First Report of the Dagger Nematode Xiphinema dentatum (Nematoda: Longidoridae) in a Deciduous Forest in the Czech Republic

Xiphinema species are migratory ectoparasitic nematodes that feed on an extensive range of hosts and several species are vectors of nepoviruses. These long nematodes are readily distinguished from most other plant parasitic nematodes by a long stylet with forked odontostyle and flanged odontophore. In May of 2005, a sample from the rhizosphere of Carpinus betulus and Acer platanoides in a forest near Silnicna, South Moravia yielded a population of Xiphinema dentatum Sturhan, 1978. X. dentatum previously has been reported to be associated with several forest and grassland species in Germany, the former Yugoslavia, and Slovakia. Specimens were extracted from soil by decanting-sieving. A few female specimens were stored at -20°C in 1 M NaCl, and the rest of the specimens were heat killed, fixed in triethanolamine formalin, and mounted in anhydrous glycerin. In 2007, nematodes from permanent slides were identified by morphological and morphometrical characters (3): female body C shaped in fixed specimens, lip region offset by a depression, reproductive system amphidelphic with the presence of well developed pseudo Z-organ, and tail broadly convex-conoid to regularly hemispherical; main average morphometric of females were body length 3.6 mm, total stylet length 220 μm, vulva position 46%, and tail ratio 0.66. Identification of these nematodes was further verified by sequencing cytochrome oxidase subunit 1 (cox1) of mtDNA and D2/D3 expansion segments of large subunit rDNA. Two individual female specimens from NaCl storage were transferred to 0.5-ml Eppendorf tubes containing 0.25 M NaOH. Total genomic DNA was prepared by a rapid technique (4). The cox1 gene was amplified using forward primer COIF (5'-GAT TTT TTG GKC ATC CWG ARG-3') and reverse primer COIR (5'-CWA CAT AAT AAG TAT CAT G-3') (2). D2/D3 expansion segments of large subunit of rDNA were amplified using forward primer D2A (5'-ACA AGT ACC GTG AGG GAA AGT TG -3') and reverse primer D3B (5'-TCG GAA GGA ACC AGC TAC TA-3') (1). The regions were sequenced in both directions after purification of PCR products from gel slices with a Qiagen gel extraction kit (Qiagen, Hilden, Germany). The sequences of two individual females were identical. The sequences were deposited in GenBank (Accession Nos. EU781537 [cox1] and EU781538 [D2/D3]). The length of cox1 was 393 bp and D2/D3 was 786 bp. The obtained sequences were compared by BLAST in NCBI. The cox1 gene sequence is not available in GenBank for X. dentatum, but the best BLAST hits were logically obtained with Xiphinema species. BLAST results of D2/D3 sequence showed strong similarities (99.6%) with X. dentatum Accession No. AY601627 and only a three nucleotide difference was observed in the beginning of the 5' end. To our knowledge, this is the first report of X. dentatum associated with deciduous forest trees in the Czech Republic. Forests are the main terrestrial ecosystems and rich in species diversity and are of great importance as natural resources. Therefore, information on these plant parasitic nematodes from forests would be useful because they are a component of the continental forest diversity. References: (1) P. De Ley et al. Nematology 2:591, 1999. (2) Y. He et al. J. Mol. Evol. 61:819, 2005. (3) P. A. A. Loof and M. Luc. Syst. Parasitol. 16:35, 1990. (4) J. M. Stanton. Australas. Plant Pathol. 27:112, 1998.

