Resistant hypertension and hyperaldosteronism

Resistant hypertension is defined as blood pressure that remains uncontrolled in spite of ≥ 3 antihypertensive medications at effective doses, ideally including a diuretic. Although exact prevalence is unknown, clinical trials suggest that 20% to 30% of study participants are resistant. Hyperaldosteronism, obesity, refractory volume expansion, and obstructive sleep apnea are common findings in resistant hypertension patients. Multiple studies indicate that primary aldosteronism (PA) is common (∼ 20%) in patients with resistant hypertension. Screening for PA is recommended for most patients with resistant hypertension, ideally by measurement of 24-hour urinary aldosterone excretion, or by the plasma aldosterone/plasma renin activity ratio. Successful treatment of resistant hypertension is predicated on improvement of lifestyle factors; accurate diagnosis and treatment of secondary causes of hypertension; and use of effective multidrug regimens. A long-acting diuretic, specifically chlorthalidone, is recommended as part of the treatment regimen. Recent studies demonstrate that mineralocorticoid receptor antagonists provide substantial antihypertensive benefit when added to multidrug regimens, even in patients without demonstrable aldosterone excess.     

Increased vaginal pH in Ugandan women: what does it indicate?

Abnormal vaginal flora (AVF), indicative of bacterial vaginosis (BV) and/or aerobic vaginitis (AV), amongst other abnormalities, is a risk factor for multiple complications in pregnant as well as non-pregnant women. Screening for such conditions could help prevent these complications. Can self-testing for increased vaginal pH reliably detect BV and other high-risk microflora types, and is this more accurate than performing Gram stain-based Nugent score when screening for high-risk microflora? A total of 344 women presenting at different outpatient clinics in Mulago Hospital and Mbuikwe Outpatient clinics in Kampala, Uganda, were asked to test themselves by introducing a gloved finger into the vagina and smearing it on a microscopy slide, on which a pH strip was attached. Self-assessed categories of normal (pH 3.6–4.4), intermediate (4.5–4.7) or high pH (>4.7) were compared with demographic and with centralised microscopic data, both in air-dried rehydrated wet mounts (Femicare), as well as in Gram-stained specimens (Nugent). AVF was present in 38 %, BV in 25 % and AV in 11 % of patients. High pH and AVF is correlated with human immunodeficiency virus (HIV), infertility, frequent sex, but not vaginal douching. Screening for raised pH detects 90 % of AVF cases, but would require testing over half of the population. As AV and non-infectious conditions are frequent in women with AVF and high pH, Nugent score alone is an insufficient technique to screen women for a high-risk vaginal microflora, especially in infertile and HIV-infected women.     

Treatment of a commercial, machined surface titanium implant with H2SO4/H2O2 enhances contact osteogenesis

BACKGROUND: It has recently been reported that controlled chemical oxidation of titanium (Ti) with sulfuric acid (H(2)SO(4))/hydrogen peroxide (H(2)O(2)) significantly influences the early stages of in vitro osteogenesis. The aim of this study was to evaluate whether this chemical treatment can also influence in vivo bone formation. MATERIAL AND METHODS: Ti implants (Mk III) were etched with H(2)SO(4)/H(2)O(2) for 4 h at room temperature. Mandibular premolars were extracted in eight dogs and, after 3 months, three treated and three untreated implants were placed in each animal. At 3 and 8 weeks postimplantation, the animals were sacrificed, and the implants with surrounding bone were harvested, fixed with formaldehyde, and processed for embedding in LR White. Sections of bone with the implants were prepared, stained with Stevenel's blue and Alizarin red, and analyzed histomorphometrically for percentage of bone-to-implant contact (BIC), percentage of mineralized bone area between threads (BABT), and percentage of mineralized bone area within the mirror area (BAMA). Data were analyzed statistically using two-way analysis of variance. RESULTS: Treated implants exhibited significantly more (P<0.05) BIC than control, untreated ones both at 3 (68.1% vs. 27.9%) and 8 weeks (73.5% vs. 14.7%) postimplantation. However, there was no difference in the BABT and BAMA. Histological analysis confirmed that, in most cases, new bone in contact with the implant formed in a direction away from it. CONCLUSIONS: These data indicate that a controlled chemical oxidation of Ti implants significantly enhances contact osteogenesis and suggest that this treatment may be beneficial for early loading of implants.     

Biomechanical evaluation of tendon regeneration with adipose‐derived stem cell

The use of Adipose‐Derived Stem Cells (ADSC) has been presented as a new alternative for tendon reconstruction. Have been admitted that ADSCs are related to better outcomes when used in tendon healing. This research was designed to apply the potential of ADSCs in tendon healing. Flexor digitorum superficialis tendon lesion was performed on both legs of eleven New Zealand rabbits and them, at the same time, treated as follows: Suture alone (Group III ? Suture, n:10), suture associated with ADSC (Group IV ? Suture + ADSC, n:10) or without suture (Group II ? SHAN, n:2). At four weeks after the tendon surgery, the animal was euthanized, and the tendon evaluated (biomechanically and macroscopically). We used 5 additional New Zealand rabbits in the control group “Group I ? Control, n:10”. In the macroscopic evaluation, the group with ADSC presented a more homogeneous gross morphology compared with the group III. Biomechanical testing showed a lower ultimate tensile load, stiffness and a higher cross‐sectional area in the group III and IV compared with the control group. The group with ADSC showed a greater ultimate tensile load, a larger cross‐sectional area and bigger deformation at the ultimate tensile load when compared to the group without ADSC. In general terms, the use of ADSCs in tendon healing have biomechanical advantages compared to the non‐use of ADSCs at 4 weeks after surgery. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1281–1286, 2019.     

