Inhibition of angiotensin-converting enzyme with libenzapril in normotensive males.

The effect of intravenous (i.v.) libenzapril was studied in six healthy males by administering i.v. angiotensin I (AI) administered in stepwise increments of 20 ng/kg/5 min until the subjects' systolic blood pressure (SBP) had increased 20-30 mm Hg above baseline. The mean baseline infusion of 63 ng/kg/5 min resulted in a significant (P < 0.05) increase in the ratio of AII to AI plasma levels from 0.52 +/- 0.46 to 7.92 +/- 4.48 and a SBP increase of 120 +/- 7.1 to 147 +/- 5.6. Within 15 minutes of starting the 1-mg infusion of libenzapril over 1.5 hours, the AII/AI ratio decreased to baseline values, and the SBP had returned to baseline in 1 hour. Repeat AI challenges at 3.5 and 5 hours postdose did not increase SBP significantly. Even the 6.5-hour challenge demonstrated only a slight increase in SBP, with an AII/AI ratio of 0.26. At 24 hours, SBP was only 40% of the baseline response, demonstrating that libenzapril is a potent long-acting ACE inhibitor.

Taste and smell losses in HIV infected patients.

Human immunodeficiency virus (HIV-1) associated wasting is an increasingly common clinical manifestation of AIDS. The pathogenesis of wasting is multifactorial and includes reduced caloric intake as a major contributing mechanism. The perceptions of taste and smell play an important role in stimulating caloric intake and in optimizing nutrient absorption through cephalic phase reflexes. The purpose of this study was to evaluate the degree of losses in taste and smell function that occur in subjects infected with HIV. Taste and smell function was evaluated in 40 HIV infected individuals and 40 healthy control subjects matched for age, sex, race, smoking behavior, and number of years of education. Chemosensory tests administered to subjects included taste and smell detection thresholds, taste and smell memory tests, taste and smell discrimination tests, and taste and smell identification tasks. Significant differences were observed between experimental and control subjects in glutamic acid taste detection threshold (p < 0.001), quinine hydrochloride taste detection threshold (p < 0.001), menthol smell detection threshold (p < 0.001) and in the taste identification task (p = 0.006). Overall the results suggest abnormalities in the peripheral and central nervous systems, and subjective distortion of taste and smell. A significant correlation was not established between CDC classification of HIV infection and taste and smell function, although trends were observed suggesting worsening function with progression of HIV disease. These results document significant taste and smell losses in HIV infected subjects which may be of clinical significance in the development or progression of HIV associated wasting.

Clearance of bacteria and non-antigenic markers following intra-uterine inoculation into maiden mares: Effect of steroid hormone environment.

Uterine response to inoculation with Streptococcus zooepidemicus organisms (antigenic markers) and 15-mum microspheres and charcoal (non - antigenic markers) was determined in seasonally acyclic maiden mares treated with either progesterone (P) n = 4, estradiol (E) n = 4 or oil vehicle (C) n = 4. At 3, 7 and 15 d after inoculation with bacteria and the 2 non - antigenic markers, uteri were flushed and the clearance of these materials, as well as the number of white blood cells and immunoglobulin concentration, determined. P-treated mares had higher numbers of bacteria and IgA and a greater volume of purulent fluid in the uterus than E- or C-treated mares at 7 d after inoculation. Clearance of inoculated materials began within 2 h in E-treated mares, and the non-antigenic markers were completely cleared in E- and C-, but not in P-treated mares, in 3 d. This suggests that in the P-dominated uterus, reduced physical clearance may contribute to an increased susceptibility to uterine infection.

Mechanisms of activation of Na+/H+ exchange in human osteoblast-like SaOS-2 cells.

