scholarly journals The Role of Oxidative Stress in the Etiopathogenesis of Gluten-Sensitive Enteropathy Disease

2017 ◽  
Vol 36 (3) ◽  
pp. 243-250 ◽  
Author(s):  
Mustafa Kaplan ◽  
Ihsan Ates ◽  
Mahmut Yüksel ◽  
Yasemin Ozderin Ozin ◽  
Muhammed Yener Akpinar ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Paraoxonase 1 ◽  
Stress Index ◽  
Control Group ◽  
Gluten Free ◽  
C Reactive Protein ◽  
Serum Samples ◽  
Reactive Protein ◽  
Gluten Sensitive Enteropathy

SummaryBackground:The objective here is to examine the role of overall oxidative stress in the etiopathogenesis of gluten-sensitive enteropathy disease and its relationship with gluten free diet and autoantibodies.Methods:Eighty gluten-sensitive enteropathy patients and 80 control group participants were included in the study. As oxidative stress parameters, we researched total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase-1 and arylesterase parameters in the serum samples of gluten-sensitive enteropathy patients.Results:In comparison to the control group, gluten-sensitive enteropathy patients had lower TAS, paraoxonase-1 and arylesterase levels and gluten-sensitive enteropathy patients had considerable TOS and OSI levels. In contrast, patients who agreed to the gluten free eating routine had a higher OSI proportion and patients who did not conform to the gluten free eating regimen had a lower paraoxonase-1 level. An affirming reciprocation was de tected amidst TOS and OSI proportion and gluten-sensitive enteropathy autoantibodies and C-reactive protein levels and a negative correlation was found between arylesterase level and gluten-sensitive enteropathy autoantibodies.Conclusions:We observed oxidative stress levels to be higher in gluten-sensitive enteropathy patients contrasted with the control group. Oxidative stress level showed differences in gluten-sensitive enteropathy patients depending on gluten diet content and autoantibody positivity. In point of fact, C-reactive protein and gluten-sensitive enteropathy autoantibodies are identified with oxidative anxiety parameters resulting in the possibility that oxidative stress might be successful in the gluten-sensitive enteropathy pathogenesis.

scholarly journals Studying the Role of C-Reactive Protein in Patients with Sleeve Gastrectomy in Baghdad

2021 ◽  
Vol 3 (1) ◽  
pp. 55-60
Author(s):  
Mohammed Abbas Fadil ◽  
Raya Ezat Maroof ◽  
Moayed Abbas Fadil
Keyword(s):  
Sleeve Gastrectomy ◽  
Healthy Person ◽  
Control Group ◽  
C Reactive Protein ◽  
Serum Samples ◽  
Reactive Protein ◽  
Medical City ◽  
Healthy Control ◽  
And Control

Obesity and severe obesity are increasing serious health problems with an epidemic percentage in most countries. In Sleeve gastrectomy, a part of the stomach structure is removed, limiting its capacity by about two to three. A total of thirty blood samples were collected from patients with obesity and the result was compared with healthy person throughout the time from November 2019 to September 2020. Before sleeve gastrectomy and after more than 6 months of sleeve surgery, the sample was collected from the Medical City/Baghdad Teaching Hospital, the withdrawal was again taken at home to have pre and post sleeve gastrectomy, Patient age ranged between [20-46] years for obese patients and healthy control. Then the serum samples were obtained from patients and control group to screen for C-reactive protein by agglutination method. The result of the present study found that the positivity of CRP in pre-operation is higher than that of post-operative with high significance [P<0.005].

scholarly journals Clinical Significance of ROMs, OXY, SHp and HMGB-1 in Canine Leishmaniosis

Animals ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 754
Author(s):  
Michela Pugliese ◽  
Alessandra Sfacteria ◽  
Gaetano Oliva ◽  
Annastella Falcone ◽  
Manuela Gizzarelli ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Lymph Nodes ◽  
Clinical Signs ◽  
Biological Tissues ◽  
Stress Index ◽  
Control Group ◽  
Canine Leishmaniosis ◽  
Oxidative Stress Parameters ◽  
Stress Parameters

