Determinants of exercise capacity in hypertensive patients

An impaired exercise capacity is common in hypertensive patients (pts) and factors affecting exercise capacity are not completely elucidated. The aim of the study was to investigate factors influencing exercise capacity in hypertensive pts Studied group consisted of 41 pts (18 males, 23 females) mean age 54.2 +/- 11.9 with essential hypertension and without coronary artery disease. Each patient underwent an echocardiographic examination followed by treadmill exercise test. Echocardiographic assessment comprised estimation of left ventricular (LV) mass index (LVMI), pattern of LV geometry, ejection fraction (LVEF), fractional shortening (LVFS), peak and integral velocities of early (E, Ei) and late (A, Ai) transmitral flow, deceleration time of E wave (DT), isovolumic relaxation time (IVRT), duration of A wave (A-dur), total ejection isovolume index (TEI), E (ETT) and A (ATT) wave transit time to the LV outflow tract, flow propagation velocity of E wave (EP), peak and integral velocities of systolic (S, Si), diastolic (D, Di) and atrial reversal (AR, ARi) pulmonary venous flow, duration of AR wave (AR-dur), acceleration (SAT) and deceleration (SDT) of systolic pulmonary venous flow, systolic forward fraction of pulmonary venous flow (SFF). Exercise capacity was assessed by exercise time and total workload expressed in MET. Significant correlations were found for MET and: age (r = -0.49, p < 0.001), A (r = -0.62, p < 0.001), E/A ratio (r = 0.55, p < 0.004), Di (r = 0.55), p < 0.004), ARi (r = -0.38, p < 0.01), SFF (r = 0.46, p < 0.002). Exercise time correlated with A (r = -0.61, p < 0.001), E/A ratio (r = 0.41, p < 0.04), Di (r = 0.51, p < 0.009), ARi (r = -0.35, p < 0.02), SFF (r = -0.51, p < 0.008), S/D ratio (r = -0.47, p < 0.01). Other investigated parameters did not correlate with both MET and exercise time. By stepwise multiple linear regression analysis Di and ARi were the only determinants of MET (multiple r = 0.85, p < 0.0001) whereas A and Di turn out to be the only independent predictors of exercise time (multiple r = 0.76, p < 0.0004). In hypertensive pts: 1. diastolic function of LV is a principle determinant of exercise capacity, 2. integral velocity of diastolic and atrial reversal pulmonary venous flow and peak velocity of late transmitral flow are the best predictors of exercise tolerance.     

Effect of an HIV counseling and testing program on AIDS-related knowledge and practices in tuberculosis clinics in Abidjan, C?te d'Ivoire.

SETTING: Two out-patient tuberculosis treatment centers, Abidjan, C?te d'Ivoire. OBJECTIVE: To assess the effect of a human immunodeficiency virus (HIV) counseling and testing program on acquired immune-deficiency syndrome (AIDS) related knowledge and behaviors among persons with newly diagnosed tuberculosis. DESIGN: Since 1994, patients with newly diagnosed tuberculosis have received individual or group HIV pretest counseling, informed consent, free HIV testing for those who consent, and post test counseling. From January 1995 through August 1996 in Abidjan's two largest tuberculosis clinics, knowledge and beliefs about HIV/AIDS were assessed before and immediately after the group pretest sessions, and again 4 months later. RESULTS: Prior to pretest counseling, 68.9% and 68.0% of the 559 enrolled subjects could correctly identify five modes of HIV transmission and five modes of HIV prevention. These proportions increased significantly immediately after pretest counseling (90.0%, 86.6%, respectively), and remained higher 4 months later (83.7%, 87.7%) (all P < 0.01). Among men, consistent condom use during the preceding 4 months with a partner who was not a commercial sex worker increased from 9.9% at enrollment to 23.6% at the 4-month visit (P = 0.001), but not for women (6.3% vs. 9.5%, P = 0.40). CONCLUSIONS: An HIV pretest counseling program conducted in an out-patient tuberculosis clinic was well accepted, and significantly increased the level of HIV/AIDS knowledge and, among men, self-reported condom use.     

乙肝病毒疫苗的类型及其免疫原性和安全性

乙型肝炎(HB)病毒(HBV)疫苗主要包括血源疫苗、基因工程酵母疫苗、地鼠及仓鼠卵细胞(CHO)疫苗．血源疫苗已被基因重组HBV(rHBV)疫苗所代替,后者现已发展到第3代及第4代,如含Pre-S的CHO疫苗及添加佐剂如寡核苷酸、3抗原(含S,Pre-S1和Pre-S2)的Hepacare疫苗和3’-单磷酸脂A(AS04)疫苗等．近年来又研制成功了肺炎球菌多糖苷蛋白结合rHBV疫苗及可口服和涂抹的DNA疫苗等．目前所应用的rHBV疫苗均具有很好的免疫原性已得到世界公认和肯定,且国内外无明显差别．不良反应普通rHBV疫苗小于2．5％,主要为针刺部位痛、红、肿、胀、痒,一般轻微,日余即消．小于0．5％的人有发热、嗜睡、食欲下降等反应,多见于HB-AS04疫苗,无需处理.     

