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Introduction: Propranolol was the first non-selective beta-adrenergic blocker to be developed. Initially it was used in the treatment of cardiovascular diseases, but since the 60's it has been used in the prevention of migraine. Objective: The objective of this study was to know the history of propranolol and its use as a migraine prophylactic. Methods: This study was an integrative literature review using articles with historical data on propranolol, from its origin in cardiology to its indication in the preventive treatment of migraine. Results: Propranolol was described in 1962 for the treatment of cardiovascular diseases. In the same decade, it was prescribed for the preventive treatment of migraine and, recently, included in the consensus of the Brazilian Headache Society. Conclusion: Although propranolol was initially synthesized for the treatment of heart disease, it has proved to be an effective drug in preventing migraine attacks
Introdução: O propranolol foi o primeiro bloqueador beta-adrenérgico não seletivo a ser desenvolvido. Inicialmente era utilizado no tratamento de doenças cardiovasculares, mas desde a década de 60 tem sido utilizado na prevenção de enxaquecas. Objetivo: O objetivo deste estudo foi conhecer a história do propranolol e seu uso como profilático para enxaqueca. Métodos: Este estudo foi uma revisão integrativa da literatura utilizando artigos com dados históricos sobre o propranolol, desde sua origem na cardiologia até sua indicação no tratamento preventivo da enxaqueca. Resultados: O propranolol foi descrito em 1962 para o tratamento de doenças cardiovasculares. Na mesma década, foi prescrito para o tratamento preventivo da enxaqueca e, recentemente, incluído no consenso da Sociedade Brasileira de Cefaleia. Conclusão: Embora o propranolol tenha sido inicialmente sintetizado para o tratamento de doenças cardíacas, provou ser um medicamento eficaz na prevenção de crises de enxaqueca
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Objectives: The objective of this study was to explore a possible association between ED and the severity of airflow obstruction in patients with COPD. Materials and methods: A cross-sectional study was conducted using the International Index Erectile Function (IIEF), a scale validated and translated to Spanish. Bivariate analyses between subgroups were made for quantitative variables using a t-test for means and MannWhitney U for medians; qualitative variables were compared using the χ2 test or Fisher's test, depending on distribution. Confusion bias in the association between ED and airflow obstruction was controlled using a logistic regression model. Results: The Spanish version of the IIEF-15 scale was valid and applicable to the Colombian population. The prevalence of ED in COPD patients living at high altitudes was similar to that found at sea level. Such prevalence is higher than in general population. Beta-blockers increased 7 times the risk of ED, but we found no association between the degree of airflow obstruction and ED. Conclusion: Although the severity of COPD is not associated with ED, the prevalence of ED in COPD is higher than in general population. Therefore, ED screening in COPD patients using the IIEF could be justified. The strong association between beta-blockers and ED had not been previously described in patients with COPD but must be considered in their clinical management.
Objetivos: Explorar una posible asociación entre DE y severidad de la obstrucción al flujo aéreo en pacientes con EPOC. Materiales y métodos: Estudio de corte transversal aplicando el Índice Internacional de Función Eréctil (IIFE), validado y traducido al español. Se realizó análisis bivariado para variables cuantitativas usando prueba-t para medias y U de Mann Whitney para medianas; las variables cualitativas fueron comparadas usando prueba de Chi2 o test de Fisher, según distribución. Los sesgos de confusión en la asociación entre DE y obstrucción al flujo aéreo fueron controlados usando un modelo de regresión logística. Resultados: La versión en español de la escala IIFE-15 fue aplicable en población colombiana. La prevalencia de DE en pacientes con EPOC viviendo a gran altura fue similar a lo encontrado a nivel del mar. Esta prevalencia es mayor que en población general. El uso de beta-bloqueadores aumentó hasta siete veces el riesgo de DE, pero no se encontró asociación entre el grado de obstrucción y la DE. Conclusiones: Aunque la severidad de la EPOC no está asociada con DE, la prevalencia de DE en EPOC es mayor que en población general. Está justificada la realización de tamizaje usando el IIFE. La asociación fuerte entre beta-bloqueadores y DE no se ha descrito previamente en pacientes con EPOC, pero debe considerarse en su manejo.
