Os anti-hipertensivos bloqueadores de canais de cálcio, por interferirem no transporte de cálcio através das membranas celulares, podem afetar muitos processos metabólicos, incluindo o metabolismo ósseo. O objetivo deste estudo foi avaliar, de forma radiográfica, histológica e bioquímica, os efeitos do bloqueador de canais de cálcio amlodipina no processo de reparo de um defeito ósseo, simulando fratura, no ramo mandibular de ratos. Foram utilizados 50 ratos machos Wistar, que foram submetidos ao mesmo procedimento cirúrgico unilateral simulando fratura mandibular, e distribuídos em dois grupos de 25 animais: grupo experimental, que receberam amlodipina, via oral, na dosagem de 0,04 mg / rato / dia, iniciando 12 dias antes do procedimento e continuando até o sacrifício; grupo controle, que permaneceu não tratado. Os animais foram sacrificados nos períodos de 1, 7, 14, 30 e 90 dias pós-operatórios. Foram realizados testes bioquímicos de fosfatase alcalina e cálcio séricos. Exame radiográfico foi obtido para mensuração da área radiolúcida do defeito ósseo. O estudo histológico compreendeu a análise descritiva do processo de reparo ósseo e a avaliação histomorfométrica da quantidade de osso neoformado. Os valores numéricos foram submetidos a análises estatísticas. A análise radiográfica demonstrou maior área radiolúcida no interior do defeito ósseo para o grupo experimental, nos períodos de 14 (p=0,016), 30 (p=0,009) e 90 (p=0,028) dias. Na análise histológica não se observaram atrasos no processo de reparo ósseo para ambos os grupos. Porém, na análise histomorfométrica, o grupo da amlodipina apresentou redução significante do volume de osso neoformado nos períodos de 7 e 14 dias (p=0,049), não havendo diferenças significativas no período de 30 dias. Houve redução significante nos níveis de fosfatase alcalina para o grupo da amlodipina nos períodos iniciais (p=0,049). Não houve alterações para os níveis de cálcio sérico. Concluiu-se que o uso crônico da amlodipina prejudicou a neoformação óssea no processo de reparo do defeito cirúrgico no ramo mandibular de ratos, porém não impediu a consolidação da fratura. / Antihypertensive, calcium channel blockers, which interfere on calcium transport across the cell membrane, may affect many metabolic processes, including bone metabolism. The aim of this study was to evaluate by radiographic, histologic and biochemical analyses the effects of calcium channel blocker amlodipine on bone healing of a defect simulating a fracture in mandibular ramus of rats. Fifty male Wistar rats were used, and submitted to the same unilateral surgical procedure simulating a mandibular fracture, distributed into two groups of 25 animals: experimental group, which received oral doses of 0.04 mg / rat / day starting 12 days before of procedure and continuing until sacrifice; control group, which remained untreated. Animals were sacrificed at 1, 7, 14, 30 and 90 days postoperatively. Blood biochemical tests of alkaline phosphatase and serum calcium were made. Radiographic examination was obtained in order to mensurate the radiolucent area of bone defect. Histological study comprised descriptive analysis of bone healing and histomorphometric analysis of the amount of newly formed bone. Numerical values were submitted to statistical analyses. Radiographic analysis showed larger radiolucent area into bone defect to the experimental group at the periods of 14 (p=0.016), 30 (p=0.009) and 90 (p=0.028) days. In the histological analysis there was no delay in the bone repair stages in both groups. However, in the histomorphometric analysis, the experimental group presented significative lowering of newly formed bone volume at 7 and 14 days periods (p=0.049), with no significant differences at 30 days period. There was significative decrease of alkaline phosphatase levels in experimental group in the initial periods (p=0.049). There was no change in the serum calcium levels. It was concluded that chronic use of amlodipine compromised bone neoformation in the repairing process of surgical defect in the mandibular ramus of rats, but no precluded occurrence of fracture consolidation.

