Medication adherence and resistant hypertension.

Non-adherence has been a major concern in the treatment of hypertension and is particularly important in understanding and intervening in patients who appear to have resistant hypertension. Relatively few studies have examined the role of non-adherence in resistant hypertension. This review will address issues related to measurement of adherence, adherence interventions and rates of non-adherence in general hypertensive populations and in patients classified as having resistant hypertension.

The role of VEGF in the diabetic patients undergoing endovascular therapy of symptomatic aortic valve stenosis.

The aim of this study was to explore changes in plasma vascular endothelial growth factor (VEGF) in aged patients who undergone transcatheter aortic valve implantation or balloon angioplasty for the treatment of aortic stenosis. Plasma VEGF was measured in subjects with diabetes mellitus type 2 (DM) (n=21, age 79.2+/-1.6 years) and in non-diabetic subjects (non-DM) (n=23, age 84.4+/-0.7 years), using an ELISA kit. Before the procedure plasma levels of VEGF were significantly lower in DM than in non-DM patients (P<0.05). Plasma VEGF significantly increased in both groups (DM and non-DM) 24 h (387+/-64 vs. 440+/-30 pg/ml, P<0.05) and 72 h (323+/-69 vs. 489+/-47 pg/ml, P<0.05) after the endovascular procedure. However, the VEGF in DM patients was significantly lower compared to non-DM subjects up to one month after the endovascular procedure (283+/-47 vs. 386+/-38 pg/ml, P<0.05). We conclude that increased plasma VEGF in aged patients associates with atherosclerotic aortic valve stenosis. In spite of that plasma VEGF in DM was constantly significantly lower than in non diabetic patients, both before and after the endovascular procedure, possibly reflecting a disturbance of angiogenic/anti-angiogenic balance in diabetes.

Multispecies biofilm in an artificial wound bed--A novel model for in vitro assessment of solid antimicrobial dressings.

Wound infections represent a major problem, particularly in patients with chronic wounds. Bacteria in the wound exist mainly in the form of biofilms and are thus resistant to most antibiotics and antimicrobials. A simple and cost-effective in vitro model of chronic wound biofilms applied for testing treatments and solid devices, especially wound dressings, is presented in this work. The method is based on the well-established Lubbock chronic wound biofilm transferred onto an artificial agar wound bed. The biofilm formed by four bacterial species (Staphylococcus aureus, Enterococcus faecalis, Bacillus subtilis and Pseudomonas aeruginosa) was stable for up to 48h post-transplant. The applicability of the model was evaluated by testing two common iodine wound treatments. These observations indicate that this method enables assessing the effects of treatments on established resilient wound biofilms and is clinically highly relevant.

Multiple-timescale relaxation dynamics in CsGd(MoO4)2--a dipolar magnet with a highly anisotropic layered crystal structure.

The dynamic properties of the dipolar magnet CsGd(MoO4)2 have been studied. The frequency and temperature dependence of the AC susceptibility investigated in the paramagnetic region above 2 K revealed the co-existence of magnetic field induced slow and fast relaxation channels with a timescale differing by three orders of magnitude. The slow relaxation is determined by the properties of the first coordination sphere of the Gd(3+) ion and has the character of a two-phonon Orbach process. The fast relaxation is potentially attributed to a two-phonon Raman process realized via a localized phonon mode associated with the layered crystal structure. The temperature dependence of the phonon mean free path in zero magnetic field indicates significant phonon scattering below 1 K resulting from the combined effect of magnetic correlations and the scattering of dominant phonons with energies corresponding to the crystal-field levels.

Slow spin relaxation induced by magnetic field in [NdCo(bpdo)(H2O)4(CN)6]⋠3H2O.

