Phytochemistry, Bioactivity, and Ethnopharmacology of the Genus Lepechinia Willd. (Lamiaceae): A Review

The genus Lepechinia (Lamiaceae) involves several aromatic shrubs that are distributed only in the American continent, inhabiting mountain areas, mainly in the Andean region of South America. Based on the PRISMA approach, we selected and critically analyzed 48 research articles. From a phytochemical point of view, most of the secondary metabolites reported in Lepechinia spp. are terpenes and terpenoids, with a few exceptions comprising flavonoids and other shikimic acid derivatives. On the one hand, sesquiterpenoids of the guajane, aromadendrane, eudesmane, and cadinane groups are characteristic of essential oils, together with (E)-β-caryophyllene as the main representative of its chemical family. On the other hand, abietane diterpenoids are the prevalent compounds described in non-volatile fractions. Many biological activities and traditional medical uses have been reported for both pure metabolites and complex mixtures (e.g., essential oils). Regarding ethno-medical uses, the treatment of muscle pain, headache, toothache, diabetes mellitus, uterine tumors, uterine infections, and diarrhea has been reported. Concerning their verified biological activities, insecticidal, antifungal, antioxidant, and anticholinesterase properties have been described. Furthermore, some data concerning anti-herpetic activity have been reported.

A Comparative Study on Chemical Compositions and Biological Activities of Four Amazonian Ecuador Essential Oils: Curcuma longa L. (Zingiberaceae), Cymbopogon citratus (DC.) Stapf, (Poaceae), Ocimum campechianum Mill. (Lamiaceae), and Zingiber officinale Roscoe (Zingiberaceae)

Essential oils (EOs) and their vapour phase of Curcuma longa (Zingiberaceae), Cymbopogon citratus (Poaceae), Ocimum campechianum (Lamiaceae), and Zingiber officinale (Zingiberaceae) of cultivated plants grown in an Amazonian Ecuador area were chemically characterised by Gas Chromatography-Flame Ionization Detector (GC-FID), Gas Chromatography-Mass Spectrometry (GC-MS), and Head Space-Gas Chromatograph-Flame Ionization Detector-Mass Spectrometry (HS-GC-FID-MS).figure The EOs analyses led to the identification of 25 compounds for C. longa (99.46% of the total; ar-turmerone: 23.35%), 18 compounds for C. citratus (99.59% of the total; geraniol: 39.43%), 19 compounds for O. campechianum (96.24% of the total; eugenol: 50.97%), and 28 for Z. officinale (98.04% of the total; α-Zingiberene: 15.45%). The Head Space fractions (HS) revealed C. longa mainly characterised by limonene and 1,8-cineole (37.35%) and α-phellandrene (32.33%); Z. officinale and C. citratus showed camphene (50.39%) and cis-Isocitral (15.27%) as the most abundant compounds, respectively. O. campechianum EO revealed a higher amount of sesquiterpenes (10.08%), mainly characterised by E-caryophyllene (4.95%), but monoterpene fraction remained the most abundant (89.94%). The EOs were tested for antioxidant, antimicrobial, and mutagen-protective properties and compared to the Thymus vulgaris EO as a positive reference. O. campechianum EO was the most effective in all the bioactivities checked. Similar results emerged from assaying the bioactivity of the vapour phase of O. campechianum EO. The antioxidant and antimicrobial activity evaluation of O. campechianum EO were repeated through HP-TLC bioautography assay, pointing out eugenol as the lead compound for bioactivity. The mutagen-protective evaluation checked through Ames's test properly modified evidenced a better capacity of O. campechianum EO compared with the other EOs, reducing the induced mutagenicity at 0.1 mg/plate. However, even with differences in efficacy, the overall results suggest important perspectives for the functional use of the four studied EOs.

Alpha-Phellandrene and Alpha-Phellandrene-Rich Essential Oils: A Systematic Review of Biological Activities, Pharmaceutical and Food Applications

Alpha-phellandrene is a very common cyclic monoterpene found in several EOs, which shows extensive biological activities. Therefore, the main focus of the present systematic review was to provide a comprehensive and critical analysis of the state of the art regarding its biological activities and pharmaceutical and food applications. In addition, the study identified essential oils rich in alpha-phellandrene and summarized their main biological activities as a preliminary screening to encourage subsequent studies on their single components. With this review, we selected and critically analyzed 99 papers, using the following bibliographic databases: PubMed, SciELO, Wiley and WOS, on 8 July 2022. Data were independently extracted by four authors of this work, selecting those studies which reported the keyword "alpha-phellandrene" in the title and/or the abstract, and avoiding those in which there was not a clear correlation between the molecule and its biological activities and/or a specific concentration from its source. Duplication data were removed in the final article. Many essential oils have significant amounts of alpha-phellandrene, and the species Anethum graveolens and Foeniculum vulgare are frequently cited. Some studies on the above-mentioned species show high alpha-phellandrene amounts up to 82.1%. There were 12 studies on alpha-phellandrene as a pure molecule showed promising biological functions, including antitumoral, antinociceptive, larvicidal and insecticidal activities. There were 87 research works on EOs rich in alpha-phellandrene, which were summarized with a focus on additional data concerning potential biological activities. We believe this data is a useful starting point to start new research on the pure molecule, and, in particular, to distinguish between the synergistic effects of the different components of the OEs and those due to alpha-phellandrene itself. Toxicological data are still lacking, requiring further investigation on the threshold values to distinguish the boundary between beneficial and toxic effects, i.e., mutagenic, carcinogenic and allergenic. All these findings offer inspiration for potential applications of alpha-phellandrene as a new biopesticide, antimicrobial and antitumoral agent. In particular, we believe our work is of interest as a starting point for further studies on the food application of alpha-phellandrene.