Modelos matemáticos de motoneurônios têm sido desenvolvidos para auxiliar na compreensão dos fenômenos que envolvem o sistema neuromuscular. Entretanto, a maioria dos modelos já desenvolvidos baseou-se na premissa de que a árvore dendrítica tem um comportamento passivo, o que ocorre em animais anestesiados, mas pode não ocorrer durante o comportamento motor normal de um animal intacto. Experimentos com animais descerebrados, em que as vias monoaminérgicas encontravam-se ativas, mostraram que os motoneurônios podem apresentar comportamentos mais complexos decorrentes da presença de condutâncias iônicas voltagem-dependentes que se situam nos dendritos e são responsáveis pela gênese de uma corrente de entrada persistente. Nesse sentido, um primeiro objetivo deste trabalho foi o de desenvolver novos modelos matemáticos de motoneurônios de diferentes tipos (i.e. dos tipos S, FR e FF), computacionalmente eficientes e contendo em seus compartimentos dendríticos uma condutância de cálcio do tipo L, de forma que os fenômenos de biestabilidade, potencial platô e amplificação da corrente sináptica efetiva possam ser gerados. Um segundo objetivo foi o de verificar como a presença da condutância iônica ativa no dendrito influencia o comportamento motoneuronal quando o mesmo está sujeito a entradas sinápticas de diferentes tipos. Os novos modelos foram parametrizados baseando-se em dados da literatura experimental para motoneurônios de gatos descerebrados e validados segundo os protocolos experimentais básicos que permitem caracterizar cada tipo de modelo como sendo totalmente ou parcialmente biestável. As entradas sinápticas foram simuladas por processos pontuais de Poisson e os trens de potenciais de ação dos motoneurônios foram analisados. Uma modulação senoidal da intensidade do processo pontual foi usada para estimar as respostas em frequência de cada modelo. Observou-se que, funcionalmente, a presença da condutância iônica dendrítica pode favorecer a ação do motoneurônio durante tarefas posturais, pois, uma vez ativada, a corrente de entrada persistente eleva a excitabilidade motoneuronal tornando os disparos mais regulares, além de prover uma alta sensibilidade dos modelos a entradas sinápticas de baixa frequência, correspondentes às oscilações observadas durante a manutenção da postura ereta quieta. / Mathematical models of motoneurons have been developed as an aid to the understanding of phenomena involving the neuromuscular system, but most of these models have been based on the hypothesis of a passive dendritic tree. This holds for anesthetized animals but not necessarily during normal motor behavior of the intact animal. Experiments with decerebrate animals in which the monoaminergic tracts were maintained intact have shown that more complex behaviors may emerge in motoneurons due to dendritic voltage-gated ionic conductances, which are responsible for a persistent inward current. Therefore, the first aim of this work was to develop computationally-efficient new motoneuron models of different types (i.e. type S, FR and FF) that include a dendritic L-type calcium conductance so that bistability, plateau potential and enhancement of effective synaptic current may be generated. The second aim of this research was to evaluate the effects of the active dendritic ionic conductance on the input-output mapping of presynaptic to postsynaptic spike trains. The new models were parameterized based on data reported in experimental literature on the decerebrate cat preparation, and they were validated using appropriate protocols for either fully or partially bistable dynamics. The synaptic inputs were simulated by Poisson point processes and the output spike trains were analyzed. Sinusoidal modulation of the point process intensity was used for the estimation of each models frequency response. The results suggested that an active dendritic ionic conductance in motoneurons has a functional role during postural tasks, because, when activated, the persistent inward current enhances the motoneuronal excitability, reducing the variability of interspike intervals, and focusing the sensitivity of the models to low frequency inputs that correspond to the low-frequency oscillations that typically occur during quiet standing posture.

