Risk factors associated with colonic diverticulosis among patients from a defined geographic area

BACKGROUND

Only a few data regarding colonic diverticulosis are available in Italy. We examined the frequency of colonic diverticulosis and its associations with risk factors in a homogeneous Northern Sardinian population undergoing colonoscopy for any reason in the last decades.

METHODS

This was a retrospective single-center study. Medical records of patients undergoing colonoscopy for any indication between 1995 and 2013 were reviewed. Demographic information including age, gender, geographic area (urban, rural), marital status, smoking habit, occupation, body mass index, and comorbidities were collected. Presence, number, and extension of diverticula were assessed by colonoscopy. The diagnosis of diverticulosis was defined by the presence of more than five diverticula.

RESULTS

A total of 4458 records were collected (39.8 % males). Analysis by birth cohorts showed a significant progressive age-related increase in the prevalence of diverticulosis. The average prevalence was 18.9 % without significant variation across the 19-year observation period. In 101 (12.1 %) subjects diverticula were single or few. Seventy-one percent of diverticula were located predominantly in the left side, 2 % in the right side, and 14.3 % were spread throughout the colon. There was a significant association with obesity but not with smoking habits, marital status, or urban versus rural environment. A strong association was observed between the presence of diverticulosis and cardiovascular and other gastrointestinal and lung disease (p < 0.0001). These associations were also confirmed by the logistic regression analysis.

CONCLUSIONS

In this endoscopic study, colonic diverticulosis in Northern Sardinia showed prevalence similar to other series in Western countries, and it was predominantly left sided and age related.

First Report of Xanthomonas citri pv. mangiferaeindicae Causing Mango Bacterial Canker on Mangifera indica in Ivory Coast

Xanthomonas citri pv. mangiferaeindicae causing bacterial canker (or black spot) is a major mango (Mangifera indica L.) pathogen in tropical and subtropical areas (3). The bacterium infects a wide range of mango cultivars, and induces raised, angular, black leaf lesions, sometimes with a yellow chlorotic halo. Fruit symptoms first appear as small water-soaked spots on the lenticels turning into star-shaped, erumpent lesions, which exude an infectious gum, yielding tear-stain patterns. Severe infections cause severe defoliation and/or premature fruit drop. Twig cankers are potential sources of inoculum and weaken branch resistance to winds. Drastic yield losses have been reported at grove scale for susceptible cultivars (3). Mango leaves showing typical angular, black, raised leaf lesions were first observed and collected in April 2014 from trees cv. Kent in five localities of the Korhogo province of Ivory Coast (i.e., the major commercial mango-growing area in this country). Non-pigmented Xanthomonas-like colonies were isolated on KC semi-selective medium (4). Five strains (LL60-1, LL61-1, LL62-1, LL63-1, and LL64-1), one from each locality, were compared by multilocus sequence analysis (MLSA) to the type strain of X. citri and the pathotype strain of several X. citri pathovars, including pvs. anacardii and mangiferaeindicae. This assay targeted the atpD, dnaK, efp, and gyrB genes, as described previously (2). Nucleotide sequences were 100% identical to those of the pathotype strain of X. citri pv. mangiferaeindicae whatever the gene assayed, but differed from any other assayed X. citri pathovar. Leaves of mango cv. Maison Rouge from the youngest vegetative flush were infiltrated (10 inoculation sites/leaf for three replicate leaves on different plants/bacterial strain) as detailed previously (1) with the same five strains. Bacterial suspensions (~1 × 10⁵ cfu/ml) were prepared in 10 mM Tris buffer (pH 7.2) from 16-h-old cultures on YPGA (7 g yeast, 7 g peptone, 7 g glucose, and 18 g agar/liter, pH 7.2). The negative control treatment consisted of three leaves infiltrated with sterile Tris buffer (10 sites/leaf). Plants were incubated in a growth chamber at 30 ± 1°C by day and 26 ± 1°C by night (12-h day/night cycle) at 80 ± 5% RH. All leaves inoculated with the strains from Ivory Coast showed typical symptoms of bacterial canker a week after inoculation. No lesions were recorded from the negative controls. The pathogen was recovered at high population densities (>1 × 10⁶ cfu/lesion) from leaf lesions, typical of a compatible interaction (1) and isolated colonies were identified as the target by atpD sequencing (2). Koch's postulates have therefore been fully verified. This is the first report of the disease in Ivory Coast, a country which has been an internationally significant mango exporter (up to 15,000 tons per year) over the last two decades. A high disease incidence and severity were observed, outlining the need for implementing integrated pest management in mango groves and the production of disease-free nursery stock. This report further expands the distribution of the pathogen in West Africa after its first description from Ghana in 2011 (5) and subsequently in other neighboring countries. References: (1) N. Ah-You et al. Phytopathology 97:1568, 2007. (2) L. Bui Thi Ngoc et al. Int. J. Syst. Evol. Microbiol. 60:515, 2010. (3) L. Gagnevin and O. Pruvost. Plant Dis. 85:928, 2001. (4) O. Pruvost et al. J. Appl. Microbiol. 99:803, 2005. (5) O. Pruvost et al. Plant Dis. 95:774, 2011.