This study aimed to investigate the role of oxidative stress parameters (ROMs, OXY, SHp), the Oxidative Stress index (OSi), and High Mobility Group Box-1 protein (HMGB-1) in canine leishmaniosis (CanL). For this study, thirty dogs, naturally infected with Leishmania spp. (Leishmania Group, LEISH) and ten healthy adult dogs (control group, CTR) were included. The diagnosis of CanL was performed by a cytological examination of lymph nodes, real time polymerase chain reaction on biological tissues (lymph nodes and whole blood), and an immunofluorescence antibody test (IFAT) for the detection of anti-Leishmania antibodies associated with clinical signs such as dermatitis, lymphadenopathy, onychogryphosis, weight loss, cachexia, lameness, conjunctivitis, epistaxis, and hepatosplenomegaly. The HMGB-1 and oxidative stress parameters of the LEISH Group were compared with the values recorded in the CTR group (Mann Whitney Test, p < 0.05). Spearman rank correlation was applied to evaluate the correlation between the HMGB-1, oxidative stress biomarkers, hematological and biochemical parameters in the LEISH Group. Results showed statistically significant higher values of SHp in the LEISH Group. Specific correlation between the ROMs and the number of red blood cells, and between HGMB-1 and SHp were recorded. These preliminary data may suggest the potential role of oxidative stress in the pathogenesis of CanL. Further studies are undoubtedly required to evaluate the direct correlation between inflammation parameters with the different stages of CanL. Similarly, further research should investigate the role of ROMs in the onset of anemia.

scholarly journals ROLE OF CARDIAC MARKERS IN CHRONIC RENAL FAILURE PATIENTS.

2020 ◽  
pp. 81-82
Author(s):  
Ramesh Chandra Thanna ◽  
B K Agarwal ◽  
Rakesh Romday ◽  
Neha Sharma
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Positive Association ◽  
Morbidity And Mortality ◽  
Control Group ◽  
High Morbidity ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Hs Crp

Introduction: Cardiovascular diseases (CVD) are known as important reasons of the increased morbidity and mortality observed in patients with chronic renal failure (CRF). The association of serum Interlukin-6 , homocysteine as well as other cardiovascular risk factors in relation to existence and cause of CVD were investigated. Method: In this study 200 CRF patients were recruited and further stratified into group with Male and Female as case groups. Those without renal failure were assigned as control group (n=200). Results: The patients with CRF showed a significant increase in plasma levels of Cpk-MB homocysteine and C-reactive protein (CRP) compared to control. The positive association were observed between homocysteine, Urea and Hs-CRP, IL_6 . It shows a significant Association of parameters in CRF . Conclusion: The results demonstrated elevation in plasma values IL-6 , homocysteine and HS-CRP in patients with CRF . However, these modifications may be lead to atherosclerosis and consequence CVD event. These parameters may be important with respect to the high morbidity and mortality of CVD found in patients with CRF.

Prognostic Value of Serum Ferritin, Transferrin Saturation and C- Reactive Protein At Diagnosis In Myelodysplastic Syndrome Patients: Analysis of Patients From the MDS Piedmont Registry,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3807-3807 ◽  
Author(s):  
Emanuela Messa ◽  
Daniela Gioia ◽  
Claudia Bertassello ◽  
Gianni Ciccone ◽  
Andrea Evangelista ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Myelodysplastic Syndrome ◽  
Negative Impact ◽  
Transferrin Saturation ◽  
C Reactive Protein ◽  
Prognostic Role ◽  
Normal Range ◽  
Reactive Protein ◽  
Iron Parameters

