A Young Healthy Woman with Supraventricular Tachycardia Reveals an Underlying Left Ventricular Non-compaction Cardiomyopathy: A Rare Case Report

LVNC (left ventricular non-compaction) is a rare congenital cardiomyopathy with a reported incidence of 0.05% in adults. It can occur in isolation or affect both ventricles. It’s characterized by prominent LV trabeculae and deep intertrabecular recesses which are filled with blood from the ventricular cavity without evidence of communication to the epicardial coronary artery system. Frequent premature supra ventricular tachycardia as unique finding in LVNC cardiomyopathy is rare manifestation of this disease. We report a case of a frequent persistent supraventricular tachycardia as first manifestation of a patient with LVNC cardiomyopathy in a young healthy woman who despite radio frequency ablation therapy of the supraventricular tachycardia remains symptomatic. The patient was later placed on medical therapy based on a non-cardio selective beta-blocker with a good clinical outcome without recurrent of supra-ventricular arrythmias.

A Contemporary Role of Beta Blockers in Myocardial Infarction

Myocardial infarction (MI) is characterized by plaque formation in the inner layer of arteries which occurs due to insufficient or complete cessation of oxygen supply in the myocardium. The common symptoms of MI are crushing or squeezing chest pain which radiates to the arms, shoulders, neck, or jaw, nausea, anxiety, restlessness, fear, heartburn, shortness of breath, cold sweat, fatigue, and dizziness. The treatment of this medical condition includes antiplatelet and thrombolytic therapy, painkillers (morphine or meperidine), diuretics and digitalis glycosides drugs. Moreover, nitroglycerin and antihypertensive drugs such as Beta-blockers, ACE inhibitors, or Calcium channel blockers may also be administered to reduce the blood pressure and improve the oxygen supply in the heart. Among them, beta blocker therapy has several beneficial properties such as it reduces myocardial oxygen demand, preventing arrhythmias, and improves ventricular remodeling, etc. However, there is no study on the role of only beta blocker therapy in the survival of MI patent is found to date. Thus, the present study focused on the evidence-based validation of Beta blocker therapy in the treatment and survival of MI patients. The retrospective study was conducted on 51 MI patients under the observation of medical practitioners. 100% of patients with MI showed a good recovery as well as survival percentage with Beta blocker therapy. This study finally concluded that beta blocker therapy is a safe and effective treatment for MI patients with negligible life-threatening medical conditions. Furthermore, a large group study is suggested with a number of health-related parameters for a better understanding of beta blocker as a first line of treatment for MI patients.

Assessment of Effect and Safety of Beta Blockers in Hypertensive Patients

Background: To assess effect and safety of beta blockers in hypertensive patients.Material & Methods:One hundred twelve adult patients who were diagnosed cases of hypertension of either gender were divided into 2 groups. Each group contained 56 patients. Group I received 25 mg atenolol twice daily and group II received 25 mg metoprolol tartrate twice daily. History of diabetes, kidney disease, lipid disorder, incident cardiovascular (CV) events etc. was recorded. Blood pressure (systolic and diastolic) was recorded before starting and after starting the drug therapy.Results:Age group 20-40 years had 12 in group I and 11 in group II, 41-60 years had 14 in group I and 17 in group II and >60 years had 30 in group I and 28 in group II. There were 40 males and 16 females in group I and 38 males and 18 females in group II. A significant difference in males and females within the group (P< 0.05) and non- significant intergroup difference was observed (P> 0.05). The mean SBP found to be 149.4 mm Hg in group I and 146.7 mm Hg in group II and DBP was 85.4 mm Hg in group I and 83.6 mm Hg in group II at baseline and SBP was 135.4 mm Hg in group I and 134.6 mm Hg in group II and 78.2 mm Hg in group I and 78.0 mm Hg in group II at 6 months. Diabetes mellitus was seen in 12 in group I and 19 in group II, lipid disorders 17 in group I and 28 in group II, chronic kidney disease 11 in group I and 16 in group II and CV event 2 in group I and 4 in group II. Conclusions:Both beta blockers found to be equally effective in management of patients with hypertension.

