Efficacy of Aliskiren/Hydrochlorothiazide Combination for the Treatment of Hypertension: A Meta-Analytical Approach

Background: Single-pill combinations of aliskiren/hydrochlorothiazide have recently been approved by the European Medicines Agency for the treatment of hypertension. Objective: This study aimed to assess the antihypertensive efficacy of aliskiren/hydrochlorothiazide combination in reducing systolic and diastolic blood pressure in hypertensive patients. Methods: A search in International Pharmaceutical Abstracts, MEDLINE, The Cochrane Library and ISI Web of Knowledge was performed from 2000 to November 2009, to identify randomized, double-blind, clinical trials using aliskiren/hydrochlorothiazide for the treatment of hypertension. Studies were included if they evaluated the antihypertensive efficacy of aliskiren/hydrochlorothiazide in patients with mild or moderate essential hypertension and age 18 years. The meta-analytical approach calculated the weighted average reductions of systolic and diastolic blood pressure for each daily dosage combination. Results: We included 5 clinical trials testing several combinations of aliskiren/hydrochlorothiazide and containing data on 5448 patients. In all studies blood pressure was assessed at inclusion (baseline) and after 8 weeks of therapy. Blood pressure reductions and control rates were significantly (p < 0.05) higher with the aliskiren/hydrochlorothiazide combinations than with placebo and the same doses of aliskiren or hydrochlorothiazide alone. The weighted mean reductions (mm Hg) from baseline of systolic and diastolic blood pressure for each aliskiren/hydrochlorothiazide combination were: -15.8/- 10.3 (150/25 mg); -15.9/-11.8 (300/12.5 mg); -16.9/-11.6 (300/25 mg). Blood pressure control rates (%) for the above combinations were, at least, respectively: 43.8, 50.1 and 51.9. Conclusions: Aliskiren/hydrochlorothiazide provided clinically significant additional blood pressure reductions and improved blood pressure control rates over aliskiren or hydrochlorothiazide monotherapy.We thank the Fundação para a Ciência e a Tecnologia (FCT) for supporting the fellowship grant SFRH/BD/36756/ 2007 to Manuel Morgado

Traumatologia renal nos HUC: experiência de treze anos

Os autores fazem uma revisão da casuística de traumatologia renal da sua instituição. Analisam-se 152 traumatismos renais ocorridos em 13 anos avaliando-se a classificação, mecanismo causal, etiologia, sintomatologia, estudo imagiológico, lesões associadas, tratamento, complicações e evolução

Blood pressure control and antihypertensive pharmacotherapy patterns in a hypertensive population of Eastern Central Region of Portugal

<p>Abstract</p> <p>Background</p> <p>Interventions to improve blood pressure control in hypertension have had limited success in clinical practice despite evidence of cardiovascular disease prevention in randomised controlled trials.</p> <p>The objectives of this study were to evaluate blood pressure control and antihypertensive pharmacotherapy patterns in a population of Eastern Central Region of Portugal, attending a hospital outpatient clinic (ambulatory setting) for routine follow-up.</p> <p>Methods</p> <p>Medical data of all patients that attended at least two medical appointments of hypertension/dyslipidemia in a university hospital over a one and a half year period (from January 2008 to June 2009) were retrospectively analysed. Demographic variables, clinical data and blood pressure values of hypertensive patients included in the study, as well as prescribing metrics were examined on a descriptive basis and expressed as the mean ± SD, frequency and percentages. Student's test and Mann-Whitney rank sum test were used to compare continuous variables and χ²test and Fisher exact probability test were used to test for differences between categorical variables.</p> <p>Results</p> <p>In all, 37% of hypertensive patients (n = 76) had their blood pressure controlled according to international guidelines. About 45.5% of patients with a target blood pressure <140/90 mmHg (n = 156) were controlled, whereas in patients with diabetes or chronic kidney disease (n = 49) the corresponding figure was only 10.2% (<it>P </it>< 0.001). Among patients initiating hypertension/dyslipidemia consultation within the study period 32.1% had stage 2 hypertension in the first appointment, but this figure decreased to 3.6% in the last consultation (<it>P </it>= 0.012). Thiazide-type diuretics were the most prescribed antihypertensive drugs (67%) followed by angiotensin receptor blockers (60%) and beta-blockers (43%). About 95.9% patients with comorbid diabetes were treated with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker.</p> <p>Conclusions</p> <p>Clinically important blood pressure decreases can be achieved soon after hypertension medical appointment initiation. However, many hypertensive patients prescribed with antihypertensive therapy fail to achieve blood pressure control in clinical practice, this control being worse among patients with diabetes or chronic kidney disease. As pharmacotherapy patterns seem to coincide with international guidelines, further research is needed to identify the causes of poor blood pressure control.</p