Ces dernières décennies ont mis à jour une implication pathologique nouvelle del’aldostérone, via le récepteur aux minéralocorticoïdes (RM) dans le coeur. L’ensemble desdonnées issues des études expérimentales et des essais cliniques suggère une association délétèreentre l’aldostérone et la survenue d’arythmies. L’utilisation d’antagonistes du RM prévient cesarythmies. Cependant, les voies de signalisations, comme les mécanismes moléculaires soustendantces effets bénéfiques du blocage des RM demeurent incertains. Nous avons accumulésdes preuves d’une modulation de la signalisation calcique dans le cardiomyocyte, et en particulierde l’influx calcique (Ca2+) au travers du canal Ca2+ de type L (LTCC). Celui-Ci pourrait être unecible primaire de l’aldostérone et du RM dans les cardiomyocytes ventriculaires. Toutefois, lesmécanismes par lesquels l’aldostérone et le RM régulent l’expression du LTCC restent à définir.Au cours de ces travaux menés sur cardiomyocytes de rats nouveau-Nés, nous avonsétudiés les évènements moléculaires par lesquels l’aldostérone exerce ses effets sur le CaV1.2,qui correspond à la sous-Unité principale du LTCC formant le pore du canal ; cette protéine estcodée par le CACNA1C. Par microscopie confocale, nous avons suivi en temps réel le traffickingnucléo-Cytoplasmique du RM couplé à la GFP en réponse à l’aldostérone, démontrant ainsi queles RM cardiaques sont fonctionnels. Le traitement durant 24 heures des cardiomyocytes avec del’aldostérone montre une augmentation dose-Dépendante des protéines et de l’ARN messager duCaV1.2. L’utilisation de la technique du gène rapporteur de la luciférase permet l’analyse del’activité du promoteur du CaCNA1C. Celui-Ci montre une activité transcriptionnelle dose ettemps dépendante en réponse à l’aldostérone. De plus, ces effets sont dépendant des RM carinhibés en présence de RU28318, un antagoniste sélectif du RM, ou par l’utilisation de siRNAdirigés contre le RM. L’analyse in silico de la séquence du promoteur du CaCNA1C nous a permisd’identifier cinq séquences putatives correspondant à des éléments de réponse auxglucocorticoïdes (GRE). La mutation du site le plus lointain du site d’initiation de la transcriptionne révèle aucun changement dans les réponses transcriptionnelles induites par un RM humainconstitutivement actif (hMRΔ5,6) ou dans les réponses doses-Dépendantes de l’aldostérone ou dela déxaméthasone, un glucocorticoïde de synthèse. La mutation des trois sites GRE putatifssuivants provoque une diminution des réponses au hMRΔ5,6 comme à l’aldostérone, alors que lesréponses à la déxaméthasone sont soit inchangées, soit augmentées. En contraste, la mutation dusite le plus proximal du promoteur augmente de façon importante l’activité transcriptionnelle dupromoteur en réponse au hMRΔ5,6, à l’aldostérone comme à la déxaméthasone.Ces résultats démontrent que le LTCC cardiaque constitue une cible directe del’aldostérone et du RM, et apportent de nouvelles perspectives quant aux conséquencesmoléculaires et fonctionnelles engendrées par l’activation délétère du système minéralocorticoïdedans la défaillance cardiaque. / During the past decades, major novel pathogenic roles of the steroid hormone,aldosterone, via the Mineralocorticoid Receptor (MR) have been identified in heart. Collectively,experimental studies and clinical trials, suggest a detrimental association between aldosteroneand life threatening arrhythmias that may be prevented by MR blockade. However, the signalingpathways and underlying mechanisms still remain elusive. We have accumulated evidence thatmodulation of Ca2+ signaling, especially Ca2+ influx via L-Type Ca2+ channel (LTCC), might bethe primary aldosterone/MR target in ventricular cardiomyocytes. Yet, the molecularmechanisms by which MR regulates expression of LTCC remain to be defined. Here, weinvestigated, in primary cultures of neonatal rat ventricular myocytes, the molecular eventscritical for aldosterone-Mediated cardiac effects on CaV1.2, the pore-Forming main subunit ofLTCC, which is encoded by the CaCNA1C gene.We showed that cardiac MR are functional as demonstrated by aldosterone-Induced MRnucleocytoplasmic trafficking observed by time-Lapse imaging of transfected GFP-Labeled MRusing confocal microscopy. Aldosterone exposure for 24 hours, induced a dose-Dependentincrease in CaV1.2 expression at both mRNA and protein levels. Analysis of the CaCNA1Cpromoter activity using luciferase reporter assays, revealed a dose- and time-Dependent activationby aldosterone. These effects were inhibited in the presence of either RU28318, a selective MRantagonist, or MR siRNA. In silico analyze enabled us to identify five putative GlucocorticoidResponse Elements (GRE) within the CaCNA1C promoter sequence. The mutation of the mostdistal GRE from Transcription Start Site (TSS) did not altered responses either elicited by theconstitutively active human MR (hMRΔ5,6) or dose-Dependent effects of aldosterone anddexamethasone (a synthetic glucocorticoïd with minimal MR effect). Mutations of the three nextones decreased responses to hMRΔ5,6 and aldosterone, whereas dexamethasone responses wereeither unchanged or increased. In sharp contrast, the mutation of the most proximal GRE fromTSS, increased responses to hMRΔ5,6, aldosterone and dexamethasone.These results provide new insights into the molecular mechanisms associated with cardiacMR activation, and suggest that LTCC is a primary MR target, with subsequent molecular andfunctional consequences that could lead to MR-Related cardiac dysfunction.