Halogen-substituted phenylalanines as enantioselective selectors for enantioselective discrimination of amino acids: effect of halogen

Halogen-substituted phenylalanines with a halogen X (X = F, Cl, Br or I) in the para position in the aromatic ring of L-phenylalanine are used as enantioselective selectors to explore the effect of the halogen substituent on the enantioselective discrimination of amino acids. Enantioselective discrimination is achieved by investigating the collision-induced dissociation spectra of the trimeric complex ion, [CuII(ref)2(A)-H]+, generated by electrospraying a solution of a mixture of D- or L-analyte amino acid (A), enantioselective reference ligand (ref) and CuCl2. The relative abundances of fragment ions resulting from the competitive loss of reference and analyte amino acids are considered for measuring the degree of enantioselective discrimination by applying the kinetic method. The enantioselectivity of the p-halogenated derivatives of L-Phe increases from fluorine to iodine for the studied amino acids (except for acidic amino acids). The validity of the present method has also been checked by cross enantioselective experiments using p-iodo-D-phenylalanine as the reference in place of p-iodo-L-phenylalanine. The enantioselectivity of fluoro-substituted L-phenylalanine is less than that obtained with L-phenylalanine. The high inductive effect of the fluorine atom decreases the strength of the pi-pi stacking interaction. The presence of halogen affects the enantioselectivity by inductive and steric effects.

Plasma MDA and antioxidant vitamins in diabetic retinopathy

Hyperglycemia and dyslipidemia in diabetes mellitus induce increased lipid peroxidation and peroxyl radical formation, an important mechanism in genesis of microangiopathy. We took up a study on oxidative stress, measured by plasma MDA and antioxidant vitamin status in type - 2 DM patients with and without retinopathy and compared them with a control non-diabetic group. Lipid peroxidation marker MDA was significantly elevated (p < 0.001) in both the diabetic groups whereas, serum vitamin E and vitamin C registered a significant fall (p<0.001) as compared to controls. Our correlation study revealed a significant positive association between plasma MDA with both fasting and 2hr post prandial plasma glucose (r=0.81, p < 0.001, r=0.92, p <0.001) suggesting the role of hyperglycemia in free radical production. Plasma MDA also depicted significant positive relation (p< 0.001) with all lipid parameters except serum HDLc pointing the role of dyslipidemia towards lipid peroxidation. Plasma MDA level was also found to be negatively correlated with both the vitamins (p<0.001, p<0.001) in the study group explaining their protective consumption in the oxidative process prevailing in diabetic retinopathy.

Changes in Heart Rate Variability in patients under local anesthesia

Spectral analysis of Heart Rate Variability (HRV) is widely used for the assessment of cardiovascular autonomic control. Several studies have shown the effect of anesthetic agents on HRV parameters. In this study a systematic approach of HRV analysis has been employed. The effect caused by the ectopic beats on the spectral measurements has been investigated and results are presented. A detrending method using Wavelet Packets has been developed which was able to remove slow varying trend from HRV signals without causing significant changes in the low frequency (LF) and high frequency (HF) component of the HRV signal. Using this methodology electrocardiogram (ECG) signals from 14 patients undergoing local anesthesia (brachial plexus block) were analyzed with parametric Autoregressive (AR) method. The results showed that the LF/HF ratio values calculated from the HRV signal decreases within an hour of the application of the brachial plexus block compared to the values at the start of the procedure. This change was noticed in approximately 80% of the patients.

Paddy straw as substrate for ethanol production

Pretreatment of paddy straw with 2% sodium hydroxide at 15 psi for 1 h resulted in 83% delignification. The hydrolysis of alkali treated paddy straw with a commercial preparation of cellulase for 2 h at 50°C resulted in release of 65% total reducing sugars. Maximum sugars were released at enzyme loading of 1.5% (v/v). The fermentation of hydrolysate supplemented with nutrients by S. cerevisiae resulted in the production of 20-30 g L(-1) ethanol after 48 h incubation which was further improved with addition of yeast nitrogen base and inoculated with 1% (w/v) yeast cells.

