Prophylactic Agents for Preventing Cardiotoxicity Induced Following Anticancer Agents: A Systematic Review and Meta-Analysis of Clinical Trials.

BACKGROUND: Anthracyclines can improve survival in many types of malignancies, but dose-dependent and irreversible results following the use of anthracyclines have been associated with cardiomyopathy. This meta-analysis aimed to compare the effects of prophylactic agents for preventing cardiotoxicity induced following anticancer agents. METHODS: In this meta-analysis, Scopus, Web of Science, and PubMed were surfed for articles published by December 30th, 2020. The keywords were angiotensin-converting enzyme inhibitor (ACEI), enalapril, captopril, angiotensin receptor blocker, beta blocker, metoprolol, bisoprolol, isoprolol, statin, valsartan, losartan, eplerenone, idarubicin, nebivolol, dihydromyricetin, ampelopsin, spironolactone, dexrazoxane, antioxidants, cardiotoxicity, n-acetyl-tryptamine, cancer, neoplasms, chemotherapy, anthracyclines, doxorubicin, daunorubicin, epirubicin, idarubicin, ejection fraction or a combination of them in the titles or abstracts. RESULTS: A total of 17 articles out of 728 studies examining 2,674 patients were included in this systematic review and meta-analysis. Ejection fraction (EF) values in the baseline, 6-month, and 12-month follow-up in the intervention group turned out to be 62.52 ± 2.48, 59.63 ± 4.85, and 59.42 ± 4.53, whereas in the control group appeared to be 62.81 ± 2.58, 57.69 ± 4.32, and 58.60 ± 4.58, respectively. Through comparison of the two groups, EF was found to increase in the intervention group by 0.40 after 6 months (Standardized mean difference (SMD): 0.40, 95% confidence interval (CI): 0.27, 0.54), thus proving higher than that of the control groups following the cardiac drugs. CONCLUSION: This meta-analysis showed that prophylactic treatment with cardio-protective drugs, including dexrazoxane, beta blocker, and ACEI drugs in patients undergoing chemotherapy with anthracycline, have a protective effect on LVEF and prevent EF drop.

Digenic inheritance of mutations in the cardiac troponin (TNNT2) and cardiac beta myosin heavy chain (MYH7) as the cause of severe dilated cardiomyopathy.

Familial dilated cardiomyopathy (DCM) is characterized by ventricular dilation and depressed myocardial performance. It is a genetically heterogeneous disorder associated with mutations in over 60 genes. We carried out whole exome sequencing in combination with cardiomyopathy-related gene-filtering on two affected family members to identify the possible causative mutation in a consanguineous Iranian family with DCM. Two novel variants in cardiomyopathy-related genes were identified: c.247 A > C; p.N83H in the Troponin T Type 2 gene (TNNT2) and c.2863G > A; p.D955N in the Myosin Heavy Polypeptide 7 gene (MYH7). Sanger sequencing and co-segregation analysis in the remaining family members supported the coexistence of these digenic mutations in affected members of the family. Carriers of either variant alone were asymptomatic. In summary, we find that digenic inheritance of two novel variants in DCM related genes is associated with a severe form of DCM. Exome sequencing has been shown to be very useful in identifying pathogenic mutations in cardiomyopathy families, and this report emphasizes the importance of comprehensive screening of DCM related genes, even after the identification of a single disease-causing mutation.

Incidence and Main Determinants of Contrast-Induced Nephropathy following Coronary Angiography or Subsequent Balloon Angioplasty.

BACKGROUND/AIMS: Patient assessment by imaging studies using contrast media is currently replacing open procedures, especially in high-risk patients. However, the use of such contrast media might result in acute events and injuries after the procedure. In the present study, we first determined the incidence of contrast-induced nephropathy (CIN) in a sample of Iranian patients who candidated for coronary angiography and/or angioplasty, and then assessed major risk factors predicting the appearance of CIN following these procedures. METHODS: Two hundred and fifty consecutive, eligible patients scheduled for coronary angiography and/or angioplasty at the Afshar Hospital in Yazd between January 2009 and August 2010 were considered for enrollment. Renal function was measured at baseline and 48 h after the intervention, and CIN was defined by an increase in creatinine of >0.5 mg/dl or 25% of the initial value. The predictive role of potential risk factors was determined in a multivariate model adjusted for comorbidities, preexisting renal impairment, and angiographic data. RESULTS: CIN following coronary angiography or angioplasty appeared in 12.8% of the cases. A myocardial infarction before the procedure (OR = 2.121, p = 0.036) and a prior history of hypertension (OR = 2.789, p = 0.025) predicted the appearance of acute renal failure following angiography or subsequent angioplasty. A low estimated glomerular filtration rate at baseline slightly predicted CIN after these interventions. CONCLUSION: Transient acute renal dysfunction occurred in 12.8% of the patients within 48 h after angiography or subsequent angioplasty and could be predicted by a myocardial infarction before the procedure or by a prior history of systolic hypertension.

Lack of visual endoscopic appearance of ureteropelvic urothelial cancer; is it a deterrence for nephroureterectomy? A case study and literature review.

Two case reports are presented with an important question what should be done when an endoscopic appearance of the urotherial lesion is unavailable. As seen in clinical practice, many patients choose nephroureterectomy with frequent follow up procedures. The other question raised is that what should be done when the lesions are ureteroscopically inaccessible. These patients can avail the advantages of radical treatment without accepting the probable as initial form of treatment to evade the risk and detriments of unnecessary additional endoscopic procedures.