Retinopatía del prematuro: actualización en detección y tratamiento / Retinopathy of the premature: update in screening and treatment

Resumen: La Retinopatía del Prematuro (RDP) es una alteración proliferativa de los vasos sanguíneos de la retina inmadura, que afecta principalmente a los recién nacidos de muy bajo peso (RNMBP) y de menor edad gestacional. El objetivo de esta revisión es describir a qué niño se debe efectuar la detección de esta enfermedad y analizar los recientes avances en su tratamiento. La detección de RDP está dirigida principalmente a los RNMBP y a < de 32 semanas de edad gestacional, pero también se ha propuesto un criterio según edad postmenstrual. Además de la fotocoagulación con láser, tratamiento estándar en la actualidad, se han desarrollado nuevas terapias, como los agentes anti factor de crecimiento vas cular endotelial (VEGF), que se han utilizado exitosamente en la retinopatía umbral, especialmente localizada en zona I, con menos efectos adversos y mejores resultados oculares a futuro. que la fo tocoagulación con láser. En los últimos años, se han realizado ensayos clínicos con propranolol oral como tratamiento de la RDP, principalmente en la etapa pre-umbral (etapa 2 o 3 en zona II ó III). Este bloqueador beta-adrenérgico puede prevenir la progresión de la retinopatía en RNMBP de etapa pre- umbral a umbral y/o evitar la necesidad de terapias invasivas, como la fotocoagulación con láser o la administración intravítrea de agentes anti-VEGF. La fotocoagulación con láser continúa siendo el tra tamiento de elección en la RDP. Los agentes anti-VEGF y el propranolol oral, evitarían la progresión de esta patología de etapa pre-umbral a umbral, y podrían complementar el tratamiento de la RDP.

Abstract: Retinopathy of Prematurity (ROP) is a proliferative disorder of the blood vessels of the immature retina, which affects mainly very-low-birth-weight infants (VLBW). The objective of this review is to describe to which infant the screening examination of this disease should be performed and to analy ze the recent advances in the treatment of this disease, which have emerged in the last decade. The detection of this disease is mainly focused on VLBW infants and newborns < 32 weeks of gestational age. In addition to laser photocoagulation, standard treatment today, new therapies have appeared, such as the anti-VEGF agents, which have been successfully used in the threshold ROP, especially located in zone I. This therapy is less harmful than laser photocoagulation and with better ocular results in the future. In recent years, oral propranolol has been used as a treatment for ROP in clinical trials, mainly in the pre-threshold stage (stage 2 or 3 in zone II or III). This drug is a beta-adrenergic blocker that can prevent the progression of retinopathy in pre-threshold to threshold stage and/or avoid the need for invasive therapies, such as laser photocoagulation or intravitreal administration of anti-VEGF agents. Laser photocoagulation continues to be the standard treatment for ROP. New treatments have emerged for ROP, such as anti-VEGF agents and oral propranolol, which could pre vent the progression of this disease from the pre-threshold to the threshold stage.

Risk of dementia in patients taking beta blocker as antihypertensive treatment: a cross sectional study

Background: Hypertension is considered to be the third most important disease in the list of diseases in the south Asian region. Several trials have shown active treatment of hypertension reduced the incidence of dementia. This study was adopted to understand the cognitive status of patients using beta blockers for hypertension for a period of more than 5 years.Methods: The study was done during the period of August 2018 and September 2018. Patients taking beta blockers for atleast 5 years were included and was made to take the MMSE test which is scored out of 30 marks containing 11 questions, each of varying marks.Results: In the study, 54 patients were included, 8 out of 54 patients taking beta blockers obtained a score of 30 which is 15% of the study population taking beta blockers, 15 out of 54 patients taking beta blockers obtained a score of 29 which corresponds to 28% of the study population, 21 out of 54 individuals taking beta blockers obtained a score of 28 which is 39% of the population taking it, 7 patients taking beta blockers obtained a score of 27 pertaining to 13% of the population. One patient obtained a score of 26 and two patients scored 25 out of 30. The average score obtained was 28.2963.Conclusions: About 18.5% of the study population had scores below the average value of 28 in this study. This population is at higher risk of developing dementia in the future and need follow up.

