrelin is independently associated with type 2 diabetes, insulin concentration, insulin resistance, and elevated BP. Therefore, it might have some role in the etiology of type 2 diabetes and the regulation of BP. The ghrelin Arg51Gln mutation is associated with low plasma ghrelin concentrations.
Hypophyseal hemorrhage and panhypopituitarism during Puumala Virus Infection: Magnetic Resonance Imaging and detection of viral antigen in the hypophysis.
We describe 3 cases of nephropathia epidemica (NE) that confirm that Puumala virus infection may cause hypophyseal injury. Autopsy revealed a hemorrhagic hypophysis positive for Puumala virus antigen in both neuroendocrine stromal and vascular endothelial cells in 1 patient, and 2 patients developed hypophyseal hemorrhage (diagnosed with magnetic resonance imaging) during or shortly after acute NE, both of whom developed panhypopituitarism.
Apolipoprotein E polymorphism affects carotid artery atherosclerosis in smoking hypertensive men.
OBJECTIVE: Smoking is a risk factor for increased carotid artery intima-media thickness (IMT). The apolipoprotein E (apoE) 4 allele has been associated with cardiovascular diseases, but the role of apoE in regard to intima-media thickness (IMT) has remained controversial. The objective was to investigate whether there is some gene-environment interaction between smoking and apoE polymorphism. DESIGN Cross-sectional case-control study. METHODS: IMTs of 511 hypertensive and control men were measured ultrasonographically and the apoE genotypes were determined. Genotypes with the 4 allele were pooled into one group and the genotypes without it into another. RESULTS: A significant interaction between the 4 allele and smoking affecting IMT was observed among the hypertensive smokers, as assessed by analysis of covariance. The mean carotid IMT was significantly greater (1.01 versus 0.90 mm, P = 0.003) in the 4 carriers than in the subjects without 4 among the hypertensive smokers. The number of plaques was also significantly higher. No differences were found in the other subjects (hypertensive non-smokers or controls). Linear regression analysis indicated that the 4 allele was an independent determinant of IMT in the hypertensive smokers but not in the other subjects. The estimated average effect of the 4 allele on the mean IMT in the hypertensive smokers was 0.088 mm (P < 0.001). In the oldest age group, the interaction of smoking and 4 was also seen in the control subjects. CONCLUSION: The findings suggest that the 4 carriers are particularly susceptible to the atherogenic effects of smoking. This interaction is particularly clear in hypertensive subjects.