Unmet Need for Further LDL-C Lowering in India despite Statin Therapy: Lipid Association of India Recommendations for the Use of Bempedoic Acid

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.

A preliminary pharmacokinetic and toxicity study of nigerloxin

A rapid RP-HPLC method was developed for the detection and quantitation of nigerloxin, a fungal metabolite active against diabetic complications, in rat plasma. The method was validated and employed to analyze samples obtained from a pharmacokinetic study after oral administration of the nigerloxin at 100 mM/kg body weight to wistar rats. The assay exhibited a dose-dependent response in a linear range from 2-500 µg/mL in rat plasma. The Cmax, AUC, and t1/2 were found to be 10.68±2.05, 49.01±8.23, 6.5±1.4, respectively. In another study, nigerloxin was fed to rats over a period of 14, 28, and 90 days at 100 mM/kg body weight. The results showed that nigerloxin fed rats were not adversely affected, based on the evaluation of various toxicological parameters. Thus, the results of the present study and the preliminary pharmacokinetic profile of the metabolite indicated the absence of any toxicity and promised its possible future application as a molecule against diabetic complications without any side effects.

Temporal, buccal and masticator space infections in an immunocompromised patient: report on a rare case

@#AIDS” is a term used to describe the various clinical syndromes, specific opportunistic infections or malignancies that occur with HIV infection. Oral manifestations are common in people with HIV infection. .Oral lesions may be due to decline in immune function. Hence patients with AIDS are subjected to recurrent, Life threatening opportunistic infection. Here is a case report of a 70 year old female who presented with right buccal, masticator and submandibular space infection. A routine blood test reveals seropositivity positive for HIV infection. She was treated with antibiotics and underwent an incision and drainage following hospitalization

A study on genetic polymorphism in Matrix Metalloproteinases-3 in oral submucous fibrosis patients and in healthy individuals

Background: OSF is a potentially malignant condition affecting the oral cavity and oropharynx. MMP-3 also known as Stromelysin -I is a key member of the MMP family which is responsible for degradation of collagen type II,IV,V,IX and X, proteoglycans, gelatins, fibronectin, laminin and elastin. It plays an important role in activation of pro MMP-1 into the active form of MMP-1 in malignant tissues. MMP-3 expression is low in normal tissues but it is altered during tumour formation, where remodeling of ECM is required. Purpose of the study: To assess the association of single-nucleotide polymorphisms, Adenosine (Insertion/Deletion) in -1171 5A > 6A in the MMP-3 promoter regions of patients with oral submucous fibrosis and in healthy individuals (controls). Methods: Thirty cases of OSF were categorized according to Khanna et al classification into four groups and Twenty age and sex matched controls were included in the study. Blood samples were collected in EDTA coated vacutainers and PCR restriction analysis was done. A statistical analysis was done using Chi-square test and Fisher's exact test to assess the frequency and association of the alleles in the case-control group. Results: The result showed a statistical significance difference between the duration of habit and disease severity with polymorphisms. The result also showed a higher frequency of the 5A allele in the study group as compared to the controls. Conclusion: A long-term follow up of these patients is mandatory to see the prognosis and their susceptibility to malignancy. The positive outcome of an association of the disease with polymorphisms would result in the development of potential diagnostic and therapeutic possibilities in potentially malignant and malignant lesions (AU)

Sclerotiorin is non-mutagenic and inhibits human PMNL 5-lipoxygenase and platelet aggregation.

Sclerotiorin, isolated from the fermented broth of Penicillium frequentans, exhibited potent inhibition against human polymorphonuclear leukocytes 5-lipoxygenase and human platelet aggregation with a half maximal value 36 µM and 250 µM, respectively. Further, the Ames test has demonstrated the sclerotiorin to be non-mutagenic.

Acromegaloid Facial Appearance Syndrome: A New Case in India

Acromegaloid Facial Appearance syndrome is a very rare syndrome combining acromegaloid-like facial appearance, thickened lips and oral mucosa and acral enlargement. Progressive facial dysmorphism is characterized by a coarse facies, a long bulbous nose, high-arched eyebrows, and thickening of the lips, oral mucosa leading to exaggerated rugae and frenula, furrowed tongue and narrow palpebral fissures. We report a case of acromegaloid facial appearance syndrome in a 19-year-old male patient who presented with all the characteristic features of the syndrome along with previously unreported anomalies like dystrophic nails, postaxial polydactyly and incisal notching of teeth.

Disseminated non-Hodgkin's lymphoma presenting as bilateral salivary gland enlargement: a case report

Non-Hodgkin's lymphoma (NHL) constitutes a group of malignancies those arises from cellular components of lymphoid or extranodal tissues. The head and neck is the most common area for the presentation of these lymphoproliferative disorders. Primary involvement of salivary glands is uncommon. This report described a case of a 73-year-old female patient who presented with involvement of both nodal and extranodal sites, with predominant involvement of salivary glands. The tumor staging worked up along with imaging, histopathological, and immunohistochemical findings were discussed. Computed tomographic images showed the involvement of Waldeyer's ring, larynx, orbit, and spleen. This report described imaging and prognostic tumor markers in diagnosing, treatment planning, and prognosis.

Acrocallosal syndrome.

Presented here is a case of a 8 year old boy with typical clinical manifestations of Acrocallosal syndrome. The characteristic features of this syndrome are craniofacial abnormalities, distinctive digital malformation, mental retardation. The clinical and major nosologic aspects of this condition are discussed.

Lysosomal membrane stabilization by antiinflammatory drugs.

Lysosomal enzymes are important mediators of acute and chronic inflammatory diseases. The release of lysosomal enzymes into cytoplasm stimulate the inflammatory mediators like oxygen radicals, prostaglandins etc. Enfenamic acid, a fenamate, along with other antiinflammatory drugs, did not stabilize lysosomal membrane isolated from normal and activated phagocytic polymorphonuclear leucocytes of different species.