Role of nebivolol in anthracycline-induced cardiotoxicity

Background: Anthracyclines are extensively used in the treatment of breast cancer. However, these therapeutic agents are responsible for chemotherapy-induced cardiotoxicity. Aim of this study was to assess the effect of use of prophylactic nebivolol for the prevention of anthracycline-induced cardiotoxicity in breast cancer patients.Methods: This was a prospective, randomized, single-blind, and placebo-controlled trial involving 80 participants with breast cancer, scheduled to undergo chemotherapy with doxorubicin. Patients were randomly divided into two groups: the nebivolol group (n=40) to receive nebivolol 5 mg daily and the placebo group (n=40) to receive placebo. All patients were evaluated with baseline Electrocardiogram (ECG) and echocardiography prior to treatment, and at the 6-month follow-up. Echocardiography included 2D echocardiography, colour doppler and tissue doppler imaging.Results: The study groups had comparable baseline echocardiographic variables. At the 6-month echocardiographic follow-up, there were no changes of statistical significance in any 2D echocardiographic variables in either group. However, there were minimal reductions of 0.4% in left ventricular ejection fraction in the nebivolol group (62.2±4.4% to 61.9±4.2%, p=0.75) and 1.6% in the placebo group (62.8±3.6% to 61.8±3.2%, p=0.18). Doppler examinations also did not reveal any statistically significant changes in variables such as peak A velocity, peak E velocity, E/A ratio, isovolumic relaxation time, and isovolemic contraction time in either group.Conclusions: Prophylactic use of nebivolol treatment may possess cardioprotective properties against anthracycline-induced cardiotoxicity in breast cancer patients although not statistically significant in this study.

Role of Beta-Blockers on Aortic Root Growth Rate in Marfan syndrome: Meta -Analysis of 243 Patients

Background: Marfan syndrome (MS) is inherited autosomal dominant connective tissue disorder caused by mutations in the FBN1 gene encoding fibrillin-1. Aortic dilatation is present in about 80% patients with MS and is the major cause of premature mortality. The objective of our study was to determine the effect of beta-blockers on aortic root growth rate in patients with MS. Methods: We performed a systematic review of all randomized controlled trials and prospective cohort studies that evaluated the efficacy of beta-blockers in patients with MS. The primary outcome of the study was aortic root growth rate. Secondary outcome was composite of death, aortic regurgitation, congestive heart failure, aortic dissection or cardiovascular surgery. Results: Five prospective trials were identified with similar comparable groups, with a total of 243 patients. In our study mean patient age was 12 years with a mean follow-up 86.5 months. There was a significant reduction in aortic root growth rate (SMD -0.86, 95% CI -1.23 to -0.48, p <0.001) with the use of beta-blockers. No significant difference was observed in secondary outcomes in the beta-blocker group as compared to placebo (OR = 1.80, 95% CI 0.21-15.53). Conclusion: Beta-blockers were associated with a significant reduction in aortic root growth rate with reduction in morbidity and mortality.

Basic and clinical insights in catecholaminergic (familial) polymorphic ventricular tachycardia

Abstract Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a potentially lethal disease, whose characteristic ventricular tachycardias are adrenergic-dependent. Although rare, CPVT should be considered in the differential diagnosis of young individuals with exercise-induced syncope. Mutations in five different genes (RYR2, CASQ2, CALM1, TRDN, and TECRL) are associated with the CPVT phenotype, although RYR2 missense mutations are implicated in up to 60 % of all CPVT cases. Genetic testing has an essential role in the diagnosis, management, pre-symptomatic diagnosis, counseling, and treatment of the proband; furthermore, genetic information can be useful for offspring and relatives. By expert consensus, CPVT gene testing is a Class I recommendation for patients with suspected CPVT. Beta-adrenergic and calcium-channel blockers are the cornerstones of treatment due to the catecholaminergic dependence of the arrhythmias. Unresponsive patients are treated with an implantable cardioverter-defibrillator to reduce the risk of sudden cardiac death. In the present article, a brief review of the genetic and molecular mechanisms of this intriguing disease is provided.

