Utility and benefits of sulfonylureas beyond glycemic control

Department of medicine, Educare institute of dental science Malappuram, Kerala and SafeCare clinics, Tirur, Keralasulfonylureas (SUs) are one of the oldest, time tested and most commonly used oral antidiabetic agent in Type 2 diabetes. Modern SUs like glimepiride and gliclazide XR were preferred over conventional SUs due to its better efficacy and minimal side effects. The use of Modern SUs in the treatment armamentarium of T2DM has evolved, over past few decades. Modern SUs possesses beneficial pancreatic glucose lowering effect and more interestingly extra-pancreatic pleiotropic benefits. This review article discusses on the utility and benefits of SUs beyond glycemic control and explaining on their pleiotropic effects.

Effect of Atorvastatin and Rosuvastatin on the Glycemic Control in Patients with Type II Diabetes Mellitus: A Comparative, Randomized, Double-Blind Study

Objectives: To compare the effects of atorvastatin and rosuvastatin in type II diabetes mellitus (T2DM) patients with dyslipidemia. Materials and Methods: Eighty patients with history of T2DM of more than 3 months duration, glycated hemoglobin <7%, dyslipidemia, and normal electrocardiogram were included in the randomized double-blind trial. The patients received either tablet atorvastatin 20 mg or rosuvastatin 10 mg once a day along with metformin and glimepiride twice daily orally. Patients were evaluated by the change in estimated average glucose (eAG), lipid profile, and incidence of adverse drug reactions (ADRs). Results: Rise in fasting blood sugar (FBS), postprandial blood sugar, and eAG were significant in the atorvastatin group as compared to the rosuvastatin group where there was a significant increase only in FBS levels. Changes in lipid parameters and incidence of ADR were similar in both the groups. Conclusion: Rosuvastatin can be preferred to atorvastatin in T2DM with dyslipidemia due to less variation in the blood sugar parameters, effective control over lipid profile, pleiotropic effects, and less microsomal interactions.

Effect of HMG?Co?A Reductase Inhibitors on Cardiac Autonomic Neuropathy in Diabetic Patients

Objective: : To observe the effect of statins on cardiac autonomic neuropathy in patients with diabetes and to study the correlation between cardiac autonomic neuropathy as assessed by cardiac autonomic reflex tests (CARTs) and by Composite Autonomic Symptom Scale (COMPASS)-31. Materials and Methods: A cross-sectional observational study was conducted on 62 patients having Type 2 diabetes mellitus for more than 5 years. Patients were randomized into two groups, one group received standard antidiabetic therapy and other group received standard antidiabetic along with statin medication at least for more than 1 year. Each patient underwent CART and heart rate variability to assess autonomic dysfunction. In addition, COMPASS 31 questionnaire was used to evaluate symptoms subjectively. Statin Experience Assessment Questionnaire was used to note adverse effects of statins. Chi-square test, Spearman correlation test, and Mann–Whitney U-test were used for statistical analysis. Results: A significant difference in severity of cardiac autonomic dysfunction was observed between two groups as measured by CART (P = 0.016) and COMPASS-31 questionnaire (P = 0.008). Moreover, COMPASS score of >16 was observed in patients with advanced cardiac autonomic neuropathy. A significant correlation was found between COMPASS 31 score and CART results (r = 0.29, P = 0.02). Conclusion: Our study highlights the potential utility of statins in curbing progression of cardiac autonomic neuropathy and can be safely administered in patients with Type 2 diabetes mellitus. COMPASS 31 questionnaire can be used as an effective screening tool for CART referral, facilitating the early detection of cardiac autonomic neuropathy.