First Report of Zucchini yellow mosaic virus in Cucurbits in Ivory Coast

During a field survey conducted in December 2008 and January 2009 in southern Ivory Coast, zucchini squash (Cucurbita pepo L.) and cucumber (Cucumis sativus L.) plants were observed showing severe symptoms of leaf mosaic and distortions, filiformism, and fruit deformations. Nine samples were collected from symptomatic plants in four locations (Adzopé, Songon, Ayamé, and Gagnoa) and dried over CaCl₂. Double-antibody sandwich (DAS)-ELISA tests were performed directly on dried samples with antisera against nine cucurbit-infecting viruses: Zucchini yellow mosaic virus (ZYMV, Potyvirus); Papaya ringspot virus (PRSV, Potyvirus); Watermelon mosaic virus (WMV, Potyvirus); Moroccan watermelon mosaic virus (MWMV, Potyvirus); Cucumber vein yellowing virus (CVYV, Ipomovirus); Cucumber mosaic virus (CMV, Cucumovirus); Cucurbit aphid borne yellows virus (CABYV, Polerovirus); Squash mosaic virus (SqMV, Comovirus); and Cucumber green mottle mosaic virus (CGMMV, Tobamovirus). ZYMV was detected alone in four of six zucchini squash samples and in mixed infection with CMV and PRSV in two of three cucumber samples. A cucumber sample (CI09-09) collected at Songon and infected by ZYMV, CMV, and PRSV was inoculated to zucchini squash. ZYMV was separated from CMV and PRSV by inoculating zucchini squash plantlets with one Myzus persicae Sulzer per plant with 2-min acquisition and 2-h inoculation access periods. Plants infected by ZYMV only developed typical symptoms of severe mosaic, distortion, and filiformism on leaves. Total RNA was extracted from the original dried sample of CI09-09 using TRI-Reagent (Molecular Research Center Inc., Cincinnati, OH) (2). One-step reverse transcription (RT)-PCR was performed with our standard protocol and specific primers (2), yielding a 605-bp fragment corresponding to part of the polymerase (NIb) and coat protein (CP) coding regions. The nucleotide sequence of the NIb-CP fragment of Ivory Coast ZYMV isolate CI09-09 (GenBank No. HM450303) shared 98.5, 92.7, 80.5, and 75.7% identity with ZYMV isolates from France (isolate E9, HM641798), Florida (D13914), Singapore (AF014811), and Vietnam (DQ925449), respectively. Sequence comparison indicated that CI09-09 belongs to the phylogenetic cluster 1 of group A of ZYMV (2). ZYMV, first described in 1981, is now one of the most damaging viruses in cucurbit crops worldwide and is characterized by an important biological and molecular diversity (1,3). ZYMV has already been reported in several African countries, mostly in the northern and southern parts of the continent (1), but to our knowledge, this is the first report of ZYMV in Ivory Coast. Among African isolates, CI09-09 shared 97.5% identity with isolate Su06-22 from Sudan (HM641799) belonging to the phylogenetic cluster 1 of group A of ZYMV, 94 to 95% identity with isolates from neighboring Mali (HM005307-HM005312) belonging to cluster 2 of group A, and 79.6% identity with the divergent isolate R5A from Réunion Island (L29569) belonging to phylogenetic group B of ZYMV. The presence of ZYMV in four distant locations in southern Ivory Coast suggests that this virus constitutes a serious threat to cucurbit production in this country. References: (1) C. Desbiez and H. Lecoq. Plant Pathol. 46:809, 1997, (2) C. Desbiez et al. Virus Res. 85:5, 2002, (3) H. Lecoq et al. Virus Res. 141:190, 2009.