Abstract Abstract 3807 Background: The prognostic role of serum ferritin (SF) evaluation at baseline in patients (pts) affected by myelodysplastic syndrome (MDS) is still controversial. In fact, increased SF mainly due to transfusion requirement during disease history has a clear negative impact on overall survival (OS) (Malcovati et al., 2006) and also on leukemic evolution (LE) (Sanz, ASH 2008, de Swart ASH 2010) while contrasting data about its role at baseline on OS has been published. Park and colleagues (ASH 2010) failed to identify a negative prognostic impact of SF higher than 300 ng/mL in a cohort of low risk untransfused MDS patients while data from the European LeukemiaNet MDS registry identified SF as an independent prognostic factor for OS and progression-free survival in low- and int-1 MDS (de Swart, Edimburgh 2011). SF can be a marker of iron overload but also of inflammation and little is known about the impact on survival of other iron parameters such as transferrin saturation (TS) or inflammation such as C reactive protein (CRP) in MDS pts at diagnosis. Aim: Aim of our study was to evaluate the prognostic role of iron parameters and inflammation at diagnosis in MDS patients analyzing data collected in the MDS Piedmont Registry. Materials and methods: 1360 patients enrolled in the MDS Piedmont Registry (1999–2010) were analyzed. Patients with information on OS and LE and available baseline SF (n=670), TS (n=299), CRP (n=287) were included in the analysis. Survival analysis was performed using Kaplan-Meier method. Patients were stratified according to a cut off value of 800 ng/mL for SF, 40% for TS and values within or higher the normal range (0,8 mg/dL) for CRP. In order to compare survival curves, log-rank test was used. Cumulative incidence of LE, according to SF, TS and CRP levels, was calculated accounting for death from any causes as a competing event. Results: In the population with SF baseline values, 3-years OS in pts with SF < 800 ng/mL was 80.7 (95%CI: 75.8–84.8) and in pts with SF >800 ng/mL was 66.1 (95%CI: 46.7–79.8) (p= 0,006). The result seems to be confirmed in the low risk MDS subgroup in toto (n=226) and considering only the untransfused pts (136 cases) (p=0,0073 and p=0,0038 respectively) but no statistically significance in OS of high risk pts (n=108) has been observed. In subjects with available data on TS, 3-years OS for pts with TS lower than 40% was 75.0 (95% CI: 64.2–83.0) while in pts higher than 40% was 72.1 (95%CI: 59.5–81.4) (p=0,1). Finally, in pts with CRP values 3-years OS was 80.8 (95%CI: 69.7–88.2) for patients < 0,8 mg/dL and 47.2 (95%CI: 34.5–58.9) for pts > 0,8 mg/dL. Also 3-year cumulative incidence of LE was higher in pts with SF > 800 ng/mL [35.8 (95%CI: 20.3–51.2) vs 18.5 (95%CI: 14.4–22.5); p=0,002 ] and in those with CPR > 0,8 mg/dL [35.3 (95%CI: 23.9–46.7) vs 12.7 (95%CI: 5.7–19.7); p<0,001]. In TS subgroups no difference was observed [13.5 (95%CI: 7.0–20.0) for TS<40% vs 20.8 (95%CI: 11.8–29.8) for TS>40%; p=0.172]. Conclusions: although the limits of missing data, our results suggest that high levels of SF and CRP above the normal range at baseline should have a prognostic role in MDS pts, while TS seems to have little impact on OS. Moreover SF and CRP seem to have both a negative impact on LE. Our data suggest a more important prognostic role of chronic inflammation parameters than iron overload or oxidative stress in MDS patients at diagnosis. Further prospective evaluation of more specific parameter of oxidative stress and inflammation need to be analyzed in order to confirm our preliminary observation. Disclosures: No relevant conflicts of interest to declare.

Ischemia modified albumin as an early biomarker in diagnosing the late stages abortus in cows

2017 ◽  
Author(s):  
Beran Yokus ◽  
Nazli Ercan ◽  
Ulvi Fidancý ◽  
Mustafa Gün
Keyword(s):  
Oxidative Stress ◽  
Positive Control ◽  
Maternal Serum ◽  
Stress Index ◽  
Control Group ◽  
Serum Samples ◽  
Ischemia Modified Albumin ◽  
Early Biomarker ◽  
Total Oxidative Stress ◽  
Complicated Pregnancy

