No abstract

SUMMARY This double‐blind, randomised, cross‐over study investigated the antihypertensive efficacy of ramipril and enalapril was completed by 30 patients with mild‐to‐moderate essential hypertension. After a four‐week placebo run‐in phase, the patients received either 2.5mg ramipril or 10mg enalapril once daily for four weeks. The dosages were increased to 5mg ramipril and 20mg enalapril for a further four weeks. After a placebo washout phase of four weeks, the patients were crossed over to the alternative treatment. The decrease in average 24‐hour ambulatory diastolic blood pressure from week 0 to week 8 was 1.6mmHg greater with ramipril than enalapril (90% confidence interval 0.6‐2.7mmHg). The corresponding reduction in for systolic blood pressure was also greater with ramipril than enalapril by 2.4mmHg (90% confidence interval: 0.5‐4.2mmHg). For the difference in the drop of 24‐hour ambulatory diastolic blood pressure between ramipril and enalapril the lower level of the 90% confidence interval (CI) is above the clinically relevant difference of ‐3mmHg. This is an indication that ramipril (2.5 and 5mg dose) is at least as effective as enalapril (10 and 20mg dose) in decreasing blood pressure in patients with mild‐to‐moderate essential hypertension. The duration of adequate antihypertensive effect was relatively long for both ramipril and enalapril; however, ramipril tended to have a more prolonged antihypertensive effect. Ramipril had a higher diastolic and systolic trough/peak ratio than enalapril, resulting in a more uniform antihypertensive effect over the 24‐hour treatment period. Both ramipril and enalapril were well tolerated and the two treatment groups had similar safety profiles.

The aim of this study was to compare the histology of nasopharyngeal masses of HIV positive and HIV negative patients and to determine the prevalence of malignancy in nasopharyngeal masses in HIV positive patients. The records of all patients who had nasopharyngeal biopsies performed at the Department of Otorhinolaryngology, Universitas Academic Hospital between January 2006 and December 2011, were reviewed and 151 patients were identified. The HIV status of 110 of these patients was known: 78 (70.9 %) were HIV positive and 32 (29.1 %) were HIV negative. The CD4 count was known in 63 (80.8 %) of the HIV positive patients with the median CD4 count being 275 cells/μl (14-712 cells/μl). Most nasopharyngeal masses in HIV positive patients were benign. Malignancies were significantly more common in the HIV negative group than in the HIV positive group, with six (7.7 %) of the nasopharyngeal masses in the HIV positive group being malignant, while eight (25 %) of those in the HIV negative group were malignant. Most nasopharyngeal masses in HIV positive patients are due to lymphoid hyperplasia. The presence of large cervical lymphadenopathy should alert one to the possibility of a malignancy rather than a benign disease process.