The American journal of the medical sciences
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The southeastern United States has the highest occurrence of heart disease and stroke and among the highest rates of congestive heart failure and renal failure in the country. The Consortium for Southeastern Hypertension Control (COSEHC) is cooperating with other organizations in implementing initiatives to reduce morbidity and mortality from hypertension-related conditions in the southeastern United States. This article outlines for clinicians special consideration for implementation of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) in the southeastern United States. Clinicians are encouraged to adapt the recommendations of JNC VI to their own patient groups, paying attention to these specific areas: (1) Ensure screening for hypertension in your practice and community. (2) Evaluate all patients for accompanying risk factors and target organ damage. (3) Promote lifestyle management for individual patients and populations for prevention and treatment of hypertension. (4) Set a goal blood pressure for each patient, and monitor progress toward that goal. (5) Recognize that many patients will be candidates for blood pressure goals of <130/85 mm Hg. (6) Pay attention to compelling and special indications such as diabetes, congestive heart failure, and renal dysfunction. (7) Consider combination therapy. (8) Maximize staff contributions to enhance patient adherence. (9) Encourage patient, family, and community activities to promote healthy lifestyles and blood pressure control.
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Clinical Trial
Efficacy of exogenous oral zinc in treatment of patients with carbonic anhydrase VI deficiency.
We previously described a disorder in 18 patients with decreased parotid saliva gustin/carbonic anhydrase (CA) VI secretion associated with loss of taste (hypogeusia) and smell (hyposmia) and distorted taste (dysgeusia) and smell (dysosmia). Because gustin/CAVI is a zinc-dependent enzyme we instituted a study of treatment with exogenous zinc to attempt to stimulate synthesis/secretion of gustin/CAVI and thereby attempt to correct the symptoms of this disorder. ⋯ Zinc treatment is effective in patients in whom this trace metal increases synthesis/secretion of gustin/CAVI and ineffective in those in whom it does not. Increased gustin/CAVI in this disorder is probably associated with zinc stimulation of the gene responsible for the synthesis/secretion of gustin/CAVI. Among nonresponders, zinc was ineffective for several possible reasons, including resistance to zinc and possible sialylation of gustin/CAVI, which may render it functionally ineffective. Results suggest the hypothesis that gustin/CAVI is a trophic factor that promotes growth and development of taste buds through its action on taste bud stem cells.
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Glutathione S-transferase (GST) M1 polymorphism is a marker for susceptibility to smoking-related neoplasms, such as lung and bladder cancer. Recently, a genetic deletion of GSTT1, an isoenzyme of GST, has been reported to be associated with myelodysplastic syndromes (MDS). ⋯ Using a polymerase chain reaction-based genotyping method, he was found to have a deletion of both the GSTM1 and GSTT1 genes. Screening for the deletion of the GSTM1 and GSTT1 genes may be useful for assessing individual genetic susceptibility to smoking-related lung cancer and MDS.
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Measurements of total glycohemoglobin (glycoHb) or hemoglobin A1c are routinely used to evaluate intermediate-to-long term glycemic control in patients with diabetes. However, despite the recent availability of more rapid methods for glycohemoglobin determination, it remains difficult in many institutions to obtain same-day glycoHb determinations in time to assist physicians with management of outpatients with diabetes. Hence, we investigated whether fructosamine, which reflects very recent (2 to 3 weeks) glycemic control and which can be assayed more rapidly in our laboratory, could serve as a useful adjunct to glycoHb for management of these patients. ⋯ Fructosamine may be a useful adjunctive test for management of outpatients with diabetes in situations where it is not practical to obtain same-day glycoHb concentrations, for patients less compliant with home glucose monitoring, or where recent changes in insulin dose or clinical presentation might not be reflected in the glycoHb levels.