Clinical profile and one-year survival of patients with heart failure with reduced ejection fraction: The largest report from India

Background India has one of the largest population of heart failure (HF) patients in the world; yet only limited information is available about HF in India. Methods This observational study was performed at Medanta- The Medicity, a large, tertiary-care institute in the National Capital Region of India. Records of HF patients with reduced left ventricular ejection fraction (LVEF) registered at Medanta HF clinic during the period early 2014 to mid-2017 were reviewed. Disease characteristics and one-year mortality details were collected. Results Mean age of the subjects (n = 5590) was 59.1 ± 11.8 years with 83.0% males. Mean LVEF was 30.0 ± 6.6%. Coronary artery disease (CAD) was the dominant cause of HF, accounting for 77.8% of the total population. Most patients received guideline-directed medical therapy with a beta blocker being prescribed to 81.8% subjects. The one-year all-cause mortality was 17.6%. On multivariate analysis, age, usage of loop diuretics and ivabradine, and serum creatinine were independently associated with one-year mortality, whereas rheumatic etiology had an inverse association. Conclusions This represents the largest single-center data of HF patients reported so far and the largest study describing clinical outcomes from HF patients in India. Our patients were younger, had high proportion of CAD, and there was higher usage of beta-blockers. Despite this, the one-year mortality was substantial. Given the enormous magnitude of HF burden in India and the paucity of information on this subject, these findings should be of help in identifying key problem areas and potential solutions for management of HF in India.

Case Study On Beta Blockers Induced Psoriasis

Drug-induced Psoriasis is one among the common etiological factors of Psoriasis reported worldwide. Familiar drugs known to cause psoriasiform eruptions include Anti-malarials, Beta blockers, NSAIDs, Lithium. etc. Certain antihypertensives like ACE inhibitors, diuretics are also documented to have caused psoriatic episodes. A 57 y old South-Indian male patient with a history of Hypertension, Diabetes Mellitus, Atrial Fibrillation for 4 y; was on antihypertensive therapy for Hypertension and Atrial Fibrillation with proponolol for past 2 y and metoprolol initially. He was presented to the hospital two weeks after switching on to Metoprolol therapy for chief complaints of erythematous scaly lesions especially over both the extremities and paronydrial appearance of nails. Initially, he was on Propranolol therapy which was then shifted to Metoprolol due to an appearance of oral lesions in the mouth. Metoprolol was now discontinued and switched on to Atenolol. After 1-2 w of therapy with Atenolol, the lesions were found to disappear and no recurrence of psoriatic conditions were found. Proper reviewing of medical history for any allergic reactions and the optimization of drug therapy through Therapeutic Drug Monitoring could be initiated by Clinical Pharmacist in order to avoid such drug-induced flares.

Advances in the treatment of infantile hemangioma with topical therapy / 中华整形外科杂志

The incidence of infantile hemangioma (IH) is relatively high, resulting in the necessity of early treatment. Topical medicine is safer than oral administration. This paper reviews the main topical drugs for IH and related mechanism, current situation and the prospect of topical beta blockers for IH.

A comparative study of effects of nebivolol and atenolol on blood pressure and lipid profile in patients of mild to moderate hypertension

Background: Beta blockers have been used in the treatment of hypertension, since last four decades and are widely accepted as the first-line treatment for hypertension. Nebivolol, a third generation ?-blocker has highest ?1 selectivity and is devoid of intrinsic sympathomimetic activity. Along with peripheral vasodilatation and nitric oxide (NO)-induced benefits such as antioxidant activity and reversal of endothelial dysfunction, nebivolol promotes better protection from cardiovascular events. The objective of the study was to compare the effects of atenolol and nebivolol on both blood pressure and lipid profile in patients of mild to moderate hypertension.Methods: This was a prospective, randomized, parallel, open labelled study. Patients were recruited from the medicine out-patient department (OPD) and cardiology OPD. A total of 100 patients were enrolled in the study. 50 patients were allocated to atenolol group and 50 patients to nebivolol group. BP and baseline investigations such as lipid profile were performed. Tests to determine lipid profile were performed on the first visit (Week 0) and at 24 weeks. Continuous variables between the two treatment groups were analyzed by unpaired t-test. Efficacy endpoints within the group were analyzed by using paired t-test.Results: All the lipid levels except HDL-C were increased with atenolol therapy. At 24 weeks, atenolol therapy led to increase in LDL-C, VLDL-C, TC and TG which was highly significant (p<0.0001). HDL levels were decreased at 24 weeks which was also statistically highly significant (p<0.0001). The mean values of lipids in nebivolol group at baseline and at 24 weeks. At 24 weeks, nebivolol therapy led to changes in LDL-C, VLDL-C, HDL-C, TC and TG which was not statistically significant (p>0.05).Conclusions: From study it can be concluded that atenolol and nebivolol are equally effective in reducing BP but atenolol worsens lipid profile as compared to nebivolol.

