Quinapril for treatment of hypertension in Turkey: dose titration and diuretic combination treatment strategies.

BACKGROUND AND OBJECTIVE: Recently the PatenT (Prevalence, awareness, treatment and control of hypertension in Turkey) study showed that while the prevalence of hypertension in Turkey is high, effective control of BP is infrequently achieved. This study investigated the efficacy and safety of quinapril (as monotherapy or in combination with hydrochlorothiazide [HCTZ]) for achieving BP control (target <140/90 mm Hg) in Turkish subjects with mild to moderate hypertension. METHODS: Two-hundred male and female outpatients aged 19-65 years with mild to moderate hypertension (stage I or II, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 guidelines) entered this 12-week, open-label study. All subjects received quinapril 20 mg/day for 6 weeks. If BP targets were achieved at week 6, responders were maintained on 20 mg/day; if BP targets were not achieved, non-responders were randomised to quinapril 40 mg/day or quinapril 20 mg/day + HCTZ 12.5 mg/day for the remainder of the study. RESULTS: After 6 weeks, 63% of subjects achieved BP targets, and 82% of week-6 responders who continued on quinapril 20 mg/day maintained BP targets at week 12. Of the non-responders, 50% and 52% randomised to quinapril 40 mg/day or quinapril 20 mg/day + HCTZ 12.5 mg/day, respectively, went on to achieve BP targets by week 12. Safety was not compromised with increased dosages or use of combination therapy. CONCLUSION: Quinapril was an effective and safe treatment for achieving and maintaining recommended BP targets in this sample population. These findings will provide clinicians in Turkey with valuable data on the use of quinapril for effective control and management of hypertension.

The relationship between anticardiolipin antibodies and vascular access occlusion in patients on hemodialysis.

Vascular access occlusion is frequently seen in some patients on hemodialysis. There are different opinions about pathogenesis of recurrent access thrombosis. Anticardiolipin (aCL) antibodies have been suggested to be involved in thrombosis and can be found in a high proportion of patients with chronic renal failure. We investigated the relationship between vascular access occlusion and the level of aCL antibodies in hemodialysis patients. We measured serum IgG and IgM aCL antibodies and protein C levels in 50 patients on hemodialysis having no fistule thrombosis (group 1), in 33 patients on hemodialysis with fistule thrombosis (group 2), and 20 nondialyzed patients with chronic renal failure (group 3). There were no differences in age and duration on hemodialysis (p > 0.05). No significant correlation was found between protein C and platelet counts in all groups (p > 0.05). In group 1, aCL IgG and IgM were 2%. In group 2, aCL IgG and IgM were 6.06% and 0%, respectively. In group 3, aCL IgG and IgM were negative. We did not find any significant difference between aCL IgG and IgM in all groups (p > 0.05). No association was found between aCL antibodies and vascular access thrombosis in our patients on hemodialysis.

Relationship between serum leptin levels and body composition and markers of malnutrition in nondiabetic patients on peritoneal dialysis or hemodialysis.

BACKGROUND: Leptin is a protein hormone secreted by adipocytes, regulating body fat and food intake. It has been reported that serum leptin levels are high in patients with chronic renal failure, and this fact has been associated with malnutrition and body composition changes in patients on hemodialysis. This present study investigated the relationship between plasma leptin concentrations and body composition and markers of malnutrition in nondiabetic patients diagnosed with end-stage chronic renal failure, treated with continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD). METHODS: A total of 152 HD and 32 CAPD patients were enrolled into the study. The body compositions of the patients were established by utilizing a Body Composition Analyzer. Triceps skinfold thickness (TSFT) was measured by using a Harpenden Skinfold Caliper. Serum leptin level was detected by radioimmunoassay in ng/mL through employing a DPC Gambyt-CR gamma counter. Standard laboratory methods were used for measuring the remaining parameters (total protein, albumin, blood urea nitrogen, creatinine, hemoglobin, hematocrit, high-sensitivity C-reactive protein [hsCRP]). RESULTS: No significant difference was observed between the HD and CAPD groups regarding leptin levels. Leptin levels of female patients in both groups were markedly higher when compared with those of men (p = 0.001). Plasma leptin levels in total, as well as for both male and female HD and CAPD patients, significantly correlated positively with age, percent fat, fat mass, body mass index and TSFT (p = 0.001). Serum leptin levels were not found to be correlated with length of time on dialysis, lean body mass, total body water, hsCRP, total protein and albumin levels (p > 0.05). CONCLUSION: The data obtained in this study indicated that serum leptin levels could be instrumental markers in establishing body fat ratio, as well as in determining metabolic and nutritional factors in patients with chronic renal failure.

Anticardiolipin antibody positivity in diabetic patients with and without diabetic foot.