Because of the importance of pH homeostasis in bone and the current uncertainty about the mechanisms by which intracellular pH (pHi) is regulated in this tissue, we have investigated the roles of cytosolic free Ca2+ concentrations ([Ca2+]i) and protein kinase C on the activation of Na+/H+ exchange in human osteoblast-like SaOS-2 cells. [Ca2+]i and pHi were measured using Fura-2 and 2'7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein (BCECF) respectively. The basal pHi in HCO3(-)-free buffer was 7.36 +/- 0.04 units (mean +/- S.D.). Addition of ionomycin in Ca(2+)-containing buffer did not cause a rise in basal pHi; however, addition of the phorbol ester phorbol 12-myristate 13-acetate (PMA) did cause a slowly developing rise in resting pHi of 0.14 +/- 0.02 unit over 4-5 min. Nigericin, a K+/H+ ionophore, caused an abrupt fall in pHi to 6.70 +/- 0.07 units. In nigericin-pretreated cells, PMA caused a rapid rise in pHi without changing the [Ca2+]i. In acidified cells, ionomycin increased [Ca2+]i and pHi in a parallel concentration-dependent (30-500 nM) manner. This action of ionomycin occurred in both the presence and the nominal absence of extracellular Ca2+. Ionomycin-induced alkalinization depended on extracellular Na+ and was inhibited in cells incubated with hexamethylene amiloride. When the incremental increase in [Ca2+]i induced by ionomycin was blocked by preincubation with bis-(o-aminophenoxy)ethane-NNN'N'-tetra-acetic acid (BAPTA)/AM, the effect on pHi was inhibited. Staurosporine, a protein kinase C inhibitor, blocked the action of PMA on pHi, but it had no effect on the ionomycin-induced increase in pHi. The action of ionomycin was not due to osmotic shock. We conclude that SaOS-2 cells have a protein kinase C-activatable Na+/H+ antiporter that is also stimulated, in acidified cells, in a concentration-dependent fashion by transients in [Ca2+]i which act via a non-protein kinase C pathway.

Dangerous monoamine oxidase inhibitor interactions are still occurring in the 1990s.

The clinical course is described of a 28-year-old woman who was severely ill following ingestion of a Do-Do tablet (which consists of ephedrine, caffeine and theophylline), 24 h after discontinuing phenelzine treatment. Signs and symptoms were delayed for 8 h after which she developed encephalopathy, neuromuscular irritability, hypotension, sinus tachycardia, rhabdomyolysis and hyperthermia. Her illness was complicated by pneumonia and adult respiratory distress syndrome (ARDS). The management of monoamine oxidase inhibitor (MAOI) toxicity, which can arise from interactions and overdoses, is discussed. It should be remembered that, despite the increase in use of alternative and safer antidepressants, MAOI interactions still occur and unless they are managed appropriately, are potentially fatal. Patients need to be warned that restrictions apply for up to 2 weeks after stopping the medication, and doctors need to be aware that serious interactions can occur in this time period.

Imported Fasciola hepatica infection in the United States and treatment with triclabendazole.

Infection with Fasciola hepatica, a liver trematode, is not frequently reported in the United States. We describe 2 patients, both originally from Cape Verde, who illustrate the spectrum of clinical presentations of F. hepatica as well as the means of treating infection with this parasite. Patient 1 had extensive disease and underwent multiple diagnostic procedures before the correct diagnosis was reached. Patient 2, who had few symptoms, had fascioliasis diagnosed by a noninvasive evaluation. Both patients were treated with triclabendazole without experiencing significant side effects. Fascioliasis that has been imported to the United States may elude prompt or accurate diagnosis. Obtaining a detailed travel history and recognizing the clinical presentation early in the course of infection may permit timely and noninvasive identification of infection. Triclabendazole is now the recommended drug for treating for fascioliasis because of its efficacy, safety, and ease of use.

Influence of human immunodeficiency virus infection on the course of hepatitis C virus infection: a meta-analysis.

Studies have shown that rates of liver disease are higher in persons who are coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) than they are in persons with HCV alone, but estimates of risk vary widely and are based on data for dissimilar patient populations. We performed a meta-analysis to quantify the effect of HIV coinfection on progressive liver disease in persons with HCV. Eight studies were identified that included outcomes of histological cirrhosis or decompensated liver disease. These studies yielded a combined adjusted relative risk (RR) of 2.92 (95% confidence interval [CI], 1.70-5.01). Of note, studies that examined decompensated liver disease had a combined RR of 6.14 (95% CI, 2.86-13.20), whereas studies that examined histological cirrhosis had a pooled RR of 2.07 (95% CI, 1.40-3.07). There is a significantly elevated RR of severe liver disease in persons who are coinfected with HIV and HCV. This has important implications for timely diagnosis and consideration of treatment in coinfected persons.