Effect of the olive leaf extract in chronic spinal cord injury model: an experimental research.

Posttraumatic myelopathy is defined as a spinal cord injury (SCI) that results in varying degrees of motor and sensory deficits. The degree of 'secondary damage,' which is caused by a variety of cellular, molecular, and biochemical cascades is linked to the outcome of SCI. According to research, the beneficial effects of oleuropein and its derivatives have been linked to radical scavenging/antioxidant actions and anti-inflammatory effects. Materials and Methods: This study was divided into six groups: control negative (sham-operated) group, control positive 1 and 2 (early chronic and chronic), treatment groups 1, 2, and 3 (prophylactic, concomitant, and late). Olive leaf extract (OLE) given dose was 350 mg/kg body weight. Blood was taken from the left corotic artery before the animals were terminated, seromarker assessment, enzyme-linked immunosorbent assay of IL-6, TNF-α, brain-derived neurotrophic factor (BDNF), and assessment of functional motoric outcome before the animal was terminated. Results: Chronic spinal cord compression increased serum levels of IL-6, TNF-α, and decreased serum level of BDNF. OLE 350 mg/kg body weight decreased serum levels of IL-6, TNF-α and increased functional motoric outcome, especially in prophylactic and concomitant therapy. Discussion: These findings indicate that OLE may be effective in protecting chronic SCI model. Conclusion: Oleuropein has a potential effect to reduce the IL-6 and TNF-α in rabbit model of SCI, and the BDNF value risen after the administration of Oleuropein.

Comparative Pharmacognostic study of market samples of Tagara collected from five different markets of Kerala with the official source plant Valeriana jatamansi Jones ex Roxb.

Background: Tagara is a very popular Ayurveda herb used in the treatment insomnia, epilepsy, neurosis, hepatoprotective, anticancerous, and analgesic. Characteristic smell is the typical feature of it. As per the Ayurvedic Pharmacopoeia of India and many other classical texts, rhizomes of Valeriana jatamansi of the family Valerianceae is the accepted source of the drug. From some of the reports from early 1980s, it was found that roots of some aquatic plants such as Nymphoides macrospermum, Nymphoides hydrophylla, Nymphoides indica, and Limnanthemum cristatum were said to be used as Tagara instead of V. jatamansi in the South Indian markets. Aim: This study proposed to assess the present status of Tagara available in herbal raw drug markets of Kerala. Materials and methods: Five market samples of Tagara were collected from selected markets of Kerala, and some of the reported aquatic plants, collected from natural habitats nearby. Macroscopic, microscopic, histochemical, and powder microscopic characterization of all these samples were done as per the standard procedure mentioned in Ayurvedic Pharmacopoeia of India and characters observed were compared with official source plant and pharmacopoeial standard. Results: Morphological characters of market samples of Tagara collected from the various markets of Kerala were not matching with the rhizomes of genuine drug V. jatamansi and that of Uttarakhand sample. The microscopic and histochemical examination also gave the same result. However, these samples showed similarities with the roots of Nymphoides macrospermam. Sample collected from Uttarakhand was the rhizome of V. jatamansi. Conclusion: The collected market samples of Tagara from various Kerala markets were not the rhizomes of V. jatamansi but the roots of N. macrospermam.

Assessment of Systemic Inflammatory Markers in Patients with Aggressive Periodontitis.

BACKGROUND: "Aggressive periodontitis (AgP) is a destructive disease characterized by the following: The involvement of multiple teeth with a distinctive pattern of periodontal tissue loss; a high rate of disease progression; an early age of onset; and the absence of systemic diseases.'' Chronic low-level bacteremia and systemic inflammatory response have been suggested as a pathogenic link between periodontal disease and systemic disease. The present study was aimed to assess the levels of systemic inflammatory markers in patients with AgP. METHODS: A sample of 50 systemically healthy patients comprised two groups, based on full mouth periodontal examination: Group I healthy individuals, includes 25 periodontally healthy subjects with fully functioning dentition. Group II includes 25 patients diagnosed clinically as AgP. Laboratory blood investigation included white blood cell (WBC) count, neutrophil count, lymphocyte count, and platelet count. Serum protein parameters included total protein (TP), albumin (ALB), and globulin (GLB). Periodontal clinical parameters including plaque index, gingival index, probing pocket depth, and clinical attachment level were recorded. RESULTS: Data analysis shows an increase in WBC, neutrophil, lymphocyte, and platelet count and a decrease in TP, ALB, and GLB in AgP patients when compared to healthy individuals. CONCLUSION: Results of the present study shows an increase in blood parameters and decrease in serum protein parameters in AgP. Hence, AgP could be considered as one of the risk factors associated with the cardiovascular diseases as assessed by changes in the level of systemic inflammatory markers observed.

