Editor(s)
Prof. Aurora Martínez Romero
Clinical Biochemistry, Juarez University, Durango, Mexico.

Short Biosketch

ISBN 978-81-19491-46-9 (Print)
ISBN 978-81-19491-47-6 (eBook)
DOI: 10.9734/bpi/cpmmr/v7

This book covers key areas of medicine and medical research. The contributions by the authors include catheter-related infections, extracorporeal detoxification methods, high costs of infections, subclavian vein, internal jugular vein, antibiotic therapy, primary amenorrhoea, turner syndrome, cytogenetic evaluation, chromosomal aberrations, hypothalamic-pituitary-ovarian, gonadotropin-releasing hormone, hypothalamic dysfunction, isochromosome, anterior radiculomedullary artery, negative pressure wound therapy, foix-alajouanine syndrome, spinal MR angiography, anterior spinal artery, adamkiewicz artery, cardiovascular disease, diabetes mellitus, ovarian cyst,  brainstem auditory evoked potential test, ovarian torsion, haemorrhagic infarction, arterial thrombosis, nonrhabdmyosarcoma soft tissue sarcomas, pediatric soft tissue sarcoma, crush syndrome, Sars CoV 2 and Real-time polymerase chain reaction. This book contains various materials suitable for students, researchers and academicians, in the field of medicine and medical research.

 

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Chapters


Large-Bore Catheters as Vascular Access for Extracorporeal Detoxification Methods: Advantages, Disadvantages, and Necessary Improvements

Rolf Bambauer , Ralf Schiel , Octavio J. Salgado

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 1-16
https://doi.org/10.9734/bpi/cpmmr/v7/5840B

After the introduction of large-bore catheters with the Seldinger technique into the vena cava superior via the internal jugular veins in 1979, the advantages of this puncturing technique versus the puncture of the femoral or subclavian veins were seen. However, complications and side effects of the puncture of the internal jugular vein, such as faulty punctures, bleeding, hematothorax, thrombosis and faults in catheter material and infections were observed, too. Infections, thrombosis, and stenosis are among the most frequent side effects associated with blood-contacting catheters. These side effects are usually related to surface properties and the material of these catheters. Surface treatment processes, such as ion implantation and ion beam assisted deposition, and microdomain structured surfaces, could be used to mitigate such complications. The complication rate was first retrospective about 28 %. A second retrospective study of surface treated catheters with silver versus untreated catheters showed 75 % decline in the infection and thrombosis rate in the surface treated catheters. However, this cannot be confirmed with more available data of these patients. One reason may be that in the surfaces treated catheters only the outer surface was coated with silver and the possibilities of contamination by handling during treatments. New materials and technologies which include the outer and inner surface are necessary to reduce the tremendous discomfort of patients and the high costs of the catheter-related infections.

Etiology and management of Primary Amenorrhea: A Cytogenetic Evaluation Study in Western India

Kumari Pritti , Vineet Mishra , Hetvi Patel , Kushani Patel , Rohina Aggarwal , Sumesh Choudhary

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 17-31
https://doi.org/10.9734/bpi/cpmmr/v7/6102C

This chapter aims to estimate the frequency and types of chromosomal abnormalities in primary amenorrhoea (PA) patients in western India and correlate their hormonal profile and sonographic findings with chromosomal reports. Amenorrhea, the lack of menstrual periods, is the primary effect of eating disorders on the reproductive system. It can be classified as primary or secondary, depending on the time of onset. Primary amenorrhea is a delay in menarche beyond the age of 16. Secondary amenorrhea occurs when periods are absent for more than 3 to 6 months in women who previously menstruated regularly.