Piper aduncum essential oil: a promising insecticide, acaricide and antiparasitic. A review

Several studies have assessed the potential of essential oils as substitutes for synthetic pesticides, in order to counter insect resistance to commercial pesticides. Piper aduncum L. is a very common shrub in the Amazon Rainforest and in other subtropical areas. The objective of this review was to analyse the existing information on P. aduncum essential oil as a raw material for new bioproducts for sustainable pest disease management. With this review, we collected and critically analysed 59 papers, representing all the studies that aimed to evaluate the essential oil properties of this species as an insecticide, acaricide and antiparasitic. The chemical composition differs depending on the origin, although phenylpropanoid dillapiole is the most cited component, followed by myristicin, 1,8-cineole and β-ocimene. Between the acaricidal, antiparasitic and synergistic activities, the insecticidal effects are highly promising, with optimal results against the malaria vector Aedes aegypti, with an LC50 that ranges between 57 and 200μg/mL. Acaricidal activity has mainly been reported against Tetranychus urticae, showing an LC50 that ranges between 5.83 and 7.17μg/mL. Antiparasitic activity has predominately been found on Leishmania amazonensis, and antipromastigote activity has been found to be between 23.8 and 25.9μg/mL. Concerning the synergistic effect between dillapiole and synthetic insecticides, four studies on Spodoptera frugiperda found promising results with cypermethrin. In this review, we highlighted the potential of P. aduncum essential oil as a biopesticide, also focusing on the lack of information about applied research. We also provide suggestions for future investigations.

Ocimum campechianum Mill. from Amazonian Ecuador: Chemical Composition and Biological Activities of Extracts and Their Main Constituents (Eugenol and Rosmarinic Acid)

The essential oil (EO), the methanolic (MeOH), and the 70% ethanolic (70% EtOH) extracts obtained from the aerial parts of Ocimum campechianum Mill. (Ecuador) were chemically characterized through gas-chromatography coupled to mass spectrometry detector (GC-MS), high-performance liquid chromatography coupled to diode array-mass spectrometry detectors (HPLC-DAD-MS) and studied for their in vitro biological activity. The radical scavenger activity, performed by spectrophotometric 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assays, highlighted significant IC50 values for the EO, extracts and their main constituents (eugenol and rosmarinic acid). EO (and eugenol) showed noteworthy activity against Pseudomonas syringae pv. syringae and a moderate effect against clinical Candida strains, with possible synergism in association to fluconazole against the latter microorganisms. The extracts and pure molecules exhibited weak cytotoxic activity against the HaCat cell line and no mutagenicity against Salmonella typhimurium TA98 and TA100 strains, giving indication of safety. Instead, EO showed a weak activity against adenocarcinomic human alveolar basal epithelial cells (A549). The above-mentioned evidence leads us to suggest a potential use of the crude drug, extracts, and EO in cosmetic formulation and food supplements as antioxidant agents. In addition, EO may also have a possible application in plant protection and anti-Candida formulations.

Comparative Study of SPA Mud from "Bacino Idrominerario Omogeneo dei Colli Euganei (B.I.O.C.E.)-Italy" and Industrially Optimized Mud for Skin Applications

The term "Salus per aquam (SPA) therapies" refers to therapeutic pathways that includes mud therapy. The therapeutic efficacy of a peloid depends on its chemical and mineralogical composition, as well as its technological properties. Considering the increasing use of clay-based products, it becomes essential to characterize peloids from a qualitative and quantitative point of view. Therefore, this research project aimed to develop a protocol that allows characterization of the chemical-physical composition of sludges collected from different areas of the Homogeneous Euganean Hills Hydromineral Basin (B.I.O.C.E.). The study established a comparative study both between different matrices and between the same matrices at different maturation times, including also a comparison with an industrialized product, that can be used at home, which maintains the characteristics of a natural mud. This research was developed studying the pH, grain size distribution, and chemical and mineralogical composition. Peloids are characterized by a neutral/basic pH and are divided into two categories from a granulometric point of view: The chemical composition allowed observation of numerous correlations between oxides present in the samples and to quantify the presence of heavy metals. Mineralogical analysis made it possible to identify and compare the composition of each sample, also according to the maturation time. Thanks to the methods adopted, important correlations were achieved.

Optimisation of ultrasound-assisted extraction of phenolic antioxidants from Ilex guayusa Loes. leaves using response surface methodology

The present study carried out the optimisation of the total polyphenol content (TPC) extraction assisted by ultrasound in Ilex guayusa leaves applying response surface methodology (RSM). Also, the evaluation of the antioxidant activity of the extract obtained under the optimal extraction conditions was performed. The effect of the variables like, time of sonication, temperature, ethanol/water ratio and solid/liquid relationship and the interactions between them were analysed through the use of a factorial design 2ˆ4. The significant factors were considered for the optimisation, employing a Box-Behnken Design, and the TPC as response variables. It was found that a quadratic model was adequate, with an adjusted R² value of 0.9367. The optimal conditions proposed, by the response surface model were: an extraction temperature of 60 °C, sonication time of 29.9 min and ethanol/water ratio of 76.8/23.2. The optimised leaves extract of I. guayusa show a TPC of 3.46 (±0.17) g gallic acid equivalents/100 g d.w. Radical scavenger activity of the obtained extract at optimum conditions, was performed through the FRAP and ABTS methods, given as result: 0.080 mmol TROLOX equivalents/100 g d.w. and 40.71 μmol TROLOX equivalents/g d.w., respectively. Due to the present findings, I. guayusa extracts can be proposed as a promising component for functional beverages, cosmetic and pharmaceutical formulation.

Ethnopharmacology, phytochemistry and pharmacology of the genus Hedyosmum (Chlorantaceae): A review

ETHNOPHARMACOLOGICAL RELEVANCE

The genus Hedyosmum (family: Chloranthaceae) represents an interesting source of natural active compounds, and the 45 species of this genus are widespread in Central and South America and to a lesser extent Southeast Asia (southern China and western Malaysia). Several species are traditionally used in folk medicine. However, the data made available in recent years have not been organized and compared.

AIM OF THIS REVIEW

The present study is a critical assessment of the state-of-the-art concerning the traditional uses, the phytochemistry and the pharmacology of species belonging to the genus Hedyosmum to suggest further research strategies and to facilitate the exploitation of the therapeutic potential of Hedyosmum species for the treatment of human disorders.

MATERIALS AND METHODS

The present review consists of a systematic overview of scientific literature concerning the genus Hedyosmum published between 1965 and 2018. Moreover, an older text, dated from 1843, concerning the traditional uses of H. bonplandianum Kunth has also been considered. Several databases (Francis & Taylor, Google Scholar, PubMed, SciELO, SciFinder, Springer, Wiley, and The Plant List Database) have been used to perform this work.

