Objective Although obstructive sleep apnoea syndrome (OSAS) is accompanied by an increased atherosclerotic cardiovascular disease burden, its relationship with arterial stiffness is not yet well determined. We investigated whether essential hypertensive individuals with OSAS are characterized by increased arterial stiffness. Methods Our study population consisted of 46 consecutive patients with newly diagnosed untreated stage I–II essential hypertension suffering from OSAS (35 men, aged 49 ± 8 years) and 53 hypertensive individuals without OSAS, matched for age, sex, and smoking status. All subjects underwent polysomnography, echocardiography and aortic stiffness evaluation by means of carotid–femoral pulse wave velocity (c–fPWV) measurements. Results Hypertensive subjects with OSAS [apnoea/hypopnoea index (AHI) ≥ 5] compared with hypertensive subjects without OSAS (AHI < 5) demonstrated increased levels of body mass index (31.4 ± 4 versus 29.3 ± 4 kg/m2, P = 0.015), office systolic/diastolic blood pressure (151/99 versus 145/94 mmHg, respectively, P < 0.05, for both cases) and relative wall thickness (RWT; 0.46 ± 0.06 versus 0.42 ± 0.07, P = 0.010). Hypertensive subjects with OSAS compared with those without OSAS had significantly increased c–fPWV by 9% (8.56 ± 0.49 versus 7.85 ± 0.93 m/s, P = 0.001) and this difference remained significant even after adjustment for confounders (P = 0.04). In the total study population, c–fPWV was correlated with age (r = 0.35, P = 0.015), office systolic blood pressure (r = 0.30, P = 0.007), RWT (r = 0.30, P = 0.03), logAHI (r = 0.389, P = 0.0001) and minimum oxygen saturation (r = −0.418, P = 0.0001). Conclusions OSAS has a significant incremental effect on aortic stiffening in the setting of middle-aged essential hypertensive subjects. This finding suggests that the presence of OSAS in a hypertensive patient accelerates vascular damage, increasing cardiovascular risk.

Background: Data concerning the outcome of lamivudine-resistant (LAM-R) chronic hepatitis B (CHB) patients with compensated cirrhosis under adefovir (ADV) treatment are limited. The aim of our study was to evaluate the medium term outcome of these, high-risk for fatal events, patients.Methods: 31 LAM-R patients with compensated cirrhosis who had been treated with ADV monotherapy (n = 8) or ADV plus LAM (n = 23) for a mean of 27.6 months, were evaluated. Virological response (VR) was defined as HBV-DNA levels < 10(4) copies/ml within the first year of treatment.Results: Twenty-three patients (74.19%) achieved VR. Six patients (19.35%) developed ADV-related mutations (annual incidence 11%). Liver-related death, liver decompensation and hepatocellular carcinoma (HCC) were observed in 12.9%, 16.12% and 16.12% of patients, respectively. HCC (annual incidence 9.1%) was the main cause of liver decompensation (4/5, 80%) and of liver-related deaths (3/4, 75%). HCC development was not related to patients' age (p = 0.440), HBeAg status (p = 0.245), HBV genotype (p = 0.598), baseline ALT levels (p = 0.981), baseline viral load (p = 0.464), VR (p = 0.504) as well as emergence of ADV resistance (p = 0.871).Conclusions: ADV suppresses viral replication in more than 70% of LAM-R cirrhotic patients during the first year of treatment. Despite that, HCC is frequently observed in these high-risk patients, irrespective of virological response or emergence of ADV resistance. (C) 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Data concerning the efficacy of PEG-IFN alpha 2a plus ribavirin treatment in treatment-naive, genotype 4-infected chronic hepatitis C (CHC) patients from Europe are limited. Hence the aim of this study was to investigate the viral kinetics as well as the sustained virological response (SVR) rates and their predictors, in these patients. One hundred and twenty-three patients were retrospectively analysed. Early (EVR) and late virological response (LVR) was confirmed by undetectable (<50 IU/mL) serum HCV-RNA at week 12 and week 24 of treatment, respectively. SVR was confirmed by undetectable serum HCV-RNA at the end of treatment as well as 6 months later. Overall, 43.5% of patients exhibited SVR, 42.6% were nonresponders and 13.9% were relapsers. EVR was observed in 40.74% and LVR in 59.25% of them. The positive predictive values of EVR and LVR were 72.97% and 86.27% whereas their negative predictive values were 64.29% and 92.85%, respectively. EVR independently predicted SVR in Caucasian patients (P < 0.001) but not in Egyptian patients (P = 0.613), in whom the only independent predictor of SVR was the absence of cirrhosis (P = 0.004). LVR seems to be a better predictor of SVR than EVR in the vast majority of genotype 4-infected CHC patients, irrespective of ethnicity and all the other baseline parameters.

