Efficacy of alteplase combined with rosuvastatin calcium in the treatment of acute cerebral infarction / 中国基层医药

Objective:To investigate the clinical efficacy of alteplase combined with rosuvastatin calcium in the treatment of acute cerebral infarction.Methods:A total of 100 patients with acute cerebral infarction who received treatment in Zhejiang Xin'an International Hospital from October 2019 to October 2020 were included in this study. They were randomly assigned to undergo either rosuvastatin calcium (control group, n = 50) or alteplase combined with rosuvastatin calcium (study group, n = 50). The National Institute Health of Stroke Scale (NIHSS) score, serum viscosity, blood lipid change, and clinical efficacy were assessed before and after treatment. Results:Response rate was significantly higher in the study group than in the control group [90% (45/50) vs. 80% (40 /50), χ2 = 4.52, P < 0.05]. NIHSS score, soluble intercellular adhesion molecule-1 level, and soluble vascular cell adhesion molecule 1 level in the study group were (7.29 ± 1.46) points, (132.68 ± 15.20) μg/L, and (118.67 ± 112.60) μg/L, respectively, which were significantly lower than those in the control group [(11.47 ± 2.80) points, (189.22 ± 9.40) μg/L, (1 372.59±125.70) μg/L, t = 4.21, 3.21, 5.12, all P < 0.05]. Insulin-like growth factor 1 level was significantly higher in the study group than in the control group [(485.41 ± 51.30) μg/L vs. (364.23 ± 44.50) μg/L, t = 6.32, P < 0.05]. Total cholesterol and low density lipoprotein cholesterol levels in the study group were (3.29 ± 1.46) mmol/L and (3.04 ± 0.15) mmol/L, respectively, which were significantly lower than those in the control group [ (4.47 ± 2.80) mmol/L, (3.22 ± 0.41) mmol/L, t = 4.54, 3.87, both P < 0.05]. Conclusion:Alteplase combined with rosuvastatin calcium can greatly improve blood circulation, reduce blood viscosity, and restore neurological function in patients with acute cerebral infarction. This study is highly innovative and scientific.

Predictive Factors In Successful Completion Of Laparoscopic Cholecystectomy In Acute Cholecystitis.

Background: Laparoscopic Cholecystectomy in acute Cholecystitis is the established treatment of choice for the management of acute Cholecystitis. The conversion rate and morbidity is higher in Laparoscopic Cholecystectomy done in acute Cholecystitis. Aims and Objectives: To identify certain preoperative criteria for the selection of patients in acute Cholecystitis that can undergo laparoscopic Cholecystectomy, so that there is decrease in the conversion rate to open procedure and decrease in the complications. Methods: A Prospective interventional study was conducted in the Department of General Surgery, Moolchand Medcity, New Delhi, on 50 patients with acute Cholecystitis from September 2009 to September 2010. Data was analyzed using standard statistical software SPSS. Chi-square test was used for statistical analysis of qualitative data. Results: There were 4 males and 46 female patients with a mean age of 37. 74 years (range 18 to 65 years). There was no significant variation in intraoperative severity (IOS) pattern of acute Cholecystitis across the various age groups (p=0. 532). Males had significantly higher IOS grades of acute Cholecystitis as (p=0. 000). Among patients with varying IOS of acute Cholecystitis, there was significant difference in mean values of duration of symptoms before surgery (p=0.006), TLC at admission (adm.) (p=0.037) and at 24 hours of adm. (p=0.016) and serum AMS at adm. (p=0.005). The difference in mean serum ALP at adm. (p=0. 0171), at 24 hours of adm. (p=0. 137) and at 48 hours of adm. (p=0. 151), and mean values of TLC (p=0. 052) at 48 hours of adm. were insignificant across the various IOS grades of acute cholecystitis. There was no significant variation in histopathological severity (HPS) pattern of acute cholecystitis across the various age groups (p=0.826). Males had significantly higher HPS grades of acute Cholecystitis compared to females (p=0.042). Among patients with varying HPS of acute cholecystitis, there was no significant difference in mean duration of symptoms before surgery (p=0. 065). The difference in mean values of TLC at adm. (p=0.001), at 24 hours of adm. (p=0.001) and 48 hours of adm. (p=0.003); serum ALP at adm. (p=0.001), at 24 hours of adm.(p=0.001) and at 48 hours of adm.(p=0.022) was very significant across the various HPS grades of acute cholecystitis. The IOS (p=0.035) and HPS (p=0.032) of acute cholecystitis was significantly less with successful early lap Chole than with failed procedure. There was no significant difference in success versus failure rates of early Lap Chole across the age distribution of the patients (p=0. 153); mean values of duration of symptoms before surgery (p=0.971); TLC at adm. (p=0.422), at 24 hours of adm. (p=0.990) and at 48 hours of adm. (p=0. 478); serum ALP at adm. (p=0.113), at 24 hours of adm. (p=0.135) and at 48 hours of adm.(p= 0. 238). Male patients had significantly higher failure rate of early Lap Chole (p=0.022). Patients with failed early Lap Chole had a significantly longer mean duration of surgery (p=0. 032) and postoperative hospital stay (p=0.028) than those undergoing a successful procedure. Conclusion: Acute Cholecystitis is much more common in females. Severity of inflammation (intraoperative/ histopathological) in acute Cholecystitis is associated with higher failure/conversion rate of early laparoscopic Cholecystectomy because of dense pericholecystic adhesions, and has longer duration of surgery and postoperative hospital stay. This has a positive relation with male sex and TLC(IOS and TLC at 48 hrs of adm. , however had insignificant relation in our study ), while as no relation with age (at least up to 65 years) and mean duration of symptoms before surgery (if surgery is done within 1.5-4 days of onset of symptoms).