First Report of Southern Blight of Okra (Abelmoschus esculentus) Caused by Sclerotium rolfsii in Côte d'Ivoire

Southern blight caused by Sclerotium rolfsii Sacc. was observed on okra (Abelmoschus esculentus) cv. Clemson Spineless in January 2010 during a survey of vegetable fields in Rubbino, Côte d'Ivoire, which is one of the most important areas for vegetable production. Plants exhibited symptoms of a dark brown lesion on the stems near the soil line. Upper roots became light to dark brown, the lower leaves wilted, turned yellow, and a white mat of fungal mycelium developed on the stem lesion. Numerous, white, spherical sclerotia formed on the infected stem and on soil surfaces around the infected plants. Sclerotia (0.5 to 1.2 mm in diameter) later turned tan to dark brown and the entire plant wilted. Eleven fields, with a total of approximately 26 ha surveyed, were affected and disease incidence reached approximately 15% in the fields. Sclerotia were collected and the fungus cultured on acidified potato dextrose agar (PDA) plates. The fungus grew rapidly on PDA and the hyphae at the edge of the colonies were large straight cells with one or more clamp connections at each septum. Secondary and tertiary hyphae were slender and lacked clamp connections. Whitish sclerotia were observed on the mycelial mats 5 to 7 days after incubation, which later turned tan to brown when mature. The fungus was identified as S. rolfsii based on the characteristics of mycelia and sclerotia (1). Sclerotia produced on PDA were used to inoculate okra seedlings under greenhouse conditions at rates of 10, 20, and 30 sclerotia per plant. Sclerotia were placed just under the soil surface around the root of 4-week-old seedlings of okra cv. Clemson Spineless. Symptoms identical to those on field samples developed on all inoculated plants. S. rolfsii was reisolated from diseased plants and the identity was confirmed. S. rolfsii has previously been reported as causing disease in Côte d'Ivoire (2). To our knowledge, this is the first report of southern blight caused by S. rolfsii on okra in this country. Okra is an important vegetable crop in Côte d'Ivoire and therefore the occurrence of southern blight and susceptibility of okra cultivars to this disease needs to be taken into account in okra production. References: (1) Z. K. Punja and A. Damiani. Mycologia 88:694, 1996. (2) R. Resplandy et al. Ann. Epiphyt. 1:1, 1954.

[Coeliac disease and membranous nephropathy]

Celiac disease results from the interaction between gluten and immune, genetic, and environmental factors. Although the main clinical manifestations are derived from gastrointestinal system, it has been described some renal diseases, especially chronic glomerulonephritis. We describe a young female patient with celiac disease that it appears after delivery. Moreover, she develops simultaneously nephrotic proteinuria and microhematuria as a result of membranous nephropathy. The treatment with gluten-free diet and other conservative measures (ACEI and statin) is followed by clinical improvement and simultaneous decrease of tissue antitransglutaminase IgA-antibodies and complete remission of proteinuria. We review the relationship between celiac disease and membranous nephropathy and the role of diet in the management of both diseases.

Inhibition of defective adenylosuccinate lyase by HNE: a neurological disease that may be affected by oxidative stress

Adenylosuccinate lyase is an enzyme of fumarase superfamily that participates in the purine biosynthetic pathway, catalysing the nonhydrolytic cleavage of succinyl groups from SAICA ribotide and adenylosuccinate. Enzyme defects are associated with a human inherited disease, which arises from single point mutations to the gene and results in mild to severe psychomotor retardation, epilepsy, muscle wasting, and autistic features. Adenylosuccinate lyase activity is lost to a different extent in the patients. Diminished levels of enzyme have been attributed to loss of catalytic activity, protein instability, or environmental factors. P100A/D422Y mutation represents a feasible model for studying the effect of cell milieu on the activity of the impaired enzyme. The defective enzyme is inhibited by micromolar concentrations of trans-4-hydroxy-2-nonenal (HNE), a major product of membrane peroxidation that has been found to accumulate in brain tissues of patients with neurodegenerative disorders. It is suggested that inactivation of defective adenylosuccinate lyase by HNE and other membrane peroxidation products may account, at least in part, for the impairment of neurological functions and recurrent worsening of the symptoms.

Investigation of lipase-catalysed hydrolysis of naproxen methyl ester: use of NMR spectroscopy methods to study substrate-enzyme interaction

(+/-)-2-(6-Methoxy-2-naphthyl)propionic acid methyl ester (methyl ester of Naproxen), the precursor of therapeutically important nonsteroidal anti-inflammatory drugs (NSAIDs) was enantioselectively hydrolysed using as biocatalyst Candida rugosa lipase. In research aimed at studying the structure-activity relationship (SAR), NMR spectroscopy methods were employed to identify which Naproxen molecular moiety was essential to the substrate-enzyme interaction. The experimental results, in agreement with previous computer modelling studies and reported kinetic data, gave new information on the enzyme-substrate complex formation in solution.