First Report of Trichodorus similis from the Czech Republic (Nematoda: Trichodoridae)

Members of the Trichodoridae can cause substantial crop losses directly by feeding on plant roots and indirectly as vectors of tobraviruses; both vector and virus are polyphagous. Although trichodorid nematodes are important pests of agricultural crops, no data are available on the presence or extent of these nematodes in the Czech Republic. In June 2005, three soil samples from the rhizosphere of a Quercus sp. at Cerveny Vrch yielded a population of Trichodorus similis Seinhorst, 1963. Specimens were extracted from soil by a decanting-sieving method, heat killed, and fixed in triethanolamine formalin (TAF), and processed and mounted in anhydrous glycerin. Nematodes were identified by morphological and morphometrical characters (2). Classical identification of these nematodes was further verified by molecular study. A single, male specimen was temporarily mounted in distilled water on a glass slide and relaxed with gentle heat. Measurements and photographs were taken, and the specimen was transferred to a 0.5-ml Eppendorf tube containing 0.25 M NaOH. Total genomic DNA was prepared by a rapid technique (4). Morphometric data of the male specimen used for DNA study are: body length 867 μm; body width 81 μm; onchiostyle length 44 μm; spicule length 36 μm; distance of anterior cervical papilla (CP)1 from anterior end 39 μm, CP1 to CP2 25 μm, CP2 to CP3 22 μm; posterior precloacal supplement (SP1) to cloacal opening 27 μm, distance SP1 to SP2 32 μm, distance SP2 to SP3 39 μm. The following primers were used in the PCR reaction: species-specific sense primer SIMIREV2 (5'-CACTCGTCGGACTCAAACC-3') and universal antisense primer UNIVERSAL (5'-CCCGTCGCTACTACCGATT-3') (1). A single fragment of approximately 452 bp was amplified. The D2 and D3 expansion regions of the large subunit 28S rDNA were amplified using the primer D2A (5'-ACAAGTACCGTGAGGGAAAGTTG-3') and D3B (5'-TCGGAAGGAACCAGCTACTA-3' (3). The region was sequenced after purification of PCR products from the gel slice with a Qiagen gel purification kit (Qiagen Inc., Valencia, CA). The obtained sequence was deposited in Genbank (Accession No. DQ832183). The obtained sequence was compared by BLAST in NCBI and the results showed strong similarities with T. similis (Accession No. AM180730). To our knowledge, this is the first report of T. similis associated with a deciduous forest in the Czech Republic. Taking into account the agricultural importance of trichodorids and tobraviruses as plant pathogens, there is a need for a comprehensive survey of these taxa in the Czech Republic. The damage level threshold is in the case of virus vector species equivalent to a single nematode. Therefore, information on these plant parasites would be useful for developing nematode management strategies. References: (1) K. Boutsika et al. Plant Pathol. 53:110, 2004. (2) W. Decraemer and P. Baujard. Fundam. Appl. Nematol. 21:37, 1998. (3) P. De Ley et al. Nematology 2:591, 1999. (4) J. M. Stanton. Australas. Plant Pathol. 27:112, 1998.

Evidence for the involvement of proline-directed serine/threonine phosphorylation in sperm capacitation

To become fertilization competent, mammalian sperm undergo changes in the female reproductive tract termed capacitation. Capacitation correlates with an increase in tyrosine phosphorylation; however, less is known about the role of serine/threonine phosphorylation in this process. Proline-directed phosphorylation is one of the major regulatory phosphorylation events in many cellular processes such as cell proliferation and differentiation. Using mitotic phosphoprotein monoclonal-2 (MPM-2) antibody in this study, we observed that several mouse sperm proteins in the range of 70-250 kDa underwent increased serine/threonine-proline phosphorylation during capacitation. In contrast to the time course of tyrosine phosphorylation, proline-directed phosphorylation could be observed at shorter time points of sperm incubation, and it was found to be independent of NaHCO(3) and adenosine 3'5'-cyclic monophosphate (cAMP). Similar to the regulation of the increase in tyrosine phosphorylation, cholesterol acceptors such as bovine serum albumin (BSA) or 2-hydroxypropyl-beta-cyclodextrin (2-OH-propyl-beta-CD) were essential for the regulation of proline-directed phosphorylation in mouse sperm. Furthermore, it was also found to be BSA dependent in human sperm. Among proline-directed kinases, extracellular signal-regulated kinase 1/2 (ERK1/2) is present in mammalian sperm; nevertheless, U0126 and PD098059, two inhibitors of the ERK pathway, did not block this phosphorylation in mouse sperm. In conclusion, capacitation is associated with an increase in proline-directed phosphorylation linked to cholesterol efflux in the sperm.