Les canaux calciques dépendants du voltage (CCVD) sont impliqués dans de nombreux processus cellulaires tels que la libération de neurotransmetteurs, la contraction musculaire ou encore la régulation de l'expression génique. Les CCVD sont constitués d'une sous-unité canalaire (alpha1 ou Cav) par laquelle les ions Ca2+ entrent dans le milieu intracellulaire, associée à différentes sous-unités auxiliaires, alpha2delta, beta et gammaqui régulent leur fonction. Ma thèse a contribué à la mise en évidence d'une nouvelle voie de régulation du couplage excitation-transcription impliquant la sous-unité beta4 des CCVD. Dans ce cadre, nous nous sommes intéressés à la compréhension des déterminants de l'entrée de beta4 dans le noyau et aux mécanismes de régulation de l'expression génique par cette sous-unité des CCVD. Un modèle animal nous a été particulièrement utile, la souris léthargique (lh), déficiente pour la sous-unité beta4 et considérée comme un modèle d'étude de l'épilepsie-absences. Une translocation de beta4 du cytoplasme vers le noyau est observée au cours de la différenciation neuronale. Cette translocation est dépendante de l'intégrité structurale de beta4 et plus précisément de l'interaction de ses domaines SH3 (Src Homology 3) et GK (Guanylate Kinase). La translocation de beta4 au noyau nécessite son association avec un partenaire : la sous-unité régulatrice de la protéine phosphatase 2A (PP2A), B56delta. La dépolarisation membranaire permet un décrochage de beta4 du canal et son association à B56delta. beta4 migre donc vers le noyau sous forme de complexe avec B56delta/PP2A. Une étude transcriptomique réalisée pour comparer le profil d'expression dans le cervelet de souris lh par rapport aux souris wild-type a montré l'implication de beta4 dans la répression et l'activation d'un certain nombre de gènes. Particulièrement beta4 réprime fortement l'expression du gène qui code pour la tyrosine hydroxylase (TH). Dans le noyau, beta4 interagit avec un facteur de transcription, le récepteur aux hormones thyroïdiennes alpha(TRalpha). Cette association permet au complexe beta4/B56delta/PP2A de cibler la région promotrice du gène TH comme cela a été montré par des expériences d'immunoprécipitation de la chromatine (ChIP). Le complexe beta4/B56delta/PP2A est capable de s'associer aux histones et de déphosphoryler spécifiquement les histones H3 en Ser10 au niveau de la région promotrice du gène TH. Cette modification de la chromatine est corrélée avec le recrutement de Heterochromatin Protein 1 gamma (HP1gamma au niveau du promoteur du gène TH. HP1gamma est impliquée dans la formation d'hétérochromatine et pourrait expliquer la répression de l'expression du gène TH. Ainsi dans le cervelet de souris lh, l'absence de beta4 déclenche un dérèglement de cette voie de signalisation qui entraîne la sur-expression du géne TH. La mutation humaine R482X à l'origine de la délétion d'une partie du domaine C-terminal de beta4 et responsable d'une forme d'épilepsie juvénile myoclonique, perturbe la localisation nucléaire de beta4. En effet, le mutant beta1-481 incapable de s'associer à B56delta/PP2A et de migrer au noyau n'interagit pas avec les histones. La voie de signalisation permettant la régulation de l'expression génique par beta4 n'est donc plus assurée par le mutant. Ainsi, la fonction debeta4 ne se limite pas à son action cytoplasmique en tant que sous-unité auxiliaire des CCVD. En effet, ce travail montre combien dans le noyau,beta4, joue un rôle important dans la régulation de l'expression génique. / Voltage dependent calcium channels (VDCC) participate to various cellular processes such as neurotransmitters release, muscular contraction or gene expression regulation. VDCC are composed of a pore-forming subunit (alpha1 or Cav), that allows Ca2+ to enter the cells associated with auxiliary subunits, alpha2delta, beta and gamma. My thesis studies on a new signaling pathway in which the beta4 subunit of VDCC couples neuronal excitability to transcription. In particular it focuses on the understanding of the beta4 nuclear translocation determinants and the mechanisms of gene expression regulation by this VDCC subunit. beta4 translocation from the cytoplasm to the nucleus is observed during neuronal differentiation. This translocation depends on beta4 structural integrity and more precisely on interaction between the beta4 SH3 (Src Homology 3) and GK (Guanylate Kinase) domains. beta4 nuclear translocation is conditioned by its association with a partner: the regulatory subunit of phosphatase protein 2A (PP2A), B56delta. Membrane