Design and realization of a tailor-made enzyme to modify the molecular recognition of 2-arylpropionic esters by Candida rugosa lipase

Within a research project aimed at probing the substrate specificity and the enantioselectivity of Candida rugosa lipase (CRL), computer modeling studies of the interactions between CRL and methyl (+/-)-2-(3-benzoylphenyl)propionate (Ketoprofen methyl ester) have been carried out in order to identify which amino acids are essential to the enzyme/substrate interaction. Different binding models of the substrate enantiomers to the active site of CRL were investigated by applying a computational protocol based on molecular docking, conformational analysis, and energy minimization procedures. The structural models of the computer generated complexes between CRL and the substrates enabled us to propose that Phe344 and Phe345, in addition to the residues constituting the catalytic triad and the oxyanion hole, are the amino acids mainly involved in the enzyme-ligand interactions. To test the importance of these residues for the enzymatic activity, site-directed mutagenesis of the selected amino acids has been performed, and the mutated enzymes have been evaluated for their conversion and selectivity capabilities toward different substrates. The experimental results obtained in these biotransformation reactions indicate that Phe344 and especially Phe345 influence CRL activity, supporting the findings of our theoretical simulations.

Probing the substrate specificity for lipases. II. Kinetic and modeling studies on the molecular recognition of 2-arylpropionic esters by Candida rugosa and Rhizomucor miehei lipases

Racemic arylpropionic esters 1-3, precursors of therapeutically important non-steroidal antiinflammatory drugs, were subjected to hydrolyses in the presence of either Candida rugosa or Rhizomucor miehei crude lipases. The hydrolyses of 1 and 2 proved to be highly enantioselective, whereas 3 was not transformed at all. Both the substrate specificity and the enantioselectivity of these lipases were explained through a molecular modeling study involving docking experiments between 1-3 and the amino acids forming the enzymes active-sites, whose three dimensional structures were obtained from X-ray crystallographic data, followed by extensive conformational analysis on their computer-generated complexes. The results of this study also account for the high enantioselective and good yielding hydrolysis of 3 (as the corresponding 2-chloroethyl ester) catalyzed by CRL pretreated with 2-propanol, recently reported in the literature, and lead to admit that such a treatment may operate very deep conformational changes on the amino acids of the enzyme active-site.

New class of poly(vinyl alcohol) polymers as column-chromatography stationary phases for Candida rugosa lipase isoforms separation

The preparation of new stationary phases of cross-linked polyvinyl alcohol esterified with various linear fatty acids is described. The physico-chemical properties of these polymers are reported, including electron microscopy and swelling measurements. Batch adsorption experiments were performed in order to characterize the basic separative properties of these phases. Cross-linked polyvinyl alcohol esterified with dodecanoic acid was used for hydrophobic interaction chromatography of a commercial crude preparation of Candida rugosa lipase. Characterization of the purified fractions was carried out via native electrophoresis and sodium dodecyl sulfate-polyacrylamide electrophoresis.

Probing the substrate specificity for lipases. A CoMFA approach for predicting the hydrolysis rates of 2-arylpropionic esters catalyzed by Candida rugosa lipase

The enzyme catalyzed hydrolysis of esters 1-3, precursors of therapeutically important non-steroidal antiinflammatory drugs, in the presence of the lipase from Candida rugosa was studied and the relative rates of the enzymatic hydrolysis were determined. With the exception of 3, which was not transformed under the reaction conditions, all transformations proved to be highly enantiospecific. Usually the mechanism of enantiorecognition is probed by substrate mapping. Although more theoretical approaches are existing, these all require knowledge of the three-dimensional structure of the enzyme. A model capable of correlating the extent of substrate hydrolysis as well as the initial reaction rates with their stereoelectronic properties has been developed by a Comparative Molecular Field Analysis (CoMFA) approach. This model does not require detailed knowledge of the three-dimensional structure of the enzyme and proved to be highly predictive. It is possible that this kind of approach holds promise for future work on enzyme-substrate interactions.

