Baricitinib as rescue therapy in a patient with COVID-19 with no complete response to sarilumab.

A patient with COVID-19-related severe respiratory failure, with insufficient response to an antiretroviral therapy, hydroxychloroquine and Interleukin-6 (IL-6) antagonist therapy, presented a prompt resolution of the respiratory function and improvement in the radiological picture after baricitinib at an oral dose of 4 mg per day for 2 weeks.

Results of the anatomic cementless prosthesis with different types of hydroxyapatite coating.

This study evaluates the clinical and radiographic results and the bone-implant osteointegration obtained with the Anatomic (Zimmer, Warsaw, Ind) cementless total hip prosthesis using three different types of surface coating. Two hundred twenty-seven patients underwent total hip arthroplasty using the Anatomic prosthesis. Patients were divided into groups based on the type of surface coating: in group A (69 patients), prostheses were uncoated; in group B (90 patients), the metaphyseal region of the prostheses was coated with calcicoat (a mixture of hydroxyapatite and tricalcium phosphate) (Zimmer); and in group C (68 patients), the fiber mesh and proximal stem of the prostheses were coated with calcicoat. Prostheses coated with calcicoat yielded better clinical and radiographic results than uncoated prostheses, especially in regard to thigh pain. No significant difference was observed between groups B and C. These results obtained with the Anatomic prosthesis are promising and encourage the use of implants coated with calcicoat.

Antihypertensive efficacy of manidipine and enalapril in hypertensive diabetic patients.

Recent studies showed that in diabetic hypertensive patients, administration of angiotensin-converting enzyme (ACE)-inhibitors or calcium antagonists can effectively lower blood pressure (BP) and prevent diabetes-related cardiovascular complications with no adverse metabolic effects. We sought to assess the antihypertensive and metabolic effects of the new dihydropyridine calcium antagonist manidipine (M) in patients with diabetes mellitus and essential hypertension as compared with the ACE inhibitor enalapril (E). After 3 weeks of placebo, 101 (62 men; age range, 34-72 years) hypertensives with type II diabetes mellitus were randomized to M 10-20 mg or E 10-20 mg, od, for 24 weeks. At the end of the placebo period and the active-treatment phase, BP was measured with a mercury sphygmomanometer (office, O) and over the 24 h by ambulatory (A) monitoring. ABP recordings were analyzed to obtain 24-h, day (6 a.m. to midnight), and night (midnight to 6 a.m.) average systolic (S) and diastolic (D) BP and heart rate (HR) values. Homogeneity of the antihypertensive effect over the 24 h was assessed by the smoothness index [SI: i.e., the ratio between the average of the 24 hourly BP changes after treatment and the corresponding standard deviation (the higher the SI, the more uniform is the BP control by treatment over the 24 h]. The O SBP and DBP were significantly (p < 0.01) and similarly reduced by M (16 +/- 10 and 13 +/- 6 mm Hg, n = 49) and E (15 +/- 10 and 13 +/- 6 mm Hg, n = 45). The percentage of patients whose O DBP was reduced < or = 85 mm Hg (i.e., the value indicated to be the optimal DBP goal in diabetic hypertensives) was similar for M (37%) and E (40%). The reduction of 24-h BP also was similar between M (n = 38) and E (n = 38) for both drugs (systolic, 6 +/- 11 and 8 +/- 10 mm Hg; diastolic, 5 +/- 8 and 5 +/- 7; NS, M vs. E). The antihypertensive effect was distributed in a similar homogeneous fashion throughout the dosing interval, as shown by the similar SI values (M, 0.6 +/- 1.2 for SBP and 0.6 +/- 0.9 for DBP; E, 0.6 +/- 0.8 for SBP and 0.5 +/- 0.7 for DBP; NS, M vs. E). O and A HR were unchanged by either treatment. Markers of glucose and lipid metabolism and renal function were not significantly modified by treatment both with M and with E. In the diabetic hypertensives, M was as effective and metabolically neutral as the ACE-inhibitor E.

Twenty-four-hour ambulatory blood pressure monitoring and antihypertensive treatment: focus on ACE inhibitors.

The use of ambulatory blood pressure monitoring in clinical studies offers some advantages in comparison to the clinic blood pressure measurement. In fact, this approach does not induce any alerting reaction and provides 24-h blood pressure values that are more reproducible and not affected by the placebo effect. This allows a better evaluation of blood pressure under antihypertensive treatment and an optimization of the number of patients to be studied in pharmacologic trials. In a recent double-blind, parallel-group study, ambulatory blood pressure monitoring was used to investigate the antihypertensive efficacy of a new angiotensin-converting enzyme inhibitor, trandolapril, in 62 mild and moderate hypertensive patients. After a washout period, patients received trandolapril, 2 mg o.d., or placebo for 6 weeks, followed by a second washout period. Clinic and 24-h blood pressures were assessed at the end of each period. In comparing the pre- and post-treatment period, trandolapril significantly reduced clinic and 24-h systolic and diastolic blood pressures. The fall was evident throughout the 24 h and was statistically significant also in the last 4 h of blood pressure monitoring. The placebo group did not show any significant blood pressure change. Thus, trandolapril, 2 mg once daily, is effective in reducing blood pressure. Its efficacy over 24 h is better documented by 24-h blood pressure monitoring than by isolated clinic blood pressure measurement.

Evaluation of the antihypertensive effect of once-a-day trandolapril by 24-hour ambulatory blood pressure monitoring. The Italian Trandolapril Study Group.

