Do all antihypertensive drugs improve carotid intima‐media thickness?A network meta‐analysis of randomized controlled trials

The many clinical trials investigating the effect of various antihypertensive drugs on carotid intima‐media thickness (CIMT) produced conflicting results. We used meta‐analysis to evaluate CIMT changes and network meta‐analysis to rank drugs according to the magnitude of these changes. We identified 31 randomized controlled trials listed in three databases as of January 2008. Using a random‐effects model, we found a significant CIMT decrease with antihypertensive drugs compared to placebo (?0.10 [?0.16; ?0.04]). Overall effect sizes vs. placebo were significant for angiotensin‐converting enzyme (ACE) inhibitors (?0.08 [?0.14; ?0.02]), and a trend was found for beta‐blockers (?0.09 [?0.19; 0.01]). The data did not allow other direct comparisons vs. placebo. Significant benefits were found for calcium‐channel blockers (CCBs) compared to both ACE inhibitors (0.37 [0.20; 0.54]), as well as for angiotensin II receptor blockers (ARBs) compared to beta‐blockers (0.42 [0.29; 0.55]). Diuretics were less efficient than CCBs (?0.09 [?0.16; ?0.02]). Indirect comparisons with network meta‐analysis showed significant effects of CCBs and ARBs vs. placebo (both P < 0.05) and vs. diuretics (both P < 0.001). The CIMT decrease with ACE inhibitors and beta‐blockers was greater than with diuretics (both P < 0.05) but was not different from the placebo effect. In subgroup analyses, significant benefits occurred with lower baseline CIMT values and shorter treatment durations but were unrelated to the size of the blood pressure decrease. In conclusion, among antihypertensive drugs, CCBs and ARBs have the greatest effect on CIMT.     

Therapy of Hypertension in African Americans

Hypertension in African Americans is a major clinical and public health problem because of the high prevalence and premature onset of elevated blood pressure (BP) as well as the high burden of co-morbid factors that lead to pharmacological treatment resistance (obesity, diabetes mellitus, depressed glomerular filtration rate, and albuminuria). BP control rates are lower in African Americans, especially men, than in other major race/ethnicity-sex groups; overall control rates are 29.9% for non-Hispanic Black men. Optimal antihypertensive treatment requires a comprehensive approach that encompasses multifactorial lifestyle modifications (weight loss, salt and alcohol restriction, and increased physical activity) plus drug therapy. The most important initial step in the evaluation of patients with elevated BP is to appropriately risk stratify them to allow determination of whether they are truly hypertensive and also to determine their goal BP levels. The overwhelming majority of African American hypertensive patients will require combination antihypertensive drug therapy to maintain BP consistently below target levels. The emphasis is now appropriately on utilizing the most effective drug combinations for the control of BP and protection of target-organs in this high-risk population. When BP is > 15/10 mmHg above goal levels, combination drug therapy is recommended. The preferred combination is a calcium antagonist/angiotensin-converting enzyme inhibitor or, alternatively, in edematous and/or volume overload states, a thiazide diuretic/angiotensin-converting inhibitor.     

波氏假阿利什菌（尖端赛多孢子菌）引起的真菌性角膜炎1例

我们报道成功治疗波氏假阿利什菌引发的真菌性角膜炎1例,患者只留有很小的角膜瘢痕。一位71岁女性患者,有疼痛、红肿和异物感病史,来到我们第三眼科中心就诊。最初角膜刮片显示有真菌成分,2d后真菌培养为阳性,5d后显示生长物为波氏假阿利什菌。患者仅用药物疗法取得临床治愈,留下微小的角膜瘢痕,最终视力为3/10。     

波氏假阿利什菌(尖端赛多孢子菌)引起的真菌性角膜炎1例(英文)