Resting blood pressure and cardiovascular response to sympathetic stimulation in adolescents

The prevalence of significant hypertension in childhood may be higher than expected. We have measured sitting blood pressure in 168 11-yr-old children attending a pre-high school in the Neapolitan area on four occasions over a 3-month period. We have also measured blood pressure and heart rate during a mental arithmetic test and during isometric exercise. Prevalence of significant hypertension (diastolic blood pressure 82-90 mmHg) was 13% at the first visit and decreased to 6.5% at the last visit; prevalence of severe hypertension (diastolic blood pressure greater than or equal to 90 mmHg) decreased from 5.4% to 1.2% from the 1st to the 4th visit. No sex-related difference was observed. A more frequently positive family history of hypertension (50% vs 30% in the fifth and first quintile of blood pressure, respectively) and higher body weight (body mass index = 21.4 vs 19.3 kg/m2) were found in children in the 5th quintile of blood pressure distribution. Blood pressure increased during mental arithmetic by 10/13% of the resting values in the first quintile and by 6/11% in the last one during mental test; during handgrip the increase was of 20/37% and 24/46%, respectively: differences between quintiles did not reach statistical significance. These data show that about 8% of a Neapolitan sample of school population have high blood pressure levels, while no difference in vascular reactivity to sympathetic stimulation was detected in children with higher blood pressure.

Effect of lacidipine, a long-acting calcium antagonist, on hypertension and lipids: a 1 year follow-up

The effect of lacidipine, a dihydropyridine calcium antagonist on lipid metabolism, has been followed in 8 patients with uncomplicated mild to moderate essential hypertension treated for up to 14 months. There were significant reductions in the systolic and diastolic pressures, from 167/102 to 146/91 mm Hg at 2 months, and to 137/85 mm Hg at the end of the study. Blood lipid concentrations did not change during the observation period (cholesterol 5.1 vs 5.3 mmol.l-1, triglycerides 1.1 vs 1.0 mmol.l-1, HDL-cholesterol 1.1 vs 1.2 mmol.l-1). The results show that lacidipine did not affect lipid metabolism and suggest that calcium antagonists may be safely prescribed for a prolonged period to patients with combined hypertension and hyperlipidaemia.

Ketanserin and hydrochlorothiazide in the treatment of arterial hypertension

The chronic antihypertensive effect of the combination of ketanserin (KET) 40 mg + hydrochlorothiazide (HCTZ) 12.5 mg was evaluated in 20 patients with arterial hypertension of mild to moderate degree. After a 2-week wash-out period, patients were prescribed a single oral dose of KET 40 mg or HCTZ 25 mg in a randomized order at 2-day intervals and blood pressure and heart rate were measured during the following 24 hrs by an automatic recorder. Thereafter patients were given the combination of KET 40 mg + HCTZ 12.5 mg for 6 weeks and 24 hrs blood pressure was recorded after the first dose of the combination and at the end of treatment. Ketanserin induced a significant fall in systolic and diastolic pressures for up to 8 hrs; thiazide did not induce any change in these parameters. The combination of KET + HCTZ in the acute study reduced significantly systolic (SBP) and diastolic (DBP) blood pressures for up to 10 hrs. After 6 weeks of treatment with KET + HCTZ, blood pressure showed a further fall at each time period and was normalized (BP greater than 160/80 mmHg) for 8 hrs after dosing. The results of this study indicate that once daily oral administration of the combination of KET 40 mg + HCTZ 12.5 mg in mild to moderate primary hypertensives significantly reduces blood pressure over 24 hrs. Fairly good control of BP, i.e. BP less than 160/90 mmHg, was, however, achieved only up to 8 hrs after drug administration, indicating that this combination given once daily is not able to normalize BP over the following 24 hrs.

The effects of nicardipine on sodium and calcium metabolism in hypertensive patients: a chronic study

There is evidence in the literature that calcium entry blockers are able to affect calcium-dependent hormone secretion and therefore can influence sodium and calcium metabolism. We have studied in 18 mild to moderate hypertensives (27-65 yrs) the effects of chronic treatment with nicardipine, a dihydropyridine derivative, vs placebo on: 1) renin-angiotensin-aldosterone axis; 2) parathyroid hormone and calcium metabolism; 3) daily sodium and calcium urinary excretion. After a 2-week placebo wash-out when any antihypertensive treatment was withdrawn, patients were kept on a well balanced normocaloric diet without salt intake restriction. Blood pressure, plasma renin and serum aldosterone after a 1-hour standardized walk, serum PTH, serum and 24-hour urinary Na, K, Ca, P, Mg were measured. Thereafter patients were randomly and blindly given nicardipine 20 mg tid or placebo tablet tid for 2 months. At the end of this period the same measurements were repeated. Blood pressure significantly dropped during nicardipine (from 165/96 +/- 19/9 vs 150/88 +/- 16/9 mm Hg P less than .05) without change in heart rate. No change was observed on placebo. Plasma renin, serum aldosterone, serum parathyroid hormone and serum and urinary electrolytes did not change during active and placebo treatment. The results of this study suggest that chronic nicardipine does not affect hormone secretion.