We report on a comprehensive investigation of the magnetic properties of [NdCo(bpdo)(H2O)4(CN)6]⋅3H2O (bpdo=4, 4'-bipyridine-N,N'-dioxide) by use of electron paramagnetic resonance, magnetization, specific heat and susceptibility measurements. The studied material was identified as a magnet with an effective spin S = 1/2 and a weak exchange interaction J/kB = 25 mK. The ac susceptibility studies conducted at audio frequencies and at temperatures from 1.8 to 9 K revealed that the application of a static magnetic field induces a slow spin relaxation. It is suggested that the relaxation in the magnetic field appears due to an Orbach-like process between the two lowest doublet energy states of the magnetic Nd(3+) ion. The appearance of the slow relaxation in a magnetic field cannot be associated with a resonant phonon trapping. The obtained results suggest that the relaxation is influenced by nuclear spin driven quantum tunnelling which is suppressed by external magnetic field.

The role of sibutramine in weight reduction.

BACKGROUND: The effectiveness of pharmacologic support with sibutramine along with the preservation of dietary and regimen measures is shown in a group of long-term treated patients at the Metabolic Clinic of the University Hospital in Hradec Králové. METHODS: In ambulatory patients, basic anthropometric parameters as body weight, BMI, waist circumference and the total amount of adipose tissue were compared before substitution with 10 mg sibutramine and after a four-month therapy. This group included 94 patients who were administered the same dose of sibutramine for the whole period of time. This group consisted of 37 men and 57 women. RESULTS: After a four-month therapy with sibutramine there was a mean reduction in weight by 7.9 ± 3.8 kg in the monitored group of patients. Their BMI was reduced by 2.3 ± 1.5 kg/height2 and the waist circumference by 4.4 ± 3.8 cm. The decrease in the percentage of the total body lipid was 2.9 %. CONCLUSION: Despite a surprising decision of the European Drug Agency to suspend the registration of sibutramine in the whole of Europe since January 2010 we can state that in our patients we have proven a positive effect of sibutramine substitution on their weight reduction (Tab. 1, Ref. 19).

Obesity in focus.

Obesity has become the most frequent metabolic disease as a result of life conditions and lifestyle which have resulted in a positive energetic balance. However, at the end of the 20th century it reached the dimension of the global epidemic as a result of constantly increasing energy intake without an adequate increase in energy expenditure. The article describes the 11th International Congress on Obesity which took place in Stockholm in July 2010. The delegates discussed recommended diagnostics and treatments in obesitology. A large number of presentations were focused on nutrition and dietary management. The Congress showed that it is necessary to keep paying obesity due attention.

Sibutramine--its impact on health-related quality of life and depression among adult obese non-diabetic patients.

BACKGROUND: Obesity is a multifactorial, chronic disorder that has reached epidemic proportions in most industrialised countries and is threatening to become a global epidemic. AIMS: The pilot study evaluates the effect of sibutramine therapy on health-related quality of life and occurence of depression symptoms among adult obese non-diabetic patients. PATIENTS AND METHODS: This study was prospective and longitudinal. It was conducted at the Department of Hygiene of Faculty of Military Health Sciences in Hradec Králove, Czech Republic. Dates were obtained during year 2007. Twenty two adult obese non-diabetic patients (6 males and 16 females) were treated with sibutramine in dose of 10 mg daily. All of these 22 patients were over 18 years old. The European Quality of Life Questionnaire--EQ-5D Version was used for evaluation of health-related quality of life. The self-assessement Zung-SDS was applied for evaluation of occurrence of depression. RESULTS: The statistical evaluation demonstrated that health-related quality of life (EQ-5D score and EQ-5D visual analogue scale) presents highly significant statistical dependence on sibutramine therapy (p < 0.05). The statistical evaluation demonstrated that index of depression (SDS index) presents highly significant statistical dependence on sibutramine therapy (p < 0.05). CONCLUSION: The results show that sibutramine therapy has a highly positive effect on health-related quality of life among adult obese non-diabetic patients. Also, the results show that sibutramine therapy has a highly positive effect on occurence of depresion symptoms among adult obese non-diabetic patients (Fig. 2, Ref. 10).

