Evidence-based approach for managing hypertension in type 2 diabetes

Blood pressure (BP) control is a critical part of managing patients with type 2 diabetes. Perhaps it is the single most important aspect of diabetes care, which unlike hyperglycemia and dyslipidemia can reduce both micro- and macrovascular complications. Hypertension is more prevalent in individuals with diabetes than general population, and in most cases its treatment requires two or more pharmacological agents (about 30% of individuals with diabetes need 3 or more medications to control BP). In this article we describe the key evidence that has contributed to our understanding that reduced BP translates into positive micro- and macrovascular outcomes. We review the data supporting current recommendation for BP target < 130/80 mmHg. Two studies suggest that a lower BP goal could be even more beneficial. We also present the comparative benefits of various antihypertensive drugs in reducing diabetes-related micro- and macrovascular complications. Finally we propose an evidence-based algorithm of how to initiate and titrate antihypertensive pharmacotherapy in affected individuals. Overall, achieving BP < 130/80 mmHg is more important than searching for the “best” antihypertensive agent in patients with diabetes

Congenital hypothyroidism

Congenital hypothyroidism (CH) occurs in approximately 1:2,000 to 1:4,000 newborns. The clinical manifestations are often subtle or not present at birth. This likely is due to trans-placental passage of some maternal thyroid hormone, while many infants have some thyroid production of their own. Common symptoms include decreased activity and increased sleep, feeding difficulty, constipation, and prolonged jaundice. On examination, common signs include myxedematous facies, large fontanels, macroglossia, a distended abdomen with umbilical hernia, and hypotonia. CH is classified into permanent and transient forms, which in turn can be divided into primary, secondary, or peripheral etiologies. Thyroid dysgenesis accounts for 85% of permanent, primary CH, while inborn errors of thyroid hormone biosynthesis (dyshormonogeneses) account for 10-15% of cases. Secondary or central CH may occur with isolated TSH deficiency, but more commonly it is associated with congenital hypopitiutarism. Transient CH most commonly occurs in preterm infants born in areas of endemic iodine deficiency. In countries with newborn screening programs in place, infants with CH are diagnosed after detection by screening tests. The diagnosis should be confirmed by finding an elevated serum TSH and low T4 or free T4 level. Other diagnostic tests, such as thyroid radionuclide uptake and scan, thyroid sonography, or serum thyroglobulin determination may help pinpoint the underlying etiology, although treatment may be started without these tests. Levothyroxine is the treatment of choice; the recommended starting dose is 10 to 15 mcg/kg/day. The immediate goals of treatment are to rapidly raise the serum T4 above 130 nmol/L (10 ug/dL) and normalize serum TSH levels. Frequent laboratory monitoring in infancy is essential to ensure optimal neurocognitive outcome. Serum TSH and free T4 should be measured every 1-2 months in the first 6 months of life and every 3-4 months thereafter. In general, the prognosis of infants detected by screening and started on treatment early is excellent, with IQs similar to sibling or classmate controls. Studies show that a lower neurocognitive outcome may occur in those infants started at a later age (> 30 days of age), on lower l-thyroxine doses than currently recommended, and in those infants with more severe hypothyroidism

First results of fission-track thermochronology in the Albanides

Albania, situated at the boundary between the Dinaric and the Hellenic branchs of the Dinaro-Hellenic fold belt, has experienced a multiphase geodynamic evolution. The internal zones show a Mid-Jurassic episode of deformation characterized by ophiolite obduction, followed by development of a fold-and-thrust belt in the external zones during the Cenozoic. More recently, Albania has experienced a tensional regime. We present apatite and zircon fission-track (AFT and ZFT) measurements for 22 samples, and seven measurements of track-length distributions to elucidate the thermal evolution. AFT ages vary from 10.8 ± 0.7 Ma to 50.5 ± 5.7 Ma. The oldest ages (Eocene) occur in the western Albanides, corresponding to Eocene emplacement of the internal zones over the external ones. Neogene ages in the eastern Albanides suggest rapid exhumation, which we relate to an extensional regime. The ZFT ages show that the internal Albanides did not reach temperatures > 200 °C during the Cenozoic

Chromium speciation and existing natural attenuation conditions in lagoonal and pond sediments in the former chemical plant of Porto-Romano (Albania)

Near the outskirts of the Albanian port of Durres on the Adriatic Coast, at a place called Porto Romano, an old chemical complex has been producing chromate salts for a period of ∼20 years (1972–1993). As a result large quantities of chromite ore processing residue (COPR) waste were released mainly as suspended particles and/or dissolved species in effluents, which settled in a decantation pond area, 200 × 250 m in size, east of the industrial plant. Unfortunately, pollutants were spread out with time. Knowing that chromium mobility and toxicity in natural settings is species dependent, the species characterization has been carried out in different sampling media (pond sediments, lagoonal sediments and water samples). Five pond profiles were sampled within the decantation area up to a depth of ∼1 m, till the underlying Quaternary lagoonal silty-clays were reached. Total Cr content is highly variable with values between 1,130 and 24,409 mg/kg which is clearly higher than the defined local background values for lagoonal silty-clays (198 mg/kg of Cr). Leaching of Cr(VI) especially occurs in the pond sediments, which are low in OC, CEC and clay content, under acidic and neutral pH conditions (e.g. up to ∼2,230 mg/kg Cr(VI) leached from a sample containing a total concentration of Cr 12,200 mg/kg). Moreover, leaching of the Cr(III) occurs only under strictly acidic conditions (maximum 1,144 mg/kg leached from a sample containing a total Cr-concentration of 17,608 mg/kg). In this study also a number of natural attenuation conditions (i.e. reaction with lagoonal clays rich in organic matter and iron as well as isomorphous substitution) have been recognized.status: publishe

pHstat, ANC and BNC in the long time prediction and release of COPR in Albania

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ANC, BNC and mobilization of Cr from polluted sediments in function of pH changes