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Humans , MaleABSTRACT
ABSTRACT Introduction: Classic coronary artery bypass grafting (CABG) surgery involves diastolic cardiac arrest under cardiopulmonary bypass, while off-pump CABG (OPCABG) has become widespread in recent years. Methods: 174 patients who underwent OPCABG were included in the study. Patients were divided into two groups. Group I (n=90) received ivabradine and Group M (n=84) received metoprolol before surgery until postoperative day 10. Intraoperative arrhythmias and hypotension were recorded. Postoperative atrial fibrillation (AF) and arrhythmia, mortality and morbidity rates were assessed based on the 30-day postoperative follow-up. Results: There were no significant differences in the intraoperative amount of inotropic support and red blood cell transfusion between groups (P=0.87 and P=0.31). However, the rates of intraoperative arrhythmias and hypotension were not significantly higher in Group M (P=0.317 and P=0.47). Ventricular tachycardia/ventricular fibrillation (VT/VF) was observed in 2 patients in both groups. Postoperative AF occurred in 7 patients (7.7%) in Group I and in 10 patients (11.9%) in Group M. Although there was a trend towards a higher prevalence of AF in Group M patients, this did not reach statistical significance. In addition, mortality and morbidity rates were comparable between groups.
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Background:Patients with hypertension in India been reported with high heart rate owing to sympathetic overdrive (SO). Beta-blockers provides several positive effects to reduce SO in patients with hypertension. The aim of present survey studywasto understand current real-world prevalence of SO in Indian patients with hypertension and usage of beta-blocker therapy in them.Methods:A cross sectional, observational, questionnaire-based survey conducted across India between June 2020 to October 2020. A specially designed validated questionnaire was shared with 157 registered health care practitioners (HCP),their anonymous inputs were captured and analysed in qualitative manner. Categorical data was summarized by number (n) and percentage (%). Results:Total 157 HCP participated and completed the survey. Around 53% of HCP observed that patients with average heart rate above 75 beats/min were associated with negative prognosis. Around 43% of HCP reported that raised heart rate is associated with advancedage and increased body mass index (BMI). Two-third of HCP reported that tachycardia is associated with stage-2 hypertension and marked by restlessness and anxiety which is suggestive of SO. Over 70% HCP agreed that the HR below 75 beats/min is associated with good prognosis. Around 89% HCP reported beta-blockers as the drug of choice in patients with augmented SO. S-Metoprololwas reported to bethemost preferred beta-blocker agent and was recommended by 76% HCP in patients with hypertension and coexisting SO.Conclusions:SO been reported prevalent conditionin Indian patients with hypertension which likely worsensthe prognosis in these patients. Beta-blockers reported to be the preferred choice of anti-hypertensive and S-Metoprololseem to be themost preferred agent amongst the available beta-blockers against SO in patients with hypertension in India.
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Objective:To investigate the protective effect of β- blocker (esmolol) on myocardia and toll-like receptor 4 (TLR4) inflammatory pathway in septic rats.Methods:Sixty male Wistar rats were randomly (random number) divided into the shame group, sepsis group (CLP group), esmolol group (CLP+ES group) and TLR4 inhibitor group (CLP+TAK-242 group) with 15 rats in each group. Cecal exploration was performed in the shame group, and cecal ligation and perforation (CLP) was performed in the CLP group, CLP+ES group and CLP+TAK-242 group. The CLP+ES group received intraperitoneal injection of esmolol diluent 20 mg/kg 12 h after CLP. The CLP+TAK-242 group was given intraperitoneal injection of TAK-242 3 mg/kg at the same time point as above. The shame group and CLP group were given the same amount of normal saline. Rats in all groups were sacrificed 24 h after operation, and the samples were collected and processed. The pathological changes of myocardium were observed by hematoxylin - eosin staining. The expression of TLR4, myeloid differentiation protein 88 (MyD88) and nuclear factor -κB (NF-κB) in myocardial tissue were observed by immunohistochemistry. Masson staining was used to observe the expression of fibers and inflammatory factors in myocardial