One hundred (100) cases of primary amenorrhea were studied for cytogenetic analysis during the period of 2014–2021. The age group of subjects ranged from 12 to 36 years, and mean age was 20.5 years. Karyotyping was done after taking informed consent from the patients. Molecular cytogenetic technique was used to confirm marker chromosomes and ring chromosomes. Genetic factors could be chromosomal or single gene disorders or multifactorial. Recently, with the advent of next generation sequencing, multiple genes have been attributed to the cause of primary amenorrhea. However, in majority it is chromosomes and their abnormalities, contributing to the constitutional etiology of amenorrhea. The results revealed 89% of PA with normal female karyotype (46,XX) and 11% with different abnormal karyotypes. Majority of females with normal karyotype were having Mullerian defects and among them most of them were categorized under Rokitansky syndrome. The chromosomal abnormalities associated with X and Y chromosomes have direct influence on stature and pubertal development. Sexual development is the result of interplay of numerous genes on the X chromosome and mutation in any of these genes can result in partial or complete failure of stature and pubertal development. Among the abnormal karyotype constituents, 27.3% numerical abnormalities, all were Turner syndrome; pure and mosaic. Four cases (36.4%) showed male (XY) karyotype. The other four cases (36.4%) showed structural abnormalities, among which three cases showed X-associated structural abnormality and one case showed balanced translocation.

In order to accurately identify chromosomal abnormalities and to ensure proper reproductive care in the case of PA, this study underlines the importance of cytogenetic analysis as a crucial component of the diagnostic approach. Genetic counseling and guidance on reproductive options depend on the early diagnosis of anomalies.

Role of Negative Pressure Wound Therapy in Burns

Ganesh Chaudhari , Satish Sonawane

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 32-43
https://doi.org/10.9734/bpi/cpmmr/v7/10784F

Background: This chapter aimed to determine the unexplored uses of Negative pressure wound therapy (NPWT) in second degree superficial burns of Hand. Negative Pressure wound Therapy is one of the important Weapons in the armamentarium of Wound management. NPWT provides an impactful and exciting development in wound care, with different clinical applications. Application of physical therapy and splinting after burned hand injuries is very important and consists in prevention oedema, contracture, maintaining or improving range of motion, functional recovery, preventing of development of keloids scars, muscle force and good cosmetic results, reduce infection and secondary complications, good to normal strength is achieved, and self-management of symptoms. Early initiation of physiotherapy, topical antibiotic cream treatment, collagen application, splintage, passive exercise for second-degree superficial burns. Many NPWT Kits are commercially available at significantly high cost. Most of the patients with burns are from low socioeconomic strata. To reduce the burden of cost we designed and used indigenously made NPWT Kit. Significant reduction in postburn edema in NPWT used burnt hand compared to topical antibiotic cream dressing observed. Burnt hands or parts that have been treated with NPWT heal more quickly. In our study, negative pressure wound therapy for acute second-degree superficial burns produced encouraging outcomes in terms of wound healing and decreased post-burn edema.

A Case of Foix-Alajouanine Syndrome Triggered by Coronavirus-19

V. V. Belenky , N. A. Plakhotina , A. A. Skoromets , V. N. Komantsev , P. P. Dugaev , O. V. Leontiev

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 44-53
https://doi.org/10.9734/bpi/cpmmr/v7/6338E

Foix-Alajouanine syndrome is the subacute spinal vasculitis of viral origin described in 1926 by Foix and Alajonanine. In this connection non-specific body response to viral infection affects spinal arteries, leading to rapidly progressive myelopathy. We present the case of a 41-year-old male patient with sporadic subacute motor neuron disease. The aim of the study is to elucidate the etiology of myelitis in the patient. For that purpose, spinal MR angiography and spinal MR tractography were used. Spinal MR tractography has revealed lateral columns to be intact, which excluded amyotrophic lateral sclerosis. Spinal MR angiography has detected narrowing and tortuosity of spinal arteries, as well as the occlusion of the right twelfth intercostal artery. Meanwhile a generalized skin eruption in the form of erythematous rings testified the presence of coronavirus-19 infection. Thus, we presume that subacute myelopathy in our patient refers to Foix-Alajouanine syndrome.

Impact of Diabetes Mellitus on Hearing by Brainstem Auditory Evoked Potential

Indira Jha , Ranjana C. Shingne , Niska Sinha

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 54-62
https://doi.org/10.9734/bpi/cpmmr/v7/6127B

Background: In India, the burden of diabetes is second only to that of cardiovascular disease (CVD) [1]. Both micro and macro vascular problems can be cause by diabetes. Nephropathy, retinopathy and neuropathy make up the triad [2]. 50 percent of patients with type 1 and type 2 Diabetes Mellitus (DM) develop diabetic neuropathy. The chance of developing diabetic neuropathy rises over time [3]. Diabetes patients experience hearing loss that may be sensory neurological in nature and worsen at higher frequencies [2].