Medication adherence patterns in aortic dissection survivors

Background & objectives: Beta-blockers have been shown to improve survival in both type A and type B acute aortic dissection (AAD) patients. Calcium channel blockers have been shown to selectively improve survival only in type B AAD patients. There is a lack of data on medication adherence in AAD survivors. The purpose of this study was to assess medication adherence in patients who survived an AAD. Methods: This was a cross-sectional survey-based study of individuals from a single medical centre which was part of the larger International Registry of Acute Aortic Dissection (IRAD). Patients with type A or B AAD who survived to discharge were included in this study. Individuals who were deceased based on the results of an online Social Security Death Index were excluded from the study. Data were obtained from both a survey and also from abstraction from the local academic institution's IRAD registry. A survey packet was sent to patients. One section of this survey was dedicated to assessing medication adherence using the 4-item Morisky scale. Results: Eighty two completed surveys were returned; 74 patients completed the section of the survey pertaining to medication adherence (response rate 38%). Morisky score was ?1.0 for 27 (36%) patients and 0 for 47 (64%) patients. Thirty three patients reported yes to 'forget to take medications' and eight reported yes to 'careless with medications.' Medication non-adherence (defined as a score of ?1.0 on Morisky) was associated with increased follow up recurrence of chest pain at one year of follow up. Only two patients stopped their antihypertensive on their own and did not cite a reason for doing this. Interpretation & conclusions: The medication adherence rate for patients who survived an AAD was 64 per cent at a median (Q1, Q3) of 7.1 yr (5.6, 11.5) after discharge, as per the Morisky scale. The clinicians should educate their patients on the importance of antihypertensive therapy and assess for forgetfulness and carelessness at each clinic visit, as well as understand patients' beliefs about drug therapy, all of which have been shown to increase medication adherence.

Mass spectrometry detection of basic drugs in fast chiral analyses with vancomycin stationary phases / 药物分析学报

Current trends in chiral analysis of pharmaceutical drugs are focused on faster separations and higher separation efficiencies. Core-shell or superficially porous particles (SPP) based chiral stationary phases (CSPs) provide reduced analysis times while maintaining high column efficiencies and sensitivity. In this study, mobile phase conditions suitable for chiral analyses with electrospray ionization LC-MS were systematically investigated using vancomycin as a representative CSP. The performance of a 2.7 μm SPP based vancomycin CSP (SPP-V) 10 cm × 0.21 cm column was compared to that of a corresponding 5 μm fully porous particles based analogue column. The results demonstrated that the SPP-V column provides higher efficiencies, 2–5 time greater sensitivity and shorter analysis time for a set of 22 basic pharma-ceutical drugs. The SPP-V was successfully applied for the analysis of the degradation products of racemic citalopram whose enantiomers could be selectively identified by MS.

Registro nacional de insuficiencia cardíaca de Costa Rica. El estudio RENAIC CR / National registry of heart failure in Costa Rica. The RENAIC CR study

Resumen Objetivo: Determinar las características clínicas y el manejo de los pacientes con insuficiencia cardíaca (IC) en Costa Rica. Métodos: El RENAIC CR es un registro observacional y prospectivo en curso que actualmente incluye pacientes con IC atendidos en Costa Rica. Resultados: Se incluyeron 695 pacientes (68,3% ≥63,5 años de edad; 57,7% de sexo masculino). La causa más frecuente de IC era cardiopatía isquémica (58,0%). La mayoría de los pacientes tenía clase funcional II (33,1%) o III (35,2%) de acuer do con la NYHA. En todos los pacientes con IC se realizó un ecocardiograma, aunque en la mitad de estos pacientes no se determinaron los niveles de péptidos natriuréticos. Muchos pacientes no recibían tratamiento para la IC basado en la evidencia. Conclusión: Este registro puede ser valioso para desarrollar estrategias que mejoren el manejo de los pacientes con IC en Costa Rica y en países similares.

Abstract National registry of heart failure in Costa Rica. The RENAIC CR study Objective: To determine the clinical features and management of patients with heart failure (HF) in Costa Rica. Methods: The RENAIC CR is an ongoing, observational and prospective registry that is currently including HF patients attended at Costa Rica. Results: 695 patients (68.3% ≥63.5 years; 57.7% male) were included. The most common cause of HF was ischemic heart disease (58.0%). Most patients were on NYHA functional class II (33.1%) or III (35.2%). In all HF patients an echocardiogram was performed, but in half of these patients natriuretic peptides were not determined. Many patients were not taking evidence-based HF therapies. Conclusion: This registry may be helpful for developing strategies to improve the management of patients with HF in Costa Rica and similar countries.