tissue. The protein expressions of TLR4, MyD88, NF-κB and aspartic acid specific cysteine protease 1 (caspase-1) were detected by Western blot. Serum levels of cardiac troponin I (cTn-I), tumor necrosis factor α (TNF-α), interleukin-6 (IL-6) and interleukin-1β (IL-1β) were detected by enzyme-linked immunosorbent assay (ELISA).Results:Compared with the shame group, myocardial injury, fibrosis and inflammatory cell infiltration were significantly aggravated in the CLP group, and the levels of myocardial injury index cTn-I and inflammatory mediators TNF-α, IL-6 and IL-1β were significantly increased [(8.70±0.22) vs. (4.41±0.31), (445.57±9.13) vs. (219.60±5.52), (165.55±2.18) vs. (93.47±3.37), (124.12±2.59) vs. (67.63±6.04),all P<0.05]. Compared with the CLP group, myocardial injury was significantly reduced in the CLP+ES group and CLP+TAK-242 group, and the levels of inflammatory transmitters were significantly reduced [(5.38±0.18) and (5.37±0.13) vs. (8.70±0.22), (322.73±7.63) and (300.58±17.47) vs. (445.57±9.13), (121.28±5.44) and (120.30±4.95) vs. (165.55±2.18), (102.60±4.09) and (105.08±7.21) vs. (124.12±2.59), all P<0.05]. Western blot analysis showed that the protein expression levels of TLR4, MyD88, NF-κB and caspase-1 in the CLP group were significantly higher than those in the shame group [(1.79±0.15) vs. (1.15±0.04), (4.70±0.30) vs. (3.87±0.10), (0.35±0.04) vs. (0.18±0.02), (2.27±0.29) vs. (1.15±0.07), all P<0.05], while the protein expression levels in the CLP+ES group and CLP+TAK-242 group were significantly lower than those in the CLP group [(1.31±0.16) and (1.18±0.14) vs. (1.79±0.15), (1.50±0.16) and (1.46±0.19) vs. (2.27±0.29), (0.27±0.02) and (0.24±0.01) vs. (0.35±0.04), (1.50±0.16) and (1.46±0.19) vs. (2.27±0.29), all P<0.05]. Conclusions:β-blocker can reduce myocardial injury and inhibit the expression of inflammatory mediators in septic rats by blocking the inflammatory response mediated by TLR4 signaling pathway.
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Background: Vasovagal syncope (VVS) is a common clinical condition involving genetic background. The role of beta-blockers in the treatment is controversial. Objective: The aim of this study was to investigate the effect of beta-1 gene polymorphism on beta-blocker therapy in patients with VVS. Methods: We included 123 patients who were diagnosed with VVS after the tilt-table test. We searched for the polymorphism Arg389Gly (rs1801253) in the beta-1 adrenoceptor gene. Results: Overall, 64 patients (52%) had Arg389Arg genotype and 59 patients (48%) had Arg389Gly genotype. The syncopal episodes of patients with Arg389Arg genotype were more frequent compared with patients having Arg389Gly genotype (total syncopal episodes [TSE], 7.9 ± 3.7 vs. 6.4 ± 3.0; p = 0.012). TSE in patients with Arg389Arg genotype decreased significantly after 18 months of beta-blocker treatment (7.9 ± 3.7 vs. 3.0 ± 1.4, p < 0.001). After 18 months of beta-blocker treatment, patients with Arg389Arg genotype had significantly fewer syncopal episodes than patients with Arg389Gly genotype (3.0 ± 1.4 vs. 6.8 ± 3.2, p < 0.001). Conclusions: Results of beta-blocker therapy in patients with Arg389Arg genotype suggest that VVS pathophysiology is a multifactorial condition, with genetic, psychological, and environmental components, and therefore, treatment selection can be based on gene polymorphism. (REV INVEST CLIN. 2020;72(5):300-7)
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Cardiovascular and central nervous system (CNS) toxicity, including tachydysrhythmia, agitation, and seizures, may arise from cocaine or bupropion use. We report acute toxicity from the concomitant use of cocaine and bupropion in a 25-year-old female. She arrived agitated and uncooperative, with a history of possible antecedent cocaine use. Her electrocardiogram demonstrated tachycardia at 130 beats/min, with a corrected QT interval of 579 ms. Two doses of 5 mg intravenous metoprolol were administered, which resolved the agitation, tachydysrhythmia, and corrected QT interval prolongation. Her comprehensive toxicology screen returned positive for both cocaine and bupropion. We believe clinicians should be aware of the potential for synergistic cardiovascular and CNS toxicity from concomitant cocaine and bupropion use. Metoprolol may represent an effective initial treatment. Unlike benzodiazepines, metoprolol directly counters the pharmacologic effects of stimulants without respiratory depression, sedation, or paradoxical agitation. A lipophilic beta-blocker, metoprolol has good penetration of the CNS and can counter stimulant-induced agitation.