Methods: A useful technique to assess the auditory circuits in the brainstem is the brainstem auditory evoked potential (BAEP) test. BAEP waves and interpeak latencies recorded.

Results: Delayed BAEP waves and interpeak latencies recorded in diabetics.

Conclusion:  These results reported abnormal auditory pathway in brainstem in diabetic patients. BAEP contributes to the clinical diagnosis of auditory neuropathy in diabetics.

Diagnosis and the Treatment of Twisted Ovarian Tumours in a 14-Year Old Young Girl

Michele Florence Mendoua , Serge Nyada , Basile Essola , Marcel Gerardin Mbarga , Dominique Noah Noah

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 63-70
https://doi.org/10.9734/bpi/cpmmr/v7/19380D

This chapter discuss about a case of Laparoscopic Management of a Large Ovarian Cyst Twist in a 14-Year Old Young Girl in Emergency. The diagnosis and the treatment of twisted ovarian tumours are still challenging, especially in adolescent girls. Torsion of an ovarian cyst also can produce no symptoms and be an incidental finding on ultrasound. In children, there has been a shift toward conservative surgery for future fertility preservation. We describe an adolescent girl with a twisted ovarian cyst, in whom emergent laparoscopic surgery was successful. A significant cystic mass, suggestive of an ovarian cyst, was seen on ultrasound. A sizable left ovarian cyst that was twisted on its axis was found during a laparoscopy. The cyst was pierced and detorsed. The surgical exploration by laparoscopy is the key to make a diagnosis of ovarian torsion and allows performing a conservative gesture. The goal for adolescents is to preserve ovarian function as much as possible, detorsion in most cases restores the ovarian vascularization.  Laparoscopy is the treatment of choice with many advantages: reduction of the hospital stay, minimal blood losses, early rehabilitation and reduction of significant aesthetic damage in adolescent girls.

 

A Case Report on Infantile Non-rhab Domyosarcoma in Foot: Therapeutic and Diagonistic Assay

Javad Mirzazada , Burcin Kececi

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 71-81
https://doi.org/10.9734/bpi/cpmmr/v7/6822A

Nonrhabdmyosarcoma soft tissue sarcomas (NRSTS) include a cluster of different types of soft tissue sarcomas clubbed together due to the rarity of individual subtypes. The diagnostic accuracy is lately reinforced due to the availability of immunohistochemical and molecular markers.  So, there is still uncertain con-sensus for treatment protocol, however, neo- adjuvant chemotherapy modality was ultima- tely promising in our case.  A healthy 3-month-old girl born with NSVD experiences and swelling on her right foot. The parents were consulted a pediatrician, who prescribes symptomatic treatment, and when the girl's pain worsens, they refer her to an orthopaedist. There, she was reexamined and diagnosed with an infantile malignant mesenchymal tumor after a series of MRIs and biopsies revealed mass.

After prospering neo-adjuvant treatment reduced mass was carefully excised within wide excision criteria and with safe surgical borders. Mass enfolded metatarsals then stripped off and fixed back after gamma irradiation. Although limb salvage surgery frequently prevents amputation, preserving the patient's life comes first before saving the patient's limb and functionality.

Nitrite Infusion is a Successful Treatment for Rat Model of Crush Syndrome

Jun Kobayashi , Isamu Murata

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 82-91
https://doi.org/10.9734/bpi/cpmmr/v7/1041G

Crush syndrome (CS) is characterized by ischemia/reperfusion injury (IRI) in skeletal muscle caused by direct trauma, injury, and compression. Skeletal muscle destruction following IRI induces massive generation of reactive oxygen species and subsequent systemic inflammation. Recent studies demonstrate that ischemic pre- and post-conditioning attenuate IRI by enhancing nitric oxide (NO) synthase activation and nitrite reduction to NO. The protective effect of nitrite infusion on experimental IRI also has been demonstrated in heart, kidney, liver, and skeletal muscle. Based on the recent progress in therapeutic strategies against CS, we discuss NO-mediated signaling involvement in CS, and utility of nitrite infusion as a pharmacological intervention in the treatment of CS.