Nutritional status of scheduled caste pre-school children

In the present study anthropometric measurements showed that all the children of scheduled caste families under investigation were under weight and suffered from protein energy malnutrition, night blindness, angular stomatitis, enlargement of liver, anaemia, spongy bleeding gum and a few cases of bow legs, polio and keratomalacia. The haemoglobin level was below World Health Organisation (WHO) standard. Their intakes of protective foods and nutrients such as energy, calcium and iron were less than respective recommended dietary allowances (RDA). Socio-economic environment is responsible for poor nutritional status ofscheduled caste pre-school children.

Extensive arterial and venous thrombosis in a patient with ulcerative colitis--a case report

BACKGROUND

Vascular thrombosis is a rare but well-recognized extraintestinal manifestation of ulcerative colitis. Thrombosis usually involves the peripheral veins and less commonly the cerebral veins and the arterial system.

CASE REPORT

A case of a 22-year-old woman is reported who presented with an exacerbation of ulcerative colitis and developed extensive arterial and venous thrombosis. Good clinical improvement was achieved after treatment with steroids, sulfasalazine, and anticoagulation with enoxaparin followed by long-term warfarin.

CONCLUSION

Early recognition of thrombotic complications is essential in initiating lifesaving therapy.

Loss of circadian rhythm of blood pressure following acute stroke

BACKGROUND

Epidemiology of acute stroke in developing countries differs from that in the developed world, for example, the age at stroke, risk factors, subtypes of stroke and prognosis. Hypertension remains a dominant risk factor and prognostic indicator in patients with stroke in all communities. The risk of stroke is directly related to elevations of blood pressure. A number of clinical studies have shown that the control of hypertension leads to a reduction in the incidence of stroke in a community. However there is still considerable controversy surrounds the changes in blood pressure in various subtypes of strokes and problem of management of elevated BP after stroke. We studied the circadian rhythm of blood pressure in patients following acute stroke.

METHODS

To study the circadian rhythm of blood pressure, fifty consecutive patients with an acute stroke who were admitted to medical emergency within 120 hours of onset were included in the study. After a detailed history and clinical examination, a continuous blood pressure monitor (Spacelab 90207) was attached on the side ipsilateral to intracranial lesion (unaffected arm). The blood pressure was recorded for 24 hours at 15 minutes interval during daytime (6.00 am-6.00 pm) and 20 minutes interval overnight (6 pm to 6 am).

RESULTS

Risk factors for stroke in 50 patients included hypertension in 31(62%), diabetes mellitus in 4 (8%), smoking in 13 (26%) and previous history of transient ischemic attack in 7 (14%) patients. Mean systolic pressure and diastolic pressure at admission were higher in patients with hemorrhagic stroke -29 patients (177 +/- 24 mmHg and 105 +/- 19 mmHg respectively) compared to patients with ischemic strokes-21 patients (150 +/- 36 mm Hg and 89 +/- 18 mm Hg respectively, p value <0.01 in both comparisons). The normal diurnal variation in blood pressure (night time dipping of more than 10%) was abolished in 44 (88%) of patients. Out of 44 nondippers, 29 patients showed reverse dipping i.e. rise of BP during night time compared to day time levels. None of the risk factors, clinical or laboratory variables, type of stroke or blood pressure changes differed significantly between these two groups.

CONCLUSIONS

Therefore, we showed a pathologically reduced or abolished circadian BP variation after stroke. Absence of normal dipping results in a higher 24 hour blood pressure load and may have more target organ damage than those with normal diurnal variation of blood pressure.

Prevalence and pattern of use of complementary and alternative medicine (CAM) in hypertensive patients of a tertiary care center in India

OBJECTIVE

To study the prevalence and pattern of use of complementary and alternative medicine (CAM) in patients with essential hypertension.