Antibody responses to human diploid cell vaccine for rabies with and without human rabies immune globulin

One hundred one volunteers with no exposure to rabies were given human diploid cell vaccine (HDCV) for rabies with or without 20 international units of human rabies immune globulin (HRIG)/kg of body weight to evaluate schedules for therapy with HDCV and HRIG after exposure. All of the volunteers who received three or more doses of HDCV alone or four or more doses of HDCV with HRIG developed high titers of neutralizing antibodies by day 35, which persisted for at least 60 days. By day 7, of the 61 volunteers given HRIG and HDCV, 53% had neutralizing antibodies by a mouse neutralization test and 67% had neutralizing antibodies by a rapid fluorescent focus inhibition test. Similar antibody levels were found in volunteers given HRIG alone, a finding which suggests that low or undetectable early titers after administration of HDCV and HRIG were due to inadequate HRIG dosage rather than any interaction between the passive antibody (HRIG) and the vaccine antigen. These results suggest that trials with 30 or 40 international units of HRIG/kg in combination with HDCV are warranted.     

Hereditary persistence of fetal hemoglobin or (delta beta)o- thalassemia: three types observed in South-Chinese families

Hematological and hemoglobin composition data, and results from extensive gene mapping, using a battery of restriction enzymes and probes, have been used to distinguish different types of hereditary persistence of fetal hemoglobin (HPFH) (or delta beta-thal) among three Chinese families from the southern part of China. The first (Family Z) is an A gamma-(delta beta)+-HPFH without a detectable deletion and may be the same as, or similar to, that described by Farquhar et al (Am J Hum Genet 35:611, 1983). The second (Family C) resembles a G gamma(A gamma delta beta)o-thalassemia and is characterized by a large deletion of DNA originating 3' to the G gamma globin gene and extending beyond sequences recognized by the pRK28 probe. Data from various digests indicate possible differences in the 3' end of the deletion when compared with data for some other types of G gamma(A gamma delta beta)o- thalassemia, described by Trent et al (Br J Haematol 57:279, 1984). The third (Family Zh) concerns a G gamma A gamma(delta beta)+-HPFH, which is characterized in heterozygotes by a fetal hemoglobin level of 20% to 25% with a G gamma value averaging 60% and by the absence of any DNA deletion detectable by extensive gene mapping analyses. The C----G mutation at position 202 5' to the G gamma globin gene [characteristic for the high G gamma-(delta beta)+-HPFH (Proc Natl Acad Sci USA 81:4894, 1984; Blood 64:1292, 1984)] was absent, but the Xmn I site at position 158 5' to the G gamma globin gene [characteristic for a modest increase in G gamma values and thus and increased G gamma to A gamma ratio (Blood)] was present. No indication has yet been obtained explaining the elevation in both G gamma and A gamma chains; haplotyping showed that the chromosome carrying this G gamma A gamma(delta beta)+ determinant is unusual among the Chinese population.     

Activity of class I,II, III,and IV alcohol dehydrogenase isoenzymes in human gastric mucosa

The gastric alcohol dehydrogenase (ADH) plays an important role in the first pass metabolism of ethanol. Human ADH exists in multiple forms, grouped into six classes and located in different tissues. In present study we investigated the activity of four classes (I, II, III, and IV) of alcohol dehydrogenase isoenzymes in the different parts of stomach (corpus and antrum) in patients with suspected gastric ulcer. The aim of the study was assess the particular role of different classes of ADH in the gastric dehydrogenase activity. For the measurement of the activity of class I and class II isoenzymes, we employed new fluorometric methods with specific substrates. The activity of class III alcohol dehydrogenase was measured by the photometric method with n-octanol and class IV with m-nitrobenzaldehyde as a substrate, respectively. All biopsy specimens were taken from less changed areas of the antrum and body of the stomach of 68 patients suspected of having gastric ulcer. It was found that ADH IV (gastric) activity was the highest (14.76 ± 0.68 in the corpus of the stomach in men; and 7.61 ± 0.68 in women, respectively). The activity of the ADH III isoenzyme was lower than that of ADH IV. The activities of class I and II ADH isoenzymes were barely detectable. All tested classes of ADH had higher activity in the corpus than in the antrum and in males than in females. In conclusion, the most important form of gastric ADH is isoenzyme of class IV, less important is the isoenzyme of class III. ADH classes I and II seem to have no role in the stomach.     

