Differences in behavior profile between normotensive subjects and patients with white-coat and sustained hypertension

It has been hypothesized that white-coat hypertensives (WCHs) have lower cardiovascular risk than sustained hypertensives (HTs), but higher emotional reactivity. We evaluated 92 HT patients (clinic and daytime BP>140/90 mmHg), 52 WCHs (clinic BP>140190 and ambulatory daytime BP<134/ 85 mmHg), and 74 normotensive subjects (NTs, clinic BP<140/90 and ambulatory daytime BP<134/85 mmHg), aged between 24 and 72 years, and matched for educational level, age, gender, and weight for depression, psychopathology, well-being, and quality of life. HTs showed worse scores than WCHs and NTs on most of the psychological variables; no differences were found between WCHs and NTs except on physical mobility. Daytime BP variability was HTs>WCHs>NTs, whereas nighttime BP variability was HTs>WCHs=NTs. We conclude that HTs have worse psychological profiles than the other two groups. WCHs and NTs have similar psychological profiles, although WCHs have a higher daytime BP variability, which is not associated with higher emotional reactivity.

Bone mineral density and depression: a community study in women

In a community sample of 102 Portuguese white women we evaluated the relationship between osteoporosis and indexes of psychopathology and well-being. Depressive symptoms were assessed by the Beck Depression Inventory (BDI), psychopathology by the Hopkins Symptom Checklist-90 Revised (SCL-90-R), and quality of life using the Psychological General Well-Being Index. A questionnaire comprising social, demographic, clinical, and behavioral characteristics was also used. The sample prevalence of osteoporosis was 47.1%. Women with osteoporosis presented significantly higher scores on the total BDI (16+/-9 vs. 13+/-10, p=0.045) and lower scores in the hostility (0.8+/-0.6 vs. 1.2+/-0.7, p=0.012) and phobic anxiety (1.1+/-0.8 vs. 1.5+/-0.9, p=0.041) subscales of the SCL-90-R. No differences were found regarding mean general well-being scores (62+/-17 vs. 64+/-19, p=0.665). This study showed that women with osteoporosis have significantly higher levels of depressive symptoms and a corresponding higher prevalence of depression, independent of other factors strongly associated with osteoporosis, such as age or body mass index.

Crystallization and preliminary X-ray crystallographic studies of the plant aspartic proteinase cardosin A

The plant aspartic proteinase cardosin A was crystallized using vapour diffusion. Crystals belong to the monoclinic space group C2, cell dimensions a = 116.9 (2), b = 87.2 (8), c = 81.3 (1) A, beta = 104.4 (4) degrees, and contain two molecules in the asymmetric unit related by a non-crystallographic twofold axis. Diffraction data were collected at room temperature with radiation from a synchrotron source up to 2.85 A resolution. When the crystals were flash cooled to 110 K in a nitrogen stream the same resolution limit could also be obtained on a rotating-anode source. Recently, synchrotron radiation together with flash cooling led to an improvement of the diffraction data to 1.72 A resolution.

[Essential arterial hypertension: psychopathology, compliance, and quality of life]

OBJECTIVE

To evaluate the influence of psychological and psychopathological factors and quality of life on hypertension, its treatment and patient compliance.

DESIGN

Case-control study.

SETTING

Primary Health Care Center in Oporto.

PATIENTS OR PARTICIPANTS

Forty nine patients (pts) with essential hypertension (HT), 35 female and 14 male, mean ages: 52 +/- 11 yrs and 59 +/- 10 yrs, respectively, and 39 normotensive controls (NT)--18 female and 21 male, mean ages: 37 +/- 15 yrs and 42 +/- 15 yrs, respectively, were recruited from the same General Practice.

METHODS

Hypertension was classified according to the Joint National Committee criteria. The following psychometric evaluations were used: the Beck Depression Inventory, the Hopkins Symptom Distress Checklist, the Psychological General Well-Being Schedule and the Eysenck Personality Inventory.

RESULTS

1. The hypertensive pts differed from the normotensive pts as they scored significantly higher in somatization (p = 0.07), aggression/hostility (p = 0.036), index of psychological distress (p = 0.08) and, neuroticism (p = 0.09); 2. the hypertensive pts showed lower scores of quality of life (p = 0.019); 3. the biochemical parameters studied (uric acid, urea, creatinine, glicose, total cholesterol, HDL cholesterol, trigliceride, transaminases and gammaglutamil transferase) did not show statistically significant correlation with the psychological variables and quality of life items studied; 4. the electrocardiographic and echocardiographic alterations, corresponding to the severity of the clinical situation, were not associated with statistically significant differences in depression and quality of life; 5. the angiotensin converting enzyme inhibitor, the calcium antagonist and the beta-blockers showed no statistically significant influence on the psychological scores studied. However, pts receiving diuretics showed higher scores of somatization (p = 0.0008) and obsession/ compulsion (p = 0.02) and, lower scores of quality of life (p = 0.04); 6. a better compliance was associated with better psychological scores, and somatization scored with statistical significance (p = 0.03).