Nature's marvels endowed in gaseous molecules I: Carbon monoxide and its physiological and therapeutic roles

Nature has endowed gaseous molecules such as O

Glycemic and Non-Glycemic Effects of Teneligliptin

The gut enzymes are released in response to intake of meal, those are GLP-I (glucagon link peptide-I) & GIP (glucose-dependent insulin tropic polypeptide) along with DPP-4(Dipeptidylpeptidase-4). GLP-I has vital role in control of glucose levels and it may also has capacity reduce body weight and it can manage some micro & macro-vascular complications. Unfortunately it has very shorter half-life 1-2 min, and eventually it was degraded by DPP-4 enzyme. Therefore GLP-I has ineffective to perform its tasks. To overcome this incidence essential to inhibit DPP-4 enzyme is benefited in diabetics and in non diabetics suffering with micro, macro vascular complications. Ubiquitous Dipeptidyl peptidase (DPP) -4 has pleiotropic effects because it is widely distributed other than intestine. DPP-4 enzyme inhibition has a promising effect on glycemic control. DPP-4 inhibition is also involved in the improvement of non-glycemic effects as directly or indirectly the DPP-4 enzyme is linked with some pathological conditions of particular organs, such as DPP-4 is linked with the intestinal secretion of triglycerides, and DPP-4 is expressed in the glomerulus in uncontrolled diabetics which in turn leads to nephritis. DPP-4 release strongly correlates with adipocyte size, potentially representing an important source of DPP-4 in obesity. DPP-4 inhibition produces an anti-inflammatory activity because the activity of DPP-4 results in reduced production of cytokines including interleukins and interferon-G. All these anti-inflammatory agents are inhibited by the DPP-4 enzyme which can lead to pathogenesis of cardiovascular diseases and provokes atherosclerosis & psoriasis. Serum sodium and brain natriuretic peptide (BNP) levels are also regulated by inhibition of the DPP-4 enzyme and which can produce vascular protection & regulates blood pressure. Teneligliptin is a recently developed oral DPP-4 inhibitor indicated for the management of T2DM in adults along with diet and exercise. Teneligliptin is recently available in India and is also available in combination with other oral hypoglycemic agents at affordable prices. This review is aimed at exploring the status of teneligliptin with emphasis on its glycemic effects and non-glycemic clinical benefits associated with increasing GLP-1 & GIP

Tendencias actuales del uso de las estatinas en dislipidemias y otros efectos extralipídicos / Current trends of the use of statins for dyslipidemias and other extra lipid effects

Introducción: Los pacientes con afecciones ateroscleróticas suelen presentar concentraciones intermedias de colesterol unido a lipoproteínas de baja densidad, lo que refleja la importancia de la interacción con otros factores de riesgo. El tratamiento con estatinas mejora el pronóstico, especialmente el tratamiento intensivo, e independientemente de los valores de colesterol, lo cual hace que se deba considerar esta estrategia terapéutica como una opción y por extensión, todos los pacientes con enfermedad vascular establecida. Objetivo: Examinar las tendencias actuales en el uso terapéutico de las estatinas. Fuente de datos: se realizó una revisión bibliográfica entre 2010-2015 en las bases de datos MedLine, Hinari, Cochrane, PubMed; de revistas líderes en la publicación de temas y artículos de interés. Síntesis de los datos: Las estatinas son fármacos eficaces para disminuir la concentración de colesterol y los triglicéridos en la circulación sanguínea. Además, aumentan moderadamente el colesterol unido a lipoproteínas de alta densidad y disminuyen la incidencia de enfermedad cardiovascular aterosclerótica, por lo que se las considera medicamentos de primera elección en el tratamiento de la dislipemia aterogénica. Se ha demostrado que el tratamiento hipolipemiante con estatinas, evita la progresión de la enfermedad hacia el episodio agudo. Conclusiones: Se actualizó que el efecto de las estatinas juega un papel fundamental en los pacientes con arteriopatía. Es conveniente iniciar el tratamiento lo más precoz posible y extenderlo a sectores arteriales como el cerebrovascular y el periférico(AU)