Nowadays, Ischemia Modified Albumin (IMA) has been regarded as an indicator for various maladies and complicated pregnancy in humans. Therefore, it is hypothesized that evaluation of the maternal serum IMA degrees can serve as an early detection of abortion in dairy cows. 252 Holstein cows’ serum samples were taken both in the 2nd and 6th months of their pregnancy. Twenty-two cattle were selected as a positive control group among the non aborted ones. Furthermore, blood samples from 20 non-pregnant cows were taken to identify the effects of physiological changes of pregnancy. IMA and Ischemia Modified Albumin Rate (IMAR) were markedly higher (p less than 0.01); and albumin was markedly lower (p less than 0.01) in aborted cows and healthy-pregnant cows compared with non-pregnant cows in both months. In aborted cows, IMA, IMAR and Oxidative stress index (OSI) degrees were found to be more increased than healthy pregnancies both in 2nd and 6th months of pregnancy; however, there were statistically significant only at 6th month (p less than 0.01). Total Oxidative Stress (TOS) levels were higher than healthy pregnancies. So, as a result of IMA which was caused by oxidative stress rising from hypoxia/ischemia could serve as an early bioindicator for miscarriage in cattle.

scholarly journals Study of oxidative stress and C-Reactive protein in type-2 Diabetes Mellitus

2019 ◽  
Vol 7 (10) ◽  
pp. 3751
Author(s):  
Shubhangi M. Dalvi ◽  
Chandrakiran D. Hathial ◽  
Neelam Yeram ◽  
Mayuri Nalavade ◽  
Vinayak W. Patil
Keyword(s):  
Oxidative Stress ◽  
Diabetes Mellitus ◽  
Acute Phase ◽  
Metabolic Diseases ◽  
Acute Phase Reactant ◽  
Low Grade ◽  
Newly Diagnosed ◽  
C Reactive Protein ◽  
Serum Samples ◽  
Reactive Protein

Background: Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion and insulin action or both. T2DM is associated with chronic low grade inflammation, possibly through a pathway involving a cytokine-mediated acute-phase response to infection and other inflammatory processes. authors aim to study C-reactive protein (CRP) which is an acute-phase reactant produced primarily in the liver hepatocytes. Oxidative stress levels in newly diagnosed T2M patients were analysed with respect to malondialdehyde (MDA) and nitric oxide (NO).Methods: Case-control study comprising of aged-sex matched subjects: newly diagnosed T2DM cases (n=30) and controls (n=30). The serum samples of subjects were analysed for levels of MDA by Buege and Aust method, while NO levels by Cortas and Wakid’s kinetic cadmium reduction method using spectrophotometer. CRP levels were analysed by using turbidimetry. Statistical analysis was done using Mini-tab 17 software with 95% confidence interval.Results: Serum levels of MDA, NO and CRP in newly diagnosed T2DM patients were significantly increased as compared to healthy controls.Conclusions:  Authors concluded that the oxidative stress and inflammation plays a pivotal role in the aetiology of hyperglycemia in T2DM. Oxidative stress and inflammatory markers might help prognosis of T2DM in hyperglycemic individuals with the help of which precautionary measure can be taken to reduce the rate of disease progression. Treatment involving anti-oxidant and anti-inflammatory medications might help to rescue vital organs from damage.

scholarly journals Evaluation of the role of CRP as an early predictor of chorioamnionitis in PPROM

2018 ◽  
Vol 7 (4) ◽  
pp. 1351 ◽  
Author(s):  
Amika Aggarwal ◽  
Sangeeta Pahwa
Keyword(s):  
Predictive Value ◽  
Early Stage ◽  
Control Group ◽  
Total Leucocyte Count ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
A Prospective Study ◽  
Early Predictor

Background: Preterm birth is one of the most important cause of perinatal morbidity and mortality. PROM is defined as spontaneous rupture of membranes before the onset of uterine contraction. Objective of present study was to evaluate the role of CRP as an early predictor of Chorioamnionitis in PPROM.Methods: A prospective study was done on 50 cases with PPROM and 50cases of control group without PPROM. All mothers and babies were observed from the time of admission to the time of discharge.Results: C-reactive protein appears to be the most sensitive acute phase protein; rising of less than 24 hours makes it suitable to serve as a marker for diagnosing an infective process in early stage. On comparing C-reactive protein levels with other laboratory tests and indicators of infection (e.g. total leucocyte count DLC, maternal fever, maternal tachycardia, fetal tachycardia) we found CRP level to be more sensitive (100%) but less specific (69.56%) in identifying clinical Chorioamnionitis. The positive predictive value was 22.22% and negative predictive value was 100%.Conclusions: In cases of PPROM, raised CRP is an early predictor of clinical Chorioamnionitis as well as histological Chorioamnionitis.