CONCLUSIONS

The hypertensive pts differed from the normotensive pts as they scored significantly higher in aggression/hostility and lower in quality of life. No statistically significant differences were found among the psychological variables in the pts with cardiac involvement. A better compliance was associated with better psychological scores. The results of this study lead us to suggest that when treating pts with HT, the most appropriate therapeutic attitude should attempt to avoid both therapeutic withdrawal and lack of medical control.

Ruptured aneurysm sinus of Valsalva and Gerbode defect with severe tricuspid and aortic regurgitation. A case report and its surgical correction

An unusual early, childhood presentation in a case with reputured non-coronary sinus of Valsalva aneurysm with Gerbode defect and severe pulmonary hypertension is described. The reasons for early rupture are discussed and anatomically important relations of membranous septum, fibroskeleton of heart and conduction system are schematically elucidated. Associated severe tricuspid and aortic regurgitation are explained to be secondary effects following the rupture of aneurysm. A technique of surgical correction of this rare association of anomalies using single PTFE patch is illustrated, cautiously safeguarding the closely related conduction system. Regurgitant aortic and tricuspid valves were also successfully repaired. In retrospect, early repair before rupture of aneurysm and onset of severe pulmonary hypertension may be more beneficial, which would also prevent the leakage of semilunar and atrioventricular valves.

[Risk factors for myocardial infarct: a case-control study in Oporto, Portugal]

A case-control study of coronary heart disease (CHD) was conducted in Oporto, Portugal. The cases series consisted of 100 consecutive patients with first time acute myocardial infarction who were admitted to the Coronary and Intermediate Care Units of a major teaching hospital. The community controls were 198 individuals without evidence of CHD by the Rose questionnaire and electrocardiography, selected by random digit dialing, with a participation rate of 70%. Data was collected by trained interviewers using a structured questionnaire and blood samples were obtained for selected laboratory data. The main analysis was made through unconditional logistic regression with calculations of odds ratios (OR). Age, OR: 1.5 (95% CI: 0.8-2.9), male gender, OR: 6.7 (3.6-12.3), family history of premature CHD, OR: 2.4 (1.4-4.3), diabetes, OR: 3.4 (1.6-7.4), antecedents of hypertension, OR:1.9 (1.1-3.1), history of high cholesterol levels, OR: 2.3 (1.4-3.9), high levels of physical activity, OR: 2.0 (0.9-4.1) and tobacco smoking, OR: 8.3 (3.8-18.5) were significant risk factors of acute myocardial infarction. After controlling for demographic variables and for the mutual confounding effects of the risk factors, the investigated factors that remained significantly associated with the risk of developing acute myocardial infarction were male gender, OR: 17.3 (4.8-62.3), family history of CHD, OR: 3.6 (1.4-9.6), diabetes, OR: 4.2 (1.0-18.1), high cholesterol levels OR: 2.7 (1.2-6.1) and smoking habits, OR: 7.7 (1.8-32.4). A negative association with high education levels was significant after controlling for all the variables, OR: 0.01 (0.01-0.5).

[Prevalence, knowledge, treatment and control of arterial hypertension in Oporto, Portugal]

The aim of this study was to assess the prevalence, awareness, treatment and control of hypertension among subjects above the age of 39 years living in the urban area of Oporto, Portugal. One hundred and seventy seven individuals from the community were selected by random digit dialing. Each subject was asked about his/her personal history of hypertension, antihypertensive treatment and had his/her blood pressure measured. The prevalence of hypertension was 57.1%, defined by systolic blood pressure (SBP) > or = 140 mm Hg and/or diastolic blood pressure (DBP) > or = 90 mm Hg and/or administration of current the antihypertensive medication. If the values defining hypertension were SBP > or = 160 mm Hg, and DBP > or = 95 mm Hg the prevalence would be 37.9%. The overall prevalence of hypertension was higher in females, but a slightly higher non significant value was found in males in the fifth and sixth decades. Among hypertensives, 62.7% were aware of their condition, 56.7% were treated, 84.2% of hypertensives treated were controlled (SBP < 160 mm Hg and DBP < 95 mm Hg) and 44.7% were very well controlled (SBP < 140 mm Hg and DBP < 90 mm Hg). The question "Are you hypertensive?" had a sensitivity of 62.7%, a specificity of 83.6% and an accuracy of 75.7%. In the preliminary results of this study of an urban population with a high prevalence of hypertension, the awareness of hypertension is similar to that described in the United States of America twenty years ago, the percentage of hypertensives treated is similar to the American percentage fifteen years ago and the percentage of hypertensives treated and controlled is close to the current American percentage.