RESULTS

Sixteen species of the genus Hedyosmum have been mentioned as traditional remedies, and a large number of ethnomedicinal uses, including for the treatment of pain, depression, migraine, stomach-ache and ovary diseases, have been reported. Five species have been used as flavouring agents, tea substitutes or foods. Sesterterpenes, sesquiterpene lactones, monoterpenes, hydroxycinnamic acid derivatives, flavonoids, and neolignans have been reported as the most important compounds in these species. Studies concerning their biological activities have shown that members of the Hedyosmum genus possesses promising biological properties, such as analgesic, antinociceptive, antidepressant, anxiolytic, sedative, and hypnotic effects. Preliminary studies concerning the antibacterial, antioxidant, antiplasmodial, and antifungal activities of these plants as well as their cytotoxic activities against different tumour cell lines have been reported. Some active compounds from the Hedyosmum genus have been used as starting points for the innovative and bioinspired development of synthetic molecules. A critical assessment of these papers has been performed, and some conceptual and methodological problems have been identified regarding the materials and methods and the experimental design used in these studies, including a lack of ethnopharmacological research.

CONCLUSIONS

The present review partially confirms the basis for some of the traditional uses of Hedyosmum species (mainly H. brasiliense) through preclinical studies that demonstrated their antinociceptive and neuroprotective effects. Due to promising preliminary results, further studies should be conducted on 13-hydroxy-8,9-dehydroshizukanolide and podoandin. Moreover, several essential oils (EOs) from this genus have been preliminarily investigated, and the cytotoxic and antibacterial activities of H. brasiliense and H. sprucei EOs certainly deserve further investigation. From the promising findings of the present analysis, we can affirm that this genus deserves further research from ethnopharmacological and toxicological perspectives.

Larvicidal activity of Ocimum campechianum, Ocotea quixos and Piper aduncum essential oils against Aedes aegypti

Aedes aegypti, the main arbovirus vector of the Yellow fever, Dengue, Chikungunya and Zika viruses, is widely distributed in tropical and subtropical areas throughout the world. Preventive control efforts have been implemented worldwide aimed at reducing its impact on human health. The recent reduction of chemicals available for vector control due to their negative impact on the environment and human health and the increase in mosquito resistance to insecticides have driven the research community to identify and evaluate sustainable alternatives to synthetic insecticides. In this study, the potential larvicidal effect of essential oils extracted from Ocimum campechianum, Ocotea quixos and Piper aduncum were tested in vitro. GC and GC-MS analyses showed that the main compounds were eugenol (18%), 1,8-cineole (39%) and dillapiole (48%), respectively. Susceptibility to essential oils was measured according to the WHO protocol. After 24 h, the mean percentage mortality ranged from 2.7 to 100% for P. aduncum, from 2.2 to 100% for O. campechianum, and from 2.9 to 100% for O. quixos. The highest potential was displayed by P. aduncum, followed by O. campechianum and O. quixos, with LC₅₀ values of 25.7, 69.3 and 75.5 ppm, respectively. The rapid and effective larvicidal activity of these three oils led us to consider these results to be promising, also considering the possibility of local cultivation of these plants in tropical and subtropical areas and the simple technology for their large-scale preparation and production. Further studies are needed to evaluate the individual components and their activity as larvicides.

Herbal extracts, lichens and biomolecules as natural photo-protection alternatives to synthetic UV filters. A systematic review

Besides the unquestionable positive effects of solar exposure for human health, UV rays have been widely investigated for toxicology aspects related to excessive UVB and UVA doses, which involve sunburns, skin aging, DNA skin damage and tumorigenesis. At present, synthetic and mineral sunscreens are used to protect against these damages but several natural molecules can provide UV protection, including also synergic effect or enhanced photo stability. Although a large number of herbal extracts and plant origin molecules can deserve potential applications, most of the study reported utilizes different method and different strategies of investigation, making thus difficult to understand the real versus claimed potential. This is possibly one of the reasons why, beside the large body of literature there are no officially approved natural commercial sun-filter but a consistent number of commercially available solar products (sunscreen) on the market that contain herbal derivatives. In this review we have evaluated the papers appeared in the last 15years and we have critically collected the most significant data. Several databases, namely Scifinder, Pubmed, Google Scholar, ISI-Web of Science and Scopus, were used as literature sources; excluding patents and symposium or congress papers. Only articles in the English language have been selected. New formulation, new skin delivery systems, skin penetration enhancers and boosters are most likely the next frontier of investigation in order to better understand the role of whole herbal extracts in exerting their photo protective activity.

Chemical characterization and antioxidant activity of Amazonian (Ecuador) Caryodendron orinocense Karst. and Bactris gasipaes Kunth seed oils

Nowadays, data concerning the composition of Caryodendron orinocense Karst. (Euphorbiaceae) and Bactris gasipaes Kunth (Arecaceae) seed oils are lacking. In light of this fact, in this paper fatty acids and unsaponifiable fraction composition have been determined using GC-MS, HPLC-DAD (Diode Array Detector), NMR approaches and possible future applications have been preliminary investigated through estimation of antioxidant activity, performed with DPPH test. For C. orinocense linoleic acid (85.59%) was the main component, lauric (33.29%) and myristic (27.76%) acids were instead the most abundant in B. gasipaes. C. orinocense unsaponifiable fraction (8.06%) evidenced a remarkable content of β-sitosterol, campesterol, stigmasterol, squalene and vitamin E (816 ppm). B. gasipaes revealed instead β-sitosterol and squalene as main constituents of unsaponifiable matter (3.01%). Antioxidant capacity evidenced the best performance of C. orinocense seed oil. These preliminary results could be interesting to suggest the improvement of the population's incomes from Amazonian basin. In particular the knowledge of chemical composition of C. orinocense and B. gasipaes oils could be helpful to divulge and valorize these autochthones plants.

[Phenotypic and genotypic characterization of imipenem-resistant Pseudomonas aeruginosa isolated in a Buenos Aires hospital]

From 129 P. aeruginosa isolated at a health care centre located in Buenos Aires (Hospital "Eva Perón"), 14% produced IMP-13. Although 18 isolates were metallo-beta-lactamases (MBL) producers, only those isolates that displayed altered outer membrane protein profiles correlated with the resistant category according to CLSI or even Subcomisión de Antimicrobianos, SADEBAC, AAM. Phenotypic screening of metallo-beta-lactamases proved to be appropriate for detecting MBL producing isolates. IMP-13 producing isolates corresponded to at least five different clonal types, which not only suggests the dissemination of the resistant strain but also of the resistant marker.