Effects of nicardipine on left ventricular hemodynamic patterns in systemic hypertension

To assess left ventricular (LV) functional and structural changes associated with the reduction of blood pressure (BP) values during nicardipine administration (60 mg daily, for two months), 17 hypertensive patients were studied by M-mode echocardiography, according to a double-blind design (11 with nicardipine and six with placebo). Decrease in BP induced by nicardipine was associated with decrease in myocardial afterload (end-systolic stress) (P less than .002) and improvement of systolic function (fractional shortening) (P less than .02), without changes in inotropic state (assessed by systolic BP/end-systolic dimension/posterior wall thickness ratio). At the end of trial, a 5% reduction was found in LV mass (P less than .002), whereas relative wall thickness did not change. Diastolic phase (assessed by relaxation time index, and the slope of EF tract of the anterior mitral valve leaflet) was improved (.01 less than P less than .001). Patients with concentric and eccentric hypertrophy were separately considered. Relaxation time index and fractional shortening were significantly improved only in patients with concentric hypertrophy (P less than .01), whereas in the other ones the effect of treatment was variable. These differences were probably due to different effects on preload in the two LV hemodynamic patterns. Thus, nicardipine shows powerful effects on cardiac mechanics in systemic hypertension, but these effects are different according to LV anatomic pattern. Only in the presence of concentric hypertrophy is it possible to foresee the improvement of LV function; LV hypertrophy can be also reduced in concentric hypertrophy, but in the short term the reduction is too small to assume pathophysiologic significance.

Adrenergic blocking agents and lipoprotein lipase activity

Lipoprotein lipase activity, total serum cholesterol and triglycerides, HDL cholesterol were determined before and after two weeks of treatment with a low dose of an alpha 1-blocking agent (prazosin) or of a beta-adrenergic-blocking drug (metoprolol). Lipoprotein lipase activity was almost doubled after prazosin (p less than 0.02) and practically unchanged after metoprolol, at a time and at a drug dosage when only minor changes in blood pressure and serum lipids were detectable. HDL cholesterol was slightly but significantly increased after prazosin (p less than 0.05). Heart rate was increased after prazosin (p less than 0.05) and decreased after metoprolol (p less than 0.01).

Body weight and cardiovascular response to sympathetic stimulation in childhood

The possible relationship between cardiovascular response to adrenergic stimulation and body weight has been studied in 166 eleven-year-old students (103 male, 63 female). Resting blood pressure (BP) by random-zero machine, heart rate (HR) and body weight (BMI) were measured four times in the school at 3-week intervals. On the third visit a mental arithmetic stress was carried out and a 24 h urine specimen was collected for the measurements of catecholamine excretion. On the fourth visit students carried out an isometric exercise (handgrip). Girls were more frequently found in the last quintiles of BMI (10/33 in the first vs 19/33 in the fifth). This might be due to a more advanced sexual maturation. BP at rest significantly increased with body weight (from 105/81 +/- 11/13 mmHg in the first to 119/87 +/- 10/12 in the fifth quintile). In each quintile no sex-related difference was observed in BP or HR. A marked cardiovascular response was observed during both tests without significant difference among quintiles. The 24 h urinary excretion of total catecholamines slightly increased with body weight (from 26.2 +/- 11 micrograms/24 h in the first to 34.5 +/- 19.5 micrograms/24 h in the fifth quintile). These data in a population of 11-year-old students therefore support the hypothesis that although BP at rest is influenced by BMI, the cardiovascular response to adrenergic stimulation is independent of body weight.

