1. We have measured plasma concentrations of renin, renin substrate and angiotensins I and II as well as plasma renin activity in nine patients with severe or malignant hypertension during treatment with captopril, hydrochlorothiazide and propranolol. 2. On captopril and hydrochlorothiazide the plasma concentrations of renin substrate and angiotensin II decreased markedly, while renin and angiotensin I levels were increased. 3. The changes in renin substrate concentration suggest a consumption of substrate induced by an increased renin release. Further, the positive feedback of angiotensin II on hepatic renin substrate synthesis may be inhibited. 4. The sequential changes in renin release during captopril treatment should be monitored by measuring plasma renin concentration since plasma renin activity measurements will be profoundly influenced by the marked changes in plasma renin substrate concentration.
Faced with medical health-care staff shortages as a result of the coronavirus disease 2019 pandemic in Denmark,1Wu JT Leung K Leung GM Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study.Lancet. 2020; 395: 689-697Summary Full Text Full Text PDF PubMed Scopus (2959) Google Scholar colleagues at Aalborg University and Aalborg University Hospital were able to shift teaching of medical students to a digital platform, employ final year students as temporary residents, and plan and initiate course programmes in ventilator therapy assistance and nursing assistance within 2 days. On March 11, 2020, the Danish Prime Minister called for the mobilisation of all medical staff.2StatsministerietSituationen kommer til at stille kæmpe krav til os alle sammen.https://www.regeringen.dk/nyheder/2020/statsminister-mette-frederiksens-indledning-paa-pressemoede-i-statsministeriet-om-corona-virus-den-11-marts-2020/Date: March 11. 2020Date accessed: April 21, 2020Google Scholar Most universities in the country cancelled lectures and barred buildings. In response to the call to mobilise all medical staff, we decided to keep medical students in their clinical placements and to initiate fast-track courses in ventilator therapy and nursing assistance. In accordance with our undergraduate medical curriculum, we included the courses and the work as a temporary resident, ventilator therapy assistant, or nursing assistant in the teaching programme. Teaching was shifted to digital solutions, and the unique learning opportunity arising from the pandemic emergency health-care work matched the learning objectives in our undergraduate medical curriculum.3Stentoft D Problem-based projects in medical education: extending PBL practices and broadening learning perspectives.Adv Health Sci Educ Theory Pract. 2019; 24: 959-969Crossref PubMed Scopus (30) Google Scholar We constructed a new portfolio to be completed by each student to demonstrate learning activities in courses, clinical placements, and pandemic work. This will be used to emphasise the commitment of medical students to the pandemic emergency health-care workforce and to support progression in medical education at this summer's examinations. Within 2 weeks, all master's students had volunteered, and almost two thirds of students (161 of 257) were working as temporary residents (76 [47%] of 161), ventilator therapy assistants (45 [28%]), or nursing assistants (30 [19%]). More than 70% of bachelor students (329 of 454) had volunteered within 1 week, and 31% (142 students) were working in nine pandemic emergency departments. The processes driving this initiative are illustrated in the figure, and the achievements were acknowledged by the Danish Ministers of Health and Education and the Danish Health Authority. Decisive support from the heads of both Aalborg University and Aalborg University Hospital facilitated the process, which was led by the heads of the medical master's programme in medicine (SR, JE, and SA) together with the heads of the medical students' organisations (PS and MSP). This immediate response to the call for pandemic emergency health-care staff by medical students, without delay to their medical education, follows a historical trend3Stentoft D Problem-based projects in medical education: extending PBL practices and broadening learning perspectives.Adv Health Sci Educ Theory Pract. 2019; 24: 959-969Crossref PubMed Scopus (30) Google Scholar and sets an example, we believe, to be followed by other universities. The support by organisations and close collaboration was key to our success (figure). There is no need to hesitate—medical students are needed just as urgently as ventilators.4Lassen HC A preliminary report on the 1952 epidemic of poliomyelitis in Copenhagen with special reference to the treatment of acute respiratory insufficiency.Lancet. 1953; 1: 37-41Abstract PubMed Scopus (282) Google Scholar, 5Ranney ML Griffeth V Jha AK Critical supply shortages—the need for ventilators and personal protective equipment during the Covid-19 pandemic.N Engl J Med. 2020; (published online March 25.)DOI:10.1056/NEJMp2006141Crossref PubMed Scopus (1367) Google Scholar We declare no competing interests. We thank Lukas Bjørn Leer Bysted (Department of Computer Science, Aalborg University, Aalborg, Denmark) for preparing the graph.
Both chronic pain and obesity are known to affect reproductive hormone profiles in male patients. However, the effect of these conditions, alone or in combination, on male fertility potential has received less attention. 20 chronic musculoskeletal pain patients and 20 healthy controls were divided into lean and overweight subgroups according to their BMI. Current level of chronic pain (visual analogue scale) and pressure pain thresholds (PPTs) in 16 predefined sites, classically described and tested as painful points on the lower body, were measured. Levels of reproductive hormone and lipid profiles were assessed by ELISA. Sperm concentration and motility parameters were analyzed using a computer-aided sperm analysis system. Sperm concentration, progressive motility, and percentage of hyperactivated sperm were generally lower in the chronic pain patients in both lean and overweight groups. The overweight control and the lean chronic pain groups demonstrated a significantly lower percentage of progressively motile sperm compared with the lean control group, suggesting that musculoskeletal chronic pain may have a negative influence on sperm quality in lean patients. However, due to the potential great negative influence of obesity on the sperm parameters, it is difficult to propose if musculoskeletal chronic pain also influenced sperm quality in overweight patients. Further research in chronic pain patients is required to test this hypothesis.
