These receptors are also expressed in many other tissues and cell types. AR 1 2 Affinity Adrenaline NE Adrenaline NE Adrenaline NE Adrenaline NE Adrenaline NE Agonist Phenylephrine Clonidine and UK-14304 Dobutamine and betaxolol Terbutaline Sibutramine and BRL 37344 Antagonist Doxazosin Yohimbine Atenolpl and CGP-20712A ICI-118, 551 Location VSMC and EC VSMC, EC and presynaptic neurons VSMC, EC and heart VSMC and EC Adipocytes and VSCM.
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The precise control of BP occurs via Na homeostasis and involves the precise regulation of the epithelial Na channel ENaC ; in the aldosterone-sensitive distal nephron. This has been corroborated by the linkage of mutations in the genes encoding ENaC subunits and Liddle's syndrome, a heritable form of human hypertension. Mapping of these mutations on ENaC indicated that inactivation of PY motifs is responsible and leads to the proposition that the channel interacts via its PY motifs with the WW domains of the Nedd4 Nedd4-like ubiquitin-protein ligase family. It is now well established that the cell surface expression of ENaC is controlled via ubiquitylation by this protein family and that this ubiquitylation is regulated by the aldosterone-induced protein serum and glucocorticoid induced kinase 1. J Soc Nephrol 16: 31673174, 2005. doi: 10.1681 ASN.2005050454, for example, atenolol forum.
The medical surgical stop-loss limits are contained in Appendix B at the back of this booklet. -- Option A Once the medical surgical stop-loss is met, most covered charges under the medical surgical program of the Plan are paid at 100% for the rest of the calendar year. -- Out of Area Option Once the medical surgical stop-loss is met, most covered charges under the medical surgical program of the Plan are paid at 100% for the rest of the calendar year. -- PPO Option Once the in-network medical surgical stop-loss is met, most covered charges under the in-network level of benefits of the medical surgical program of the PPO Option are paid at 100% for the rest of the calendar year. Once the out-of-network medical surgical stop-loss is met, most covered charges under the out-of-network level of benefits of the medical surgical program and the Preventive Services program of the PPO Option are paid at 100% for the rest of the calendar year. Coinsurances you pay by obtaining preventive services out-of-network under the Preventive Services program ; are applied toward the out-of-network medical surgical stop-loss. In-network, out-of-network, and exception benefit level coinsurances apply toward meeting the in-network stop-loss limit. Only out-of-network coinsurances apply toward meeting the outof-network stop-loss. Covered charges under the MMH Program and the Prescription Program are not paid at 100% after the medical surgical stop-loss is reached. You can refer to "Helpful Terms" section of this booklet for more information about how the stop-loss limit works.
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Received: october 25, 2004 accepted: february 2, 2005 number of print pages : 5 number of figures : 1 , number of tables : 2 , number of references : 8 free abstract article fulltext ; article pdf 116 kb ; journal home journal content guidelines and
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DRAFT 10-11-06 I.L. Bernstein, MD 5723 5724 5725 early technique has been superseded by chemical fluorometric ; and most recently, immunologic methods. a. Chemical A method for the chemical determination of histamine was first described by Shore et al. in 1959 102 ; . Since then, this method has been modified to increase both its specificity and sensitivity. It is based on the coupling of ophthalaldehyde to histamine at alkaline pH to form a fluorescent product. The fluorescence of the histamine-o-phthalaldehyde complex is more intense and more stable at an acid pH, unlike the complex formed by some other amines. To remove interfering compounds, the histamine is extracted before the condensation step. Protein is removed from the sample to be analyzed by perchloric acid precipitation; the histamine is extracted into n-butanol from the alkalinized salt-saturated solution. The histamine is recovered in an aqueous solution in dilute hydrochloric acid by adding heptane. This dilute hydrochloric acid solution is then used for the condensation of histamine with ophthalaldehyde. The extraction procedure with organic solvents is essential to remove histidine and other interfering compounds before the condensation step. A completely automated fluorometric technique is capable of analyzing 30 samples h with a precision between 1% and 2%. The sensitivity of the method is such that 0.1 to 10 ng histamine can be accurately determined. This method is convenient in handling large numbers of samples with excellent precision. The methods for both the and
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Raymond G. Slavin, MD Departments of Internal Medicine, Molecular Microbiology and Immunology Saint Louis University, Health Science Center St Louis, Missouri Sheldon L. Spector, MD Department of Medicine UCLA School of Medicine Director, California Allergy & Asthma Medical Group Los Angeles, California I. Leonard Bernstein, MD Department of Medicine and Environmental Health University of Cincinnati College of Medicine Cincinnati, Ohio, for example, apo atenolol.
Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. The GISEN Group Gruppo Italiano di Studi Epidemiologici in Nefrologia ; . Lancet 1997; 349: 1857 RT Mann JF, Gerstein HC, Yi QL, Franke J, Lonn EM, Hoogwerf BJ, Rashkow A, Yusuf S, HOPE Investigators. Progression of renal insufficiency in type 2 diabetes with and without microalbuminuria: results of the Heart Outcomes and Prevention Evaluation HOPE ; randomized study. J Kidney Dis 2003; 42: 936942. RT Ruggenenti P, Fassi A, Ilieva AP, Bruno S, Iliev IP, Brusegan V, Rubis N, Gherardi G, Arnoldi F, Ganeva M, Ene-Iordache B, Gaspari F, Perna A, Bossi A, Trevisan R, Dodesini AR, Remuzzi G, Bergamo Nephrologic Diabetes Complications Trial BENEDICT ; Investigators. Preventing microalbuminuria in type 2 diabetes. N Engl J Med 2004; 351: 19411951. RT Mogensen CE, Viberti G, Halimi S, Ritz E, Ruilope L, Jermendy G, Widimsky J, Sareli P, Taton J, Rull J, Erdogan G, De Leeuw PW, Ribeiro A, Sanchez R, Mechmeche R, Nolan J, Sirotiakova J, Hamani A, Scheen A, Hess B, Luger A, Thomas SM, Preterax in Albuminuria Regression PREMIER ; Study Group. Effect of low-dose perindopril indapamide on albuminuria in diabetes: Preterax in albuminuria regression: PREMIER. Hypertension 2003; 41: 10631071. RT Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensinconverting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med 1993; 329: 14561462. RT Parving H-H, Lehnert H, Brochner-Mortensen J, Gomis R, Andersen S, Arner P. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345: 870878. RT Schjoedt KJ, Rossing K, Juhl TR, Boomsma F, Tarnow L, Rossing P, Parving HH. Beneficial impact of spironolactone on nephrotic range albuminuria in diabetic nephropathy. Kidney Int 2006; 70: 536542. RT Voyaki SM, Staessen JA, Thijs L, Wang JG, Efstratopoulos AD, Birkenhager WH, de Leeuw PW, Leonetti G, Nachev C, Rodicio JL, Tuomilehto J, Fagard R, Systolic Hypertension in Europe Syst-Eur ; Trial Investigators. Follow-up of renal function in treated and untreated older patients with isolated systolic hypertension. Systolic Hypertension in Europe Syst-Eur ; Trial Investigators. J Hypertens 2001; 19: 511519. RT Rahman M, Pressel S, Davis BR, Nwachuku C, Wright JT Jr, Whelton PK, Barzilay J, Batuman V, Eckfeldt JH, Farber M, Henriquez M, Kopyt N, Louis GT, Saklayen M, Stanford C, Walworth C, Ward H, Wiegmann T. Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic: a report from the Antihypertensive and LipidLowering Treatment to Prevent Heart Attack Trial ALLHAT ; . Arch Intern Med 2005; 165: 936946. CT Barnett AH. Preventing renal complications in diabetic patients: the Diabetics Exposed to Telmisartan And enalaprIL DETAIL ; study 1. Acta Diabetol 2005; 42 Suppl 1 ; : S42S49. RT Ibsen H, Olsen MH, Wachtell K, Borch-Johnsen K, Lindholm LH, Mogensen CE, Dahlof B, Snapinn SM, Wan Y, Lyle PA. Does albuminuria predict cardiovascular outcomes on treatment with losartan versus atenolol in patients with diabetes, hypertension, and left ventricular hypertrophy? The LIFE study. Diabetes Care 2006; 29: 595600. CT Viberti G, Wheeldon NM, MicroAlbuminuria Reduction With VALsartan MARVAL ; Study Investigators. Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus: a blood pressure-independent effect. Circulation 2002; 106: 672678. RT Vogt L, Navis G, Koster J, Manolis AJ, Reid JL, de Zeeuw D, on behalf of the Angiotensin II Receptor Antagonist Telmisartan Micardis in Isolated Systolic Hypertension ARAMIS ; Study Group. The angiotensin II receptor antagonist telmisartan reduces urinary albumin excretion in patients with isolated systolic hypertension: results of a randomized, double-blind, placebo-controlled trial. J Hypertens 2005; 23: 20552061. RT White WB, Duprez D, St Hillaire R, Krause S, Roniker B, Kuse-Hamilton J, Weber MA. Effects of the selective aldosterone blocker eplerenone versus the calcium antagonist amlodipine in systolic hypertension. Hypertension 2003; 41: 10211026. RT Dalla Vestra M, Pozza G, Mosca A, Grazioli V, Lapolla A, Fioretto P, Crepaldi G. Effect of lercanidipine compared with ramipril on albumin excretion rate in hypertensive Type 2 diabetic patients with microalbuminuria: DIAL study. Diabetes Nutr Metab 2004; 17: 259266. RT and bactroban.