Differential Pattern of Cerebellar Atrophy in Tremor-Predominant and Akinetic/Rigidity-Predominant Parkinson’s Disease

Parkinson’s disease (PD) is an akinetic-rigid disorder characterized by basal ganglia dysfunction and a possible cerebello-thalamo-cortical circuit involvement. This study aims to investigate the pattern of cerebellar involvement in PD and to assess whether it correlates with clinical parameters. MRI scans were acquired from 50 healthy controls (HC) and 63 patients; 44 were classified as tremor-predominant-PD (PDT) and 19 as akinetic/rigidity-predominant-PD (PDAR). We designed an analysis of covariance including the three groups and contrasted as follows: (1) all 63 PD vs HC, (2) PDT vs HC, (3) PDAR vs HC, and (4) PDT vs PDAR. For a precise evaluation of the cerebellum, we used the SUIT tool for voxel-based morphometry. Applying p = 0.001 and extent threshold = 20 voxels, the overall PD group vs HC showed decreased gray matter (GM) in the left lobules VI and crus I. The PDT group showed decreased cerebellar GM when compared with HC at left lobules VI, VIIb, and VIIIa; at right lobules Crus I, VIIb, and VIIIb; and vermal lobules VI and VIIIa. When compared with PDAR, PDT also showed a decrease in the left lobules VIIIa (p < 0.001). There were small clusters of both positive and negative correlation between disease duration and PDT group. The PDAR group showed no cerebellar changes. Our findings support the growing evidence of cerebellar involvement in the pathogenesis of the resting tremor.     

Antimutagenic potential of Solanum lycocarpum against induction of chromosomal aberrations in V79 cells and micronuclei in mice by doxorubicin

Solanum lycocarpum A. St. Hil. (Solanaceae) is a hairy shrub or small much-branched tree of the Brazilian Cerrado. S. lycocarpum fruits are commonly used in traditional medicine in powder form or as folk preparations for the treatment of diabetes and obesity, as well as for controlling cholesterol levels. The aim of the present study was to chemically characterize the hydroalcoholic extract (SL) of S. lycocarpum by determination of total flavonoids and total poyphenols and quantification of steroidal alkaloids, as well as to evaluate its mutagenic and/or antimutagenic potential on V79 cells and Swiss mice using chromosomal aberrations and bone marrow micronucleus assays, respectively. Three concentrations of SL (16, 32, and 24?μg/mL) were used for the evaluation of its mutagenic potential in V79 cells and four doses (0.25, 0.50, 1.0, and 2.0?g/kg body weight) were used for Swiss mice. In the antimutagenicity assays, the different concentrations of SL were combined with the chemotherapeutic agent doxorubicin (DXR). HPLC analysis of SL gave contents of 6.57?%?±?0.41 of solasonine and 4.60?%?±?0.40 of solamargine. Total flavonoids and polyphenols contents in SL were 0.04 and 3.60?%, respectively. The results showed that not only SL exerted no mutagenic effect, but it also significantly reduced the frequency of chromosomal aberrations induced by DXR in both V79 cells and micronuclei in Swiss mice at the doses tested.     

Approach on smoking cessation by training public health providers

The study evaluated the results of a smoking cessation training program including 40 public health providers from November 2004 to March 2007. A total of 3,419 smokers received minimum individual intervention and 982 had group intervention. Of all, 9.2% quit smoking. The main difficulties for smoking cessation reported by health providers were: low patient compliance (11%); lack of medications (38%); and lack of health unit infrastructure/support (29%). The training allowed to reaching out a larger population through smoking cessation approaches at health units.     

Validation of food and beverage indicators obtained by telephone survey in Belém, Pará State, Brazil

The aim of this study was to evaluate the relative validity of indicators of food and beverage intake obtained from the telephone interview surveillance system (VIGITEL). A random sample (n = 100) was evaluated from the total sample of approximately two thousand adults studied by the system in 2009 in Belém, Pará State, Brazil. The indicators were protective factors (adequate consumption of fruit, vegetables, and leafy vegetables) and risk factors (consumption of saturated fat, soft drinks, and alcoholic beverages) for chronic non-communicable diseases. The telephone interview results were compared with those of three 24-hour recalls (reference standard). The reference standard showed underestimation in the indicators' frequency, except for soft drinks and alcoholic beverages. The mean consumption frequencies were generally higher in the exposed group interviewed by the VIGITEL system. We cannot conclude that the VIGITEL system is not a good indicator of consumption, since the reference standard also shows limitations. Nevertheless, its use as a surveillance tool in Brazil is justifiable.