METHOD

521 consecutive patients visiting the Hypertension Clinic at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, over a 6-month period were interviewed. Information was gathered on the patients' demographics, type(s) of CAM used, sequence of seeking CAM and conventional medicine, sources of recommendation, reasons for opting for CAM and areas of satisfaction and dissatisfaction associated with the use of CAM. Patients were also asked if they had informed their doctor about CAM use.

RESULTS

It was observed that 63.9% of patients overall used CAM. Ayurveda was the most commonly used CAM (56.7%), followed by herbal medicines (14.4%). The most commonly cited reason by patients for using CAM was fear of adverse drug reactions of conventional medicines (59.0%). However, more than half of the patients eventually became dissatisfied using CAM. Only 5.4% of CAM users had informed their medical doctors about the use of CAM.

CONCLUSION

A significant proportion of patients receiving conventional treatment for hypertension also use CAM therapies. A better understanding of the pattern of CAM use amongst these patients will help dispel prevalent misconceptions concerning CAM and, at the same time, assist conventional practitioners to critically evaluate possible gaps or omissions in their own prescribing habits.

Patterns and perceptions of complementary and alternative medicine (CAM) among leukaemia patients visiting haematology clinic of a north Indian tertiary care hospital

PURPOSE

The use of complementary and alternative medicine (CAM) in cancer treatments is widespread with substantial number of patients deserting conventional cancer therapies in favour of unproven methods. The present study aimed at discovering the prevalence of use of CAM cancer therapies in leukaemia patients visiting haematology clinic of a north Indian tertiary care hospital.

METHODS

533 consecutive leukaemia patients were interviewed. Information was gathered about patients' demographics, types of CAM taken, sequence of seeking CAM and conventional medicine, sources of recommendation, reasons of opting for CAM, and areas of satisfaction and dissatisfaction associated with the use of CAM. Patients were also asked if they had informed their doctor about CAM use.

RESULTS

Prevalence of CAM use in leukaemia patients was found to be 56.6%. Ayurveda was the most commonly used CAM (33%). Most of the patients sought conventional medicine first, followed by CAM therapies. Fifty-two percent of the patients opted for CAM hoping for a miracle cure and 51% were dissatisfied with these therapies. Family members and neighbours constituted major source of recommendation of CAM therapy. Only 3.8% of the patients had informed their doctors about CAM use.

CONCLUSION

A sizeable percentage of patients receiving conventional treatment for leukaemia also use CAM therapies. Clinicians should not underestimate the value of hopeful attitude in their management of leukaemia patients and ought to be conversant with popular forms of CAM cancer therapies.

Epidural abscess and Staphylococcus aureus endocarditis - a rare association

Epidural abscess is a relatively uncommon disorder. Although the surgical management is the mainstay of treatment, there are case reports of it being managed conservatively in selected patients. We report a patient who presented with quadreparesis due to epidural abscess and had infective endocarditis due to Staphylococcus aureus septicemia. Both epidural abscess and infective endocarditis were managed conservatively with intravenous antibiotics given for four weeks, with complete recovery of patient.

Time trends in the prevalence of hypertension and associated risk factors in Chandigarh