Estimation of Specific Salivary Enzymatic Biomarkers in Individuals with Gingivitis and Chronic Periodontitis: A Clinical and Biochemical Study.

BACKGROUND: Host response to periodontal disease includes the release of different enzymes from stromal, epithelial or inflammatory cells. The enzymes which are produced from these cells are associated with cell injury and cell death like: Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP) and Blood urea nitrogen (BUN). Normal enzymatic activity of these enzymes is necessary for healthy functioning of gingiva and periodontium. The aim of the study is to estimate the levels of enzymes AST, ALT, ALP and BUN and to correlate the level of estimated enzymes with that of clinical parameters in the saliva of Healthy subjects, Gingivitis patients and patients with chronic periodontitis. METHODS: The study included a total of 40 male subjects within the age group of 21 to 50 years, and examined the activity of enzymes AST, ALT, ALP and BUN in saliva spectrophotometrically and compared their values between healthy subjects, gingivitis and chronic periodontitis patients. Clinical parameters like OHI - S (Oral hygiene index - Simplified, SBI (Sulcus Bleeding Index), PPD (Probing Pocket Depth), CAL (Clinical Attachment Level), and PI (Periodontal Index) were recorded. RESULTS: Obtained results showed statistically significant increases of activity of AST, ALT, ALP, and BUN in saliva from patients with periodontal disease (p<0.001) in relation to gingivitis and control groups. There was also an increase in periodontal parameters with an increase in salivary enzymes. CONCLUSION: The present study shows that the salivary enzyme activity can be used as biomarkers to determine periodontal tissue damage, which may be useful in diagnosis, prognosis and evaluation of post therapy effects in periodontal disease.

Pt Diffusion Dynamics for the Formation Cr-Pt Core-Shell Nanoparticles.

Layered core-shell bimetallic Cr-Pt nanoparticles were prepared by the formation and later reduction of an intermediate Pt-ion-containing supramolecular complex onto preformed Cr nanoparticles. The resultant nanoparticles were characterized by X-ray diffraction analysis, transmission electron microscopy, X-ray photoelectron spectroscopy, and aberration-corrected scanning transmission electron microscopy. The results are consistent with the presence of Pt diffusion during or after bimetallic nanoparticle formation, which has resulted in a Pt/Cr-alloyed core and shell. We postulate that such Pt diffusion occurs by an electric-field-assisted process according to Cabrera-Mott theory and that it originates from the low work function of the preformed oxygen-defective Cr nanoparticles and the rather large electron affinity of Pt.

Qualitative assessment of red blood cell parameters for signs of anemia in patients with chronic periodontitis.

AIM: Anemia of chronic disease is defined as anemia occurring in chronic infections and inflammatory conditions that is not caused by marrow deficiencies or other diseases and in the presence of adequate iron stores and vitamins. The present case control study was aimed to assess the red blood cell parameters for signs of anemia in patients with mild, moderate, and severe chronic periodontitis. MATERIALS AND METHODS: A simple random sampling method was used to select 80 healthy male patients, who were divided into four groups based on full mouth periodontal examination as follows: group I patients comprised the control group (n = 20), which included patients with a clinically healthy periodontium, group II patients (n = 20) were diagnosed with mild chronic periodontitis, group III (n = 20) included moderate chronic periodontitis patients, and patients with severe chronic periodontitis formed group IV (n = 20). Laboratory blood investigations included total number of erythrocytes, hemoglobin concentration, packed cell volume, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration. RESULTS: Data analysis showed a statistically significant decrease in red blood cell parameters with increase in different grades of periodontitis. CONCLUSION: Results of the present study show a substantial decrease in red blood cell parameters with increase in the severity of periodontal destruction.

Non-assessable endometrium in women with post-menopausal bleeding: to investigate or ignore.