Relación entre consumo crónico de betabloqueadores y mortalidad en sepsis y choque séptico / Relationship between chronic beta-blockers usage and mortality in sepsis and septic shock / A relação entre o consumo crônico de betabloqueadores e mortalidade em sepse e choque séptico

Resumen: Se ha considerado que los betabloqueadores pueden reducir la sobreestimulación adrenérgica en pacientes sépticos. Se diseñó este estudio retrospectivo de casos y controles para identificar la relación del consumo crónico de betabloqueadores en pacientes que desarrollaron sepsis y choque séptico tratados en UTI y la mortalidad a 30 días. Se incluyeron 104 pacientes dividiéndose en dos grupos: betabloqueadores (n = 16) y control (n = 88). Los pacientes del grupo de estudio no presentaron diferencia de mortalidad en relación con el control (p = 0.99); sin embargo, el SOFA cardiovascular fue mayor (p = 0.05), requirieron mayor dosis de vasopresores (p = 0.18) y mayor tiempo de estancia en UTI (p = 0.11). El consumo crónico de betabloqueadores no fue factor de protección para mortalidad en pacientes sépticos.

Abstract: It has been considered that beta-blockers are used to reduce adrenergic overstimulation in septic patients. Therefore, we designed a case-control study to identify if chronic use of beta-blockers is related to less 30-day mortality among septic patients. We review medical records of ICU admission. In total, we included 104 patients divided into two groups: beta-blockers (n = 16) and control (n = 88). Patients in the study group showed no difference in mortality relative to control (p = 0.99), however the cardiovascular SOFA was higher (p = 0.05), required higher dose of vasopressors (p = 0.18) and longer stay in UTI (p = 0.11). The chronic use of beta-blockers was not protective factor for mortality in septic patients.

Resumo: Considerou-se que os betabloqueadores podem reduzir a superestimulação adrenérgica em pacientes sépticos. Assim, desenhou-se um estudo retrospectivo de caso e controle para identificar a relação de consumo crônico de betabloqueadores em pacientes que desenvolveram septicemia e choque séptico tratados na UTI e mortalidade aos 30 dias. Foram incluídos 104 pacientes divididos em dois grupos: betabloqueadores (n = 16) e de controle (n = 88). Os pacientes no grupo do estudo não demonstraram diferença na mortalidade em relação ao grupo de controle (p = 0.99), no entanto o SOFA cardiovascular foi maior (p = 0.05), necessitaram uma dose mais elevada de vasopressores (p = 0.18) e maior tempo de UTI (p = 0.11). O consumo crónico de betabloqueadores não foi o fator de proteção para a mortalidade em pacientes sépticos.

Precision medicine is ammunition for anesthesiologists to improve patient outcomes during the perioperative period:genetic variability of beta-blockers and opioids / 临床麻醉学杂志

The evolving practice of precision medicine allows physicians to make disease treat-ments and prevention decisions based on a patient's individual genetic and molecular profile.In recent years,gene sequencing and related techniques are becoming more affordable and more accessible to healthcare providers,and their use in various medical fields continues to expand.In particular,there are numerous opportunities for the use of precision medicine in the perioperative setting.For example, individual polymorphisms in alpha and beta adrenergic receptors can improve the efficacy of beta blockade,or predispose a patient to adverse drug reactions including hypotension and bradycardia. Likewise,particular polymorphisms in opioid receptors can increase or decrease the effectiveness of various opioid medications for achieving adequate postoperative analgesia.In addition,mutations in the cytochrome P4502D6 (CYP2D6)enzyme can drastically affect the clinical response to a particular subset of beta blockers and opioids by accelerating or decelerating their metabolism and clearance. Preoperative genetic testing would allow anesthesiologists to identify these and other relevant molecu-lar characteristics in their patients,and choose appropriate perioperative therapies accordingly in order to maximize clinical outcomes while minimizing the incidence of adverse events.It is the time for anes-thesiologists and perioperative care providers to practice precision medicine.