Health-related quality of life in multiple myeloma survivors treated with high dose chemotherapy followed by autologous peripheral blood progenitor cell transplantation: a retrospective analysis.

A pilot study analyses an effect of selected demographic, psychosocial and health aspects on quality of life (QoL) in multiple myeloma survivors treated with high-dose chemotherapy followed by autologous peripheral blood progenitor cell transplantation (PBPCT). The total number of respondents with multiple myeloma treated with high-dose chemotherapy followed by autologous PBPCT between years 2001-2003 at the Department of Clinical Haematology of the 2nd Department of Internal Medicine of Charles University Hospital and Faculty of Medicine in Hradec Králové, Czech Republic was 32 (18 male, 14 female). The average age of respondents was 60 years old. The Czech version of an international generic European Quality of Life Questionnaire - Version EQ-5D was used. The effect of selected demographics, psychosocial and health aspects on QoL was determined by means of analysis of variance (ANOVA). The QoL questionnaires were evaluated by means of descriptive analysis. The above-mentioned aspects proved statistically significant dependence of QoL on respondents age and on smoking abuse. EQ-5D score (dimensions of QoL) and EQ-5D VAS (a subjective health condition) significantly decrease with increasing age and with smoking abuse. The effect of other aspects on QoL was not proven as statistically significant. Prevailing complaints in respondents with multiple myeloma were: 1. regular activity with complaints 81,2 % (26/32 respondents), 2. medium serious pain / discomfort 68,8 % (22/32 respondents), 3. movement with complaints 59 % (19/32 respondents), 4. medium serious anxiety / depression 59 % (19/32 respondents). The QoL in patients with multiple myeloma treated with high-dose chemotherapy followed by autologous PBPCT was on low level (mean EQ-5D score was 68,9 %, mean EQ-5D VAS was 66,6 %). The results had shown that with an increasing age, the QoL of patients with multiple myeloma treated with high-dose chemotherapy followed by autologous PBPCT, declines. The smokers and former smokers have lower QoL than non smokers. The global QoL in all studied patients with multiple myeloma treated with high-dose chemotherapy followed by autologous PBPCT was on low level.

Influence of premorbid IQ and education on progression of Alzheimer's disease.

BACKGROUND: Lower education is associated with a higher risk of developing Alzheimer's disease (AD). Years of education and measures of general intellectual function (IQ) are highly correlated. It is important to determine whether there is a relationship between education and AD outcomes that is independent of IQ. OBJECTIVE: To test the hypothesis that premorbid IQ is a stronger predictor of cognitive decline, global progression, and overall survival, than education in patients with AD. METHODS: The study included 478 probable AD patients (322 women and 156 men, mean age 74.5 years) followed in a large AD referral center for a mean of 3.2 years. Eligible participants had a baseline estimate of premorbid IQ using the American version of the Nelson Adult Reading Test (AMNART) and at least one follow-up visit with complete neuropsychological assessment. We used random effects linear regression analysis, and Cox proportional hazards analysis to determine whether or not education and/or premorbid IQ were independently associated with cognitive decline, global progression of AD, and survival. RESULTS: When the baseline AMNART score was included in regression models along with education and other demographic variables, AMNART score, but not education, was associated with a higher baseline score and slower rate of decline in MMSE and ADAS-Cog scores, and the Clinical Dementia Rating sum of boxes score. Neither higher premorbid IQ nor higher education was associated with longer survival. CONCLUSIONS: We conclude that a baseline AMNART score is a better predictor of cognitive change in AD than education, but neither variable is associated with survival after diagnosis.

Correlation between the sizes of Mauthner neurons and the preference of goldfish to turn to the right or left.