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Adult , Female , Humans , Benzodiazepines , Bupropion , Central Nervous System , Cocaine , Dihydroergotamine , Electrocardiography , Metoprolol , Respiratory Insufficiency , Seizures , Tachycardia , ToxicologyABSTRACT
Objective@#To investigate the efficacy of metoprolol in the emergency treatment of chronic congestive heart failure.@*Methods@#From January 2016 to September 2018, 300 cases of chronic congestive heart failure with acute attack in Zhoushan Hospital were selected.According to random number table method, the patients were divided into two groups, with 150 cases in each group.The control group was given conventional heart failure treatment, the observation group received conventional heart failure therapy combined with metoprolol.The clinical efficacy, heart color ultrasound indicator, 6 minutes walking distance, NT-proBNP level, life quality score and adverse reactions were compared between the two groups.@*Results@#(1)The total effective rate of the observation group was 96.00%(141/150), which was higher than 87.33%(131/150) of the control group (χ2=7.375, P<0.05). (2) After treatment, the LVEDD[(58.12±3.89)mm], LVESD[(44.39±6.17)mm], NT-proBNP[(378.32±27.82)ng/mL] in the observation group were lower than those in the control group (t=10.646, 9.966, 9.283, all P<0.05), the LVEF[(49.36±6.25)%], SV[(76.29±6.24)mL] in the observation group were higher than those in the control group(t=9.092, 8.739, all P<0.05). The 6-minute walking distance[(452.37±61.75)m] of the observation group was longer than that of the control group(t=7.717, P<0.05). The quality of life scores in the emotional field[(6.47±1.29)points], physical field[(10.46±1.65)points], other fields[(10.51±1.32)points]and comprehensive score[(27.44±4.26)points] of the observation group were lower than those of the control group(t=9.030, 9.024, 9.299, 9.114, all P<0.05). (3)During the treatment, no obvious adverse reactions occurred in the two groups.@*Conclusion@#In the emergency treatment of patients with chronic congestive heart failure, the application of conventional anti-heart failure treatment regimen metoprolol can effectively improve the patients' heart function, and is conductive to improving their clinical efficacy and quality of life, with fewer adverse drug reactions and good safety.
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Objective To investigate the efficacy of metoprolol in the emergency treatment of chronic congestive heart failure.Methods From January 2016 to September 2018,300 cases of chronic congestive heart failure with acute attack in Zhoushan Hospital were selected.According to random number table method ,the patients were divided into two groups,with 150 cases in each group.The control group was given conventional heart failure treatment ,the observation group received conventional heart failure therapy combined with metoprolol.The clinical efficacy,heart color ultrasound indicator ,6 minutes walking distance ,NT－proBNP level,life quality score and adverse reactions were compared between the two groups.Results (1) The total effective rate of the observation group was 96.00%(141／150),which was higher than 87.33%(131／150) of the control group ( χ2 ＝7.375,P＜0.05).( 2) After treatment,the LVEDD[(58.12 ±3.89)mm],LVESD[(44.39 ±6.17) mm],NT－proBNP[(378.32 ±27.82)ng／mL] in the observation group were lower than those in the control group (t＝10.646,9.966,9.283,all P＜0.05),the LVEF [(49.36 ±6.25)%],SV[(76.29 ±6.24)mL] in the observation group were higher than those in the control group (t＝9.092,8.739,all P＜0.05).The 6－minute walking distance [(452.37 ±61.75) m] of the observation group was longer than that of the control group (t＝7.717,P＜0.05).The quality of life scores in the emotional field [(6.47 ± 1.29)points],physical field[(10.46 ±1.65)points],other fields[(10.51 ±1.32)points] and comprehensive score [(27.44 ±4.26) points] of the observation group were lower than those of the control group ( t＝9.030,9.024, 9.299,9.114,all P＜0.05).(3) During the treatment,no obvious adverse reactions occurred in the two groups. Conclusion In the emergency treatment of patients with chronic congestive heart failure,the application of conventional anti－heart failure treatment regimen metoprolol can effectively improve the patients＇heart function,and is conductive to improving their clinical efficacy and quality of life,with fewer adverse drug reactions and good safety.