Caracterización fitoquímica de la especie Ilex guayusa Loes. y elaboración de un prototipo de fitofármaco de interés comercial

<p>De los 17 países megadiversos del mundo cuatro de ellos se ubican en la zona andina y concentran el 75% de la diversidad en especies de animales y plantas, estos son: Colombia, Perú, Venezuela y Ecuador (Estrella et al. 2005). La Amazonía ecuatoriana representa una de las áreas con mayor biodiversidad del planeta y por su enorme variedad de plantas se convierte en una fuente de investigación de interés permanente, especialmente para el desarrollo de nuevas materias primas del mercado farmacéutico, cosmético y alimentario. Al interés comercial se unen también el científico y el antropológico, sobre todo cuando se trata de recuperar una de las plantas sagradas de las nacionalidades indígenas que habitan en la región amazónica ecuatoriana conocida con el nombre vernáculo de guayusa (Ilex guayusa Loes.) y que es usada tradicionalmente por los Achuar y mestizos en forma de infusión.</p><p>Dentro de este contexto, es fundamental aclarar que el conocimiento fitoquímico de la guayusa es limitado y la literatura científica es escasa, razón por la cual es necesaria una profunda investigación científica con el fin de evaluar su actividad biológica o farmacéutica y los posibles usos comerciales. Actualmente, los pocos datos fitoquímicos de esta planta solo revelan datos de su contenido en cafeína, así como la presencia de triterpenos y ácidos clorogénicos (Rosero Gordón 2006-2007); por lo tanto, aún no se pueden explicar todas las propiedades curativas que la tradición popular le atribuye. Así, los objetivos de esta investigación fueron:</p><p>1. Desarrollar un fitofármaco con base en Ilex guayusa Loes. que actúe como un coadyuvante en el tratamiento de manifestaciones sintomáticas como gripe, jaqueca y fiebre.<br />2. Identificar las familias químicas presentes en Ilex guayusa Loes.<br />3. Desarrollar la preparación de un extracto adecuado a la formulación final.<br />4. Desarrollar un método de cromatografía líquida de alta resolución (CLAR) para la dosificación de la cafeína en el producto final.<br />5. Establecer los parámetros de calidad del producto transformado.<br />6. Realizar un proceso productivo apto a las condiciones tecnológicas locales.</p><p>El enfoque de la investigación se puede resumir en nueve etapas principales (Figura 1), las cuales deben ser completadas con el desarrollo de un prototipo sometido a estudios preclínicos y clínicos, pruebas industriales y finalmente, el producto desarrollado debe tener un plan de comercialización.</p>

[Comparison of different methods in order to identify Proteus spp]

Comparison of different methods in order to identify Proteus spp. The objectives were: (a) to identify Proteus strains to species level, following Farmer's and O'Hara's conventional biochemical reactions; b) to evaluate the sensitivity and specificity of both the API 20E method and a schema of reduced reactions (TSI and MIO agar: motility, indole and ornithine) comparing them with conventional methodology, and c) to evaluate the utility of SDS-PAGE (total proteins) in order to identify Proteus strains to species level. Two hundred and five Proteus spp. clinical isolates, were collected between January 1998 and September 2004, from inpatients and outpatients at Hospital de Clinicas. Strains were identified by means of conventional methodology, the API 20E method, and a schema of reduced reactions. SDS-PAGE (total proteins) was used in 48 out of the 205 strains. The API 20E method identified 79 out of 87 (90.8%) strains of P. mirabilis, 103 out of 103 P. vulgaris complex, and 15 out of 15 P. penneri. Eight strains of P. mirabilis were identified as Proteus spp., the acid production from maltose being necessary to identify them to species level. The schema of reduced reactions identified 205 out of 205 (100%) strains, that is, this schema of reduced reactions identified all the strains to species level without any additional tests, in marked contrast to the API 20E method. The SDS-PAGE (total proteins) identified the three species of the genus, even if the strains of P. mirabilis showed different biochemical reactions.

[Genetic environment of CTX-M-2 in Klebsiella pneumoniae isolates from hospitalized patients in Uruguay]

We studied two CTX-M-2-producing Klebsiella pneumoniae clinical strains, K96005 and K13, isolated from hospitalized patients in Uruguay, during 1996 and 2003, respectively. The genomic surroundings of bla(CTX-M-2) were characterized by PCR-mapping and DNA sequencing. Our results show that blaCTX-M-2 is included in a complex class-1 integron (InK13), associated with an orf513 in both isolates. The genetic array of the integron, aac(6')-lb, bla(OxA,2), orfD (gene cassette region), associated with an orf513-bla(CTX-M-2), seems to be widely disseminated over the Rio de la Plata region.

[Prevalence of metallo-beta-lactamase in carbapenem resistant Pseudomonas aeruginosa at a university hospital of Buenos Aires City]

The present study was conducted to estimate the prevalence of metallo-beta-lactamases in 91 consecutive carbapenem resistant Pseudomonas aeruginosa isolates, recovered from inpatients at Hospital de Clínicas in Buenos Aires. Both, phenotypic and genotypic methods detected the presence of carbapenemases in 10 (11%) isolates, corresponding to VIM-11 in 7/10 and VIM-2 in the others. Codifying genes were all included in class 1 integrons, upstream genes coding for aminoglycoside modifying enzymes. One hundred percent sensitivity and specificity was achieved by the metallo-beta-lactamases phenotypic screening method using EDTA (1 micromol) disks in the Pseudomonas aeruginosa isolates included in this study. Sensitivity to aztreonam in carbapenem resistant isolates was suspicious of the presence of these enzymes.

[Phenotypic and genotypic characterization of resistance to third-generation cephalosporins in Enterobacter spp]

Enterobacter spp. are becoming increasingly frequent nosocomial pathogens with multiple resistance mechanism to beta-lactam antibiotics. We carried out the phenotypic and genotypic characterization of beta-lactamases in 27 Enterobacter spp. (25 Enterobacter cloacae y 2 Enterobacter aerogenes), as well as the ability of different extended spectrum-lactamase (ESBL) screening methods. Resistance to third generation cephalosporins was observed in 15/27 (63%) isolates. Twelve resistant isolates produced high level chromosomal encoded AmpC beta-lactamase; 6 of them were also producers of PER-2. Resistance to third generation cephalosporins in the remaining 3 isolates was due to the presence of ESBLs, PER-2 in 2 cases, and CTX-M-2 in the other. Only CTX-M-2 production was detected with all tested cephalosporins using difusion synergy tests, while cefepime improved ESBLs detection in 7/8 PER-2 producers, 4/8 in the inhibitor approximation test and 7/8 with double disk test using cefepime containing disk with and without clavulanic acid. Dilution method, including cephalosporins with and without the inhibitor detected 1/9 ESBLs producers.

