Although the activity of the nitric oxide pathway is increased in patients with cirrhosis and might contribute to the hemodynamic alteration, other factors are involved. Interleukin-6, possibly through nitric oxide-independent mechanisms, also might play a role in the vasodilatation of cirrhosis and the pathogenesis of hepatic encephalopathy.

Background: Loop diuretics are beneficial in heart failure in the short term because they eliminate fluid retention, but in the long-term, they could adversely influence prognosis due to activation of neurohumoral mechanisms. Aims: To explore the changes induced by diuretic withdrawal in chronic nonadvanced heart failure. Methods: Diuretics were withdrawn in 26 stabilized heart failure patients with systolic dysfunction (ejection fraction [EF]b45%). Clinical status was evaluated by physical exam, exercise capacity (corridor test) and New York Heart Association (NYHA) class. Biochemical and neurohumoral determinations were performed at baseline and at 3 months. Results: At 3 months, 17 out of 26 patients (65%) were able to tolerate diuretic interruption without a deterioration in exercise capacity or New York Heart Association functional class. Renal function parameters improved (baseline urea 46.2F10.8 to 39.2F10.1 mg/dl at 3 months, p=0.014; creatinine 1.1F0.23 to 0.98F0.2 mg/dl, p=0.013). Glucose metabolism also improved (fasting glucose 151F91 to 122F14 mg/dl, p=0.035). Heart rate and systolic blood pressure did not significantly change, while diastolic blood pressure increased (from 80F10 to 87F13 mm Hg, p=0.006). Neurohumoral determinations showed a decrease in plasma renin activity (4.19F5.96 to 2.88F4.98 ng/ ml, p=0.026), with no changes in aldosterone, arginine-vasopressin, endothelin-1 and norepinephrine. In contrast, atrial natriuretic peptide significantly increased (115F87 to 168F155 pg/ml, p=0.004). Conclusion: Diuretic withdrawal in stabilized heart failure with systolic dysfunction is associated with an improvement in renal function parameters, glucose metabolism and some neurohumoral parameters, such as plasma renin activity; however, atrial natriuretic peptide levels increased.

Although the activity of the nitric oxide pathway is increased in patients with cirrhosis and might contribute to the hemodynamic alteration, other factors are involved. Interleukin-6, possibly through nitric oxide-independent mechanisms, also might play a role in the vasodilatation of cirrhosis and the pathogenesis of hepatic encephalopathy.

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IntroductionADHD in adults is associated with a significant impairment in many life activities increasing the risk of chronic stress in everyday life. Previous studies reported normal cortisol awakening response (CAR) in children with ADHD without comorbidities, nevertheless there is a lack of studies in adults.The aim of the present research is to examine CAR in adults with ADHD and to assess possible differences between the combine and inattentive subtypes.MethodologyPatients were recruited from the Program for adults with ADHD in the Department of Psychiatry of the Hospital Universitari Vall d’Hebron. The clinical sample consisted of 50 adults, age between 18 and 51 years (mean 35.24 ± 9.21) fulfilling current diagnostic criteria for ADHD (DSM-IV criteria). All patients were naïve to stimulant medication. Psychiatric and organic comorbid disorders were excluded. To assess CAR, four salivary cortisol samples were collected at 0, 30, 45 and 60 minutes after awakening.ResultsThe mean increase in CAR for the whole group of patients was 10.34±8.79 nmols/l. T-test comparisons showed no significant differences in the mean increase of CAR between the inattentive (mean: 9.47±9.04 nmols/l) and combine (mean: 11.25±8.67 nmols/l) subtypes (t=0.610; z=0.546).ConclusionDespite there were no significant differences in salivary CAR between ADHD subtypes in adults, the mean increase of CAR was higher in combine than in the inattentive subtype. Salivary CAR needs to be further explored as an index of vulnerability to stress in these patients.

IntroductionAhe adult patients with attention deficit hyperactivity disorder (ADHD) are characterized by an increased vulnerability to daily life stressors. Cortisol awakening response (CAR) can be used as an index of the adrenocortical activity that relates to chronic stress. Although gender differences in cortisol response have been explored in children with ADHD, there is a lack of gender studies in adults with this disorder.The aim of the present study is to evaluate possible gender differences in CAR in adults with ADHD.MethodsA total of 50 patients (22 female, age 37.00±8.62 years, and 28 male, age 33.86±9.57 years), with ADHD were recruited from the program for adults with ADHD in the Department of Psychiatry of the Hospital Universitari Vall d’Hebron. Patients fulfilled current DSM-IV diagnostic criteria for ADHD. Psychiatric and organic comorbid disorders were excluded and all the patients were naïve to psychostimulant treatment. Four salivary cortisol samples were collected at 0, 30, 45 and 60 minutes after awakening (work days).ResultsMean increase in CAR was 10.39±8.68 nmols/l for men and 10.29±9.13 nmols/l for women. T-test comparisons showed no significant gender differences in CAR in adults with ADHD (t= 0.033, z=0.974).ConclusionsAs reported in children, adults with ADHD show no differences in CAR. Albeit these results are still preliminary, they suggest some gender differences in CAR between adults with ADHD and cortisol response in general population.

An increased nocturnal nitric oxide production might contribute to the hemodynamic changes observed in cirrhotic patients during nighttime.