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Considering the recognized role of thyroid hormones on the cardiovascular system during health and disease, we hypothesized that type 2 deiodinase (D2) activity, the main activation pathway of thyroxine (T4)-to-triiodothyronine (T3), could be an important site to modulate thyroid hormone status, which would then constitute a possible target for β-adrenergic blocking agents in a myocardial infarction (MI) model induced by left coronary occlusion in rats. Despite a sustained and dramatic fall in serum T4 concentrations (60-70%), the serum T3 concentration fell only transiently in the first week post-infarction (53%) and returned to control levels at 8 and 12 weeks after surgery compared to the Sham group (P<0.05). Brown adipose tissue (BAT) D2 activity (fmol T4·min-1·mg ptn-1) was significantly increased by approximately 77% in the 8th week and approximately 100% in the 12th week in the MI group compared to that of the Sham group (P<0.05). Beta-blocker treatment (0.5 g/L propranolol given in the drinking water) maintained a low T3 state in MI animals, dampening both BAT D2 activity (44% reduction) and serum T3 (66% reduction in serum T3) compared to that of the non-treated MI group 12 weeks after surgery (P<0.05). Propranolol improved cardiac function (assessed by echocardiogram) in the MI group compared to the non-treated MI group by 40 and 57%, 1 and 12 weeks after treatment, respectively (P<0.05). Our data suggested that the beta-adrenergic pathway may contribute to BAT D2 hyperactivity and T3 normalization after MI in rats. Propranolol treatment maintained low T3 state and improved cardiac function additionally.
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Animals , Male , Rats , Propranolol/administration & dosage , Thyroxine/blood , Adipose Tissue, Brown/metabolism , Adrenergic beta-Agonists/administration & dosage , Iodide Peroxidase/metabolism , Myocardial Infarction/metabolism , Thyroxine/drug effects , Triiodothyronine/drug effects , Triiodothyronine/blood , Adipose Tissue, Brown/drug effects , Rats, Wistar , Disease Models, Animal , Iodide Peroxidase/drug effectsABSTRACT
@#Hemangioma is the most common vascular benign tumor in infants and young children, 60% of which occur in the oral maxillo-facial region. One characteristic of oral and maxillofacial hemangioma is spontaneous regression, which generally does not require treatment; however, a few hemangiomas can produce complications including ulceration, functional disorders and disfigurement, which require active treatments. Currently, the treatment of oral and maxillofacial hemangioma include drug treatment, laser treatment and surgical treatment. The drugs used to treat hemangioma mainly include beta blockers, glucocorticoids, alpha-interferon, imiquimod and antitumor drugs. Drug therapy is suitable for multiple, rapidly proliferating hemangiomas and hemangiomas that affect vital organ function or endanger life. Laser therapy can be applied to the early treatment of rapidly growing hemangiomas at exposed sites. Surgical treatment is suitable for proliferative hemangioma with serious complications, the reconstruction of any external deformity and the repair of a scar after an ulcer. Combined therapy and the development of new technologies provide new directions for the treatment of hemangioma but the efficacy remains to be proven by large sample prospective studies. Clinicians should appropriately evaluate the patients with hemangioma and develop individualized treatment programs for patients with treatment indications. This article reviews the efficacy, mechanism, clinical application and adverse reactions of different treatment methods and provides references for clinical treatment.
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Background Heart rate (HR) reduction is of benefit in chronic heart failure (HF). The effect of heart rate reduction using Ivabradine on various echocardiographic parameters in dilated cardiomyopathy has been less investigated. Methods Of 187 patients with HF (DCM, NYHA II–IV, baseline HR > 70/min), 125 patients were randomized to standard therapy (beta blockers, ACEI, diuretics, n = 62) or add-on Ivabradine (titrated to maximum 7.5 mg BD, n = 63). Beta-blockers were titrated in both the groups. Results At 3 months both groups had improvement in NYHA class, 6 min walk test, Minnesota Living With Heart Failure (MLWHF) scores and fall in BNP, however the magnitude of change was greater in Ivabradine group. Those on Ivabradine also had lower LV volumes, higher LVEF (28.8 ± 3.6 vs 27.2 ± 0.5, p = 0.01) and more favorable LV global strain (11 ± 1.7vs 12.2 ± 1.1, p = <0.001), MPI (0.72 ± 0.1 vs 0.6 ± 0.1, p = <0.001), LV mass (115.2 ± 30 vs 131.4 ± 35, p = 0.007), LV wall stress (219.8 ± 46 vs 238 ± 54) and calculated LV work (366 ± 101 vs 401 ± 102, p = 0.05). The benefit of Ivabradine was sustained at 6 months follow up. The % change in HR was significantly higher in Ivabradine group (−32.2% vs −19.3%, p = 0.001) with no difference in blood pressure. Resting HR < 70/min was achieved in 96.8% vs 27.9%, respectively in the two groups. Conclusion Addition of Ivabradine to standard therapy in patients with DCM and symptomatic HF and targeting a heart rate < 70/min improves symptoms, quality of life and various echocardiographic parameters.