Use of Siddha Formulations for SARS-COV2 Variants Infection: A Case Study from India

S. M. Chitra , P. Mallika , N. Anbu

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 92-106
https://doi.org/10.9734/bpi/cpmmr/v7/7186A

Many research groups have examined the potential use of natural products and substances already available for use for other indications, such as Ayurvedic formulations that are widely used in India and within the Indian diaspora. Traditional Siddha formulations were given for cases reported with positive Covid 19 infection, in home setting, at Chennai and the reports were shared here. The examples reported here were in close proximity to the potential of omicron and mixed variations, despite the fact that genome sequencing is the precise diagnostic method for variants detection. Thippili rasayanam, adathodai kudineer, and Amukkara choornam are herbal preparations that were shown to work well with Maha vasantha kusumakaram tablet, a shastric higher order metals preparation.  The patients recovered in a short span of time and the repeat Real time polymerase chain reaction (RTPCR) tested negative within 10 days.  The fact that Siddha medicines were effective against various mutations of the Covid virus without causing any negative side effects was extremely encouraging. Post-testing of liver and kidney parameters further demonstrated the safety and efficacy of the medications. Repurposing already existing drugs in traditional system of medicine for novel diseases like covid19 should be encouraged and time tested in future.

Topical Anti-inflammatory Activity of a Medicinal Plant Spondias mombin L.

Karla Michelli Garcia de Oliveira , Fernanda Kelly Costa , Ana Lúcia Santos de Matos Araújo, Fernanda Maria Pinto Vilela , Mirian Pereira Rodarte , Maria Silvana Alves , Célia Hitomi Yamamoto , Orlando Vieira de Sousa

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 107-126
https://doi.org/10.9734/bpi/cpmmr/v7/6064B

The objective of this chapter is to describe the identification of ellagic acid and the topical anti-inflammatory activity of Spondias mombin L. stem in experimental models. This species is a tree extensively used in herbal medicine worldwide. The juice and leaf powder are traditionally used topically for healing and anti-inflammatory activity. Spondias mombin L. was collected at the Federal University of Bahia (UFBA), Salvador city, Bahia State, Brazil. From the dried stem, powdered bark and wood were separately subjected to ethanol extraction by static maceration to obtain the EESB (bark) and EESW (wood) extracts. These extracts were analyzed by TLC and HPLC-DAD-UV. The topical anti-inflammatory action was carried out using extracts (EESB and EESW - 0.1, 0.5, and 1 mg/ear), gel formulations (GEESB and GEESW - 1, 3, and 5%), and ellagic acid (EA - 1 mg/ear). Nitric oxide (NO), myeloperoxidase (MPO), N-acetyl-D-glucosaminidase (NAG), and histopathological analyses were evaluated. The ability of S. mombin extracts and gel formulations to reduce the effect of Croton oil shows an inhibitory potential on oxidative stress that prevents the generation of ROS and allows the suppression of inflammation of the skin and the proliferation of epidermal tissue. EA was identified in EESB and EESW as the main compound. After 6 h of treatment, EESB (53.83 to 63.06%), GEESB (41.45 to 43.48%), EESW (37.51 to 49.30%), GEESW (45.02 to 50.70%), and EA (58.59%) inhibited the ear thickness. In 24 h, the ear thickness was reduced by EESB (56.22 to 58.01%), GEESB (44.79 to 60.67%), EESW (44.11 to 62.69%), GEESW (49.38 to 62.88%) and EA (62.90%). In this time, ear weight, MPO, NAG, NO, leukocyte migration and vasodilation were decreased.  These findings validate the traditional applications of S. mombin stem and may offer an alternative for the treatment of cutaneous inflammation by indicating that it exhibits topical anti-inflammatory effect. The gel formulations of EESB and EESW can constitute a phytotherapeutic application and represent an alternative for the treatment of inflammatory skin disorders.