depolarization induces beta4 channel uncoupling and association with B56delta. Thus, beta4 migrates to the nucleus in complex with B56delta/PP2A. A study on gene expression generated by microarray was carried on to compare profiles of gene expression in lethargic (lh) mice, considered as spontaneous beta4 KO with wild-type (WT) mice cerebellum. This study proved the influence ofbeta4 on the repression and the activation of certain genes. Particularly, beta4 strongly represses tyrosine hydroxylase (TH) gene expression. In the nucleus, beta4 interacts with a transcription factor: the thyroid hormone receptor alpha (TR alpha). This association allows beta4/B56delta/PP2A complex to target the TH gene promoter as shown by chromatin immunoprecipitation (ChIP) experiments. This complex is also able to associate itself with histones and dephosphorylate Ser10 histone H3 in the TH gene promoter. This chromatin modification is correlated with HP1 gamma (Heterochromatin Protein 1 gamma) recruitment in the TH gene promoter. HP1 gamma is known to promote heterochromatin formation that could explain the TH gene repression by beta4. Thus, in lh mice cerebellum, the absence of beta4 triggers a complete disorganization of this signaling pathway that results in the up-regulation of the TH gene. R482X, the human mutation inducing the C-terminus domain deletion of beta4 and responsible for a form of juvenile myoclonic epilepsy prevents beta4 nuclear localization. In fact, the mutant beta1-481 unable to associate with B56delta/PP2A and to migrate to the nucleus does not interact with HP1gamma and histones. The signaling pathway allowing gene regulation by beta4 is prevented by the mutant. Thus, beta4 does not play a confined role in the cytoplasm as CCVD auxiliary subunit but also functions in the nucleus as a gene expression regulator.

Modelos matemáticos de motoneurônios têm sido desenvolvidos para auxiliar na compreensão dos fenômenos que envolvem o sistema neuromuscular. Entretanto, a maioria dos modelos já desenvolvidos baseou-se na premissa de que a árvore dendrítica tem um comportamento passivo, o que ocorre em animais anestesiados, mas pode não ocorrer durante o comportamento motor normal de um animal intacto. Experimentos com animais descerebrados, em que as vias monoaminérgicas encontravam-se ativas, mostraram que os motoneurônios podem apresentar comportamentos mais complexos decorrentes da presença de condutâncias iônicas voltagem-dependentes que se situam nos dendritos e são responsáveis pela gênese de uma corrente de entrada persistente. Nesse sentido, um primeiro objetivo deste trabalho foi o de desenvolver novos modelos matemáticos de motoneurônios de diferentes tipos (i.e. dos tipos S, FR e FF), computacionalmente eficientes e contendo em seus compartimentos dendríticos uma condutância de cálcio do tipo L, de forma que os fenômenos de biestabilidade, potencial platô e amplificação da corrente sináptica efetiva possam ser gerados. Um segundo objetivo foi o de verificar como a presença da condutância iônica ativa no dendrito influencia o comportamento motoneuronal quando o mesmo está sujeito a entradas sinápticas de diferentes tipos. Os novos modelos foram parametrizados baseando-se em dados da literatura experimental para motoneurônios de gatos descerebrados e validados segundo os protocolos experimentais básicos que permitem caracterizar cada tipo de modelo como sendo totalmente ou parcialmente biestável. As entradas sinápticas foram simuladas por processos pontuais de Poisson e os trens de potenciais de ação dos motoneurônios foram analisados. Uma modulação senoidal da intensidade do processo pontual foi usada para estimar as respostas em frequência de cada modelo. Observou-se que, funcionalmente, a presença da condutância iônica dendrítica pode favorecer a ação do motoneurônio durante tarefas posturais, pois, uma vez ativada, a corrente de entrada persistente eleva a excitabilidade motoneuronal tornando os disparos mais regulares, além de prover uma alta sensibilidade dos modelos a entradas sinápticas de baixa frequência, correspondentes às oscilações observadas durante a manutenção da postura ereta quieta. / Mathematical models of motoneurons have been developed as an aid to the understanding of phenomena involving the neuromuscular system, but most of these models have been based on the hypothesis of a passive dendritic tree. This holds for anesthetized animals but not necessarily during normal motor behavior of the intact animal. Experiments with decerebrate animals in which the monoaminergic tracts were maintained