[Echocardiographic analysis of anatomical and functional changes in the left heart ventricle during antihypertensive treatment with nicardipine]

Changes in hemodynamic variables regulating systolic function were assessed by M-mode echocardiography, under 2D control, in 11 patients with primary uncomplicated hypertension treated with nicardipine (60 mg/daily). At the end of treatment (8 weeks) blood pressure and end-systolic stress were greatly reduced (p less than 0.001), and systolic fractional shortening was increase (p less than 0.02). The percentage increase in fractional shortening was correlated with a decreased in end-systolic stress (r = 0.67). The index of left ventricular performance (systolic pressure/end-systolic dimension ratio) was reduced: no variation was found in the hypertrophy-independent index of the inotropic state (systolic pressure/end-systolic dimension ratio normalized for posterior wall thickness). No change in the inotropic state was caused by a negligible sympathetic reflex outflow: heart rate also remained unchanged. The only index of left ventricular hypertrophy which was slightly reduced after two months of treatment was left ventricular mass (p less than 0.001). In conclusion, the short-term treatment with nicardipine, in hypertensive patients, showed powerful effects in the improvement of systolic function; the possible regression of left ventricular hypertrophy must be confirmed in long-term therapy.

Noninvasive assessment of hemodynamic changes during therapy with nitrendipine in arterial hypertension

Changes in hemodynamic variables regulating systolic function were examined by M-mode echocardiography in 14 patients with long-duration primary uncomplicated hypertension treated with nitrendipine once daily (20 mg). At the end of treatment (8th week) blood pressure and peripheral resistance were greatly reduced (p less than 0.0001), while the indices of cardiac function (ejection fraction and cardiac index) showed significant increases (p less than 0.01). The variations in ejection fraction were analyzed by multiple linear regression and were mainly influenced by the decrease in end-systolic stress (contribution: 60%). At baseline, despite no radiographic or clinical signs of heart failure, 6 of the studied patients showed impaired systolic function, likely due to the strength of other variables (age, risk factors); in those patients, systolic function was clearly enhanced at the end of treatment, while no change was found in patients with initial normal pump function. Changes in cardiac output were due to a significant increase in heart rate in patients with normal pump function and to improved stroke volume in the others. Left ventricular mass index was slightly reduced (p less than 0.005), primarily because of the reduction in end-diastolic volume (p less than 0.01). When analyzed by the 2 subgroups (with or without impaired systolic function), the left ventricular mass index appeared to be significantly reduced only in those patients with normal basal pump function. This difference was most likely due to the different effects of treatment on end-diastolic volume.

Effects of alpha-adrenergic and beta-adrenergic receptor blockade on lipid metabolism

The role of lipoprotein lipase in the pathophysiology of lipid changes during alpha-receptor or beta-receptor blockade was evaluated in this clinical trial. Thirty hypertensive patients were given 2 mg of prazosin twice daily or 100 mg of metoprolol twice daily for 10 weeks, according to an open, randomized protocol. Both drugs were effective in reducing arterial blood pressure (from 153 +/- 16/102 +/- 6 mm Hg to 146 +/- 12/92 +/- 8 mm Hg with prazosin and from 158 +/- 17/103 +/- 8 to 144 +/- 14/94 +/- 10 mm Hg with metoprolol). Prazosin significantly reduced total plasma cholesterol from 202 +/- 39 to 188 +/- 36 mg/dl and increased high-density lipoprotein cholesterol from 36 +/- 8 to 40.5 +/- 11 mg/dl. Prazosin did not affect plasma triglycerides levels, whereas patients taking metoprolol had a slight rise in these levels, from 122 +/- 42 to 142 +/- 57 mg/dl, along with a decrease in high-density lipoprotein cholesterol from 37 +/- 10 to 31 +/- 8 mg/dl. The concentration of apoprotein B did not change significantly with either treatment. Lipoprotein lipase activity increased in the prazosin group from 28.4 +/- 16 to 37.7 +/- 14 mumol/liter per minute (p less than 0.01), but did not change significantly (29.9 +/- 12 versus 32.8 +/- 8 mumol/liter per minute) in patients treated with the beta blocker. These data, which confirm previous reports of serum lipid changes during antihypertensive therapy, suggest that alpha1 blockers may interfere with lipoprotein lipase, possibly by reducing its catecholamine-mediated inactivation.