Evidence for the evolutionary steps leading to mecA-mediated ß-lactam resistance in staphylococci

The epidemiologically most important mechanism of antibiotic resistance in Staphylococcus aureus is associated with mecA–an acquired gene encoding an extra penicillin-binding protein (PBP2a) with low affinity to virtually all β-lactams. The introduction of mecA into the S. aureus chromosome has led to the emergence of methicillin-resistant S. aureus (MRSA) pandemics, responsible for high rates of mortality worldwide. Nonetheless, little is known regarding the origin and evolution of mecA. Different mecA homologues have been identified in species belonging to the Staphylococcus sciuri group representing the most primitive staphylococci. In this study we aimed to identify evolutionary steps linking these mecA precursors to the β-lactam resistance gene mecA and the resistance phenotype. We sequenced genomes of 106 S. sciuri, S. vitulinus and S. fleurettii strains and determined their oxacillin susceptibility profiles. Single-nucleotide polymorphism (SNP) analysis of the core genome was performed to assess the genetic relatedness of the isolates. Phylogenetic analysis of the mecA gene homologues and promoters was achieved through nucleotide/amino acid sequence alignments and mutation rates were estimated using a Bayesian analysis. Furthermore, the predicted structure of mecA homologue-encoded PBPs of oxacillin-susceptible and -resistant strains were compared. We showed for the first time that oxacillin resistance in the S. sciuri group has emerged multiple times and by a variety of different mechanisms. Development of resistance occurred through several steps including structural diversification of the non-binding domain of native PBPs; changes in the promoters of mecA homologues; acquisition of SCCmec and adaptation of the bacterial genetic background. Moreover, our results suggest that it was exposure to β-lactams in human-created environments that has driven evolution of native PBPs towards a resistance determinant. The evolution of β-lactam resistance in staphylococci highlights the numerous resources available to bacteria to adapt to the selective pressure of antibiotics

X-ray diffraction and Raman study of nanogranular BaTiO3-CoFe2O4thin films deposited by laser ablation on Si/Pt substrates

Nanocomposite thin films composed by (BaTiO3)1-x-(CoFe2O4)x with different cobalt ferrite concentrations (x) have been deposited by pulsed laser ablation on platinum covered Si(001) substrates. The films structure was studied by X-ray diffraction and Raman spectroscopy. It was found that the CoFe2O4 phase unit cell was compressed along the growth direction of the films, and it relaxed with increasing x. The opposite behavior was observed in the BaTiO3 phase where the lattice parameters obtained from the X-ray measurements presented a progressive distortion of its unit cell with increasing x. The presence of the strain in the films induced a blueshift of the Raman peaks of CoFe2O4 that decreased with increasing CoFe2O4 concentration. Cation disorder in the cobalt ferrite was observed for lower x, where the nanograins are more isolated and subjected to more strain, which was progressively decreased for higher CoFe2O4 content in the films.This work has been financially supported by the Portuguese Foundation for Science and Technology (FCT), through the project POCI/CTM/60181/2004 and the Bilateral Research Action nºB48-06 between CRUP (Portugal) and British Council (UK)

A hierarchical view on material formation during pulsed-laser synthesis of nanoparticles in liquid

Pulsed-laser assisted nanoparticle synthesis in liquids (PLAL) is a versatile tool for nanoparticle synthesis. However, fundamental aspects of structure formation during PLAL are presently poorly understood. We analyse the spatio-temporal kinetics during PLAL by means of fast X-ray radiography (XR) and scanning small-angle X-ray scattering (SAXS), which permits us to probe the process on length scales from nanometers to millimeters with microsecond temporal resolution. We find that the global structural evolution, such as the dynamics of the vapor bubble can be correlated to the locus and evolution of silver nanoparticles. The bubble plays an important role in particle formation, as it confines the primary particles and redeposits them to the substrate. Agglomeration takes place for the confined particles in the second bubble. Additionally, upon the collapse of the second bubble a jet of confined material is ejected perpendicularly to the surface. We hypothesize that these kinetics influence the final particle size distribution and determine the quality of the resulting colloids, such as polydispersity and modality through the interplay between particle cloud compression and particle release into the liquid

