Diuretic Effects of Roselle (Hibiscus Sabdariffa) – Stevia (Stevia Rebaudiana) Tea Compared with Hydrochlorothiazide in Diabetic Patients with Hypertension

Objective: To compare diuretic effects of Roselle-Stevia (R-S) tea withhydrochlorothiazide (HCTZ) in diabetic patients with hypertension. Method:This study was a prospective randomized, open label, crossover study.Twenty two diabetic patients with hypertension were randomly assignedwith concealed allocation to receive either R-S tea (each sachet 2/0.2 g) 2sachets daily or HCTZ 25 mg once daily for 30 days. Then a two-waycrossover with a 7-day washout period was used. Serum and 24-hour urinespecimens were collected at the beginning and the end of each 30 daystreatment period. Diuretic effects were assessed from urinary sodiumexcretion and urinary volume. Results: After 30-day treatment periods, themean changes from baseline on urinary sodium excretion (-5.4±92.5 vs.-21.3±100.2 mmol/day, n=22) and urinary volume (-101.4±684.8 vs -40.5±806.4 mL, n=22) were not significantly difference between R-S teaand HCTZ respectively. HCTZ significantly increased serum glucose anddecreased serum potassium and chloride from baseline (p<0.05) but nosignificantly changed after R-S drinking. Nobody dropped out because ofadverse events. Conclusion: There was no statistically significantdifference in diuretic effects between R-S tea and HCTZ in hypertensivediabetic patients. Our result do not support diuretic effects from bothtreatments after 30 days.Keywords: Roselle, Stevia, diuretic, hydrochlorothiazide, hypertension,diabete

Clusters of Sudden Unexplained Death Associated with the Mushroom, Trogia venenata, in Rural Yunnan Province, China

INTRODUCTION: Since the late 1970's, time-space clusters of sudden unexplained death (SUD) in northwest Yunnan, China have alarmed the public and health authorities. From 2006-2009, we initiated enhanced surveillance for SUD to identify a cause, and we warned villagers to avoid eating unfamiliar mushrooms. METHODS: We established surveillance for SUD, defined as follows: sudden onset of serious, unexplained physical impairment followed by death in <24 hours. A mild case was onset of any illness in a member of the family or close socially related group of a SUD victim within 1 week of a SUD. We interviewed witnesses of SUD and mild case-persons to identify exposures to potentially toxic substances. We tested blood from mild cases, villagers, and for standard biochemical, enzyme, and electrolyte markers of disease. RESULTS: We identified 33 SUD, a 73% decline from 2002-2005, distributed among 21 villages of 11 counties. We found a previously undescribed mushroom, Trogia venenata, was eaten by 5 of 7 families with SUD clusters compared to 0 of 31 other control-families from the same villages. In T. venenata-exposed persons SUD was characterized by sudden loss of consciousness during normal activities. This mushroom grew nearby 75% of 61 villages that had time-space SUD clusters from 1975 to 2009 compared to 17% of 18 villages with only single SUD (p<0.001, Fisher's exact test). DISCUSSION: Epidemiologic data has implicated T. venenata as a probable cause of clusters of SUD in northwestern Yunnan Province. Warnings to villagers about eating this mushroom should continue

2022 Thai Hypertension Society guidelines on home blood pressure monitoring

Abstract In 2021, the Universal Health Coverage Payment Scheme of Thailand approved home blood pressure monitoring (HBPM) devices for reimbursement. National utilization of HBPM devices will begin in 2022. This article provides the recommendations for HBPM from the Thai Hypertension Society. In this report, the authors review the benefits of HBPM and recommend confirming the diagnosis of hypertension by HBPM. Devices for HBPM should be the automated and validated upper arm cuff devices. HBPM should be ideally done for seven consecutive days before each clinic visit and take at least two readings (1 min apart) in the morning and before going to bed. The average blood pressure (BP) of 125–134/75–84 mmHg is classified as high normal BP and hypertension is BP of 135/85 mmHg or more. Target BP levels depend on the age of the patients; that is, < 125/75 mmHg for patients aged 18–65 years old, and <135/85 mmHg for patients over 65 years of age

Mutations in the gene for cardiac myosin-binding protein C and late-onset familial hypertrophic cardiomyopathy

Background: Mutations in the gene for cardiac myosin-binding protein C account for approximately 15 percent of cases of familial hypertrophic cardiomyopathy. The spectrum of disease-causing mutations and the associated clinical features of these gene defects are unknown. Methods: DNA sequences encoding cardiac myosin-binding protein C were determined in unrelated patients with familial hypertrophic cardiomyopathy. Mutations were found in 16 probands, who had 574 family members at risk of inheriting these defects. The genotypes of these family members were determined, and the clinical status of 212 family members with mutations in the gene for cardiac myosin-binding protein C was assessed. Results: Twelve novel mutations were identified in probands from 16 families. Four were missense mutations; eight defects (insertions, deletions, and splice mutations) were predicted to truncate cardiac myosin-binding protein C. The clinical expression of either missense or truncation mutations was similar to that observed for other genetic causes of hypertrophic cardiomyopathy, but the age at onset of the disease differed markedly. Only 58 percent of adults under the age of 50 years who had a mutation in the cardiac myosin-binding protein C gene (68 of 117 patients) had cardiac hypertrophy; disease penetrance remained incomplete through the age of 60 years. Survival was generally better than that observed among patients with hypertrophic cardiomyopathy caused by other mutations in the genes for sarcomere proteins. Most deaths due to cardiac causes in these families occurred suddenly. Conclusions: The clinical expression of mutations in the gene for cardiac myosin-binding protein C is often delayed until middle age or old age. Delayed expression of cardiac hypertrophy and a favorable clinical course may hinder recognition of the heritable nature of mutations in the cardiac myosin-binding protein C gene. Clinical screening in adult life may be warranted for members of families characterized by hypertrophic cardiomyopathy