Cytochrome c3 from Desulfovibrio gigas: crystal structure at 1.8 A resolution and evidence for a specific calcium-binding site

Crystals of the tetraheme cytochrome c3 from sulfate-reducing bacteria Desulfovibrio gigas (Dg) (MW 13 kDa, 111 residues, four heme groups) were obtained and X-ray diffraction data collected to 1.8 A resolution. The structure was solved by the method of molecular replacement and the resulting model refined to a conventional R-factor of 14.9%. The three-dimensional structure shows many similarities to other known crystal structures of tetraheme c3 cytochromes, but it also shows some remarkable differences. In particular, the location of the aromatic residues around the heme groups, which may play a fundamental role in the electron transfer processes of the molecule, are well conserved in the cases of hemes I, III, and IV. However, heme II has an aromatic environment that is completely different to that found in other related cytochromes c3. Another unusual feature is the presence of a Ca2+ ion coordinated by oxygen atoms supplied by the protein within a loop near the N-terminus. It is speculated that this loop may be stabilized by the presence of this Ca2+ ion, may contribute to heme-redox perturbation, and might even be involved in the specificity of recognition with its redox partner.

Bone marrow transplantation with major ABO incompatibility. Experience of the Bone Marrow Transplantation Unit--Francisco Gentil Portuguese Institute of Oncology, Lisbon Centre

Thirteen patients submitted to bone marrow transplantation (BMT), HLA A and B identical, with mixed negative lymphocyte culture and major ABO incompatibility were retrospectively evaluated. Gravity sedimentation by hydroxyethyl starch was used in almost all cases to deplete erythrocytes from bone marrow (12/13): a removal rate of 90%--corresponding to an erythrocyte residual volume of 27,4 rate ml--and a nucleated cell recovery of 76% (mean values) were obtained. All patients underwent a hyperhydration regimen and received corticosteroid prophylaxis before bone marrow infusion. Considering the most important immunohematological problems associated to this type of transplant, we verified that seven patients developed minor complications and among them only one had long term consequences. In comparison with the control group, ABO identical and with minor incompatibility, the study group had delayed onset of erythropoiesis and needed greater erythrocyte transfusion support. We concluded that major ABO incompatibility does not constitute a drawback to BMT success in most patients.

[Compliance to therapy -- its importance in research and clinical practice]

Compliance, defined as patients behaviour to treatment schedule over time, specially in chronic diseases, is an important parameter to be measured in clinical trials. Compliance to a specific drug may compromise the final efficacy expected result assumed by phase I II and III studies. The medication events monitors systems (MEMS) appeared to get a more specific and sensitive measurement than the classic counting pills and drug or markers levels to analyses of compliance. The authors made a revision of literature in order to evaluate the benefits of compliance measurement in trials (specially hypertension as a paradigm of chronic disease) and clinical practice. Partial compliance with antihypertensive treatment could be an obstacle to an effective control or to demonstrate long term efficacy on decreasing morbidity and mortality. A short discussion is made about the possible benefits of using MEMS on clinical trials to evaluate patient's quality of life and behaviour to long term treatment for chronic diseases.

A comparative study of four different staining methods for estimation of live yeast form cells of Paracoccidioides brasiliensis

A comparative study of four different staining methods for estimation of live yeast form cells of Paracoccidioides brasiliensis was carried out. The staining methods used were fluorescent staining, vital dye exclusion tests with erythrosin B and by Janus green and lactophenol cotton blue staining. Colony forming units (cfu) of the yeast form of eight P. brasiliensis isolates on brain heart infusion agar (BHIA) supplemented with 4% horse serum plus 5% P. brasiliensis cell extract (BHIA + HS + EXT) were examined for reliability of staining in determining the number of live fungal units in eight different isolates. Cfu on BHIA + HS + EXT plates showed an excellent plating efficiency over 96% in all isolates tested. The percentage of the live cells indicated by fluorescent staining (FL) or vital dye exclusion test with erythrosin B (EB) or Janus green (JG-1) was lower than that of cfu. By contrast, the percentage due to modified dye exclusion test with Janus green (JG-2) and that due to lactophenol cotton blue staining (LPCB) showed a close correration to that of cfu. Our results indicate that the modified dye exclusion test with Janus green and lactophenol cotton blue staining are useful for estimating cell viability of yeast form cells of P. brasiliensis.