intact have shown that more complex behaviors may emerge in motoneurons due to dendritic voltage-gated ionic conductances, which are responsible for a persistent inward current. Therefore, the first aim of this work was to develop computationally-efficient new motoneuron models of different types (i.e. type S, FR and FF) that include a dendritic L-type calcium conductance so that bistability, plateau potential and enhancement of effective synaptic current may be generated. The second aim of this research was to evaluate the effects of the active dendritic ionic conductance on the input-output mapping of presynaptic to postsynaptic spike trains. The new models were parameterized based on data reported in experimental literature on the decerebrate cat preparation, and they were validated using appropriate protocols for either fully or partially bistable dynamics. The synaptic inputs were simulated by Poisson point processes and the output spike trains were analyzed. Sinusoidal modulation of the point process intensity was used for the estimation of each models frequency response. The results suggested that an active dendritic ionic conductance in motoneurons has a functional role during postural tasks, because, when activated, the persistent inward current enhances the motoneuronal excitability, reducing the variability of interspike intervals, and focusing the sensitivity of the models to low frequency inputs that correspond to the low-frequency oscillations that typically occur during quiet standing posture.

In this thesis, we included results from two studies. The first one considered the effects of the blood volume changes, during blood donation, on the heart rate variability (HRV) measured, non-invasively, form electrocardiographic (ECG) and photoplethysmographic (PPG) signals. Our results showed that, during blood donation, there were no significant changes in the pulsatile area of PPG signal, while heart rate increased. No significant changes were noticed in HRV extracted from both signals. Error analysis between the HRV extracted from ECG and peak interval variability (PIV) suggested that the error during blood donation was increased which means that the use of PIV extracted from PPG signal, used as a replacement diagnostic tool in clinical applications, needs further investigations and should be carefully studied in non-stationary cardiovascular situations such as blood donation. The imbalance between the two branches of the autonomic nervous system, sympathetic and parasympathetic, vagal, may result in a harmful activation of myocardial tissues which cause arrhythmias and sudden cardiac death. Although the study of the sympathovagal balance have been attracting many researchers, further studies are needed to elucidate the effects of many kinds of drugs on the autonomic modulation of the cardiac muscle, specifically, the cells of sinoatrial (SA) node. The aim of the second part of this thesis was to assess the effects of calcium channel blocker (Verapamil), calcium channel sensitizer (Levosimendan), calcium chloride (CaCl2), the combinations of verapamil/ CaCl2, levosimendan/ CaCl2, and noradrenaline infusion on beat-to-beat cardiovascular variability represented, in this research, by systolic blood pressure variability (SBPV), and stroke volume variability (SVV) signals. We used Fat Fourier Transform (FFT) to evaluate the power spectral density of the fluctuations in both signals to evaluate the effects of short-term treatments with those drugs on the sympathovagal balance in normal rats. Then, we compared the spectra obtained from SBPV and SVV to decide which of these fluctuations along with corresponding spectrum was more able to provide a clear feedback about the autonomic nervous system. Our data suggests that there were a significant correlations between low- (LF), mid- (MF), and high-frequency (HF) spectra obtained from SBPV and SVV except between the HF spectra estimated from after the infusion of levosimendan where a poor correlation (r = 0.530, p = 0.281) was noticed. This that both HF components obtained provide different information regarding the autonomic nervous system modulation of the SA node cells, while the results obtained from the rest of experiments showed that both signals provide same information about the modulation of sympathetic and parasympathetic tone due to all stages of different drugs infusion studied in this thesis. Besides that, we found that both spectra may be used to track the fluctuations in the cardiac output as a result of the drugs infusion.

No description available.