Beta blockers and or diuretics are preferred agents for the treatment of hypertension because a reduction in morbidity and mortality has been demonstrated. Beta blockers are recommended as first-choice agents unless they are contraindicated or unacceptable, or unless there are special indications for other agents. In addition, beta blockers should be initiated and continued for an indefinite period after acute myocardial infarction MI, because xtenolol nifedipine.
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[36] Packer M, Bristow MR, Cohn JN et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996; 334: 1349-55. [37] Brouwer J, van Veldhuisen DJ, AJM Veld, Dunselman PHJM, Boomsma F, Haaksma J, Lie K I for the DIMT Study L Group. Heart rate variability in patients with mild to moderate heart failure: effects of neurhormonal modulation and ibopamine. J Coll Cardiol 1995; 26: 983-90. [38] Krum H, Bigger, JT, Goldsmith RL, Packer M. Effect of long term digoxin therapy on autonomic function in patients with chronic heart failure. J Coll Cardiol 1995; 25: 289-94. [39] Newton GE, Tong JH, Schofield et al. Digoxin reduces cardiac sympathetic activity in severe congestive heart failure. J Coll Cardiol 1996; 28: 155-61. [40] Ferrarri A, Gregonni K, Ferrari MC, Preti L, Mancia G. Digitalis and baroreceptor reflexes in man. Circulation 1981; 63: 279-85. [41] Ferguson DW. Digitalis and neurohormonal abnormalities in heart failure and implications for therapy. J Cardiol 1992; 69: 24G-32G. [42] van Veldhuisen DJ, Man in't Veld, Dunselman PHJM et al. Double-blind, placebo-controlled study of ibopamine and digoxin in patients with mild to moderate heart failure: results of the Dutch Ibopamine Multicentre Trial DIMT ; . J Coll Cardiol 1993; 22: 1564-73. [43] The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 1997; 336: 525-33. [44] Packer M. Pathophysiologic mechanism underlying the adverse effects of calcium channel-blocking drugs in patients with chronic heart failure. Circulation 1989; 80 Suppl 4 ; : 59-67. [45] Devries RJM, Dunselman PHJM. The potential role of calcium antagonists in the management of congestive heart failure-initial experience with lacidipine. J Cardiovasc Pharmacol 1995; 25: S33-S39. [46] Goldsmith SR. Effect of amlodipine and felodipine on sympathetic activity and baroreflex function in normal humans. J Hypertens 1995; 8: 902-8. [47] Devries RJM, Quere M, Lok DJA et al. Comparison of effects on peak oxygen-consumption, quality of life, and neurohormones of felodipine and enalapril in patients with congestive heart failure. J Cardiol 1995; 76: 1253-8. [48] Lindqvist M, Kahan T, Melcher A, Hjemdahl P. Acute and chronic calcium antagonist treatment elevates sympathetic activity in primary hypertension. Hypertension 1994; 24: 287-96. [49] Cook JR, Bigger JT, Kleiger RE, Fleiss JL, Steinman RC, Rolnitzky LM. Effect of atenolol and diltiazem on heart period variability in normal persons. J Coll Cardiol 1991; 17: 480-4. [50] Timmis AD, Kenny JF, Smyth P. Campbell S, Kerkez SA, Jewitt DE. Restoration of normal reflex responses to orthostatic stress during felodipine therapy in congestive heart failure. Cardiovascular Research 1984; 18: 613-19. [51] Kassie E, Armtorp O. Cardiovascular and neurohumoral responses to baroreceptor abnormalities during a course of adjunctive vasodilator therapy with felodipine for congestive heart failure. Circulation 1987; 75: 1204-13. [52] Hirsch AT, Dzau VJ, Cutler SS, Levenson DJ, Creager MA. Effect of isradipine on cardiopulmonary baroreflex function, regional blood flow, and vascular responsiveness in hypertensive patients. J Cardiovasc Pharmacol 1992; 19: 272-81. [53] O'Connor CM, Belkin RN, Carson PE et al. Effect of amodipine on mode of death in severe chronic heart fail.