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Background: Chronopharmacology is the science dealing with the optimization of drug effects and the minimization of adverse effects by timing medication in relation to the biological rhythm. This concept came into picture to make us understand about periodic and predictable changes in both desired effects and tolerance of medication Chronotherapeutics approach gives more accurate determination of the time when patients are at highest risk and in greatest need of therapy. This Chronopharmacological principle is used in the therapy of various diseases like cardiovascular diseases, allergy and many more. The objective of the study was to analyse whether chronopharmacological approach was being applied in clinical practice by comparing chronopharmacology of 4 drugs to their prescribing pattern by the physicians.Methods: This was observational study where 700 prescriptions written by physicians were audited. To study all the drugs would have been tedious so four commonly used drugs were chosen that is, Proton pump inhibitors, statins, Beta blockers and subcutaneous Insulin.Results: Results showed that chronopharmacological approach has been applied in the clinical field though physician didn’t have clear concept about chronopharmacology and it is relation to the prescribing. Despite this, maximum physician prescribing pattern was comparable to the chronopharmacological data except in case of Proton pump inhibitors.Conclusions: It is concluded that Chronotherapeutics approach gives more accurate determination of the time when patients are at highest risk and in greatest need of therapy. Nevertheless, this variation is only seldom considered by clinicians. If drugs are prescribed by following chronopharmacological approach it can prove beneficial to the patients as more of effectiveness of the drug and lesser side effects.
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BACKGROUND: We aimed to evaluate effect of heart rate (HR) reduction on left ventricular reverse remodeling (LVRR) in Korean patients with heart failure with reduced ejection fraction (HFrEF). METHODS: Ambulatory patients with HFrEF, who had paired echocardiograms, N-terminal prohormone brain natriuretic peptide (NT-proBNP), and global assessment score (GAS) at baseline and 6-month (n = 157), were followed up on preset treatment schedule with bisoprolol. RESULTS: The LVRR occurred in 49 patients (32%) at 6-month. In multivariable analysis, independent predictors associated with LVRR were use of anti-aldosterone agent (odds ratio [OR], 4.18; 95% confidence interval [CI], 1.80–9.71), young age (OR, 0.96; 95% CI, 0.92–0.99), high baseline HR (OR, 3.76; 95% CI, 1.40–10.10), and favorable baseline GAS (OR, 1.73; 95% CI, 1.06–2.81). Beneficial effect of bisoprolol, in terms of LVRR, NT-proBNP, and GAS, was remarkable in the high HR group (baseline HR ≥ 75 beats per minute [bpm]), which showed a large HR reduction. CONCLUSION: High baseline HR (≥ 75 bpm) showed an association with LVRR and improvement of NT-proBNP and GAS in patients with HFrEF. This seems to be due to a large HR reduction after treatments with bisoprolol. Trial registry at www.ClinicalTrials.gov, NCT00749034.
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Humans , Appointments and Schedules , Bisoprolol , Heart Failure , Heart Rate , Heart , Natriuretic Peptide, BrainABSTRACT
Objective To investigate the clinical efficacy of combined use of beta blocker in the treatment of chronic severe congestive heart failure (CHF). Methods 78 patients with severe chronic congestive heart failure in patients from November 2015 to January 2017 were randomly divided into study group (n=39) and control group (n=39). The control group was treated with routine treatment of chronic severe congestive heart failure, and the study group was treated with beta blocker metoprolol on the basis of routine treatment. The changes of DBP, SBP, LVEF, LVEDD and the incidence of adverse reactions were recorded before and after treatment in two groups. Results After the analysis of the two groups before treatment, DBP, SBP, LVEF, LVEDD and other indicators compared no significant difference; after the treatment of DBP, SBP, LVEDD group index decline and increase of LVEF were better than the control group, comparing the data with significant difference (P<0.05); drug therapy in the treatment of severe chronic group occurred during the study period the rate of adverse reactions in patients with congestive heart failure and there is no significant difference compared with control group. Conclusion The use of routine regimen based on the use of beta blocker metoprolol can significantly improve the clinical efficacy of patients with chronic severe congestive heart failure, and is conducive to the protection of their prognosis and quality of life.