During the manufacturing of chromate salts (1972–1992) large quantities of Chromite Ore Processing Residue (COPR) were released into a decantation pond east of the former chemical plant of Porto-Romano (Durres, Albania), giving rise to yellow colored pond sediments. These Cr(VI) bearing sediments were deposited upon Quaternary silty-clay lagoonal sediments rich in iron oxides and organic matter. The pH values in these lagoonal sediments vary around 6.6, while in the pond sediments, it is mainly acidic (due to the presence of the sulfur stock piles in the area and the release of the H2SO4 from the activity of the former chemical plant), varying between 1.4 and 3.8. Continuous leaching of the COPR waste resulted in yellow-colored surface water runoff. The prediction of pH changes in the different types of sediments based upon acid/base neutralizing capacity (ANC/BNC) jointly with the quantitative data on release of heavy metals and especially Cr is considered an important advantage of the pHstat leaching test if compared to conventional leaching procedures. Thus, factors controlling the leaching of Cr(VI), Cr(III), Ca, Al, Fe, Mg from the COPR were investigated by means of pHstat batch leaching tests and mineralogical analysis. Moreover, mathematical and geochemical modeling complemented the study. The COPR in the area contain very high concentrations of chromium 24,409 mg/kg, which mainly occurs as Cr(III) (75–90%) as well as Cr(VI) (25–10%). The leaching of Cr(VI) occurs in all the range (2–10) of the tested pH values, however, it decreases under acidic conditions. Beside some reduction of Cr(VI) to Cr(III), the Cr(VI) content of the leachtes remains relatively high in the acidic environment, while the limning of Cr(VI) pond sediments will increase the release of the latter specie. The leaching of the Cr(III) occurs strictly under acidic conditions, whereby limning of these sediments will give rise to the lower solubility of Cr(III). The key mineral phases responsible for the fast release of the Cr(VI) are: the chromate salts (i.e. sodium chromate and sodium dichromate), while sparingly soluble chromatite (CaCrO4) and hashemite (BaCrO4) release Cr(VI) very slowly. Thus, pH and mineral solubility have been identified as key factors in the retention and the release of the hexavalent CrO4 2− and Cr2O7 − from the COPR-rich pond sediments.status: publishe

Nature and origin of the Triassic volcanism in Albania and Othrys: a key to understanding the Neotethys opening?

International audienceTriassic volcanic rocks, stratigraphically associated with pelagic or reef limestones, are tectonically juxtaposed with Mesozoic ophiolites in the Tethyan realm. From the central (Dinarides, Hellenides) and eastern Mediterranean (Antalya, Troodos, Baër Bassit) to the Semail nappes (Oman), they occur either associated to the tectonic sole of the ophiolitic nappes or as a distinct tectonic pile intercalated between the ophiolites and other underthrust units. In the Dinaro-Hellenic belt, the Pelagonian units represent the lower plate, which is underthrust beneath the ophiolites. Middle to Late Triassic volcanic sequences are interpreted as the eastern flank of the Pelagonian platform and are therefore considered as a distal, deep-water part of the Pelagonian margin. The Triassic volcanics from Albania and Othrys are made up of basaltic pillowed and massive flows, associated locally with dolerites and trachytes. New elemental, Nd and Pb isotopic data allow to recognize four types of volcanic suites: (1) intra-oceanic alkaline and tholeiitic basalts, (2) intra-oceanic arc-tholeiites, (3) back-arc basin basalts, (4) calc-alkaline mafic to felsic rocks. Nd and Pb isotopic initial ratios suggest that the within-plate volcanic rocks were derived from an enriched oceanic island basalt type mantle source, devoid of any continental crustal component. The lower {varepsilon}Nd value of the trachyte could be due to assimilation of oceanic altered crust or sediments in a shallow magma chamber. Island arc tholeiites and back-arc basin basalts have a similar wide range of {varepsilon}Nd. The absence of Nb negative anomalies in the back-arc basin basalts suggests that the basin floored by these basalts was wide and mature. The high Th contents of the island arc tholeiites suggest that the arc volcanoes were located not far away from the continental margin. Albania and Othrys volcanics contrast with the Late Triassic volcanism from eastern Mediterranean (SW Cyprus, SW Turkey), which displays solely features of oceanic within plate suites. The presence of back-arc basin basalts associated with arc-related volcanics in Central Mediterranean indicates that they were close to a still active subduction during the Upper Triassic, while back-arc basins developed, associated with within-plate volcanism, leading to the NeoTethys opening