Avaliação da Senescência de Células Sanguíneas Mononucleares Periféricas e na Disfunção Endotelial entre Adultos com Alto Risco Cardiovascular / Assessment of Peripheral Blood Mononuclear Cells Senescence and Endothelial Dysfunction among Adults with High Cardiovascular Risk

Resumo Fundamento Doenças cardiovasculares (DCV) são uma das principais causas de mortalidade e morbidade em todo o mundo. O envelhecimento biológico tem sido associado à ocorrência de resultados cardiovasculares. Entretanto, o mecanismo subjacente desse processo ainda é desconhecido. Objetivos Buscamos avaliar se a senescência das células sanguíneas mononucleares periféricas (CSMP) e biomarcadores endoteliais poderiam influenciar o risco cardiovascular (CV) e ser marcadores adequados para a detecção precoce de doenças cardiovasculares em adultos. Métodos Neste estudo transversal, pacientes livres de DCV foram classificados como baixo (n=32) e alto (n=28) escore de risco intracardaco (IHR) A senescência das CSMP foi avaliada estimando-se a atividade de telomerase (AT) e detectando-se a presença de células senescentes e disfunção endotelial, estimando-se a concentração de nitrito e nitrato e a capacidade antioxidante total (CAT). A análise estatística foi realizada com o software SPSS, versão 16.0 (SPSS Inc., Chicago, IL). Todos os p-valores <0,05 foram considerados estatisticamente significativos. Resultados A senescência de CSMP de 0,95 [p-valor = 0,0001; 95% IC (0,874-1,026)] foi um indicador significativo de pacientes com escore de IHR mais alto, com um valor de corte de 21,65, com sensibilidade e especificidade de 92% e 88% respectivamente. Identificou-se que a senescência de CSMP, nitrito e nitrato, e AT eram independentemente associadas a um escore de IHR alto. Conclusão Os status de nitrito e nitrato e AT, e a senescência de CSMP são medidas adequadas para prever o alto risco cardiovascular em adultos com risco CV. Entretanto devem ser realizados estudos de acompanhamento de longo prazo para confirmar esses achados. (Arq Bras Cardiol. 2021; 116(1):37-47)

Abstract Background Cardiovascular diseases (CVD) are one of the leading causes of mortality and morbidity worldwide. Biological aging has been associated with the occurrence of adverse cardiovascular outcomes; however, the underlying mechanism of this process remains unknown. Objectives This study sought to evaluate if peripheral blood mononuclear cell (PBMC) senescence and endothelial biomarkers could influence cardiovascular (CV) risk and be suitable markers for the early detection of cardiovascular diseases in adults. Methods In this cross-sectional study patients free of CVD were classified as lower (n=32) and higher Interheart Risk (IHR) scores (n=28). PBMC senescence was assessed by estimating the telomerase activity (TA) and detecting the presence of senescent cells and endothelial dysfunction by estimating the concentration of nitrite and nitrate and of total antioxidant capacity (TAC). Statistical analysis was performed with SPSS version 16.0 (SPSS Inc., Chicago, IL). All p-values <0.05 were considered statistically significant. Results PBMC senescence 0.95 [p-value = 0.0001; 95% CI (0.874-1.026)] was a significant predictor of patients with higher IHR scores with a cut-off value of 21.65 with a sensitivity and specificity of 92% and 88% respectively. PBMC senescence, nitrite and nitrate and TA were found to be independently associated with high IHR scores. Conclusion PBMC senescence, TA and nitrite, and nitrate status are suitable measures to predict high cardiovascular risk in adults with CV risk. Nevertheless, long-term follow-up studies are needed to confirm these findings. (Arq Bras Cardiol. 2021; 116(1):37-47)

Abnormal cardiotocographic findings and perinatal outcome: a prospective study

Background: CTG as an intrapartum fetal surveillance can be judged appropriately taking the abnormal features of CTG individually into account for decision making of early delivery to reduce the fetal and neonatal morbidity. Objectives of this study were to identify the fetuses at risk of developing hypoxia as evidenced by abnormal FHR pattern seen by CTG and to correlate the abnormal features with perinatal outcome and find out the most specific feature among all abnormal features of CTG in detecting the adverse perinatal outcome.Methods: This was an observational study where total of 249 uncomplicated pregnant patients in active labor were selected randomly and CTG were done for them. Progress of labor was recorded in partogram. Only pathological CTGs were considered for early decision of delivery by LSCS. After delivery Apgar score 1 min, 5 min, baby weight, colour of liquor, NICU admission and no of days of admission in NICU were recorded.Results: For liquor colour, variability and absence of acceleration were good screening heart rate features and baseline was considered the most specific feature. For all babies with poor Apgar score at 1 min, abnormal baseline was the most specific feature. For NICU admission, the abnormal baseline the most specific feature. Acceleration was found to be the most sensitive heart rate feature among all other heart rate features. Liquor colour had better sensitivity for detecting poor Apgar score at 1min and 5 min. There was increase rate of cesarean section and operative vaginal delivery.Conclusions: Abnormal intrapartum CTG features of an uncomplicated laboring mother >37 weeks can detect fetuses at distress with different specificities and sensitivities when considered individually and can reduce the perinatal morbidity.

Utility of apremilast in the treatment of psoriasis

Psoriasis is an autoimmune disease that affects more than one bodily system with predominantly skin and also joint manifestations affecting almost 2% of the world population that occurs primarily due to immune dysregulation. Apremilast is an oral, selective inhibitor of phosphodiesterase-4 (PDE4) enzymes. Inhibition of PDE-4 results in specific elevation of cAMP, an innately occurring intracellular secondary messenger that functions as a modulator of inflammatory responses. The drug is taken orally in strengths of 10, 20 and 30 mg. The drug may be a suitable alternative to different systemic therapies. Apremilast is a much-needed molecule for the treatment of psoriasis that is resistant to first line therapy and also useful in combination therapies.

Empagliflozin: an exciting prospect in the treatment of diabetes

Type 2 diabetes mellitus (T2DM) continues to be a chronic and disabling disease that is associated with high mortality and morbidity. The epidemic burden of diabetes mellitus has increased in developing countries and Asia is considered as the “diabetic epicentre”. Type 2 diabetes (T2DM), is characterised by reduced secretion of insulin from pancreatic beta cells independently or associated with reduced response of peripheral tissues to circulating insulin. A proper glycaemic control is essential to delay the micro and macrovascular complications of T2DM. Standard anti-diabetic agents including insulin happen to induce minor to major adverse outcomes in certain populations over prolonged period of administration. Hence there has been a compelling need to develop newer and novel approach to treatment of T2DM. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are a novel category of drugs that happen to reduce glycaemic overload by inducing glycosuria. The safety, efficacy and tolerability profile of these drugs were studied separately under various trials and was approved for use in August 2014 by US-FDA. This review is an attempt to describe the history of SGLT-2 inhibitors, their mechanism of action, safety and efficacy as well as its current status among anti-diabetic agents.