ABSTRACT
Lipid-lowering therapy plays a crucial role in reducing adverse cardiovascular (CV) events in patients with established atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia. Lifestyle interventions along with high-intensity statin therapy are the first-line management strategy followed by ezetimibe. Only about 20–30% of patients who are on maximally tolerated statins reach recommended low-density lipoprotein cholesterol (LDL-C) goals. Several factors contribute to the problem, including adherence issues, prescription of less than high-intensity statin therapy, and de-escalation of statin dosages, but in patients with very high baseline LDL-C levels, including those with familial hypercholesterolemia and those who are intolerant to statins, it is critical to expand our arsenal of LDL-C-lowering medications. Moreover, in the extreme risk group of patients with an LDL-C goal of ?30 mg/dL according to the Lipid Association of India (LAI) risk stratification algorithm, there is a significant residual risk requiring the addition of non-statin drugs to achieve LAI recommended targets. This makes bempedoic acid a welcome addition to the existing non-statin therapies such as ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. A low frequency of muscle-related side effects, minimal drug interactions, a significant reduction in high-sensitivity C-reactive protein (hsCRP), and a lower incidence of new-onset or worsening diabetes make it a useful adjunct for LDL-C lowering. However, the CV outcomes trial results are still pending. In this LAI consensus document, we discuss the pharmacology, indications, contraindications, advantages, and evidence-based recommendations for the use of bempedoic acid in clinical practice.
ABSTRACT
Introduction: Assessment of thyroid function duringpregnancy is important for assessing maternal and foetalwell being. However, the complex physiological alterationsoccurring during normal pregnancy cause thyroid hormonelevels to change. Hence, the interpretation of the thyroidprofile becomes difficult in pregnancy if normal referenceranges are not defined. Study objective was to determinetrimester specific reference ranges for thyroid hormone innormal pregnancy.Material and methods: Serum sample was collected from194 females in various trimester of normal intrauterine singlepregnancy and total T3, total T4 and TSH was determined.The results obtained were then analysed to determine gestationspecific thyroid hormone levels.Result: The normal ranges of thyroid hormone in first, secondand third trimesters during normal pregnancy in our studywere: total T3 (83.9-196.6, 86.1-217.4, 79.9-186 ng/dl), totalT4 (4.4-11.5, 4.9-12.2, 5.1-13.2 μg/dl) and TSH (0.1-2.7, 0.4-3.3, 0.5-3.8 IU/ml) respectively.Conclusion: The levels of thyroid hormones in pregnancynot only show characteristic changes from non pregnant statebut also vary with each trimester. Hence, trimester specificreference ranges for thyroid hormone need to be defined toensure correct interpretation of these tests.
ABSTRACT
Aim: The Aim of present study is to analyse conserved functional Short Dehydrogenase Reductase (SDR) domain from bacteria. Based on the domain analysis selection of coniferyl alcohol dehydrogenase gene for isolation from Pseudomonas nitroreducens Jin1. Place and Duration of Study: Department of Biotechnology, Punjabi University, Patiala. From July, 2012 to November, 2012. Methodology: Bioinformatics tools were used to analyse various calA genes from bacteria based on the presence of conserved domain in members of SDR family. Based on insilico analysis, Pseudomonas nitroreducens Jin1 calA was selected. PCR was used for amplification of the gene from the genome of Pseudomonas nitroreducens Jin1. Result: Multiple sequence alignment results for conserved domains amongst members of SDR family identified presence of all domains of Short Dehydrogenase Reductase members in Pseudomonas nitroreducens Jin1 calA gene. Amongst the various sequences compared the P. nitroreducens Jin1, calA was found to be the smallest in size. The locus of calA in the genome resides at 103513-104280 bases. It was amplified from the genome of Pseudomonas nitroreducens Jin1. The calA gene that was amplified is of size 768bp. Conclusion: calA gene isolated from Pseudomonas nitroreducens Jin1 is a small gene with all the functional domains and can be used for biotransformation of coniferyl alcohol to coniferyl aldehyde.