Background: Calcium channel blockers are mainly divided into antihypertensive and antianginal treatment agents. In 2000 it was estimated that 972 million adults worldwide were living with hypertension and it is expected to affect 1.56 billion patients by 2025. The incremental expenditure for the antihypertensive therapeutic group in the United States of America was estimated at $US 55 billion per annum in 2006. It was stated that around seven million people in the United States of America suffered from angina, with around 400 000 new reports every year. Objective: To determine the prescribing patterns of calcium channel blocker medicine items during 2005 to 2008 in a section of the private health care sector of South Africa. Methods: A retrospective quantitative drug utilisation review was done using a medicine claims database ranging over four years from 1 January 2005 to 31 December 2008. The total medicine claims database was divided into cardiovascular medicine items and then into calcium channel blockers. These were analysed according to age as well as gender. Further analysis included adherence of calcium channel blockers as well as an analysis of prescribers of these items during the study period. Results: The total number of patients on the medicine claims database consisted of 1 509 621 patients in 2005. This number decreased to 974 497 patients in 2008. The most medicine items were dispensed in 2006 (n = 21 113 422) with an average cost of R 92.82 (SD = 196.42) per medicine item. It was noted that 16.05% (n = 242 264) of patients used at least one cardiovascular item in 2005. The percentage of cardiovascular medicine item users increased by 4.36% during the study period to 20.41% (n = 198 847) in 2008. In 2008 the cardiovascular medicine items dispensed were responsible for 19.18% (R 342 565 308.41) of the total cost of all medicine items claimed. In 2005 the results revealed that 1.63% (n = 318 258) of all medicine items dispensed were calcium channel blocker medicine items. The percentage of calcium channel blockers increased to 2.24% (n = 367 437) of the total number of medicine items in 2008. The cost prevalence index was calculated for the calcium channel blockers and the value declined from 1.5 in 2005 to 1.22 in 2008, which indicated that the items dispensed were relatively expensive, but less than in 2005. An increase of 16.17% in the usage of generic medicine items were noted from 2005 to 2008. More female patients than male patients claimed medicine items during the study period. A higher percentage of male patients used a cardiovascular medicine item as well as calcium channel blockers during the study period compared to females and a larger percentage of their medicine expenditure was used on cardiovascular medicine items as well as calcium channel blockers compared to females. The usage of cardiovascular medicine items as well as calcium channel blocker medicine items increased with patient age. In 2008, 17.98% of patients older than 65 years of age used a calcium channel blocker compared to 0.97% of patients aged > 25 <= 35 years. Only 60.34% of calcium channel blockers items were used with acceptable refill adherence rates during the study. More than a third of the calcium channel blockers medicine items used had unacceptable low adherence rates from 2005 to 2008. In each of the study years the highest potential saving with generic substitution was seen with amlodipine containing items. It was also observed that some generic substitutions could be relatively more expensive than the innovator products and an increased cost instead of a saving through generic substitution may have occurred. Conclusion: This study highlighted the prescribing patterns and cost implications of calcium channel blockers in the private health care sector of South Africa. It is recommended that a more in–depth study of the adherence of calcium channel blockers be done. This study should also include the cost strategies of generic substitution of calcium channel blockers in South Africa. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

Background: Calcium channel blockers are mainly divided into antihypertensive and antianginal treatment agents. In 2000 it was estimated that 972 million adults worldwide were living with hypertension and it is expected to affect 1.56 billion patients by 2025. The incremental expenditure for the antihypertensive therapeutic group in the United States of America was estimated at $US 55 billion per annum in 2006. It was stated that around seven million people in the United States of America suffered from angina, with around 400 000 new reports every year. Objective: To determine the prescribing patterns of calcium channel blocker medicine items during 2005 to 2008 in a section of the private health care sector of South Africa. Methods: A retrospective quantitative drug utilisation review was done using a medicine claims database ranging over four years from 1 January 2005 to 31 December 2008. The total medicine claims database was divided into cardiovascular medicine items and then into calcium channel blockers. These were analysed according to age as well as gender. Further analysis included adherence of calcium channel blockers as well as an analysis of prescribers of these items during the study period. Results: The total number of patients on the medicine claims database consisted of 1 509 621 patients in 2005. This number decreased to 974 497 patients in 2008. The most medicine items were dispensed in 2006 (n = 21 113 422) with an average cost of R 92.82 (SD = 196.42) per medicine item. It