Primary antibody deficiency and Crohn's disease

Five patients with primary antibody deficiency were investigated because of intermittent but persistent diarrhoea of several years duration despite immunoglobulin replacement therapy. We found no evidence of Giardia lambia or other intestinal pathogens to explain their gastrointestinal symptoms. All five had definite radiological evidence of small bowel Crohn''s disease and three had histological specimens available with abnormalities consistent with Crohn''s disease. One patient had a non-caseating granuloma in an oral ulcer. A second patient with stricturing disease in the small bowel had a mucosal inflammatory infiltrate with non-caseating granulomas. A third had transmural inflammation but no granulomas. All five patents were diagnosed as having Crohn''s disease and have responded symptomatically to steroid therapy.


     

Cogan's syndrome: an oculo-audiovestibular disease

Typical Cogan''s syndrome is a rare disease of young adults consisting of flares of interstitial keratitis and sudden onset of Ménière-like attacks (nausea, vomiting, tinnitus, vertigo and hearing loss). Life-threatening aortic insufficiency develops in 10% of reported cases. Atypical Cogan''s syndrome (audiovestibular dysfunction with other types of inflammatory eye disease) is associated with vasculitis in 20% of cases and has a less favourable prognosis than typical Cogan''s syndrome.


     

Management of non-Hodgkin's lymphomas

The non-Hodgkin''s lymphomas (NHL) are a heterogenous group of disorders characterised by malignant proliferation of lymphoid cells. The cellular origin is relatively well established with subtypes corresponding to the various stages of lymphocyte differentiation. The term encompasses a hotchpotch of conditions with very different morphological appearance, behaviour and clinical outcome. NHL comprise 2.4% of all cancers, with incidence increasing with age. The commonest presentation is with progressive lymphadenopathy, though extranodal manifestations are present in a significant proportion. The clinical behaviour ranges from a benign, indolent course to rapidly progressive disease; prognosis varies from weeks to many years. Treatment is correspondingly diverse, from `watchful waiting'' to high-dose chemotherapy with bone marrow stem cell transplantation. Cure is possible in an increasing number of patients and much interest currently lies in identifying patients with high-risk disease necessitating the use of intensive treatment regimens.


     

Lung carcinoid related Cushing's syndrome: report of three cases and review of the literature

Three patients with lung carcinoid related Cushing''s syndrome (LCRCS) treated at Frenchay Hospital, Bristol between 1984 and 1994 are described. The first patient presented with hyperpigmentation 13 years after bilateral adrenalectomy. The second patient had no recurrence or metastases 14 years after removal of a typical carcinoid tumour. The last patient survived nine years after diagnosis of liver metastasis. The possibility of LCRCS should be considered in every patient proved to have Cushing''s disease and bilateral adrenal enlargement on abdominal computed tomography. Biochemical sets of investigation (for example, adrenocorticotrophic hormone (ACTH) stimulation, dexamethasone suppression, and metyrapone response) could be misleading and should not be relied upon solely. Search for an ectopic ACTH source should be called off only when ACTH has been demonstrated in the surgically removed specimen, and most importantly, when the serum ACTH concentration returns to normal after surgery. Lung carcinoid tumours are compatible with long survival, and liver metastasis could prove indolent and slowly growing.


     

Lemierre's syndrome (necrobacillosis)

Lemierre''s syndrome or postanginal septicaemia (necrobacillosis) is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. Fusobacterium necrophorum is the most common pathogen isolated from the patients. The interval between the oropharyngeal infection and the onset of the septicaemia is usually short. The most common sites of septic embolisms are the lungs and joints, and other locations can be affected. A high degree of clinical suspicion is needed to diagnose the syndrome. Computed tomography of the neck with contrast is the most useful study to detect internal jugular vein thrombosis. Treatment includes intravenous antibiotic therapy and drainage of septic foci. The role of anticoagulation is controversial. Ligation or excision of the internal jugular vein may be needed in some cases.