[Consensus for antimicrobial susceptibility testing for Enterobacteriaceae. Subcommittee on Antimicrobials, SADEBAC (Argentinian Society of Clinical Bacteriology), Argentinian Association of Microbiology]

Taking into account previous recommendations from the National Committee for Clinical Laboratory Standards (NCCLS), the Antimicrobial Committee, Sociedad Argentina de Bacteriología Clínica (SADEBAC), Asociación Argentina de Microbiología (AAM), and the experience from its members and some invited microbiologists, a consensus was obtained for antimicrobial susceptibility testing and interpretation in most frequent enterobacterial species isolated from clinical samples in our region. This document describes the natural antimicrobial resistance of some Enterobacteriaceae family members, including the resistance profiles due to their own chromosomal encoded beta-lactamases. A list of the antimicrobial agents that should be tested, their position on the agar plates, in order to detect the most frequent antimicrobial resistance mechanisms, and considerations on which antimicrobial agents should be reported regarding to the infection site and patient characteristics are included. Also, a description on appropriate phenotypic screening and confirmatory test for detection of prevalent extended spectrum beta-lactamases in our region are presented. Finally, a summary on frequent antimicrobial susceptibility profiles and their probably associated resistance mechanisms, and some infrequent antimicrobial resistance profiles that deserve confirmation are outlined.

Composition and functional properties of the essential oil of amazonian basil, Ocimum micranthum Willd., Labiatae in comparison with commercial essential oils

Wild Amazonian basil Ocimum micranthum Willd. (O. campechianum Mill.) Labiatae essential oil was analyzed by GC and GC-MS: 31 compounds were identified. The main components were eugenol (46.55 +/- 5.11%), beta-caryophyllene (11.94 +/- 1.31%), and beta-elemene (9.06 +/- 0.99%), while a small amount of linalool (1.49 +/- 0.16%) was detected. The oil was tested for its in vitro food-related biological activities and compared with common basil Ocimum basilicum and Thymus vulgaris commercial essential oils. Radical scavenging activity was evaluated employing 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay. The oil exerted a good capacity to act as a nonspecific donor of hydrogen atoms or electrons when checked in the diphenylpicrylhydrazyl assay, quenching 76,61 +/- 0.33% of the radical, with values higher than those reported by reference oils. In the beta-carotene bleaching test, the oil provided an antioxidant efficacy comparable with that of O. basilicum and T. vulgaris essential oils. These data were confirmed by photochemiluminescence, where the oil showed a remarkable antioxidant capacity (2.39 +/- 0.1), comparable to that of Trolox and vitamin E, and higher than the other essential oils. Antibacterial activity of O. micranthum essential oil was evaluated against Gram positive and Gram negative bacterial strains. The oil showed a dose-dependent antifungal activity against pathogenic and food spoiling yeasts.

Extended-spectrum beta-lactamases in enterobacteriaceae in Buenos Aires, Argentina, public hospitals

Resistance to extended-spectrum cephalosporins is often associated with plasmid encoded extended spectrum beta-lactamases (ESBL). In order to evaluate the prevalence and diversity of ESBLs in enterobacteria in our city, a 1-month-period survey was carried out from April to May 2000. Extended-spectrum-cephalosporin-resistant strains, isolated from inpatient clinical specimens other than stools, were collected among 17 participating hospitals. From a total of 427 enterobacterial strains that were collected during this period, 39 were extended-spectrum cephalosporin resistant. The National Committee for Clinical Laboratory Standards' Screening and Confirmatory Tests for ESBL production were performed using cefotaxime and ceftazidime; cefepime and cefepime-clavulanic acid-containing disks were included. beta-Lactamases were characterized by isoelectric focusing and PCR amplification using specific primers. Three different ESBLs were detected: SHV-related (4 isolates), PER-2-type (9 isolates), and CTX-M-2-related (26 isolates). Sequencing of the corresponding genes confirmed CTX-M-2 in 19 of 21 and CTX-M-31 (an allelic variant) in the remaining 2 of 21. CTX-M-2 (or its variant) was detected in all Escherichia coli, Enterobacter aerogenes, Serratia marcescens, Proteus mirabilis, and Providencia stuartii strains, while PER-2 was detected in Enterobacter cloacae, E. aerogenes, and Klebsiella pneumoniae; SHV-related ESBL were found only in K. pneumoniae. These results clearly show that CTX-M-2 is the most prevalent ESBL produced by enterobacterial species isolated from public hospitals in Buenos Aires.

[Consensus on antimicrobial sensitivity tests in gram-positive cocci. Subcommittee on Antimicrobials, SADEBAC (Argentinian Society of Clinical Bacteriology), Argentinian Association of Microbiology]

Antimicrobial susceptibility testing is mainly performed in Argentina by disk diffusion method, following National Committee for Clinical Laboratory Standards (NCCLS) recommendations. We worked out new recommendations for the reporting and interpretation of this test when dealing with gram-positive cocci, in accordance to local trends and epidemiology. General considerations for performing the diffusion assay, quality control, and an update on susceptibility testing for gram-positive cocci are reported in this first document. The present update should be considered as a group of recommendations summarized by Argentinean experts and as the result of a consensus meeting coordinated by the Subcomisión de Antimicrobianos of the Sociedad Argentina de Bacteriología Clínica (Asociación Argentina de Microbiología). Experts in antimicrobial agents were convened in order to prepare this final document. These recommendations take into account local needs, affordability and availability to be used in current practice, tending to contribute to the correct antimicrobial treatment election, according to the particular microorganism and the infection sites.

Third-generation cephalosporin resistance in Shigella sonnei, Argentina

Shigella sonnei resistant to cefotaxime (but not to ceftazidime) was isolated for the first time in stool samples from a pediatric patient with vomiting and bloody diarrhea in northern Argentina. Microbiologic and biochemical tests confirmed the presence of an extended spectrum beta-lactamase displaying an apparent isoelectric point value of 8.2.