Nanogranular BaTiO3–CoFe2O4 thin films deposited by pulsed laser ablation

Detailed structural and magnetic measurements were performed on nanostructured composite thin films of cobalt ferrite (CoFe2O4 - magnetostrictive) dispersed in a barium titanate (BaTiO3 - piezoelectric) matrix, with different CoFe2O4 concentrations (ranging from x=20% to x=70%). The films were deposited by laser ablation on platinum covered Si(100). Their structure was studied by X-ray diffraction and Raman spectroscopy. The magnetic properties were measured with a SQUID magnetometer. The nanocomposite films were polycrystalline and composed by a mixture of tetragonal-BaTiO3 and CoFe2O4 with the cubic spinel structure. The lattice parameter of the CoFe2O4 phase varied from 8.26Å (x=20%) to 8.35Å (x=70%), and, comparing with bulk CoFe2O4, it was under compressive stress that relaxed as its concentration progressively increased. In the tetragonal-BaTiO3 phase, the lattice parameter a was contracted relative to the bulk phase and decreases with x. The lattice parameter c increased from 4.088 Å (x=20%) to 4.376 Å (x=70%), so that the BaTiO3 c axes was increasingly expanded as the quantity of the barium titanate phase was reduced. This behavior was the opposite of that observed in CoFe2O4. The magnetic measurements showed that the coercive fields decreased from 6.6 kOe (x=20%) to 2.3 kOe (x=70%) which was attributed to the progressive relaxation of the stress in the films as well as to the increase of particle agglomeration in bigger polycrystalline clusters with increasing cobalt ferrite concentration. For higher temperatures T=300 K the reduction of magnetocrystalline anisotropy induced a strong reduction of the coercive field.This work has been financially supported by the Portuguese Foundation for Science and Technology (FCT), through the project POCI/CTM/60181/2004

Horton's Disease. 40 Clinical Cases

Apresentamos uma casuística de 40 casos de Doença de Horton observados no Serviço de Medicina 2 e na Consulta de Doenças Autoimunes do Hospital de Santo António dos Capuchos, entre 1984 e 2002. Pretendemos comentar e destacar os aspectos práticos, clínicos, de diagnóstico e de terapêutica, relacionados com o adequado controle da doença, através da análise comparativa da literatura com os nossos dados

Structural and magnetic properties of nanogranular BaTiO3-CoFe2O4 thin films deposited by laser ablation on Si/Pt substrates

Thin film nanogranular composites of cobalt ferrite (CoFe2O 4) dispersed in a barium titanate (BaTiO3) matrix were deposited by laser ablation with different cobalt ferrite concentrations (x). The films were polycrystalline and composed by a mixture of tetragonal- BáTiO3 and CoFe2O4 with the cubic spinnel structure. A slight (111) barium titanate phase orientation and (311) CoFe2O4 phase orientation was observed. As the concentration of the cobalt ferrite increased, the grain size of the BaTiO 3 phase decreased, from 91nm to 30nm, up to 50% CoFe 2O4 concentration, beyond which the BaTiO3 grain size take values in the range 30-35nm. On the other hand the cobalt ferrite grain size did not show a clear trend with increasing cobalt ferrite concentration, fluctuating in the range 25nm to 30nm. The lattice parameter of the CoFe2O4 phase increased with increasing x. However, it was always smaller than the bulk value indicating that, in the films, the cobalt ferrite was under compressive stress that was progressively relaxed with increasing CoFe2O4 concentration. The magnetic measurements showed a decrease of coercive field with increasing x, which was attributed to the relaxation of the stress in the films and to the increase of particle agglomeration in bigger polycrystalline clusters with increasing cobalt ferrite concentration.This work has been financially supported by the Portuguese Foundation for Science and Technology (FCT), through the project POCI/CTM/60181/2004