Mortality reduction with use of oral beta-blockers in patients with acute coronary syndrome

OBJECTIVES: Recent studies have revealed a relationship between beta-blocker use and worse prognosis in acute coronary syndrome, mainly due to a higher incidence of cardiogenic shock. However, the relevance of this relationship in the reperfusion era is unknown. The aim of this study was to analyze the outcomes of patients with acute coronary syndrome that started oral beta-blockers within the first 24 hours of hospital admission (group I) compared to patients who did not use oral beta-blockers in this timeframe (group II). METHODS: This was an observational, retrospective and multicentric study with 2,553 patients (2,212 in group I and 341 in group II). Data regarding demographic characteristics, coronary treatment and medication use in the hospital were obtained. The primary endpoint was in-hospital all-cause mortality. The groups were compared by ANOVA and the chi-square test. Multivariate analysis was conducted by logistic regression and results were considered significant when p<0.05. RESULTS: Significant differences were observed between the groups in the use of angiotensin-converting enzyme inhibitors, enoxaparin, and statins; creatinine levels; ejection fraction; tabagism; age; and previous coronary artery bypass graft. Significant differences were also observed between the groups in mortality (2.67% vs 9.09%, OR=0.35, p=0.02) and major adverse cardiovascular events (11% vs 29.5%, OR=4.55, p=0.02). CONCLUSIONS: Patients with acute coronary syndrome who underwent early intervention with oral beta-blockers during the first 24 hours of hospital admission had a lower in-hospital death rate and experienced fewer major adverse cardiovascular events with no increase in cardiogenic shock or sustained ventricular arrhythmias compared to patients who did not receive oral beta-blockers within this timeframe.

Role of Beta Blockers on Adrenaline Induced Leukocytosis in Rabbits

Background: Plasma Leukocytosis is known to occur in a variety of clinical conditions viz. infections, inflammations and collagen disorders. Apart from these many physiological factors like heat, solar radiation and high altitude also causes leukocytosis. It has been reported that even corticosteroids can cause leucocytosis which is usually polY morphonuclear leucocytosis. Adrenaline administered by various routes like I/M, I/V and S/C is also known to cause a rise in blood leukocytes. It has been reported that even corticosteroids can cause leukocytosis, which is usually polymorphonuclear leukocytosis. Since catecholamines have been implicated in the release of polymorphs from bone marrow into blood in the glucocorticoids induced leukocytosis, this could be a likely mechanism. If so then adrenergic receptors may be mediating this release. Attempt will be made to characterize these adrenergic receptors by studying the effect of some beta blockers on adrenaline induced Leukocytosis. Materials and Methods: The study was conducted in conscious albino rabbit. The rabbits were divided into 3 groups with 6 rabbits in each group beta blockers used in the study were propranolol (0.5mg/kg) and atenolol (0.5mg/kg). Cell counts before drug administration served as control values. Adrenaline was used in the dose of 200microgram/kg. Result: Group1- significant rise in total leukocytes count in the form of 2 peaks, first occurring at 1hr with 21.85% rise and 2nd at 4hr with 41.89 % rise, at 2hr rise was not significant. At 24hr the counts came back to normal values Group2- significant fall in TLC at 1hr +1.2% and at 4hr +5% while at 2hr +2.4%. The fall in TLC at 24hr was insignificant.Group3- significant fall in TLC at 1hr +1.5% and at 4hr +10.2% while at 2hr +7.94%. The fall in TLC at 24hr was insignificant. Conclusion: The beta-blockers Propranolol and Atenolol successfully blocked the rise in blood leukocyte counts induced by Adrenaline which shows that Adrenaline induced leukocytosis occurs through the activation of beta-adrenoreceptors.

The Role of Common Pharmaceutical Agents on the Prevention and Treatment of Pancreatic Cancer

Survival from pancreatic cancer remains poor. Conventional treatment has resulted in only marginal improvements in survival compared with survival in the previous several decades. Thus, considerable interest has emerged regarding the potential use of common pharmaceutical agents as chemopreventative and chemotherapeutic options. Aspirin, metformin, statins, β-blockers, and bisphosphonates have biologically plausible mechanisms to inhibit pancreatic neoplasia, whereas dipeptidyl-peptidase 4 inhibitors may promote it. Regardless, real-world epidemiological data remain inconclusive. This review examines the hypotheses, evidence, and current state of the literature for each of these medications and their potential roles in the prevention and treatment of pancreatic cancer.