Nimodipine Dose Reductions in the Treatment of Patients with Aneurysmal Subarachnoid Hemorrhage

BACKGROUND: The incidence of cerebral infarction and poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH) is reduced by oral nimodipine but acute effects of the drug may include a significant decrease in mean arterial blood pressure (MAP). A dose reduction or discontinuation of the drug is recommended if recurrent MAP drops occur. The aim of our study was to evaluate the frequency and clinical significance of nimodipine dose modifications in patients suffering from aSAH. METHODS: 270 patients were included in our retrospective analysis of consecutively collected data of patients suffering from aSAH. The local treatment protocol was in accordance to national and international guidelines. Nimodipine was intended to be applied orally with a dosage of 60 mg every 4 h. RESULTS: Only 43.6 % of patients eligible for vasospasm prophylaxis with nimodipine received the full daily dose of 60 mg every 4 h. In 28.6 %, the dose had to be reduced by 50 % due to a significant reduction in blood pressure after administration and/or high dose of catecholamines. In 27.7 % of patients, oral administration of the drug was discontinued for the same reason. Dose reduction and discontinuation occurred with a significantly higher frequency in patients in poor clinical condition. Application of the full nimodipine dosage decreased the risk of unfavorable clinical outcome in multivariate analysis (OR 0.895, p = 0.029). CONCLUSIONS: Our results show that dose reduction or discontinuation of nimodipine due to changes in MAP occur frequently in clinical routine and may be associated with unfavorable clinical outcome

Green Manure Addition to Soil Increases Grain Zinc Concentration in Bread Wheat

Zinc (Zn) deficiency is a major problem for many people living on wheat-based diets. Here, we explored whether addition of green manure of red clover and sunflower to a calcareous soil or inoculating a non-indigenous arbuscular mycorrhizal fungal (AMF) strain may increase grain Zn concentration in bread wheat. For this purpose we performed a multifactorial pot experiment, in which the effects of two green manures (red clover, sunflower), ZnSO4 application, soil γ-irradiation (elimination of naturally occurring AMF), and AMF inoculation were tested. Both green manures were labeled with 65Zn radiotracer to record the Zn recoveries in the aboveground plant biomass. Application of ZnSO4 fertilizer increased grain Zn concentration from 20 to 39 mg Zn kg-1 and sole addition of green manure of sunflower to soil raised grain Zn concentration to 31 mg Zn kg-1. Adding the two together to soil increased grain Zn concentration even further to 54 mg Zn kg-1. Mixing green manure of sunflower to soil mobilized additional 48 µg Zn (kg soil)-1 for transfer to the aboveground plant biomass, compared to the total of 132 µg Zn (kg soil)-1 taken up from plain soil when neither green manure nor ZnSO4 were applied. Green manure amendments to soil also raised the DTPA-extractable Zn in soil. Inoculating a non-indigenous AMF did not increase plant Zn uptake. The study thus showed that organic matter amendments to soil can contribute to a better utilization of naturally stocked soil micronutrients, and thereby reduce any need for major external inputs