was noted that 16.05% (n = 242 264) of patients used at least one cardiovascular item in 2005. The percentage of cardiovascular medicine item users increased by 4.36% during the study period to 20.41% (n = 198 847) in 2008. In 2008 the cardiovascular medicine items dispensed were responsible for 19.18% (R 342 565 308.41) of the total cost of all medicine items claimed. In 2005 the results revealed that 1.63% (n = 318 258) of all medicine items dispensed were calcium channel blocker medicine items. The percentage of calcium channel blockers increased to 2.24% (n = 367 437) of the total number of medicine items in 2008. The cost prevalence index was calculated for the calcium channel blockers and the value declined from 1.5 in 2005 to 1.22 in 2008, which indicated that the items dispensed were relatively expensive, but less than in 2005. An increase of 16.17% in the usage of generic medicine items were noted from 2005 to 2008. More female patients than male patients claimed medicine items during the study period. A higher percentage of male patients used a cardiovascular medicine item as well as calcium channel blockers during the study period compared to females and a larger percentage of their medicine expenditure was used on cardiovascular medicine items as well as calcium channel blockers compared to females. The usage of cardiovascular medicine items as well as calcium channel blocker medicine items increased with patient age. In 2008, 17.98% of patients older than 65 years of age used a calcium channel blocker compared to 0.97% of patients aged > 25 <= 35 years. Only 60.34% of calcium channel blockers items were used with acceptable refill adherence rates during the study. More than a third of the calcium channel blockers medicine items used had unacceptable low adherence rates from 2005 to 2008. In each of the study years the highest potential saving with generic substitution was seen with amlodipine containing items. It was also observed that some generic substitutions could be relatively more expensive than the innovator products and an increased cost instead of a saving through generic substitution may have occurred. Conclusion: This study highlighted the prescribing patterns and cost implications of calcium channel blockers in the private health care sector of South Africa. It is recommended that a more in–depth study of the adherence of calcium channel blockers be done. This study should also include the cost strategies of generic substitution of calcium channel blockers in South Africa. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

In this thesis, we included results from two studies. The first one considered the effects of the blood volume changes, during blood donation, on the heart rate variability (HRV) measured, non-invasively, form electrocardiographic (ECG) and photoplethysmographic (PPG) signals. Our results showed that, during blood donation, there were no significant changes in the pulsatile area of PPG signal, while heart rate increased. No significant changes were noticed in HRV extracted from both signals. Error analysis between the HRV extracted from ECG and peak interval variability (PIV) suggested that the error during blood donation was increased which means that the use of PIV extracted from PPG signal, used as a replacement diagnostic tool in clinical applications, needs further investigations and should be carefully studied in non-stationary cardiovascular situations such as blood donation. The imbalance between the two branches of the autonomic nervous system, sympathetic and parasympathetic, vagal, may result in a harmful activation of myocardial tissues which cause arrhythmias and sudden cardiac death. Although the study of the sympathovagal balance have been attracting many researchers, further studies are needed to elucidate the effects of many kinds of drugs on the autonomic modulation of the cardiac muscle, specifically, the cells of sinoatrial (SA) node. The aim of the second part of this thesis was to assess the effects of calcium channel blocker (Verapamil), calcium channel sensitizer (Levosimendan), calcium chloride (CaCl2), the combinations of verapamil/ CaCl2, levosimendan/ CaCl2, and noradrenaline infusion on beat-to-beat cardiovascular variability represented, in this research, by systolic blood pressure variability (SBPV), and stroke volume variability (SVV) signals. We used Fat Fourier Transform (FFT) to evaluate the power spectral density of the fluctuations in both signals to evaluate the effects of short-term treatments with those drugs on the sympathovagal balance in normal rats. Then, we compared the spectra obtained from SBPV and SVV to decide which of these fluctuations along with corresponding spectrum was more able to provide a clear feedback about the autonomic nervous system. Our data suggests that there were a significant correlations between low- (LF), mid- (MF), and high-frequency (HF) spectra obtained from SBPV and SVV except between the HF spectra estimated from after the infusion of levosimendan where a poor correlation (r = 0.530, p = 0.281) was noticed. This that both HF components obtained provide different information regarding the autonomic nervous system modulation of the SA node cells, while the results obtained from the rest of experiments showed that both signals provide same information about the modulation of sympathetic and parasympathetic tone due to all stages of different drugs infusion studied in this thesis. Besides that, we found that both spectra may be used to track the fluctuations in the cardiac output as a result of the drugs infusion.