scholarly journals Integrative indicators of anti-endotoxin immunity and systemic inflammation in bronchial asthma patients with different inflammatory phenotypes

2020 ◽  
pp. 58-64
Author(s):  
В.А. Белоглазов ◽  
Ю.О. Попенко ◽  
Н.А. Шадчнева ◽  
А.И. Гордиенко ◽  
В.Б. Калиберденко ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Systemic Inflammation ◽  
Peripheral Blood ◽  
Induced Sputum ◽  
Control Group ◽  
C Reactive Protein ◽  
Blood Concentrations ◽  
Reactive Protein ◽  
Inflammatory Phenotypes

Актуальность. Поскольку роль эндотоксина в индукции бронхообструктивного синдрома сегодня уже не вызывает сомнений, представляется целесообразным и определение роли антиэндотоксинового иммунитета (АЭИ) в формировании различных биофенотипов хронического воспаления, которые лежат в основе особенностей течения бронхиальной астмы (БА). Цель настоящего исследования - определение роли гуморального и мукозального звеньев АЭИ и системного воспаления при различных биофенотипах воспаления у больных БА, которые могли бы быть полезны для разработки персонифицированной терапии. Материалы и методы. В исследование включены 109 больных с верифицированным диагнозом среднетяжёлой и тяжёлой бронхиальной астмы. Пациенты были разделены на 3 группы в зависимости от типа воспаления в дыхательных путях: 1-я группа - эозинофильный, 2-я группа - нейтрофильный, 3-я группа - смешанный гранулоцитарный. Гуморальное и мукозальное звенья эндотоксин-связывающих систем оценивали по уровням специфических эндотоксин-связывающих антител классов M, A, G (анти-ЭТ IgM, анти-ЭТ IgA, анти-ЭТ IgG) в периферической крови, и уровню секреторного антиэндотоксинового иммуноглобулина класса A в индуцированной мокроте. Системное воспаление оценивали по концентрации С-реактивного белка (СРБ). Результаты. При нейтрофильном и смешанном биофенотипах воспаления зарегистрированы повышенные уровни анти-ЭТ IgM и анти-ЭТ IgА в периферической крови. В то время как при эозинофильном биофенотипе воспаления не выявлено существенных различий данных показателей от контрольной группы. Концентрация анти-ЭТ IgG во всех группах больных бронхиальной астмы не отличалась от диапазона нормы. При всех биофенотипах воспаления выявлено повышение концентраций секреторного анти-ЭТ IgА и СРБ в рамках низкоинтенсивного воспаления. Наибольший уровень анти-ЭТ IgА и СРБ зарегистрирован при нейтрофильном и смешанном биофенотипах воспаления. Выявлены умеренные прямые корреляционные связи: между уровнем секреторного анти-ЭТ IgA и относительным количеством нейтрофилов в индуцированной мокроте (r = 0,469, р < 0,05); между уровнем СРБ и уровнем секреторного анти-ЭТ IgA (r = 0,427, р < 0,05). Выводы. Наиболее выраженный гуморальный и мукозальный ответ на эндотоксин и интенсивность системного воспаления при нейтрофильном и смешанном биофенотипах воспаления свидетельствуют о значительной роли ингаляционного эндотоксина в формировании тяжёлой астмы. Выявленный дисбаланс гуморального и мукозального звеньев АЭИ систем дополняет современные представления патогенеза бронхиальной астмы с различными биофенотипами воспаления, предоставляет перспективу возможности персонификации лечения и достижения контроля заболевания. Background. Since the role of endotoxin in induction of broncho-obstructive syndrome is above any doubt today, we focused on the role of anti-endotoxin immunity (AEI) in the formation of different phenotypes of chronic inflammation, which underlie characteristics of the course of asthma. The aim of this study was to determine the role of humoral and mucosal components of AEI and systemic inflammation in different inflammatory phenotypes in patients with asthma, which could be useful in developing personalized therapy. Materials and methods. The study included 109 patients with a verified diagnosis of moderate to severe asthma. All patients were divided into 3 groups depending on the type of inflammation in the respiratory tract: Group 1, eosinophilic; Group 2, neutrophilic; and Group 3, mixed granulocytic inflammation. The humoral and mucosal components of endotoxin binding systems were evaluated by levels of specific endotoxin-binding class M, A, and G antibodies (anti-ET IgM, anti-ET IgA, and anti-ET IgG) in peripheral blood and the level of secretory anti-endotoxin IgA in induced sputum. Systemic inflammation was assessed by concentration of C-reactive protein (CRP). Results. Peripheral blood concentrations of anti-ET IgM and anti-ET IgA were elevated in neutrophilic and mixed inflammatory phenotypes. At the same time, in the eosinophilic inflammatory phenotype, these indexes were not significantly different from the control group. In all groups of patients with asthma, concentrations of anti-ET IgG were similar and remained within the normal range. In all inflammatory phenotypes, concentrations of secretory anti-ET IgA and C-reactive protein were increased within the range of low-intensity inflammation. The highest levels of anti-ET IgA and CRP were found in neutrophilic and mixed inflammatory phenotypes. Levels of secretory anti-ET IgA moderately directly correlated with the relative number of neutrophilic leukocytes in induced sputum (r = 0.469, р < 0.05) and levels of CRP moderately directly correlated with levels of secretory anti-ET IgA (r = 0.427, р < 0.05). Conclusions. The most pronounced humoral and mucosal response to endotoxin and the intensity of systemic inflammation in neutrophilic and mixed inflammatory phenotypes evidenced a significant role of inhaled endotoxin in the formation of severe asthma. The observed imbalance of humoral and mucosal components in AEI systems supports modern ideas of the pathogenesis of asthma with different inflammatory phenotypes and provides a promising possibility of individualized treatment and control of the disease.