To estimate the changes in the prevalence of hypertension and associated risk factors over a 30 years period a cross-sectional population survey in three randomly selected sectors of Chandigarh city was carried out. Study population consisted of 1181 individuals (570 males and 611 females) aged 35 years and above. A total of 1049 subjects were interviewed using a structured interview schedule, and 937 were examined by a physician. Blood pressure and anthropometric measurements were recorded. Physical activity was graded according to the job performed by the individual. Guidelines of the Fifth Joint National Committee (JNC-V) of USA were used for diagnosis of hypertension. Estimation of body fat from skin fold thickness was done by applying Grande's formula and the method of Pascale et al. Data were compared to that of year 1968 when a similar cross-sectional survey had been carried out in Chandigarh. Age and sex standardised prevalence of hypertension according to JNC-V criteria increased from 26.9 per cent in 1968 to 44.9 per cent in 1996-97. In 1968, 70% of the male population were engaged in sedentary and light physical activity compared to 73.7 per cent in 1996-97. Total body fat has increased in both men and women. High and high middle income groups in males were 61.2% in 1996-97 compared to 37.4% in 1968. Smoking rates, however, remained unchanged, 25.4 per cent men smoked in 1968 compared to 24.6 per cent in 1996-97. The prevalence of hypertension has almost doubled over 30 years in Chandigarh. Unfavourable change in prevalence of hypertension, physical activity and body fat makes this population highly vulnerable to cardiovascular morbidity and mortality.

Distinct phosphorylation patterns underlie Akt activation by different survival factors in neurons

The survival of cultured cerebellar granule neurons can be maintained by depolarizing levels of potassium (high K(+), HK), insulin-like growth factor (IGF-1), cyclic AMP or lithium. We examined the possibility that the signaling pathways activated by these different factors converge and that Akt might represent such a point of convergence. Consistent with this possibility, we find that Akt is phosphorylated and activated by all four survival factors. The pattern of Akt phosphorylation induced by the four survival factors, however, shows differences. While IGF-1 induces phosphorylation of Akt at both Ser473 and Thr308, HK and cyclic AMP stimulate phosphorylation at Thr308 only. Lithium increases phosphorylation at Ser473 but not at Thr308. Our results are consistent with the possibility that Akt is a central component of different survival-promoting pathways in granule neurons. The different phosphorylation patterns, however, point to a previously unappreciated complexity in the regulation of Akt activity in neurons. Finally, we provide evidence indicating that SGK, a kinase that is structurally related to Akt, is also activated by the four survival factors.

Celiac disease presenting as iron-deficiency anemia in northern India

BACKGROUND

Adult celiac disease is infrequent in India. Iron-deficiency anemia as its presenting manifestation is still rarer.

METHODS

We investigated patients with refractory iron-deficiency anemia attending the hematology clinic of a tertiary-care hospital for celiac disease. The diagnosis of celiac disease was based on histology, serology and response to treatment.

RESULTS

Of 19 patients with refractory iron-deficiency anemia seen from April 1998 to March 2000, 11 were diagnosed to have celiac disease. Four of these had abnormal D-xylose test and 3 had fat malabsorption. All 11 patients responded to gluten-free diet with improvement in hematological parameters.

CONCLUSION

Patients with refractory iron-deficiency anemia of unknown cause should be investigated for subclinical celiac disease.

QT prolongation associated with azithromycin/amiodarone combination

Administration of oral azithromycin, in addition to previously well-tolerated long-term amiodarone therapy, was associated with a marked prolongation of QT interval and increased QT dispersion, both substrates for life-threatening ventricular tachyarrhythmia and torsades de pointes. This is a report of QT prolongation and increased QT dispersion associated with the use of azithromycin. The report assumes an added significance, in view of widespread empirical use of this antibiotic for the treatment of lower respiratory infections and belief of its safety in patients with cardiac diseases. Based on the authors' experience, they would like to emphasize that the combination of azithromycin with other drugs known to prolong QT or causing torsades de pointes be used with caution until the question of the proarrhythmic effect of azithromycin is resolved by further studies.

Natural products of plant origin as anticancer agents

Natural products have been used as effective remedies for the treatment of various ailments. Numerous plant products in the form of decoction, tincture, tablets and capsules have been clinically used for the treatment of different kinds of cancer. This review covers some of the important plants with clinically proven anticancer activity, including Catharanthus roseus, Podophyllum peltatum, Taxus brevifolia, Camptothecin acuminata, Cephalotaxus harringtonia, Viscum album, Onchrosia elliptica, Annona bullata, Asmina triloba and Rhizoma zedoariae. Synthetic analogues in some cases have also been prepared to improve the efficacy and decrease the side effects of parent compounds. The modes of action of clinically used drugs are also delineated.