Antihypertensive and cardiovascular effects of nitrendipine: a controlled study vs. placebo

The antihypertensive and cardiovascular effects of nitrendipine, a calcium entry blocker similar to nifedipine, have been evaluated in a double-blind, placebo-controlled study in 20 patients with hypertension. At baseline and at the end of the 8-week period (nitrendipine, 20 mg once a day, or placebo, 1 tablet once a day) the following parameters were measured: systolic and diastolic blood pressure (BP) and heart rate (HR) at rest by an automatic recorder; BP, HR, and cardiac workload (systolic BP X HR) during exercise testing on a bicycle; left ventricular mass (LVMe according to the method of Devereux) and cross-sectional area (CSA), and main parameters of systolic function (end diastolic volume, end systolic volume [ESV], and ejection fraction [EF]) by M mode echocardiography. There was a significant decrease in BP at rest (163/108 vs. 144/92 mm Hg; P less than 0.001) and during exercise in subjects receiving nitrendipine, while placebo did not modify these parameters. LVMe (from 195 to 188 gm; P less than 0.01) and CSA (from 20.2 to 19.8 cm2; P less than 0.05) were reduced by nitrendipine, which also improved cardiac performance (ESV fell from 44 to 38 ml [P less than 0.001] and EF fell from 62% to 66% [P less than 0.01]). No effect was observed in the placebo group. Our results indicate that nitrendipine is a powerful antihypertensive agent that also improves cardiac performance and slightly but significantly reduces left ventricular mass.

Cardiovascular effects of ketanserin, a new antiserotonergic agent in the treatment of arterial hypertension

Ketanserin, an investigational, antiserotonergic agent, at a dose of 40 mg bid was given to 18 patients with mild to moderate primary hypertension in a randomized, double-blind, crossover study, with 100-mg metoprolol bid for four weeks each. The following parameters were evaluated: blood pressure, heart rate, cardiac workload (product of systolic blood pressure and heart rate during bicycle exercise), systolic time intervals, and peripheral blood flow (by strain-gauge plethysmography). Significant reductions in diastolic and concomitant slight decreases in systolic blood pressure without changes in heart rate were observed during ketanserin treatment; cardiac oxygen demands during exercise test did not change, however. Pre-ejection period and left ventricular ejection time were unchanged, while significant increase in rest flow to the lower limbs and decrease in peripheral resistance were demonstrated by strain-gauge plethysmography. The results indicate that ketanserin has vasodilating properties and hypotensive activity that may be useful in the management of patients with essential hypertension.

Age related antihypertensive effect of nitrendipine, a new calcium entry blocking agent

The effect of nitrendipine 20 mg o.d., a new calcium entry blocker similar in structure to nifedipine, on blood pressure has been evaluated in 14 patients (aged 24-62 years) with uncomplicated mild or moderate arterial hypertension. A significant decrease both in systolic (160 +/- 12 at baseline vs 141 +/- 8 mm Hg, p less than 0.001) and diastolic (106 +/- 8 vs 93 +/- 3 mm Hg, p less than 0.001) blood pressure was observed at the end of 8 weeks of nitrendipine treatment. An inverse correlation was found between age and the reduction in diastolic blood pressure (r = 0.772, p less than 0.001 as absolute reduction; r = 0.791, p less than 0.001 as percentage reduction versus baseline). This peculiar characteristic differentiates the effect of nitrendipine from that of other calcium entry blockers, which appear to be more effective in older patients.

Once a day indapamide therapy in hypertension. Effects on the heart and peripheral arterial circulation

Indapamide, a sulphonamide derivative, was prescribed for 8 weeks at low dose (2.5 mg once a day) to 14 hypertensive patients in order to investigate its effects on systolic and diastolic blood pressure (SBP, DBP), cardiac function and peripheral arterial resistance (PAR). During treatment we observed decreases in both SBP and DBP without any change in HR in the supine and standing positions and on exercise. As a result cardiac work was significantly reduced. Slight changes in pre-ejection period (PEP) and left ventricular ejection time (LVET) along with a more significant decrease in rate of rise of left ventricular pressure (DBP to PEP ratio) were observed during treatment. An increase in RBF and a decrease in PAR were also detected in the peripheral circulation. These findings may indicate that indapamide antagonizes the cardiovascular effects of catecholamines.

[Relations between hepatitis B surface antigen and parasitic diseases: observations in patients with ancylostomiasis and schistosomiasis]

Hepatitis B antigen carriage was studied in Somalia in 155 patients with ancylostomiasis, with urinary schistosomiasis and with leprosy (lepromatosus and tuberculoid type and leprosy with schistosomiasis). The results have showed a significantly (p less than 0,001) higher frequency of HBsAg among the patients with ancylostomiasis (33,33%) and with urinary schistosomiasis (25,92%) than either the leprosy patients (9,67% in the L type and 6,89% in the T type) or the controls (11,11%); in the leprosy patients with schistosomiasis the frequency was 40,0%. The role of some penetrating skin parasites in the epidemiology of hepatitis B was discussed.