Psychological Distress and the Role of Health Locus of Control in Lung Cancer Patients during the Covid-19 Pandemic

Frosyna Anagnosti , Georgia Hardavella , Dimitra Lekka , Dimitra Darahani , Fragkiski Anthouli-Anagnostopoulou , Petros Papagiorgis , Dimitrios Chaniotis , Nikolaos Thalassinos

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 127-148
https://doi.org/10.9734/bpi/cpmmr/v7/6013E

Aim: To prospectively investigate the prevalence of psychological distress experienced by lung cancer patients during COVID-19 pandemic, the factors contributing in its increase, and the impact of health locus of control on it.

Materials and Methods: 160 consecutive lung cancer outpatients were studied, at the Oncology Clinic of Chest Diseases General Hospital “Sotiria”, Athens, Greece.  Health behaviours and psychological distress were assessed using the Health Locus of Control Scale (HLOCS) and the Distress Thermometer (DT), respectively. Demographic and medical data were retrieved through medical records.

Results: The mean age of the sample was 66.2 years and the majority was men, with chemotherapy being the most frequents treatment modality. The most frequent physical problems were fatigue (63.7%), breathing (48.1%), and sleep disorders (45.0%). Nervousness (41.3%), anxiety (46.9%), fears (21.9%) and grief (29.4%) were the most prevalent emotional problems. Women experienced overall distress at a greater extent compared to men (p .012), with significant differences in physical (p=.005), emotional (p=.001), family (p= .011) and practical problems (p=.008), and more specifically with treatment-related decisions (p=.000), depression (p=.000), fears (p=.000), grief (p=.000), spiritual/religious worries (p=.008) and appearance (p=.000) A strong positive correlation was found between all DT subscales (p .012). HLOC tended to be external since distress was positively affected by the subscales “doctors” and “chance”, indicating that patients rely more on these two factors to control their disease rather than themselves. HLOC was also positively correlated with the presence of psychological problems (p < .05), with a difference between the two sexes, with men having higher scores in iHLOC compared to women (p=.004).

Conclusions: External HLOC has a negative impact on psychological distress, which in turn is affected by interdependent emotional and physical problems. These should be taken into account when treating lung cancer patients amidst unpredictable situations and frequent screening should be applied, in order to enhance lung cancer patients’ quality of life.

Traditional Chinese Medicine Techniques Impact on the Quality of Life of the Older People

Helena Andrade Figueira , Olivia Andrade Figueira , Joana Andrade Figueira , Alan Andrade Figueira , Estelio Henrique Martin Dantas , Delson Lustosa Figueiredo , Ronaldo Vivone Varejão , Adonay Pimentel Aleluia Freitas Júnior , Jymmys Lopes dos Santos , Cilene Oliveira Feu Galiasso , Carlos Antônio Feu Galiasso , João Victor da Costa Alecrim

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 149-158
https://doi.org/10.9734/bpi/cpmmr/v7/6577E

The focus of this study was to determine the potential influence of traditional Chinese medicine (TCM) practices on the quality of life (QOL) of the elderly. Elders should be interviewed as reporters on the quality of their own lives. Two non-selected volunteer groups of Rio de Janeiro (Brazil) municipality residents were studied: a control group (36 older adults) who did not use TCM and a group participating in an experiment (28 older people) that did use TCM at the ABACO/Sohaku-in Institute in Brazil. The WHOQOL-Old questionnaire, developed by the World Health Organization, was employed, as were descriptive statistical approaches such as mean and standard deviation. The Shapiro-Wilk test was used to ensure that the distribution was normal. Furthermore, for the intergroup comparison, the Student t test was used to aspects 2, 4, 5, 6, and total score, and the Mann-Whitney U rank test was applied to facets 1 and 3, both tests intended to examine the P value difference between experimental and control groups. The degree of significance used was 95% (P >0.05). The experimental group had the greatest overall and individual QOL scores. It was determined that TCM might improve the QOL of the elderly. The overall conclusion of this study, which reports a greater QOL for the old who receive TCM treatment, is beneficial for the adoption of TCM procedures in the West, at least among the senior population.