Increase in condom use and decline in HIV and sexually transmitted diseases among female sex workers in Abidjan, C?te d'Ivoire, 1991-1998.

OBJECTIVE: To assess clinic- and community-based trends in demographic and behavioral characteristics and clinic-based trends in HIV infection and other sexually transmitted diseases (STD) in female sex workers in Abidjan, C?te d'Ivoire. DESIGN: Multiyear cross-sectional study of first-time attenders in Clinique de Confiance, a confidential STD clinic; biannual community-based behavioral surveys. METHODS: From 1992 to 1998, female sex workers were invited to attend Clinique de Confiance, where they were counseled, interviewed, clinically examined during their first visit and tested for STD and HIV infection. Community-based surveys, conducted in 1991, 1993, 1995, and 1997, interviewed women regarding socio-demographic characteristics and HIV/STD-related knowledge, attitudes and behavior. RESULTS: Among female sex workers in Abidjan, there was a trend toward shorter duration of sex work, higher prices, and more condom use. Among sex workers attending Clinique de Confiance for the first time, significant declines were found in the prevalence of HIV infection (from 89 to 32%), gonorrhoea (from 33 to 11%), genital ulcers (from 21 to 4%), and syphilis (from 21 to 2%). In a logistic regression model that controlled for socio-demographic and behavioral changes, the year of screening remained significantly associated with HIV infection. CONCLUSION: The increase in condom use and the decline in prevalence of HIV infection and other STD may well have resulted from the prevention campaign for female sex workers, and such campaigns should therefore be continued, strengthened, and expanded.     

In aged men,central vessel transmural pressure is reduced by brief Valsalva manoeuvre during strength exercise

A brief Valsalva manoeuvre, lasting 2–3 s, performed by young healthy men during strength exercise reduces transmural pressure acting on intrathoracic arteries. In this study, we sought to verify this finding in older men. Twenty normotensive, prehypertensive and moderately hypertensive otherwise healthy men 46–69 years old performed knee extensions combined with inspiration or with brief Valsalva manoeuvre performed at 10, 20 and 40 mmHg mouth pressure. Same respiratory manoeuvres were also performed at rest. Non‐invasively measured blood pressure, knee angle, respiratory airflow and mouth pressure were continuously registered. In comparison to inspiration, estimated transmural pressure acting on thoracic arteries changed slightly and insignificantly during brief Valsalva manoeuvre at 10 and 20 mmHg mouth pressure. At 40 mmHg mouth pressure, transmural pressure declined at rest (?8·8 ± 11·4 mmHg) and during knee extension (?12·1 ± 11·9 mmHg). This decline ensued, as peak systolic pressure increase caused by this manoeuvre, was distinctly <40 mmHg. Only a main effect of mouth pressure was revealed (P<0·001) and neither exercise nor interaction between these factors, what suggests that transmural pressure decline, depended mainly on intrathoracic pressure developed during brief Valsalva manoeuvre. Resting blood pressure did not influence the effect of brief Valsalva manoeuvre on transmural pressure.     

HIV and human papillomavirus as independent risk factors for cervical neoplasia in women with high or low numbers of sex partners

OBJECTIVE: To explore whether HIV types 1 and 2 and CD4 cell count affect cervical neoplasia independent of human papillomavirus (HPV) in women with high or low numbers of sexual partners residing in Abidjan, Cote d''Ivoire. METHODS: The study population and methods are described in the companion paper. Additional methods include a Papanicolaou smear for cytological diagnosis and statistical analysis. RESULTS: In maternal women, both HIV-1 and high risk HPV were significant independent risk factors for squamous intraepithelial lesions (SIL) (adjusted odds ratio (OR) 11.0 (95% CI 1.1-112) and 5.4 (1.5-18.8), respectively). Only high levels of HPV DNA in the lavage were associated with SIL (OR 13.2 (3.6-47.8)) in the maternal group. In female sex workers, high risk HPV was significantly associated with SIL (OR 23.7 (4.4-126)); HIV seropositivity was not. Any positive level (high or low amounts) of HPV DNA was significantly associated with SIL in sex workers (ORs 15.9 (3.3-76) and 12.7 (3.6-44), respectively). There was no association of SIL with CD4 cell counts < or = 500 x 10(6)/l in HIV seropositive women from either group. CONCLUSION: HPV or HIV-1 infection independently affect cervical neoplasia in women with low numbers of sex partners.