     

The effect of magnesium on erythrocytic electrolytes in digitalis toxicity

Summary Concentrations of K⁺, Na⁺ and Mg⁺⁺ were measured in plasma (K⁺ _e, Na⁺ _e, Mg⁺⁺ _e) and in erythrocytes (K⁺ _i, Na⁺ _i, Mg⁺⁺ _i) in patients with digitalis toxicity before and after administration of Mg. K⁺ concentration in 24-hour urine was also measured. 70 persons were divided into 5 groups: (1) 11 normal persons as controls; (2) 19 patients with congestive heart failure, in whom Mg⁺⁺ _i and Mg⁺⁺ _e concentrations were found to be lower than that of the control group; (3) 16 patients with digitalis toxicity treated by Mg⁺⁺, whose K⁺ _i concentration increased much quicker, and Na⁺ _i and Na⁺ _i/K⁺ _i decreased remarkably in comparison to non-Mg treatment group; (4) 12 patients with digitalis toxicity not treated by Mg⁺⁺: in these the above-mentioned changes were not significant; (5) 12 patients with arrhythmia of other causes treated by Mg⁺⁺: whose K⁺ _i also increased significantly on the 3rd day after treatment. K⁺ concentration in 24-hour urine was much lower in Mg treatment group than in non-Mg treatment group. Besides, acute digitalis toxicity was observed in experimental dogs. The concentration of K⁺ _i recovered much quicker in Mg treatment group than in control group. These findings indicate that hypomagnesemia may induce digitalis toxicity. In this paper the possible mechanism of the therapeutic effect of Mg in the treatment of digitalis toxicity is discussed.     

Effect of Yizhitongxuan decoction on learning and memory ability,Gαq/11 expression and Na+−K+-ATP enzyme activity in rat models of Alzheimer's Disease

ObjectiveTo study the effects of Yizhitongxuan decoction on learning and memory abilities, Gαq/11 expression and Na⁺−K⁺−ATP enzyme activity in rat models of Alzheimer's disease (AD) caused by injecting Aβ_25-35 into the hippocampus.MethodsNinety male Wistar rats (age ≤10 months) were selected and injected with Aβ_25-35 into their hippocampi to establish model animals, which were randomly divided into six groups including a sham-operated group (blank group), a model group, a donepezil HCL group (Western Medicine group), and a high/general/dilute concentrations of Yizhitongxuan decoction groups (TCM I II III group). The Morris water maze was used to examine the learning and memory abilities of rats in each group by place navigation and spatial probe tests. Then, the rats were sacrificed to collect the hippocampi for biochemical tests, using western blotting to detect the expression of Gαq/11 and an ultramicro Na ⁺−K⁺−ATP enzyme kit to measure Na⁺−K⁺−ATP enzyme activity.ResultsYizhitongxuan decoction improved model rats' learning and memory abilities, and increased the expression of Gαq/11 in the hippocampus and the level of Na⁺−K⁺−ATP enzyme activity in brain tissue.ConclusionsYizhitongxuan decoction could improve model rats' learning and memory abilities, and had a regulating effect on the expression of Gαq/11 and Na⁺−K⁺−ATP enzyme activity.     

Analysis of the inhibitory effect of gypenoside on Na+, K+-ATPase in rats’ heart and brain and its kinetics

Objective： To study the effects of gypenoside （Gyp） on the activity of microsomalNa^＋, K^＋-ATPase in rat＇s heart and brain in vitro. Methods： The microsomal Na^＋, K^＋-ATPase was prepared from rat＇s heart and brain by differential centrifugation. The activity of microsomal Na^＋, K^＋-ATPase was assayed by colorimetric technique. Enzyme kinetic analysis method was used to analyze the effect of Gyp on the microsomal Na^＋, K^＋-ATPase of rats. Results： Gyp reversibly inhibited the brain and heart＇s microsomal Na^＋, K^＋-ATPase in a concentration-dependent manner, and showed a more potent effect on enzyme in the brain. The IC50 of Gyp for the heart and brain were 58.79± 8.05 mg/L and 52.07± 6.25 mg/L, respectively. The inhibition was enhanced by lowering the Na^＋, or K^＋-concentrations or increasing the ATP concentration. Enzyme kinetic studies indicated that the inhibitory effect of Gyp on the enzyme is like that of competitive antagonist of Na^＋, the counter-competitive inhibitor for the substrate ATP, and the mixed-type inhibitor for K^＋. Cenclusien： Gyp displays its cardiotonic and central inhibitory effects by way of inhibiting heart and brain＇s microsomal Na^＋, K^＋-ATPase activities in rats.     