In vitro reconstructed dermis implanted in human wounds: degradation studies of the HA-based supporting scaffold

The objective of the present study was to demonstrate the safety and efficacy of a dermal replacement for cutaneous wounds of diverse origin. Autologous fibroblasts were cultured in fleece scaffolds made from benzyl esters of hyaluronic acid and applied onto cutaneous lesions. The cases presented are (1) skin removal for multiple epithelioma and (2) chronic deep decubitus ulcer. Dermal-like tissue applied by the surgeon elicited no adverse reactions, and was fully integrated and well-vascularized by 1-3 weeks. In Case 1, the material was fully integrated after 1 week, and after 3 weeks an epidermal autograft was overlaid which showed good take with excellent integration observed after 4 weeks. At 12 months, skin demonstrated visual normo-elastic properties and no signs of excessive scarring. In Case 2, 2-3 weeks after the dermal implant was applied, the wound was invaded with granulation tissue and healing occurred by secondary intention. The ulcer was healed by 8 weeks, with the biomaterial completely resorbed and a complete re-epithelialization over the dermal-like tissue. These results suggest that autologous fibroblast culture in hyaluronan-derived scaffolds may be successfully grafted in diverse cutaneous pathologies and constitute a suitable bed for further epidermal implantation.

Use of dermal-like tissue in the management of chronic and acute full-thickness cutaneous wounds

This paper presents a dermal replacement technique for cutaneous wounds of diverse origin. An autologous tissue-engineered dermal-like structure was implanted in one patient with an acute surgical excision of a nevus and in another patient with a chronic post-traumatic ulcer. The dermal constructs were well integrated with the wound area, and, at 3 weeks, an epidermal covering was implanted. In both cases, 3 to 8 weeks after autografting, good integration of the transplanted epidermis with the surrounding native skin and a good take over the dermal-like tissue occurred. The use of this technology, despite its high cost, is increasing. Clinicians choose it because it helps heal critical wounds for which current therapies have failed.

Use of a hyaluronan-based biomembrane in the treatment of chronic cholesteatomatous otitis media

OBJECTIVE

To test the efficacy and safety of a hyaluronan-based biomembrane in stimulating the healing process in patients undergoing tympanomastoid surgery.

STUDY DESIGN

The trial was an open, two-arm, controlled, randomized, prospective, multicenter study conducted at two different hospitals.

PATIENTS

Sixty subjects (18-65 years of age, both sexes) with chronic cholesteatomatous otitis media were enrolled and treated by the "one-stage open technique." Efficacy and safety parameters were assessed at 3, 5, 7, 9, 11, 13, 17, 21, and 25 weeks after surgery. Three sets of composite criteria were considered: patient's assessment of quality of healing, otomicroscopy, and audiometry.

RESULTS

Of the 60 patients, 50 completed the study. Subjects treated with the biomembrane had statistically significant better scores than controls (no treatment) for all variables considered, excluding audiometry (no significant differences). No adverse events occurred in treated patients.

CONCLUSION

Data demonstrate that the application of a hyaluronan-based biomembrane improves the healing of the mastoid cavity following "open" tympanoplasty. In particular, re-epithelialization was significantly faster after the application of the biomembrane. Moreover, the device neither caused any adverse events nor showed signs of ototoxicity. Re-epithelialization of open cavities and tympanic grafts still represents for surgeons an unpredictable step in the healing process. Hyaluronian-derivates may effectively contribute to the reduction of such variability.

Hyaluronan-based biopolymers as delivery vehicles for bone-marrow-derived mesenchymal progenitors

The tolerability and safety of hyaluronan-based three-dimensional scaffolds as a culture vehicle for mesenchymal progenitor cells was investigated in this pilot study. The proliferation patterns and extracellular matrix production of rabbit and human mesenchymal, bone-marrow-derived progenitors first were characterized in vitro. Subsequently rabbit autologous cells were cultured in this hyaluronan-based scaffold and implanted in a full-thickness osteochondral lesion. In vitro histologic findings showed that mesenchymal progenitor cells adhered and proliferated onto the hyaluronan-derived scaffold. Human stem cells were shown to produce the main extracellular matrix molecules, accompanied by an occasional synthesis of mature type II collagen. In vivo data demonstrated that the biomaterial, with or without mesenchymal progenitors, did not elicit any inflammatory response and was completely degraded within 4 months after implantation. With regard to the efficacy of this cell therapy, even among the small number of animals tested there was histologic evidence that lesions filled with the biomaterial, either seeded or unseeded with cells, achieved a faster and better healing compared to empty controls. The present data suggest that the hyaluronan-based scaffolds are well tolerated and safe and may be a valuable delivery vehicle for tissue engineering in the repair of articular cartilage defects.

Cefotaxime-hydrolysing beta lactamases in Morganella morganii

The frequency of enterobacterial isolates with high resistance to expanded-spectrum beta-lactam antibiotics (mainly cefotaxime or ceftriaxone) has increased notoriously in Argentina, mainly because of the spread of extended-spectrum beta-lactamases. The aim of this work was the study of extended-spectrum beta-lactamases in several Morganella morganii isolates with unusually high resistance to ceftriaxone. These strains produced at least two beta-lactamases, of apparent pIs of 5.4 and 8.2, molecular weight 23 000, well inhibited by clavulanate, compatible with a broad-spectrum beta-lactamase - perhaps TEM-1 - and an extended-spectrum beta-lactamase, respectively. The extended-spectrum beta-lactamase was identified as a CTX-M-type beta-lactamase - probably CTX-M-2 - by polymerase chain reaction, restriction profile analysis and DNA-DNA hybridisation. The remaining isolates studied produced either the broad-spectrum beta-lactamase plus the ubiquitous AmpC beta-lactamase (13 strains), or the AmpC beta-lactamase only (10 strains).

Chondrocyte aggregation and reorganization into three-dimensional scaffolds

Articular cartilage has a very limited self-repairing capacity; thus, chondral lesions normally result in chronic degeneration and, eventually, osteoarthritis development. Currently, tissue engineering offers a new tool for the clinical treatment of osteochondral defects. The present investigation aimed to develop an in vitro engineered cartilage using a new class of semisynthetic scaffolds. Two nonwoven meshes of hyaluronan esters (Hyaff(R) derivatives) were seeded with sternal chick embryo chondrocytes cultured for up to 21 days, after which time they were assessed for both the cellular growth profile and histological features. Avian chondrocytes easily adhered and proliferated onto hyaluronan-based scaffolds, demonstrating a significant preference for the fully esterified benzylic form. Histochemical staining revealed the presence of a neosynthesized glycosaminoglycan-rich extracellular matrix, and immunohistochemistry confirmed the deposition of collagen type II. Moreover, ultrastructural observations supported evidence that chondrocytes grown onto a hyaluronan-derived three-dimensional scaffold maintained their unique phenotype and organization in a cartilage-like extracellular matrix. These findings support the further pursuit of a transplantable engineered cartilage using human chondrocytes for the regeneration of chondral lesions.