The aim of this study was to evaluate the effects of trandolapril on 24-hour blood pressure in patients with mild-to-moderate essential hypertension. After a washout period of 4 weeks, 42 patients were randomized to receive 2 mg of trandolapril once daily and 20 to receive placebo in a double-blind fashion for 6 weeks. This was followed by a second washout period of 4 weeks. At the end of each period, clinic blood pressure was assessed at 24 hours after the last dose and 24-hour ambulatory blood pressure was measured noninvasively, taking blood pressure readings every 15 minutes during the day and every 20 minutes during the night. Two patients were dropped out before any blood pressure evaluation under treatment. Analysis of ambulatory blood pressure was performed in 48 patients who met the criteria for the minimal number of ambulatory blood pressure data (2 values per hour during the day and 1 value per hour in the night). In the trandolapril-treated group (n = 41) clinic systolic/diastolic blood pressures were 159.8 +/- 2.0/102.4 +/- 0.8, 146.8 +/- 2.3/94.8 +/- 1.1, and 155.7 +/- 2.0/99.2 +/- 0.7 mm Hg in the pretreatment, treatment, and post-treatment periods, respectively. The corresponding values for 24-hour mean blood pressure (n = 31) were 139.5 +/- 1.9/91.2 +/- 1.5, 131.0 +/- 2.0/84.3 +/- 1.2, and 139.7 +/- 1.8/90.9 +/- 1.1 mmHg. The differences between the lower treatment, versus the higher pre- and post-treatment, values were all statistically significant (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Nifedipine and isometric exercise. Evaluation of the pressure response in hypertensive patients]. / Nifedipina e sforzo isometrico. Valutazione della risposta pressoria negli ipertesi.

Because of isometric efforts are a normal component of the usual life, we studied 35 patients suffering from mild and moderate essential hypertension, by means of an isometric exercise test, using the "handgrip method". The purpose of the experimental work was the evaluation of pressure changes at the top of an isometric stress in basal conditions and the demonstration of the protective effect against pressure increase of nifedipine, acutely administered (20 mg sublingual). The results largely confirmed the usefulness of nifedipine in the treatment of hypertension at rest and at the top of an isometric exercise. Moreover, the pressure increase during the same effort after nifedipine administration is smaller than during a therapy with others antihypertensive drugs.

No effect of ketoconazole on thyroid function of normal subjects and hypothyroid patients.

To investigate a possible inhibitory effect of the antifungal agent ketoconazole on thyroid function, five patients with hypothyroidism and ten normal subjects were treated with ketoconazole at high doses (600 mg/daily in three 20-mg oral doses) for four weeks. The thyroid-stimulating hormone (TSH), and also TT3, TT4, FT3 and FT4, were measured before and after the end of treatment. In all of the subjects of our study, both normal and hypothyroid patients no significant modifications of circulating thyroid hormones and TSH were detected. Both normal and hypothyroid subjects did not show clinical changes of thyroid function as compared with the basal condition. These findings do not support any inhibitory effect of ketoconazole on the synthesis of thyroid hormones and thyroid function.

No effect of ketoconazole on thyroid function of normals and thyrotoxic patients.

To investigate a putative inhibitory effect of the antifungal agent ketoconazole on thyroid function, five patients with thyrotoxicosis and ten normal subjects were treated with ketoconazole at high doses (600 mg daily in three 200 mg oral doses) for four weeks. TSH, TT3, TT4FT3 and FT4 were measured before and after the end of treatment. In all of the normal subjects no significant modifications of circulating thyroid hormones and TSH were detected. In patients with thyrotoxicosis an increase of the levels of circulating thyroid hormones and a worsening of clinical signs were observed. However, this behaviour could not be related to an action of the drug since it not differ from the normal evolution of untreated hyperfunctional thyroid disease. These findings confirm the lack of any inhibitory effect of ketoconazole on the synthesis of thyroid hormones and thyroid function.

Clinical and hormonal effects of ketoconazole on hirsutism in women.

Twelve women affected by functional postpuberal hirsutism were administered daily with 400 mg of ketoconazole. A significant reduction in the levels of concentration of circulating androgens (T, DEA-S, D4) was observed. A rapid clinical improvement of hirsutism and acne was noted and was even appreciable after treatment had been completed. This study is a further confirmation of the prevalent antiandrogenic action of ketoconazole, seen in its inhibiting effect on steroid synthesis in the adrenal and gonadal glands, and as such indicates that this drug is a useful alternative treatment of hirsutism in women.

[Carcinoid heart disease. Report of a case with triple valvular lesion (author's transl)]. / Cardiopatia da carcinoide. Presentazione di un caso con triplice lesione valvolare.

A case of carcinoid syndrome, stemming from a tumor of the large intestine with hepatic metastases, is reported. Clinical features included cardiac disease with triple valvular lesion: tricuspid insufficiency with stenosis, pulmonary artery stenosis and mitral insufficiency. More recent views about the pathogenesis of the cardiac involvement in the carcinoid syndrome are reported, and the cardiac therapy is discussed.

[Na K ATPase changes in the erythrocyte membrane in subjects treated with inosine]. / Modificazioni della Na +K+ATPasi di membrana nelle emazie di soggetti trattati con inosina.

The effect of inosine on red cell membrane Na+K+ATPase in lead poisoning was studied in 13 subjects. In addition to enzyme damage, an appreciable increase in enzyme level was noted after 100 mg inosine i.m. for 20 days. It is felt that this form of management is useful in lead poisoning as a means of treating and preventing anaemia.