Nouvelles stratégies pour le contrôle de l’hypertension: preuves supplémentaires en faveur des associations faiblement dosées

New Strategies for hypertension control. More evidence for low-dose combination therapyHypertension control remains inadequate around the world with many hypertensive people untreated and many treated patients remaining hypertensive. Normalisation of the systolic blood pressure presents the greatest challenge to the physician even though it is the dominant predictor of cardiovascular risk in hypertensive subjects. This is particularly true in people over the age of 50, reflecting the progressive “stiffening” of the arteries with advancing age.New strategies are needed to combat this challenge and the American, European and International guidelines in 2003 all recommend the use of more intensive therapy using combination therapy for the majority of patients. Furthermore, these guidelines all approve the use of fixed dose combinations, particularly fixed low-dose combinations, to improve compliance with therapy and blood pressure control, and to reduce costs. The American and European Guidelines approve the use of fixed low dose combinations to initiate the drug treatment of hypertension.The fixed low-dose combination of perindopril 2 mg and indapamide 0.625 mg, exemplifies all the benefits to be obtained with this strategy. Studies so far have confirmed the superior efficacy of this perindopril/indapamide combination in lowering blood pressure, particularly systolic blood pressure, and in slowing or reversing the progression of target organ damage, including left ventricular hypertrophy and albuminuria. These benefits appear to reflect actions on both large central arteries and on the microcirculation. Effective use of this fixed combination of perindopril and indapamide has the potential to reduce the growing burden of blood pressure related disease worldwide.     

Le polynucléaire basophile : du contrôle de l’immunité à celui des leucémies

The basophils, first described by Paul Ehlrich in 1879, are rare circulating cells, representing approximately 0.01 to 0.3% of the blood leukocytes. Until recently, these cells have been neglected because of their minority status among immune cells and because they show some similarities to mast cells residing in tissues. However, basophils and mast cells are now recognized as distinct cell lines and it appears that basophils have important and non-redundant functions, distinct from those of mast cells. On the one hand, basophils have beneficial contribution to protective immunity, in particular against parasitic infections. On the other hand, basophils are involved in the development of various benign and malignant pathologies, ranging from allergy to certain leukemias. Basophils interact with other immune cells or neoplastic cells through direct contacts or soluble mediators, such as cytokines and proteases, thus contributing to the regulation of the immune system but also to allergic responses, and probably to the process of neoplastic transformation. In this review, we will develop recent knowledge on the involvement of basophils in the modulation of innate and adaptive immunity. We will then describe the benign or malignant circumstances in which an elevation of circulating basophils can be observed. Finally, we will discuss the role played by these cells in the pathophysiology of certain leukemias, particularly during chronic myeloid leukemia.     

Toxicité sérotoninergique résultant d’une interaction médicamenteuse entre le bleu de méthylène et les inhibiteurs de la recapture de la sérotonine

Background:

Methylene blue is used in medical practice for various reasons. Recent findings point to a potential interaction with serotonin reuptake inhibitors (SRIs) that could lead to serotonergic toxicity.

Objective:

To describe the risk of serotonergic toxicity associated with the interaction between methylene blue and SRIs.

Data sources:

Relevant publications were searched systematically via MEDLINE (1946 to March 21, 2013) and Embase (1974 to 2013, week 11) with the following search terms: “methylene blue”, “methylthioninium”, “monoamine oxidase inhibitors”, “serotonin reup-take inhibitors”, and “serotonin syndrome”. No restrictions were applied in relation to the indication for methylene blue or the language of publication. The reference lists of identified articles were also searched.

Study selection and data extraction:

Eighteen case reports and 2 case series were identified for inclusion. To date, no randomized controlled trials have been published.

Data synthesis:

The first case report indicating suspicion of an interaction between methylene blue and SRIs was published in 2003. Seventeen other case reports describing the same type of interaction have been published since then. The 2 case series provided data from about 325 parathyroidectomies in which methylene blue was used for staining. The 17 patients who experienced central nervous system toxicity were all taking SRIs in the preoperative period.

Conclusion:

When administered in combination with SRIs, methylene blue may lead to serotonergic toxicity at doses as low as 0.7 mg/kg. Methylene blue would seem to have monoamine oxidase A inhibitory properties. Precautions should be taken to avoid this interaction.[Publisher’s translation]     

Propriétés différentielles d'un inhibiteur de la décarboxylase envers la l-Dopa et le l-5-HTP. Données polygraphiques et biochimiques

This study, comparing polygraphic data and biochemical dosages with a short term rabbit EEG recording technique, shows that Ro 4602 does not have the same quantitative (or even qualitative) effect whether combined with l-Dopa or l-5-HTP. Thus minimal and optimal doses of this inhibitor of the decarboxylase are not the same for the two precursors. Using equimolar doses, clinical effects on the whole appeared to be much more evident with the association Ro 4602-l-5-HTP than with Ro 4602-l-Dopa.