Residual Cardiovascular Risk Remains Despite of Statin Treatment: Importance of High-Density Lipoprotein Cholesterol / 대한내과학회지

Lowering low-density lipoprotein-cholesterol (LDL-C) is the primary target to prevent cardiovascular events in patients with dyslipidemia at high risk for cardiovascular disease. Many patients on statin therapy have initial or recurrent coronary heart disease events despite reductions in LDL-C. Indeed, 2/3 of patients on statin therapy suffer from residual risk. Low high-density lipoprotein-cholesterol (HDL-C) and high triglycerides levels are modifiable and important factors to resolve a residual risk. Especially, low serum levels of HDL-C (< 40 mg/dL for men, < 50 mg/dL for women) are highly prevalent and are recognized as an independent risk factor for cardiovascular morbidity (myocardial infarction, stroke, peripheral arterial disease, and restenosis after coronary stenting) and mortality. Thus, therapy focusing on raising HDL-C may be an important paradigm for treating and slowing progression of atherosclerosis, coronary heart disease, and co-morbid metabolic disorders. In this review, we discuss the importance of HDL-C based on experimental and large scaled clinical trials.

Comparison of ramosetron and ondansetron for control of post-operative nausea and vomiting following laparoscopic cholecystectomy.

Background: Post-operative nausea and vomiting (PONV) is common. 5HT 3 receptor antagonists are commonly used drugs for its prevention. A study was designed to compare the efficacy and safety of ramosetron and ondansetron in patients undergoing laparoscopic cholecystectomy (lap chole). Materials and Methods: A prospective randomized case controlled study was conducted at J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, India, in patients who underwent lap chole following intravenous administration of ondansetron (4mg) or ramosetron (0.3mg) at the end of surgery, and efficacy as well as side effects of ondansetron and ramosetron was documented and compared. Results: One hundred and thirty adult females undergoing lap chole were studied - 65 patients in each of the two groups. In first 24 h after surgery, complete response (No PONV) was observed in 28 patients of the ondansetron group and in 32 patients of the ramosetron group (P>0.05). Complete response in the second 24 h after surgery was observed in 30 patients of the ondansetron group and in 45 patients of the ramosetron group (P<0.05). During the first and second 24 h, PONV requiring rescue antiemetic was significantly higher (P<0.05) in the ondansetron group as compared to the ramosetron group. Adverse drug effects in the post-operative period were observed in 11 and 8 patients in ondansetron and ramosetron groups respectively (P>0.05). Conclusion: Ramosetron was found safe and more effective antiemetic than ondansetron in patients undergoing lap chole.