BACKGROUND: In women presenting with post-menopausal bleeding (PMB), the incidence of endometrial cancer is 1-10 %; Trans-vaginal scan (TVS) is offered as the first line of investigation to triage women further and a thick endometrium (>4 mm) merits endometrial tissue sampling for further evaluation. When it is difficult and not possible to assess the endometrium sonographically, decision to investigate further lies with the clinician. AIM: Study outcomes for women with PMB and endometrium not assessable on TVS. METHODS: We collected data retrospectively between September 2007 and December 2010. We identified our study group from the radiology database. Data collected include ultrasound findings, methods of endometrial sampling, and the result of cytology/histology. RESULTS: In our study period of 40 months, 671 women with post-menopausal bleeding were referred to the ultrasound department for TVS to assess endometrial thickness. 92 % (614/671) women had the assessment. In 57 women (8 %), endometrial thickness was not assessable and this formed our study group. 3/57 records were not retrievable and excluded from our study. 43/54 (79 %) had some form of endometrial sampling done. Among the 81 % adequate samples (35/43), 7 (20 %) had endometrial cancer; 1 (3 %) had CAH, 1 (3 %) was diagnosed with cervical cancer. In women who had thickened endometrium (>4 mm; n = 448), there were 29 cases of endometrial cancers detected giving an incidence of 6.4 %. In women with PMB and non-assessable endometrial thickness, there is increased incidence of endometrial cancer when compared to the group where endometrial thickness could be measured. (Odds ratio = 3.3 [95 % CI = 1.2-9]). This is a statistically (p = 0.017) and clinically significant finding. CONCLUSION: In women with PMB, there will be a subgroup in which ultrasound cannot assess endometrial thickness. When compared to women where endometrial thickness is measurable, this group stands a higher risk of endometrial cancer and hysteroscopy/ hysterosonography with endometrial sampling is recommended in this group.

Cardiovascular outcomes in patients with normal and abnormal 24-hour ambulatory blood pressure monitoring.

Introduction. 24-hour ambulatory blood pressure monitoring (ABPM) plays an important role in assessing cardiovascular prognosis, through presence or absence of ABPM-related prognostic features. Objectives. To study relationship between 24-hour ABPM and cardiovascular outcomes in patients from Chesterfield Royal Hospital. Material and Methods. Over 12 months from the 1st of August 2002, 1187 individuals had 24-hour ABPM performed. Cardiovascular outcomes were studied in a subset (297) of the original cohort, made up by every 4th consecutive subject. The following ABPM-related prognostic features were studied-high day time systolic and diastolic BP (≥135, ≥85 mmHg), high night time systolic and diastolic BP (≥120 mmHg, ≥75 mmHg), absence of nocturnal dip (≤10% fall in night time SBP), high early morning SBP (≥140 mmHg), and morning surge (≥20/15 mmHg). The cardiovascular outcomes studied in the fourth table included fatal and nonfatal MI, new diagnosis of angina, acute coronary syndrome, sudden cardiac death, cardiac arrhythmias, acute LVF, cerbrovascular events, peripheral vascular disease, abdominal aortic aneurysm, and CKD stage 3 or above. Results. Over a followup period of 2015 ± 116 days (1720-2305 days) 82 cardiovascular events occurred in 61 subjects. Cardiac arrhythmias were the most common CV outcome (34 events) followed by cerebrovascular events (15). Statistically significant associations found were between cerebrovascular events and absent nocturnal dip ≤ 10% (P = .05) and high day time DBP (P = .029), peripheral vascular disease and morning surge ≥ 20/15 mmHg (P = .014), cardiac arrhythmias and high day time and night time DBP (P = .009 and .033, resp.). Conclusion. Significant associations were found between cerebrovascular events and absent nocturnal dip ≤ 10% and high day time DBP, peripheral vascular disease and morning surge ≥ 20/15 mmHg, cardiac arrhythmias and high day time and night time DBP.

Chemical manipulation by X-rays of functionalized thiolate self-assembled monolayers on Au.

