Lercanidipine valuable effect on urine protein losses: the RED LEVEL study.

OBJECTIVE: The RED LEVEL study (REnal Disease: LErcanidipine Valuable Effect on urine protein Losses) directly compares, in an explorative fashion, the effects of lercanidipine + enalapril and amlodipine + enalapril combinations on renal parameters in hypertensive subjects. RESEARCH DESIGN AND METHODS: This was a 1 year, prospective, multi-center, randomized, open-label, blinded-endpoint (PROBE) study in hypertensive patients with albuminuria. MAIN OUTCOME MEASURES: Renal function (albuminuria, serum creatinine, creatinine clearance, estimated glomerular filtration rate and proteinuria); blood pressure. RESULTS: Albuminuria was significantly reduced, compared with baseline values, with the lercanidipine + enalapril combination over the entire study period; at month 3, month 6 and month 12, changes from baseline were: -162.5 (p-value = 0.0439), -425.8 (p-value = 0.0010), -329.0 (p-value = 0.0011) mg/24 h), respectively. On the other hand, this improvement was not observed with enalapril + amlodipine. Other parameters of renal function such as serum creatinine, creatinine clearance, estimated glomerular filtration rate and proteinuria did not change over the study. Both lercanidipine + enalapril and amlodipine + enalapril significantly reduced systolic and diastolic blood pressure values from baseline all over the study period with no significant differences between groups. Safety outcomes were comparable between the two groups. CONCLUSIONS: Overall, the results of this explorative study lend support to the anti-albuminuric effect of the lercanidipine + enalapril combination and to the long term renal-protective effects of this combination in patients with hypertension.

Hypertension in the elderly.

Data collected over a 30-year period have demonstrated the increasing prevalence of hypertension with age. Aging is an inevitable part of life and brings along two inconvenient events: physiologic decline and disease state. High blood pressure (HBP) is an important risk factor for cardiovascular morbidity and mortality, particularly in the elderly. It is a significant and often asymptomatic chronic disease, which requires optimal control and persistent adherence to prescribed medication to reduce the risks of cardiovascular, cerebrovascular and renal disease. Hypertension in the elderly patients represents a management dilemma to geriatric and cardiovascular specialists and other practitioners. Furthermore, with the wide adoption of multiple drug strategies targeting subgroups of hypertensive patients with specific risk conditions to lower blood pressure (BP), difficult questions arise about how aggressive treatment of elderly patients should be. The purpose of the following chapter article is to review the pathophysiology of aging as well as the epidemiology and the clinical assessment of high blood pressure (HBP) in older people.

Human NKCC2 cation­Cl­ co-transporter complements lack of Vhc1 transporter in yeast vacuolar membranes.

Cation­chloride co-transporters serve to transport Cl­ and alkali metal cations. Whereas a large family of these exists in higher eukaryotes, yeasts only possess one cation­chloride co-transporter, Vhc1, localized to the vacuolar membrane. In this study, the human cation­chloride co-transporter NKCC2 complemented the phenotype of VHC1 deletion in Saccharomyces cerevisiae and its activity controlled the growth of salt-sensitive yeast cells in the presence of high KCl, NaCl and LiCl. A S. cerevisiae mutant lacking plasma-membrane alkali­metal cation exporters Nha1 and Ena1-5 and the vacuolar cation­chloride co-transporter Vhc1 is highly sensitive to increased concentrations of alkali­metal cations, and it proved to be a suitable model for characterizing the substrate specificity and transport activity of human wild-type and mutated cation­chloride co-transporters.

Peripheral arterial disease associated with caries and periodontal disease.

BACKGROUND: Peripheral arterial disease (PAD) is an important cardiovascular disorder of the peripheral arteries. Chronic infections, such as periodontitis, may play an important role in the etiology and pathophysiology of PAD and other cardiovascular conditions. Recently, Streptococcus mutans has been found with high frequency in atheromatous plaques. The aim of this study is to evaluate the possible clinical and microbiologic association between PAD and periodontitis and dental caries. METHODS: Thirty patients with PAD and 30 control individuals were selected. PAD and its severity were established by the use of the ankle-brachial index (ABI). Clinical attachment loss (AL); probing depth; decayed, missing, and filled teeth (DMFT) index; and C-reactive protein (CRP) levels were evaluated. The presence of bacterial DNA from Streptococcus mutans, Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, Treponema denticola, and Aggregatibacter actinomycetemcomitans was identified by polymerase chain reaction in subgingival biofilm and serum. RESULTS: Patients with ≥30% AL ≥ 4 mm had six-fold increased risk of having PAD (odds ratio = 8.18; 95% confidence interval = 1.21 to 35.23; P = 0.031). There was statistical difference in the CRP (P = 0.0413) and DMFT index (P = 0.0002), with elevated number of missing teeth (P = 0.0459) in the PAD group compared with the control group. There were no significant differences in the frequency of bacteria in serum and subgingival plaque. CONCLUSION: There was a positive relationship between periodontitis based on AL and PAD determined by the ABI (odds ratio = 8.18).

Caries, periodontal disease and tooth loss in patients with diabetes mellitus types 1 and 2.

The aim of this work was to determine the frequency of caries, periodontal disease and tooth loss in patients affected by diabetes mellitus types 1 and 2. It was a cross-sectional study involving 175 subjects distributed in the following groups: (1) 35 patients with diabetes type 1 (glycosylated hemoglobin values from 6.5%-7%), (2) 35 patients with diabetes type 1 (values of glycosylated hemoglobin higher than 7%), (3) 35 subjects without diabetes mellitus type 1, (4) 35 patients with diabetes type 2 and (5) 35 subjects without diabetes mellitus type 2. The following clinical parameters were evaluated for all the subjects who participated in the study: frequency of caries, filled teeth, missing teeth, prosthetic restoration, bacterial dental plaque, calculus index, probing depth and attachment level. On comparing the groups of patients with diabetes type 1 to the control group, there were no statistically significant differences among any of the study variables. On comparing the group of patients with diabetes type 2 to the control group, there were statistically significant differences in the variables missing teeth (p=0.0134), calculus (p=0.0001), probing depth (p=0.0009) and attachment level (p=0.0093). The variable periodontal disease showed statistically significant dIfferences in the group of patients with diabetes type 2. Prevention, supervision and review of the oral health of patients with diabetes (types 1 and 2) are needed in order to prevent oral alterations.

Cytomegalovirus excretion in children attending day-care centers.

BACKGROUND: Healthy children attending day-care centers (DCC) may excrete cytomegalovirus (CMV) frequently. Mothers of children excreting CMV are at higher risk for acquiring this infection than mothers of children not excreting CMV. Despite the increased attendance to DCC by children there is a lack of information regarding CMV infection in Mexico. METHODS: Prospective determination of CMV excretion in saliva of children attending public and private DCC. Three saliva samples were collected during a 2-month follow-up period from participating children and the presence of CMV was determined by viral culture. Demographic features of children and DCC type were taken into account when comparing children with and without CMV excretion. RESULTS: One hundred fifty-two children participated in the study (84 from public and 68 from private DCC). Overall, 17 (11.2%) children excreted CMV during the study period. Excretion rates varied between DCC from 3.1 to 31.3%. Children from private DCC were as likely to excrete CMV as children from public DCC. There were no demographic or clinical features of children associated with viral excretion. CONCLUSIONS: CMV was excreted on an average of 11.2% children attending DCC. The type of DCC or other demographic features were not associated with the likelihood of CMV excretion. CMV seronegative mothers of children who attend DCC need to be aware of the possibility of CMV acquisition and transmission in DCC.