Activation of angiotensin II type 1 receptors in the median preoptic nucleus induces a diuretic and natriuretic response in rats

Objective

To investigate the effect of activation of angiotensin II (AngII) type 1 (AT1) receptors in the median preoptic nucleus (MnPO) of rats on renal sodium excretion.

Methods

After anesthesia, the rats were injected into the MnPO via an implanted cannula. Urine samples were collected via a bladder cannula, and the urine sodium concentration was assayed with flame spectrophotometry. The serum level of endogenous digitalis-like factor (EDLF) and Na⁺, K⁺-ATPase activity in the renal cortex tissue were assayed respectively with a radioimmunoassay and with an ammonium molybdophosphate-based kit.

Results

Both the urinary volume and the sodium excretion peaked 60 min after AngII was administered into the MnPO. The responses were accompanied by an increase in serum EDLF and a decrease in Na⁺, K⁺-ATPase activity in the renal cortex. The responses of diuresis and natriuresis, as well as an increase in serum EDLF and a decrease in Na⁺, K⁺-ATPase activity in the renal cortex induced by MnPO adminstration with AngII were inhibited by pior treatment with the AngII receptor blocking agent losartan into the MnPO.

Conclusion

These results suggest that activation of AT1 receptors in the MnPO of rat induces diuretic and natriuretic responses. The responses are associated with an increase release of EDLF and with the inhibition of Na⁺,K⁺-ATPase activity in renal cortex tissue.     

尿电解质肌酐比、总蛋白肌酐比在体检和高血压人群中的临床应用

目的 运用尿电解质肌酐比计算膳食盐,评价人群盐摄入量。探讨尿电解质肌酐比、尿蛋白肌酐比(urinary protein/creatinine ratio, TPCR)在体检和高血压患者中的应用价值。 方法 检测948例(其中842名>50岁)健康体检者,616例住院高血压患者的尿钠、尿钾、尿总蛋白和空腹血清脂类项目,计算出尿钠肌酐比,尿钾肌酐比、尿钠钾比(Na⁺/K⁺)、TPCR和血清载脂蛋白B/A1(apoB/apoA1)。 结果 948例体检者按年龄段分组比较中,尿TPCR在50~60岁年龄组与>70岁年龄组差异最明显(P=0.000);842例>50岁体检者不同性别间比较,尿盐、尿钾差异均有统计学意义(P=0.000);高血压组与体检组比较,尿TPCR、尿Na⁺/K⁺、尿盐差异有统计学意义(P=0.000);不同级别高血压的尿盐、Na⁺/K⁺及TPCR等指标均显著增高(P=0.000);616例高血压尿总蛋白与尿Na⁺/K⁺、尿Na⁺具有相关性;图中的尿TPCR浓度随年龄加大逐渐上升,高血压尿TPCR与尿Na⁺/K⁺均显著高于正常体检者。 结论 通过尿电解质计算膳食盐,能简便有效反映人群盐摄入量的高低。尿电解质肌酐比、尿TPCR与高血压的升级及年龄增大紧密相关。     

RELATIVE CHANGES IN SALIVARY SODIUM AND POTASSIUM IN RELATION TO EXPOSURE TO HIGH G STRESS

Salivary Na⁺ and K⁺ was studied in 16 fighter pilots who were undergoing one week of intensive training for improving their tolerance to G stress. Their saliva was collected on first, third/fourth and sixth day of training. The subjects were also administered a stress coping strategy inventory to obtain scores on their pattern of stress coping. The results showed that K⁺ increased by 9.45 mEq/1 (p < 0.01) whereas Na⁺ decreased by 3.58 mEq/L (p > 0.05) under peak stress situation. Both K⁺ and Na⁺ showed a non significant decrease of 4.81 and 2.93 mEq/1 respectively in third sample (post stress) compared to second sample (peak stress). K⁺ concentration in saliva showed a transient phasic shift whereas Na⁺ concentration showed a more persistent tonic shift in relation to G stress. Regression analysis showed significant positive correlation of baseline Na⁺ with score on danger control strategy. A significant negative correlation was found between score on danger control strategy and baseline and poststress K/Na ratio.KEY WORDS: Stress coping strategies, Human centrifuge training     