The chemical modification caused by prolonged exposure to X-rays on a series of para-substituted phenyl moieties (-NO2, -CN, -CHO, -COOH, -CO2Me, and -CO2(1)Bu) at the surface of thiolate-Au self-assembled monolayers (SAMs) has been investigated by X-ray photoelectron spectroscopy (XPS). Furthermore, the influence that the phenyl group has on the chemical modification induced by the X-ray irradiation on the SAMs was investigated by comparing the XPS results obtained from irradiation on a NO2-aromatic-terminated SAM (6-(4-nitro-phenoxy)-hexane-1-thiolate (NPHT)) and NO2-aliphatic-terminated SAM (thioacetic acid S-(12-nitrododecyl) ester (TNDDE)). The NPHT and TNDDE SAMs have been shown to behave differently to X-ray exposure. The irradiation of the NPHT SAM led to the reduction of the nitro (-NO2) moiety to the amine (-NH2) moiety, as shown by the decrease in the intensity of the N 1s photoelectron peak for -NO2 (406 eV) in the XPS spectra with the concomitant increase in the N 1s photoelectron peak for -NH2 (399 eV). On the TNDDE SAM, XPS showed the -NO2 photoelectron peak again decreasing with prolonged X-ray irradiation whereas no peak was observed at 399 eV; therefore, the -NO2 moieties are selectively cleaved. No change was observed on the other functionalized monolayers apart from the -CO2(t)Bu-functionalized monolayer, where after 100 min of X-ray irradiation approximately 11% of the carbon content was lost. The S 2p and O 1s spectra remained unchanged during the irradiation suggesting the conversion of the -CO2(t)Bu to the -COOH moiety, although the conversion was not complete because the tertiary butyl moiety contributes 25% to the total carbon content of the SAM. Also, there was no evidence of the molecules desorbing from the substrate for any of the SAMs studied during the X-ray irradiation as shown by no change in the S 2p and C 1s XPS spectra taken during the X-ray irradiation.

Twenty four hour ambulatory blood pressure monitoring: a new tool for determining cardiovascular prognosis.

Twenty four hour ambulatory blood pressure monitoring (24-H ABPM) plays an important part in the management of subjects with suspected and confirmed disorders of blood pressure regulation. This article reviews the prognostic significance of various aspects of the 24-H ABPM and describes the authors experience in Chesterfield. Over the course of 12 month period from 1 August 2002, 1264 subjects had 24-ABPM. A total of 1187 (93.91%) subjects were included in this study, with mean age of 59.30 years and male:female ratio was 46%: 54 %. Fifty two (4.38%) of the subjects had all of the seven features associated with an adverse prognosis. Only 82 (6.90%) subjects had none of the seven adverse prognostic features with the remainder having one or more adverse prognostic features.

Rhabdomyolysis induced by a single dose of a statin.

Statins have been shown to cause myotoxicity and rhabdomyolysis. In most cases rhabdomyolysis occurs following the use of these drugs for at least one week. A case of rhabdomyolysis after just a single dose of simvastatin is reported.

The effect of pregnancy on bone density and bone turnover.

During pregnancy, the mother adapts to meet the calcium demands of the fetus. The effect of this adaptation on the maternal skeleton is not fully understood. Our objectives were to evaluate changes in bone mineral density (BMD) and bone turnover during pregnancy. We studied 16 women longitudinally, with baseline measurements before pregnancy; then at 16, 26, and 36 weeks of pregnancy; and postpartum. We measured total-body BMD and biochemical markers of bone resorption (urinary pyridinium crosslinks and telopeptides of type I collagen) and bone formation (serum bone alkaline phosphatase, propeptides of type I procollagen [PINP] and osteocalcin). We also measured parathyroid hormone (PTH), insulin-like growth factor I (IGF-I), and human placental lactogen. Postpartum, BMD increased in the arms (2.8%, P < 0.01) and legs (1.9%, P < 0.01) but decreased in the pelvis (-3.2%, P < 0.05) and spine (-4.6%, P < 0.01) compared with prepregnancy values. All biochemical markers, with the exception of osteocalcin concentration, increased during pregnancy. The change in IGF-I at 36 weeks was related to the change in biochemical markers (e.g., PINP, r = 0.72, P = 0.002). Pregnancy is a high-bone-turnover state. IGF-I levels may be an important determinant of bone turnover during pregnancy. Elevated bone turnover may explain trabecular bone loss during pregnancy.

Age-related variations in presentation and outcome in Wegener's granulomatosis.