Clostridial collagenase releases bioactive fragments from extracellular matrix molecules

The current study was designed to investigate the biological role of small extracellular matrix fragments in wound healing. Human burn eschar tissue was digested with bacterial collagenase, and small aminoacidic fragments were inoculated in both human dermal fibroblast cultures and polyvinyl alcohol sponges implanted subcutaneously in the rat. Proliferation assays on cell cultures and biochemical and histologic analyses of the animal model were then performed. Results showed that fibroblasts treated with low concentrations of eschar fragments duplicated significantly faster than controls. Biochemical and histologic data from sponge implants showed that the inflammatory response was augmented by eschar-derived fragments at postoperative day 2, whereas protein and hydroxyproline synthesis were decreased at day 14. In conclusion, these data substantiate that the application of bacterial collagenase to débride necrotic tissue may have an indirect healing effect resulting from the local release of bioactive matrix-derived fragments.

Histamine effects on conjunctival fibroblasts from patients with vernal conjunctivitis

Histamine, an important mast cell mediator in allergic disorders, may affect extracellular matrix production and cell growth in vernal keratoconjunctivitis (VKC). In the present study, the histamine reactivity of conjunctival fibroblasts derived from VKC patients was investigated in vitro. Conjunctival fibroblast cultures were derived from biopses of 8 tarsal VKC patients and 5 normal subjects. These cells were maintained in vitro and stimulated with different concentrations of histamine with and without H1 (clorpheniramine) and H2 (cimetidine) receptor antagonists. Comparisons were made to fibroblasts grown in the same media without histamine and to fibroblasts stimulated with just antihistamine. The effects of histamine were evaluated by: (1) the MTT test to assess cell proliferation; (2) an in vitro wound model for cell migration and (3) the measurement of procollagen I (PIP) and procollagen III (PIIIP) in supernatants for collagen production. Results showed: (1) While VKC-derived fibroblasts proliferated at a faster rate than normal cells in unstimulated media, after histamine stimulation, VKC and normal cells grew at a similar rate. Both H1 and H2 antagonists significantly inhibited (P<0.05) histamine-induced cell proliferation. (2) Histamine enhanced cell migration after wounding; this effect was inhibited only by H2 antagonism. (3) When stimulated with histamine, VKC fibroblasts produced significantly more PIP than those in control media. Furthermore, VKC-derived fibroblasts were more sensitive to histamine challenge, producing significantly more PIP than normal fibroblasts. H1 and H2 antagonists did not modify histamine-stimulated PIP production. The enhanced proliferative and productive capacity of VKC fibroblasts may be the result of a selective overgrowth of one or more fibroblast subpopulations in a chronically inflamed tissue. Histamine increased proliferation, migration and collagen production in both normal and VKC fibroblasts. Since H2 antagonism modulated both cell growth and migration, but not histamine-induced collagen production, the latter may be mediated by a different receptor. These results showed that histamine is at least partially responsible for fibroblast stimulation.

Semisynthetic resorbable materials from hyaluronan esterification

In recent years, research on new, biocompatible, degradable materials has seen the development of a series of modified natural polymers. Among these, a new class of materials consisting of different hyaluronan derivatives promises to be useful in a whole range of clinical applications thanks to their varied biological properties. These new materials are obtained by chemical modification of purified hyaluronan consisting of the partial or total esterification of the carboxyl groups of this natural polymer. This review on the properties of the new materials reports some of their biocompatibility and characterization aspects based on findings from studies conducted on the ethyl and benzyl hyaluronan esters, two representative members of this new class of compounds, and is intended to arouse interest in the potential of other, as yet unexplored derivatives. From the results of a number of investigations, the various derivatives appear to possess different physico-chemical properties, especially as far as the degree of hydration and polymer stability are concerned. In addition, the type of esterification and extent of chemical esterification of hyaluronan considerably affects the biological properties of these materials, offering a range of polymers either favouring or, conversely, inhibiting the adhesion of certain types of cell.

In vitro engineering of human skin-like tissue

Coverage of large, full-thickness burns presents a challenge for the surgeon due to the lack of availability of the patient's own skin. Currently, tissue engineering offers the possibility of performing a suitable therapeutic wound coverage after early burn excision by using cultured keratinocyte sheets supported by a dermal layer. The aim of this study was to develop and characterize a skin substitute composed of both epidermal and dermal elements. For this purpose we grew keratinocytes and fibroblasts separately for 15 days within two different types of biomaterials. Cells then were co-cultured for an additional period of 15 days, after which samples were taken and processed with either classic or immunohistochemical stainings. Results showed that (1) human fibroblasts and keratinocytes can be cultured on hyaluronic acid-derived biomaterials and that (2) the pattern of expression of particular dermal-epidermal molecules is similar to that found in normal skin. The data from this study suggest that our skin equivalent might be useful in the treatment of both burns and chronic wounds.

In vitro engineering of human skin-like tissue

Coverage of large, full-thickness burns presents a challenge for the surgeon due to the lack of availability of the patient's own skin. Currently, tissue engineering offers the possibility of performing a suitable therapeutic wound coverage after early burn excision by using cultured keratinocyte sheets supported by a dermal layer. The aim of this study was to develop and characterize a skin substitute composed of both epidermal and dermal elements. For this purpose we grew keratinocytes and fibroblasts separately for 15 days within two different types of biomaterials. Cells then were co-cultured for an additional period of 15 days, after which samples were taken and processed with either classic or immunohistochemical stainings. Results showed that (1) human fibroblasts and keratinocytes can be cultured on hyaluronic acid-derived biomaterials and that (2) the pattern of expression of particular dermal-epidermal molecules is similar to that found in normal skin. The data from this study suggest that our skin equivalent might be useful in the treatment of both burns and chronic wounds.

Antioxidant effects of hyaluronan and its alpha-methyl-prednisolone derivative in chondrocyte and cartilage cultures

OBJECTIVE

To compare hyaluronan and its alpha-methyl prednisolone derivative (HYC-141) with respect to their potential to directly cause tissue damage and to protect tissues from attack by reactive oxygen species.