Anticardiolipin (aCL) antibodies may play a role in the enhancement of platelet aggregation and/or progression of the macrovascular diabetic complications. Also, aCL antibodies may cause or promote ischemia and thrombosis. Therefore, we aimed to investigate IgG aCL and IgM aCL antibodies positivity in type 2 diabetic patients with and without ischemic diabetic foot. In this case-control study, we examined 40 diabetic patients without diabetic foot problem and 35 diabetic patients with ischemic diabetic foot. Forty diabetic patients (19 females, 21 males) without diabetic foot served as Group 1 and 35 diabetic patients (17 females, 18 males) who had ischemic diabetic foot served as Group 2. In the control group, 35 nondiabetic healthy subjects (18 females, 17 males) were included in Group 3. The groups were similar in age and sex, which is not statistically significant (P>.05). There was no difference in the IgG aCL antibodies positivity between Groups 1 and 3 (P>.05). However, IgG aCL antibodies positivity in Group 2 was significantly higher than those of the other groups (P<.05). IgG aCL antibodies were found positive in 10% (4/40) of Group 1, 34.3% (12/35) of Group 2 and 8.6% (3/35) of Group 3. When Groups 1 and 2 were compared, the odds ratio adjusted for age, gender, hypertension, coronary artery disease history, cigarette smoking, duration of diabetes mellitus, cholesterol, and haemoglobin A(1C) (HbA1c) was 6.8 [95% confidence interval (CI), 1.41-32.66; P=.016] for aCL positivity. In conclusion, although available evidence does not prove a causal association between positivity of aCL and diabetic foot, we believe that a causal association is supported by the data obtained from this study.

Retrospective analysis of antibiotic susceptibility patterns of respiratory isolates of Pseudomonas aeruginosa in a Turkish University Hospital.

BACKGROUND: Lower respiratory tract infections due to Pseudomonas aeruginosa have a high mortality rate. Antibacterial activity of various antibiotics against P. aeruginosa isolated from each hospital depends on the variety or amount of antibiotics used in each hospital. METHOD: A total of 249 respiratory isolates of Pseudomonas aeruginosa in Sivas (Turkey) were included between January-1999 and January-2002. Isolates were tested against 14 different antibiotics by a disc diffusion method or standardized microdilution technique. RESULTS: Organisms were cultured from the following specimens: sputum (31.3%), transtracheal/endotracheal aspirates (37.8%), and bronchial lavage (30.9%). Isolates in bronchial lavage were highly susceptible to cefoperazone and aminoglycosides. Resistance to ampicillin/sulbactam was 98.8%, ticarcillin 40.1%, ticarcillin/clavulanic acid 11.2%, piperacillin 21.8%, aztreonam 66.6%, cefotaxim 75.4%, ceftriaxone 84.2%, cefoperazone 39.0%, ceftazidime 50.8%, gentamicin 57.5%, tobramycin 58.4%, amikacin 25.4%, ciprofloxacin 16.1%, and imipenem/cilastatin 21.6%. The term multidrug-resistant P. aeruginosa covered resistance to imipenem, ciprofloxacin, ceftazidime, gentamicin, and piperacillin. 1.2% of isolates were multidrug-resistant. CONCLUSIONS: These findings suggest that amikacin resistance increases progressively in Turkey. Piperacillin and ticarcillin/clavulanate were the most active agents against both imipenem- and ciprofloxacin-resistant isolates in our region.

Effect of vitamin C and zinc on osmotic fragility and lipid peroxidation in zinc-deficient haemodialysis patients.

Peroxidation of the membrane lipid structure of red blood cell leads to haemolysis and anaemia in haemodialysis patients. Dietary constituents of antioxidant vitamins and trace elements may play an important role in protecting against oxidant damage. In this study, the effects of supplementation of vitamin C and zinc on osmotic fragility and lipid peroxidation of erythrocytes were investigated in 34 zinc-deficient haemodialysis patients. Sixteen sex- and age-matched normal volunteers acted as controls. Patients were randomized to receive vitamin C (250 mg day(-1)), zinc (20 mg day(-1)) or a placebo treatment for 3 months. The levels of vitamin C, zinc, malondialdehyde (MDA) and osmotic fragility were measured initially and 3 months after supplementation. Mean serum concentration of vitamin C and zinc increased significantly in the groups at the end of the respective study periods. Supplementation with vitamin C and zinc improved osmotic fragility, and decreased the level of MDA in the groups, but some side-effects (i.e. nausea, vomiting, fever, muscle pain, weakness) were observed during the zinc treatment. The results showed that the supplementation of both treatments decreased osmotic fragilty and MDA in zinc-deficient haemodialysis patients. However, vitamin C treatment was found to be safer than zinc supplementation.

Antibiotic susceptibility patterns of respiratory isolates of Staphylococcus aureus in a Turkish university hospital.

A total of 391 respiratory isolates of Staphylococcus aureus in Sivas (Turkey) were studied between January 1999-2002. The organisms were cultured from the following specimens: throat (43%), sputum (28%), transtracheal/endotracheal aspirates (27%), and bronchial lavage (2%). The isolates were tested against 11 different antibiotics by a disk diffusion method or standardized microdilution technique. Methicillin-resistant isolates constituted 76.9% of all isolates. Most of the methicillin-resistant isolates (95.1%) were isolated from inpatients. The rate of methicillin-resistant isolates in throat, sputum, and tracheal aspirates was 17.2%, 60.1%, and 68.9%, respectively. The resistance of methicillin-resistant isolates in throat to teicoplanin was 3.4%. The methicillin-sensitive isolates were susceptible to most agents tested, while most methicillin-resistant isolates were resistant to these agents. Overall resistance to erythromycin was 61.9%, tetracycline 56.6%, gentamicin 50.7%, ofloxacin 42.0%, rifampin 40.8%, clindamycin 38.9%, chloramphenicol 19.0%, co-trimoxazole 10.2%, and vancomycin 0%.