Determination of Three-Dimensional Ultrasound Measurement of Fetal Adrenal Gland and Maternal Serum Fructosamine Level in Gestational Diabetes Mellitus: A Prospective Cohort Study

Saowapak Junhasavasdikul , Panyu Panburana , Sommart Bumrungphuet , Wirada Dulyaphat

Current Progress in Medicine and Medical Research Vol. 7, 14 August 2023, Page 159-173
https://doi.org/10.9734/bpi/cpmmr/v7/6940A

This chapter evaluate the correlation between fetal adrenal gland size and volume observed using two-dimensional (2D) ultrasound measurement in transverse, coronal, and sagittal planes and three-dimensional (3D) ultrasound measurement using virtual organ computer-aided analysis (VOCAL) software and maternal serum fructosamine levels in GDM patients. Gestational diabetes mellitus (GDM) has an impact on fetal adrenal gland size and volume, which are greater in women with GDM compared to those without.

 This prospective cohort study was performed at GDM clinic in Ramathibodi hospital, Mahidol University from January to December 2019. The foetal zone and overall adrenal gland volume in 3D ultrasonography were assessed using the virtual organ computer-aided analysis (VOCAL) software. Up until birth, all subjects were monitored. The link between foetal adrenal gland ultrasonography measures and the relevant parameters was investigated using Pearson's correlation analysis.

The study consisted of sixty-six (82.5%) pregnant women with diet-controlled GDM (GDMA1) and 14 (17.5%) with insulin-managed GDM (GDMA2). There was no difference in fetal adrenal gland measurements between the groups. In addition, all participants achieved optimal glucose levels at the time of ultrasound acquisition.  The findings of this study indicate that fetal adrenal gland measurements using 2D and 3D ultrasonography in the third trimester can be visualized and measured adequately in 96.4%. The total adrenal gland length and fetal zone volume are correlated with EFW, maternal fructosamine, and HbA1c levels in well-controlled GDM. The total adrenal gland length and fetal zone volume had statistically significant positive correlations with EFW (r = 0.69, p = 0.02 and r = 0.84, p = 0.01, respectively). After adjusting for EFW, the relationships of total adrenal gland length with fructosamine levels (adjusted-OR = 0.4, 95% CI: 0.1, 0.7) and HbA1c levels (adjusted-OR = 0.3, 95% CI: 0.1, 0.6) were statistically significant (p < 0.05). Likewise, the relationship between fetal zone volume with fructosamine levels (adjusted-OR = 2.4, 95% CI: 1.5, 3.9) and HbA1c levels (adjusted-OR = 2.5, 95% CI: 1.6, 4.3) were statistically significant (p < 0.05).

The study also discovered a correlation between EFW, fructosamine levels, and HbA1c levels and total adrenal gland length and foetal zone volume. These non-invasive methods can be useful for GDM patients as glycemic monitoring indirect markers.

This chapter presents the differential diagnosis of the case of a 23-year-old female patient referred to the emergency department due to persistent generalized muscle weakness, hypokalemia, hypomagnesemia and metabolic alkalosis gradually deteriorating during the last three months as well as the steps towards final clinical diagnosis of the syndrome (Gitelman syndrome).

The patient’s medical history as well as family history were thoroughly reviewed by experienced specialized internists. Detailed physical examination was subsequently performed and a panel of blood biochemistry was ordered accordingly. Differential diagnosis was performed subsequently.

The patient’s medical history was unremarkable. Physical examination of the patient did not reveal any abnormal signs. twice daily blood pressure measurements were within the normal range. Blood tests biochemistry revealed metabolic alkalosis, hypokalemia, hypomagnesemia, hypocalciuria, increased plasma renin activity, and elevated plasma levels of aldosterone. A Gitelman syndrome-like phenotype, including hypomagnesemia and hypocalciuria, has also been associated with mutations in the CLCNKB gene encoding the chloride channel ClC-Kb, the cause of classic Bartter syndrome.  The woman was treated with spironolactone and oral potassium supplements, and, once her symptoms disappeared and her serum potassium levels returned to normal, Gitelman's syndrome was officially diagnosed. Gitelman syndrome is typically characterized by hypokalemia, metabolic alkalosis, hypomagnesemia, hypocalciuria, increased serum renin and aldosterone levels and normal arterial blood pressure.