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Objective To investigate the clinical efficacy of combined use of beta blocker in the treatment of chronic severe congestive heart failure (CHF). Methods 78 patients with severe chronic congestive heart failure in patients from November 2015 to January 2017 were randomly divided into study group (n=39) and control group (n=39). The control group was treated with routine treatment of chronic severe congestive heart failure, and the study group was treated with beta blocker metoprolol on the basis of routine treatment. The changes of DBP, SBP, LVEF, LVEDD and the incidence of adverse reactions were recorded before and after treatment in two groups. Results After the analysis of the two groups before treatment, DBP, SBP, LVEF, LVEDD and other indicators compared no significant difference; after the treatment of DBP, SBP, LVEDD group index decline and increase of LVEF were better than the control group, comparing the data with significant difference (P<0.05); drug therapy in the treatment of severe chronic group occurred during the study period the rate of adverse reactions in patients with congestive heart failure and there is no significant difference compared with control group. Conclusion The use of routine regimen based on the use of beta blocker metoprolol can significantly improve the clinical efficacy of patients with chronic severe congestive heart failure, and is conducive to the protection of their prognosis and quality of life.
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ABSTRACT: This study aimed to evaluate and compare the effects of the fixed combination of dorzolamide/timolol with those of tafluprost on intraocular pressure (IOP) and pupil diameter (PD) in healthy dogs (n=10). Two experiments were conducted with an interval of 30 days. In both, IOP and PD were assessed at 8, 11, 14, 17, and 20h. Parameters were evaluated during baseline, treatment period of four days, and one day of post-treatment. During treatment phase, IOP decreased by 0.74 (P<0.05), 1.88 (P<0.01), 2.94 (P<0.001), and 3.10mmHg (P<0.01), in dorzolamide/timolol-treated eyes; and by 1.50, 2.18, 2.14, and 2.18mmHg (P<0.001), in tafluprost-treated eyes. PD decreased by 0.24 (P<0.01), 0.32 (P<0.01), 0.49 (P<0.001), and 0.40mm (P<0.001), in dorzolamide/timolol treated eyes; and by 2.31, 2.55, 2.43, and 2.70mm (P<0.001), in tafluprost-treated eyes. Dorzolamide/timolol and tafluprost were able to decrease IOP and PD in healthy dogs. However, a cumulative effect of the fixed combination of dorzolamide/timolol was more effective in reducing IOP, than tafluprost. Comparisons between treatments showed that tafluprost was more effective in reducing PD throughout the treatment phase.
RESUMO: O estudo objetivou avaliar e comparar os efeitos da combinação fixa da dorzolamida/timolol com os da tafluprosta sobre a pressão intraocular (PIO) e o diâmetro pupilar (DP) em cães saudáveis (n=10). Dois experimentos com intervalo de 30 dias foram conduzidos. Em ambos, a PIO e o DP foram avaliados às 8, 11, 14, 17 e às 20h. Os parâmetros foram avaliados durante a fases basal, um período de tratamento de quatro dias, e um dia de pós-tratamento. Durante a fase de tratamento, a PIO dos olhos tratados com dorzolamida/timolol reduziram em 0.74 (P<0.05), 1.88 (P<0.01), 2.94 (P<0.001), e 3.10mmHg (P<0.01); e dos olhos tratados com tafluprosta em 1.50, 2.18, 2.14 e 2.18mmHg (P<0.001). O DP dos olhos tratados com dorzolamida/timolol reduziram em 0.24 (P<0.01), 0.32 (P<0.01), 0.49 (P<0.001) e 0.40mm (P<0.001); e dos olhos tratados com tafluprosta em 2.31, 2.55, 2.43 e 2.70mm (P<0.001). A dorzolamida/timol e a tafluprosta foram capazes de reduzir a PIO e o DP em cães saudáveis. Porém, efeito cumulativo do tratamento com dorzolamida/timolol foi observado, decorridos três dias de tratamento. Por essa razão, a dorzolamida/timolol foi mais efetiva que a tafluprosta na redução da PIO. Comparações entre os tratamentos demonstraram que a tafluprosta foi mais efetiva em reduzir o DP, durante toda a fase de tratamento.