[Bone marrow transplantation with major ABO incompatibility. Experience at the bone marrow transplantation unit of the Center of Lisbon at the IPOFG]

Thirteen patients submitted to major ABO incompatible, HLA A and B identical, mixed lymphocyte culture negative bone marrow transplantation (BMT) were retrospectively evaluated. Gravity sedimentation by hydroxyethyl starch was used in almost all cases to deplete erythrocytes from bone marrow (12/13): a removal rate or 90%--corresponding to an erythrocyte residual volume of 27.4 rate ml--and a nucleated cell recovery of 76% (mean values) were obtained. All patients underwent a hyperhydration regimen and received corticosteroid prophylaxis before bone marrow infusion. Considering the most important immunohematological problems associated to this type of transplant we verified that seven patients developed minor complications, and among them only one had long term consequences. In comparison with the control group, ABO identical and with minor incompatibility, the study group had delayed onset of erythropoiesis and needed greater erythrocyte transfusion support. We concluded that major ABO incompatibility does not constitute a drawback to BMT success in most patients.

[Essential thrombocythemia. Therapy with interferon alfa]

A clinical case of essential thrombocythaemia is presented to demonstrate good therapeutic response to subcutaneous Alpha-2b Interferon in a dosage of 3 x 10(6) units, three times a week. Based on this case and on a literature research we propose that Alpha-2b Interferon is a legitimate alternative to alkylating agents or radioactive phosphorus (32P), showing identical efficacy and less Leukemogen effect.

Essential hypertension: the relationship of psychological factors to the severity of hypertension

165 hypertensive patients attending one general practice in Portugal were found to report significantly higher scores on measures of neuroticism, anxiety, depression and general psychological distress than 152 normotensive patients at the same practice. Hypertensive patients with evidence of organ damage exhibited significantly higher depression scores than those without such damage. These differences between normotensives and hypertensives, and between hypertensive with and without organ damage are discussed and previous research in this area is reviewed.

[In vitro study of tubulin polymerisation. Effects of ATP, vinblastine and isaxonine (author's transl)]

The dual action of vinblastine on tubulin, namely disruption and aggregation, is analyzed by turbidimetry. The existence of two different binding sites for the alkaloid is confirmed. The high affinity site binds vinblastine at low concentrations, at which no effect is observed on depolymerized tubulin, but where pre-formed microtubules are disrupted. The low affinity site is associated with tubulin aggregation. The binding constants of these two sites have been evaluated. Isaxonine (N-isopropyl-amino-2 pyrimidine) partially inhibits the effects of vinblastine, both on microtubule disruption and tubulin aggregation.

[Acceleration of the speed of neuronal growth by a new neurotropic substance: N-isopropyl-amino-2-pyrimidine]

16 hrs. after per os administration of 14C N-isopropyl-amino-2-pyrimidine (IAP) in the Rat, radioactivity of the sciatic nerve is significantly higher than in plasma and other organs. In vitro IAP (base, orthophosphate or dichloracetate) accelerates neurite outgrowth of explained spinal ganglion after 48 hrs. of incubation in nutritive medium. Results suggest that IAP incorporated in nerve cell acts on cellular mechanisms controlling nerve growth.

[Preliminary report concerning the histologica patterns of an anthracotic pneumoconiosis observed in the area of Londrina, Brasil (author's transl)]

The A. presents a preliminary report concerning on the histologic patterns of an anthracotic pneumoconiosis found in necropsies of the "Hospital Universitário da Universidade de Londrina", Paraná, Brazil, and in some cases from the Legal Institute of the same town. The lesions, on its histologic pattern are comparable to those observed in the lung of coal and iron mines workers as described in the consulted literature. The cases studied (plantations workers and dwellers at rural and suburban areas) are proceeding from an essencially agricultural region, without detectable polluition by industry or others known factors. This agricultural zone presents some geophysic peculiarities and dust from the errosive soil, is a constant factor in the local athmosphere. The soil is so called "Terra Roxa" (red soil) and in its physicochemical composition there is a great amount of iron oxides, silica (silt, agril laceous material), aluminium, manganese, organic compounds. In this preliminary report the A. suggests further research for a better knowledge of the composition of the respirable air and if dust exposures are or not responsible for the lung lesions.