scholarly journals Relationships of oxidative stress and systemic inflammation markers depending on the degree and duration of hypertension

2016 ◽  
Vol 7 (2) ◽  
pp. 118-122
Author(s):  
T. Ashcheulova ◽  
N. Gerasimchuk
Keyword(s):  
Oxidative Stress ◽  
Arterial Hypertension ◽  
Systemic Inflammation ◽  
Control Group ◽  
C Reactive Protein ◽  
Multisystem Disease ◽  
Reactive Protein ◽  
And Gender ◽  
Relationship Of ◽  
Healthy Persons

Arterial hypertension (AH) is a heterogenic and multisystem disease. It has been suggested that oxidative stress (OS) and systemic non-specific inflammation may be involved in pathogenesis of cardiovascular pathology including AH. The aim of our study was to characterize the plasma C-reactive protein (CRP) level as a marker of systemic inflammation in relation to OS development (on the base of 8-isoprostane level assessment), depending on duration and degree of AH. We examined 117 persons, of which 102 patients from 30 to 65 years old (average age – 54.7 years) who had previously not been receiving regular antihypertensive therapy had I–III degrees of essential hypertension and 15 healthy persons (average age – 48.7 years). In 34 patients from this group the degree of OS activity was determined by 8-isoprostane level as the main marker of OS. The control group consisted of 10 healthy persons, by age and gender comparable with the study group. Determination of plasmatic CRP levels and the level of 8-isoprostane in the serum was performed by ELISA. The study established an increase of the plasmatic CRP levels in patients with hypertension, and a statistically significant increase of serum 8-isoprostane content in hypertensive patients compared to the control group. When assessing the relationship of 8-isoprostane and CRP content in patients with different degrees of hypertension we found that the strongest positive relationship between their levels was observed in the case of I degree hypertension. This may indicate the role of oxidative stress in the pathogenesis of hypertension as a damaging mechanism which contributes to the activation of immune mechanisms and further progression of the disease. Increased CRP and 8-isoprostane levels confirm the involvement of autoimmune mechanisms and oxidative stress in the pathogenesis of hypertension. The level of C-reactive protein is dependent on the duration of hypertension, while the 8-isoprostane levels – only on degree of hypertension. A raised level of C-reactive protein can be used as an independent marker of systemic inflammation in patients with arterial hypertension.

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