人乳牙牙髓干细胞对干燥综合征患者CD4+T细胞的免疫抑制效应

目的 探讨在体外人乳牙牙髓干细胞(stem cells from human exfoliated deciduous teeth, SHED)及其联合IL-6抗体对干燥综合征患者(Sjgren syndrome, SS)外周血活化的CD4⁺T细胞的免疫抑制效应。方法 培养并鉴定SHED;流式细胞术检测健康者和SS患者外周血CD4⁺T细胞中Th1、Th2、Th17、Treg及Tfh的比例;将健康者和SS患者PBMC各自单独培养或与SHED共培养,ELISA法检测培养上清液中IL-6浓度,在各组中添加或不添加IL-6抗体,72h后流式细胞术检测CD4⁺T细胞增殖情况。结果 SS患者外周血CD4⁺T细胞中Th17及Tfh比例较健康者升高(P<0.05);健康者与SS患者共培养组的Th17比例显著降低(P<0.001),SS患者共培养组的Treg比例有所升高(P<0.05);在SS患者共培养组中添加IL-6抗体,可显著降低CD4⁺T细胞中Th2的比例(P<0.05)。结论 SHED可抑制SS患者CD4⁺T细胞的增殖,降低SS患者CD4⁺T细胞中Th17的比例且增加Treg的比例;IL-6抗体可降低与SHED共培养的SS患者PBMC中CD4⁺T细胞Th2亚型比例。     

The popularization and application of cold storage red blood cells or whole blood at −80 °C of the Rh(D) negative patients in surgical operation

Summary The efficiency of cold storage red blood cells (CSRBC) or whole blood at −80 °C used in 27 Rh(D) negative patients during surgical operation was reported. The Rh(D) negative patients received the transfusion of CSRBC or whole blood stored at −80 °C for 180 to 360 days. The changes in the indexes, such as blood TB, DB, K⁺, Na⁺, BUN, Cr, urine protein (URPO), UOB, Hb, HCT, serum total protein, relative to hemolytic reaction and blood volume before and after transfusion were observed. The results showed that after transfusion of CSRBC or whole blood 27 cases were negative for urine protein and UOB, and the levels of BUN and Cr were normal (P>0.05). Blood TB, DB, Hb, and HCT were increased, while pH, blood K⁺ and blood Na⁺ was normal with the difference being not significant before and after operation (P>0.05). Plasma protein was decreased, but there was no significant difference before and after operation (P>0.05). It was suggested that CSRBC or whole blood at −80 °C could be safely infused to the Rh(D) negative patients without side effects during the surgical operation. YU Zhongqing, male, born in 1957, Technician in Charge     

帕金森病伴情绪障碍患者证素分布及神经递质特征初探

[目的] 分析帕金森病（PD）伴情绪障碍患者的证素分布特征,初步探究PD伴情绪障碍患者的脑内神经递质特征。[方法] 选择2016年1—12月就诊于本院脑病科门诊的41例PD患者,按照情绪障碍诊断标准分为PD伴情绪障碍组与PD非情绪障碍组,对纳入患者进行一般情况、中医四诊信息、汉密尔顿抑郁量表、汉密尔顿焦虑量表的测评,并对其中可配合脑电超慢涨落分析的27例PD患者进行神经递质检测。[结果] PD伴情绪障碍组心神、气滞出现频次明显高于PD非情绪障碍组,差异具有统计学意义（P<0.05）;PD伴情绪障碍组心神、心、肝、热、气滞、阳亢、阴虚的分值明显高于PD非情绪障碍组,两组间差异具有统计学意义（P<0.05）。PD伴情绪障碍组与PD非情绪障碍组相比,谷氨酸（GLU）的测定值较高,5-羟色胺（5-HT）、乙酰胆碱（ACH）的测定值较低,两组间差异具有统计学意义（P<0.05）。[结论] PD伴情绪障碍患者可在治疗帕金森病的基础上佐以养心安神,理气通滞之品。GLU的升高,5-HT、ACH的降低可能为PD患者发生情绪障碍的神经生化基础。     