Introduction: Patients with acute atherosclerotic conditions usually present with moderate cholesterol concentrations together with low-density lipoprotein levels, which indicates the importance of the interactions with other risk factors. Statin therapy improves prognosis after the occurrence of an acute coronary syndrome, especially in intensive care and regardless of cholesterol values, which leads to consider this therapeutic strategy as an option to be extended to all the patients with a set vascular disease. Objective: To examine the present tendencies in the statin therapy. Data sourse: A literature review was made from 2010 to 2015 in MedLine Hinari, Cochrane and PubMed databases and in leading journals in the publication of topics and articles of interest. Data synthesis: Statins are effective drugs to decrease the blood cholesterol and triglyceride levels. Besides, they increase the high density lipoprotein cholesterol and reduce the incidence of atherosclerotic cardiovascular disease, therefore, they are considered first-choice drugs for the treatment of atherogenic dyslipidemia. It has been proved that hypolipidemic treatment with statin avoids the progression of the disease into the acute stage. Conclusions: The review provides an update on the fundamental role of statins in the treatment of patients with artheropathy. It is desirable to initiate the treatment as early as possible and to extend it to other arterial areas such as cerebrovascular and peripheral ones(AU)

Mozart Effect and Its Clinical Applications: A Review.

Recent research efforts examining the effects on the brain of listening to music have discovered that music, with specific characteristics, is able to improve cognitive and learning capacity. Recent studies have demonstrated that music, in particular some musical compositions (such as those of W. A. Mozart and J. S. Bach), has a notable role not only in cognitive disturbances, but also in the treatment of several syndromes and diseases, either by rehabilitating or by stimulating cerebral synaptic plasticity. The Mozart Effect was described for the first time in 1993. Subsequently, other studies with similar designs were made. This review summarizes the recent scientific literature on the Mozart Effect. More studies are needed, in order to define specific protocols in which music helps clinicians in recuperating patients and in improving their quality of life.

La rosuvastatina atenúa la progresión de la estenosis aórtica generada por hipertensión arterial, independientemente de sus efectos hipolipemiantes / Rosuvastatin Slows the Progression of Aortic Stenosis Caused by Hypertension Regardless of Its Lipid-Lowering Effects / Rosuvastatin Slows the Progression of Aortic Stenosis Caused by Hypertension Regardless of Its Lipid-Lowering Effects

Introducción Existe evidencia epidemiológica que vincula factores de riesgo cardiovascular con la estenosis valvular aórtica. Recientemente se ha demostrado el desarrollo de estenosis valvular aórtica en un modelo de hipertensión arterial en animales. Planteamos la hipótesis de que el tratamiento con rosuvastatina modifica esta transformación. Objetivo Evaluar el efecto de la rosuvastatina sobre el desarrollo de estenosis valvular aórtica. Material y métodos Se instrumentaron conejos NZ machos (n = 43) con el modelo 1-riñón 1-clip de Goldblatt para generar hipertensión arterial. Los animales fueron aleatorizados a: HT (n = 17) que no recibió otro tratamiento, HT+R (n = 14) tratado con rosuvastatina 2,5 mg/kg/día y HT+R+C (n = 12) tratado con rosuvastatina 2,5 mg/kg/día + suplemento de colesterol dietético para mantener los niveles basales de colesterol plasmático. Un grupo control (GC) fue sometido a cirugía simulada (n = 15). Las características de la válvula aórtica se midieron por ecografía en condiciones basales y a los 3 y a los 6 meses de hipertensión arterial. Resultados A los 6 meses de seguimiento, los incrementos de PAS y PAD fueron más elevados en HT (49% y 40%, respectivamente; p < 0,001) en comparación con los grupos tratados con rosuvastatina (PAS = 23% y 25%; PAD = 28% y 26%; p < 0,001 para HT+R y HT+R+C, respectivamente). El colesterol total se redujo el 45,7% (p < 0,01) sólo en HT+R. El espesor valvar se incrementó en HT (0,50 ± 0,01 vs. 0,62 ± 0,02 mm; p < 0,01), sin mostrar diferencias en HT+R y HT+R+C. Finalmente, el área valvular aórtica mostró una reducción en HT (0,277 ± 0,024 vs. 0,208 ± 0,014 cm²; p < 0,05), sin cambios en HT+R y HT+R+C y un aumento no significativo en el GC (0,264 ± 0,022 vs. 0,32 ± 0,016 cm²; p = 0,07). Conclusiones La rosuvastatina atenúa la progresión de la estenosis valvular aórtica generada por hipertensión arterial. Esta protección podría ser mediada por efectos no hipolipemiantes de estas drogas.