Wegener's granulomatosis (WG) is increasingly being diagnosed in older people. The object of this study was to see whether age influences the clinical presentation and prognosis. In a retrospective open case-note review of 51 patients with a diagnosis of WG based on internationally accepted criteria, 29 patients (56.9%) below 60 years and 22 (43.1%) aged 60 or above were compared. The incidence of limited (10% vs 9.1%) and classical (89.6% vs 90.9%) disease was similar in the two groups, but some clinical features were commoner in the younger cohort at presentation: ear, nose and throat (100% vs 68.1%; p < 0.01), ophthalmic (48.3% vs 18.2%; p = 0.05) and dermatological (51.7% vs 18.2%; p = 0.05). There were no significant differences in the incidence of renal, pulmonary, rheumatological or neurological involvement or in the presence of antineutrophil cytoplasmic antibody. Outcome was significantly worse for the over 60 group despite a similar treatment regimen (prednisolone, cyclophosphamide, and dialysis if required) (six months' survival: 96.5% vs 59.1%; p < 0.01). Renal function at presentation was a significant determinant of prognosis: mean serum creatinine at presentation was 525 mumol/l vs 291 mumol/l respectively in those who died within six months and in those who survived (p = 0.03). Uncontrolled pulmonary vasculitis was the commonest cause of death. In conclusion, the classical presentations of WG are similar in older patients. Disease in the latter is more often restricted to the lungs and the kidneys, and this may cause diagnostic uncertainty. The outcome is worse in older patients, with uncontrolled pulmonary vasculitis the commonest cause of death despite immuno-suppressive treatment. Early diagnosis and treatment may improve outcome.

Antihypertensive therapy and orthostatic responses in elderly hospital in-patients.

The study aim was to determine the association between use of antihypertensive drugs and orthostatic hypotension on prolonged standing in an elderly in-patient population. Hospital in-patients aged > 60 years had manually and automatically determined blood pressure (BP) measurements recorded in the supine position. On standing a total of nine measurements were taken over 10 min, six measurements were taken using a mercury sphygmomanometer and three by an automatic monitor. Seventy-four patients of mean age 73 +/- 7 years were studied; 52 (70%) were taking > or = 1 antihypertensive drug and 22 (30%) none. On standing, manually determined systolic BP (SBP) fell to a similar extent in the group of patients taking antihypertensive therapy compared to those not taking such treatment (at 9 min standing: -6 +/- 16 vs -10 +/- 15 mm Hg, respectively) and the frequency of orthostatic hypotension (SBP fall > or = 20 mm Hg) was similar in both groups [at 9 min: 9 (17%) vs 5 (23%)]. Automatically determined measurements also revealed similar orthostatic SBP responses in both treated and non-treated groups (at 8 min: -3 +/- 18 vs -6 +/- 13 mm Hg, respectively) and a similar frequency of orthostatic hypotension. No significant change in standing compared to supine diastolic BP (DBP) measured manually or automatically was seen in either group. Even in the subgroup of patients taking > or = 2 antihypertensive drugs the orthostatichypotension. BP response and the frequency of orthostatic hypotension was similar to that in the non-treated group. In conclusion no association was found between use of antihypertensive therapy and orthostatic hypotension in an elderly in-patient population.

Management of urinary incontinence in the elderly.

Urinary incontinence is common in the elderly, affecting 6-8% of people over 64 years in the community and up to 31% in hospital and long-term care. It is possible to establish the diagnosis clinically in most incontinent patients with the likelihood of improving symptoms in the majority. Treatment of patients with urinary incontinence requires attention to general and specific measures. General measures include moderation of fluid intake to about 1.5 litres/day, reduced intake of caffeine-rich drinks, treatment of aggravating conditions such as urinary infection, oestrogen deficiency, increased solute load as in diabetes mellitus and uraemia, and drugs like diuretics, sedatives and antidepressants. Specific measures include pelvic floor exercises, vaginal cones, interferential therapy and oestrogens for patients with stress incontinence. Bladder retraining and anticholinergic drugs are for patients with urge incontinence, and alpha-blockers and 5-alpha reductase inhibitors for patients with overflow incontinence due to prostatic hyperplasia.

Orthostatic blood pressure changes on prolonged standing in elderly hospital in-patients.

