Improved cerebral vasoreactivity after statin administration in healthy adults.

BACKGROUND AND PURPOSE: Significant improvements of cerebral vasomotor reactivity during statin treatment were found in patients with cerebral small-vessel disease. The authors analyzed the cerebrovascular CO(2) reactivity before and after statin administration in healthy adults using a case-control study design. METHODS: The mean cerebral blood flow velocity (CBFV) of both middle cerebral arteries and the vasomotor reserve capacity (VMRC) were measured by repeated and simultaneous bilateral transcranial Doppler sonography in 25 healthy adults (7 men, mean age 28.8 years [95% confidence interval (CI): 25.7; 31.9]) before, during (days 1, 3, 7, and 14), and after administration of 40 mg pravastatin for 14 days as compared to 10 healthy control persons (4 men, mean age 30.6 years [95% CI: 22.9; 38.3]). The VMRC was calculated off-line as the percentage change of CBFV per 1% increase in end-tidal CO2 by a blinded investigator. RESULTS: In the statin group, 5 persons were excluded from further analysis. In the remaining 20 volunteers, the authors observed a highly significant effect of statin administration on VMRC (P = .002). The VMRC was significantly increased after statin administration on day 7 as compared to the initial value (3.03 [95% CI: 2.67; 3.38] vs 2.64 [95% CI: 2.41; 2.86]; P = .04). The effect was most pronounced in patients with lower initial VMRC values. In the control group, the VMRC did not differ significantly from baseline at different time intervals. CONCLUSIONS: The findings indicate an improvement of cerebral vasoreactivity even after short-term statin administration in healthy adults. However, this effect was related to baseline vasoreactivity.

Pattern of sexually transmitted diseases in a Malagasy population.

BACKGROUND: Data concerning the spectrum and antimicrobial susceptibility of STDs in Madagascar are scarce. OBJECTIVES: Improvement of STD patient management in Madagascar. GOAL OF THE STUDY: Assessment of the spectrum of STDs and improvement of therapy. STUDY DESIGN: Etiologic study of 400 patients (169 men, 231 women) under consultation at the major STD service in Antananarivo for one or more of the STD syndromes, urethral discharge, cervicovaginal discharge, genital ulcers, or condylomata according to a fixed diagnostic schedule. RESULTS: Of genital ulcers, syphilis accounted for 46%, lymphogranuloma venereum for 24%, chancroid for 16%, and herpes for 1%. Of the syphilis cases, 51% presented as condyloma lata. Discharge was found in 124 men and 210 women. Counting concomitant infections separately, gonorrhea occurred in 69% of the men and 20% of the women with discharges, chlamydia infection in 42% and 52%, trichomoniasis in 9% and 31%, candidiasis in 12% and 30%. Bacterial vaginosis was found in 37% of the women with discharges. In 32% of male and 71% of female gonorrhea cases, there was concurrent chlamydia infection. Infection with HIV 1 or 2 was not detected. Determination of the antibiotic susceptibility of Neisseria gonorrhoea revealed high efficacy of ampicillin, ciprofloxacin, and spectinomycin; but frequent resistance to tetracycline and cotrimoxazole. CONCLUSIONS: High priority should be given to the management of infections with chlamydia and with Treponema pallidum as well as to educational measures to increase awareness of genital ulcer disease.

PIP: Between November 1992 and April 1993, interviews were conducted with 400 patients (169 men, 231 women) aged 14-52 years at the sexually transmitted disease (STD) clinic of the Institut d'Hygiene Sociale in Antananarivo, Madagascar, to determine the pattern of STDs and to improve treatment of the leading STDs. The 400 patients presented with 434 syndromes. 124 men had urethral discharge. 210 women had cervicovaginal discharge. 43 men and 18 women had genital ulcers. Clinicians could not establish a diagnosis in 33 patients. 171 patients had more than one infection. Chlamydia infection was the most common infection associated with another STD (gonorrhea in 22% of men and 11% of women with discharge, trichomoniasis in 2.4% of men and 13% of women, candidiasis in 1.6% of men and 9% of women, and bacterial vaginosis in 15% of women with discharge). Gonorrhea was the most common etiology for male discharge (69%) while chlamydia infection was for female discharge (52%). Women with discharge were more likely than men with discharge to have chlamydia infection (52% vs. 42%), trichomoniasis (30% vs. 9%; p 0.00001), and candidiasis (32% vs. 12%; p 0.00001). 37% of women with discharge had bacterial vaginosis. Chlamydia infection was the most common STD in this population (45%). 32% of male and 71% of female gonorrhea cases also had chlamydia infection. 70 patients had syphilis. 36 of them had secondary stage syphilis. No one had HIV-1 or HIV-2 infection. The most efficacious antibiotics for gonorrhea were ampicillin, ciprofloxacin, and spectinomycin (100% susceptibility). 31% and 26% of isolates were susceptible to tetracycline and cotrimoxazole, respectively. Public facilities in Madagascar do not have the capabilities to diagnosis chlamydia, resulting in many untreated chlamydia cases. These findings stress the need to improve combined treatment of gonorrhea and chlamydia infection and for educational efforts to increase awareness of genital ulcer disease.