Three-dimensional computer reconstruction working from serial histological sections was used to study the morphology of the right and left Mauthner neurons (MN) in goldfish fry showing marked preferences to turn stably to the right or left in a narrow water channel or showing no asymmetry in their choice of side during turns. Visually, fish with left-sided motor asymmetry had larger MN on the right side, while fish with right-sided motor asymmetry had larger MN on the left side. Fish with symmetrical turns to the right and left showed no differences in MN size. Quantitative assessment of the MN of fish with preferences for turns to one side or the other revealed significant differences in the sizes of the somatic part, the axon hillock, and the axons of neurons located on the contralateral side of the medulla oblongata. Analysis of the statistical relationships between the functional (motor) asymmetry of fish and the morphological asymmetry of the somatic parts of MN in the same fish revealed a stable correlation (0.69) between these measures. Given that MN initiate unilateral turns of the body in free movement, the data obtained here lead to the conclusion that the larger neuron is more frequently activated in natural conditions as compared with the smaller, contralateral, neuron.

[Correlation of the sizes of Mauthner neurons with the preference in the goldfish to turn rightwards or leftwards].

Using the three-dimensional computer reconstruction from serial histological sections, the morphology of right and left Mauthner cells (MC) was examined in the goldfish fry which demonstrated clearly pronounced preference to turn to the right or to the left in a narrow water channel or which did not show any asymmetry in choosing the side of turning. Visually, the goldfish with left-sided motor asymmetry seemed to possess larger right MC, while in the goldfish with right-sided motor asymmetry left MC were larger. In fish with symmetric proportion of right or left turnings, the sizes of MC did not differ. Quantitative evaluation of MC in fish showing the preference of turning side has revealed significant differences in the sizes of cell bodies, axon hillock and axons of MC, located contralaterally in medulla oblongata. Analysis of a statistic relations between functional (motor) and morphological asymmetry of MC cell body in the same fish indicated the existence of a stable correlation (0,69) between them. Taking into consideration that MC initiate unilateral body turn during free swimming of fish, it may be concluded that the larger size of neuron predetermines its more frequent natural activation in comparison with the contrlateral neuron, that has smaller size.

Changing patient characteristics and survival experience in an Alzheimer's center patient cohort.

BACKGROUND: Large and diverse dementia patient cohorts can further a variety of research programs aimed at improving diagnosis, treatment, and meaningful survival in AD. METHOD: We recruited 1,502 dementia patients between 1989 and 2002, subclassified using standardized criteria and laboratory procedures, and treated according to established guidelines. Baseline clinical and psychometric measures were repeated annually, in person or by use of a multi-modal telephone follow-up program that included many of the measures obtained at in-person visits. We tracked vital status of all subjects at 6-month intervals and offered autopsies to all participants. We assessed for cohort effects in baseline characteristics by 2-year intervals, examined the characteristics and outcomes for those who remained active compared to those who were eventually lost to follow-up, examined survival times for demographic or diagnostic subgroups, and assessed the accuracy of clinical diagnoses versus neuropathology. RESULTS: The average age at entry, average educational level, and baseline MMSE scores for subjects are increasing over time, and probable AD diagnoses are also increasing. Most (80.6%) subjects have remained active in our Center; those who did not were more likely to have a non-AD diagnosis. Survival averages 5.2 years (CI 4.98--5.37) and is influenced by age and gender, but not by diagnosis of probable versus possible AD. Our diagnostic accuracy is 89.6%, with high sensitivity to the presence of AD (96%). CONCLUSIONS: In a large and representative clinical cohort, the demographics of AD are changing over time. Careful analyses of those who continue and those who drop out from follow-up suggest that atypical diagnosis, rather than severity or demographic issues accounts for most of the attrition. Clinicians are likely to encounter increasingly older patients with milder disease, and these trends have implications for the design of clinical trials. Survival from the onset of first symptoms, similar for probable and possible AD cases, may be increasing over time.

Physical activity does not mitigate G-protein-related genetic risk for obesity in individuals of African descent.