Chikungunya infection--an emerging disease in Malaysia

Many countries neighboring Malaysia have reported human infections by chikungunya virus, a mosquito-borne togavirus belonging to the genus Alphavirus. However, although there is serological evidence of its presence in Malaysia, chikungunya virus has not been known to be associated with clinical illness in the country. An outbreak of chikungunya virus occurred in Klang, Malaysia, between December 1998 and February 1999. The majority of the cases were in adults and the clinical presentation was similar to classical chikungunya infections. Malaysia is heavily dependent on migrant workers from countries where chikungunya is endemic. It is speculated that the virus has been re-introduced into the country through the movement of these workers.

Enalapril acts through release of nitric oxide in patients with essential hypertension

BACKGROUND

Endothelial dysfunction has been proposed as an etiological agent in the pathogenesis of essential hypertension. Amongst the various antihypertensive drugs, angiotensin converting enzyme inhibitors (ACEI) have been implicated in modifying the vascular endothelium by the release of mediators that include bradykinin, nitric oxide, prostaglandins and thromboxane A2.

MATERIALS AND METHODS

To study the mechanism of action of enalapril, an ACEI, serum reactive nitrite intermediates (RNI) and citrulline, by products of nitric oxide metabolism were measured before and after treatment with enalapril in 25 consecutive patients of essential hypertension.

RESULTS

Following treatment serum RNI intermediate increased from a pretreatment value of 164.5 +/- 20.2 nmol/mL to a post treatment value of 266.9 +/- 47.3 nmol/mL (p < 0.05), however there was no significant change in the levels of citrulline (p > 0.1). There was no significant correlation between the severity of hypertension and serum RNI. Serum RNI levels were lower in the postmenopausal women but did not reach statistical significance.

CONCLUSIONS

It is postulated that enalapril exhibits its antihypertensive property through release of nitric oxide.

Anomalous circumflex coronary artery: benign or predisposed to selective atherosclerosis

Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva is the most common coronary anomaly and is usually considered benign. Although several researchers in the past believed that aberrancy predisposes this vessel to accelerated atherosclerosis, this could not get wide acceptance owing to lack of convincing data. To examine the suggestion that atherosclerosis affects the anomalous circumflex artery more severely, the authors reviewed the clinical and angiographic features of patients with this anomaly identified from 2,684 coronary angiography procedures performed between January 1998 and March 2000 at their institution. The degree of atherosclerotic narrowing in the anomalous artery was compared with that in other coronary arteries in the same patient as well as in the nonanomalous circumflex arteries in controls. For comparison 3 control subjects were selected for each patient with anomalous circumflex artery, matched by age, sex, and clinical presentations. The results showed earlier and greater degree of atherosclerotic narrowing of the anomalous artery as compared to the other coronary arteries in the same patients as well as to nonanomalous circumflex arteries of age- and gender-matched control subjects with similar clinical characteristics. However, this predilection for atherosclerosis was evident only in anomalous vessels arising from the right side and pursuing a retroaortic course. The anomalous artery was responsible for myocardial infarction in 3 patients, all of whom were 60 years or older. Two of the patients with this anomaly and myocardial infarction underwent successful angioplasty with stent placement for symptomatic relief.

Safety and efficacy of moxonidine in mild to moderate hypertension

AIMS

Moxonidine, a new imidazoline II receptor agonist was evaluated in patients with essential hypertension.

METHODOLOGY

After an informed consent, 16 patients with essential hypertension were recruited. After a wash out period, the patients received increasing doses of Moxonidine (maximum dose 0.6 mg) for four weeks to control the blood pressure.

RESULTS

The mean reduction in blood pressure (systolic/diastolic) was 17.6/14.5 mm Hg in supine position and 18.2/12.6 mm Hg in standing position. The significant side effect was observed only in one patient.

CONCLUSIONS

Moxonidine thus appears to be safe and effective antihypertensive drug in patients with essential hypertension.