Enalapril versus bendroflumethiazide in type 2 diabetes complicated by hypertension

In a double-blind, double-dummy, randomized, multi-centre study, the effects of bendroflumethiazide vs. enalapril on blood pressure, glycaemic control, lipoprotein concentrations and albuminuria were compared in non-proteinuric, hypertensive type 2 diabetic patients; they were treated for 20 weeks with either bendroflumethiazide 2.5-5.0 mg (n = 59) or enalapril 10-20 mg (n = 55). Age, fasting plasma glucose, HbA1c and BMI were similar in the groups. Systolic and diastolic blood pressure were reduced in both groups. Bendroflumethiazide was accompanied by minor but significant elevations in fasting plasma glucose and serum C-peptide. HbA1c was increased during both treatments. Lipoproteins and urinary albumin/creatinine ratio were stable. Bendroflumethiazide caused a decrease in serum potassium and an increase in serum urate. No significant correlations were observed between the decline in blood pressure and changes in the metabolic risk factors. Baseline levels of age, sex, BMI, blood pressure or urinary albumin/creatinine ratio were not related to changes in blood pressure, metabolic parameters or urinary albumin/creatinine ratio.     

Effects of a behavioural rhythm on conception probability and pregnancy outcome

This paper concerns a behaviour-driven weekday rhythm in conception rates in a large natural human population. From 1978 to 1991, North Carolina normal live single births arose from menstrual cycles which began on Monday in clear excess over other weekdays. Cycles beginning on Friday were also in excess. Cycles starting on Saturday and Sunday, or Wednesday and Thursday, each represented significantly less than one in seven of weekly totals. The source of the observed synchrony was a Sunday morning peak of coital frequency. Average cycles which began on Monday had their most fertile day on the most likely day for intercourse, translating a weekly insemination rhythm into a weekly conception rate rhythm. The secondary conception peak in Friday-onset cycles increased with age, to become the major peak for mothers aged > 30 years. We interpret this to represent a previously unreported second type of cycle with a modal follicular phase length of 10 days, the frequency of which increases with age. Several large groups of anomalous human births depart significantly from the weekday rhythm of normal conceptions. These outcomes parallel results of experimental interference with fertilization timing in estruative mammals. We believe that this implicates anomalous fertilization timing in several of the most numerous anomalies of human prenatal development.     

Disappearing left atrial vegetation in an intravenous drug abuser

Isolated left atrial mural endocarditis is rare. We report a case where the diagnosis was made clinically and supported by blood cultures and transoesophageal echocardiography. Appropriate intravenous antibiotics were administered and serial transoesophageal echocardiograms helped in monitoring the decrease in size and final disappearance of the vegetation, thus avoiding the need for surgical intervention.     

Evaluation of the aortic root by MRI: insights from patients with homozygous familial hypercholesterolemia

Hepatitis C chronically infects approximately 1.5% of Americans and is the most common clinical problem facing hepatologists. Since the virus was initially described in 1989, development of an effective therapy has been challenging. Although several different therapeutic agents have been used, no therapy has been shown to reliably eradicate the virus. Interferon-alpha, a cytokine with immunostimulatory and anti-viral properties, has become the therapy of choice for patients with chronic hepatitis C infection. Trials assessing the efficacy of interferon-alpha have characterized host and viral factors predictive of responses to treatment. A thorough understanding of these predictive factors is requisite to providing cost-effective therapeutic decisions for the patient with chronic hepatitis C infection.     

Low-pressure pyrolysis studies of a new phosphorus precursor: Tertiarybutylbis(dimethylamino)phosphine

The low pressure decomposition of tertiarybutylbis(dimethylamino) phosphine, (t-Bu)P(NMe₂)₂, (TBBDMAP), has been studied on quartz and deposited GaP and InP surfaces. This new phosphorus precursor has been found to pyrolyze on quartz surfaces at much lower temperatures than the related compounds tertiarybutylphosphine, (t-Bu)PH₂, (TBP) and tris(dimethylamino)phosphorus, P(NMe₂)₃, (TDMAP). In contrast to the results obtained for TDMAP, GaP and InP surfaces decrease the decomposition temperature of TBBDMAP only slightly. The TBBDMAP reaction products were dimethylamine, methylmethyleneimine, and isobutylene, consistent with previous pyrolysis studies of TBP and TDMAP.     

Giardiasis. Issues in diagnosis and management

Giardia lamblia is a frequent cause of diarrhea throughout the United States and the world. Advances in basic biology indicate that different strains of Giardia exist, that mammals can be infected with G. lamblia-type organisms, and that secretory IgA is important to host protection. Although water remains the most common mode of transmission of Giardia, there has been an increase in the number of person-to-person cases, especially related to children in day care, as well as an increase in food-borne cases. New antigen detection assays have improved the ability to diagnose Giardia in the stool and make it unlikely that duodenal sampling will be necessary. Metronidazole has become the drug of choice for most cases of giardiasis because of its efficacy, favorable tolerance, and availability. For pregnant women who require treatment, a non-absorbable aminoglycoside, paromomycin, may be tried first and metronidazole used if initial treatment fails.     

Aldosterone and dexamethasone stimulate calcineurin activity through a transcription-independent mechanism involving steroid receptor-associated heat shock proteins

1. PD 81,723 has been shown to enhance binding of adenosine to A1 receptors by stabilizing G protein-receptor coupling ('allosteric enhancement'). Evidence has been provided that in the perfused hearts and isolated atria PD 81,723 causes a sensitization to adenosine via this mechanism. 2. We have studied the effect of PD 81,723 in guinea-pig isolated atrial myocytes by use of whole-cell measurement of the muscarinic K+ current (I[K(ACh)]) activated by different Gi-coupled receptors (A1, M2, sphingolipid). PD 81,273 caused inhibition of I[K(ACh)] (IC50 approximately 5 microM) activated by either of the three receptors. Receptor-independent I[K(ACh)] in cells loaded with GTP-gamma-S and background I[K(ACh)], which contributes to the resting conductance of atrial myocytes, were equally sensitive to PD 81,723. At no combination of concentrations of adenosine and PD 81,723 could an enhancing effect be detected. 3. The compound was active from the outside only. Loading of the cells with PD 81,723 (50 microM) via the patch pipette did not affect either I[K(ACh)] or its sensitivity to adenosine. We suggest that PD 81,723 acts as an inhibitor of inward rectifying K+ channels; this is supported by the finding that ventricular I(K1), which shares a large degree of homology with the proteins (GIRK1/GIRK4) forming I[K(ACh)] but is not G protein-gated, was also blocked by this compound. 4. It is concluded that the functional effects of PD 81,723 described in the literature are not mediated by the A1 adenosine receptor-Gi-I[K(ACh)] pathway.