The G-protein beta3 subunit 825 TT genotype has been associated with obesity and hypertension. We examined the interaction between the G-protein TT genotype, physical activity and body mass index (BMI) in a cross-sectional study of African immigrants and African Americans. The genotype frequencies were 6.3% CC, 37.7% CT, and 56% TT. After adjusting for potential confounders, BMI was found to be significantly higher in the sedentary than in the physically active participants (p=0.045). There was no statistically significant effect for genotype (p=0.215) or the interaction between genotype and the level of physical activity (p=0.219). However, the individuals with the CC or CT genotype who were physically active had substantially lower BMIs (M+/-SE) (i.e., 25.74+/-2.02) than any of the other groups: sedentary CC + CT (30.58+/-1.03), sedentary TT (30.65+/-1.00) or active TT (29.43+/-1.65). Because of the low statistical power of this study, further research is needed to confirm these findings and to explore potential gene-environment/lifestyle interactions.

Characteristics of patients with uncontrolled hypertension in the United States.

BACKGROUND: Treatment of hypertension is one of the most common clinical responsibilities of U.S. physicians, yet only one fourth of patients with hypertension have their blood pressure adequately controlled. METHODS: We analyzed data from the third National Health and Nutrition Examination Survey to assess the role of access to and use of health care in the control of hypertension. We assessed demographic characteristics, clinical data, health insurance status, and awareness and treatment of hypertension in subjects with hypertension (defined as a blood pressure of at least 140/90 mm Hg or the use of antihypertensive medication) and subjects without hypertension. RESULTS: The study sample consisted of 16,095 adults who were at least 25 years old and for whom blood-pressure values were known. We estimated that 27 percent of the population had hypertension, but only 23 percent of those with hypertension were taking medications that controlled their condition. Among subjects with untreated or uncontrolled hypertension, the pattern was an elevation in the systolic blood pressure with a diastolic pressure of less than 90 mm Hg. The great majority had health insurance. Independent predictors of a lack of awareness of hypertension were an age of at least 65 years, male sex, non-Hispanic black race, and not having visited a physician within the preceding 12 months. The same variables, except for non-Hispanic black race, were independently associated with poor control of hypertension among those who were aware of their condition. An age of at least 65 years accounted for the greatest proportion of the attributable risk of the lack of awareness of hypertension and the lack of control of hypertension among those who were aware of their condition. CONCLUSIONS: Most cases of uncontrolled hypertension in the United States consist of isolated, mild systolic hypertension in older adults, most of whom have access to health care and relatively frequent contact with physicians.

Genetic bottlenecks, perceived racism, and hypertension risk among African Americans and first-generation African immigrants.

The complexity of factors influencing the development of hypertension (HTN) in African Americans has given rise to theories suggesting that genetic changes occurred due to selection pressures/genetic bottleneck effects (ie, constriction of existing genetic variability) over the course of the slave trade. Ninety-nine US-born and 86 African-born health professionals were compared in a cross-sectional survey examining genetic and psychosocial predictors of HTN. We examined the distributions of three genetic loci (G-protein, AGT-235, and ACE I/D) that have been associated with increased HTN risk. There were no significant differences between US-born African Americans and African-born immigrants in the studied genetic loci or biological variables (eg, plasma renin and angiotensin converting enzyme activity), except that the AGT-235 homozygous T genotype was somewhat more frequent among African-born participants than US-born African Americans. Only age, body mass index, and birthplace consistently demonstrated associations with HTN status. Thus, there was no evidence of a genetic bottleneck in the loci studied, ie, that US-born African Americans have different genotype distributions that increase their risk for HTN. In fact, some of the genotypic distributions evidenced lower frequencies of HTN-related alleles among US-born African Americans, providing evidence of European admixture. The consistent finding that birthplace (ie, US vs Africa) was associated with HTN, even though it was not always significant, suggests potential and unmeasured cultural, lifestyle, and environmental differences between African immigrants and US-born African Americans that are protective against HTN.

Dyslipidaemia in African Americans, Hispanics and whites with type 2 diabetes mellitus and hypertension.