DCs及其膜糖蛋白在慢性淋巴细胞性甲状腺炎中的临床研究

目的 就甲状腺组织树突状细胞（DCs）数量及患者外周血DCs细胞膜糖蛋白变化在慢性淋巴细胞性甲状腺炎（HT）患者病理过程中的意义进行分析研究。方法 研究选取确诊HT患者113例,为观察组,同时选取同期健康体检者120例作为对照组;收集患者手术中的甲状腺组织以及外周血进行DCs计数以及DCs膜糖蛋白Galectin-9表达情况进行分析讨论。结果 本研究中观察组受试对象113例,对照组120例受试对象基本情况可比性良好。观察组患者分型参照Woolner''s分类法,包含L-型（lymphoid type）39例,O-型（oxyphilic type）37例, P-型（pronounced type）37例。L-型HT患者DCs细胞计数为（6.54±1.37）×10⁶/L,O-型HT患者DCs细胞计数为（9.55±1.08）×10⁶/L,P-型HT患者DCs细胞计数为（3.59±1.33）×10⁶/L,全部HT患者的平均DCs细胞计数为（7.27±1.35）×10⁶/L;均高于对照组的水平（1.12±0.34）×10⁶/L,差异均有统计学意义（P<0.05）。使用流式细胞仪检测DCs中Galectin-9蛋白表达比例水平,结果提示L-型HT患者DCs中Galectin-9蛋白表达比例为24.66%,O-型HT患者DCs中Galectin-9蛋白表达比例为21.29%,P-型患者为20.54%,全部患者的平均DCs中Galectin-9蛋白表达比例则为24.32%;均高于对照组的7.20%。同时,DCs膜表面糖蛋白Galectin-9表达的Western blot法检测结果也提示观察组显著高于对照组。结论 在HT病理过程中存在者DCs细胞的参与,故可见几种常见类型患者DCs细胞计数均高于健康对照组;同时健康人DCs中Galectin-9蛋白量表达高于HT患者水平,可能与HT患者存在过度免疫有关。     

Cl− Dependence of HCO3− Transport in Frog Gastric Mucosa

Frog (Rana temporaria) fundic mucosae in vitro were pretreated with the histamine H₂ receptor antagonist Metiamide (10^?3M, nutrient side) until net H⁺ secretion had ceased and a steady rate of HCO₃^? transport (luminal alkalinization) was titrated. Removal of Cl^? with SO₄^2- or isethionate replacement from solutions bathing both sides of the mucosa abolished luminal alkalinization. Readdition of Cl^? to the luminal side only reestablished full rates of HCO₃^? transport. Nutrient (serosal) side Cl^? had no effect in this aspect. The results support the previous suggestion that the gastric HCO₃^? transport process is located at the luminal membrane of the surface epithelial cells and indicate that it occurs by (electroneutral) HCO₃^?/Cl^? exchange.     

The pattern of plasma sodium abnormalities in an acute elderly care ward: A cross-sectional study

Introduction

The combination of ageing, illness, and medications can lead to hyponatraemia or hypernatraemia.

Aims

To describe the distribution of plasma sodium levels in older patients admitted to hospital.

Methods

We carried out a hospital based cross-sectional study examining 1,511 serum sodium concentrations ([Na⁺]) among 336 elderly patients and attempted to elucidate the cause(s) of the abnormal serum [Na⁺].

Results

The study population had a mean age of 81.4. Ninety-two (27.4%) patients had hyponatraemia and seven patients (2.1%) had hypernatraemia during their hospitalisation. The distribution of [Na⁺] results was towards the lower end of the normal range. The mortality rate of patients with hyponatraemia was 14.1% and that of patients with normal serum [Na⁺] was 8.9%. Six patients with hypernatraemia died in hospital. Lower respiratory tsuract infection and medication accounted for the majority of cases.

Conclusions

Deranged [Na⁺] is common among elderly patients admitted to hospital.     

Saa3缺失改善阿尔茨海默病模型小鼠认知功能障碍和Tau蛋白病理进展

探究血清淀粉样蛋白A（serum amyloid A, SAA）对阿尔茨海默病（Alzheimer′s disease,AD）模型小鼠的认知功能及tau蛋白磷酸化水平的影响。构建Saa3缺失的APP/PS1转基因AD小鼠模型和侧脑室内（ICV）注射链脲佐菌素（STZ）AD小鼠模型。采用免疫荧光方法检测两种AD模型小鼠脑内Saa3的表达。记录ICV注射STZ小鼠造模期间的体重变化。采用转棒式疲劳仪、旷场实验和高架十字迷宫分别检测小鼠运动协调和平衡能力、自主运动能力和焦虑程度。Morris水迷宫实验评估小鼠的空间学习和记忆能力。Western blot实验检测小鼠脑组织中tau蛋白的磷酸化水平。结果发现,两种AD模型小鼠脑内Saa3的表达显著增加。Saa3缺失对两种AD模型小鼠的运动协调和平衡能力及自主运动能力无显著影响。Saa3缺失缓解了AD小鼠的焦虑程度。Saa3缺失改善了ICV注射STZ模型小鼠和APP/PS1小鼠的学习和记忆能力损伤。Saa3缺失降低了AD小鼠脑内tau蛋白特定位点的磷酸化水平。组间差异有统计学意义（P < 0.05）。这些结果表明,Saa3参与AD的认知功能和tau蛋白的病理进展,抑制SAA为AD的治疗和预防提供了新策略。     