To determine early and delayed orthostatic BP responses in elderly hospitalized patients on prolonged standing, 85 patients, including normotensive and hypertensive persons, both treated and untreated, aged between 60 and 90 years, were studied. Following 10 min rest a series of nine supine BP measurements were undertaken, first with a mercury sphygmomanometer, immediately followed by an automatic oscillometric BP monitor (SpaceLabs 90207), then again by the sphygmomanometer. Patients then stood and the series of BP measurements was repeated, giving a total of nine standing BP determinations at 1 min intervals. Orthostatic BP measurements recorded by both devices were assessed at 1-3 min (early phase), 4-6 min (mid-phase), and 7-9 min (late phase). The orthostatic fall in SBP was greater during the late than early phase when measured by both the sphygmomanometer (-7.5+/-14.9 vs -2.6+/-10.3 mmHg; difference 4.9+/-8.7 mmHg, p<0.001, 95% CI: 3.0, 6.7 mmHg) and the automatic monitor (-3.5+/-16.9 vs 0.5+/-14.5 mmHg, difference 4.0+/-11.6 mmHg; p=0.002, CI: 1.5, 6.5 mmHg). Orthostatic changes in DBP were similar during early and late phases. More patients had systolic orthostatic hypotension (SBP fall > or =20 mmHg on standing) measured by the sphygmomanometer during the late than early phase (19 [22%] vs 6 [7%]; respectively, p=0.009), but not when measured by the monitor (10 [12%] vs 9 [11%], respectively). Many hospitalized elderly patients may exhibit systolic orthostatic hypotension as measured by sphygmomanometry only after prolonged (> or =7 min) standing.

Validation of the SpaceLabs 90207 automatic non-invasive blood pressure monitor in elderly subjects.

OBJECTIVE: To validate the SpaceLabs 90207 ambulatory blood pressure monitor in the elderly. METHODS: Eighty-five subjects aged 60-90 years were recruited from hospital inpatients. Using the same-arm sequential measurement technique two observers recorded blood pressure with a mercury sphygmomanometer first and then by using the SpaceLabs 90207 ambulatory monitor. This set of blood pressure readings was performed three times with all 85 subjects supine, sitting and standing. Data were analysed according to the British Hypertension Society protocol. RESULTS: Over the blood pressure range tested the SpaceLabs 90207 device recorded diastolic blood pressure (DBP) satisfactorily, achieving grade A in all body postures, but not systolic blood pressure (SBP; supine D, standing C, sitting C). However, at SBP

Differences in orthostatic blood pressure changes measured with an oscillometric blood pressure monitor and a mercury sphygmomanometer.

AIMS: To compare orthostatic blood pressure (BP) changes recorded with the SpaceLabs 90207 BP monitor (SL) and the standard mercury sphygmomanometer (HgS). METHODS: 85 hospital in-patients aged 60-90 years had nine BP measurements recorded by both instruments using the same arm sequential measurement technique in supine and standing position by two observers. Supine BP was taken as the final set of three supine measurements, ie, one made with the SL, and the mean of the two HgS readings immediately before and after the monitor reading. From the SL supine reading was subtracted the three standing SL monitor readings and from the mean of the 2 supine HgS readings was subtracted the six standing measurements taken by the HgS. The orthostatic BP changes recorded by the HgS immediately before and after each SL monitor reading were averaged and compared with the corresponding orthostatic change recorded by the monitor. RESULTS: The monitor underestimated orthostatic SBP changes at all 3 comparisons compared to the HgS; i) -0.9 +/- 14.9 vs 2.7 +/- 10.3 mmHg, p < 0.05; ii) 0.3 +/- 15.4 vs 4.5 +/- 12.1 mmHg, p < 0.05; iii) 3.5 +/- 16.9 vs 7.5 +/- 14.9 mmHg, p < 0.05, respectively. These differences were more pronounced in males than females. Orthostatic hypotension (defined as SBP fall on standing of > or = 20 mmHg) was recorded in males by the monitor in four (8%) and by the HgS in 12 (25%), p < 0.05. Mean orthostatic DBP changes were similarly recorded by the monitor and HgS. On average only 60% and 77% of orthostatic SBP measurements taken by both instruments agreed within 10 and 15 mmHg respectively while 75% and 88% respectively of orthostatic DBP changes agreed within these limits. CONCLUSION: Orthostatic BP falls measured by an automatic oscillometric BP monitor may not be equivalent to those taken with a HgS and their use adds a further variable to the comparison of orthostatic BP changes between studies.