And to a greater extend than hydrochlorothiazide.133 The most convincing evidence was provided by the Losartan Intervention For Endpoint Reduction in Hypertension LIFE ; study.134 In 8602 hypertensive patients with ECG-ascertained left ventricular hypertrophy, treatment with losartan significantly reduced UAE. In addition, the reduction was significantly greater than the one achieved with atenolol, as was the reduction in cardiovascular endpoints. The authors concluded that part of the mechanism behind the superiority of losartan is related to its greater UAE-reducing effect.134 Interestingly, ARBs seem to have pleiotropic effects. For example, telmisartan has the ability to interact with the nuclear peroxisome proliferator-activated receptor gamma PPAR- ; , 135 and olmesartan has been reported to exhibit antiinflammatory effects in hypertensive patients.136 The clinical value of these findings needs further exploration. In summary, both ACE inhibitors and ARBs are first choice components of an antihypertensive treatment regimen in patients with diabetic or nondiabetic renal disease with albuminuria.114; 137 However, the predicted specific cardiovascular benefits of RAS-inhibitors in terms of survival and morbidity in subjects with renal damage need further verification and
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Candesartan, n 44 27 ; 169 152191 ; 85 51113 ; 31 13 3 ; 165 Atenolol, n 44 28 16 ; 170 148185 ; 84 61130 ; 30 14 4 ; 161 P 0.90 0.70 0.91 Treatment groups were well matched at baseline Table 1 ; , and candesartan-based and atenolol-based treatments achieved similar reductions in BP reduction. Heart rate was reduced by atenolol treatment Table 2 ; . There was no significant difference in the use of second- or third-line agents between treatment groups.
1- "Biomedicine and the Stock Market". In: "Ethical Issues in the Publication of Medical Information" Robert R Mc Cormick Tribune Foundation - Cantigny Conference Series, Wheaton USA ; : 1999: 80122.
COUNT 23 That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession is unprofessional in that on or about 14 December 2002 you and or your practice issued a fraudulent medical certificate to Mr Bheki Ntombela as per annexure "A" COUNT 24 That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession is unprofessional in that on or about December 2002, you failed to account for the management of your practice by: 24.1 failing to keep proper records; and or; 24.2 failing to safeguard medical certificate pads resulting in an unregistered person issuing a medical certificate from your practice as per annexure "A". COUNT 25 That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession is unprofessional in that on or about 14 November 2002 in relation to Mr Bheki Ntombela you and or your practice used medical certificate pads with an incorrect practice number as per annexure "A" COUNT 26 That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, is unprofessional in that on or about 07 October 2002 you and or your practice issued a fraudulent medical certificate to Mr Vusumuzi Mbatha as per annexure "A". COUNT 27 That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession, is unprofessional in that on or about October 2002, you failed to account for the management of your practice by: 27.1 failing to keep proper records; and or 27.2 failing to safeguard medical certificate pads resulting in an unregistered person issuing a medical certificate from your practice as per annexure "A'. COUNT 28 That you are guilty of unprofessional conduct or conduct which, when regard is had to your profession is unprofessional in that on or about 07 October 2002 in relation to Mr Vusimuzi Mbatha you and or your practice used medical certificate pads with an incorrect practice number as per annexure "A". COUNT 29 That you are guilty of unprofessional conduct or conduct which, when regard is had to your, for example, gen atenolol.
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