Increased levels of anti-glycan antibodies in patients with cystic fibrosis

Background

The prevalence of Crohn''s disease (CD) is increased in patients with cystic fibrosis (CF). Anti-Saccharomyces cerevisiae antibodies (ASCA) have been suggested as a screening tool to detect CD in CF. Recently, several new anti-glycan antibodies have been reported in CD.

Materials and methods

The sera of 119 CF patients of various age groups were prospectively screened for ASCA type IgG (gASCA), anti-laminaribioside carbohydrate IgG antibodies (ALCA), anti-chitobioside carbohydrate IgA antibodies (ACCA), and anti-mannobioside carbohydrate IgG antibodies (AMCA). The frequency of these anti-glycan antibodies was then compared in patients with CD, ulcerative colitis, rheumatoid arthritis and healthy volunteers.

Results

A significant number of CF patients were positive for gASCA (51.3% [41.6-60.6]) and up to three other anti-glycan antibodies concurrently. Serum levels of anti-glycan antibodies in CF and CD were not related to parameters of inflammation. Despite the well-documented difference in clinical course between male and female CF patients no gender difference of anti-glycan antibodies was found. In contrast, there was a significant positive correlation between anti-glycan markers and age in CF patients.

Conclusions

Our findings demonstrate for the first time the increased frequency of a panel of anti-glycan antibodies in CF and provide a link between the presence of these serological biomarkers and patient''s age. Anti-glycan antibody profiling may therefore become a valuable tool in the care of patients with CF.     

Antihypertensive efficacy of metoprolol XL/Low dose chlorthalidone (6.25 mg) combination: a randomized,comparative study in Indian patients with mild-to-moderate essential hypertension

Objective

High blood pressure is one of the most important risk factors, directly responsible for increasing the cardiovascular morbidity and mortality. The primary objective was to evaluate the efficacy of metoprolol XL/chlorthalidone against metoprolol XL/hydrochlorothiazide with respect to mean fall in systolic and diastolic blood pressure. The secondary objective was to compare the response rates and to evaluate the tolerability of study medications in patients with mild-tomoderate essential hypertension.

Methods

Total 130 eligible patients (65: metoprolol XL 25 mg/chlorthalidone 6.25 mg; 65: metoprolol XL 25 mg/HCTZ 12.5 mg) were enrolled in this randomized, comparative, multicentric, 12-weeks study. Sixty-two patients from each group completed the study. After 4-weeks of treatment, non-responders from chlorthalidone 6.25 mg combination group were shifted to metoprolol XL 50 mg/chlorthalidone 12.5 mg and non-responders from HCTZ 12.5 mg combination group were escalated to metoprolol XL 50 mg/HCTZ 12.5 mg.

Results

The study treatment groups were comparable with respect to demography and baseline disease characteristics. Both the starting therapies were comparable with respect to mean fall in SBP (p = 0.788) and DBP (p = 0.939), and response rates (p = 1.0) after 4-weeks of therapy. Also both the step-up therapies showed similar mean fall in SBP (p = 0.277) and DBP (p = 0.507) at the end of 12-weeks. However, significantly more number of patients from chlorthalidone 12.5 mg/metoprolol XL 50 mg group responded to therapy as compared to that from HCTZ 12.5 mg/metoprolol XL 50 mg group (p = 0.045). All the reported adverse events were of mild-to-moderate intensity. There were no clinically significant trends in electrolytes (Na⁺, K⁺, Cl^-)and fasting blood sugar, evident across the treatment groups.

Conclusion

Chlorthalidone in combination with metoprolol XL is as effective and well tolerated as widely used combination of metoprolol XL/HCTZ, thus providing an alternative therapeutic option.