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Objective To compare cost-effectiveness between endoscopical esophageal variceal ligation (EVL) combined non-selective beta-receptor blocker strategies and covered-stents transjugular intrahepatic portosystemic shunt (cTIPS) in preventing esophageal variceal rebleeding in liver cirrhosis with portal hypertension.And to explore the threshold of cost-effectiveness in stents in China.Methods According to clinical practice and associated guidelines,a six state Markov-based decision analytic model was established with TreeAge Pro Suite 2014 to compare the cost-effectiveness between two interfering strategies after followed up for seven years.The parameters such as costs,life years (LY),quality-adjusted life-years (QALY) and incremental costeffectiveness ratio (ICER) were directed.Results The results of baseline research in the seven-year follow-up period indicated that the cost of endoscopical EVL combined non-selective beta-receptor blocker B was 7 444.25 United States dollar (USD)/each,and yielded 1.98 QALY.The expected cost of cTIPS was 13 151.69 USD/ each and could have 2.34 QALY.In the 7th year,ICER was 16 001.74 USD.Based on willingness-to-pay (WTP) threshold of China (19 887.00 USD),cTIPS had better cost-effectiveness than endoscopical EVL combined non-selective beta-receptor blocker B.The price of covered stents less than 5 401.52 USD had cost-effectiveness.The results of single factor sensitivity analysis indicated that rebleeding probability of endoscopical EVL combined non-selective beta-receptor blocker B group was the most influential factor in the result of model.The second important factor was the cost of cTIPS.The probabilistic sensitivity analysis reported cTIPS to be the optimal strategy at WTP of 19 887.00 USD in 83％ of the iterations.Conclusions Seven-year follow-up indicates that cTIPS may be a more cost-effective strategy than endoscopical EVL combined non-selective beta-receptor blocker B in preventing esophageal variceal rebleeding.The price of covered stents less than 5 401.52 USD which have cost-effectiveness in China.
ABSTRACT
Aim: We report an extremely unusual case of thyrotoxicosis presenting as recurrent acute flaccid quadriparesis in a south Indian male. This case is reported to disseminate knowledge about this rare presentation of thyrotoxicosis among medical professionals. Presentation of Case: This patient presented with sudden onset of symmetrical weakness of both upper and lower limb since early morning with unexplained hypokalemia. He had diffuse toxic goiter with subtle features of hyperthyroidism associated with flaccid quadriparesis. Laboratory investigation revealed marked hypokalemia and hyperthyroidism. He was clinically diagnosed to have hyperthyroidism presenting as thyrotoxic periodic paralysis. He improved with potassium supplementation, beta blocker & anti-thyroid agent. Discussion: Thyrotoxic periodic paralysis (TPP) may be the initial presentation of thyrotoxicosis in rare occasion. Proximal muscle weakness of lower limb is often the first symptom noted. Hypokalemia noted in TPP is the consequence of a rapid and massive shift of potassium from the extracellular into the intracellular compartment, mainly into the muscles. TPP is distinguished from other forms of periodic paralysis (especially hypokalemic periodic paralysis) with thyroid function tests. Failure to recognize this rare disorder may result in fatal cardiac arrhythmia which is a potential cause of mortality. Conclusion: Clinicians should be aware of this atypical presentation of thyrotoxicosis as it is lethal if not treated. Young people with unexplained hypokalemic paralysis even without apparent evidence of thyroid dysfunction should be subjected to thyroid function test to identify this rare disorder.
ABSTRACT
Long QT syndrome (LQTS) is a rare cardiac channelopathy associated with syncope and sudden death due to torsades de pointes and ventricular fibrillation. Syncope and sudden death are frequently associated with physical and emotional stress. Management of patients with LQTS consists of life-style modification, β-blockers, left cardiac sympathetic denervation (LCSD), and implantable cardioverter-defibrillator (ICD) implantation. Prohibition of competitive exercise and avoidance of QT-prolonging drugs are important issues in life-style modification. Although β-blockers are the primary treatment modality for patients with LQTS, these drugs are not completely effective in some patients. Lifelong ICD implantation in young and active patients is associated with significant complications. LCSD is a relatively simple and highly effective surgical procedure. However, LCSD is rarely used.