Objectives: To investigate early viral kinetics, sustained virological response (SVR) rates and their predictors, in treatment-naïve, genotype-4-infected, chronic hepatitis C (CHC) patients treated with PEG-IFNα2b plus ribavirin. Patients and Methods: In total, 58 patients were retrospectively analyzed. Early virological response (EVR) was defined as undetectable HCV-RNA (<50 IU/ml) at week 12 (complete, cEVR) or at least a 2 log decrease in HCV-RNA levels (partial, pEVR). Results: Thirty-one patients exhibited SVR (53.4%), 17 (29.3%) were non-responders and 10 (17.2%) relapsed. Thirty-seven patients (63.8%) exhibited EVR. The positive predictive values of EVR, cEVR and pEVR for the SVR achievement were 83.87, 54.83, and 29.03%, whereas their negative predictive values were 59.25, 77.77, and 81.48%, respectively. Both cEVR (OR 0.040, p = 0.042) and EVR (OR 0.016, p = 0.006) independently predicted SVR. Baseline viral load (p < 0.001), age (p = 0.035) and stage of liver disease (p = 0.04) were significantly related to the EVR achievement, whereas only baseline viral load (p = 0.003) and ethnicity (p = 0.025) predicted cEVR. Conclusions: Partial or complete EVR represent independent predictors of SVR in genotype-4-infected CHC patients, regardless of their baseline parameters. The absence of pEVR, rather than the absence of cEVR, should be used as an early indication for discontinuation of treatment in these patients.

Epidemiological data on the prevalence of serological markers of hepatitis B virus (HBV) infection in pregnant women in Greece are limited. We evaluated the prevalence of HBV serological markers in a multinational population of pregnant women in Athens, Greece. The overall prevalence of hepatitis B surface antigen (HbsAg) was 4.1% with the highest rates among Albanian immigrants (12%). Relatively low vaccination-induced protection rates (32.5%) were observed, a finding suggesting that surveillance and immunisation programmes targeted at pregnant women are necessary.

April 24 and treatment duration were set according to HCV genotype and body weight as per current standard recommendations.Dose reductions were dictated by individual patient tolerability.Results: 22 patients (M/F 15/7, median age 58 years) accepted to start PEG-IFN/RBV under informed consent.Median pre-treatment HCV-RNA level was 1.1 MIU/ml; median BMI was 25; median ALT was 1.9×UNL; 12 patients had HCV genotype 1, 8 genotype 2 and 2 genotype 3 infection.The distribution of HDs was as follows: ischemic heart disease, 9 patients; prior mechanical heart valve replacement, 7 patients; valvular and ischemic heart disease, 2 patients; chronic arrhythmias, 9 patients; cardiomyopathy, 5 patients; surgically corrected congenital heart disease, 2 patients.19 patients (86%) completed the prescribed treatment schedule.Six-month post-rx data are available in 19 patients.Responses were as follows: sustained virological response, 63%; relapse, 31%; nonresponse, 6%.Dose reductions were needed in 6 cases for PEG-IFN and 6 cases for RBV.No serious adverse event was observed.The major adverse events were: anemia (Hgb < 10), 59%; thrombocytopenia, 27%; depression, 32%; flulike syndrome, 91%.No patient experienced recurrent angina, heart failure, new-onset or worsening arrhythmias.Post-treatment clinical history and examination, electrocardiography and echocardiography, did not show any sign of progression of the pre-existing HD.Conclusions: Treatment with PEG-IFN/RBV may be safely offered to CHC patients with co-existing, clinically significant HD.In this setting, response rates overlap with those obtained in non-HD patients, without additional safety issues.In qualified centers, CHC patients with overt HD should not be denied treatment, whenever indicated.

To investigate the possible interrelationship between Left atrial (LA) enlargement, BNP and aortic stiffness in essential hypertensive subjects. 235 consecutive, newly diagnosed subjects (aged 52±10 years), with untreated essential hypertension [office BP = 151/97 mmHg] underwent echocardiography and 24-h ambulatory BP monitoring. LA volume was indexed for body surface area to estimate LA volume index (LAVI). Aortic stiffness was evaluated on the basis of the carotid-femoral pulse wave velocity (c-f PWV) measurement by an automatic device (Complior SP). The study population was divided into two groups: those with increased LAVI (>26ml/m2, n = 45) and those without increased LAVI (⩽26ml/m2,n = 181). Subjects with increased LAVI compared to those without increased LAVI did not differ regarding age, body mass index, 24-h systolic and diastolic BP and metabolic profile. Subjects with increased LAVI compared to those without increased LAVI had significantly increased 24-h pulse pressure (54.6±9.0 vs 51.3±7.9 mmHg, p < 0.05), left ventricular mass index (LVMI) (123±31 vs 99±23g/m2, p < 0.0001), LA diameter (4.3±0.38 vs 3.9±0.34 cm, p < 0.0001) and BNP plasma levels (41.5±14 vs 19.7±10 pg/ml, p < 0.05), while did not differ regarding c-f PWV (8.2±1.3 vs 8.1±1.3 m/s, p = NS). Multiple regression analysis model revealed that LVMI and BNP were independent predictors of LAVI (p < 0.05). Even in newly diagnosed essential hypertensive subjects LA enlargement is associated with increased plasma levels of BNP but not more impaired aortic stiffness. These findings support the notion that LA enlargement is closely related with humoral activation in this setting.