AIM: To study the pattern of dyslipidaemia in African American, Hispanic, and White patients with type 2 diabetes mellitus and/or hypertension. METHODS: The data were collected retrospectively on 6450 patients followed in the Harris County Hospital District Community Clinics. The information collected from review of the charts included each patient's age, sex, race, body mass index (b.m.i.), duration of type 2 diabetes mellitus and hypertension, medications, fasting plasma glucose, haemoglobin A1c, and fasting lipid profile. Mean lipid and haemoglobin A1c levels in the three ethnic groups were compared. The risk of abnormal cholesterol and triglyceride levels was assessed with logistic regression analysis. RESULTS: The results show that in patients with type 2 diabetes mellitus after correcting for age, sex and b.m.i., African Americans have the lowest serum triglyceride concentrations and Whites have the highest values. This trend holds true even in patients with hypertension and in patients with both hypertension and type 2 diabetes mellitus. The risk of having abnormal triglycerides is 74% lower in African Americans, and 42% lower in Hispanics than Whites based on logistic regression model. Despite better glycaemic control, Whites have a greater increase in serum triglyceride concentrations than Hispanics and African Americans. CONCLUSIONS: Although African Americans are known to be at higher risk for cardiovascular complications than Whites or Hispanics, they appear to have lower triglyceride concentrations than Whites or Hispanics in the presence of type 2 diabetes mellitus. This suggests that an increased prevalence of other adverse factors must contribute to their heightened cardiovascular risk.

Quantifying the problem of abuse and neglect in adults--analysis of a statewide database.

BACKGROUND: Mistreatment of adults, including abuse, neglect, and exploitation, affects more than 1.8 million older Americans. Presently, there is a lack of precise estimates of the magnitude of the problem and the variability in risk for different types of mistreatment depending on such factors as age and gender. OBJECTIVES: To describe the universe of case reports received during one year in a centralized computer database maintained by the Texas Department of Protective and Regulatory Services--Adult Protective Services Division (TDPRS-APS). DESIGN: Descriptive. SETTING: Texas. PARTICIPANTS: Mistreated or neglected older people. MEASUREMENTS: The distribution of abuse types reported and population prevalence estimates of each abuse type by age and sex. RESULTS: There were over 62,000 allegations of adult mistreatment and neglect filed in Texas in 1997. Neglect accounted for 80% of the allegations. The incidence of being reported to the TDPRS-APS increased sharply after age 65. The prevalence was 1,310 individuals/100,000 > or = 65 years of age for all abuse types. CONCLUSIONS: The TDPRS database is an excellent tool for characterizing and tracking cases of reported elder mistreatment. Achieving a clearer understanding of this ever-increasing public health problem can aid in the development of better interventions and prevention strategies.

Lower hypertension prevalence in first-generation African immigrants compared to US-born African Americans.

Both genetic and environmental factors have been hypothesized to explain the higher prevalence of hypertension in US African Americans compared to populations still residing in western Africa. Studies of first-generation immigrants can help to identify risk factors for increased chronic disease expression in the developed world. Since we could identify no prior studies of hypertension in African immigrants to the United States, we conducted a cross-sectional survey of African-born and US-born African-American health professionals to compare the two groups for the prevalence of hypertension (blood pressure > or = 140/90 mm Hg or use of antihypertensive medication) and risk factors for hypertension (body mass index, lifestyle factors, and psychosocial variables hypothesized to relate to hypertension). Subjects were registered pharmacists and nurses recruited by mail. For the 182 individuals who completed study measurements (95 US-born and 87 African-born), the unadjusted odds ratio for hypertension associated with birthplace was 2.16 (95% CI = 1.12, 3.98). After adjustment for body mass index and age, the OR for birthplace was 1.92 (95% CI = 0.92, 4.00). No lifestyle or psychosocial variables were associated with hypertension prevalence. We conclude that there is a lower prevalence of hypertension in first-generation African immigrants that cannot be readily explained by the environmental effects measured in this study. Larger scale studies with African immigrants could advance understanding of the causes of the increased hypertension prevalence in US-born African Americans.