METHODS

Cartilage samples and chondrocytes were isolated from 15-day chick embryos and were exposed to enzyme-based and activated inflammatory cell-free radical generating systems in the presence of varying concentrations of alpha-methyl prednisolone, hyaluronan, and HYC-141. Tissue and cell vitality was measured by determining the incorporation of radioactive sulphate into newly synthesized glycosaminoglycans.

RESULTS

Only alpha-methyl prednisolone caused a significant decrease in biosynthetic activity. All the tested substances were capable, to some extent, of protecting tissues and cells from damage by reactive oxygen species; HYC-141 demonstrated the greatest protective effect.

CONCLUSION

These data suggest that HYC-141 may possess certain advantages over the individual component molecules in the local treatment of arthropathies.

Antimicrobial activity of 5,6-dihydrobenzo-[a]-carbazoles. Part II

A new series of twenty-two 5,6-dihydrobenzo[a]carbazoles was synthesized, some showing good antibacterial activity. The presence and position of substituents seems to be critical for such activity.

Different effects of acute administration of aminophylline and nitroglycerin on exercise capacity in patients with syndrome X

To investigate the effects of the acute administration of aminophylline and nitroglycerin on effort ischemia, 20 patients with syndrome X underwent 3 bicycle exercise tests after sublingual nitroglycerin (0.3 mg) and after 90 minutes of oral administration of aminophylline (400 mg). Compared with the basal test, only aminophylline induced a significant increase in the time to ischemic threshold and to angina; these findings support the potential therapeutic role of this adenosine receptor blocking agents and suggest a possible role of "steal phenomenon" in the pathogenesis of effort angina in patients with syndrome X.

Abnormal response to exercise in middle-aged NIDDM patients with and without autonomic neuropathy

The cardiovascular response to exercise in middle-aged non-insulin-dependent diabetes mellitus (NIDDM) patients and the potential role of clinical characteristics and autonomic function were evaluated. One hundred and eight NIDDM patients, aged 40-65 years, were compared with a control group of 112 subjects, matched by age, sex, physical fitness, and presence of hypertension. All subjects performed a maximal exercise test. The diabetic patients completed cardiovascular autonomic neuropathy (CAN) tests: deep breathing, postural hypotension and lying to standing. There were no significant differences in total work capacity, heart rate, and blood pressure, either at rest or at peak exercise between the two groups. Diabetic patients showed significantly lower values of systolic and diastolic blood pressure during exercise, significantly slower recovery of heart rate (at 5th minute the average values were 102.7 +/- 14.1 beats min-1 vs 91.9 +/- 11.1, p < 0.001); and significantly higher proportion of blunted increase of heart rate (9.2% vs 0.9%, p < 0.001) and systolic blood pressure (9.2% vs 0.7%, p < 0.001) during exercise. No correlation between the exercise results and the main clinical characteristic (presence of hypertension, BMI, duration of diabetes, treatment, microalbuminuria, total score of CAN) was observed. These findings suggest that the cardiovascular response to exercise could be impaired also in the absence of signs of CAN. This impairment was higher in patients showing a dysfunction of orthosympathetic activity.

Non-typhoid Salmonella spp. resistant to cefotaxime

beta-Lactamases with pIs of 5.4 and 8.1 were detected by hydrolysis of ampicillin and ceftriaxone respectively among cefotaxime resistant serovars of Salmonella spp. suggesting TEM-1 and an unidentified extended spectrum beta-lactamase have spread throughout these strains in Argentina.

Antimicrobial activity of 5,6-dihydrobenzo-[a]-carbazoles

A new series of 5,6-dihydrobenzo[a]carbazoles was synthesized, some showing good antibacterial activity. The presence of a dialkylamino ethyl chain on the 2-, 3- or 4-O-substituent seems to be critical for such activity.

Usefulness of changes in exercise tolerance induced by nitroglycerin in identifying patients with syndrome X

Two exercise tests, one under basal conditions and one after sublingual nitroglycerin (NTG), were performed in 39 patients with stable angina pectoris--16 with critical coronary stenoses and 23 with normal coronary arteries (syndrome X). Under basal conditions, times at ischemic threshold, at peak exercise, and at complete ECG recovery were similar in the two groups. Peak ST depression was significantly higher in patients with coronary artery disease (CAD). In a similar proportion of patients, ST-segment depression developed earlier or at a low heart rate. Patterns of heart rate, blood pressure, and rate-pressure product during exercise and recovery were also similar. After NTG an increase in the ischemic threshold was observed in a significantly higher proportion of patients with CAD (93.8% vs 39.1%). Furthermore, a subgroup of patients with syndrome X showed a worsening of exercise performance. This suggests that NTG does not directly affect small coronary vessels. Our results confirm that no relevant differences exist in exercise responses between patients with CAD and those with syndrome X under basal conditions. NTG-induced changes in this response could be useful in identifying patients with normal coronary arteries. Moreover, this test could be used as a guide to therapeutic approaches.

Antihypertensive efficacy and tolerability of different drug regimens in isolated systolic hypertension in the elderly

The pharmacological treatment, mainly based on diuretics, of isolated systolic hypertension (ISH) has recently been shown to reduce the risk of stroke and coronary heart disease in the elderly. The purpose of this study was to compare the antihypertensive effect and tolerability of different drug regimens in elderly subjects with ISH (systolic blood pressure--SBP-- > or = 160 mmHg and diastolic blood pressure--DBP-- < 90 mmHg). A multicentre, randomized, controlled open trial was planned in the general practice setting. Four widely used treatment schedules were tested: hydrochlorothiazide 25 mg plus amiloride 2.5 mg (H+Am), nifedipine slow release 20 mg (N), atenolol 50 mg (At) and atenolol 25 mg plus chlorthalidone 6.25 mg (At+C). After a baseline evaluation, 308 patients (76.3% female, mean age 75.3 +/- 7.1 years) were randomized and followed up for 6 months. After 3 months the drug dosage was doubled if the systolic blood pressure goal (SBP < 160 mmHg and SBP reduction of at least 20 mmHg) had not been reached. Ninety-four subjects (30.5%) presented contraindications to beta-blockers. At the 3rd- and 6th-month visits all treatment groups, except At, showed a significant reduction in SBP compared to the control group; DBP showed no significant reduction in any group at any time. At the end of the follow-up the percentage of hypertensives who had reached the BP goal was 14.6% in the control group, 52.9% in H+Am, 54.8% in N, 28.6% in At and 52.2% in At+C.(ABSTRACT TRUNCATED AT 250 WORDS)