Background There is epidemiological evidence associating cardiovascular risk factors with aortic valve stenosis. The development of aortic valve stenosis has been recently demonstrated in a hypertensive animal model. We hypothesize that treatment with rosuvastatin modifies this transformation. Objective To evaluate the effect of rosuvastatin on the development of aortic valve stenosis. Material and Methods Hypertension was induced in 43 male NZ rabbits by a onekidney, one-clip Goldblatt procedure. The animals were randomly assigned to 3 groups: HT (n=17) without treatment; HT+R (n=14) treated with rosuvastatin 2.5 mg/kg/day and HT+R+C (n=12) treated with rosuvastatin 2.5 mg/kg/day + cholesterol-enriched diet to keep baseline cholesterol levels. A control group (CG) underwent sham surgery (n=15). The characteristics of the aortic valve were measured by echocardiography at baseline, 3 and 6 months after inducing hypertension. Results After 6 months of follow-up, SBP and DBP presented greater increase in the group HT (49% and 40%, respectively; p<0.001) compared to groups treated with rosuvastatin (SBP = 23% and 25%; DBP = 28% and 26%; p <0.001 for HT+R and HT+R+C, respectively). Total cholesterol decreased by 45.7% (p <0.01) only in HT+R group. The aortic valve became thickened in the HT group (0.50 ± 0.01 vs. 0.62± 0.02 mm; p <0.01); there were no significant differences in HT+R and HT+R+C. Finally, the aortic valve area was reduced in HT (0.277 ± 0.024 vs. 0.208 ± 0.014 cm² ; p <0.05), had no differences in HT+R and HT+R+C, and presented a non-significant increase in CG (0.264 ± 0.022 vs. 0.32± 0.016 cm²; p=0.07). Conclusions Rosuvastatin slows the progression of aortic valve stenosis caused by hypertension. This protection might be independent of the lipid-lowering effect of the drug.

Interferón: 50 años después (1957-2007) / A review of interferons: fifty years later (1957-2007)

Identificados inicialmente como un mecanismo de defensa contra las infecciones virales, en el transcurso de los últimos 50 años se ha definido que los interferones forman parte de la extensa familia de las citocinas, sustancias indispensables para el funcionamiento del sistema inmunológico. Debido a sus diversas funciones pleiotrópicas, los interferones fueron las primeras citocinas empleadas para el manejo de una amplia gama de padecimientos, propiedades que progresivamente los han colocado como medicamentos de primera elección para el tratamiento de la infección crónica por el virus de la hepatitis B, virus de la hepatitis C, esclerosis múltiple, algunas leucemias, melanoma, etc. No obstante, la administración de dosis suprafisiológicas de interferones con fines terapéuticos, independientemente de su indicación primaria, se han asociado con toxicidad importante, incluyendo la inducción de autoinmunidad y más de 30 enfermedades autoinmunes diferentes.

Initially identified as a defense mechanism against viral infections, in the last 50 years interferons have been defined a group of substances belonging to the cytokine family indispensable for the normal functioning of the immune system. Derived from their pleiotropic functions interferons were the first biological products used to treat several diseases. Their properties have progressively placed them as the first treatment choice for chronic infection with hepatitis B virus, hepatitis C virus, multiple sclerosis, some forms of leukemia, melanoma, etc. It has been noted however that the administration of supra physiological doses of interferons with therapeutic objectives, independently of its primary indication, has been associated with significant toxicity, including autoimmunity and induction of more than thirty different autoimmune diseases.

The protective effects of statins on organs after cardiopulmonary bypass to statins / 医学研究生学报

Cardiopulmonary bypass(CPB) often result systemic inflammatory response syndrome.In addition to lipid lowing effects,statins appears to exhibit pleiotropic effects such as antiinflammatory properties,improvement of endothelial dysfunction and reduction of ischemia-reperfusion injury.In this review,the author summarized advances in these respects.