我们报道成功治疗波氏假阿利什菌引发的真菌性角膜炎1例,患者只留有很小的角膜瘢痕。一位71岁女性患者,有疼痛、红肿和异物感病史,来到我们第三眼科中心就诊。最初角膜刮片显示有真菌成分,2d后真菌培养为阳性,5d后显示生长物为波氏假阿利什菌。患者仅用药物疗法取得临床治愈,留下微小的角膜瘢痕,最终视力为3/10。     

The atherogenic and metabolic impact of non-HDL cholesterol versus other lipid sub-components among non-diabetic and diabetic Saudis

Background  

Several trials from different populations have reported that non-high density lipoprotein cholesterol (non-HDL-C) has more predictive power than low-density lipoprotein cholesterol (LDL-C) in detecting coronary heart disease (CHD) and none in any Arab community whose propensity to develop CHD is higher compared to other ethnicities. This study aims to determine and compare the impact of non-HDL-C versus other lipid parameters, in predicting coronary heart disease among diabetic versus non-diabetic adult Saudis and identify the lipid parameters which make a significant contribution in the development of coronary heart disease, diabetes mellitus, and metabolic syndrome. 733 adult Saudis were recruited and divided into groups of diabetics and non-diabetics. Each participant completed a questionnaire, underwent physical exam including 12-L ECG, and submitted a fasting blood sample where glucose and lipid parameters were analyzed using routine procedures.     

Hyponatraemia and hypothyroidism in a previously irradiated case of carcinoma of the tongue

A case of squamous cell carcinoma of the tongue was complicated by post operative hyponatraemia. The criteria for the syndrome of inappropriate secretion of anti diuretic hormone, [ADH] (SIADH) were met but the patient remained hyponatraemic despite adequate treatment. The patient had previously received radical external radiotherapy to the neck and was found to be profoundly hypothyroid. Correction of the hypothyroid state led to clinical and biochemical recovery. The frequency of post-irradiation hypothyroidism and the possible mechanisms of hypothyroid-induced hyponatraemia are discussed.     

Lack of apoptosis in the hypoxic brain of a rat model mimicking cyanotic heart disease

OBJECTIVE: To assess the effect of chronic hypoxia on brain neuronal apoptosis, an animal model mimicking cyanotic heart disease was utilized. METHODS: Rats were placed in an hypoxic environment at birth and oxygen levels were maintained at 10% in an air-tight Plexiglass chamber. Controls remained in room air. Animals were sacrificed and the brains were harvested at 1 and 4 weeks, respectively. RESULTS: Significant polycythemia developed in the hypoxic rats at 1 and 4 weeks. Indexed brain mass to body weight was significantly increased in the hypoxic groups by 18% (p < 0.01) and 38% (p < 0.01) as compared to controls at 1 and 4 weeks, respectively. There was no difference in the number of apoptotic neurons between the chronically hypoxic rats and controls, as assayed by TUNEL labelling and Hoechst staining. The role of the sphingolipid ceramide was then examined because of its reported role in stress response, growth suppression and apoptosis. It was found that the brain ceramide accumulation was not significantly different in the hypoxic and control groups at 1 and 4 weeks. CONCLUSION: A protective adaptive response to chronic hypoxia in the neonatal brain may exist.     

Development and physical characterization of a periodontal bioadhesive gel of metronidazole

To develop a localized drug delivery system that offers prolonged administration of metronidazole into the periodontal pocket, muccoadhesive gel formulations containing 5% w/w metronidazole were prepared using the bioadhesive polymers: carboxymethylcellulose, methylcellulose, hydroxyethylcellulose, polyvinylpirrolidone, and carbopol. Increased concentrations of the polymers decreased the drug release rate and enhanced syringeability, yield value, and adhesiveness but decreased the spreadability. The bioadhesive properties of the gels were affected by pH and Ca 2+ concentration. The gel containing 20% hydroxyethylcellulose, 20% polyvinylpirrolidone, and 1% carbopol exhibited zero-order drug release kinetics and suitable physical properties for drug delivery to the periodontal pocket.